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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

Doug Badger
Senior Health Policy Advisor

October 1, 2004

Doug Badger

Good afternoon everyone and thanks for logging on to Ask the White House. We're talking about Medicare today. Let's go to the questions....

Jules, from Ohio writes:

Doug Badger
Jules, that’s a great question and it’s why the President has avoided “one-size-fits-all” government solutions to the problem of the uninsured. The problem with putting another 20 million people on Medicaid, as some have proposed, is not just that it will cost taxpayers an estimated $880 billion dollars, according to some budget experts. The other problem is that just when you start to get a little ahead – you get a raise or you pick up more hours – the government takes your health care away. You know the old saying: no good deed goes unpunished.

The President has proposed to help get more working Americans covered through something called “refundable tax credits.” This is a form of government assistance that varies with income. So, for example, a family of four earning $25,000 would get $3,000 in assistance under the President’s program. They could use this to help buy coverage that – unlike Medicaid – they own. They can also, if they choose, take $1,000 of that assistance as a government contribution to something called a “health savings accounts.” The family would own this account. It wouldn’t belong to their employer or to the government. It would belong to them. They could use money from the account to pay for routine medical expenses and to save for future health care needs. Their employers could also add money to this account, and the state government – since their children qualify for coverage under their health insurance program – could also put money into their account and give them more help with their premiums. So, instead of insuring their children under a separate government program (coverage they’ll lose if their parents start earning more money), the children would be on their parents’ policy.

That way, the family owns something – their health savings account – that is theirs to keep even when their assistance declines as their earnings rise. And they’ll always get some help from the government, under the President’s proposal, even if their income rises to $50,000 or $60,000 or more. Families at these income levels are paying taxes. So the President has proposed to let them deduct any money that pay for their insurance and any money that they put into their health savings account.

So, low income families get help, but as their income rises over the years, the help never goes away. They get something they own, not government coverage that they lose if they manage to earn a little more money.

Kim, from Raleigh, NC writes:
I don't understand how or why my mother is spending $400.00 per month on medical prescriptions. She has medicare but according to her, medicare if for health care, not the prescriptions. Does Pres. Bush have any plan in the near future to address prescriptions coming in from Canada. I hear they are much cheaper for the elderly to afford but it's illegal at this point.

Doug Badger
Kim, there are millions of seniors like your mom who have waited years for the government to do something about the high cost of prescription drugs. That’s why he worked with a bipartisan group in Congress last year on legislation that creates a prescription drug benefit for people on Medicare.

The new benefit, which will begin covering medicines in 15 months (January 2006), will reduce prescription drug spending for someone who’s now paying $400 for their medicines by about $2460 per year. Depending on your mom’s income, she may qualify for a richer benefit, one that would cover 85% - 95% of her drug costs.

That’s great, but what do you do in the meantime? In June, we introduced something called Medicare prescription drug discount cards. More than 4.4 million seniors already are signed up for these cards, which are saving them hundreds, even thousands, of dollars on their prescription medicines. Again, depending on your mom’s income, she may also qualify for $1200 in assistance through the end of next year to help buy her drugs at discounted prices.

Let me suggest that you think about going to and checking out whether one of these cards will help your mom. Or call 1-800-MEDICARE and one of our folks will do it for you. All you need to know is your mom’s zip code, what medicines she’s taking (you might want to get the list together before you log on or call the toll-free number), and if she has a pharmacy where she likes to shop.

Within minutes (12 minutes on average on our toll-free line), you’ll know the best card for your mom, exactly how much she’d pay for her medicines at her preferred pharmacy, how much she might save by getting her prescriptions filled at a different drugstore in her community or getting her medicines delivered directly to her home through the mail, whether there are safe and effective generic alternatives to some of her medicines and how much she might save if her doctor prescribed these instead, and even if there might be some more affordable brand name drugs that she could talk about with her doctor. She’ll also find out whether she qualifies for the $1200 in additional cash assistance.

All of this will help your mom start saving now on her medicines without running the risk of getting drugs through internet sources that could be counterfeit or unsafe.

Betty, from Vincent, AL writes:
Why are you increasing to part B medicare premiun? This only hurts seniors, some of whom can not afford this increase.

Doug Badger
The same law that required this increase also protects your Social Security COLA. No senior will see a reduction in the Social Security checks as a result of this $11.60 increase in the Medicare premium. For more than 6 million of the poorest seniors, there will be no premium increase. The government pays their Medicare premiums for them, and the President yesterday signed into law legislation that extends this protection for many retirees.

