Medicare Drug Benefit Raises Workflow Issues for SSA
The Social Security Administration is having difficulty keeping up with the volume of work created by the new Medicare prescription drug benefit, and some services provided under the agency might have to be cut back as a result, an SSA official said in a recent e-mail, the Los Angeles Times reports (Alonso-Zaldivar, Los Angeles Times, 2/4). Under the 2003 Medicare law, SSA is responsible for providing Medicare beneficiaries with information on low-income subsidies and processing applications for the subsidies (Carey, CQ HealthBeat, 2/3).
In an e-mail to SSA employees dated Jan. 21, Linda McMahon, deputy commissioner for operations, said that the agency is facing a large volume of requests for assistance with the benefit and that the added workload -- combined with a reduction in the SSA's annual budget -- is straining resources (Los Angeles Times, 2/4). According to McMahon's e-mail, which SSA confirmed is legitimate, 200,000 people are visiting SSA offices daily, and one in three calls to the agency's toll-free assistance number "results in a busy signal" (Washington Post, 2/4).
According to the e-mail, SSA is struggling to pay overtime and will need to cut resources for performing audits and for other areas. McMahon also said SSA is experiencing a backlog of Social Security cases because resources have been directed to handle the drug benefit, adding that the backlog "will be exacerbated by the need to put more people on the phone to bring down the busy rate and keep people from needing to visit field offices."
McMahon said Social Security checks to beneficiaries will not be affected by the problems (Los Angeles Times, 2/4). She said, "Ever since the Medicare Modernization Act passed, those of you on the front line have been expressing your deep concern that SSA is not positioned well to help people understand, enroll in and negotiate the new Medicare Part D coverage. Now we are seeing the consequences of that fact" (Washington Post, 2/4).
Rep. Henry Waxman (D-Calif.) cited McMahon's e-mail in a letter sent on Friday to House Speaker Dennis Hastert (R-Ill.). In the letter, Waxman said that Congress approved $9.1 billion for SSA for fiscal year 2006, a decrease of $200 million from FY 2005. He said that the budget cuts are "crippling" SSA's ability to perform its duties (CQ HealthBeat, 2/3).
Waxman also said, "The problems faced by the Medicare program in implementing the benefit are spilling over and having significant impact on the Social Security program" (Los Angeles Times, 2/4). "This is a matter of grave concern. While these benefits are not at risk, the ability of [SSA] to mange the program, respond to beneficiaries' basic inquires and questions, and prevent fraud and abuse appears to be severely degraded," Waxman wrote (CQ HealthBeat, 2/3).
He called on Congress to take immediate action to restore the funding to SSA's budget (Los Angeles Times, 2/4). Waxman also called on Hastert to schedule committee hearings on the matter (CQ HealthBeat, 2/3).
According to the Times, McMahon did not mention the problems cited in the e-mail in her testimony on Thursday before the Senate Special Committee on Aging. In her testimony, McMahon thanked Congress for "providing [SSA] with the resources we have needed to begin this challenging process."
SSA said in a statement on Friday, "As [SSA] handles the increased phone calls and office visits associated with [drug benefit], we continue to provide (financial) benefits and assistance with timeliness and professionalism. As always, we remain dedicated to providing the best possible service to the American people" (Los Angeles Times, 2/4).
Several newspapers recently examined issues related to the Medicare drug benefit. Summaries appear below.
Bloomberg News/Richmond Times-Dispatch: The Bloomberg/Times Dispatch on Sunday examined how fifteen lawmakers, congressional aides and Bush administration officials who helped gain passage of the 2003 Medicare law began working for the health care industry within a year of the measure passing. Nine of those who left the government to work in health care registered to lobby on the implementation of the law, including former CMS administrator Thomas Scully and former Rep. Billy Tauzin (R-La.), now president of the Pharmaceutical Research and Manufacturers of America. According to the Bloomberg News/Times-Dispatch, some lawmakers said the issue is "a case study for why tighter laws are needed" for lobbying (Salant, Bloomberg/Richmond Times-Dispatch, 2/5).
Washington Post: The Post on Monday examined how "some of the estimated two million mentally ill" U.S. residents who are dually eligible for Medicare and Medicaid "have gone without the drugs that keep their delusions, paranoia, anxieties or stress in check" since the benefit began. Many of the mentally ill who have been unable to obtain their medications "are at high risk of relapse," and "[n]umerous people have been hospitalized," the Post reports (Levine, Washington Post, 2/6).
New York Times: The Times on Monday examined how the prescription drug benefit "was an effort to blend a classic big government program from the Great Society with the conservative, market-oriented philosophy of the Republicans in power." Now, state and federal officials "face widespread complaints from beneficiaries, advocates, pharmacists, lawmakers and others that it is too complex, too cumbersome, too hard to navigate," according to the Times (Toner, New York Times, 2/6).
Bloomberg News/Arizona Daily Star: The Bloomberg News/Star on Monday examined how prices for medications under some Medicare drug plans increased $400 or more for a year of medication during the first month of the program, according to a sampling by Consumers Union. The Consumers Union examined drug plans at the end of December 2005 and at the end of January in five U.S. zip codes, finding that there was an average cost increase of 5%. CMS spokesperson Gary Karr said the agency has tracked the plans since the program began and has not seen "any significant price increases" (Bloomberg News/Arizona Daily Star, 2/6).
St. Paul Pioneer Press: The Pioneer Press on Sunday examined how the Medicare drug benefit "will give drug companies up to $2 billion in extra profits this year because they're no longer required to pay rebates on drugs bought by the government for the elderly poor." The increase in profits comes from a shift in the drug coverage of 6.4 million poor and elderly people from Medicaid to the new Medicare drug benefit, according to the Pioneer Press. The "windfall raises concerns that the Bush administration won't fully realize its promises of lower drug prices in the troubled program," the Pioneer Press reports (Pugh, St. Paul Pioneer Press, 2/5).