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Medicare Alert -- URGENT ACTION NEEDED

Medicare Bill in Conference Could Weaken Medicare and Medicaid and Hurt Seniors and People with Disabilities and Chronic Illnesses

It appears that Members of the House-Senate Conference Committee negotiating a Medicare reform bill may agree to changes that will weaken Medicare by capping the program in the future, and making it unaffordable for Medicare beneficiaries to stay in the traditional Medicare program. Even worse, this
legislation, if enacted, could weaken existing drug coverage for Medicare beneficiaries that currently receive Medicaid-these are among the sickest and most disabled Medicare beneficiaries who have the lowest incomes and the most extensive health care needs. Conferees reportedly plan to prohibit Medicaid programs from supplementing the Medicare drug coverage-even though this new Medicare benefit through its formulary restrictions and cost-sharing structure could leave many drugs uncovered and others
unaffordable.

It is anticipated that the Conference Committee will agree to a conference report (i.e. final bill) as soon as November 11th with a final vote by both the Senate and the House before November 21st.

Help make sure that Congress seizes the moment to enact positive reforms to Medicare by creating a new prescription drug benefit-but that it does not weaken Medicare or Medicaid in the process.

The HIV Medicaid and Medicare Working Group, working in partnership with a range of disability and seniors organizations, is asking you to do two things immediately:

1. Circulate this sign-on letter widely to coalitions and organizations that you work with. We are seeking sign-ons from national, state, and local organizations. (We are not seeking sign-ons from individuals. Individuals are encouraged to contact their own Members of Congress directly.)
2. Sign-on to the attached letter by e-mailing Christine Lubinski of the HIV Medicine Association at hivma@idsociety.org. Please provide the organization's name and city and state (as it should appear on the letter), along with a contact person with phone number and e-mail address. Please
   also indicate if this is a national organization. Alternatively, you can complete the form below and fax it in.

Note: This letter may be edited if a Conference Agreement is reached before this letter is sent. The substantive content and message of the letter will remain unchanged.

Please respond as soon as possible, but not later than COB, Monday, November
17, 2003.

*********************************************
FAX FORM:

Organization Name: ___________________________________________________

City and State (Main office if you have multiple locations):
________________________

Is this a national organization? (circle one) YES / NO

Contact Person and Phone and E-mail Address:
________________________________

Fax to 703-299-0473 Deadline: COB, Monday, November 17, 2003


Dear Senator/Representative:

As local, state, and national organizations representing seniors and people with disabilities and chronic illnesses, we have watched the House-Senate Medicare Conference with both hope and trepidation. Our vulnerable constituents rely extensively on Medicare and Medicaid for life-saving and life-sustaining health care coverage. We believe that the current moment represents an historic opportunity to improve the lives of millions of Americans by providing an outpatient prescription drug benefit to Medicare beneficiaries. At the same time, we have grown increasingly worried that the potential to enact positive changes to Medicare with broad bipartisan support is being held hostage by a small group in Congress with a radical
agenda to undermine Medicare and Medicaid and the concept of public financing for health care insurance and health care services.

Conference negotiations always involve give and take on a range of important policy issues. Surely, the more important the legislation is to ordinary citizens, the higher the stakes become. While our members and constituents need and want Medicare to provide prescription drug coverage, the price for this positive reform cannot be changes to Medicare that weaken the program-or that constrict the role of state Medicaid programs in providing supplemental coverage to fill in for gaps in Medicare coverage, gaps which certainly exist for the nascent drug benefit.

If any of the provisions described below are included in the Medicare conference report, we will oppose this legislation and urge you to work strenuously to ensure that this legislation is not enacted into law:

Proposals to implement "cost containment" that could effectively lead to a capped Medicare benefit. The nation's commitment to providing quality and appropriate health care coverage to seniors and workers who become disabled must not be compromised by setting arbitrary limits on how much general revenue funding can finance the Medicare program. Further, as proposed, cost-containment measures would be structured to permit new Medicare improvements only if financed through offsetting cuts to the Medicare
program without giving policy makers broader and more equitable tools to address future financing challenges.

Provisions subjecting the Medicare program to competitive bidding with private health plans that will weaken traditional Medicare in order to "privatize" the program. These provisions are being considered despite the record of Medicare+Choice that includes shrinking benefits and health plan withdrawals from communities.

Changes to Medicaid that would restrict or prohibit states from providing wrap-around Medicaid prescription drug coverage to individuals who are dually eligible for both Medicare and Medicaid. Since the Medicare drug benefit is likely inadequate for many dual eligibles (who are often severely disabled and have extensive health care needs), any efforts to prevent Medicaid from providing supplemental drug coverage (as it does for other services), could lead to millions of current dual enrollees being made worse
off.

A prohibition on state Medicaid programs from subsidizing Medicare cost-sharing for prescription drugs for dual eligibles. Changes to Medicaid that would restrict states from taking advantage of existing regulations to use less restrictive methodologies when calculating income and assets for Medicaid coverage (as well as low-income subsidies for low-income Medicare beneficiaries).

The imposition of cost-sharing for low-income individuals that is higher than current Medicaid standards. Under Medicaid, cost-sharing must be nominal and certain populations are exempt including nursing home residents.

The establishment of a Medicare prescription drug benefit is an important national priority, and we understand that many Members of Congress would be loath to work against such legislation. As health care providers and representatives of the beneficiaries of such a benefit, however, we must urge you to be mindful that the price of a drug benefit must not be the further weakening of the health care system. We urge you to use whatever means are at your disposal to ensure that the aforementioned issues are not
enacted into law.

Sincerely,