So why is the premium going up? Because the law requires it. The biggest reason is that Congress enacted legislation that provides slightly higher Medicare payments to doctors. Many in Congress were concerned that the government was about to cut Medicare payments to doctors by 4.5 percent this past January. The AMA and other physician organizations told Congress that this might force some doctors to stop seeing Medicare patients. That’s a result no one wanted. Almost all doctors have agreed to treat Medicare patients, giving seniors and people with disabilities lots of choices about where they get their care. To protect patient choice, the new law increased payments to doctors by 1.5 percent in both 2004 and 2005, rather than cutting payments by 4 or 5 percent both years. In addition, the new Medicare law passed last year provides some benefit enhancements and some additional help to seniors enrolled in Medicare Advantage plans.

Ever since the 1980s, the law has required that beneficiary premiums cover around 25 percent of the costs of estimated Medicare “Part B” services (like doctor services, lab tests and other outpatient care). So some of the costs of these enhancements result in higher premiums. But Medicare is still a good buy: in exchange for these premiums, beneficiaries will receive an average of about $300 per month in benefits.

Judith, from Wrightstown, NJ writes:
Mr. President, I will eligible for medicare in a few years. I have, for most of my working life used an HMO. I expect the majority of non-self employed Americans access an HMO. I think older seniors are reluctant to use an HMO because the think of them as "clinics" rather than Dr's offices.

Could convince people on medicare to join an HMO if the advantage would be that, the money the government saved in the process would be reinvested in social security? (The government may not be able to spend social security monies but I don't know that they can not add to them.) Seniors would, basically, be insuring their children's future and still securing their own.

Doug Badger
Judith, I’m glad to hear from a fellow New Jerseyan and I’m glad to hear that you like the coverage you have and want to keep it when you retire.

That’s what the Medicare legislation that the President signed last year is all about: better benefits and more options. You’ve probably heard about the better benefits – more preventive care, including a “Welcome to Medicare” physical, disease management and chronic care coordination, and new prescription drug coverage that has been promised for years but now is a reality.

But what about the “more options” part? Well, most seniors like their traditional Medicare coverage, and the President has assured that coverage will always be there for current beneficiaries and future retirees. But this legislation also includes an alternative to traditional Medicare, called “Medicare Advantage.”

These are private plans, many of which are HMOs and some of which are likely to be PPOs (“preferred provider organizations”). They offer coverage that’s a lot more like what you’re used to. Congress had been starving this program over the past few years, but a bipartisan group of Members pushed to get more resources included for the program in last year’s Medicare Act and millions of seniors already are benefiting.

Seniors enrolled in these plans pay less when they see a doctor than under the traditional Medicare program, and many are getting benefits that the traditional program doesn’t cover, like prescription drugs or vision and even dental care. On average, people in Medicare Advantage plans spend about $700 less on their medical care than those enrolled in the traditional Medicare.

As you might imagine, there are some in Congress who want to take these benefits away from seniors. The President is fighting to preserve those benefits, so that you’ll have that option when you retire.

Joann, from California writes:
How is the White House addressing the issue of over-billing for dialysis services and related pharmceuticals by Dialysis centers across this country and especially in the midwest? This is affecting both our commercial and MediCare patient population as well as our tax payers.

Doug Badger
Boy, Joann, you’ve really hit on an important issue.

Medicare won’t cover most drugs until 2006, when the benefit that seniors waited years for – and that President Bush delivered – takes effect. But it does cover some drugs now, including dialysis medication, chemotherapy drugs, and certain other medicines.

For years, Medicare patients and taxpayers have been overcharged for those drugs because the program uses prices set by the government, rather than market prices that private insurers negotiate with manufacturers and pharmacies.

The overcharges have run into the billions of dollars over the years, according to the HHS Inspector General, the General Accountability Office, the Congressional Budget Office and the Department of Justice.

The Medicare legislation that President Bush signed into law last year puts a stop to that practice. From now on, Medicare will pay market-based prices, instead of the inflated prices that the government came up with. At the same time, Medicare will adjust payments for services (especially oncology services) to assure that we start paying the right amount both for drugs and for the cost of administering those drugs.

