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