U.S. Health and Human Services Secretary Mike Leavitt gave that assessment Tuesday while in the Salt Lake Valley to publicize Medicare's upcoming drug benefit.
The benefit is supposed to save states millions, as the federal government picks up the prescription tab for 10 million "dually eligible" Americans - elderly and disabled citizens who receive both Medicare and Medicaid. The states had been covering such expenses under Medicaid; now they will be covered by Medicare.
States' savings are limited, however, by "clawback" payments that require them to chip in a portion of what they formerly spent on dual eligibles' drugs. Utah Health Director David Sundwall told Leavitt that Utah stands to lose $13 million to the clawback, and pressed him to explain how he will handle petitions from states seeking financial relief.
It was the first of many pointed questions lobbed at Leavitt on Tuesday by seniors and a small group of disabled Utahns protesting the Bush administration's proposed Medicaid cuts - a chilly reception on a rain-drenched morning for the former Utah governor.
Leavitt told Sundwall he is working with states to address concerns about the clawback. But he said, "Frankly, I have yet to see a state that loses money on it."
For now, Leavitt said there are no plans to change the mechanism under which states must pay the federal government back for 90 percent of their dual eligible drug costs in 2006. Eventually, that percentage will drop to 75 percent.
States, including California and Colorado, have complained that the payments are based on 2003 drug expenditures, and many states have fought since then to contain prescription spending.
As the crowd at the Columbus Senior Center in South Salt Lake waited for Leavitt Tuesday, a band of guitar-accompanied harmonicas played "Amazing Grace." A woman entered holding a sign that read, "Leavitt's Utah: The fish whirl. The poor die."
Skeptical seniors asked Leavitt for guarantees that their specific prescriptions will be covered and that the offered insurance plans, which will be announced later this year, won't go broke. One man, frustrated at being turned away by doctors because of Medicare's low reimbursement rates, wanted to know whether Leavitt will boost rates.
"We're working hard on that problem, but that's really a subject for another day," answered Leavitt.
Meanwhile, a group of about 10 protesters from the Disabled Rights Action Committee picketed outside, claiming a White House call to cut $10 billion from Medicaid over five years will harm those who rely on it.
"I am terrified that I'll end up losing my income and not be able to afford to do my hobbies, which is my therapy to keep me off my medication," said Tammi Diaz, who receives about $500 per month from Medicaid to buy Ritalin and Effexor.
Jerry Costley, executive director of the committee, said the group wanted to take advantage of Leavitt's presence to argue against his proposals to increase co-payments and eliminate optional services, like dental and vision care, from Medicaid coverage.
"We really resent being called 'optional' and our critical services being called 'optional,' " Costley said.
Leavitt said he met with the group and told them he understood their concerns. He said many of the states were working to cover the increased co-pays, which are $1 for generic medicine and $3 for brand-name prescriptions.
kstewart@sltrib.com
