Congress did not finish much of its key legislation prior to breaking for the election recess. When Congress reconvenes on Nov. 13 at least three key Medicare issues need to be addressed, according to Howard Gochberg and Brian Berggren, co-chairs of the Federation's Medicare Justice Coalition.  These include physician payments, Medicare Part D and prescription drug costs.

Physician Payments: Without quick congressional action all physicians will experience a 5.1 percent cut in Medicare reimbursement as a part of a projected 30 percent cut in physician reimbursement by Medicare, due to take place in the next six years.

There is all but universal consensus that Medicare physician reimbursement is a mess. The current system may be paying some specialists too much, while underpaying primary care doctors, who are at the core of quality affordable health care. The current system rewards providers for high-intensity, excessive and poor quality healthcare. The system also penalizes both consumers and providers in many areas of the country, including Minnesota, that provides relatively cost-effective quality care. According to Berggren, "Minnesota seniors paid the same as everyone else into the system but they are not getting the same services out of the system. It's not fair and it isn't right."

Only a miracle would let Congress address this full issue in November, but to let these cuts to physicians go through will largely result in two adverse consequences:

• Less access to physicians by Minnesota's seniors, as more and more primary care physicians stop seeing Medicare beneficiaries. This is becoming a crisis in greater Minnesota where many primary docs lose money every time they see a Medicare patient.
• Increased cost-shifting to the young and privately insured as Medicare underpayments cause increased charges and insurance rates for all Minnesotans.

Congress has an easy and fair way to find the money to pay for physician reimbursement - eliminate the Medicare Stabilization Fund. This $10 billion "slush fund" undermines Minnesota's health care system by paying new national "for-profit" insurance companies more then Minnesota's non-profit plans.

Medicare Part D  - The new Medicare Prescription Drug program is about to begin its second year with even more confusion, less standardization, a general erosion of benefits, and significant price increases for most beneficiaries. In Minnesota, premiums for Medicare Part D stand-alone polices will increase almost 15 percent on average next year. Yet these policies will generally provide fewer benefits with higher annual deductibles, and a larger "donut hole." 

Much of the real fixes will need to be dealt with next year. Meanwhile more than 160,000 Minnesotans face an increase of at least 7 percent as a lifetime penalty for drug coverage because they did not or could not enroll before the May 15, 2006 deadline. Nationwide, 15 million of an estimated 38 million people who are Medicare eligible did not enroll in Medicare Part D largely because they did not know about it or were simply were too confused. The problem is only getting worse for 2007 when there will be 110 choices (up from 63 available in 2006) and even less standardization. There is strong bi-partisan support to encourage these people to enroll by eliminating the 2007 late enrollment penalty. In order to make it happen, Congress needs to get beyond politics and get the job done now for low-income seniors. More serious reform will undoubtedly need to wait until the next Congress.

Prescription Drug Prices - More and more studies are pointing out that the new Part D drug program is primarily a benefit for drug manufacturers and large insurance companies that are taking in record profits at the expense of the American taxpayer.  While Congress clearly ought to authorize our government to negotiate drug prices on behalf of Medicare, this is not likely to happen as long as the current administration sits in power.

Safe prescription drug importation, however, has strong bipartisan support and is favored by a clear majority in both houses. The Senate Dorgan-Snowe legislation may have as many as seventy votes in the Senate (all Senators in the upper Midwest with the exception of Senator Coleman) is ready for floor action. Similar House legislation led by Congressmen Gil Gutknecht and Rahm Emmanuel clearly has the majority of representatives supporting it (all of Minnesota's delegation with the exception of Kline and Kennedy).

Serious efforts will be taken by House and Senate importation backers to bring it to the floor during the lame duck session. If passed, this legislation would improve the drug safety in America and allow not only individuals but more importantly U.S. pharmacies and wholesalers to use the power of international markets to save all Americans as much as 50% on safe, brand name drugs.

Congress needs to act and act now.  Call your senators and representative to take Medicare Action now!

For more information about the Medicare Justice Coalition including its Fix Medicare Rx Campaign visit www.mseniors.org or call 651-783-5014.