New drug plan confuses many senior citizens

Monday, October 25, 2004 | 12:00 a.m. CDT; updated 6:02 p.m. CDT, Thursday, July 10, 2008

Nearly two months after her mother was approved for a drug discount card through AARP, Jackie Cruise is still struggling with red tape.

“Mom is 95 and lives in Kansas City,” Cruise said. “She is starting to become less sure of herself with paperwork and doesn’t even understand the cards, so my sister and I decided I should help her out.”

In early September, Cruise’s mother was approved for the AARP card, one of about 40 available, and the $600 federal tax credit given to low-income seniors. She had a prescription filled and assumed the tax credit would cover it. A few days later, however, she received a full bill.

“She called me and told me … not to worry, because she sent them a check,” Cruise said.

Luckily, because of a mislabeled envelope, the check was returned. The episode, however, marked the beginning of a six-week ordeal in which Cruise made dozens of phone calls and filled out stacks of forms in an effort to activate her mother’s benefits. At one point, she said, AARP botched the paperwork so badly that it enrolled Cruise, instead of her mother, in the program.

While Cruise remains uncertain of her mother’s benefits status, she is seeking authorization to handle prescription paperwork for her.

“I have a part-time job, and I really don’t have time to be driving up to Kansas City every few days to make sure Mom doesn’t throw away some important forms or mail something in, but that’s what I am having to do,” Cruise said.

Steve Hollis, social services supervisor at the Columbia/Boone County Health Department, said such hassles are not uncommon. Many seniors, he said, aren’t aware of all the discounts available to them, and the programs are convoluted.

“Although a lot of seniors qualify for free credit, they don’t even know it,” Hollis said. “I’d say that it’s a little more complicated than it should be.”

Cruise agrees.

“I know that my mother wouldn’t even have got to square one with this thing,” she said. “Let alone square two or three or 18.”

Seniors’ mindsets should be considered, Hollis said.

“The feds say that it’s easy, that there is a number to call: 1-800-Medicare,” he said. “And that is easy, but many seniors cannot fill out forms, they are skeptical of giving anyone money, and there is no guarantee that the program won’t change.”

Hollis said most seniors are reluctant to ask for help, which means the problem is probably more widespread than the number of complaints and inquiries would indicate.

“A lot of people don’t understand the programs in general, and it’s hard to coordinate all the programs,” Hollis said. “You’ve got Medicare, Medicaid Spend-Down and Missouri Senior Rx. The three programs don’t interface very well. It’s more like a jigsaw puzzle rather than a map. … If they have private coverage or a card, they all tend to cancel out. Sometimes you have to use one before the other. The process is hard. I would even have a hard time walking you through it.”

Whoever wins the race for the 9th District congressional seat will certainly face the issues of health care and prescription drugs.

Democrat Linda Jacobsen, who is challenging Republican incumbent Kenny Hulshof, agrees discount programs are confusing but said the larger problem is that medicine is too expensive.

“The seniors that are unable to afford drugs are angry, and they feel cheated. I have seen with my own eyes in the Walgreen’s by my house in St. Charles County,” Jacobsen said, recounting a story about a senior couple who were unable to purchase all their necessary medicine because of the high costs.

Jacobsen says prescription prices are a significant part of the overarching health-care crisis in America.

“Prescription drugs are a key part of health care,” she said. “We’ve come to a crossroads in society and in our country. We can either support the free-market view, which is that business controls it and tough luck if you can’t afford it, or look and say when it comes to health care, this is human need and this is human right.”

Hulshof is confident the Medicare Modernization and Improvement Act, which will take effect in January 2006, is the answer. The act will “provide full-blown drug benefits” for seniors on Medicare. He emphasized that the discount cards available now are voluntary and part of a transition.

“At first, people were complaining that there aren’t going to be many companies interested, but it turned out to be a competitive process, and in Missouri we have 40 separate cards,” Hulshof said. “We’ve heard people say, ‘Which do I pick?’ A lot of advocacy groups are helping senior citizens.”

The tax credits and discount program have been criticized for leaving a “doughnut hole” for seniors who do not qualify for low-income tax credits but still have prescription drug bills up to $5,000. For seniors who have to pay more than $5,000 out-of-pocket, there are additional discounts.

Hulshof said that the 2006 act will cause drug prices to drop about 25 percent and provide comprehensive coverage for the average senior paying $1,400 per year for medicine.

Hollis is also confident the new law will improve the situation.

“Once the full effect of the program kicks in, Senior Rx will change to cover what is called the doughnut hole,” he said. “So, it will also get better down the road as far as the understandability.”

Instead of the new law, Jacobsen favors importing drugs from Canada as a temporary solution.

“Canada has a production based on its own population, and they won’t be able to supply us for very long,” Jacobsen said.

Jacobsen proposes reducing drug prices in the long term by requiring other countries to share in research and development costs through a new program of Food and Drug Administration subscriptions.

“Many nations, as soon as FDA approves drugs, it’s like the Good Housekeeping Seal of Approval: They approve it, too,” Jacobsen said. “Those countries are saving literally billions of dollars and riding on our research coattails.”

Jacobsen advocates universal health care as a cure-all.

“This is the bottom line, and we don’t want to face it: In many developed countries like Sweden, the United Kingdom and Japan, they are paying four to five times less per person for universal health care than we are paying in the U.S. even with 45 million Americans uninsured,” she said. “We are spending more and getting less. … If we have a universal health-care system, we would be able to calculate with greater accuracy the cost of heath care and prescriptions drugs.”

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