Enrollment problems not first glitch for Medicare drug plan

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The inability of the earliest Medicare prescription drug plan enrollees to get their medicine _ prompting California and at least 12 other states to step in with emergency aid _ could be a sign of major problems to come for the already troubled program.

"It's not just a little glitch, it's a fairly big glitch," said Leighton Ku, senior fellow at the Center on Budget and Policy Priorities, a Washington think tank that studies how government policy impacts low-income groups.

"For a very long time people predicted implementation problems were going to occur, and (suggested) it would be worthwhile to have a safety valve," Ku said. "... But the White House and congressional leadership said, 'No, everything is going to be OK, everything is taken care of.' It's not a surprise, and it's frustrating."

California is one of as many as 20 states that have announced a medical emergency and stepped in to cover costs for low-income seniors and disabled people who have been unable to get prescription drugs from Medicare.

The implementation problem follows months of skepticism over whether the program will cost significantly more than President Bush had promised, and massive confusion by seniors who are faced with so many drug choice plans that they're having trouble navigating the system.

Potential future problems include low enrollment, which could cause financial problems; continued confusion among beneficiaries, pharmacists and health care providers; non-competitive pricing of drugs; and continued politicization of the issue, experts say.

Many of the people who are having problems are among the 6.5 million so-called "dual eligibles" who were initially getting drugs from Medicaid. They were automatically moved over to Medicare when the federal prescription drug plan took effect at the start of the year.

Those who chose to change the plan they were enrolled in _ which all of them are entitled to do _ are running into the most trouble when they try to retrieve drugs at their discounted price from their pharmacist, said Gary Karr, a spokesman for the Centers for Medicare and Medicaid Services.

"Even if it's apparently limited to that group, it's not acceptable," Karr said. "These people need to have their medications."

Jeanne Finberg, directing attorney for the National Senior Citizens Law Center, said she thinks the problem is being understated.

"I think they are trying to sweep problems under their rug," Finberg said of the Bush administration. Karr confirmed that as many as 20 states have taken action.

"There is such a broad nature of problems and volume it seems unlikely it's going to get fixed in a day or two," she said. "It is clear the administration is overlooking the problems that have been identified. Although they are taking some steps to resolve them, they are simultaneously denying they exist."

Out of about 25 million senior citizens who are eligible to join a plan on their own, only a million seniors had by late December, Karr said, though Medicare administrators expect a major surge of late enrollees.

"The early indicators are that so few people are enrolling that it appears this is going to be a case of 'we threw a party and nobody came,' and the program will not serve its original purpose," said Henry Aaron, senior fellow at the Brookings Institution.

Aaron said enrollment is important because the solvency of the program depends on having enough enrollees to share costs.

"Whether it will indeed happen is a big mystery and nobody knows for sure yet," Aaron said.

Finberg said that the current problem with "dual eligibles" is the most serious because it involves a population that is particularly vulnerable. But she predicts more problems down the road for the general Medicare population.

"The problems are tremendous complexity and lack of uniformity of the benefit that is already foretelling its demise," she said. "Seniors, physicians and pharmacists are crying out because of not having standardized procedures or being able to compare plans."

Deane Beebe, a spokeswoman for the Medicare Rights Center, said there also has been low enrollment for an additional low-income subsidy; it is available to 7 million people but only 661,000 have applied for it.

"We have learned that people who have applied and been approved, they too are discovering the extra help is not available to them," Beebe said. "The pharmacists don't seem to know they're eligible for extra help."

Ku said lawmakers may have to grapple with calls for extending the enrollment period past May 15.

Finberg said another predictable problem is with a mechanism intended to allow beneficiaries to appeal when their drug or their dosage isn't part of the "formulary" of their plan.

"It is too complex and nobody knows what the procedures are," she said, adding that pharmacists would have to know thousands of different codes for various plans.

Drug prices also could become an issue.

Rep. Henry Waxman, D-Calif., released a report last year that showed many seniors could get a better deal at a Costco store or in Canada than they could with the federal plan.

The White House has said Bush wants to make health care a top priority this year, and will discuss it in his State of the Union address.

White House spokesman Trent Duffy said Bush's health care initiative would include new tax breaks for Americans who buy health insurance on their own.

But now several people are predicting there could be a political fallout from the prescription drug problems if the plan doesn't turn around quickly.

"The danger is that to a lot of people it looks like a medical version of FEMA," John J. Pitney Jr., a politics professor at Claremont McKenna College, said referring to widespread accusations of ineptitude that the Federal Emergency Management Agency faced with its response to Hurricane Katrina last year.

"Republicans had been hoping the prescription drugs would count as a big plus with seniors and that seems not to be the case.

"At the very least, the problems are denying them an advantage they had been counting on. And the possibility is there it could also hurt at the polls."

Sen. Dianne Feinstein sent a letter to Health and Human Services Secretary Michael Leavitt demanding that states and seniors be fully reimbursed for expenses incurred to federal government failures, and Sen. Barbara Boxer, D-Calif., intended to do the same.

Beebe said Congress needs to "go back to the drawing board" and turn the program into a government benefit instead of turning it over to private insurers.