| The governor was there. There, when seniors and disabled citizens all across the state were
in need of continued prescription drug coverage.
The governor was adamant and determined.
Determined — that all seniors and disabled citizens
would continue to receive their lifesaving medications, no matter the cost to the state.
“I cannot allow seniors to not get the
medicines they need. A person who does not get a life-sustaining drug could end up
hospitalized or even die. I can’t let that happen,” said the governor. “I
won’t let that happen.”
The ills that have plagued America since the federal
government announced its new program, Medicare Part D — that was meant to provide
cheaper prescription drugs for the elderly — started back in November ’05.
Governor Baldacci assauges Eleanor
Sawyer worries about Medicare D. Eleanor lives on Social Security benefits and she shared
her story at a press conference
The governor started planning for the impact that Medicare
D would have on Maine citizens, back in the spring of ’05.
Baldacci was the first governor to take action to protect
his citizens from the ill effects of the faulty Medicare D program. Since January, over 20
states have followed his example.
Since November 15, ’05, seniors with Medicare have
been forced to choose a prescription drug plan offered by a private company in order to
continue to get prescription drug benefits. Sixteen companies offered the federally
mandated Medicare D coverage in Maine, with over 40 different plans to choose from, which
has made the process confusing to many. More than 85,000 people that were on either the
MaineCare or the Maine Drugs for the Elderly program have been faced with a reduction in
coverage and higher costs because of Medicare D. To help these seniors the governor
announced an outreach program that would pay for any extra costs they may incur. The
governor’s program also helps them choose the best plan for their needs.
The fear was that too many seniors would not apply for
Medicare D because the program was too confusing. By federal law, if seniors are not on a
plan authorized by the federal government, then they would lose all their benefits and be
forced to pay the full price of the prescriptions.
Eleanor Sawyer who lives on Social Security benefits shared
her story at the press conference, “I’m doing pretty well for 94, but as you
might expect, have some health problems. I’m a breast cancer survivor; I’ve had
three stints in my heart, high cholesterol, and high blood pressure.” She needs five
medications to keep healthy. “My doctor says if I keep taking my medications, I could
keep going strong for some time to come.” She went on to express how confused she was
with Medicare D and worried that her medications would cost too much for her to afford on
a fixed income, or not even be available under the plan she has to choose. “This
isn’t just my problem. I know that my friends are scared about what will happen to
them, too.”
After the governor explained his outreach plan at the press
conference, Sawyer was clearly relieved, “I’m grateful that the state will see
that we won’t lose our coverage.”
“The Maine plan is a frontline defense. This is about
making sure we protect Maine citizens, so that they can remain in their homes and avoid
costly emergency-room visits and hospitalizations,” stated Governor Baldacci. “I
have created a team to provide a safety net to help MaineCare and Drugs for the Elderly
members navigate this new system, pick the plan that is best to meet their needs, and help
them with the new out-of-pocket expenses they face. No one will fall through the
cracks.”
A special office with phone hotlines was set up and
inundated with thousands of calls every day.
“We are working hard to ensure that vulnerable Maine
citizens continue to have access to affordable prescription drugs,” said Jude Walsh,
special assistant to the Governor’s Office of Health Policy and Finance, who heads up
the program.
The federal government never tried to get lower-priced
prescription drugs for the program, and only a limited variety of drugs are available.
This could disable many that need certain medications, by making them pay a higher price.
Fortunately, the governor’s safety net eliminates this threat to Maine citizens. In
addition, more medications will be available through the Drugs for the Elderly program to
counter the limited drug choice under Medicare D.
Baldacci talks to seniors about
Medicare D and how the state will help them to ensure they remain covered for prescription
drugs.
Because of the governor’s actions already helping
citizens work through the maze of confusion posed by Medicare D, Maine was prepared for
the dramatic events that began on January 1, 2006 — the day Medicare D took over
providing prescription drugs for the elderly and disabled.
Thousands of seniors were not on the federal computerized
lists by January 1st, making them ineligible for discount prescription drugs. Some were
told they had a plan, but it didn’t cover the medications they needed. Others got a
plan and their drugs, but were overcharged by up to $100, having been told to expect a $1
co-pay.
Half of Maine’s 45,000 “dual- eligibles”
— people who qualify for both Medicaid and Medicare — and 12,000 beneficiaries
of the state’s Drugs for the Elderly and Disabled program were not recorded in the
federal computers, as of the New Year’s Day deadline.
That’s over 22,000 Maine seniors and disabled citizens
left high and dry by the Bush administration’s mistake.
Governor John Baldacci came to their rescue and immediately
ordered the state’s Medicare and Drugs for the Elderly programs to continue to serve
these people.
These seniors would have faced going to a pharmacy and
having to pay the full amount for their prescription drugs. For many this could have been
a choice between food and their medications. The governor was determined that Maine
citizens would not suffer from the defective Medicare D program.
Until the federal computer lists are updated, pharmacies
have no way of knowing which one of several plans available under Medicare D covers a
particular individual and therefore what drugs are covered for that individual.
The governor acknowledged he may be stretching his
authority to order drug coverage at state expense, but he believes he has the authority to
order emergency coverage. Moreover he believes it is the right thing to do.
