By Kathleen Sebelius
May 25, 2011
We got some good news Tuesday about how the Affordable Care Act is helping people with Medicare get the health care they need. Already this year, 271,000 seniors and people with disabilities have saved an average of $613 with the new 50 percent discount on brand name medications for those in the Medicare prescription drug “donut hole.” In total, Medicare beneficiaries with the highest drug costs have saved $166 million — with much of those savings for critical medications like cancer drugs.
Today, it’s not uncommon for a Medicare beneficiary to fill dozens of prescriptions a year. Costs can add up to hundreds of dollars a month, or more. Since 2006, Medicare has offered drug coverage through the Part D program. But the law creating the program had a major flaw. Medicare covers most beneficiaries’ drug costs, until they hit a certain limit. Once they do, however, Medicare stops paying until out-of-pocket costs hit $4,550 — when coverage begins again. This gap – the “donut hole” – forced people with Part D coverage to pay up to $3,600 out of their own pockets or go without medications they needed.
That’s a terrible choice — which is why President Barack Obama and Congress made sure last year’s health reform legislation closes the “donut hole” in several big steps. First, we sent $250 checks last year to nearly 4 million beneficiaries, who had reached the donut hole, to help defray their costs. Second, this year we’re giving a 50 percent discount on brand name drugs for seniors in the “donut hole.” And we’ll keep providing additional relief until 2020 — when the Part D coverage gap will be closed.
People with severe chronic conditions, like cancer and multiple sclerosis, have already seen big savings. In fact, 20 percent, or $32 million, of the 2011 savings have been for cancer drugs. An additional 10 percent, or $16 million, helped people with MS get the drugs they need.
That’s just the start of the new benefits for those with Medicare. They can now get potentially life-saving preventive care like mammograms and other cancer screenings, with no co-pay or deductible. And they can also get a free annual wellness visit with a doctor of their choice.
Over the past few weeks, much of the Medicare debate has focused on the long-term consequences of the House Republican plan to end Medicare as we know it, and turn future beneficiaries over to private insurance company voucher program. People are right to be concerned — given that the plan would force the average 65-year-old in Medicare to spend an additional $6,400 out of pocket for health care.
But another consequence of the GOP budget is that Medicare beneficiaries would lose the important new benefits they’re now getting under the Affordable Care Act. Seniors would see new costs for preventive screenings, leading some to put off tests that could save their lives. Disabled and older Americans with high medication costs would again see bills rise, forcing many to go without the medicines they need.
Those with the most serious conditions could be harmed the most. New therapies for cancers and a long list of other devastating diseases have given millions of Americans new hope and a new ability to live their lives to the fullest. But these drugs can be incredibly expensive. By eliminating the new Medicare prescription drug discount, the Republican budget would deny savings to the sickest Americans — just as relief has finally arrived.
With health care costs expected to rise rapidly in the coming years, almost everyone agrees that we need to act to protect Medicare for beneficiaries today, and preserve it for our children and grandchildren. But there’s a right way to reform Medicare and a wrong way.
The right way is to strengthen it, closing coverage gaps while also bringing down costs by improving care and reducing waste and fraud. Medicare’s trustees estimate that the new health care law has already added eight years to the life of the Medicare trust fund by doing just that. The president’s fiscal framework would put the program on even more solid ground in the future.
Shifting huge costs to seniors and disabled Americans and taking away key benefits is the wrong way to move forward – for Medicare beneficiaries today and tomorrow.
Kathleen Sebelius is the Secretary of Health and Human Services.