In the back-room bargaining over Congress' $500 billion omnibus spending bill, one large group of average citizens--the more than 200,000 senior and disabled citizens enrolled in Medicare HMOs in the state of Massachusetts--got the short end of the stick.
While Massachusetts law mandates that HMOs give seniors and disabled people unlimited prescription drug coverage, a federal law passed last year contained a provision reportedly pushed by the managed care industry pre-empting the popular state law. According to reports in the Boston Globe, a last-minute attempt by Senator Edward Kennedy to write an exemption for Massachusetts into the omnibus bill "ran into stiff opposition from Republican majority leader Trent Lott." Leading HMOs in the state have already announced their intention to restrict prescription coverage to a maximum of $200 every three months, pending the resolution of a lawsuit filed by the state to block the federal law.
This skirmish represents just one more win for HMOs and the insurance companies, and one more loss for the average health care consumer. The insurers responded en masse to Senator Lott's call, in the fall of 1997, to "Get off your butts, get off your wallets" to fight congressional proposals to regulate the managed care industry. According to the Center for Responsive Politics, they have given just over $2.1 million in contributions to candidates and the parties in 1997-98, 72 percent of which went to the GOP. This is almost twice as much as they gave in 1993-94, the last mid-term election. Managed care interests also donated $13,500 directly to Senator Lott and another $19,500 to his leadership PAC.
Not only did the HMO lobby prevent passage of any version of a "Patients Bill of Rights," it appears to have succeeded in undermining prescription coverage for the elderly and disabled in Massachusetts and set a bad precedent for the rest of the country. Across America, HMOs are raising the premiums they charge the elderly and cutting back on coverage. For example, Kaiser Foundation Health Plan of the Mid-Atlantic States has just announced the doubling of health care premiums it charges individuals over the age of 60, and the elimination of unlimited prescription coverage.
Prescription drugs are a big part of many seniors' monthly budget. In fact, in New England, some senior citizens actually travel north, to Canada, to stock up on prescription drugs because the prices there are so much cheaper. Older Americans and other uninsured consumers pay more than double for the 10 best-selling prescription drugs than the drug companies' preferred customers-- such as large HMOs, hospital chains, and the federal government. While these large customers of the drug companies are able to buy drugs at discounted prices, the most vulnerable consumers, the uninsured and others without insurance coverage for prescriptions, pay full price and effectively subsidize the more well-heeled consumers.
