Addabbo advocates for 3-point health care plan

Health care is one of the primary concerns of the 21st century, according to City Councilman Joseph Addabbo Jr., who on Friday laid out a three-point plan to address the issue.

The cost of coverage is escalating and insurance companies continue to encroach upon clinics, Addabbo noted. He was joined by Dr. Frank Proscia, executive director of the Doctors Council SEIU — a union that represents more than 3,000 doctors — and pharmacist John Rossi at Rossi’s Pharmacy, located at 84-01 101st Ave. in Ozone Park.

“We need to put health care back into the hands of the doctors and nurses who think first about the patient and second about the bottom line,” the Councilman said, adding that steps must also be taken to improve existing programs and expand options.

Addabbo, who is running for the State Senate against incumbent Serphin Maltese (R-Glendale), is pushing for passage of bills that already exist in the state Legislature for each of the measures in the three-point plan.

The first measure would convert life insurance to long-term-care coverage. That would allow New Yorkers to cash-in their life insurance policies to pay for current long-term care needs, instead of waiting to do so after the fact.

That measure would reduce state Medicaid expenses by providing more liquid assets patients can use to pay for nursing homes or home health care.

The second component in the health care plan is raising the income threshold for Elderly Pharmaceutical Insurance Coverage, a state program that helps seniors pay for prescription drugs.

Eligibility requirements for EPIC are capped at $35,000 for an individual and $50,000 for a couple. Addabbo encourages the passage of legislation that expands the income threshold to $50,000 for an individual and $75,000 for a couple.

Some 35,170 more seniors in Queens would be eligible for the program if coverage were expanded, according to Addabbo, who is a candidate in the race for the 15th Senate District seat. They would be protected from the gap in Medicare Part D coverage of prescription expenses, which totals $1,650.

Actually, only about 3,500 of the newly eligible seniors would enroll in EPIC, Addabbo estimated. Historical trends show that only a small percentage of those at the high end of income eligibility — which makes up about 10 percent of eligible seniors — would enroll.

Even if only 3,500 Queens seniors were to enroll, they could still see aggregate savings of $5.8 million due to EPIC coverage of the Medicare Part D gap, the councilman said. The legislation would also result in considerable Medicaid savings.

The third part of the plan addresses single source drug coverage. Addabbo is pushing for the passage of legislation that prevents New York’s largest HMOs from denying or restricting access to drugs that have no generic equivalent — a trend revealed in a report released in May by state Sen. Jeff Klein (D-Bronx/Westchester).

Lipitor and Plavix, which treat high cholesterol and cardiovascular disease, are single source drugs. If insurance companies remove them from their formularies, or lists of covered drugs, patients taking those medications would face a difficult choice.

They could ask their physicians to prescribe them a different medication that does have a generic equivalent. But, according to Rossi, that could pose a problem for patients whose condition is improved best by the single source drug: changing medications could risk their health.

Those who cannot change medications can ask their physicians to notarize prescriptions, which would mean that they’re still covered and can continue taking their single source drug. But that comes at a cost: they would be charged incredibly high copayments on the medication, Rossi said.

Addabbo supports legislation that would prohibit insurance companies from removing single source drugs from HMOs’ formularies or from increasing co-payments on those that are removed. He wants to help pass legislation that requires insurance companies to cover all medically necessary prescription medications.

The councilman expressed the need for better coverage for all New Yorkers, but emphasized the negative effects of the drug pricing system on minority communities, which, in many cases, are disproportionately impacted by insurer practices.

Of the major HMOs operating in New York, 14 place restrictions on medications that are most often required by African-American and Hispanic-American New Yorkers.

According to the Centers for Disease Control and Prevention, 31.6 percent of non-Hispanic blacks who are 18 and older suffer from heart disease, compared to only 22.4 percent of non-Hispanic whites.

The American Heart Association lists stroke and diseases of the heart as the leading killers of Latino and Hispanic Americans. They claim the lives of 28.6 percent of the more than 122,000 Latinos or Hispanics who die each year.

At 23 percent, southwest Queens has one of the highest percentages of uninsured adults among the 42 neighborhoods in New York City, according to the city Department of Health.

Additionally, 23 percent of southwest Queens residents do not have a regular doctor, which means they rely mostly on emergency rooms rather than preventive care.