Congressman Bill Pascrell

Representing the 9th District of NEW JERSEY

The Right Prescription is Medicare

Sep 6, 2002

Millions of Medicare beneficiaries woke up this morning with no prescription drug coverage. Millions more are at imminent risk of losing the coverage they have. These are not just statistics. They are people just like you and I, parents and grandparents, friends and neighbors that daily must choose between paying for medications they need and other necessities of life, such as food and shelter. This is a national disgrace.

Lack of prescription drug coverage is not just a problem for low-income individuals. Approximately 40% of beneficiaries without coverage today have incomes above 200% of the poverty level. Further, it is estimated that almost two-thirds of all Medicare beneficiaries have drug coverage that is unreliable or inadequate.

Medicare was enacted in 1965 to provide the elderly with access to quality medical care without regard for one's economic status. It has proven to be one of the most successful federal initiatives in history. Now, Medicare must be modernized to cover the cost of prescription drugs.

It is inconceivable that if Medicare were to be created this year, rather than 37 years ago, it would not include coverage for prescription drugs. Further, Congress has demonstrated a willingness to upgrade Medicare when the need has arisen.

In 1980, Medicare's home health benefit was expanded, and in 1985, beneficiaries were permitted to enroll in HMOs. Recall that at its inception, Medicare did not cover preventive benefits. Over time, Congress has incrementally expanded coverage to include such tests as pap smears, flu shots, mammograms, colorectal cancer screening, and prostrate cancer screening.

Now its time to do the same when it comes to prescription drug coverage. In fact, it is long past time.

Along with many of my House Democratic colleagues, I have offered a Medicare prescription drug plan that would provide voluntary prescription drug coverage for all Medicare beneficiaries, beginning in 2005. For a small deductible and affordable co-payment, this program would ensure seniors voluntary and reliable access to every prescription drug, and needed catastrophic coverage.

Unfortunately, the House of Representatives has thus far taken a radically different course. It passed a Republican plan in June that did not provide coverage under Medicare, but rather, through private health insurers. This is a flawed approach for several reasons.

First, the bill provides no guaranteed premium cap. Medicare beneficiaries would pay $35 to $40 in monthly premiums with a $250 annual deductible, but these costs are not capped. The real cost is ultimately left up to the insurer to impose.

Secondly, this plan does not include full coverage of prescription drug costs. In fact, it contains an inexcusable gap in coverage. Beneficiaries would receive coverage for 70% to 80% of the first $1,000 of their annual prescription drug expenses, and coverage for 50% of their annual costs between $1,000 and $2,000. But for expenses from $2,000 to $3,700, seniors would have to cover 100% of their annual costs. All expenses over $3,700 would then be covered in full. Almost half of all seniors would be affected by this gap in coverage.

Third, this plan has no defined benefit. The benefit described above is merely a "suggestion" for what private insurance plans might offer. That is not good enough.

Congress should put aside the gamesmanship and get to work. Cost is always a concern, but we need to begin the process of introducing a guaranteed prescription drug benefit now. We should pass, and the President should sign, a prescription drug bill that provides a defined benefit under Medicare, guarantees a cap in the costs past along to the beneficiary, and covers all seniors, not just a select few.

When it has become clear in the past that Medicare needed to be modernized to meet the needs of seniors, we have done so. We should do so again.

Rep. Bill Pascrell Jr., D-Paterson, represents the 8th Congressional District.