Justice Implications of a Proposed Medicare Prescription Drug Policy

Social justice is a core value to the mission of social work. Older people are among the most vulnerable populations for whom social workers are called on to advocate. Although Medicare prescription drug coverage has been a top legislative issue over the past few years, such a benefit expansion has yet to be implemented. This article examines the historical context of Medicare and reviews the proposals for prescription drug coverage, identifying the concerns raised. Medicare History and Coverage Medicare, under Title XVIII of the Social Security Act, provides health insurance for U.S. citizens over age 65 and disabled people receiving social security benefits. This legislation was initially a part of the Social Security Amendments of 1965 (P.L. 89-97). In 1973, people receiving Railroad Disability or social security benefits for 24 months or more and those with end-stage renal disease also became eligible. Hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care are covered under Part A of Medicare. Part B is also known as Supplementary Medical Insurance, encompassing some home health services and outpatient care, durable medical equipment, home health care, and medical care and services provided by doctors and other medical practitioners (Almanac of Policy Issues, 2001; Center for Medicare Advocacy, Inc., 2002; Gross & Brangan, 1998; Social Security Administration, 2001). Similar to private insurance coverage, a percentage of the medical cost is paid, and the recipient pays the deductible. In 1999 Medicare Plus Choice became known as Medicare Part C, which allows beneficiaries to choose from options such as managed care plans or medical savings accounts to finance their Medicare coverage (Center for Medicare Advocacy, Inc.). In the United States 95 percent of the elderly population is covered by Medicare, as are many people with disabilities (Social Security Administration, 2001). Thus, Medicare health insurance continues to be important for older people and people with disabilities in this country (Laschober, Kitchman, Neuman, & Strabic, 2002). Yet, Medicare does not offer complete coverage, leaving out hearing-related care, dental care, basic vision care, long-term nursing care, and prescription drugs (Almanac of Policy Issues, 2001). Because of the gaps in coverage and the large co-payments, people have felt the need to supplement the benefit. Some Medicare beneficiaries have purchased Medigap insurance to cover deductibles and some services or items not covered by Medicare (Gorin, 2001; Laschober et al.; O'Sullivan, 2001). Some low-income Medicare recipients qualify for either partial or full Medicaid coverage, which could cover the co-payments and possibly other services. Yet, many low-income Medicare recipients remain ineligible for full Medicaid benefits (O'Sullivan). Furthermore, employer-sponsored coverage is decreasing, and the costs of Medigap are increasing, making supplemental coverage more difficult to obtain (Barry, 2002; Gorin, 2001; Gross, 2002; Laschober et al.). Prescription Drug Coverage Although there are several gaps in Medicare coverage, many feel that the greatest problem is the lack of prescription drug coverage (Chordas, 2001; Gorin, 2001; Gross, 2002; O'Sullivan, 2001). At the time Medicare was developed, most health care costs were related to hospital inpatient and surgical procedures (Chordas; Families USA, 2002a). Now, most of the health care spending in the United States is for pharmaceuticals (Chordas; Families USA, 2002a; Gorin). Laschober and colleagues (2002) found that individuals just above the poverty level, individuals 85 and older, and rural populations are habitually vulnerable groups with an increased likelihood of lacking prescription drug coverage. Even among supplemental insurance plans, the pharmaceutical coverage is either very little or nonexistent. Also, prescription drugs are not covered by some limited Medicaid plans (O'Sullivan). …