Stephen, from Columbia, SC writes:
With the inevitable approach of the baby boomer generation into the social security system, it is clear that the surpluses used to cover the current losses in medicare are going to vanish. Is there a forward looking plan to contend with this impending disaster?

Doug Badger
The inevitable approach of the baby boomers into retirement is one of the reasons why Social Security needs to be fixed. In 1950, there were 16 people paying into Social Security for every one receiving benefits.

Today, that ratio is 3:3 to 1. By the time today's young workers retire, there will only be two people paying into Social Security for each one receiving benefits.

The President has called for bipartisan action to fix Social Security. He has said that there should be no changes in benefits for those now in or near retirement, but that we need to fix the program for younger workers.

The President created a bipartisan Commission to Strengthen Social Security, which offered multiple options for strengthen the program while at the same time creating voluntary personal accounts within Social Security for younger workers.

These accounts would give younger workers the chance to build a nest egg for retirement that they would own and control, and which could be passed on to their children and grandchildren.

Fred, from Grant, AL writes:
Not a question but a fact concerning drug discount cards. My spouse, who is on medicare, ordered a Nations Health discount card several months back and we used it for the first time recently. We both had gone to the Dr.(together) and received the same prescriptions for antibotics and cough syrup. The prescriptions were filled at Cosco's and my antibotics cost $25.00; her's cost $10.00. My cough syrup cost $5.00 and her's cost $3.00. As far as I'm concerned that's a real significant savings and the general public needs to be informed.

thank you


Doug Badger
Fred, thanks for helping us get the word out about the new Medicare drug cards. More than 4.4 million people already have these cards and are saving lots of money through them. The costs you cite here might sound small to some, but we’ve talked to many seniors who have big prescription drug bill and have started to get some real relief from high prices. But don’t take my word for it. Here’s what Mary Jane Jones, a senior who participated in an event yesterday that was designed to tell more people about the drug card, has to say:

On July 30, 2003 I visited the White House and met President Bush and Secretary Thompson.

The purpose of my visit was to talk about the importance of getting a Medicare prescription drug bill passed.

I told the President that I was having a hard time affording my medicines which were costing me more than $500 per month.

I’m not a complainer, but I’ve really struggled at times to pay for my medicines and other basic necessities.

I’m a diabetic, so skipping my medicine is a bad idea.

The President and Secretary Thompson told me that they would do everything they could to make sure that I wouldn't have to struggle any longer to pay for my medicines.

The President said that I represented millions of seniors who were struggling with the high cost of medicine, and he promised that he was going to do something about it.

I was very excited to meet the President, who seemed so sincere and concerned about my situation, but I went back to Midlothian thinking that his promise was one seniors have been hearing for years.

Imagine my surprise when I found out that the Medicare prescription drug bill had become a reality.

Before I met the president, I was working 20 hours per week, and struggling to pay for my food and medicines. Today I am retired.

Although at times I still struggle, it is no longer because of medicines.

I learned about patient assistance programs and as a result virtually eliminated my costs for three medicines.

I signed up for the Medicare approved drug discount program and now have a card that cut my drug costs from $157 dollars per month to $100.

I have been shocked at how many negative things I have heard about the discount card and the new prescription drug benefit. I am here today because I think that people need to know the truth.

Because of the President, I am saving with a Medicare drug discount card.

In January, I will receive a $600 credit on my Medicare card and in a little over a year, I’ll only have to pay $2 for generics medicines and $5 for name-brand medicines.

Help is no longer on the way. Help is here. Please look into the Medicare prescription drug discount card. It makes a big difference.

Seniors who have a hard time paying for their medicines need to take advantage of all the opportunities to save money because every penny counts.

Don't listen to the naysayers. You are only hurting yourself. Work with all of these wonderful groups that are here today to get a discount card and start to save.

I can’t add anything to that!

Joseph, from Clovis, CA writes:
We hear a lot about healthcare and what both parties are planning to do but all they talk about is medicare. What is being done for us not old enought for medicare? Thank you

President Bush is working to make health care more affordable for all Americans, including seniors, people with disabilities and the tens of millions of working age adults and children who are not on Medicare. Rising health care costs impose a burden on families and small businesses and put coverage out of the reach of many Americans. The President's plan will help reduce the rising cost of health care; provide new and affordable health coverage options for all Americans; and provide not just a government program, but a path to greater opportunity, more freedom, and more control over your own health care and your own future.

