Drug Companies May Narrow Medicare Coverage Gap (AP)
The pharmaceutical industry would finance improved coverage under the Medicare prescription drug program and help defray the cost of President Barack Obama's health care legislation under an $80 billion deal with key lawmakers and the White House that officials said Friday night was close to agreement.
These officials said the 10-year proposal under discussion would have drug firms pay as much as half of the cost of brand-name drugs for lower and middle-income seniors in the so-called "doughnut hole."
Medicare patients with incomes up to about $80,000 would realize some benefit. The term "doughnut hole" refers to a feature of the current drug program that requires beneficiaries to pay the entire cost of prescriptions after initial coverage is exhausted but before catastrophic coverage begins.
Additionally, officials said any agreement would reduce anticipated payments for the pharmaceutical industry under government-run health programs such as Medicare and Medicaid. The government would use those savings to help pay for legislation expanding health insurance to millions who now lack it.
One official close to the talks said agreement had been reached, but there was no immediate confirmation. All officials spoke on condition of anonymity to discuss private negotiations.
Nor was it known whether other elements might be envisioned that could ease the sting for the industry.
Any agreement with Pharmaceutical Research and Manufacturers of America, or PhRMA, which represents drug companies, would mark a major accomplishment for Sen. Max Baucus, the chairman of the Senate Finance Committee, who is attempting to draft legislation that can command bipartisan support in Congress. The Montana Democrat has been negotiating with several outside interests — hospitals, doctors and insurance companies among them — in hopes they would accept lower-than-planned payments from government-run health care programs. A deal with drugmakers would presumably increase pressure on other groups to do the same.
It would also counter a recent series of stumbles that, while common with any major legislation, have contributed to the impression that the drive to enact health care legislation was sputtering.
Ken Johnson, senior vice president of the PhRMA, declined to comment, except to say, "We remain committed to comprehensive health care reform and we are still in discussions with the administration and congressional leaders about ways we can make a positive contribution to this important effort."
The industry is under pressure, particularly in the House, where senior Democrats are considering legislation that could cut more deeply than drug companies would accept on their own. Additionally, some lawmakers have sought for years to permit the importation of prescription drugs from Canada and other countries, a step the industry has fought and was able to fend off while Republicans controlled Congress.
Rep. Henry Waxman, D-Calif., chairman of the Energy and Commerce Committee, said during the day drug makers reaped a "windfall of billions of dollars" from the Medicare prescription benefit and Congress wants some of it back. He was referring to seniors who had been covered under Medicaid, which requires rebates from drugmakers. Many were switched to Medicare, which does not.
Obama has called for $75 billion worth of savings in government payments to drug companies from Medicare and Medicaid over the next decade to help pay for his health legislation, which he says must not add to the deficit.
Under the drug program for Medicare, which began in 2006, most plans included a gap in coverage. Under a standard plan in effect, the benefit covered costs until the beneficiary and government together had spent $2,250. At that point, beneficiaries had to pay all their drug costs until their out-of-pocket costs reached $5,100 for the year. Benefits then resumed, paying 95 percent of any additional expenses.
Republicans and the Bush administration, who designed the program, created the "doughnut hole" to hold down the government's cost.
Democrats attacked the bill, taking particular aim at the doughnut hole, and pledged to narrow or close it if they won a majority. Even so, they made no concerted effort to do so after winning majorities in the 2006 elections.
But now, many leading Democrats have vowed to make better Medicare prescription drug coverage a part of a health care overhaul.
6.) Adult Homes Haven't Changed Much-Bad Facilities Remain Open; Reform Far Off (Times Herald-Record)
There's no question that the worst adult homes in our region were Monticello Manor and Roscoe Manor. Together the two homes, which are owned by the same person, racked up 358 serious violations in Health Department inspections from 2001 to January 2009.
The pattern in New York is that bad adult homes — and there are too many — stay open despite chronic problems. After more than a decade of inspections that uncovered violations — including in 1998 the rape of one resident by another — Monticello Manor was shut down in June 2008. Last week, the state announced that owner Charles Benson's other property, Roscoe Manor, is closing voluntarily.
Why, with such long histories of repeated violations, did they remain open? Efforts to reform and improve the system, often triggered by tragedy, have started and stalled for decades.
After last year's Times Herald-Record series, politicians once again promised legislative action.
"Not much has changed" in the past few years, said Karen Schimke, president of the Schuyler Center for Advocacy and Analysis, which works on behalf of adult-home residents. "The day-to-day life of adult home residents is the same."
State Sen. William Larkin Jr., R-C-Cornwall-on-Hudson, said he met three times last year with officials from the Health Department, the governor's office and providers to discuss adult homes.
"It was their opinion," Larkin said, "that they had corrected the issues at hand," and that the problem homes were a few bad apples.
Many of the 479 adult homes in New York do meet or exceed the state requirements to provide room, food, assistance with personal care and hygiene, medications and activities for the residents. The state has made some strides in recent years, adding higher care classifications and qualifications to house people in need of enhanced care and new Assisted Living Programs. All require more specialized staff than adult homes.
When an adult home closes, the state works with residents to relocate them to other facilities that meet their needs. This hasn't been a problem, said Health Department spokeswoman Beth Goldberg. The state has 39,341 beds in adult care facilities — more than in 2007, she said.
"The health and safety of the residents in our priority," Goldberg said.
On June 10, the Assembly passed a bill to increase incident reporting, and sent it to the Senate. A handful of other bills has been proposed, including comprehensive bills in each house.
Assemblywoman Aileen Gunther, D-C-Forestburgh, said the state preserved adult-care beds statewide despite the budget crunch, and increased reimbursement rates to the facilities for providing care.
Stephen Powers, counsel to Sen. Thomas Morahan, R-C-New City, said the Legislature would be willing to pass any legislation the involved agencies want. Morahan, who sits on the Senate's mental health committee, has introduced a number of adult-home bills in the past, including one to create waiting lists for mental health housing, which advocates have wanted for years.
"Anything we do that mandates certain reporting requirements is only as good as the people who report," said Assemblywoman Nancy Calhoun, R,C-Blooming Grove.
Assemblywoman Annie Rabbitt, R-C-Greenwood Lake, said that what's needed is enforcement, not more legislation.
Sen. John Bonacic, R-C-Mount Hope, said the Health Department has stepped up inspections since last year. "They have monitored more closely, and issued fines and violations," Bonacic said.
Local inspections from 2008 support that contention. Surveyors visited the five adult homes in Sullivan County a total of 23 times for various inspections, issuing numerous violations at Monticello Manor, Roscoe Manor, the Narrowsburg Adult Home and Jeffersonville Senior Living.
The New York State Coalition for Adult Home Reform, an alliance of advocates, residents and state agencies coordinated by the Schuyler Center and the New York State Association for Psychiatric Rehabilitation Services, continues to push for reforms and a better housing model, particularly for the roughly one-third of adult home residents statewide who have psychiatric diagnoses.
The coalition formed in 2002 after The New York Times exposed appalling conditions in city adult homes. Like Monticello and Roscoe Manor, those homes were "impacted," meaning that more than a quarter of the residents had psychiatric diagnoses. The 2002 Adult Care Facilities Workgroup recommended trying to move eligible residents with mental illness into supportive housing, but that never happened.
"The state simply doesn't have the political will to solve this problem," Schimke said. "These are real people. It's kind of convenient to say, don't ask, don't tell, don't look. If you don't look, you don't have to see it."