US takes new steps to prod enrollment in a Medicare plan

WASHINGTON -- The government has added 6,000 operators, has quadrupled its computer capacity for enrollment, and will assist with more than 1,000 events this week as part of a push to sign people up for the Medicare drug benefit.

Many legislators want to extend the May 15 deadline and waive the penalty for those who sign up later. The secretary for the Health and Human Services Department, Mike Leavitt, said yesterday that he opposes both moves, which would be popular in an election year, though there are exceptions for the poor.

Leavitt said he will go to 24 cities before the enrollment deadline to promote administration efforts.

''We've got a shot at getting to 90 percent, which would be a remarkable outcome for the first year of the program," Leavitt said.

He was referring to the number of older and disabled people who have prescription drug coverage through Medicare, other federal plans such as the Veterans Administration drug program, or their former employers.

Almost 43 million people are eligible to sign up for drug coverage through Medicare. Leavitt said he estimates that the number of beneficiaries with drug coverage through Medicare and other programs now stands at more than 38 million.

Leavitt said that the deadline will be waived for about half of those who have not signed up, if the government determines that they qualify for extra help because of their income. For the others, he said: ''The reason they have chosen not to sign up will probably be as true in June or July as it is today."

Leavitt said it would not be fair to those who signed up to waive the enrollment penalty. Some of those who have enrolled may not need the benefit yet, but are paying monthly premiums anyway and helping to fund the benefit.

He also said there are four groups of people who have declined to enroll. At the top of the list are those who have no drug expenses now.

''They don't think they need a plan," Leavitt said. ''But that's not right. You should enroll so you preserve your options for the future. The second group just thinks it's for low-income citizens. That's not true, either."

Procrastinators make up the third group.

The fourth group includes people who do not want to sign up for a government program, he said.

By the May 15 enrollment deadline, federal officials expect to have more than 20 million seniors enrolled in plans under Medicare Part D, as the benefit program is called.

That would include an estimated 7 million or more who had lacked insurance for outpatient prescriptions. Of the millions who have signed up, many are enjoying significant savings, sometimes $1,000 a year.

One of the reasons the program is not being hailed as an unqualified success is that it is hard for seniors to navigate. About 2 million people who live near the poverty line have not taken advantage of the coverage.

Another reason is that Part D is not working well for many seniors with complex illnesses and those requiring relatively expensive medicines.

These patients often face high costs, under the new program, that threaten to put needed treatment beyond their reach. A recent poll for the Kaiser Family Foundation has found that 19 percent of enrolled seniors said they expect their medications to cost them more under Part D, compared with the 55 percent who said they would save.

That is because the private insurance companies quietly put these medicines into special coverage tiers that carry higher costs for patients. Doing this helps the companies save taxpayers money while still making a profit.

Officials of organizations representing patients with multiple sclerosis, mental illnesses, arthritis, and cancer have expressed particular concern about the coverage policies of the plans.

Another problem with Part D is that many pharmacists say they continue to experience difficulties with basics, such as timely payment. Pam Grisnik of Grove City, Pa., told Congress recently that more than one-third of fellow pharmacists around the country fear that the program will put them out of business.

Funding problems could loom farther down the road because Part D does not have its own dedicated revenue stream or tax base. It's financed with general tax revenues and premiums paid by beneficiaries.

Currently, costs are running below projections, but that is bound to change. The program's long-term financial shortfall is estimated to be greater than that of Social Security. Both the insurance companies and the government have pledged to fix the problems.

Material from the Los Angeles Times was included in this report.