If you wish to read a description and analysis of the legislation after it is voted upon, please go to the Web site of the National Committee to Preserve Social Security and Medicare and click on NC Analysis. Although we do not control the content on that site we have confidence, based on their previous advocacy work and analysis, that their information will be accurate and dependable.

Depending upon your perspective, the preliminary information on the proposed Medicare changes is either good, bad or a combination of both.

The following preliminary information is drawn from a variety of sources and attempts to be impartial and unbiased. Please remember that the agreement from the conference committee must still be sent back to the Senate and House for final passage. If you feel that this proposal does not reflect your wishes, now is the time to contact your elected officials and make your opinion known. [ Advocating ideas ]

The Good News: For the first time, seniors would be eligible for a drug benefit that would cover a portion of their annual prescription costs. Under the tentative agreement, beginning in 2006, Medicare beneficiaries would have access to the drug benefit by enrolling in either a stand-alone private drug plan or a private health plan that offers drug coverage. The new Medicare drug benefit would pay 75 percent of seniors' drug costs up to $2,200 a year, with a $275 deductible for prescription drugs and a monthly premium that would average $35.

However: Individuals, 65 years or older, who sign up for the benefit will be confronted with a number of issues that would determine whether the drug benefit would actually help them.

1. Seniors would pay annual premiums of about $35 per month and an annual deductible of $275. Medicare would cover 75 percent of annual drug costs between $275 and $2,200. The program would pay nothing more until the beneficiary had spent a total of $3,600 out of pocket.
Then, the beneficiary would pay a sliding scale of co-payments for each new prescription, depending on his or her income level.

2. If income eligible beneficiaries signed up for a prescription drug discount card before the drug benefit began, they would be eligible for $600 in additional assistance per year to buy drugs in 2004 and 2005. The Department of Health and Human Services estimates that the discount card could provide seniors with savings of 15 to 25 percent.

3. The premium and deductible would be waived for people making less than $12,124 a year, provided they do not have more than $6,000 in liquid assets. People who do qualify for premium waiver would still have co-payments of $1 to $5 per prescription. If their income is higher or if they have assets totaling more than $6,000 they must pay a monthly premium for coverage. This could disqualify approximately 2.8 million poor seniors from the subsidies they need to make medicines affordable.

4. Seniors at or below the poverty level who have been receiving drug benefits through state-administered Medicaid programs stand to lose current benefits because of a provision to the Medicare legislation that House negotiators insisted upon. Under existing Medicaid policies, the states pick up the co-payments for low-income seniors and make sure they receive all medically necessary drugs. Elimination of the benefit for those who are eligible for both Medicare and Medicaid, the "wrap-around" help with their Medicare drug co-payments, may cause as many as six million of the lowest-income Medicare beneficiaries to pay more for their drugs than they do today.

5. Health insurers would compete for market share in the new Medicare business and, in some areas of the nation, would directly compete with traditional fee-for-service Medicare. The federal government would provide increased reimbursements for health insurers that offer Medicare managed care plans, which would make the plans a more profitable business. Under the bill, the federal government would offer health insurers an estimated $12 billion to provide prescription drug coverage for beneficiaries and would cover more of the cost of medications for beneficiaries

However: Upper-income seniors who sign up for the benefit will be hit with higher premiums and co-payments in a program that for the first time would take their incomes (known as means testing) into account. The higher premiums would be charged to the estimated three percent of people on Medicare whose annual income is more than $80,000 a year.

And, seniors of all income levels whose annual prescription drug bills exceeded $2,200 would be required to continue paying monthly premiums to the programs while their benefit was cut off until they reached the "catastrophic" level of $3,600, when the benefit would kick in again. That refers to the $1,400 gap between $2,200 and $3,600 during which seniors will have to pay the total cost of their medication and their monthly premium. After the catastrophic level is reached the federal government would cover 95 percent of drug costs.

More Good News: Beginning in 2006, Medicare beneficiaries will have the option of a voluntary separate insurance policy to be created by the insurance industry or join a private health plan that also offers drug coverage. This fee-for-service Medicare will begin competing with private health plans to lower costs in a scaled-back compromise, through government sponsorship. Beginning in 2010 pilot projects in six metropolitan areas in which private plans have achieved 25 percent of the Medicare market share will be initiated. Beneficiaries would have to pay more to stay in traditional, fee-for service Medicare if that program's costs are higher than in private plans, but premium increases could be capped.

However: Medicare analysts have indicated that the proposal could do more harm than good and that the economic benefits of the prescription drug benefit would not equally benefit all income groups. Seniors—most in need of the benefit—because they have fixed modest incomes and who spend $4,000 to $5,000 a year on prescription drugs to treat chronic conditions, will end up getting very small benefits overall—about 30 percent of their drug costs are covered. And, they will be adding the cost of the premium.