The President's plan includes:

  • Affordable Health Care for Children:

  • The year before President Bush took office, some 3.3 million low-income children were enrolled in SCHIP. By 2003, that number had risen to 5.8 million, a 75 percent increase. Over that same period, by working cooperatively with state governors, the Department of Health and Human Services increased the number of low-income adults and children on Medicaid by 6.8 million.

    Despite these efforts, millions of children who are eligible for SCHIP or Medicaid coverage are not yet enrolled. Billions in Federal dollars available to the states to insure these children remain unspent because the children haven't been signed up.

    • Cover the Kids campaign. To ensure coverage for uninsured low-income children, the President will launch an aggressive, billion-dollar effort to enroll eligible kids for quality health care coverage. The Cover the Kids campaign will combine the resources of the Federal government, states, and community organizations, including faith-based organizations, with the goal of covering millions more SCHIP and Medicaid-eligible children within the next two years.

  • Affordable Health Care for Low-Income Families and Individuals:

  • President Bush signed legislation creating Health Savings Accounts (HSAs), which are a new, affordable option in health care coverage. HSAs are tax-free savings accounts that people can set up when they purchase a low-premium, high-deductible policy to cover major medical expenses. Money from the HSA can be used to pay for routine medical expenses or saved for future health needs, while the major medical policy helps cover big expenses, like hospital stays.

    The President has proposed allowing individuals who set up HSAs to deduct from their income taxes the premiums they pay for their major medical polices, thus reducing the net cost of those policies. Individuals who set up HSAs can save substantial sums on their health insurance and their taxes. Moreover, HSAs give Americans more control over their health care spending. If you own an HSA, you can go to the doctor of your choice and keep the account even if you change jobs.

    To extend the benefits of HSAs to low-income families and individuals, the President proposes giving low-income families a $1,000 contribution made directly to their HSA, along with a $2,000 refundable tax credit to help purchase a policy to cover major medical expenses.

    • A family of four making $25,000 or less will be able to get $1,000 from the Federal government to put into their HSA. These families can use the money to pay for doctor visits, medicines, and other routine medical expenses. What the family does not spend in a year can be saved in the account and carried over into the next year, earning interest tax-free. Each year that the family remains eligible, the government will deposit another $1,000 into their HSA. The family – not the government and not the employer – owns the HSA and keeps it whether a family member changes jobs or increases his or her earnings. Low-income individuals could receive a $300 contribution to their HSAs.
    • In addition to the $1,000 contribution to their HSA, the same low-income family of four will be able to get a $2,000 refundable tax credit to help them buy an insurance policy that covers them for major medical expenses. The $2,000 will cover a significant amount of the premiums on the insurance policy. Average premiums for family major medical coverage cost a little over $3,300 a year, according to the Kaiser Family Foundation based on data collected by eHealthInsurance. Low-income individuals could receive a refundable tax credit of about $700.
    • Families who elect not to set up an HSA may use the refundable $3,000 tax credit to buy standard medical coverage instead. Individuals will be able to claim a $1,000 refundable tax credit.
    • Low-income families will not have to wait until tax time to get their tax credits. The low-income health care credits will be advanceable and available immediately to qualifying families.
    • The President has also proposed $4 billion in grants to encourage states to create state-run insurance pools to make sure low-income Americans get the most out of the credit. These purchasing pools – or HealthPools – will provide people an easier, faster way to shop for coverage. States could make it easier to sign up for coverage through toll-free numbers and websites, and by making applications available at state government offices, motor vehicle administrations, and private workplaces. HealthPools will use the purchasing power of thousands of individual families to help reduce the cost of health insurance premiums for all eligible families.

  • Affordable Health Care for Small Business Employees and the Self-Employed:

  • More than half of the uninsured are small business employees and their families. Small businesses face obstacles in providing health benefits including high costs, complicated regulations, and a lack of bargaining power with insurance companies. The President.s plan helps them in several ways. President Bush has supported Association Health Plans (AHPs), which allow small businesses to band together to negotiate lower-priced health insurance for their employees. He also is proposing a tax credit to encourage small businesses and their employees to set up HSAs. President Bush proposes to:

    • Provide a tax credit for contributions to the HSAs of small business employees. To help individuals and families who work for small businesses fund their HSAs, President Bush proposes giving small business owners a tax credit on HSA contributions for the first $500 per worker with family coverage and the first $200 per worker with individual coverage.

