Medicare Fiasco Prompts Gov., Legislators to Team Up

By George Skelton

Jan. 19, 2006 12 AM PT

Sacramento — The Bush administration’s fumbled takeover of prescription drug coverage for the elderly poor and disabled has a klutzy resemblance to its botched relief effort for Hurricane Katrina victims.

This disaster has a much lower profile, of course.

TV crews have not been following old folks in wheelchairs out pharmacy doors after they’ve been denied the medicine they need to blunt debilitating pain, or even to stay alive. Networks haven’t been going live as desperate, frail seniors fight telephone “hotlines” for hours trying to get straight answers.

These victims don’t lend themselves to chopper coverage.

A brief refresher: President Bush lobbied Congress to pass a Medicare prescription drug benefit that took effect Jan. 1. It was supposed to have been a political winner for the president and Republican members of Congress. Instead, it has become an embarrassment.

The drug program was voluntary for most Medicare beneficiaries. But it was made mandatory for the elderly poor and disabled who are eligible for both Medicare and Medicaid (Medi-Cal in California).

To be eligible for Medicare, you’ve got to be 65 or disabled. To be on Medicaid, you have to be poor. Across America, there are roughly 6 million people who are “dual eligible” for both programs. In California, they number 1 million and had been getting their prescription drugs just fine, thank you, under Medi-Cal.

Then Bush and Congress switched everyone from the Medicaid -- or Medi-Cal -- drug program to the new, uncooked Medicare system. Chaos.

In California, an estimated 200,000 of the state’s most vulnerable citizens couldn’t get their medicines and fell through the cracks. Blame faulty computer programming. Byzantine complexity. Feds rushing it.

Society’s weakest -- the elderly poor, the physically and mentally disabled -- were dumped on the front lines to kick off this new federal program. As guinea pigs? Or just to pad the recipient roles to assure profits for middlemen insurers?

It certainly wasn’t to save the states money.

Washington is administering the program, but the states are being forced to help pay for it through what’s euphemistically called a “claw-back” provision. The rationale is that state Medicaid drug costs are being reduced because federal Medicare is taking over coverage for the elderly poor and disabled.

The “claw-back” will bite California for an extra $70 million annually, according to state Health and Human Services Secretary Kim Belshe.

“California will end up paying more than we did before -- for benefits that appear to be somewhat less,” Belshe says.

“A change of this size, complexity and magnitude was destined to be an incredible challenge,” she continues. “And, frankly, it was the federal government’s decision to go forward notwithstanding our concerns....

“Adding prescription drugs to Medicare was long overdue. It’s absolutely insane to contemplate a meaningful health benefit for anyone that doesn’t include prescription drugs. That said, the dual-eligible population already was receiving prescriptions from Medi-Cal.”

So for California’s aged poor and disabled, the Bush program was unwanted, unnecessary and an unmitigated disaster.

Actually, there’s now some mitigation.

Proving that government can too work, Gov. Arnold Schwarzenegger has stepped up -- along with governors in at least 20 other states -- to resume buying drugs for the aged poor and disabled on an emergency basis.

Assembly Majority Leader Dario Frommer of Glendale says he’ll introduce legislation to pull California completely out of the failing federal program. The claw-back “is outrageous,” he says, and California should refuse to pay it.

Similar legislation is moving in Texas, Frommer says.

It’s all a slap at the Bush administration. Democrats are doing most of the slapping, but neither Schwarzenegger nor any Republicans are trying to restrain them.

“This is not just a bureaucratic nightmare. It’s truly a national disgrace,” Assembly Speaker Fabian Nunez (D-Los Angeles) asserted at a news conference Tuesday with Schwarzenegger and other legislative leaders. “No question, the Bush administration has faltered and failed in its responsibility.”

But he praised Schwarzenegger for “his leadership.”

Senate Leader Don Perata (D-Oakland) said: “I hope the federal government can get it [fixed] in a timely manner so we don’t have to be subsidizing them indefinitely.”

Legislative leaders are pushing a $150-million appropriation bill to pay for the drugs until the feds fix their program. The measure is expected to zip through the Legislature in two days and land on the governor’s desk tonight. Two days?

It shows how fast the Legislature can move when lawmakers want. When Sacramento’s rear isn’t on the line, only Washington’s. When no special interests are fighting over the money pie. When Democrats get a free shot at the Republican president. And when the Republican governor, running for reelection, is trying to distance himself from the unpopular president.

Sure, there’s a political benefit in this for Sacramento’s pols. They get to pose as bipartisan and produce without pain.

But the poor folks living on the edge couldn’t care less about political moves. They just want their pills -- want to be rescued from Bush’s bumbling bureaucrats.

The governor and Legislature deserve credit for quick pain relief.

George Skelton writes Monday and Thursday. Reach him at [email protected].