Medicare Prescription Drug Benefits What

Medicare Prescription Drug Benefits

What is the legislation/policy that will be analyzed in this paper?

The principal legislation that is being analyzed is about Medicare and the reach of the service to the intended groups, its pros and cons. The "Medicare Prescription Drug Improvement Act' of 2003 and the consequent Sections 1102, 1106, 1860D -- 1 through 1860D -- 42, and 1871 of the Social Security Act (42 U.S.C. 1302, 1306, 1395w -- 101 through 1395w -- 152, and 1395hh have to be discussed with the issue regarding the use of the act and Medicare allowances for prescription drugs." (ECFR, 2011) The 'Part 423 -- Voluntary Medicare Prescription Drug Benefit of the Federal Regulations' dealing with the 'Prescription Drug Benefits' is also a part of the consideration. (ECFR, 2011) The principal issue is the federal policy with regard to Medicare and its current status both in implementation, evaluation, and the public service ethics. The Medicare policy and the additional requirements of prescription drugs policy which are two issues that have been clubbed together and the use and benefits of prescription drugs, and the federal laws and activities of administering the law falls well into the scope of this act. (DuBrin, 2008)

There have been a lot of changes to the laws from the time it was passed and these changes have now made it possible to deliver medical care and drugs to the senior citizens and also indigent persons. The process of the legal changes in the case dates back to the time when the act was passed in 2003 to the time when prescription drugs were included in the benefits in 2005. There are many problems that the act sought to address. The major problem was the medical care for the poor, and elderly who cannot afford the cost of medication. Isolation of this aspect alone is not possible and therefore the effect of the legislation and the changes it brought for the issue for prescription drugs and affordability can be discussed together.

After the legislation there has been improvement in health care delivery and larger sections of the employees have benefited. However the legislation initially did not have the provision to include the costs of prescription drugs and this was amended to be included three years later in 2006. Thus the act brought about a change after the amendment. The 'Medicare Prescription Drug Improvement Act of 2003' was amended in 2006 to include the provision of the cost of prescription drugs which has altered the way health care is being given in the U.S. However the problem of poverty and unaffordable costs still plagues the nation with regards to the act and this will be discussed too.

2. What is the problem/issue that this legislation attempts to address?

Medicare's history that stretches to over thirty five years still has a lot of problems with the aged seniors being left out and older women are filing bankruptcy on account of high medical costs. From the year 1965 to this day, the seniors pay a high cost for the Medicare. (Blevins, 2001) That is the opinion that was published in 2001. There was no provision for many things including the prescription drugs and the Medicaid beneficiaries and some of the expenditure was on psychotropic drugs. Though the cost of the prescription drugs for dually eligible beneficiaries shifted from Medicaid to Medicare, after the passing of the act, there is also a persistence of the population that have set drug use patterns in Medicaid in the dually eligible beneficiaries whose demands are fairly stable. The modern Part D plans and Medicaid are at tangents and the drug expenses for dually eligible beneficiaries are yet to be resolved. (Bagchi, et al. (2007) Secondly the act if it has benefited the socially indigent persons is also a question that is linked with the issue of prescription drug and changes in the act of 2003. The Part D and Part C address the problems being discussed.

3. What is the history of the legislation?

The dichotomy between medical services and insurance which was a subject of employment and which provided very little to the employee by way of health care prompted the Federal government to seek the unification in the delivery of health care. This resulted in various legislations that provided financing along with the health care delivery system. The most famous is the Medicare. While at first it was begun to provide employees with medical claim and hospitalization insurance, the healthcare delivery systems now in place are a result of larger concerns and debates that resulted in the act that brought in Medicare. The proposal of unifying the prescription drug expenditure with the Medicare was debated for long. Thus during the Clinton administration there was an estimate of costs made in a research by Waldo (1994) which came out with the result then that those enrolled in the Medicare program comprised of one thirds of the outpatient prescription drug consumers in the United States. It was suggested then that the prescription drug benefit under the Medicare program as it was envisaged by the Clinton Administration's health reform initiative would benefit the drug industry on account of expansion. The coverage of prescription drugs by Medicare should have thus increased the size of the program as per the research. (Waldo, 1994)

The actual act came much later on. The act was signed by President George W. Bush on December 8, 2003. The aim of the act was to provide prescription drug benefit program for Medicare beneficiaries, and to make private employers continue the retiree prescription drug coverage. This was sought to be achieved by creating a tax break to subsidies of the federal government and a tax break for payment of medical expenses. Thus from 2004, an employer who sponsors a retiree medical plan will get subsidy payments from Medicare equal to "28% of a retiree's allowable prescription drug costs in excess of a $250 deductible, up to $5,000, provided that the employer provide prescription drug coverage with an actuarial value of at least the standard Medicare drug coverage." (Whitecase, 2004) The payments are termed as "health savings account" and these are exempt to taxes and can be set up by an individual who is covered by an employer's group health plan. The legislation has attempted to close a large gap in the health delivery system and has brought about benefits. However there are still some issues that have to be solved.

