[lbo-talk] BG: Lying about Plan D Medicare numbers

Michael Pollak mpollak at panix.com
Fri Feb 24 09:29:53 PST 2006


http://www.boston.com/yourlife/health/aging/articles/2006/02/23/medicare_numbers_at_odds_with_us_claims/

The Boston Globe

Medicare numbers at odds with US claims

Fewer volunteers for new drug plan

By Jeffrey Krasner, Globe Staff | February 23, 2006

Since December, the US Department of Health and Human Services has

repeatedly overstated the number of enrollees in the new Medicare

prescription drug plan.

Yesterday, Mike Leavitt, secretary of health and human services,

said more than 25 million people were receiving benefits under the

program, called Part D, and that millions more are signing up

monthly.

But according to Medicare's own figures, the actual number of

voluntary enrollees is much smaller, about 5 million. Some of the

20 million other participants cited by Leavitt were automatically

enrolled in Part D on Jan. 1. Others are counted as Part D

enrollees, even though they receive coverage from former employers,

unions, or the government.

Leavitt, through his press office, declined several requests for an

interview.

Since Nov. 15, when enrollment began, there has been widespread

confusion about the complex program. Some senior citizens and

disabled people have had difficulty filling prescriptions because

they could not prove they had coverage from one of the many

insurers that are offering the Medicare drug plan. More than 30

states, including Massachusetts, have enforced emergency rules to

ensure that patients receive medications.

Critics say the numbers are emblematic of the government's efforts

to make a flawed plan look successful.

''For an administration that frequently provides inaccurate

information, the use of the 25 million enrollment figure breaks new

ground in misleading propaganda," said Ron Pollack, executive

director of Families USA, an advocacy group that has been critical

of the drug program. ''The only real number that is worth focusing

on is the approximately 4 million to 5 million who now have

prescription drug coverage who did not have it prior to the start

of the program. Unfortunately, the administration is trying to mask

that failure with an exaggerated number that has nothing to do with

new people who gained coverage."

In January 2005, the government estimated 39.1 million people would

receive drug coverage this year under Part D. When enrollment

started Nov. 15, the projections dropped to 28 to 30 million. The

enrollment of about 5 million people who did not have drug coverage

previously falls far short of the goal.

But in press releases and conference calls with reporters, Leavitt

and Medicare chief Dr. Mark B. McClellan, have presented a variety

of enrollee statistics. Sometimes they refer to numbers of people

eligible to receive benefits rather than those who have actually

signed up, and they have counted millions of people whose drug

coverage only changed on paper as of Jan. 1.

For instance, 3.1 million military and federal government retirees

received comprehensive drug benefits before the start of the

Medicare plan. Their benefits are still provided by Tricare, the

military healthcare system, and the Federal Employees Health

Benefits Plan. But Medicare counts those retirees in those programs

as Part D beneficiaries.

A letter on the FEHB website even cautions beneficiaries against

joining the new program. ''You do not need to enroll in Medicare

Part D and pay extra for prescription drug benefits," it says.

The assistant secretary of defense for health affairs wrote a

similar letter to Tricare beneficiaries. ''There will almost always

be no advantage to enrolling in a Medicare prescription drug plan

for most Tricare beneficiaries," Dr. William Winkenwerder Jr.

wrote.

Other groups are counted by the government as Medicare drug plan

enrollees even though their connection is tenuous. They include:

* About 6.4 million retirees who receive drug benefits from their

former companies or unions. The companies or unions previously

financed the full cost of the benefits, but Medicare now pays a

subsidy to defray part of the expense.

* About 4.5 million people who already had drug coverage through

Medicare Advantage plans, private managed-care insurance plans that

offered benefits beyond traditional fee-for-service Medicare, which

didn't cover drugs. Those Medicare Advantage beneficiaries were

automatically enrolled in new Medicare Advantage plans that

incorporate Part D coverage. Their drug benefits may be better in

the new plans.

* 6.2 million low-income elderly and disabled people -- known as

dual eligibles because they qualify for assistance from Medicaid

and Medicare -- who already received drug coverage from Medicaid,

the assistance program for low-income people run by federal and

state governments. On Jan. 1, their drug coverage was switched to

Medicare, and beneficiaries were placed into drug plans chosen at

random.

In press conferences, Leavitt and McClellan speak interchangeably

about enrollees and beneficiaries, blurring the line between those

who have voluntarily joined Part D drug plans, and those whose

pre-existing benefits are now associated with the new federal plan.

Senator Max Baucus, Democrat of Montana, emphasized the difference

between the two groups when McClellan testified at a Senate Finance

Committee hearing on Feb. 8. He called the 24 million enrollment

number being used at the time ''inaccurate." Baucus told McClellan

he wanted to confirm that only about 8 percent of the seniors

eligible for Part D had voluntarily signed up.

McClellan did not dispute the number.

Dr. Charlotte Yeh, regional administrator for the Centers for

Medicare and Medicaid Services, which oversees the drug plan, said

it counts people who have coverage equivalent to the Medicare

benefit, regardless of who is paying for it.

For instance, CMS press releases continue to cite as Part D

enrollees 500,000 people who receive drug coverage through former

employers -- even though their employers declined to accept

government subsidies.

''The reason you want to count them is their coverage is at least

as good as Medicare's," Yeh said. ''At least there's another half

million that have coverage."

Jeffrey Krasner can be reached at krasner at globe.com.

Read complete Boston Globe coverage of the Medicare drug plan at

boston.com/business.

© Copyright 2005 The New York Times Company



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