CONTRIBUTORS

Maine’s budget shortfall threatens health coverage for seniors

Posted June 03, 2013, at 9:58 a.m.

With less than three weeks left in the regular 2013 legislative session, many of Maine’s seniors are wondering whether they will be able to afford their health care costs and much-needed prescription drug coverage. As Maine continues to address budget constraints, the target for the shortfall is, once again, our most vulnerable elders.

While it is clear that Maine’s budget challenges are daunting, there is no good news in the state budget for seniors and disabled Mainers on low or fixed incomes. These Mainers are grappling, as they do each year, with the crushing everyday costs of buying food, heating their homes and other living expenses. For them, the proposed cuts to the Medicare Savings Program and the elimination of the Drugs for the Elderly Program will be nothing short of devastating. Sadly, many of our leaders do not understand the depth of the impact.

The Medicare Savings Program covers Medicare Part B premiums which pay for doctor visits, preventive care, ambulance services and outpatient care. It also covers Medicare Part D prescription drug costs and co-payments. Under the current proposal, 40,000 seniors and adults with disabilities will be cut from the program. Depending on their circumstances, these at-risk Mainers will lose some or all coverage for prescription drugs, hospital deductibles, skilled nursing care, outpatient medical services and more.

Maine’s seniors cannot absorb these costs. They will stop going to their doctors and taking their medications. They will use the emergency room as their primary care and only as a last resort. They risk institutional placement — a much more costly alternative to staying at home in the communities they love.

If our elected leaders vote to reduce eligibility for the Medicare Savings Program, seniors will not only lose that benefit, they will also lose their low income subsidy. The subsidy offsets premiums, deductibles and copayments for Medicare Part D drug plans.

Cutting the Medicare Savings Program also doesn’t make sense economically because the program is matched with federal dollars. The so-called “savings” to the state of $23.8 million through cuts to the program actually comes with the considerable loss of over $40 million in federal matching funds. In fact, the services provided to Medicare Savings Program participants is estimated to have a value of over $498 million including physician, home health, hospital and hospital outpatient services.

With the proposed elimination of the Drugs for the Elderly program, an even larger number of people will be impacted. The program helps pay for prescription drugs for 80,000 Mainers whose income is below 175 percent of the federal poverty level. The program is paid for by tobacco settlement and racino dollars, not taxpayer dollars. Current beneficiaries are on the cusp of Medicare eligibility — between the ages of 62 and 64 ½. These are the poorest of the poor in Maine. They are counting the days to Medicare eligibility.

To suggest that people from either group can get prescription drugs cheaply at hospitals, pharmacy chains or through the pharmaceutical companies themselves is short-sighted. Many of the drugs older people take to manage chronic diseases do not have a generic alternative. Still other drugs are not offered as part of the low-cost formulary. Additionally, many patients are required to take a brand-name drug instead of the generic because their doctor determines that it is “medically necessary.”

While some pharmaceutical companies may be willing to offer a limited supply of a certain drug, this option is not sustainable, especially when considering that most people take multiple drugs, not just one. The application process to the pharmaceutical companies is complicated. In most cases, an application must be submitted for each drug request, subsequent refill requests, and there is a different application process for each drug manufacturer. Some applications require specific documentation of “patient need” or even copies of a patient’s tax returns. Most applications require the involvement of a physician, further slowing the process. Such barriers are troublesome for healthy individuals and all but impossible for older, sick individuals.

On behalf of our more than 230,000 Maine members, we urge our state lawmakers to reject any budget proposal that does not protect our most vulnerable residents. Those affected by these budget cuts are our parents and grandparents. For many, cutting back on health care and prescription drugs could force them into institutional care or even endanger their lives. At AARP, we find this unacceptable and urge anyone reading this to call their legislators. We must not balance our state budget on the backs of those who have absolutely nothing to give.

John Hennessy is the AARP Maine director of advocacy.

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