2 min read

With icy cold, bone-thin fingers, the federal government is reaching its hand into Maine’s wallet.

This time, the feds are coming after $9.2 million in Medicaid funding to pay for the poorly designed drug benefit that will become Medicare Part D.

As part of the Medicare Reform Act that created the prescription drug plan for seniors, lawmakers wrote the law so low-income people who are eligible for both Medicare and Medicaid, called MaineCare here, would receive their drug benefits through Part D. Because states would be relieved of their obligations to buy drugs for these low-income seniors, they are expected to kick some money into the pot to pay for the benefit. For Maine, the amount is estimated at $9.2 million.

The Medicare prescription drug plan is plagued with problems, not the least of which is its ever-increasing cost. When the plan was adopted by Congress, the president demanded a spending cap of $400 billion over 10 years. The number was always bogus, a marketing tactic. Recent estimates say the plan will cost between $720 billion and $1.2 trillion from 2006 to 2015.

The law prohibits the government from negotiating with drug makers for a better price, which will deliver unto the pharmaceutical industry a taxpayer-financed windfall for the next 10 years.

Medicare Part D is a complicated mix of private insurance plans and government programs that’s difficult to navigate. Enrollees must sign up for one of more than a dozen specific plans, each different in the prescription drugs in covers. Additionally, the benefit has a coverage gap that will cost people with a moderate need for prescription drugs – not the poorest or the sickest, but people in the middle – significantly. Between $2,250 in drug spending and $5,100, there’s no drug coverage. After drug spending reaches $5,100, Medicare will cover 95 percent of costs.

Once seniors sign up for a plan, they’re locked in for a year regardless of whether their drug needs change. Providers are able to rewrite their plans at any time.

Maine is more effective at controlling the growing costs of prescription medicines than the federal government. Through the combined buying power of programs such as Drugs for the Elderly, Maine Rx Plus and MaineCare and other cost-shaving strategies, the state has been able to hold down the projected growth trend to about 10 percent. The federal government projects its costs to grow 35.5 percent.

By pulling about 52,000 people out of the state’s negotiating pool – those are people who are eligible for MaineCare and Medicare – the state’s buying power is reduced.

Through its cost-containment efforts, the state gets more drug coverage for the $9.2 million than the federal government can. Gov. Baldacci says he will petition the federal government for a waiver, which he expects will be rejected.

If the intent of the Medicare law is to provide as much help as possible with prescription drug costs, the waiver should be granted. If that’s not the intent, then that’s another reason to reconsider this badly flawed law.

Comments are no longer available on this story