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By Otto Kreisher While Ways and Means Health Subcommittee Chairman Fortney (Pete) Stark, D-Calif., would like to make dramatic changes in the Medicare Part D prescription drug benefit, he conceded at a hearing Thursday the best he could expect would be to make some improvements in health legislation he hopes will be enacted this year. "In a perfect world, today's hearing would focus on creating a Part D plan run by Medicare that would negotiate for lower prices and compete against the private plans," said Stark, citing the proposal the Republican-run Congress and Bush administration rejected before enacting the new benefit two years ago. "I know that proposal isn't yet ripe, but I hope we can at least talk about standardizing Part D products so beneficiaries are better able to compare the 50 or more plans available in their community," he said. But Health Subcommittee ranking member Dave Camp, R-Mich., praised Part D and warned against "calls to modify or gut" the two-year-old program. Camp cited administration figures that Part D participants saved an average of $1,200 on prescription drugs last year and that surveys showed more than 80 percent of beneficiaries were satisfied with the program, which went into effect Jan. 1, 2006. "Is Part D perfect? Of course not. Can part D be improved? Absolutely," Camp said. "But we need to tread carefully when considering fundamental changes to this important, successful and well-liked program." Thursday's hearing was aimed specifically at problems encountered with "dual-eligible beneficiaries," low-income senior citizens who are eligible for both Medicare and Medicaid benefits, which reduces their co-payments for prescription drugs. Leslie Norwalk, acting administrator of the Centers for Medicare and Medicaid Services, gave a highly positive report on Part D's performance in its first year, using the high satisfaction numbers and savings Camp cited. Norwalk also noted that the total cost of the program was running 13 percent below initial estimates. Norwalk acknowledged there had been start-up problems, but said CMS had worked with the plan providers and states to correct them. Kathleen King, GAO's director of healthcare issues, reported that CMS's process for enrolling dual-eligible individuals "involves many parties, information systems and administrative steps and takes a minimum of five weeks to complete." That mainly affected the two-thirds of dual-eligible seniors who are Medicare recipients who later become eligible for Medicaid. They often had trouble getting their drug bills reimbursed, King said. But she added that CMS had generally eliminated that problem for the one-third of beneficiaries who were on Medicaid and then became eligible for Medicare.
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