“Within hours of this new program taking
effect, my phone rang, and on the other end was a woman who couldn’t get her
medication for kidney dialysis, because the Feds had signed her up for the wrong plan.
With our help she got what she needed. But she and the thousands of other Mainers who were
in similar situations should never have to face that crisis to begin with.
“We are going to make sure the federal
government meets its obligations to all Maine people,” said Governor Baldacci during
his Sate of the State address.
The state help line averaged more than 16,000 calls a day
in January.
“Before the state intervened, people were only buying
two or three pills at a time because they couldn’t afford their normal monthly
prescriptions,” said Bill Moyes, a pharmacist in Gorham. “Now a lot of them are
back to getting a month’s supply.”
Maine officials said the state will continue to be billed
by pharmacies until problems with the benefit subside. Maine was the first state to have
taken this step, according to the New York based advocacy group Medicare Rights Center.
The cost to the state has been close to $6 million.
"Nobody will fall through the
cracks. Everyone will get the prescriptions that they need," stated Governor
Baldacci.
Working as a team to make Washington accountable:
On January 17, 2006, Governor Baldacci and thirteen other
governors wrote President Bush a joint letter demanding accountability and reimbursement
for the Medicare D program’s expense to states.
On January 23, Governor Baldacci and Congressman Tom Allen
held a press conference informing the public that Allen is cosponsoring legislation that
could fix Medicare D’s problems.
“My bill will fully reimburse Maine and other states
for all the costs they have born by paying the prescription drug bills for beneficiaries
the federal government let slide through the cracks in Part D,” Representative Allen
said. “But my legislation does not just throw good money at an ill-conceived program
that has proven to be a mess. My bill goes to the root of the problem. It eliminates the
new law’s gaps in prescription drug coverage that have plagued millions of low-income
seniors and individuals with disabilities across Maine, and America.”
Two days later the federal government announced that it
would reimburse states but imposed an unreasonable deadline for claims.
“We are requesting an extension in the repayment
deadline until March 31st, 2006, since so many of our enrollees continue to have high
co-pays and are being charged deductibles inappropriately,” said the governor.
Over 10,000 Mainers who are eligible for Medicare D
benefits still have not been recognized correctly by federal officials.
Maine Sues the Federal Government :
“The powers not delegated to the United States by the
Constitution, nor prohibited by it to the States, are reserved to the States respectively,
or to the people,” so says the Tenth Amendment to the US Constitution. It is the
basis that Maine is using in its lawsuit to challenge the constitutionality of federal
provisions requiring states to pay back what they should be saving by no longer providing
drug coverage under their Medicaid programs.
This “clawback provision” has enraged states that
already are taking care of prescription drugs for the elderly and disabled and have been
harnessed with the Medicare Part D program that is costing them more.
On March 3, Maine, along with three other states, announced
that they are suing the federal government over the clawback provision.
“We should not have to pay a clawback,”
said Baldacci. “It was a process that was supposed to save money but ended up costing
states money.”
“Prior to this federal mismanagement in the
implementation of the Medicare Part D program, Maine led the nation with a model program
that was far less expensive than the Medicare Part D program that’s now been
implemented,” said House Speaker Richardson who stated that he was filing a joint
resolution with Senate President Beth Edmonds against the clawback and demanding the
federal government reimburse Maine for the costs of Medicare D. “Maine is being
forced to pay more for less coverage to its seniors.”
“We are being lumped in with other states who have not
done what they needed to do in providing for their people, and so we are being penalized
for, in fact, providing better care for our folks,” Edmonds said.
Maine hopes to prove that the payments violate the Tenth
Amendment by forcing them to relinquish control over how they budget taxpayer dollars to
pay for a federal program.
“The clawback ignores the system of ‘dual
sovereignty’ that is ingrained in our federal Constitution,” said Maine Attorney
General Steven Rowe. “Congress treats states as agents of the federal government,
rather than as separate sovereigns in their own right. The clawback requires state
legislatures to collect, allocate and remit state funds to the federal government to
operate a purely federal program. This violates the intergovernmental tax-immunity
doctrine grounded in the Tenth Amendment of our federal Constitution.”
The state was expected to pay $3 million more to the
federal government this fiscal year than it would have paid for the dual-eligibles under
MaineCare, the state’s Medicaid program. The additional cost for the next fiscal year
is expected to be more than $17 million.
Congressman Tom Allen said the action was necessary to
protect Maine taxpayers. “Medicare is a federal health benefit. The clawback
provision requires states to assume part of the cost of providing this federal
benefit.”
Rep. Hannah Pingree who has a bill concerning Medicare D
and is the chairman of the Health and Human Services Committee said, “Maine has been
working really hard to take care of our people, despite all of the problems with Medicare
Part D. Should we have to pay this clawback, it will really diminish our ability to care
for our seniors.”
Rowe believes the case raises issues that are of great
constitutional magnitude. No adequate alternative forum for resolving disputes like this
is available — these two criteria historically have always been present for the
Supreme Court to review the case.
For many it is apparent that Medicare D is the Bush
administration’s attempt to begin to privatize Medicare.
Medicare Part D will give drug companies up to $2 billion
in extra profits this year, because they are no longer required to pay rebates on drugs
bought by the government for the elderly poor. Medicare D will also increase profits of
insurance providers who are handing the different plans seniors must choose from.
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