During one of the most difficult times in our country’s modern history, protecting the health, economic stability and safety of every American, especially vulnerable senior populations, must remain the priority of our president and lawmakers. As members of Congress and President Donald Trump continue to implement policies and economic relief packages to respond to the effects of the COVID-19 pandemic, they must ensure that patients, particularly our nation’s seniors, are protected from the pressures of rising out-of-pocket health care costs that are especially debilitating in these uncertain times. If federal policymakers are truly committed to providing support to America’s most vulnerable citizens, they should move immediately to put a cap on out-of-pocket costs in the Medicare Part D prescription drug program for seniors.
Older Americans, especially those who manage a chronic or complex condition, remain increasingly vulnerable to the devastating effects of coronavirus. According to the CDC, 80 percent of coronavirus deaths reported in the United States have been in adults 65 years old and older. During the COVID-19 pandemic, many of these individuals are also facing economic crises as many have lost their jobs or were already struggling to make ends meet. These economic consequences often force patients to make even more difficult choices about their healthcare.
According to a health tracking poll from the Kaiser Family Foundation, nearly half of American adults or someone in their household had to postpone or skip medical care due to coronavirus. Over 30 percent of adults polled by KFF said they had fallen behind on their bills or struggled to afford household expenses such as food or health coverage because of the pandemic. When seniors have to make these tough decisions, the consequences can be dire.
The harsh economic realities of the coronavirus are compounded for seniors across the country who rely on Medicare Part D to access their prescriptions, because there is currently no limit on out-of-pocket costs in the Medicare prescription drug program. What’s more, in 2020, a provision in the Affordable Care Act expired that had been in place since 2014 to help limit the growth in out-of-pocket costs for seniors in Medicare Part D. As a result, the out-of-pocket threshold increased by $1,250 this year, meaning seniors will need to pay this additional amount out-of-pocket before they see a benefit from reduced costs.
The expiration of this provision forces many of the 44 million low-income seniors who rely on Medicare Part D to make tough decisions about their care: stop paying for food, housing or other basic necessities to afford a medication; split pills in half; or stop taking their medication altogether. COVID-19 has only intensified the financial burden that rising out-of-pocket costs in Medicare Part D are putting on seniors. According to the same KFF poll, 1 in 4 Americans have skipped meals or relied on charity food programs during the coronavirus. Nearly 1 in 10 polled said they are experiencing difficulties paying for their prescription medication. Seniors, who are already vulnerable to the severe effects of COVID-19, are only made weaker when they are forced to stop taking their medication or skip meals for financial reasons.
When any patient stops taking their medication, it can lead to side effects, loss of disease control and even hospitalization. Not only does this harm seniors, it can also put an immense burden on our nation’s hospitals as they continue to face the overwhelming demands related to coronavirus.
For the millions of American seniors who are managing diabetes, financial relief is coming in 2021. This May, the Trump administration announced that seniors will be able to choose a Medicare prescription drug plan for 2021 that caps their copays at $35 a month for insulin.
We should commend the president for this action, but Congress should go a step further to shield every senior by putting a cap on out-of-pocket costs in Medicare Part D now and for good. It’s a simple solution that will help seniors access their medications today and in the future. It’s time for federal lawmakers to stand up and protect America’s seniors from rising out-of-pocket costs at a time when older Americans are more vulnerable than ever.
Andrea Baer, MS, BCPA, is the executive director of Mended Hearts, a national, community-based nonprofit organization based in Albany, Ga., that supports patients with heart disease.
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