| April 14, 2005 Note: The Legislature did not
include these copays in their budget, in part due to the enormous amount
of attention generated by this story.
Medicaid patients
fear copay proposal in state budget
By REBECCA COOK
Associated Press Writer
SEATTLE (AP) _ Three times a week, a taxi takes Jane Lubin to the
kidney dialysis appointments that keep her alive.
Lubin's health depends on dialysis and the 15 prescription drugs she
takes to control her diabetes, high blood pressure and allergies. The
state pays for her rides to dialysis, her treatment and her medication.
Now
state lawmakers say the free ride is over - literally.
They
want Lubin and other elderly and disabled Medicaid patients to pay $3
for prescriptions and $2 for transportation to and from medical
appointments.
Patients, pharmacists and doctors decry the copay proposal, saying it
will force the poorest, sickest patients to skimp on health care. Many
legislators loathe the idea. Even the state Medicaid director says it
simply won't work.
But
House and Senate budget-writers say copays are needed. Gov. Christine
Gregoire says it's still a possibility for the final state budget,
expected to come out next week.
So
Lubin, 50, wonders how she will cut $69 from her $863 monthly income.
Rent for her Seattle apartment and utilities are nonnegotiable. She
could spend less on groceries, but she has to eat a special diet because
of her diabetes and kidney failure. She knows she could save money if
she gave up Bailey and Jasmine, her two cats, but some days they are her
only companions.
"It's
a very, very difficult thing," said Lupin, who worked for 20 years as a
medical assistant before she became disabled. "It would cause a lot of
emotional strain as well as financial strain each month."
Copays are a standard feature for most people's health insurance. But
while middle-income people can afford $10 or $20 for prescriptions,
advocates say that even small copays will force low-income patients to
skip pills or delay preventive care, causing more serious and expensive
health problems down the line.
"It
is seriously wrong," said Joyce Jackson, president and CEO of Northwest
Kidney Centers, where Lubin gets her dialysis.
"The
patient who doesn't have that dollar or two could choose to skip"
dialysis sessions, she said. "If you don't have treatment, within a week
or two you are seriously ill and you will die."
Washington state tried this before, in the early 1990s, when the state
imposed a $1 copay for Medicaid prescription drugs. Officials scrapped
the program a year later.
One
problem is that Medicaid patients don't actually have to pay the
prescription drug copay. Federal law allows states to impose Medicaid
copays, but it requires pharmacists to fill prescriptions for Medicaid
patients regardless of their ability to pay. So the $3 prescription
copay will likely come out of pharmacists' $4.20 dispensing fee - a 71
percent cut to pharmacists.
"The
large majority of it will be absorbed by pharmacists," said Washington
Medicaid director Doug Porter. "These would be the same pharmacists who
two years ago threatened to leave the program because we cut their
reimbursement by 2 percentage points."
Pharmacists are predictably perturbed.
A 71
percent cut in their Medicaid fee is "just an unsustainable business
model," said Rod Schafer of the Washington State Pharmacy Association.
"We all need to take some responsibility for how we utilize health care,
but if you can't afford it there should be some sort of fallback
mechanism, a safety net."
Porter has supported other attempts to get Medicaid patients to share
the cost of their health care, such as sliding-scale premiums. But he
said he doesn't think these copays will work.
Medicaid pays brokers in eight regions of the state to provide
transportation, which ranges from buses to taxis. Porter said the state
has no mechanism for collecting transportation copays from Medicaid
patients.
"I
just don't see how I'm going to make this one work," Porter said. "I
don't want to think about someone who should be going to get their blood
tested, and saying 'I can't afford the dollar copay.' What we will end
up paying for is the ambulance trip to the emergency room."
Bill
Daly, lobbyist for the consumer advocacy group Washington Citizen
Action, agreed.
"Our
concern is this will prevent people from getting their medicine," he
said. "They're both poor and sick. They're not on Medicaid by accident."
Jerome Pipitone, 48, certainly never expected to be scraping together
nickels for the bus. A former landscaper, he was just starting a
videography business when diabetes wiped him out. Now he's 48, legally
blind, a bilateral amputee, and recently had a kidney transplant. He
takes 10 to 12 medications a day, and said he couldn't afford $30 a
month in copays.
"Right now my concern is, am I going to have food at the end of the
month or what?" Pipitone said. "So many things are being taken away from
the ones that can't really fight back."
Imposing transportation and prescription copays would save the state
about $6.8 million a year, in a $13 billion annual state budget.
Jackson, Daly and Porter have been lobbying legislators to take the
copays out of the budget.
House
and Senate leaders say they have to do something to control skyrocketing
health care costs - and patients should have to share the burden with
taxpayers. Health care costs are growing by 10 percent a year, double
the growth rate for state tax revenues.
Gov.
Christine Gregoire said she doesn't like the idea of Medicaid copays,
but she won't rule them out of the final budget.
"It's
not the direction I think overall is right for the state ... copays of
any kind drive up administrative costs," Gregoire said. "But we're going
to have to take cuts and we're gong to have to find ways to make things
more affordable."
Legislators and the governor are negotiating a final budget this week.
Medicaid patients like Lubin and Pipitone anxiously await their answer. |
