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Despite Bungling Bush's Medicare Drug Rollout, GOP Still Attacks Obamacare "Navigators"

September 3, 2013

In October, uninsured Americans will begin the process of selecting from health insurance plans offered in online exchanges created by the Affordable Care Act. While 16, mostly Democratic states are investing hundreds of millions of dollars to ensure their success, in the rest Republicans nationwide are doing everything they can to bring about their failure. The GOP's latest act of sabotage targets Obamacare's "navigators," the dozens of community groups, hospitals, charities and universities receiving a combined $67 million in federal grants to provide outreach, customer service, information and assistance to those Americans trying to enroll in the states that refused to set up their own health care exchanges.
As it turns out, that obstructionism is more than little ironic. After all, as badly as the Bush administration and its GOP allies bungled the 2006 launch of their Medicare Part D prescription drug program for 43 million seniors, it would have been much worse without the very kinds of groups the Republicans are undermining now.
Former Bush Health and Human Services Secretary Mike Leavitt acknowledged as much in his July 12 Washington Post op-ed, a screed which advised the Obama administration to learn from the launch of the Medicare drug program:

Before the program was implemented, only 21 percent of seniors had a favorable opinion of it, and 66 percent didn't understand what the reform would mean for them.
So we spent 18 months devising and implementing a campaign to explain the prescription drug benefit, prepare seniors as well as partners -- such as community groups, churches, pharmacies, insurance plans and state and local governments -- and then sign people up. A national bus tour supported each phase. The summer before enrollment (the same period that the ACA is in now) we logged more than 600,000 miles and visited 48 states. As secretary, I made 119 stops in 98 cities. I learned that with a program like the ACA, you can't count on Washington to sell it. You have to reach people where they live, work, pray and play.

Nevertheless, Leavitt admitted that "in early 2006, there were days when I thought we could crash at any moment."
Those fears were well-founded. When it first launched, HHS had only 300 customer service representatives on hand to help 43 million people sign up by May 15, 2006 for one of the dozens of new plans from private insurers. While the number of support staff was later boosted to 7,500 by that spring, the roll-out was a mess from the get-go. As the Washington Post reported on January 18, 2006:

President Bush's top health advisers will fan out across the country this week to quell rising discontent with a new Medicare prescription drug benefit that has tens of thousands of elderly and disabled Americans, their pharmacists, and governors struggling to resolve myriad start-up problems.

It is worth remembering that the complexity of the new Medicare Part D was a feature, not a bug. Refusing to simply add prescription coverage to the existing Medicare program or allow the government to negotiate drug prices directly with pharmaceutical firms, the new Part D benefit required Americans to buy a policy through private insurers. That rule included the roughly 6.4 million seniors who already had their prescriptions paid for by Medicaid. The result was chaos:

Two weeks into the new Medicare prescription drug program, many of the nation's sickest and poorest elderly and disabled people are being turned away or overcharged at pharmacies, prompting more than a dozen states to declare health emergencies and pay for their life-saving medicines.
Computer glitches, overloaded telephone lines and poorly trained pharmacists are being blamed for mix-ups that have resulted in the worst of unintended consequences: As many as 6.4 million low-income seniors, who until Dec. 31 received their medications free, suddenly find themselves navigating an insurance maze of large deductibles, co-payments and outright denial of coverage.
Yesterday, Ohio and Wisconsin announced that they will cover the drug costs of low-income seniors who would otherwise go without, joining every state in New England as well as California, Illinois, Pennsylvania, Arkansas, New Jersey, North Dakota, South Dakota and New Jersey.

By January 16, 2006, the New York Times reported, "About 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England, have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program." Among the governors taking action were future Obamacare foes Tim Pawlenty and Mike Huckabee, who declared a health emergency in his state of Arkansas. The fiasco prompted the Bush administration to take drastic measures:

With tens of thousands of people unable to get medicines promised by Medicare, the Bush administration has told insurers that they must provide a 30-day supply of any drug that a beneficiary was previously taking, and it said that poor people must not be charged more than $5 for a covered drug.

It's no wonder why Paul Krugman summed up the whole catastrophe as "D for Debacle."
As we fast forward to 2013, the Republican scorched-earth campaign against the Affordable Care At continues to metastasize. After Supreme Court challenges, 40 failed repeal votes, and refusals to either accept the federal Medicaid funds that would insure millions or create state health care exchanges, Republicans are putting new roadblocks in the way of those navigators whose task is simply their residents with the enrollment process the Bush administration bungled so badly in 2006. As ThinkProgress reported, "Fifteen Republican members of the House Committee on Energy and Commerce, including Chairman Fred Upton (R-MI), are requesting detailed responses and thousands of pages of documents from approximately 60 percent of Navigator-recipients across the country by Sep. 13." Navigators include organizations as diverse as the United Way, the Catholic hospital chain Ascension Health and even the University of Georgia. Nevertheless, Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month:

"Let me tell you what we're doing [about Obamacare.] Everything in our power to be an obstructionist."
"We have passed a law that says that a navigator, which is a position in that exchange, has to be licensed by our Department of Insurance. The ObamaCare law says that we cannot require them to be an insurance agent, so we said fine, we'll just require them to be a licensed navigator. So we're going to make up the test, and basically you take the insurance agent test, you erase the name, you write 'navigator test' on it."

The contrast with the Democratic response to President Bush's Medicare drug plan could not be greater. Democrats in both the House and the Senate largely opposed the bill precisely because it had no "public option" and barred the government from negotiating lower prices with the drug companies. (That was just part of the reason that the program's cost ballooned from an estimated $395 billion over 10 years in December 2003 to a forecast of $700 billion just two years later. None of it was funded because, as Utah Senator Orrin Hatch later admitted, "It was standard practice not to pay for things.") And yet, Democratic governors stepped up to protect seniors during Part D's disastrous launch. Unlike some of their Republican counterparts today, Democratic representatives helped their constituents through the brutal process. And it was President Obama and the Democratic-controlled Congress which in 2010 improved the Medicare drug benefit by moving to shrink the so-called "donut hole" in coverage. The point was not lost on the authors of NBC News' First Read:

Here's a thought exercise on this summer morning: Imagine that after the controversial Medicare prescription-drug legislation was passed into law in 2003, Democrats did everything they could to thwart one of George W. Bush's top domestic achievements. They launched Senate filibusters to block essential HHS appointees from administering the law; they warned the sports and entertainment industries from participating in any public service announcements to help seniors understand how the law works; and, after taking control of the House of Representatives in 2007, they used the power of the purse to prohibit any more federal funds from being used to implement the law. As it turns out, none of that happened.

(For more background, see "To Attack Obamacare, Republicans Forget the Lessons of Bush's Medicare Reform.")


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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