Dean and Thompson

Howard Dean, left, and Tommy Thompson

State Journal archives

Members of Congress should never be forced to choose between low-income children and low-income seniors. But that is the decision lawmakers will face if congressional leaders rework Medicare benefits to pay for an extension of the Children’s Health Insurance Program.

The plan under discussion would dramatically increase out-of-pocket costs for low-income seniors who need brand-name prescription drugs. The change would effectively make this medicine more expensive for the Medicare population that can least afford higher prices.

This is a very real concern for people who can barely afford their existing drug coverage. Most of the people who qualify for low-income subsidies under Medicare, also known as “Extra Help,” make less than $18,000 a year. And they are more likely to suffer from common ailments such as diabetes, heart failure and chronic kidney disease.

This is the problem with tinkering with patients’ co-pays. People often base their health-care decisions on financial incentives, but doctors and diseases do not. Low-income patients are particularly vulnerable to these changes because studies show they are more inclined to choose lower-cost medicine if the price increases for another, even if doctors recommend other treatments that would be more effective.

For Americans struggling to make ends meet, every penny matters, and research shows even a modest uptick in out-of-pocket costs will force patients to choose lower-priced alternatives, even if they are less effective. Some forgo treatment entirely. One study found small increases in co-pays for cancer patients on Medicaid prompted them not to take the medicines they need.

Increasing co-pays for branded pharmaceutical products pose the biggest threat to patients who suffer from diseases for which there are not as many generic treatments. Low-income Americans are more likely to suffer from HIV, for example, and the most prevalent HIV treatments are branded biopharmaceutical products. Similarly, a change could limit the options available to physicians looking to treat psychiatric conditions.

This is not typically a partisan issue. Prominent Republicans have supported Extra Help in the past. The credits were established by the prescription-drug bill former President George W. Bush signed into law with the help of GOP majorities in the House and Senate. At the time, Oregon Rep. Greg Walden, who is now chairman of the powerful House Energy and Commerce Committee, penned an editorial endorsing the program and encouraging lower-income Oregonians to enroll.

Medicare’s prescription-drug benefit is hugely successful by every possible measure. A survey of 2,000 seniors over the summer found 87 percent are satisfied with their Part D drug coverage and 90 percent think the costs they pay for prescription drugs would be much higher if they didn’t have this coverage. In July, the Centers for Medicare and Medicaid Services announced that premiums for the popular prescription-drug plans will fall. The announcement was a welcome sign that Medicare is already helping to tame prescription-drug costs.

The program is also helping seniors live healthier lives. A study by the University of Illinois released earlier this year found that expanded access to prescription drugs has resulted in a noticeable drop in the mortality rate for American seniors. That means seniors, on average, are living longer lives.

This program is working well and has a demonstrated history of helping seniors from every income bracket. It does not make any sense to disrupt such a wildly successful program, especially for the very seniors who need it the most.

Medicare was designed to help older Americans meet their basic health care needs, just as the Children’s Health Insurance Program does for lower-income kids. Pitting one group against the other defeats the purpose of both programs. Surely Congress can find other ways to finance both programs, preserving two basic backstops for two groups who need the most help.

Dean, a Democrat, was governor of Vermont and chair of the Democratic National Committee. Thompson, a Republican, was governor of Wisconsin and secretary of Health and Human Services.

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