  • Affordable Health Care for all Americans:

    • High health care costs are the underlying reason why many Americans are uninsured. President Bush has proposed Medical Liability Reform and new investments in Health Information Technology to help lower costs. In addition, he is proposing the following new initiatives:
    • Extend Association Health Plans to civic groups and other community organizations. Community, civic, and religious groups may want to offer health plans to their members. President Bush proposes to allow local groups to band together through their regional or national organizations to negotiate low-priced coverage for their members.
    • Allow individuals to buy the best coverage they can find anywhere in the country. Today, it is easy to use the Internet or 800 numbers to shop anywhere for anything. But different rules apply to health insurance. Individual consumers can only purchase health insurance in the state in which they live and can't shop around for a better deal in another state. The President believes that creating a competitive marketplace across state lines can increase the availability of health care coverage and help drive down the costs for everyone. He proposes to give people this freedom to shop for the best buy on the health coverage that best meets their individual needs. This proposal will help individuals save on health insurance, and includes provisions to prevent fraud and abuse.
    • Establish a health center or clinic in every poor county in America. The President believes that access to primary and preventive health care services is critical, especially in poor communities that are medically underserved. For example, many rural communities with higher levels of poverty have little access to basic health care services. The President's current initiative has successfully increased the number of people served in health centers by almost 30 percent. However, there are still poor counties throughout the country that have no community health center at all. The goal of the President's new initiative is to ensure that every poor county in America has a community or rural health center.

Russell, from Seattle, Washington writes:
What steps is the Bush administration taking to ensure that in 35 years, upon my retirement, that medicare or a similar program will be in place with benefits that I can use?

Doug Badger
Russell, the President understands that we need to preserve social security and Medicare for today’s seniors and to strengthen these programs for future retirees.

The President has called for reforms to strengthen Social Security so that it will be strong for our children and grandchildren. First among his principles is that there be no changes to the benefits of those already receiving Social Security, whether because they have retired or because they have qualified for the program’s disability benefits.

For younger workers, we must fix Social Security so that it is sound when they need it. The President favors the creation of voluntary personal accounts for younger workers, which would allow them to build a nest egg for retirement that they would own and control, and which could be passed on to their children and grandchildren.

A number of different plans have been put forward that would fix Social Security and create personal accounts for younger workers. While these plans differ in their details, analysis by the non-partisan Social Security actuaries clearly shows that projected Social Security benefits in the future will be higher if we create personal accounts than if we do not.

Marie, from Panorama City, California writes:
when can my 90 yearold mother on Social Security get her Medicare Prescription card to buy medications?

Doug Badger
Marie, help is available to your mom today! While the new Medicare drug benefit doesn’t take effect until January 2006, Medicare prescription drug discount cards became available this past June. Millions of beneficiaries like your mom already are saving on their medicines.

Here’s what to do. First, sit down with your mom and make a list of all the medicines she’s taking. Also, find out where she likes to get her prescriptions filled. Then either log on to or call our toll-free number, 1-800-MEDICARE.

Either way, you'll know within a few minutes which card offers the best prices at pharmacies in your community. You'll also get helpful hints on other ways to save through safe and effective generic medicines, and by having her prescriptions filled through the mail. You can also find out whether your mom qualifies for $1200 in assistance through end of next year. If she does, she can use this money to pay for her medicines at discounted prices.

Gary, from Cleveland writes:
Many doctors are leaving the Ohio area due to the spiraling cost of liability insurance. Why doesn't Medicare allow patients to voluntarily pay their doctor more than Medicare allows so that their doctor can remain in practice?

Doug Badger
That’s why the President has worked tirelessly for medical liability reform, which will do away with “junk lawsuits” and keep good doctors in practice. Too many lawsuits without merit are being filed against doctors and hospitals, forcing them to practice defensive medicine, driving good doctors out of practice, and driving up health care costs for everyone.

The President believes people who have a legitimate claim must have their day in court. But to make health care more affordable and accessible to everyone, we must reduce the number of frivolous lawsuits and limit excessive jury awards. No patient has ever been healed by a frivolous lawsuit.

Doug Badger
That's all the time I've got today. Sorry I couldn't get to more of the questions but I look forward to hosting another "Ask the White House" session later this month to answer more questions. I'll set aside more time for that session. Until then, thanks and have a nice weekend.

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