U.S. Senator Daniel K. Akaka (D-Hawaii) cited an analysis of the national and state impacts of the Senate Democratic, Senate Republican, and House Republican prescription drug plans released today by the Senate Committee on Health, Education, Labor, and Pensions to urge swift Senate passage of the Medicare Prescription Drug Act (S. 2625) introduced by Senators Bob Graham (D-FL), Zell Miller (D-GA), and Edward M. Kennedy (D-MA). Senator Akaka is a cosponsor of the legislation.
"Approximately 19 million seniors in the U.S. have little or no prescription drug coverage," Akaka noted. "Prescription drugs are the largest out-of-pocket health care cost for seniors. Many who cannot afford drug coverage often do not take the drugs their doctors prescribe, and one in eight senior citizens is sometimes forced to choose between buying food and buying medicine. Medicare needs a voluntary prescription drug benefit so seniors have the same protection against the high cost of prescription drugs as they have for hospital care.
"The legislation would establish a guaranteed Medicare prescription drug benefit. Of all the alternatives that have been proposed, this is the best Medicare prescription drug benefit for the people in Hawaii. Comprehensive coverage would be available to all seniors regardless of their health or income."
The Graham-Miller-Kennedy proposal provides coverage for every prescription without any deductible or gaps in coverage. 159,000 senior citizens and disabled Medicare beneficiaries in Hawaii would be eligible for coverage under the proposal. 41,000 seniors with low incomes qualify for extra assistance. Seniors will not lose their current employer retirement coverage and will not have to rely on the public benefits provided by the plan. Under the Republican plans, over 80 percent of Hawaii senior citizens would have much greater out-of-pocket costs for drug expenses. Annual premiums under the Senate Democratic and Republican plans are comparable; premiums are higher under the House-passed plan.
The Outpatient Prescription Drug Act benefit would require a $25 monthly premium. There is no deductible, no coinsurance, and no benefit hole, unlike the Senate and House Republican plans. A $10 copayment would be required by the legislation for generic drugs. No medically necessary brand-name drugs would have a copayment over $40. After seniors reach a catastrophic limit and spend $4,000 on medication, the plan would cover all drug expenses. The benefit would begin on January 1, 2005.
The complete Committee analysis for Hawaii is attached.
Impact of the Graham-Miller-Kennedy Outpatient Prescription Drug Act (S. 2625) on Hawaii Senior Citizens: Affordable, Comprehensive Medicare Coverage
Key Program Features:
· Premiums of $25 a month/$300 a year No Deductible Copayments: $10 for generic drugs; $40 for preferred brand drugs; and $60 for non-preferred brand drugs No drug that is medically indicated for the individual will cost more than $40 for a brand name drug or $10 for a generic drug Assistance begins with the very first prescription, and there are no gaps or limits on the coverage Catastrophic cap on out-of-pocket expenditures above $4,000 Special assistance with copayments and premiums for individuals with incomes below 150% of poverty No asset test Private retiree health plans encouraged to maintain coverage or wrap around the Medicare benefit Multiple pharmacy benefit managers (or other private entities) in each region would manage, deliver, and administer the prescription drug benefit using the same methods they use in the private sector Pharmacy benefit managers would be required to contain drug costs for beneficiaries and taxpayers, and provides high quality care and high quality service
Hawaii facts:
159,000 Hawaii residents enrolled in Medicare Median income of senior citizens is $18,735 41,000 senior citizens with incomes below 150 percent of poverty 78,000 senior citizens with prescription drug coverage through employer retirement plans 20,000 Hawaii Medicare beneficiaries (12.6%) are enrolled in Medicare HMOs
Impact of Graham-Miller-Kennedy Plan in Hawaii
· 159,000 Hawaii senior citizens and disabled Medicare beneficiaries are eligible for coverage under the Graham-Miller-Kennedy Plan.
No Hawaii senior citizens and disabled Medicare beneficiaries - 0% of the total - fall into a benefit hole and must continue to pay premiums and incur high drug costs while not receiving any benefits.
No Hawaii senior citizens - 0% of the senior beneficiaries with employer coverage - lose good retirement coverage and will have to rely on the public benefits provided under the plan.
41,000 low income Hawaii senior citizens - 28% of the elderly beneficiaries - qualify for extra assistance based on poverty status.
