Part D Cruelty

Why penalize seniors who missed deadline Monday?

Social services workers in Horry and Georgetown counties and Brunswick County, N.C., worked hard the past few weeks to locate seniors not yet enrolled in the Medicare Part D prescription drug program and sign them up for low-cost medications. But some local seniors most likely missed Monday's sign-up deadline because they live beyond the easy reach of social service agencies or aren't connected to senior networks. If those people do eventually enroll in a Part D plan, they will incur the nasty penalty that Congress built into the program - a penalty that could plague them the rest of their lives.

The people we worry about most are so-called "dual eligible" seniors - the poorest of the elderly poor in our communities. They not only qualify for Medicare by virtue of being 65 or older but also have such low incomes that they qualify for Medicaid - the federal-state health care program for S.C. residents who fall below the federal poverty line.

Dual-eligible seniors formerly got their prescriptions, at low cost and with relative ease, through Medicaid. That arrangement ended with the onset this year of Part D. Medicare automatically enrolled them in arbitrarily chosen plans that not only increased prescription costs but didn't always cover the medications they are - or were - taking.

This process was imperfect and many seniors reportedly didn't get switched over. Unlike better-off seniors, for whom enrollment in a Part D plan could be accomplished online or toll-free in a single step, nonenrolled dual-eligible seniors had to take several bureaucratic steps to get signed up for an appropriate Part D plan.

It seems a safe bet, therefore, that many of the seniors who didn't enroll in a Part D plan are dual-eligible. Under Medicare law, they and other seniors who didn't enroll by Monday will incur penalties of 1 percent per month against the average monthly Part D premium for 2007 - a penalty that will never lapse. For the folks who didn't enroll, that amounts to a permanent 7.5 percent surcharge on future prescription drug costs.

It is bad enough that the Part D program allows insurance companies such broad latitude in designing plans that no senior can enroll in complete confidence that he or she has picked the ideal one. It's bad, as well, that the Republican Congress that put forth the plan was more interested in protecting pharmaceutical companies' profits than in using the power of the government to leverage low prices for seniors.

But those are public policy decisions that stem from the pro-business Republican outlook. The penalty provision, in contrast, seems aimed at punishing seniors who, by virtue of educational deficit or lack of help from adult children or social service workers, couldn't navigate the bewildering Part D rules that apply to dual-eligible seniors and missed Monday's deadline. This is downright cruel.

If members of Congress do nothing else to fix the program's flaws, they should eliminate the penalty provision. The public policy goal should be to get every eligible person possible into a Part D plan - at the lowest possible cost.