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Selected research from leading health care experts whose findings have a direct bearing on public policies effecting medical progress. Research is chosen based on its quality and relevance by the Medical Progress Today editorial staff.

Selected Research

Who Failed to Enroll In Medicare Part D, And Why? Early Results
Health Affairs, 8-1-06

Health Affairs released another Medicare Part D survey this week tracking satisfaction with the program and enrollment demographics. The survey found that although the plan reached its 90% enrollment goal, many hard to reach groups (lower-educated and low-income seniors) are still without coverage.

We conclude from our early results from the RPS survey, and from CMS enrollment figures, that the primary objective of the new Part D program—to provide most seniors with affordable coverage for the medications they need—has been largely achieved. An unanswered question is whether provision of drug coverage by Medicare without private insurance intermediaries would have been equally or more effective in controlling drug costs. The information and administrative problems that arose early in the inaugural enrollment period appear to have been overcome, although they might have colored attitudes toward the program. Concerns that large numbers of seniors, particularly among vulnerable groups, would fail to enroll in the program are largely allayed. However, there remains a substantial core of seniors who need to be educated that Part D is in their own interest, and reaching them should continue to be a health policy priority.

The CMS has an extensive outreach program (the Low-Income Subsidy, or LIS) and a Special Enrollment Period without a late enrollment penalty for low-income nonenrollees. These mechanisms need to be effective in bringing the 0.8 million remaining nonenrolled low-income people into the program. More effort is needed to reach the 1.5 million nonenrolled unhealthy people who should be enrolled in their own interest and whose incomes are too high to qualify for the LIS. Healthy people with low education should also be targeted with counseling on the future benefits of coverage. A well-publicized penalty forgiveness window could help bring some of the nonenrolled into the program.

The Medicare Part D program was envisioned as a lever for future free-market reforms of the system; free market "intermediaries" have largely performed as expected.

One reason that market intermediaries are being used is to offer seniors a wide range of options and prices. On the other hand, allowing the federal government to "negotiate" prices would have inevitably led to more restrictive formularies and less choice for seniors. Medicare spending should certainly be brought under control, but through additional market reforms, rather then administrative pricing mechanisms.



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