CHARLESTON, W.Va. -- Health reform is working for West Virginia seniors. Since passage of the Affordable Care Act in 2010, West Virginia seniors on Medicare have saved almost $60 million on prescription drug costs.
This year alone 28,700 seniors saved $23 million or an average of $817 per person. Health reform is addressing an enormous inequity for seniors with high prescription drug costs.
Health reform also gives seniors first dollar coverage for preventive services. No longer will financial worries keep seniors from getting that important test for breast cancer and other cancers or forego tests they need to understand how to maintain their health. In West Virginia, about 170,000 seniors have taken advantage of screening and preventive benefits offered by Medicare. As more seniors become educated about these benefits and take advantage of them, more seniors will be able to maintain healthy and active lives.
According to a report from the West Virginia Center on Budget and Policy and the Partnership for Elder Living, half of all seniors have barely enough income to make ends meet. For these seniors savings on prescription drugs and co-payments for preventive services make an enormous difference.
You may wonder, why in the world have we had a health-care program that does not put prevention first and penalizes seniors, who have high prescription drug costs?
When Medicare was passed in 1965, the biggest worry for seniors was high hospital costs. Cancer screening and other preventive measures were in their infancy and the expensive drugs that today improve the lives of millions were not invented. Today we know much more about treating cancer and other diseases in the early stages and keeping people at home and out of the hospital.
In 2003, Congress and the Bush administration passed Medicare Part D, adding prescription drugs as a benefit. Adding prescription drug coverage to Medicare was the right thing to do. From the very first, however, the law was flawed. Fearing run-away drug costs, the law created a gap in benefits. Before the 2010 health reform law, Medicare paid for prescription drugs up to approximately $2,900. Thereafter the benefit ceased until the senior spent a total of $4,700 in out-of-pocket costs, at which point the benefit kicked in again. The law did not permit Medicare to negotiate with the pharmaceutical industry over prescription drug costs nor did the law include a mechanism to pay for the new benefit. Consequently Medicare Part D added billions to the deficit.
In the 2010 health-reform law, new Medicare benefits are paid for. Beginning in 2011, the pharmaceutical industry agreed to give a 50 percent discount on brand name drugs to seniors who fall into the doughnut hole. The federal government will contribute additional assistance for generic drugs bought while the senior is in the doughnut hole. Overall, Medicare costs are moderated in future years by decreasing overpayments to insurance companies, hospitals and other health related industries as well as some new taxes on high-income earners.
Some West Virginians are skeptical about the numbers of the Congressional Budget Office and other financial experts, who say that the 2010 health-reform law will actually decrease the deficit. Increasing benefits and at the same time reducing costs may seem counterintuitive. But a September 2012 report from the Institute of Medicine documented an annual $750 billion in unnecessary health system spending. In the U.S. health-care system, the most expensive and wasteful in the world, it seems there are plenty of savings to be had without denying or reducing health care for those who need it most.
But you don't have to take their word for it. During the health-care debates of 2009, Sen. Robert C. Byrd sent word to the president and the Congress that he would not vote for a health-care bill that increased the deficit. When the vote was taken in the Senate, an ailing Sen. Byrd was there to give a resounding, Aye!
Pore is health policy director for the West Virginians for Affordable Health Care and the West Virginia Center on Budget and Policy.