Posts filed under ‘Access to Health Care’
In “Fighting to Honor a Father’s Last Wish: To Die at Home” (the New York Times, September 25, 2014) author Nina Bernstein eloquently lays out the heartbreaking story of Joseph Andrey, whose last year of life was spent shuttling between inadequate care in every possible care setting. Often the services he received were provided in the most expensive available setting, regardless of the wishes of the family. Mr. Andrey finally died back in his home, but that final year of his life, quite likely the lowest quality-of-life year he ever endured, cost over a million dollars in Medicare, Medicaid and private funds.
It doesn’t have to be this way.
Unfortunately, too often it is. I have devoted over 30 years as a lawyer to Medicare advocacy, yet I could not help my uncle when his Medicare coverage was prematurely ended in the hospital and the nursing home. This resulted in his ending up at home with inadequate care, and he, too, experienced many of the dreadful occurrences that befell Mr. Andrey. A day after his death, and almost a year after his premature discharge, we won his Medicare appeal. Like too many others, he died after poor care and unfair denials from his private Medicare plan. Another victim of profits over people.
Too often people with low and moderate incomes fail to get the health coverage they need. Women are frequently harmed the most. In addition to their own health concerns, they are usually the gender responsible for family-planning and family care-taking.
The Supreme Court’s decision in Hobby Lobby reduces women’s rights and erodes women’s access to health care. In Hobby Lobby, the Court found that “closely held” corporations needn’t provide health insurance for their employees if it would violate their religious beliefs Incredibly, the decision advances corporate rights over women’s rights. And it advances the notion that corporations are people too – with religious beliefs!
Corporations don’t bleed; they don’t get pregnant; they don’t take care of children and parents. Women do.
Congress: Take action. Reconsider the Religious Freedom Restoration Act at the heart of the Hobby Lobby decision.
Women, Men, people who bleed, get sick, and take care of others who do: Speak out against this injustice.
From the New York Times, January 8, 2014
“…This past year, I have achieved something big that I’ve not spoken of until now. Countless hours of physical therapy — and the talents of the medical community — have brought me new movement in my right arm. It’s fractional progress, and it took a long time, but my arm moves when I tell it to. Three years ago, I did not imagine my arm would move again. For so many days, it did not. I did exercise after exercise, day after day, until it did. I’m committed to my rehab and I’m committed to my country, and my resolution, standing with the vast majority of Americans who know we can and must be safer, is to cede no ground to those who would convince us the path is too steep, or we too weak. “
How can we not stay the course? We will continue to advocate for those who need a voice – for the long term.
In yesterday’s Wall Street Journal, Cong. Paul Ryan weighs in yet again on “entitlement” reform. Suddenly the debate in DC is changing from demolishing Health Care Reform to the traditional Republican targets: Medicare and Social Security.
Here are Mr. Ryan’s suggestions:
• “Reform Medigap plans to encourage efficiency and reduce costs.”
What does this mean? Whose costs would be reduced and where would we find the alleged efficiency? Since we’ve heard this refrain before we know the answer: This proposal would cost older and disabled beneficiaries more. It would require them to pay more for Medicare Part B if they want “first dollar” coverage from a Medigap plan. The efficiency mentioned is based on the assumption that people will forego this kind of Medigap coverage as a result of the increased cost and then forego unnecessary health care that they would obtain if they had full Medigap coverage.
This is suggestion is based on so many false premises it’s hard to know where to begin. Importantly, Medigap policies only make payment for health care that Medicare has already determined meets coverage criteria and is medically necessary and reasonable. Medigap insurance is there to cover some of the Medicare cost-sharing for this necessary care. Without the Medigap coverage the “efficiencies” and savings Mr. Ryan lists would come as a result of older and disabled people foregoing care that is by definition necessary and reasonable.
• Combine Medicare Parts A and B so the program is less confusing.
We are all for making Medicare less confusing. The Medicare Part C and D systems, added to Medicare in 2003, dramatically increased the complexity of the program and decreased the ability of people to understand and use Medicare. But Mr. Ryan does not suggest reducing reliance on the expensive and redundant Parts C and D. He suggests combining Parts A and B. Again, we have heard these proposals before. In the guise of adding simplicity, they increase costs to the older and disabled people who rely on Medicare. While reducing costs for inpatient hospital care, especially for longer stays, the proposals to combine Parts A and B increase beneficiary costs for those services that people need far more frequently: doctors’ care and other outpatient and community-based health services.
If negotiations are returning to the ceaseless discussions about so-called entitlement reform, (which always makes me wonder who’s entitled and what do we mean by reform), we should be serious. The standard should be what’s best for older and disabled beneficiaries and the budget – regardless of the interests of insurance and pharmaceutical industries.
Anyone who truly wants to simplify Medicare and reduce costs, both worthy goals, should bring these suggestions to the table:
Combine Parts B and D. Do away with the expensive costs associated with running a Medicare prescription drug program only through private plans – or at least give people the choice of getting drug coverage through Part B, in the traditional Medicare program.
