Bill Overview
Title: Territories Medicare Prescription Drug Assistance Equity Act of 2022
Description: Territories Medicare Prescription Drug Assistance Equity Act of This bill makes certain subsidies under the Medicare prescription drug benefit available to beneficiaries who reside in Puerto Rico or another U.S. territory. Current law makes such beneficiaries ineligible for premium and cost-sharing subsidies, but establishes a process for U.S. territories to apply for financial assistance with respect to the provision of Medicare prescription drugs. The bill eliminates this process and makes the subsidies available to beneficiaries who reside in a U.S. territory and are otherwise eligible.
Sponsors: Sen. Menendez, Robert [D-NJ]
Target Audience
Population: Medicare beneficiaries residing in U.S. territories
Estimated Size: 3500000
- The bill specifically targets Medicare beneficiaries residing in U.S. territories such as Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands.
- These beneficiaries are not currently eligible for certain subsidies under the Medicare prescription drug benefit, which the bill seeks to provide.
- According to the Centers for Medicare & Medicaid Services (CMS), there are approximately 3.5 million people living in the U.S. territories, a significant portion of whom could be beneficiaries under Medicare and potentially impacted by this change.
Reasoning
- The policy primarily benefits Medicare beneficiaries in U.S. territories, removing previous barriers to cost-sharing subsidies. Due to the geographical limitation, it does not affect those in the mainland U.S. who are already covered under these provisions.
- Targeted territories, such as Puerto Rico and Guam, contain over 3 million residents collectively, many on fixed incomes that will benefit from lowered prescription drug costs. This has the potential to moderately or even significantly improve their wellbeing scores on the Cantril scale, particularly for those dependent on high-cost prescriptions.
- A budget constraint of $1.5 billion in Year 1 and $16.44 billion over 10 years suggests moderate policy outreach, aiming to significantly alleviate drug costs for a portion of the targeted beneficiaries but not all. The policy must judiciously allocate resources to balance initial start-up costs with sustained support.
- For those not directly impacted by cost changes, their wellbeing scores remain mostly steady, providing a control perspective on the policy's direct financial impact.
Simulated Interviews
Retired (San Juan, Puerto Rico)
Age: 68 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- The cost of my medications takes up a significant portion of my budget.
- With this new policy, I hope to have more financial freedom to spend on other essentials like food and utility bills.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 6 | 3 |
Retired school teacher (Charlotte Amalie, U.S. Virgin Islands)
Age: 72 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I've had to choose between medications and other necessities.
- This policy will help me better manage my health conditions without financial stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 3 |
Homemaker (Saipan, Northern Mariana Islands)
Age: 81 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- It's hard to keep up with the costs. This would alleviate a great burden.
- My Budget is very tight, and any relief from medication costs would be substantial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 5 | 1 |
Part-time vendor (Tamuning, Guam)
Age: 60 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 14/20
Statement of Opinion:
- The policy might help my parents manage better financially.
- As I'll be eligible for Medicare soon, this could be beneficial for my future costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Retired (Aguadilla, Puerto Rico)
Age: 67 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- This policy could finally make my medication affordable.
- Living alone, this support will relieve my stress immensely.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 2 |
| Year 5 | 7 | 2 |
| Year 10 | 6 | 1 |
| Year 20 | 5 | 0 |
Retired fisherman (Pago Pago, American Samoa)
Age: 75 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 9/20
Statement of Opinion:
- This could be exactly what my wife and I need to secure our future.
- We've been trying to cut costs wherever possible.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Retired nurse (Caguas, Puerto Rico)
Age: 70 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 11/20
Statement of Opinion:
- Lower drug costs would allow me to contribute more to local health initiatives.
- This could provide a better quality of life for many here in Puerto Rico.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 2 |
Retired military (Hagatna, Guam)
Age: 79 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- Affordable medications mean I can focus on my well-being rather than financial stress.
- I'm grateful to see the government addressing these needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
Part-time librarian (San Juan, Puerto Rico)
Age: 66 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- This legislation is a relief for families like ours that struggle to afford the basics.
- This will allow us to balance health needs with other life necessities.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 1 |
Retired (Road Town, U.S. Virgin Islands)
Age: 63 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- The price of drugs has been taxing, and this policy will significantly ease my financial burden.
- An improvement in my health without extra costs is a big plus.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 1 |
Cost Estimates
Year 1: $1500000000 (Low: $1200000000, High: $1800000000)
Year 2: $1530000000 (Low: $1230000000, High: $1830000000)
Year 3: $1560000000 (Low: $1260000000, High: $1860000000)
Year 5: $1620000000 (Low: $1320000000, High: $1920000000)
Year 10: $1800000000 (Low: $1500000000, High: $2100000000)
Year 100: $5000000000 (Low: $4000000000, High: $6000000000)
Key Considerations
- This policy extends existing Medicare Part D benefits to territories, ensuring equitable healthcare access for residents.
- The number of eligible beneficiaries and their utilization patterns in territories significantly influence cost estimates.
- Demographics and healthcare needs in territories might differ, affecting subsidy costs per capita.