What Can You Do To Speed Medicare Reform?

Because Medicare is a federal program, action to modernize and improve it must come from Washington. But those at state and local levels are closer to the problems that this antiquated program is creating – problems like a lack of prescription drug coverage that forces beneficiaries to purchase supplementary insurance if they can afford it, or sometimes go without needed medicines if they can’t.

Solutions have been developed that have bi-partisan support, but Washington needs to hear that you want them to move forward.

State and local governments and membership organizations can encourage Washington to act by passing resolutions to get the attention of Congress and the White House.

Here are some suggestions of wording that could be incorporated into your resolution.

Drug Benefit Resolution / Principles

Whereas: The Medicare program covers only half of the health costs of America’s seniors and is increasingly out of step with modern medicine.

Whereas: Medicare does not cover outpatient prescription drugs, even though ninety-nine percent of private health plans provide such coverage.

Whereas: Millions of seniors do not have insurance coverage for prescription drug therapies that are increasingly important to promote and maintain good health.

Whereas: Low-income elderly are particularly at risk of not being able to afford life-saving drug therapies.

Whereas: The State of ____ is committed to protecting the health and welfare of its citizens.

Whereas: Adding universal drug coverage to Medicare in its current structure would dramatically increase the program’s cost and accelerate its financial insolvency.

Therefore be it resolved that: Congress design a Prescription Drug Benefit for the Medicare program, guided by the following statement of principles. These principles point toward market-based reforms that will result in greater access to quality health care, including affordable coverage for prescription drugs, for today’s and tomorrow’s beneficiaries.

  • Overall reform: Congress should create a prescription drug benefit program that puts in place the foundations for future Medicare reform to give beneficiaries a choice of competing, private health plans — plans which will have incentives to offer drug coverage as an integral part of health coverage.
  • Target the needy: In designing a drug benefit, Congress should target drug coverage to low-income Medicare beneficiaries who are most likely to be without coverage.
  • Private insurance: Government assistance should not crowd out private arrangements for drug coverage. It should supplement a private insurance market, not supplant it.
  • Efficiency: Government should not adopt policies that would prevent private health plans from offering coverage that would encourage efficiency in the purchase and utilization of drugs.
  • Choice: Beneficiaries should have a choice of private plans with different types of coverage and different forms of utilization controls. They should not be forced or enticed by subsidies into a monolithic government plan.
  • Controls: The government should not use its purchasing and law-making power to place controls on prices or ration access to medicines.
  • Innovation: Long-range innovation and development of new drugs should not be sacrificed to politically determined prices set to benefit today’s beneficiaries.
  • No penalties. Any new federal programs should not penalize states that already have programs to assist the needy in obtaining prescription drugs.
  • Federal funding. Medicare is a federal program. Therefore funding for a Medicare prescription drug benefit should be federally funded.
  • State flexibility: If states are to be asked to assist in administering a drug benefit for Medicare beneficiaries, the states should be given maximum flexibility and ample time to develop programs.
  • Exclude HCFA: In order to move toward overall reform of the program, the drug benefit should not be administered by the Health Care Financing Administration, whose tools are regulation and price controls.
But while we offer these recommendations, we believe there is no substitute for overall Medicare reform that gives beneficiaries the ability to choose private, integrated coverage in a competitive market. Therefore, we strongly encourage the Congress to proceed with overall Medicare reform.

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