Lawmakers Should Remember ‘Lessons Learned’ from Medicare+Choice in Medicare Prescription Drug Benefit Debate
Congress should "keep in mind the lessons learned" from the "failed" Medicare+Choice program as they "struggle to reconcile House and Senate versions" of legislation to add a prescription drug benefit to Medicare, according to a Santa Rosa Press Democrat editorial. Under Medicare+Choice, Medicare reimburses private managed care plans that provide health coverage for seniors, but the editorial points out that low reimbursement rates and increased health care costs have forced many health plans to exit the program. The editorial says that lawmakers must address similar issues -- "inadequate government funds and a realistic assessment of the private sector to handle the risk" -- when they consider Medicare prescription drug benefit legislation. For example, a GOP-sponsored bill (HR 4954) approved in the House last week would pass the risk of "rising costs and utilization to the private sector," the editorial says (Santa Rosa Press Democrat, 7/5). Under the legislation, Medicare beneficiaries would purchase prescription drug coverage directly from private insurance companies for a $250 annual deductible and a $33 monthly premium. The federal government would cover 80% of seniors' annual prescription drug costs up to $1,000, 50% up to $2,000 and no costs between $2,000 and $3,700, after which a catastrophic benefit would begin (California Healthline, 6/28). According to the editorial, insurance companies may decide to drop their prescription drug plans "in the same manner" that many health plans decided to drop their Medicare+Choice plans, and seniors could lose their prescription drug coverage as a result.
The editorial supports a rival plan proposed by Senate Democrats. Under the legislation, private insurance companies would administer prescription drug coverage for Medicare beneficiaries, but the government would "retain most of the risk," the editorial says (Santa Rosa Press Democrat, 7/5). Under the plan, Medicare beneficiaries would pay a $25 monthly premium with no deductible, a $10 copayment for generic drugs and a $40 copayment for brand-name drugs, and the government would cover seniors' annual prescription drug costs more than $4,000 (California Healthline, 6/13). The editorial concludes, "It would be nice if Congress could reduce costs by giving seniors and the private sector responsibility for the program, but recent history has shown this doesn't work" (Santa Rosa Press Democrat, 7/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.