Though we at TNS are currently in the throes of a major financial crisis, we havenâ€™t lost perspective, even on our last official day of publishing.
Here is some late-breaking news that didnâ€™t make todayâ€™s edition â€“ about a nationwide funding crisis affecting some seven million people on this very same day: The Medicare "doughnut hole."
Today, millions of American seniors my be destined for a notorious void in the Medicare bureaucracy, and an untold number have already sunken in.
Known as the "doughnut hole," the gap in Medicare Part D prescription drug coverage is poised to suck in an estimated seven million enrollees, and this week, the average seniorâ€™s drug benefits will bottom out, according to the Campaign for Americaâ€™s Future, a liberal political-advocacy coalition.
As previously reported by TNS, the doughnut hole is a product of a broad overhaul laid out in the Medicare Modernization Act of 2003. Under the standard Part D program in 2006, the first year of full implementation, after paying an initial $250 deductible, Medicare covers 75 percent of prescription drug costs. But once total drug expenses reach $2,250, coverage drops off and all costs shift onto the enrollee. Those payments continue until costs reach $5,100 â€“ the threshold for "catastrophic" coverage, which then pays 95 percent of costs.
According to a study by the healthcare research organization Kaiser Family Foundation in 2004, out of 6.9 million individuals projected to fall into the doughnut hole this year, nearly 30 percent have incomes below 150 percent of the poverty level, and about 40 percent are considered in "fair or poor" health.
Still, the Kaiser Family Foundationâ€™s analysis of congressional budget data found that Part D enrollees would save substantially on out-of-pocket drug costs compared to what they would have paid without the Medicare Modernization Act â€“37 percent less on average.
But liberal healthcare advocates say Part D is primarily a boon for influential pharmaceutical interests that helped push the plan through Congress. Meanwhile, they argue, Medicare recipients are overwhelmed, and even deterred, by Part Dâ€™s daunting paperwork and convoluted payment schemes.
In a recent report based on federal data and other health research, Campaign for Americaâ€™s Future calculated, based on typical prescription-drug spending rates, that the average senior would enter the doughnut hole on September 22. The date is a statistically derived one: actual spending patterns, medical needs and financial circumstances vary for different types of enrollees, the group reported, and many have already hit the hole.
At a phone press conference on Thursday timed to coincide with what the group has dubbed "Doughnut Hole Day," Roger Hickey, co-director of the Campaign, called for legislative reform of Part D, describing it as a "costly, confusing and corrupt prescription drug plan written by and for the pharmaceutical and insurance companies."
As you know, dissecting stories like this is what we at TNS live for, but we can't provide the in-depth coverage we would like to as long as we ourselves are barely treading water. Now is the time to help us marshal our resources to keep us publishing... before we sink into a hole of our own.
Campaign for Americaâ€™s Future: No Doughnut Hole Campaign
Public Citizen: "Medicare Prescription Drug Legislation" website