Joanne Devlin needs about 20 prescription drugs to regulate her blood pressure, keep her arthritic joints limber and pain-free and control her asthma.
She counts on financial help from Rhode Island when her Medicare Part D insurance plan maxes out and no longer pays her drug bills, which can reach $3,000 every three months. But that state help may no longer be an option after Jan. 1.
The financial crisis has grown so severe that lawmakers in Rhode Island and five other states have debated whether to cut or reduce the state funding that helps seniors and disabled people like Devlin buy their drugs.
Devlin, 62, who lives off about $10,000 a year, worries she may need to stop taking her arthritis medication to make ends meet. She stocks shelves and helps distribute food as a volunteer at a Salvation Army food shelter.
"I wouldn't be able to move a lot," she said. "I probably wouldn't even be able to come here. I'd probably have to stay home and some days be bedridden, probably."
Devlin's predicament is shared by many of the nearly 27 million people enrolled nationally in Medicare Part D, the federal insurance plan that covers prescription drugs for seniors until the total bill reaches $2,700.
Seniors then hit what's commonly called the "doughnut hole," and must personally pay the drug bill until their out-of-pocket costs reach $4,350, at which point Medicare coverage resumes. When seniors fall into this gap, 16 states offer financial assistance, said Thomas McCormack, a consultant for the Community Access National Network and editor of the Medicaid Watch newsletter.
Other states offer help to help defray some of the premium costs associated with Medicare.
Eliminating the program in Rhode Island would save about $700,000 and affect around 8,000 people, while a proposal to scale back benefits in South Carolina would have trimmed roughly $7 million. Officials in South Carolina have estimated about 22,000 people are eligible for the program.
Those savings aren't huge: they amount to less than 1 percent of the total budget in both states.
Vermont's governor proposed eliminating the funding this year, but lawmakers instead instituted co-payments that cost recipients $1 or $2. New York and Connecticut rejected plans to curtail assistance, while Massachusetts has scaled back co-payment assistance for its seniors.
'Human cost could be pretty profound'
Advocates for the elderly fear the cuts will force cash-strapped seniors to stop taking their medications, leading to serious health problems.
"What we repeatedly see happen is that people stop taking their medications, they get sick, they end up in emergency rooms and the they get hospitalized for more serious health problems," said David Certner, the legislative policy director for AARP.
"In the long-term, this is going to cost more money because it's going to lead to greater health problems," Certner said.
Bill Flynn, executive director of the Senior Agenda Coalition of Rhode Island, believes the Rhode Island proposal is the result of across-the-board budget cuts run amok.
"The approach in hard times should not be necessarily, 'Well, everything's on the table so low-income seniors need to suffer along with everyone else,'" he said. "The human cost of something like this could be pretty profound."
In January — as South Carolina grappled with worsening unemployment and $1.1 billion in cuts to its $7 billion budget — the state slashed its doughnut-hole help for seniors from 95 percent to 10 percent.
Gov. Mark Sanford vetoed nearly all of a $5.7 billion budget, including all Medicaid and prescription drug spending, in a fight over using $700 million in federal stimulus money. By overriding his veto on May 20, lawmakers raised South Carolina's doughnut hole coverage to about 50 percent.
Sanford, who says it is unconstitutional for lawmakers to require him to use the stimulus cash, has responded by filing a federal lawsuit.
He said the vote to force him to seek the cash was unconstitutional and that he would fight it in court.
In Rhode Island, which is also wrestling with high unemployment and severe budget shortfalls, Gov. Don Carcieri has proposed cutting his state's prescription drug program for seniors.
"It was a very difficult decision, and it's strictly a budget decision," said Corinne Russo, director of the state Department of Elderly Affairs, which runs that program.
Rhode Island cuts would affect 8,000 poor
Carcieri's plan would eliminate next Jan. 1 the program that pays 60 percent of drug costs for its poorest enrollees and covers all their costs beyond $1,500. The assistance, which costs $1.5 million and serves more than 8,000 people, mostly targets the poor, Russo said.
About three-quarters of the state's funding helps the poorest people enrolled in the program, the group Russo most worries might skimp on medication to make ends meets.
"Those are the people who are most at risk either of not purchasing medication or not being compliant with their medication regimen," she said. "If a doctor says take one a day, they may take one every other day," she said.
Compromises may keep the assistance operating. Carcieri's administration is investigating whether it could use federal Medicaid funding to keep the program running, or perhaps restrict it to the neediest only.
Democrats hold a veto-proof majority in the state Legislature, allowing them to rewrite the Republican governor's spending plans. But Rep. Steven Costantino, the Democratic chairman of the House Finance Committee, said he could not commit to saving it.
Lawmakers have asked Carcieri's administration to present them with cost-saving alternatives to totally eliminating the program.
"We're at the point where we need to ask everybody to sacrifice on this budget," Costantino said.
And that frightens Anne Fortin, 72, who counts on the state's help to help her pay for drugs that control her asthma and emphysema. Without it, her monthly drug bill would easily double to $400 or more.
"I could never pay that," Fortin said. "I've been thinking about it. I said, 'My God, what am I going to do?'"