4. Has (or will) the legislation been effective in addressing the problem or issue?

In so far as the prescription drugs and the Medicare issues are concerned it was quite effective but there are more problems that were observed during the 2003 act that has not yet been resolved. The costs of the premium are very high still and many cannot afford it especially the unemployed.

The majority of the population is aware of the issues and rights of Medicare claims. There are available surveys on the issue, one being the CAHPS® surveys, and the Medicare CAHPS® survey showed the result for prescription drug coverage for Medicare beneficiaries. This survey comes after the 'Medicare Prescription Drug, Improvement, and Modernization Act' that was in force from 2006. Thus it was obligatory for beneficiaries to enroll in the part D plans of private companies for the benefit of medical services and prescription drugs -- MA-PD or the prescription drug plan that provides drug coverage only. The Medicare drug plan survey conducted in 2009 shows that by 2008, more than one thousand prescription drug plans were available. It showed that the subscribers are not aware of what they were subscribing to and thus the survey concludes that the Medicare beneficiaries are likely to find it difficult to make an informed decision about prescription drug coverage. (Martino; et al., 2009)

The modern and most up-to-date position on the issue is that the Medicare coverage is available to most persons above age sixty five but with some stipulations. These beneficiaries are the cause of the major Medicaid spending on prescription medications. This is partly solved by providing encouragement to the employers to include the retirement benefits and pay the costs of retirees by offering tax cut and incentives. It can be said that it solved most of the problems.

5. What group(s) of people have been the most affected by the problem?

The people most affected by the problem are the retired, aged and the poor and some disadvantaged ethnic minorities. Considering the availability of the plan to the majority, of whom the surveys and research quoted have shown to be employees there is a great majority of people above the age of sixty five and those who are unemployed, dependants like mentally unstable persons and others who depend on prescription drugs, may of whom are deprived of the benefits on economic inadequacy. There is also the issue of poverty linked to the ethnic origins of persons. (Briesacher; et al., 2003)

Thus in a study by Briesacher; et al. (2003) that examined the access that black and Hispanic Medicare beneficiaries have to prescribe drugs for chronic conditions. Not much has changed in the times since then and taking the findings of the study it can be established that the Black and Hispanic Medicare beneficiaries are subject to medication under use for economic reasons. This is also true for the chronically-ill black and Hispanic beneficiaries, who require constant medication but have no resources and have very meager drug coverage. The three common diseases that cause the depravity foremost are heart ailments, diabetes and HIV / AIDS. Though the federal initiatives have given importance to the three diseases in removing disparities, yet the benefits are to reach the target. (Briesacher; et al., 2003)

The general access to prescription drugs is not available for black and Hispanic Medicare beneficiaries. Thus these groups of people may need a different amendment in the policy to ease their burden of payment and create an easy access to medicines. The research is an eye opener and though there has been lot of changes since then it is worthwhile considering if these problems have been set right in 2009, six years after the preliminary finding. As mentioned earlier there is a direct relation between age and the use of medical resources and this applies to prescription drugs. The examination of the Medicare program that is meant to provide health insurance benefits for elderly and disabled persons initially did not have provisions for the payment of the purchase of prescription drugs for persons. While the employed may have health benefits there is no provision to cover the outpatient prescription drug purchase. At the beginning of the millennium the status of the Medicare and the previous legislations in this regard was detailed and discussed in a research. (Poisal, et al., 1999)

We may note that there have been up to the year 2000 many acts passed to overcome the deficits of the Medicare legislation that include The 'Medicare Catastrophic Coverage Act', which could have brought the benefit required but was repealed in 1989. It can also be taken into account that the 'National Bipartisan Commission' on the 'Future of Medicare' recommended far back in 1977, adding an outpatient prescription drug benefit to Medicare for persons with low incomes. (Poisal, et al., 1999) However the situation as found in the beginning of the Millennium is that mostly beneficiaries who have the Medicare risk health maintenance organizations -- HMOs have prescription drug coverage. The statistics at that time showed that the black persons and other minorities had coverage rates higher than white people because of the numbers in population. Income was also a factor and the people with incomes greater than $20,000 had coverage. Thus there is a need to stress on the Prescription drugs being made a part of the Medicare benefit. The second issue is that these are based on employer-sponsored insurance, and is not available to the elderly.