Pombo Gives Seniors The Donut Hole

When the Republican-controlled Congress passed the Medicare Prescription Drug Bill in late 2003, they put in place a $700 billion system that benefits pharmaceutical companies and HMOs at the same time that it punishes seniors. Instead of legalizing the importation of drugs from Canada or allowing Medicare to negotiate lowered prices from the drug companies, Richard Pombo and the Republican majority put into place a complicated and convoluted program that takes advantage of some of the weakest members of our society.

When Medicare Plan D finally took effect earlier this year, most seniors were confused by the many options that were presented to them. With looming deadlines and 47 different plans available, many struggled to wade through conflicting options for payments, deductibles, and drug coverage. It was easy to miss one little detail which has now come back to haunt them. It’s called the donut hole. Millions of seniors signed up for standard plans which called for them to pay a monthly premium and a 25% co-payment for their prescriptions. What they didn’t realize was that these plans would completely stop their coverage once the total annual expenses reached $2,250 and wouldn’t kick in again until the annual expenses totaled $5,100. After $5,100, almost all of their drugs would be provided for free. This $2,850 gap where seniors have no drug coverage at all is the donut hole.

According to the Campaign for America’s Future, today is National Donut Hole day, the day when the average American senior citizen will reach the $2,250 mark and enter into a period where they must pay all of their drug expenses out of pocket (while, of course, still making their monthly premium payment). For some, the donut hole came many months ago; for the lucky ones, it will be avoided altogether. However, it’s estimated that 7 million seniors nationwide will struggle to pay for their prescription drugs over the next few months.

And the really bad news is that the process will start all over again on January 1. With costs set to rise, premiums will likely go up, and the donut hole will come earlier and earlier in each successive year. Congress has put our seniors on a treadmill of escalating costs and declining benefits.

The Institute for America’s Future shares this perspective:

Dorothy Berger of Urbana, Illinois recently went to her pharmacy, private Part D plan card in hand, to get her monthly pain patch. "I had my $10 out to pay $8 for the patch. The pharmacist says, 'No, it's $489 and some change.'" Dorothy continues, "This system is terrible, and that's all there is to it. Whoever dreamt this up must have had a rock between their ears."

Perhaps this is because the Republican Congressional leaders behind the program were beholden to a pharmaceutical industry, and its 952 lobbyists, that filled their campaign coffers. Under Republican Majority Leader Tom Delay’s K Street Project, industries were permitted unprecedented access to the creation of legislation in return for their political/financial help.

Is it any wonder that the resulting legislation favored the drug companies and HMOs over average citizens? Now, 7 million seniors will bear the burden for Republican lawmakers’ greed and corruption; 7 million seniors will pay the price for Richard Pombo’s “yes” vote on Medicare Plan D.


There is hope, though. The Democratic Party has a plan to reform Medicare Part D, and with the addition of new Representatives like Jerry McNerney, they will be able to implement an approach to drug benefits that finally puts the needs of seniors above drug company profits.

As Jerry McNerney points out on his website, if, instead of having 47 different private plans, we simply allowed Medicare, which has a proven track record, to both administer the drug plan and negotiate for lower drug prices, we could save more than $600 billion over the next six years, and seniors would not be facing the donut hole crisis every fall.

In the meantime, many of our most vulnerable senior citizens are going to face difficult choices: “Buy medicines or food?”

Tags: CA-11, Richard Pombo, Medicare Plan D, Donut Hole, Jerry McNerney