For the last several weeks, the Medicare prescription drug debate has been the primary focus of the U.S. Senate and the U.S. House of Representatives. Pushed by the Administration to pass legislation to fund a prescription drug benefit for Medicare beneficiaries prior to the July 4th recess, both the House and Senate approved bills for such a benefit on June 27th. The Senate ve rsion, S.1, co-sponsored by Senators Frist (R-TN), Grassley (R-IA), and Baucus (D-MT), passed by a vote of 72-21, while the House version, HR 1, sponsored by Representatives Hastert (R-IL), Thomas (R-CA) and Tauzin (R-LA), passed by the razor-thin margin of 216 to 215. As House and Senate negotiators attempt to work out the differences between their respective bills, what role should Christians, Presbyterians in particular, play in the debate?

The Presbyterian Church (USA) has had a long history calling for health care to be accessible, affordable, and available for all. In “Life Abundant: Values, Choices and Health Care,” a policy statement adopted by the 200th General Assembly of the PC(USA) in 1988, the writers noted:

God’s intention of health – shalom – for the earth and its people, and Jesus’ promise of abundant life – health, healing, and restoration to wholeness in body, mind, and spirit - are central dimensions of the faith we profess and the vocation to which we are called as Christians.

General Assemblies have recognized the vital role played by Medicare, the federal health insurance plan that now covers 41 million older adults and persons with disabilities, as a means to strengthen wholeness and life abundant for individuals and community. The 203rd General Assembly of the PC(USA) passed a resolution on Christian Responsibility and a National Medical Plan. That General Assembly called on the Administration “to provide moral and political leadership so that an equitable, efficient, and universally accessible health plan … will be established.” Until such a plan is instituted, the General Assembly called on federal and state governments to protect uninsured persons from erosion of health care benefits or an increase in cost of health care benefits and to expand Medicare and Medicaid benefits, among other activities. In 1999, in a resolution on managed care, the 211th General Assembly called on the U.S. Congress and state legislatures to protect Medicare and Medicaid benefits and, as they promote the use of managed care in the Medicare and Medicaid programs, to require such plans to provide quality affordable health care for all people enrolled (including members of vulnerable populations).

In 2003, it is vital that Presbyterians continue to call for improvements in the health care system, including Medicare. In the United States alone, there are now an estimated 41 million uninsured Americans, or for 16% of non-elderly Americans (adults age 65 and older are granted health insurance through Medicare). Though older adults have access to health care through Medicare, that program does not cover prescription drug costs. The Kaiser Family Foundation noted that prescription drug costs are rising rapidly, with average annual out-of-pocket drug costs among the elderly increasing from $644 to $996 between 2000 and 2003.

In response to constituent pressure regarding the escalating cost of prescription drugs, the 108th Congress pledged to take action to fund a prescription drug benefit for Medicare beneficiaries. In the FY ’04 budget resolution, Congress set aside $400 billion (over 10 years) to fund such a benefit. Though there was not consensus that this amount was sufficient to fund a benefit, both the House and Senate used $400 billion as the basis for their respective bills. This limited that scope of the proposed benefit.

The House and Senate passed bills would both increase the participation of private plans in the program and would give beneficiaries an equal drug benefit regardless of whether they are enrolled in Medicare or a private plan. However, there are major differences regarding how the drug benefit would be structured.

Benefits:
The House bill helps those with lower and catastrophic costs more, while the Senate bill would stretch out benefits farther. In the Senate bill, seniors would pay monthly premiums of about $35 and an annual deductible of $275. Medicare would pay half of drug costs from $276 to $4,500. But the coverage would stop from $4,501 until $5,813 – or until a senior paid $3,700 in out-of-pocket costs. Medicare would then cover 90 percent of costs. In the House bill, beneficiaries would pay monthly premiums of about $35 and an annual deductible of $250. Medicare would pay 80 percent of drug costs from $251 to $2,000. Seniors would pay drug costs from $2,001 to $4,900 – or until a senior paid $3,500 out-of pocket. Medicare would then cover all further drug costs.

Government Option:
Under the Senate bill, if two private plans do not offer benefits in an area, then Medicare would offer a government-run option. No such provision is in the House bill, which only allows Medicare to offer insurers greater incentives to enter areas without private plans.

Competition:
The House bill contains a provision favored by conservatives. Starting in 2010, the traditional Medicare program would have to bid against private plans on price. The competition would be phased in over five years. The Senate bill would allow a far more limited type of competition. For five years starting in 2009, private plans in some areas could bid against each other on price but not against traditional Medicare. Before that time, plans could compete against each other but their payments would be limited by the rates for traditional Medicare.

Low-Income Subsidies:
The Senate bill has more generous low-income subsidies. The House bill would pay premiums for seniors with incomes below 135 percent of the federal poverty level, with subsidies offered on a sliding scale for seniors earning between 135 percent and 150 percent of poverty. Cost-sharing for drugs up to $5 for those groups would be allowed. The Senate bill would pay average premiums for seniors with incomes below 135 percent of poverty, with subsidies offered on a sliding scale for seniors earning between 135 percent and 160 percent of poverty.

Dual Eligibles:
“Dual eligibles,” individuals who are eligible for both Medicare and Medicaid, the federal health insurance program for low-income Americans, are currently eligible for prescription drugs through Medicaid. Under the Senate plan, they would continue to attain prescription drugs through Medicaid, and would not receive prescription drugs through Medicare. The House has no such provision. There are concerns that, by excluding lowest income individuals from this benefit, Medicare would no longer be a universal social insurance program.

Restoration of Benefits for Immigrants:
Senate version includes the state option to restore Medicaid benefits for certain legal immigrant children and pregnant women. An amendment to remove this provision failed by a vote of 33-65. The House has no such provision.

Medical Savings Accounts:
The House voted, 237-191, to include language creating two tax-preferred personal savings accounts for unreimbursed medical costs such as drugs. The Senate has no such provision.

With all of these complicated issues, how can Presbyterians use faith to help guide legislators to do the just thing for older adults? Here are some suggestions:

Pray. Thank God for health, wholeness, and abundant life. Thank God for all those who heal us – doctors, nurses, caregivers, family, and our congregations. Pray for those who seek wholeness, health, and justice. Pray for those in Congress as they continue deliberating on this and other important issues.

Listen. Ask others (and yourself) how a lack of a prescription drug benefit under Medicare has impacted them? How could these proposed changes to Medicare impact you and others in the future? How would people you love fare under the House and Senate plans? How would you change the benefit to strengthen the program?

Speak Truth to Power. Contact your Members of Congress and share your concerns about this legislation. Tell them that past PC(USA) General Assemblies have called on Congress to strengthen Medicare. Ask them to support a prescription drug benefit that is accessible, affordable, and available to all.

(Sources: CQ Weekly, National Committee to Preserve Social Security and Medicare, http://Thomas.loc.gov)

(Medicare is a federal health insurance program established in 1965 that covers 41 million people and serves all those eligible without regard to income or medical history. Medicare provides broad coverage of basic benefits, but does not cover outpatient prescription drugs or long-term care. (The legislation passed by both Congressional chambers would add a prescription drug benefit for Medicare beneficiaries.) Currently, Medicare covers more than 35 million people ages 65+ and 6 million younger adults with permanent disabilities. Most individuals ages 65 and over are entitled to Medicare if they or their spouse are eligible for Social Security payments. People under 65 who receive Social Security cash payments due to a disability generally become eligible for Medicare after a 2-year waiting period. People with end-stage renal disease are entitled to Medicare regardless of their age. Medicare benefit spending in 2003 is projected to be $269 billion in 2003, accounting for 13% of the federal budget.)