[lbo-talk] "Dual Eligibles" was Shiavo "Forbidden video"

[Marta Russell]

>WKiernan wrote:
>Now that this topic is in the public's eye, I'd like to see 
>defenders of Michael Schiavo turn and attack the obscene cruelty of 
>the Texas "Futile Care Act" in particular, and the inhumanity of the 
>U.S.A.'s for-profit health care system in general.  In the richest 
>country in the history of mankind, for a hospital company to allow 
>Marta Russell or someone like her to die just because she hasn't 
>enough money to pay their extortionate bills, is naked murder.  We 
>should be willing to descend to "bad form" to uphold that position. 
>I'm not saying that because I calculate the terminal-health-care 
>issue is one opponents of the far-Right can use to boost our polls, 
>but because matters like this are precisely the Left's reason to 
>exist.
>
>Yours WDK - WKiernan at ij.net
>

Bravo.
Hope you don't mind that I take the opportunity to inform of one 
issue that falls into the realm of your comments.  I've been 
circulating the letter below to try to get a state legislator to 
craft a wrap around policy that will cover those who will fall 
between the cracks.

Dear Senator Keuhl,

I am writing out of need and for hundreds of others all across the 
nation who will find themselves in the same dire straights I see 
coming down the road at the end of this year.

The new Medicare Prescription Drug plan going into effect January 1, 
2006 may have some serious consequences for me. I am what they call a 
"dual eligible", that is, I have Medicare and Medi-Cal.

All dual eligibles are going to be thrown onto the Medicare drug 
plan, which relies on private insurance carriers to pay for drugs. 
Now I depend upon Medi-Cal to pay for my prescriptions as I am 
disabled, unemployed, and cannot afford to pay for them on my own.

CMS has been working on the Medicare drug regulations and the private 
insurance companies that will offer a plan under Medicare are coming 
up with their formularies to determine the drugs that they will and 
will not cover. According to the latest information I have, we won't 
know until October or November exactly what these plans will offer, 
what drugs will be covered and what drugs will not!

I could be much worse off in January on Medicare than I am now on 
Medi-Cal which pays for all my drugs, even ones not on its formulary 
through a process called TARs. CMS has already stated that some drugs 
that most states cover through their Medicaid programs-such as 
benzodiazepines-will not be covered by Medicare Part D. (See #17 at 
http://www.familiesusa.org/site/PageServer?pagename=Medicare_Central_Analysis_Final_Regs#seven)

  It is highly likely that I will be worse off on the Medicare drug 
plan given the fact that Medicare will only pay for the limited drugs 
on their formulary and the insurance companies are looking at how 
much money they can make off people like me and how much they stand 
to lose in the deal they make with the federal government.  I may 
have to chose a private plan which covers only one, two, or three of 
the drugs I need.

Historically disabled people have been shifted onto public programs 
like Medi-Cal because our medical expenses are so high, insurers 
don't want us, and we are so poor. That is why it is illogical for 
the federal government to be forcing dual eligibles onto private 
plans.

I cannot do without even one of the drugs I must take each day yet I 
may be faced with this dire circumstance where I may not be able to 
pay out of pocket for an indispensable drug.  Believe me thousands of 
disabled persons across the nation will similarly be affected.  In 
addition to cost, often we require specific drugs (not substitutes) 
for our conditions.  Many of us have spent years getting to the right 
combination of drugs that keep us going.

According to the Families USA evaluation of the regulations, states 
can continue to provide Medicaid coverage for non-Part D drugs (ones 
that the insurance companies refuse to cover) and receive federal 
matching assistance but the State of California to date has not set 
such legislation into motion.

Will you help to enlist the State of California to pass such a law or 
suggest who I may contact to pursue this vital matter?

Most sincerely,
Marta Russell

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