Some Republican congressional leaders -- including Senate Finance Committee Chair Chuck Grassley (R-Iowa), House Ways and Means Health Subcommittee Chair Nancy Johnson (R-Conn.) and others -- are considering legislation that would waive financial penalties for Medicare beneficiaries who sign up for the Medicare prescription drug benefit after Monday's enrollment deadline, the Washington Post reports. Under the current rules, beneficiaries who are eligible to enroll in the drug benefit who do not sign up before May 15 will have to pay a penalty of a 1% premium increase for each month of delayed enrollment. Because the next enrollment period begins Nov. 15, beneficiaries would pay a minimum late-enrollment penalty of 7% (Goldstein/Murray, Washington Post, 5/13). Beneficiaries who qualify for a low-income subsidy under the drug benefit are exempt from the penalty (Kaiser Daily Health Policy Report, 5/10). Hurricane Katrina evacuees also will be allowed to enroll without a late-enrollment penalty for 63 days after May 15 but will have to pay a 2% penalty beginning the 64th day (Kaiser Daily Health Policy Report, 5/12). One plan that is "gaining momentum" would maintain the Monday sign up deadline but waive the late-enrollment penalty, the New York Times reports (Pear, New York Times, 5/15). Johnson said she plans to introduce such a proposal and has received promises of support from enough lawmakers that the bill should pass in the fall (Freking, AP/San Francisco Chronicle, 5/14).

Other Options
Grassley said lawmakers are considering several other options, including a proposal to keep penalties only for beneficiaries who have higher annual incomes (Washington Post, 5/13). However, he added that he will not consider legislative changes to the drug benefit until after he sees final enrollment numbers. Meanwhile, on Thursday, 46 senators -- including Republican Sens. Arlen Specter (R-Penn.), Mike DeWine (R-Ohio) and Susan Collins (R-Maine) -- wrote a letter to HHS Secretary Mike Leavitt asking that the deadline be extended until the end of the year and the penalty be eliminated (AP/San Francisco Chronicle, 5/14). Sen. Olympia Snowe (R-Maine) on Friday also expressed support for the extension (Wolf, USA Today, 5/15). Reps. Jeb Bradley (R-N.H.) and Tom Price (R-Ga.) have introduced bills to waive the penalty for this year (New York Times, 5/15). According to the Post, the shift among some congressional leaders "marks the first time Republicans have broken with the White House over the program." Still, "GOP lawmakers are reluctant to talk openly of their plans" before the deadline passes "for fear of counteracting a cheerleading blitz that President Bush and his top health advisers have undertaken to spur a last-minute surge in enrollment" (Washington Post, 5/13).

Comments
Johnson said, "The bottom line is this is a democracy, and the Congress responds to the people and shapes the program so it's good for them" (AP/San Francisco Chronicle, 5/14). Price said, "We should not penalize those who still need time to make this very personal and important choice" (Pear, New York Times, 5/15). Rep. Charles Rangel (D-N.Y.) said, "To put a penalty for the rest of their lives on our oldest citizens, I think, is just an improper and wrong thing to do" (AP/San Francisco Chronicle, 5/14). Rep. Clay Shaw (R-Fla.), said, "Democrats have scared seniors away from the program by bad-mouthing it" (New York Times, 5/15). CMS Administrator Mark McClellan did not respond to Republicans' comments on the late-enrollment penalty, saying, "We have not been focused on [the penalty]. We've really been focused on getting to May 15" (Washington Post, 5/13). He added that the administration "will revisit the issue after May 15" (New York Times, 5/15). AARP CEO Bill Novelli said, "It is critical that people enroll by midnight tonight, but there is always some confusion with any new benefit," adding, "It makes sense to waive any penalty." Ron Pollack, executive director of Families USA, said, "Politically, eliminating that penalty is a smart thing to do and will no doubt get serious consideration" (USA Today, 5/15).

