Florence Soltys didn't hesitate for a second. When the UNC-Chapel Hill clinical social work professor heard last month that the American Association of Retired Persons--the nation's powerhouse lobbying group for the elderly--was backing a controversial Medicare prescription drug bill, she promptly ripped up her membership card.
It's not that Soltys is opposed to prescription drug assistance for seniors. Working at UNC's geriatric clinic she frequently encounters patients who are chopping pills in half or skimping on food to pay for increasingly expensive medications. What started Soltys' outrage meter ticking was the idea that the AARP would sign onto a bill she's convinced will harm more seniors than it will help by pushing all but the lowest-income elderly off the federal benefit rolls.
"I was shocked that the AARP would support such a thing," Soltys says. "The whole thing stinks. The winners are the insurance companies and the drug companies."
Her criticisms are echoed by groups like the national Consumers Union and the North Carolina Health Access Coalition, whose leaders have spoken out against the narrow benefits, higher co-pays, lack of price controls and drug restrictions contained in the new $400 billion Medicare overhaul.
In addition to health-care concerns, critics have raised questions about the politics of the legislation signed by President Bush Dec. 8. They note that many of the new law's congressional supporters (the majority were Republicans) have received campaign donations from companies that stand to gain financially from its passage. The national Center for Responsive Politics reports that lawmakers who voted for the bill have raised twice as much on average since 1999 from insurers, drug companies and HMOs than those who opposed it. (Visit http://capitaleye.org/inside.asp?ID=113 for details.)
The AARP, which sells health-insurance policies, could also benefit from the new program's subsidies to private health plans and its focus on steering more seniors toward private coverage. "That's why most people do not buy their argument that this [bill] was better than nothing," Soltys says. "What happened is, they cut a deal."
William Novelli, chief executive officer of the 35-million member AARP, has denied any connection between his organization's insurance policies and its policy decisions. "We don't sit around saying, 'Can we make some money on this?'" he told The New York Times.
Helen Savage, advocacy director for North Carolina's AARP chapter, calls the decision by national headquarters to back the Medicare bill a "judgment call" that found the admittedly limited benefits it provides were still worth fighting for. "The strength of this bill is that it helps the people with the most needs," she says---namely, low-income seniors who do not qualify for state Medicaid benefits, and those with very high drug bills.
Still, Savage admits many AARP members don't see things the same way. She's been fielding angry phone calls since the bill was passed. And while she has no North Carolina numbers, nationally, some 15,000 seniors have canceled their AARP memberships over the prescription drug issue.
Gina Upchurch is executive director of Senior PHARMAssist, a Durham-based nonprofit that's been helping moderate and low-income seniors pay for prescription drugs since 1994. She's less worried about what's in the new Medicare bill than about what's not there: price controls to address the reason the drug benefit is needed in the first place.
"If you control costs with generic drugs and cost comparisons, you can offer people a better benefit," she says. "The way this new law will work, each HMO will have a set [list] of drugs that will be heavily influenced by the rebates they get from the manufacturers. It's marketing driving things rather than evidence-based medicine."
Upchurch is also concerned that the new benefits, which begin in 2006, will mean the end of many discount programs drug companies are currently offering seniors. "The discount cards will probably disappear," she says.
A call to Research Triangle Park's GlaxoSmithKline shows such fears may be warranted. When asked whether the pharmaceutical giant will continue its Orange Card discount for low-income seniors, Patty Seif, a spokeswoman for the company, says, "We are committed to continuing the Orange Card program until we have something on the federal level. When we have a federal card program we will determine at that time whether to continue it or not."
And there are other unpleasant surprises contained in the Medicare legislation. The New York Times reported last week that a little-noticed provision bars seniors from buying "Medigap" coverage to help pay drug costs after the new benefits begin. Currently, millions of seniors on Medicare buy private insurance to fill gaps in the federal program's coverage.
Despite the ferocity of the public backlash, Savage of the North Carolina AARP sees the flap as a temporary one. "I've been with the organization for 20 years and I know we are sometimes criticized for not taking positions," she says. "On this one, we were very up front and aggressive and tried to get as good a bill as we possibly could within the current political climate."
But Soltys says she and others like her have just begun to fight. She warns that moderate income seniors--the group she believes will be left behind by the new drug program--are also the most informed and active on the issue.
"I tore up my [AARP] card and I'm suggesting that others do the same," Soltys says. "When I was in the geriatric clinic yesterday, every patient I saw brought this up. It's going to build to the point where there will be an explosion."