Additionally:

• The bill would provide tax-free subsidies worth up to $70 billion to encourage employers that currently provide retiree drug coverage to continue doing so once the Medicare drug benefit begins.
• The bill includes an estimated $18 billion in tax incentives for employers that offer retiree drug coverage; the government would pay 28 percent of the costs for the coverage from $250 to $5,000 in drug costs. The financial support from the government would be exempt from taxes.
• The legislation also would likely increase sales for pharmaceutical companies because prescription drug use among Medicare beneficiaries would likely increase.
• The proposal also includes $12 billion in subsidies to private health plans to encourage them to participate in Medicare.
• The proposal also would allow U.S. residents to purchase prescription medications from Canada, but only if HHS certifies the safety of the practice. The tentative agreement also would authorize a study of safety issues surrounding re-importation. In addition, the plan would ease market entry of generic drugs by preventing brand-name drug makers from obtaining more than a 30-month delay in competition from generic drug makers.
• The proposal includes an "unprecedented increase" in payments of at least $25 billion to doctors and hospitals in rural areas.
• The proposal also would eliminate planned reductions in payments to physicians nationwide and instead would increase payments.
• With billions going to private health plans, the Congressional Budget Office will determine whether the package will stay within the $400 billion over 10 years that was budgeted by Congress. If its cost is higher than what has been allotted, conferees and Republican leaders will have to make cuts.

How to Advocate:

As an individual ...

Many important reforms in public policy and laws at all levels begin with local citizens willing to devote themselves to a cause. Success comes with a step-by-step realistic plan to heighten public awareness, network with like-minded citizens and coalitions, develop a clear message and workable solutions, and persuade your legislators that your goal is worthwhile.

Here are some suggestions:

• Letters to the editor: Keep your letter to the point and within the paper's word limit. Include your name, address, and phone number. Email your letter if the paper accepts that form.
• Writing op-eds: Most papers devote editorial page space for longer commentaries, or "op-eds," by local citizens with knowledge of an issue. Ask your local editor if he would publish an op-ed you've authored.
• TV and radio editorials: Some stations give free airtime to issues of public interest. Your local TV or radio public affairs director can tell you how to get an editorial on the air.
• TV talk shows: If your local stations, especially public-access TV channels, broadcast them, ask the producer about being a guest, particularly if your issue affects local residents.
• Community calendars: Most papers and TV and radio stations run calendars of upcoming community events. Talk to the individual in charge and find out how to include your events.
• Phone tree: To send short messages quickly, phone calls may win supporters for your issue. Call a few key people who, in turn, call others. Ask friends and neighbors to begin phone trees.
• Use Internet and Email: Explore relevant Web sites and chat rooms. Exchange email addresses with other activists and organizations.
• Find dedicated individuals: identify potential supporters and determine which groups and communities are likely to back your cause. Find leaders and VIPs to help lend credibility and attract publicity. Keep a list of names and telephone numbers of important people. Places to look for volunteers include:
  • Your congregation
  • Public or consumer interest groups
  • Former and current public officials and their staff
  • Up-and-coming politicians
  • Prominent activists and community leaders
  • Political parties and civic groups
• Educate the public: Compliment your media campaign by distributing literature whenever and wherever possible: at hearings, public meetings, club meetings, and anywhere potential supporters might congregate.
• Target your resources: Spend time and resources only where there are individuals likely to join your cause. Focus your resources for the greatest impact and the lowest cost.
• Conduct a rally: As support for your effort grows, plan an event to show lawmakers and the press the public's concern for your issue. Send notices to the media at least two weeks in advance. Follow up with phone calls a few days before the meeting. Notify the public through flyers and advertisements your local radio, TV and paper. Convince community leaders to commit to bringing people with them. Put the name of your group or effort on a banner or a placard so the media can pick it up in photos. Have fact sheets for the press and public.
• Recruit volunteers: Volunteers are the backbone of activism. Make public announcements and circulate sign-up sheets at meetings to recruit new volunteers. Make sure there is enough work to keep volunteers busy or they may become frustrated and lose interest. For each volunteer position, list the duties, responsibilities, and qualifications.
• Working with coalitions: There is strength in numbers. Uniting with a coalition of organizations, groups or individuals with a common interest is a powerful way to advocate for an issue. Clearly define the issue or purpose for which you are coming together. Keep coalition members informed and involved through open communications. Let coalition members know quickly about any developments so they can help update others with similar interests.

Use Media for Public Awareness
The press plays a vital role in setting public policy at every level. News coverage is one of the most effective ways of reaching large numbers of people, focusing public attention, and spurring action.

The media and their sources share mutually beneficial relationships. Watch for press opportunities to highlight your issue. Be an asset to the media by knowing the facts about an issue and being ready when they need you. Here are basic guidelines for a good working relationship with the press.

