As both Cindy and I have discussed previously, there's reason for concern about Medicare Part D's long term viability if it fails to meet enrollment goals. That's because of adverse selection, which in normal speak means the tendency for sick people to sign up for insurance over healthy people (because they anticipate they'll need it more). But any viable insurance pool requires many healthy people to off-set the costs of the sick. With Medicare Part D, seniors who don't take any prescriptions, or only a couple inexpensive ones, won't deem their monthly premium, co-pays, and initial $250 deductible worth paying for.
So far that's been the case. But low-income seniors who don't qualify for Medicaid can still participate in the drug benefit for no premiums or deductibles and co-pays of $5. And as the Washington Post reported today, even that proposal has a snag:
A $400 million campaign by the Bush administration to enroll low-income seniors in prescription drug coverage that would cost them just a few dollars per prescription has signed up 1.4 million people, a fraction of the 8 million eligible for the new coverage.
At this rate, by some calculations, the government is on track to spend about $250 for each person it enrolls, and even then it would have only 2 million poor senior citizens taking advantage of what is perhaps the most generous government benefit available today.
The problem they're running into, of course, is that it's complicated to sign up. As I often experienced with my work at the Venice Family Clinic in Los Angeles, the largest free clinic in the nation, it can be exceedingly difficult to get patients to sign up for assistance. With Medicare Part D, these seniors first have to choose from among dozens of drug plans, then they have to pass a series of means tests to get the discounted coverage.
The key is a streamlined process. Anyone who's worked with low-income Americans can tell you that the best way to get people to participate is if you can finish the application in one visit (it's hard to get people to come back again). Social workers need to memorize the facets of available drug plans for low-income seniors and present them with 3 or 4 options (rather than 10 or 12). Means testing isn't as easy, which is why it's crucial to use trusted individuals when dealing with sensitive information.
Remarkably, Medicare outlined a program that would have worked much more smoothly, but inexplicably scrapped it for mass-outreach methods:
The council provided a report to Social Security last spring outlining a recruitment strategy that Firman said would have enrolled millions more seniors and cost about $100 per person. They key involves using "trusted intermediaries," such as volunteers at community centers, to work individually with each client, he said. Mass mailings, group meetings and advertising are insufficient when dealing with a hard-to-reach population and an application that involves supplying both income and asset data, Firman said.
Sometimes, it's hard to believe the Administration isn't purposefully trying to make Part D fail. They're certainly doing a good job accidentally doing so.