By Webb Hubbell
Could the Obama administration‘s health-care policies mean political disaster for Democrats in 2014? Many people think so. But if they are thinking of the Affordable Care Act as the root of the disaster, it may actually come from another source. This administration seems willing to do anything to make Obamacare palatable, but it has gone to tinkering with Medicare, the tried-and-true social insurance program that so many older Americans rely on – which so many future older Americans will rely on, too.
You have to wonder why the administration would hand the Republicans such a gift.
The Department of Health and Human Services, or HHS, proposes to allow insurance companies to limit Medicare coverage for certain classes of drugs, including anti-rejection medications for transplant patients and medications to treat depression and schizophrenia in the elderly. The proposal isn’t based on a needs analysis but on an actuarial cost study that has drug companies, patient advocates and both Democrats and Republicans in Congress all up in arms. And when Republicans and Democrats agree on anything, we all stand up and take notice.
Full disclosure: I have a dog in this hunt. Not only am I covered by Medicare, I am a thankful transplant survivor – I will take anti-rejection medication every day for the rest of my life. So my antennae naturally went up when an article appeared in the New York Times with the headline “Plan to Limit Some Drugs in Medicare Is Criticized.” After reading the article and doing my research, I came to the conclusion that HHS “has now gone to meddling.”
Like anything Medicare related, what HHS proposes is complicated. At more than 150 pages, it’s almost impossible for a layman to comprehend. In essence, it lifts the requirement that Medicare insurers cover “all or substantially all” drugs in a certain treatment areas. When Medicare Part D first went into effect, there were six protected classes of treatment. The treatment protocols apply to patients who must often try several drugs before finding one that works and need maximum flexibility in their options. The administration’s proposal is to remove protective status from three of these classes of drugs: immunosuppressants used by transplant patients, anti-depressants and anti-psychotic medicines. The three other classes – covering cancer, HIV and anti-seizure drugs – would retain protected status, and insurance companies would still be required to cover nearly all the drugs in those classes.
Those opposed to this proposal are rightfully asking why an administration that has called Medicare Part D a “phenomenal success” is making changes to a program that isn’t broken. Concerned patients as well as advocates fear that denying a full range of therapies to people will have a devastating effect on their health.
Why put people at risk? The administration’s response has to do with cost and reducing drug overuse. They cite a 2008 actuarial study by the firm Milliman stating that the six protected classes accounted for 17 to 33 percent of drug spending under Part D. (It’s also the rare government program that gets high marks from consumers and costs taxpayers billions less than expected.) Apparently money trumps well-informed, accepted and successful medical care even if it undermines “a key protection for some of the sickest, most vulnerable Medicare beneficiaries.”
The administration’s other rationale is reduction of overuse. When it comes to anti-rejection drugs, for example, it’s hard to see the logic. Such medications limit one’s immune system; the higher the dosage, the more likely one’s system can combat other diseases. Trust me, no transplant patient wants to take more anti-rejection medication than absolutely necessary. And we already have a wide variety of safeguards, including criminal penalties, to protect against the over-prescribing or abuse of anti-psychotic drugs. To deny coverage for drugs like Wellbutrin and Prozac to treat depression in the elderly, merely to prevent a potential for abuse, makes no medical or practical sense at all.
Here’s what also troubles me: The administration’s proposal isn’t supported by any research suggesting that it isn’t medically necessary to require mandatory insurance coverage for these three protected classes. The only people who seem to be for this rule are the administration – and the insurance companies who stand to save money. To deny medical coverage for purely economic reasons invokes the fear many citizens have of government-sponsored health care.
After reading the administration’s reaction to criticism from patient advocates, pharmacists and physicians, not to mention both Republicans and Democrats, I fear those behind this proposal are digging in their heels. So what if transplants become a thing of the past when no one can afford the drugs to keep them alive? So what if your widowed mother spends her final days mired in severe depression?
Here’s another reason to dump this proposal: It could cost the Democrats control of the Senate and even more losses in the House. Republicans are already telling older and disabled Americans that the administration is “raiding Medicare to pay for Obamacare.” What will happen when Republican strategists figure out that the popular Medicare Part D is being altered to take life-saving medications from the disabled and elderly – just to save insurance companies money? I bet you can hear the train wreck.
I don’t mean to accuse the president’s advisers of sinister motives; surely they’re not that callous. I believe the administration is sincerely trying to improve a good program, but sometimes good intentions produce poor results. Transplant patients are legitimately concerned that this proposal means no anti-rejection drugs will be covered under Medicare, that we will be faced with paying big bucks for life-saving medicine. The elderly and their families are equally worried that anti-depression medication will no longer be covered as well. When Medicare no longer requires coverage of “all or substantially all” drugs in a category, how long does it take before its “no drugs in any category”?
The Obama administration is doing all it can to make universal health coverage via Obamacare a working reality. But this proposal is not a good idea, not good politics, not good messaging, and not good for Americans.
Webb Hubbell is the former associate attorney general of the United States. He is an author and lecturer. He writes regularly for the Clyde Fitch Report. His new novel, “When Men Betray,” can be pre-ordered here. He also writes a daily meditation at The Hubbell Pew.