Continuing Problems, Asset Test
In related news, Medicare officials last week reported continuing problems with low-income beneficiaries trying to obtain medications. According to a memorandum sent recently by the Bush administration, officials have "received numerous complaints" that dual eligibles are "being charged incorrect copayments at the pharmacy." In addition, some beneficiaries are finding that they have been assigned to drug plans different from the one they chose, CMS officials said. Meanwhile, Beatrice Disman, chair of the Medicare Planning and Implementation Task Force at Social Security, said more than 1.7 million beneficiaries of the eight million beneficiaries eligible have been approved for a low-income subsidy that provides assistance with premiums and copays under the drug benefit. The subsidy is available to beneficiaries with assets of less than $11,500, not including homes and cars. Disman said many of those who were disqualified failed the asset test. Some advocacy groups and insurers have called for elimination of the test. Jacqueline Kosecoff of UnitedHealth Group said, "We support elimination of the asset test." Novelli said some beneficiaries were intimidated by the subsidy application form because it warns that applicants "may be sent to prison" if they do not disclose the value of certain assets. McClellan said, "We are not supporting legislation to change the asset test at this time. Our efforts are focused on getting help to people who need it most" (New York Times, 5/15).

Additional Coverage
Several other newspapers featured articles on the Medicare prescription drug benefit. Headlines appear below.

• "The ABCs of Medicare Part D" (Lamb, Christian Science Monitor, 5/15).
  
  
• "Kinks Remain as Drug-Plan Deadline Nears" (Goldstein, Philadelphia Inquirer, 5/13).
  


• "Deadline Near for Medicare Drug Plan" (Schaefer, Philadelphia Inquirer, 5/14).
  


• "Healthy Seniors Weigh Skipping Out on Part D" (Snowbeck, Pittsburgh Post-Gazette, 5/14).
  


• "Local Medicare Enrollee Got Help -- and Saved Big" (Booker, Richmond Times-Dispatch, 5/14).
  


• "Medicare Advocates Fear for the Poor" (Mussenden, Richmond Times-Dispatch, 5/14).
  


• "Debate on Drug Benefit Persists" (Fagan, Washington Times, 5/15).
  


• "Senate Hopefuls Slam Medicare Plan for Seniors" (Miller, Washington Times, 5/14).
  

Broadcast Coverage
Several broadcast programs reported on the enrollment deadline for the Medicare prescription drug benefit:

• APM's "Marketplace Morning Report": The segment reports on how Canadian pharmacies are offering an automated program to compare U.S. residents' prescription drug costs through Medicare Part D and reimportation from Canada. The segment includes comments from David McKay with CanadaWayDrugs.com (McNalley, "Marketplace Morning Report," APM, 5/12). The complete segment is available online in RealPlayer.
  


• C-SPAN's "Washington Journal": Guests on the program are scheduled to include Mary Grealy, president of the Healthcare Leadership Council; Leslie Norwalk, deputy administrator for CMS; Pollack; and Susan Winckler, vice president for policy and communications at the American Pharmacists Association ("Washington Journal," C-SPAN, 5/15). The complete segment will be available online in RealPlayer and Windows Media after the broadcast.
  


• KCRW's "To The Point": The program is scheduled to include a discussion on the reasons for the enrollment deadline (Olney, "To The Point," KCRW, 5/15). The complete segment will be available online in RealPlayer after the broadcast.
  


• NPR's "All Things Considered": Julie Rovner, health policy correspondent for NPR, discusses the deadline (Elliott, "All Things Considered," NPR, 5/14). The complete segment is available online in RealPlayer.
  


• NPR's "Day to Day": The segment includes comments from George Kelemen, campaign manager for Medicare prescription drug outreach for AARP (Adams, "Day to Day," NPR, 5/12). The complete segment is available online in RealPlayer.
  


• NPR's "News & Notes with Ed Gordon": The segment includes comments from a Medicare beneficiary in Illinois who still has questions about selecting a Medicare prescription drug plan (Gordon, "News & Notes with Ed Gordon," NPR, 5/12). The complete segment is available online in RealPlayer.
  


• NPR's "News & Notes with Ed Gordon": The segment includes comments from John Agwunobi, assistant secretary of health at HHS, about efforts to reach black Medicare beneficiaries who might be reluctant to enroll in the benefit (Chideya, "News & Notes with Ed Gordon," NPR, 5/12). The complete segment is available online in RealPlayer.