Statement of Lore Wilkinson, Durham, North Carolina

Testimony Before the Subcommittee on Health
of the House Committee on Ways and Means

Hearing on Medicare Reform: Laying the Groundwork for a Prescription Drug Benefit

March 27, 2001

Good morning. It is a great honor to be here today before the Committee on Ways and Means to share my thoughts about the Medicare program and prescription drugs.

My name is Lore Wilkinson. I am 70 years old and I live in Durham, North Carolina. I live a very active lifestyle, volunteering in various community service projects and I also walk 3 miles every day. I am a firm believer in the importance of wellness and preventive care. To that end, I also take some prescription medicines on a daily basis. Because of arthritis and a hypertensive condition, I take 3 doses of medication daily. These medications keep me active and therefore keep me well.

One of the reasons I appreciate my private retiree plan coverage is because I have a range of options. Recently, retirees of the company I worked for learned that we would have the option of enrolling in HMO coverage or choosing one of the other employer-sponsored plan options available to us. I am enrolling in the HMO coverage because it will continue coverage for my prescription drug needs and the doctors I see participate in this HMO. After some research, I learned that the medicines I take were included on their approved list. I used the information my employer gave me to comparison shop and found a plan that best suited my needs.

I am here today because it is important to me to have those choices and I appreciate having employer-sponsored coverage. I am concerned that if the government decides to offer a "one size fits all" government-run plan, I will not be able to make choices about my coverage. I do not want a government plan to disrupt my ability to choose private coverage that best meets my needs.

The even more important issue I would like to raise is the possibility that employers will not continue offering coverage if a government-run plan is adopted. If employers see that the government will finance coverage for retirees, I am sure employers would make business decisions to stop offering health care coverage to retirees. The result for many seniors like me would be to lose our choices of coverage and face increased costs and hassles in a new government-run program. I agree that it is important for seniors to have access to prescription drug coverage. But, I think it is very important that it is structured so that employers will continue to maintain coverage for the millions of retirees who are happy with their employer-sponsored plans. Such plans were, in essence, computed into retirees' compensation.

Earlier, I referenced some medical conditions which I am currently taking medications to manage. I would like to share with you a little bit of background about one experience I had relating to another condition. Last year, at an examination as I was recovering from a hip fracture, my physician pointed out to me that I was measuring at one and a half inches shorter than what had always been my height. Her recommendation was that I needed to have a bone mass measurement done to determine the severity of my condition. After obtaining the results, my doctor was able to recommend calcium pills which helped me to regain my strength and maintain my exercise and community service commitments. Yet, Part B Medicare, run by the government, initially denied the claim for the bone density measurement and it took me three months of fighting with Medicare representatives to finally get reimbursement for my test. I know I am one of the lucky ones to have been able to resolve the claim in only three months.

There are two problems with this situation. One is that the inefficiency and bureaucracy of the government-administered program makes obtaining health care services a daunting task to many seniors.

I have no problem asking questions. I am a well-informed and careful consumer. I have learned how to ask questions and shop around to find the right solution for me. Those skills were developed because I have options and have not been forced into a large government program.

The second problem is something I also ask you to keep in mind as you begin your important work on modernizing Medicare. I want to take this opportunity today to emphasize the importance of preventive medicine and wellness. If I only had the government-run Medicare plan, some of the medical conditions I have had in retirement would have been treated by doing nothing about it until it was a debilitating condition warranting an inpatient hospital stay and surgery. Yet, there are so many new treatments available which help seniors to achieve wellness, remain active in our communities and help us to get more out of life.

I know how fortunate I am to have good employer-sponsored coverage which affords me the choice of private coverage that best meets my needs. But, I do worry that a big, new government plan could eliminate those choices for me. I ask you to keep my experience in mind as you begin crafting your proposal to improve access for all seniors to prescription drug coverage.