Filling the Donut Hole

By Congressman Henry Cuellar

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Washington, September 26, 2006 | comments

After battling for months with inaccurate and confusing enrollment information surrounding the Medicare Prescription Drug program, the House Ways and Means Committee is now reporting that 522,856 seniors and disabled workers in Texas--  86% of newly enrolled Medicare Part D beneficiaries -- are now at risk of falling into the “donut-hole.” The “donut hole” is a flaw in the plan that causes a gap in coverage where beneficiaries continue to pay premiums without receiving financial coverage for medicines.  Out of pocket prescription drug costs ranging from $2,250 to $5,100 are not covered by the new plan. Therefore, Medicare coverage starts, stops, and then starts again. Nationwide, 88% of enrollees are at risk of falling into the gap. The report also concluded that only 7.1% of new enrollees  gained  full, uninterrupted coverage through the new law and that those beneficiaries paid a high price – premiums that were 228% higher – to get full coverage.

Due to the complexity and tight deadlines of the new prescription drug plans, most seniors were unaware of this gap in their coverage. Because of the overwhelming numbers of seniors whose plans include a “donut hole,” millions of them with fixed incomes, chronic illnesses, and disabilities, will be struggling to pay for the life-sustaining medications they need but can’t afford.

We cannot allow this dangerous “donut hole” to continue growing. We must put a stop to the unbearable burden of costly and confusing healthcare plans for all our seniors. Medicare should be a program that Americans benefit from, and I will continue to support measures that provide everyone with personalized healthcare plans, affordable options, and the right medicines to keep them healthy and active.

Some of us have offered an alternative plan to fix the new Prescription Drug program. In the Democratic Prescription for Change, House Democrats have proposed making the Medicare drug benefit simple, affordable, and reliable for senior citizens and people with disabilities.  Under the proposal, Medicare would be required to use its bargaining power to negotiate lower drug prices, and the savings would be used to fill the “donut hole.” After all, the longer we go without allowing Medicare to negotiate prices, the worse this situation will become. The Democratic plan would also waive the late enrollment penalty for millions of beneficiaries who are now locked out of coverage, and simplify the program by creating a Medicare-sponsored option.

The most important thing is that we provide our seniors with accessible, long-term healthcare support, and that we continue to fight for a better direction for all Medicare beneficiaries. I am fully committed to ensuring that Congress implements a plan that gives seniors the prescription drug coverage they need while remaining affordable.


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