Spearheaded by Delegate Ronald A. Guns, D-Cecil, a troop of legislators from Western and Southern Maryland and the Eastern Shore are researching alternatives to temporarily relieve seniors’ prescription dilemma until the federal government can add drug coverage to Medicare.
“Seniors should not have this kind of worry – not in this nation and not in this state,” said Delegate Norman H. Conway, D-Wicomico.
With a $1 billion state surplus and an expected $4 billion in tobacco settlements, legislators have fiscal room for such action.
One idea under discussion is to use this money to lure Medicare HMOs back to rural areas with subsidies. Another is to set up a state-run prescription service.
“We all understand senior citizens’ problems right now. We are just trying to find the quickest and simplest way to deal with it,” said Delegate Donald B. Elliott, R-Carroll.
Elliott, a pharmacist, said to save money his customers don’t take their medications as prescribed or miss filling a prescriptions.
“Now that is just a sad situation,” he said.
FreeState Health Plan and United Healthcare-Mid Atlantic pulled out of 14 rural counties Jan. 1, after claiming federal reimbursements for Medicare recipients were too low.
Federal budget cuts in 1997 slashed about $200 billion from Medicare over five years, thereby greatly reducing federal reimbursements to health providers. Plus, federal reimbursements already were lower for rural patients.
In 1998, FreeState tried to recover millions of dollars it says it lost by imposing a $75 premium in rural areas. But it still was forced to withdraw because the sparse senior populations and distant doctors combined were too costly. It charges a $50 premium in urban areas.
With such a large population of seniors and 14 counties left without coverage, Maryland legislators are left tossing around ideas and crunching numbers trying to fill the void. While their plans to correct the state’s prescription predicament are embryonic, their determination to pass something this session is firm.
“We are just trying to get (rural) seniors on the same playing field as the urbanite seniors,” said Delegate George C. Edwards, R-Garrett. “Right now they have nothing.”
A portion of the $4.4 billion the state expects from the tobacco settlement over the next 20 years could be tapped to compensate FreeState’s claimed $3 million loss and lure the company back, lawmakers say.
But patient advocates urge legislators to use the money more wisely and funnel the surplus more directly to senior citizens.
It would be a “gross disservice” to filter tax and tobacco money through “badly mismanaged HMOs,” said Charles Gerhardt of the Maryland Patient Advocacy Group. He recommended using the money to enhance the state’s existing prescription programs, such as the Maryland Pharmacy Assistance Program for low- income Medicare and Medicaid recipients.
Indeed, legislators are weighing using the money to set up a temporary prescription service similar to MPAP or the State Employees Pharmacy Plan.
“We just want to provide (senior citizens) with adequate medication so we can prevent long-term hospitalization,” said Delegate Adelaide C. Eckardt, R- Dorchester.
We can’t sit around when the “federal level has not been responsive,” she said.
Last November, U.S. Sen. Barbara A. Mikulski, D-Baltimore, passed the Balanced Budget Refinement Act of 1999 that restored $16 billion in Medicare funding to providers nationwide and gave a 5 percent bonus to HMOs entering areas without one. But there was no provision requiring HMOs stay in rural areas.
Mikulski has vowed to pass legislation that would add a prescription drug benefit to Medicare this session in Congress.
But until then, seniors will have to scrape for prescription money.
Without a Medicare HMO, seniors can either apply for a Medicare supplemental insurance plan that, for about $100 to $200 per month, covers prescription or dental expenses, or simply pay out-of-pocket for prescriptions.
“And that is bad for senior citizens on a fixed income, who often have multiple prescriptions,” said Stephanie Garrity, Chief of the Client and Community Services Division for the Maryland Department on Aging.
“Senior citizens,” she said, end up “halving and quartering their medications to save money, making choices between food and medication and relying on doctors for sample medications.”