Many concerned about health coverage

By Greg Little, Managing Editor, The Covington Leader Online
August 30, 2005

It didn’t take long for more than 100 people to begin sharing their concerns about prescription drugs and health care issues in general.

The people gathered last Thursday afternoon at Dyersburg State Community College in Covington at the invitation of Sen. Mark Norris, R-Collierville.

Norris called the meeting to try to provide information to residents who are losing TennCare as well as the upcoming changes in Medicare.

“I am trying to help bridge that gap,” said Norris.

TennCare, the state’s own medical assistance program, has been greatly reduced and Norris said many people who need assistance are now struggling to find ways to simply purchase prescriptions.

“TennCare has let so many people down in so many ways,” said Norris. “And Tipton County has been particularly hit hard.”

TennCare issues

“We’re about as in the dark as you are,” said Liz Alvey, administrative assistant to Norris.

Norris said Alvey has been working “tirelessly” on the TennCare issue.

“There are a lot of people in the state in this situation,” said Alvey. “I apologize to you for that.”

One issue Norris said he was “very disappointed” in was the fact the so-called “safety net” for TennCare enrollees who were dropped was not put in place by Gov. Phil Bredesen.

“They admitted that last week,” said Norris.

“A lot of things we were told would be done are not being done,” said Norris. “Right now we have got to find help for the victims of TennCare. And it’s going to get worse before it gets better.”

Alvey said she attempted to get some answers from the state the previous day, but found the going difficult.

“Yesterday, I could have bit through steel,” said Alvey.

Her big frustration was attempting to find out more information through the state’s Web site. She said there is no main link and you have to go through a financial department site to find out anything.

Alvey said she was calling on behalf of a transplant patient who had been taken off the TennCare roles and was trying to see if there were any alternatives available.

Alvey said she was told by the person who answered the phone the transplant patient was “just out of luck.”

Norris and Alvey both said the “safety net” alternatives for people appear to be at the county health departments or the emergency rooms at hospitals.

“There are not good choices,” said Alvey. “It’s my understanding the health departments around the state are overrun. It just keeps snowballing.”

Norris said he tried to make this a bigger issue in 2003. A story in The Tennessean quoted Norris as saying there was “too much money” being pumped into TennCare and something needed to be done.

“We needed to come up with a new program,” said Norris.

The senator also pointed out that TennCare is an administration program and the only control the Legislature has is in the budget process.

“We made proposals to the previous governor and to this governor,” said Norris. “And they fell on deaf ears. The ears are even deafer with this governor.”

Tom Reynolds of Brighton called on Norris to ask for a special session of the Legislature to deal with this issue.

“I know ethics is important, but people’s lives are more important,” said Reynolds.

One of the reasons Norris called the meeting was to help inform people of alternative prescription programs which are available.

Tim Byler of Novartis, a pharmaceutical company, said options are available for people not eligible for Medicare.

Presently, the state has a program called “Rx Outreach,” he said, but many of those at the meeting said they were frustrated with that program.

One woman said she discovered if you use mail-in prescriptions, the drugs are now free, but if you got to a pharmacy, there is a charge. The plan which was approved by the state required all drugs to be free until January of next year when charges would then apply.

“See, you know more than we do,” said Norris.

Byler urged people to talk to their doctors and “see if there are alternatives” which would benefit them.

Another woman said when TennCare was dropped, those who lost coverage were supposed to get three option plans which they could purchase but to date, she had only received the Rx Outreach plan.

Norris promised the audience he would continue to work on the issue and felt the Legislature would have to deal with the problems which have resulted from the TennCare changes.



Medicare changes

The first part of the meeting focused on changes in the national Medicare system which will take place in the near future.

Byler made a presentation to the people about the changes.

He said “Part D” of Medicare will begin in January of next year and now is the time for people to be considering the options.

Part D is the government’s prescription drug plan and can be utilized by anyone who now has Part A, Part B or Part C Medicare coverage.

Enrollment for the new plan is scheduled to begin on Nov. 15 and coverage will begin Jan. 1, 2006. Byler said there is a seven month window for people to sign up. If they wait until after that, there is a penalty.

Byler called it a “very good plan” but said people must look closely at their current drug costs and make comparisons.

Though not finalized, Byler said it “looks like” the premium for the plan will be $32 a month. There is also a $250 annual deductible.

Then, he said, persons will have to pay 25 percent of the drug costs up to $2,250. That means the maximum out-of-pocket expense is $3,600, once the co-pays are computed.

Though Byler said that is a lot of money, he said if persons use a lot of medications, the next part of the plan is where the savings is big. Once you reach that level, persons will then only have to pay 5 percent of the drug costs and the government will pick up the balance.

One person asked if the plan can be used as a supplement to company insurance from where they retired. Byler said it cannot be, but he also encouraged people to “shop around” and see if the new plan might be better than a company plan.

Also, he told people if they lose their insurance because they are dropped by a company, they have two months to sign up for the program without penalty.

He also said there will be different levels of coverage and persons can change their plans once each year.

One man told Byler he needs more than $2,000 per month in prescriptions and last month “I was just dropped. I can’t afford $2,000 to save my life. But this program could help.”

Byler also spoke of cheaper drug programs which are available from pharmaceutical companies and most people took several brochures which were made available.