William Vaughan from Families USA began the first plenary session on the current
state of Medicare reform efforts by describing the final days of the Medicare reform
conference as “an incredible swirl of confusion as the conferees try to solve the last
few difficult problems.” Next, Mr. Vaughan laid out a day-by-day timeline of how he
expected the legislation to emerge over the next week. He recognized that it is a
complex and confusing bill and that many seniors do not like it but that it will probably
be passed. 

Mr. Vaughan explained that Families USA and other advocacy groups are concerned
about how some features of the bill would affect low-income seniors including those
living with HIV/AIDS who are  eligible for both Medicare and Medicaid. Mr. Vaughan
provided handouts that detailed where congressional negotiators stood on key issues
|as of that morning, November 14.

During the question and answer session, Mr. Vaughan was asked whether or not the
conference agreement will allow state Medicaid programs to continue to provide wrap
around drug coverage for dual-eligibles [a category which includes many people living
with HIV/AIDS] and whether private plans would be able to restrict people living with
HIV and AIDS to the one or two of the least expensive antiretroviral drugs. Mr.
Vaughan responded that this area is still open for debate. “"We heard everything from
‘thou shalt not do any wrap around’ to ‘gee, you can do a copay wrap but you require
people to pay $2 for generic presumably and $5 [for a brand name drug].’“ So instead
of the 0 - $3 that we have arranged today, it would go to $2 and $5 inflated maybe so
that would grow to $4 and $10 by 2012,” Vaughan explained.

Bill Vaughan concluded his discussion by saying that he hoped Congress makes sure
the people who need the most help receive it, but that at Families USA, they are
concerned. “Did you ever play cats cradle as a kid? These strings are all moving right
|now, and we don’t know where they’re going to land  … but we’re real nervous,”

Vaughan confessed. “It is a bill that is like a dead fish on the beach in the moonlight.
It both shines and stinks at the same time. The shining is that you have a
|conservative Congress who would put $400 billion into an entitlement. These are
|people who don’t like entitlements. If we don’t take that, next year it disappears in
the sands of Iraq and more tax cuts and Lord knows what. So you better take it. But
then you get close to the shining fish, and it starts to stink because of all of the stuff
they’ve done to try to not make it an entitlement,” Vaughan explained.