Impact of Senate Republican Prescription Drug Plan on Hawaii Senior Citizens: Not Affordable and Not Adequate
Key Program Features:
· Premiums of $24 a month/$288 a year · Deductible of $250 · Coinsurance of 50% on drug expenditures of $251-$3,450 · No assistance (benefit hole) on drug expenditures from $3,451-$5,300 · Partial stop-loss for expenditures above $5,300 (out-of-pocket expenditures of $3,700); beneficiaries pay 10% of costs for expenditures above this amount · Expenditures by employer retirement plans do not count toward partial stop-loss · Special assistance with coinsurance and premiums for individuals with incomes below 150% of poverty, but only if individual passes rigorous asset test · Benefits provided by private insurance companies receiving subsidy payments from government. Premiums paid by beneficiaries set at level chosen by company. No coverage available if insurance companies decline to participate. · Program starts in 2005.
Hawaii facts:
· 159,000 Hawaii residents enrolled in Medicare · Median income of senior citizens is $18,735 · 41,000 senior citizens with incomes below 150 percent of poverty · 78,000 senior citizens with prescription drug coverage through employer retirement plans · 20,000 Hawaii Medicare beneficiaries (12.6%) are enrolled in Medicare HMOs
Impact of Senate Republican Plan in Hawaii
· 134,000 Hawaii senior citizens and disabled Medicare beneficiaries - 84% of the total - will have drug expenses of up to $5,300. These Hawaii Medicare enrollees will not benefit from the partial stop-loss, and the Republican plan will pay as little as 25% of their drug costs.
47,000 Hawaii senior citizens and disabled Medicare beneficiaries - 30% of the total - fall into the benefit hole and must continue to pay premiums and incur high drug costs while not receiving any benefits.
26,000 Hawaii senior citizens - 33% of the senior beneficiaries with employer coverage - lose good retirement coverage and will have to rely on the much less adequate public benefits provided under the plan.
41,000 low income Hawaii senior citizens - 28% of the elderly beneficiaries - only qualify for extra assistance if they are willing to undergo a rigorous assets test that bars them from having total assets of more than $4,000; personal property such as furniture or jewelry worth more than $2,000; a car worth more than $4,500; or even a burial fund worth more than $1,500.
16,000 low income Hawaii senior citizens - 40% of the elderly beneficiaries eligible by poverty level - would not pass the assets test even if they are willing to undergo it.
. Impact of House Republican Prescription Drug Plan on Hawaii Senior Citizens: Not Affordable and Not Adequate
Key Program Features:
· Premiums of $34 a month/$408 a year · Deductible of $250 · Coinsurance of 20% on drug expenditures of $251-$1000 · Coinsurance of 50% on drug expenditures of $1001-$2000 · No assistance (benefit hole) on drug expenditures from $2001-$4,800 · Stop-loss for expenditures above $4,800 (out-of-pocket expenditures of $3,700) · Expenditures by employer retirement plans do not count toward stop-loss · Special assistance with coinsurance and premiums for individuals with incomes below 175% of poverty, but only if individual passes rigorous asset test · Benefits provided by private insurance companies receiving subsidy payments from government. Premiums paid by beneficiaries set at level chosen by company. No coverage available if insurance companies decline to participate. · Program starts in 2005.
Hawaii facts:
· 159,000 Hawaii residents enrolled in Medicare · Median income of senior citizens is $18,735 · 48,000 senior citizens with incomes below 175 percent of poverty · 78,000 senior citizens with prescription drug coverage through employer retirement plans · 20,000 Hawaii Medicare beneficiaries (12.6%) are enrolled in Medicare HMOs
Impact of House Republican Plan in Hawaii
· 129,000 Hawaii senior citizens and disabled Medicare beneficiaries - 81% of the total - will have drug expenses of up to $4,800. These Hawaii Medicare enrollees will not benefit from the stop-loss, and the Republican plan will pay as little as 14% of their drug costs.
75,000 Hawaii senior citizens and disabled Medicare beneficiaries - 47% of the total - fall into the benefit hole and must continue to pay premiums and incur high drug costs while not receiving any benefits.
26,000 Hawaii senior citizens - 33% of the senior beneficiaries with employer coverage - lose good retirement coverage and will have to rely on the much less adequate public benefits provided under the plan.
48,000 low income Hawaii senior citizens - 33% of the elderly beneficiaries - only qualify for extra assistance if they are willing to undergo a rigorous assets test that bars them from having total assets of more than $4,000; personal property such as furniture or jewelry worth more than $2,000; a car worth more than $4,500; or even a burial fund worth more than $1,500.
22,000 low income Hawaii senior citizens - 45% of the elderly beneficiaries eligible by poverty level - would not pass the assets test even if they are willing to undergo it.
