Democrats Announce Investigation into Trump’s Part D Copay Cards

In September, President Trump announced that the government would soon issue $200 vouchers to Medicare beneficiaries to help mitigate out-of-pocket costs for prescription drugs. While many outside observers view this as a last-minute ploy to shore up support among senior citizens before the November elections, staff at the Centers for Medicare and Medicaid Services (CMS) have reportedly been busy trying to roll out the program before November 3.

The administration plans to send the almost 40 million Medicare beneficiaries eligible for the cards a letter in the coming week notifying them of the program, though the cards will not arrive until after Election Day. The estimated $7 billion in costs for the program will be covered by funds from the Medicare trust fund. It will cost $20 million to send the notification letters; these funds will also come from the Medicare trust fund, as this was not a program authorized by Congress.

Tuesday, Congressional Democrats announced that they have requested additional information on the plan from the Department of Health and Human Services (HHS) and have also requested an expedited review of the legality of the program from the U.S. Government Accountability Office (GAO). Because only Congress can appropriate money, the Executive Branch has limited authority to spend funds on programs like this.

The Trump Administration is claiming authority under a statutory provision allowing CMS to implement demonstration programs that meet certain requirements, namely that the demonstrations aim to test whether something will help reduce spending without harming outcomes or will improve outcomes while not increasing spending. Authorities claim that the cards are intended to test whether reduced out-of-pocket expenses will improve patient medication adherence.

Of course, we already have access to lots of research on that subject, so it is unclear why there is a need to generate more, especially at the cost of $7 billion to taxpayers. And it is reasonable to question whether $200 would be enough to broadly impact patient behavior. Finally, programs such as this don’t actually impact spending and costs, they merely shift them from one party to another.

It will be interesting to see if the letters make their way to mailboxes before November 3 and whether the cards ever make their way to beneficiaries either.