House and Senate conference committee members continue to work to reconcile the differences in their respective Medicare prescription drug bills, HR 1 and S 1. What will they do to ensure that all those eligible for Medicare – particularly those of lower incomes – receive equal access to a prescription drug benefit?

Consumer advocates and all 50 governors have urged the conference committee to support the House provision to include dual eligibles, individuals enrolled in both Medicare and Medicaid, in the Medicare prescription drug benefit. However, the Bush administration recently called on Congress to support the Senate bill’s provision, which excludes dual eligibles from the Medicare drug benefit and instead calls on the 6 million dual eligibles to rely on Medicaid for their prescription drug coverage. What would this mean for dual eligibles and for Medicare – and how can Presbyterians work to encourage Congress to support a Medicare prescription drug benefit that is affordable and accessible to all?

Currently, Medicare covers more than 35 million Americans ages 65+ and 6 million younger adults with permanent disabilities. Of those, over 6 million are “dual eligibles,” low-income elderly and individuals with disabilities who are enrolled in both Medicare and Medicaid. The Kaiser Family Foundation noted, “Most dual enrollees are very low-income individuals with substantial health needs: 77 percent have annual incomes below $10,000, compared to 18 percent of all other Medicare beneficiaries.” (KFF Dual Enrollee Fact Sheet, 2/03)

Medicare covers basic health services for dual eligibles, including hospital and physician care, while Medicaid (funded jointly by federal and sate governments) assists in paying Medicare premiums and cost sharing and covers benefits Medicare doesn’t cover, like prescription drug benefits and long-term care. Medicaid benefits vary state by state, and prescription drug coverage is an optional benefit. All states have chosen to have a Medicaid prescription drug benefit. However, advocates are concerned that, due to state fiscal problems, such benefits could diminish.

Many states have scaled back their Medicaid drug coverage due to severe budget deficits, further limiting the number of drugs available per month or requiring onerous prior approval procedures before beneficiaries can obtain the drugs that their physicians prescribe. These trends are likely to continue as states face annual Medicaid drug cost increases of nearly 20 percent. A number of dual eligibles will likely find their Medicaid drug benefit to be far less adequate than the Medicare drug benefit especially with continuing state budget deficits.

In an article about the fate of dual eligibles in the conference committee, Robert Pear of The New York Times wrote, “A major issue of principle and large amounts of money are at stake. The principle, rooted in the history of Medicare, is that all benefits are generally available to all beneficiaries, regardless of their income.” (9/24 NYT)

First, the exclusion of dual eligibles from a Medicare drug benefit would go against the principal of universality that has been central to the Medicare benefit. Never before have Medicare beneficiaries been denied access to a Medicare covered benefit. Whenever Medicare and Medicaid both cover a benefit, Medicare serves as the primary payer and Medicaid serves as the secondary payer, providing wrap-around services for whatever Medicare does not cover.

Second is the issue of money. When the House and Senate came up with their prescription drug legislation, they were bound by a budget resolution they adopted that limited their spending on a benefit to $400 billion over 10 years. Since this amount of funding will not provide universal coverage for a prescription drug benefit, both chambers were limited in how to provide a benefit.

States are now paying $7 billion a year on prescription drugs for dual eligibles. Under the House legislation, the federal government would gradually pick up these state costs, over a 15-year period. As Rep. Bill Thomas (R-CA) noted, “We spend $43 billion over the next decade picking up these low-income seniors.” (qtd. in NYT, Pear, 9/24) Instead of funding drug coverage for dual eligibles, the Senate made a priority of providing more generous subsidies for low-income seniors who do not qualify for Medicaid.

Past Presbyterian Church (U.S.A.) General Assemblies have consistently spoken out in support of health care that is accessible and affordable for all. The 203rd General Assembly (1991) also called for the expansion of Medicare and Medicaid benefits. And in 1999, the 211th General Assembly called for the protection of Medicare benefits. What can Presbyterians do to ensure that the prescription drug benefit is accessible and affordable to all? Stand up for the least of these among us who could be treated unequally under this legislation. With so many concerns about the ability of states to provide such a benefit through Medicaid, Presbyterians can call for an equal drug benefit for all those eligible for Medicare. Share your concerns with Congress now. They may act soon to reach agreement on this legislation.

ACTION: Call the Capitol switchboard at (202) 224-3121 and ask to be connected with your Representative and/or Senator(s).

Sample script: “My name is _________ and I’m calling from YOUR CITY, YOUR STATE to urge you to ensure that ALL seniors have access to the prescription drug benefit through Medicare. Poor seniors and the disabled deserve Medicare too. Give them the Medicare prescription drug benefit.”