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State Orders Help for Elderly as Medicare Glitches Spread

California joins other states in giving seniors emergency assistance. Bush's signature program draws sharp criticism nationwide.

January 13, 2006|Ricardo Alonso-Zaldivar and Peter Nicholas | Times Staff Writers

SACRAMENTO — California officials ordered emergency action Thursday to cover drug costs for 1 million elderly citizens, many of whom have been denied life-saving medications or charged exorbitant amounts because of glitches in the new federal prescription drug program.

The action by Gov. Arnold Schwarzenegger's administration capped a day in which the Medicare prescription drug program -- one of President Bush's signature domestic policy initiatives -- came under sharp criticism from members of Congress and governors of both major political parties.

Critics said the program, which Bush has touted as the most significant advance in Medicare in 40 years, was fast becoming a public health emergency. California officials said that as many as one-fifth of the 1 million elderly, poor or disabled state residents who were switched into the federal program on Jan. 1 could be wrongly denied their medications because of flaws in the program.

In Illinois, Gov. Rod Blagojevich, a Democrat, took action similar to Schwarzenegger's, ordering state funds to be used to provide emergency drug coverage for the elderly. Arkansas Gov. Mike Huckabee, a leading figure among Republican governors on health policy issues, took a similar step Wednesday. Nine states, including California, have stepped in to fill the gaps in the federal program.

Bush has staked considerable political capital on the Medicare program, and Democrats were quick to seize on its problems. Sen. Hillary Rodham Clinton (D-N.Y.) criticized the program at a news conference as "a bad policy poorly implemented."

"It's a double whammy," Clinton said.

Medicare officials in Washington said they were dismayed by the problems and were working around the clock to resolve them. The program is working for most people, said Medicare spokesman Gary Karr, adding that up to 40,000 prescriptions an hour are being successfully dispensed during peak times.

"Many states are reporting they really don't have any problems," Karr said. "Most of the pharmacies seem to be reporting to us that things were easier this week than last week."

The problems with the Medicare drug benefit do not yet seem serious enough to lead to an immediate repeal effort.

But the spectacle of governors bailing out Washington, poor people unable to get their medications and pharmacists angry over not getting paid could damage the Bush administration's credibility on healthcare -- an important election-year issue that the White House wants to showcase in President Bush's State of the Union speech, which is scheduled for Jan. 31.

James Firman, president of the National Council on the Aging and a supporter of the program, said that continued problems could cause deep trouble for the entire program.

"Right now the pressure isn't to repeal it, but to get it right," he said. "I think everybody underestimated the complexity involved. If these problems don't get fixed in four to six weeks, it's going to be very serious."

The root of the current problems is a provision of the Medicare prescription drug law that automatically switched about 6 million elderly, low-income and disabled people into the new program Jan. 1.

Those people had previously been covered by Medicaid -- Medi-Cal in California -- the joint state-federal healthcare program for the poor.

Moving that many people into the new program, all at one time, appears to have overwhelmed the complicated Medicare drug benefit system.

In designing the program, the Bush administration did not want the Medicare drug benefit to be administered directly by the federal government.

Instead, it devised a public program run by hundreds of competing private drug plans, each with its own prices and coverage policies.

In many cases, pharmacists and patient-advocates say, elderly people are being denied benefits because of inaccurate or outdated information in computer databases used by the government and the individual health plans to interact with pharmacies.

In some cases, there is no information on a beneficiary, or the computer says the beneficiary is ineligible for coverage. In other cases, cost-sharing information is wrong, and pharmacists are being told to charge beneficiaries hundreds of dollars when in fact they have co-payments of only $1 to $5.

"We've been inundated with calls about this, so we're thrilled" by the state's action, said Sandy Risdon, program manager of the Center for Health Care Rights in Los Angeles, an advocacy organization for Medicare beneficiaries.

Staff attorney Deepti Sethi said the center had received as many as 40 emergency calls a day from patients who were told that they could not get their prescription drugs or were asked to pay unaffordable amounts.

"People are walking out without their medicine across the board -- high-blood-pressure medicine, insulin, pain medication," she said, adding that the problems were putting people at risk for stroke and other health problems. "This is the most vulnerable population."

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