Pressure Mounts to Extend Deadline for Drug Benefit

Although the sign-up period for the new Medicare prescription drug benefit is barely two weeks old, pressure is mounting in Congress to extend it so that senior citizens can have more time to understand a program many find dauntingly complex.

The registration period is scheduled to end May 15. But lawmakers who have been in their home districts during the Thanksgiving holiday have reported being besieged by elderly constituents.

Despite being attracted to the plan’s promise of saving them money, many seniors are struggling to sort through the options -- and through sometimes incomplete or inaccurate information on costs and benefits.

“My guess is when [Congress] comes back from Thanksgiving recess, they’ll be jumping up and down to do something, because they’re hearing from a lot of people who are getting heartburn trying to figure this out,” Rep. Pete Stark (D-Fremont) said Thursday. He wants to extend the deadline through the end of 2006.

The Republican Party leadership has opposed an extension.

Supporters of the drug benefit -- a signature domestic policy accomplishment of the Bush administration -- are trying to discern whether the program will right itself after a rough launch or whether the trouble is more serious.

Under current law, seniors who enroll after the deadline face a monetary penalty in the form of higher monthly premiums for as long as they remain in the program.

That’s partly why the idea of granting more time is gaining ground, said a spokesman for Rep. Michael G. Fitzpatrick (R-Pa.), who has proposed a bill seeking a six-month extension. Like Stark’s legislation, Fitzpatrick’s would delay the penalty.

“It reflects what we are hearing from our constituents,” said the spokesman, Jeff Urbanchuk. “We have met with more than 3,000 senior citizens in 12 town-hall meetings. And you compound that with polls that say people around the country are confused.”

Fitzpatrick represents suburban Bucks County north of Philadelphia.

In a test vote last month, a majority in the Senate supported extending the deadline and postponing the penalty. But the 51-47 vote, on an amendment by Sen. Bill Nelson (D-Fla.), fell short of a 60-vote requirement for adding provisions to tax bills.

“I think that vote is reflective of bipartisan support,” said Nelson spokesman Dan McLaughlin, who noted that seven Republicans broke ranks with the party leadership to support the measure. “We intend to push it again in January.”

The White House has said that it strongly opposes an extension. But organizations working to sign up seniors say President Bush may have to reconsider if potential beneficiaries remain on the sidelines in large numbers.

“We all know there is initial confusion,” said John Rother, policy director for the seniors lobby AARP, which provided key political support to pass the benefit and is co-sponsoring one of the national drug plans. “What we don’t know is whether people will work their way through it.”

Granting more time “is not something you would do lightly,” Rother said. “It is something that you could do when and if it becomes clear there is a real need. It is a judgment that cannot be made until the spring.”

The government has projected that 29 million of Medicare’s 43 million beneficiaries will take the outpatient prescription coverage, which will be offered effective Jan. 1 through an array of private plans. Initial enrollment statistics, expected this month, could show that 10 million or more have signed up.

Such numbers would seem robust, but they could disproportionately reflect poor, sick people who will be automatically enrolled in the program -- as well as members of health maintenance organizations for whom the benefit is widely acknowledged to be a good deal.

“You need to get 20 million to 25 million people into the program for it to be successful,” said President James P. Firman of the National Council on the Aging, which is involved in educating seniors about their options. “If there are only 10 million people enrolled by April, then that would make the case for a longer sign-up period. If it’s 20 million to 25 million, then I would feel differently.”

The larger numbers would spread insurers’ risk and help keep per-capita costs of the program in check.

Bush administration officials and their congressional allies are trying to head off any talk of an extension.

Part of their calculation is that reopening the program to legislative action could invite foes on the left and the right to seek more substantive changes. Some Democrats want to expand the benefit and authorize the government to directly negotiate drug prices. Some Republicans want to repeal the program, citing costs. Stark and Nelson, for example, both voted against the administration plan.

“Deadlines motivate people,” White House spokesman Trent Duffy said. “We believe that it is necessary for seniors to enroll in this drug benefit so they can begin to receive the benefit as soon as possible. For many of them, it’s a life-and-death matter.”

Senate Majority Leader Bill Frist (R-Tenn.) said it was premature to talk about granting more time. “We are only 15 days into the enrollment period, and we are months from the deadline,” said Frist spokeswoman Amy Call. “Let’s concentrate on enrolling seniors in the best plan rather than proposing to change the program before it even starts. We should know what the enrollment numbers are before we jump to conclusions.”

Stark said he was not interested in making wholesale changes to the plan. “I didn’t vote for the bill, but it’s law -- so let’s vote to make the thing work as well as it can,” he said.

Advocates for the elderly say the process of picking a plan has been made more complicated by the fact that some details on Medicare’s website about the cost and coverage of individual plans have turned out to be wrong.

“It’s not a reasonable task to be required to choose a plan based on incomplete or inaccurate information,” said Jeanne Finberg, a lawyer in Oakland for the National Senior Citizens Law Center.

Medicare Administrator Mark B. McClellan acknowledged Thursday that there had been some problems, but he said the errors were being caught and fixed.

“When we see a problem ... we respond quickly,” McClellan said in a teleconference. “What we are seeing is the number of cases where [errors are] occurring is going way down.”

Medicare has developed an Internet-based “Plan Finder” into which seniors enter their individual information and their prescription drugs and then get a list of plans ranked by cost, from lowest to highest.

“The drug cost estimates we provide are approximate,” McClellan said. “But you can get a general ... idea of what the costs are going to be.”

Seniors also must decide how they want to deal with the “doughnut hole,” a coverage gap built into the program to save the government money. The drug benefit applies fully until a person’s out-of pocket annual expenses exceed $2,250. Then the beneficiary must pay the full cost of their drugs until their expenses reach $5,100. After that, the drug benefit kicks in again. Some plans offer coverage in the gap, usually for a higher monthly premium.

Separately on Thursday, Medicare announced additional safeguards for Medicaid beneficiaries who will be switched into the Medicare drug plan starting Jan. 1.

Even if such beneficiaries are not clear on how the plan works for them, they will be able to get prescriptions filled temporarily at their drugstore, McClellan said.

A coalition of advocacy groups is suing the government to provide a stronger safety net for these beneficiaries during the transition.