• Prohibit Medicare from paying any more for the medications it covers than Medicaid pays. The Congressional Budget Office reports this would save at least $140 billion over ten years.
• Reduce the dependence on private Medicare Part C plans.
These private plans are more expensive to taxpayers and provide less value for beneficiaries.
Case in point: Out of the blue, Connecticut residents learned today that one of the largest Medicare Advantage plans, United Healthcare, is dropping 2250 physicians from its network. This means a lot fewer providers will be available for thousands of older and disabled people – as a result of one non-appealable decision made in the best interest of private profit, not Medicare beneficiaries. Medicare Part C adds complexity and costs and should be scaled back accordingly. Beneficiaries should be encouraged to stay in traditional Medicare, which includes all physicians who participate in the program nationwide and is less expensive for taxpayers.
If Mr. Ryan and his colleagues really want to save money and reform Medicare and Social Security, while maintaining their core missions, it can be done. Let’s talk seriously – if there’s the will, there’s a way.
Senator Ted Cruz’s long speech on the Senate floor against “Obamacare” (the Affordable Care Act)might have been a remarkable spectacle and certainly led to a lot of press coverage. But many of his statements do real harm. Declarations like “you don’t want an IRS agent deciding if your mom lives or dies,” lead to people calling our office in fear that they will lose their health insurance. (For the record, people on Medicare will stay on Medicare.) The relentless efforts by Senator Cruz and others to turn people against Obamacare, to the point of telling them not to sign up for health insurance they may desperately need, brought to mind a contrast with the implementation of Medicare Part D, the prescription drug benefit that was passed under President George W. Bush.
In 2006 people were starting to enroll in Medicare Part D. It was not the drug benefit that many of us in the Medicare advocacy world wanted. It was administered by numerous private insurance companies rather than being a straightforward, public Medicare benefit. Its structure was difficult to explain, with a big “donut hole” that left many vulnerable people with high out of pocket costs. It prohibited Medicare from negotiating lower drug prices from manufacturers. We voiced these complaints and advocated for a different kind of drug coverage. But Part D was the drug benefit we got. It was the law, and we knew people on Medicare who were in desperate need of prescription drug coverage, even if that coverage was imperfect. Many of us had clients who split pills, skipped doses, or had to choose between medicine and food.
So we went to trainings, gave talks at senior centers, helped people choose plans, and helped resolve problems that prevented some from getting their medications smoothly. Once Part D got started – and it was a rocky start – we even filed lawsuits to make sure that people were actually getting the Part D benefits they were supposed to get, improving the existing program. We did not try to prevent Part D’s implementation, “defund” it, spread falsehoods about it, or try to make it fail.. We tried to make sure people could make the best possible use of Part D, because people needed their medications. We did and still do advocate for changes to Part D (like closing the donut hole, finally being accomplished by Obamacare!). Today there are millions of people who need health insurance and cannot get it. Obamacare will help them get that insurance. (Luckily, there are also people working hard to enroll the uninsured.) This new program may not be perfect, but obstructing its implementation, scaring away people who truly need insurance coverage, placing political gain over the urgent medical needs of real people – those tactics should be out of bounds.
And we quote:
“Private insurers’ Medicare Advantage plans cost Medicare an extra $34.1 billion in 2012
Instead of being more efficient, private insurers have cost Medicare almost $300 billion more over the life of the program
A study published online today finds that the private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985, most of it over the past eight years. In 2012 alone, private insurers were overpaid $34.1 billion.
That’s wasted money that should have been spent on improving patient care, shoring up Medicare’s trust fund or reducing the federal deficit, the researchers say.
The findings appear in an article published in the International Journal of Health Services by Drs. Ida Hellander, Steffie Woolhandler and David Himmelstein titled “Medicare overpayments to private plans, 1985-2012: Shifting seniors to private plans has already cost Medicare US$282.6 billion.”
Hellander is policy director at Physicians for a National Health Program (PNHP), a nonprofit research and advocacy group. Woolhandler and Himmelstein are professors at the City University of New York School of Public Health, visiting professors at Harvard Medical School and co-founders of PNHP.”
We have to say, Forbes has it right! The co-pay for Medicare home health care proposed in the President’s budget is a big mistake. It will not save money, will harm people with chronic conditions, and will increase avoidable hospitalizations. It isn’t even a good tool for fighting fraud – if that is the goal.
Far from getting too much care, our experience is that thousands of people with multiple sclerosis, Parkinson’s disease, ALS, paralysis, and other long-term conditions, struggle to get the home care they DO need. A little bit of nursing and/or therapy, along with hands-on health aide services, often means the difference between staying home and requiring a hospital stay or nursing home placement. For most Medicare beneficiaries with chronic conditions, home health care is more humane, more effective and less expensive.
If fraud is the concern, fight it. Don’t add co-pays or other barriers for those who really do need home care and qualify for Medicare coverage.