RutlandHerald.com - We Are Vermont

Health bill would end 'doughnut hole'



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By DANIEL BARLOW Vermont Press Bureau - Published: November 6, 2009

MONTPELIER – Terry Branon finds herself lost in the so-called Medicare "doughnut hole."

Branon, a 77-year-old South Burlington resident, has spent more than a thousand dollars so far this year on medications – money that comes right out of her purse after she exhausted her Medicare prescription drug coverage.

"Sometimes I have to choose between buying food and buying my medications," Branon said Thursday. "The medications are always more important."

Part of President George W. Bush's health care reforms, the so-called doughnut hole is the gap that occurs when the federal government stops paying the cost of medications for those on Medicare. Typically, this is when the person is spending more than $2,700 and less than $6,100 on medications each year.

That gap would begin closing under a health care reform plan in the U.S. House, which is expected to come up for a vote Saturday. The product of three committees in the House, the bill would expand access to health insurance for 36 million Americans, according to supporters.

If that bill becomes law, the prescription drug doughnut hole would shrink by $500 annually until it completely disappears in about a decade.

"That's marvelous," said Branon, who added that she has not closely followed the health care reform debate.

President Barack Obama's health care reform efforts gained new steam Thursday as the AARP, the nationwide organization representing older Americans, endorsed the bill before the U.S. House. Members of the organization said the House bill contains several important and positive changes for senior citizens struggling with high health insurance costs.

"Doing nothing is not an option," said Jim Leddy, president of AARP Vermont. "This is not a perfect bill by any means, but it is the most substantial health care reform bill considered by Congress since 1965, when Medicare and Medicaid were created."

In addition to closing the prescription drug doughnut hole, Leddy said the House bill will reduce financial penalties insurance companies place on older Americans and will allow the federal government – one of the largest purchasers of medications in the world – to negotiate with drug companies to get better prices.

Leddy said the House health care bill is also important to Vermont, which has a progressive track record when it comes to expanding access to health care.

"What we've done here is not sustainable without assistance from the federal government," he said. "If this bill does not pass, we put at risk everything we've done here."

U.S. Rep. Peter Welch, D-Vt., makes no predictions on how the health care bill will fare when it comes up for a vote Saturday. But he knows two things: He will support it and it will not net a single Republican vote.

That's a shame, he said, because the bill contains several provisions suggested by Republicans, including medical malpractice reform, allowing people to buy insurance across state lines and being deficit-neutral, he said.

"This legislation is our first step toward major health care reform," he said.

Welch said he is pleased that a public option insurance plan is in the final House bill, along with a number of other insurance reforms, including prohibiting a company from dropping coverage due to a pre-existing condition.

"The public option included here is not as robust as I wanted it to be," Welch said. "But it will provide consumers with a choice and insurance companies with competition."








READER COMMENTS


Truth about Medicare.

Reducing the doughnut hole is great. The real issue though is how this enhancement and the bill in general are going to be paid for and what other Medicare limits are imposed and how it impacts recipients.

Recipients on Traditional Medicare pay a premium of $95 per month and an additional 20% of all medical expenses. For those that want a prescription plan using Traditional Medicare they have to pay an additional premium and 20% of all costs for medicine. Those on Traditional Medicare that can afford it pay a private insurance company for a supplement that pay's for what Medicare doesn't (20% of all expenses).

Within the last 8 years Medicare recipients were offered an improved Medicare Advantage Plan. This plan has received criticism as a plan that benefits only big insurance companies. This isn't true. With the Medicare Advantage Plan recipients can sign up for a plan that has out of pocket limits and can include a prescription and in some cases even a dental plan for no more than the same premium amount paid for Traditional Medicare health care. All management and payment of expenses is done by the insurance company saving Medicare on admin costs and payment for coverage.

Many Traditional Medicare recipients that can't afford an additional premium for prescription drugs and can't afford a private supplement to pay the 20% of all expenses have greatly benefited from this option. Currently 25% of all Medicare recipients are on a Medicare Advantage Plan.

The current health care reform bill will greatly reduce payments for this plan and with other requirements limit its benefits and essentially phasing it out over time.

When it is all said and done what do we really have for Medicare recipients?

With the changes being required by this Health Care reform for the Advantage Plan companies running the plan will reduce benefits and require additional premiums and some will refrain from offerings the plan reducing competition and further reducing the benefits to recipients. This will make many Medicare recipients go back to Traditional Medicare that they can't afford. This will make them limit care including Drs visits and needed medicine.

This Health Care reform bill may benefit some of the limits of Traditional Medicare but overall it will have a very adverse impact on the many Medicare recipients.

This is why polls show the vast majority of individuals over 60 are against this bill.

The Medicare Advantage Plan isn't perfect yet this bill ignores all the positive benefits of this option and will essentially limit care for Medicare recipients in the future.

To ignore the negative impact on Medicare is wrong any way you look at it.
-- Posted by None None on Fri, Nov 6, 2009, 9:41 am EST

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