Work with the Press ...

DO ... Keep appointments with reporters and be on time. They cope daily with hectic schedule and deadlines.

DO ... Know the facts by researching your subject. Keep up with current events so you can tell the reporter how your story relates to others.

DO ... Know the key members of your local media: feature reporters, city editors, photographers, TV anchors and correspondents, radio news directors. Stop by the news offices and introduce yourself. Leave a fact sheet and try to arrange a meeting with the editorial board.

DO ... Know news deadlines. Morning paper reporters are easiest reached after 10 a.m. or early afternoons. TV assignment editors and afternoon paper editors should be contacted in the early morning.

DO ... Invite the media to your events. Use a news release to announce your event and make sure the media has it in ample time beforehand.

DO ... Recruit local dignitaries to draw coverage. An issue alone may not seem newsworthy, but an involved local personality often is. Involve these VIPs whenever possible.

DO ... Create and keep an up-to-date media list with telephone numbers, email addresses and fax numbers for your press contacts.

DO ... Always tell the truth. Offer to follow-up later after you review the facts when you can't answer a question. Your credibility is critical.

DON'T ... Contact the media unless it's newsworthy. When you do contact them, they'll know you have something important to say.

DON'T ... Call a reporter when you are angry. Never be abusive or threatening.

Communicate with your elected officials!
Each year members of Congress struggle constantly to stay abreast of the hundreds of proposed laws on which they must vote. How a bill will affect people, the "constituents," in a legislator's district or state often is the key consideration by the lawmaker.

That's where you, your Sunday school class, or your congregation come in. Elected officials are impressed when constituents take the time to express their views on an issue. You can write a letter, make a personal visit to their office, telephone, send a telegram or email, attend a public event at which they will be present, and provide testimony at these meetings.

But be sure to know the basic facts of the issue. Legislators appreciate the information you can share with them. If it's accurate, they may come to rely on you as an important source of local concerns. So study the facts and get the views from others in the community.

Be sure you know your opponents' viewpoints as well. Be prepared to rebut arguments that the opposition will use.

By letting officials know your concerns, you help them stay in touch with local opinion. You help yourself by promoting your point of view and help your community by speaking out on its behalf.

Writing to an Elected Official
Letters can be the most valuable and economical methods of grassroots advocacy. Thoughtful and numerous personal letters from constituents can influence his or her vote. Here are some basic letter-writing tips.

• Address it properly.
  • For Congress, write to:
    The Honorable ...
    United States Senate
    Washington, D.C. 20510
    U.S. House of Representatives
    Washington, D.C. 20515
  • For the State Assembly or Legislature write to:
    The Honorable:
    State Senator or Representative
    Capital City, State, Zip
• Identify yourself. If you are writing on behalf of an organization, mention its name, number of members and your title. Make sure your full name, address, and phone number are clearly written on the letter. Use your own words. Tell your own personal story. How are you, your family, neighbors and community affected by the issue?
• Be specific and keep it short. When possible, refer to a bill by its number and name. If you do not know the bill number, briefly describe the issue that concerns you.
• Don't threaten or insult. It's a sure way to lose the lawmaker's support. Don't play partisan politics. Don't remind a lawmaker that you are of his political persuasion or that you contributed to his campaign.
• Ask for a response. Urge the lawmaker to support or oppose a bill, become a co-sponsor, or whatever else is needed. Request a reply to your letter.
• Follow-up. If you are not satisfied with the legislator's reply, write again and include new facts or information. A follow-up letter shows you are serious about the issue.
• Write a thank-you note. If the legislator takes favorable action on your behalf or provides you with information you requested, show your appreciation.
• Don't give up. If a lawmaker doesn't agree with you on one issue, you still may need his or her support later on another issue.
• Don't write if you have nothing to say. Letters or news clippings with notes scrawled in the margins will be ignored if they are received too frequently.
• Faxing, emailing or telegramming. These are quick ways to give an elected official a message just before a critical vote.

Calling an Elected Official

• A telephone call can be a very effective method of influencing lawmakers, particularly if placed shortly before an important vote. You likely will be connected with a staff aide, but they will take down your concern for the legislator.
• Write a brief script for yourself. Note key points and phrases before you call. Keep your comments brief and focused. Be polite.
• State your name and why you are calling. Specify what you want. Do you want the lawmaker to vote for or against a specific bill or amendment? Specify the name or number of the bill or amendment if you have it.
• Urge friends to call also. Ask each of them to contact five more friends and have them call, too. A solid number of calls from home can influence a legislator's vote.
• Note the date and time. Be sure also to save the name and title of the person to whom you spoke. You can use this information in future calls or letters.
• Call back later. Follow up and thank the lawmaker for considering your suggestion and mail written thank you notes as appropriate.

If you don’t have an opinion on this issue, you are not paying attention!