MEDICARE...Dave & Sharyn Madison
I do not know the Madison’s personally, but painfully, their story hits home for many (TOO MANY) Americans:
"Medicare’s Sinkhole"
Senior citizens stuck in drug program's coverage gap
At first, health insurance with the new Medicare prescription drug plan seemed like a good deal to Dave and Sharyn Madison.
Then Dave Madison got cancer.
That was when the Madisons found out about the "hole" in their drug plan.
This month, their co-pay was $1,307 for the oral chemotherapy Dave Madison needs to fight his pancreatic cancer.
That seemed like a lot, until they learned that in July, they'll have to pay the entire cost of that drug: $2,587.
"We've hit that doughnut hole," Sharyn Madison said.
The "doughnut hole" is a designed coverage gap in the new Medicare program, which began in January.
Almost 7 million senior citizens with Medicare drug coverage are expected to fall into the doughnut hole this year, according to a Kaiser Family Foundation study.
The Medicare drug benefit's basic coverage, known as Part D, pays nothing until drug costs reach $250.
The plan then covers 75 percent of costs - until the annual bill reaches $2,250 - with the individual paying the remaining 25 percent.
"From $2,250 to $5,100, the plan pays zero," said Mike Fierberg, a regional spokesman for the Centers for Medicare and Medicaid Services.
"The beneficiary pays 100 percent," Fierberg said. "That's what's called the doughnut hole."
The expenditures are calculated annually, so anyone who needs a lot of drugs faces the gap year after year.
Some plans also cover fewer drugs or pay less for particular drugs.
Dave Madison, 66, will be one of those people. Doctors have told him he'll have to stay on his grueling chemotherapy regimen - an intravenous treatment once a week for three weeks, then one week off, plus the oral drug Tarceva - for the rest of his life.
Congress intentionally created the coverage gap, said Vicki Gottlich, a senior policy attorney with the Center for Medicare Advocacy.
"Congress wanted to fund catastrophic needs and make sure everybody got something," Gottlich said.
"The only way they could do that for the amount of money they intended to allocate was to create the doughnut hole," she said.
Even with the coverage gap, the 10-year price tag for Medicare drug coverage is currently estimated to be $724 billion, far more than the $395 billion originally projected, according to federal figures.
Congressional reasoning isn't much solace to the Madisons, whose fixed income, including Dave's pension from 40 years as a bricklayer, amounts to about $34,000 a year.
"There's something wrong with the way they wrote Medicare Part D because people who earn as little as we live on and have worked hard all our lives, it drops us out of the picture," Sharyn Madison said.
Before Medicare Part D, many drug companies offered special assistance for people who couldn't afford lifesaving medication.
But there is confusion over whether such assistance is legal under Part D, leading many companies to cut back or cut off that assistance to seniors.
Medicare's Fierberg said drug companies can still legally provide drugs.
But Debra Charlesworth, a spokeswoman for the pharmaceutical company Genentech, said many drug companies are awaiting official clarification on what assistance they can and can't provide.
Genentech makes Tarceva, the drug Dave Madison needs.
Since January, pharmaceutical assistance has dried up, according to Thomas Stephansky, a social worker with Rocky Mountain Cancer Center's Aurora clinic.
"With Medicare Part D, we're told patients can no longer get assistance through the manufacturer directly," he said.
In Colorado, 436,900 seniors, about 83 percent of those eligible, have signed up, Fierberg said.
They've enrolled in one of 43 private-insurance plans offered in the state.
The monthly premiums vary from no charge for some HMOs to about $73.
It is possible to buy coverage that includes a much smaller doughnut hole, Fierberg said.
"A number of plans in Colorado do offer coverage in the doughnut hole, particularly for generic drugs," he said, adding that those plans cost more.
Nationwide, the Center for Medicare Advocacy is starting to hear stories of people with expensive drug regimens - especially cancer patients, and people with HIV/AIDS or multiple chronic conditions - who are struggling, Gottlich said.
Advocates and health-care providers are seeing those people in Colorado as well.
"I've had patients who have gone into debt, who are getting second mortgages, putting expenses on credit cards, even filing for bankruptcy," Stephansky said.
Sharyn Madison fears that sort of financial catastrophe. "We've always had really, really good credit," she said. "Now it's becoming questionable because we're struggling to pay our bills every month. We used to be able go to the movies or out to dinner. Now we just put all the money into medicine and hope it saves his life."
There are already 10 bills in Congress that would reduce or eliminate the doughnut hole, including one co-sponsored by Colorado Sen. Ken Salazar.
Gottlich said there is little hope that any of the measures will become law. "I think Congress is reluctant to open up anything about Part D," she said.
Andrew Nannis, Salazar's spokesman, said making a change in an election year "would be tough."
"However, as more and more people either butt up against the doughnut hole or realize the benefit isn't ... giving them more coverage than they had with private insurers, it's going to be hard for members of Congress to ignore," Nannis said.
Meantime, Sharyn and Dave Madison are scraping together money for his July chemotherapy and have applied for aid through the drug company.
"We have some of it, but we're starting to panic," Sharyn Madison said.
She said they will probably have to sell Dave's truck to get the entire amount.
After July, they will be through the doughnut hole - at least for this year.
"Then on January 1st, we have to start it all over again," Sharyn Madison said.
Yep, the V.I. has done it again by telling folks to bend over and take it up the tail. Nope, you don’t get a reach-around, grease or even a kiss, just bend over and take it.
Medicare will not be fixed until one thing happens and the solution is simple. Make ALL politicians eligible for Medicare and Social Security. Take away their lifetime benefits and make them vulnerable and poverty-stricken just like the people and then and only then will the problems of Medicare and Social Security go away.
The average annual salary for most politicians is over $150.000.
I don’t know why anyone would stand by those who refuse to show any interest in the people, but easily squander away money. Politicians should only receive raises when the minimum wage is adjusted. Why pay politicians over $150,000 a year when all they do is lie about where the money is spent - all while the people suffer on minimum wage. Most politicians claim they are looking out for the people so one can assume they are risking their lives while doing the work for the people; as if they are performing a job that they love. They are public servants and should behave in such a manner. In short, cut their pay and give some of that surplus back to the people who blindly stand by them.
When our politicians get the same treatment as the people, only then will they realize the sinister acts of government.
Only after working 40 plus years and coming down with illnesses such as cancer and other debilitating -and possibly deadly diseases, will our politicians change their minds about fixing the problem.
Sadly, the people have worked hard all of their lives not seeking a handout but merely expecting to provide for their families, but in the end, get trampled by this polluted government. Consider Mr. Roy E. Johnson who has served in Vietnam only now to be a steady worker on downtown Denver streets as a beggar. How does our government repay him for his tour of duty? Yep, come up with a new article that says panhandling should be outlawed. Furthermore, they want to fine those who give to the panhandlers. Yikes, they are at it again!
It is not surprising, but what is most baffling is the menials who continue to endorse them; contributing to the pain on the people. Is it any wonder that people commit suicide? Okay, that to me is very drastic, but is it any wonder that crime is on the rise? Yes there are more people, but the government should have done something better to control that problem. Humph! You see a huge increase in fraudulent activity while at the same time, more homes in foreclosure. Yes, our money, MY money could be spent more wisely. Luckily our government has made the choice to spend YOUR money on wood investigations all that is costing the people only a small amount of $6 million dollars per year.
No big deal.
I read a study that claims if you were conceived at a young age, then there is a possibility that you’ll live longer. I suppose that study could coincide with the same report that claims people are living longer today then they did 10 years ago. Okay, that’s cool, but my question remains why? Why is it that the Fuzzy Math guy thinks this is so great under this administration? Is it because they have more people to take advantage of? Is it because those so-called lucky folk who live so long that they can now endure more pain? How lucky can one be? Yes Mr. V.I. I can certainly see why that is something to cheer about.
How is that there are so many homeless people are living in a park only yards away from the State Capital?
I pray that the following will do more then just waste the people’s money, but make a stand and do right by and for the people:
Mr. Bill Owens, Ms. Diana DeGette, Mr. Wayne Allard, Mr. Ken Salazar, Mr. Mark Udall, Mr. John Salazar, Ms. Marilyn Musgrave, Mr. Joel Hefley, Mr. Thomas Tancredo, Mr. Bob Beauprez, Mr. John Hickenlooper, Colorado’s Health Care Task Force, the lobbyists, council representatives; ALL elected officials.
And for all the Madisons, I want you to know that you’re not alone, but that there are people out there who care and are praying for you and yours.
©Keeba Smith
Hankered Writer and Feared Compressor
K Smith is an author, columnist and social issues commentator KSmith023@yahoo.com