Posts filed under ‘Access to Health Care’

Gabby Giffords Reminds Us Why Long Term Physical Therapy and Health Care Is So Important

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.

January 8, 2014 at 11:30 pm 2 comments

Back to You, Cong. Ryan

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.

October 10, 2013 at 2:05 pm Leave a comment

Medicare Lessons for Senator Cruz

Alice Bers, JD – Litigation Attorney

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.

September 27, 2013 at 5:27 pm Leave a comment

Stop Bleeding Medicare By Wasting Money on Private Plans

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.”

May 15, 2013 at 6:19 pm Leave a comment

Proposed Home Health Co-Pay is a Big Mistake

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.

April 22, 2013 at 2:56 pm Leave a comment

Priorities: People – and Medicare – Before Drug Company Profits

As we said in today’s Politico Op Ed, it’s time to support Senator Rockefeller’s bill – and all serious efforts to reduce what Medicare pays for prescription drugs. High time. There are over 50 million people with Medicare. Why would we not insist on lowering drug prices for all of them? It would save Medicare $141 Billion over ten years. Wal-Mart knows the value of negotiating low prices for vast numbers of people, and is sure to do so. So should Medicare.

April 17, 2013 at 2:35 pm Leave a comment

Why DOMA Matters for Medicare

This week, the Supreme Court is set to hear oral arguments in two cases relating to the Defense of Marriage Act (DOMA), the law prohibiting the federal government from recognizing same-sex marriages. DOMA has serious implications for same-sex couples regarding the benefits they earn, including Medicare.  How same-sex couples qualify and pay for Medicare is directly impacted by DOMA – and has serious financial ramifications for these couples.

Access to Medicare is generally achieved by reaching age 65 and accruing 10 years (40 quarters) of Social Security-covered employment, or by being the spouse of a worker who is age 65 who has accrued 40 qualifying quarters.  Because the federal government cannot legally recognize the validity of a same-sex married couple under DOMA, same-sex spouses with no work history, or fewer than 40 qualifying quarters, cannot acquire Medicare coverage on the basis of their spouses’ work history.  In order to have access to Medicare coverage that would be available to an individual in a mixed-gender marriage, a spouse in a same-sex marriage must pay hefty out-of-pocket premiums to buy into Medicare Part A. In 2013, the monthly Part A premium is $248 for beneficiaries with 30 to 39 quarters of qualifying work history, and $451 for those with less than 30 quarters in the system.

Simply put, DOMA often causes same-sex couples to pay significantly higher out-of-pocket costs for Medicare than they would if they could legally marry in their states and if their marriages were recognized federally. Though some progress has been made by the Department of Health and Human Services in recognizing the rights of same-sex couples regarding hospital visitation, DOMA still presents them with significant barriers to affordable health care under Medicare.

The Supreme Court’s rulings on DOMA will have serious implications for same-sex spouses and their families. Ironically, this is LGBT Health Awareness Week. We hope the Supreme Court will mark the occasion with a decision that recognizes the full and equal rights of Americans in same-sex marriages.

March 26, 2013 at 4:02 pm Leave a comment

ACA is Good for Medicare!

Misconceptions and misinformation about the Affordable Care Act are still too many to innumerate. However, as advocates for Medicare beneficiaries and a strong Medicare program, we can tell you that the Affordable Care Act (ACA) is good for beneficiaries and good for the stability of a full and fair Medicare program. ACA has already added significantly to Medicare-covered preventive services – with no beneficiary cost-sharing, continues to reduce the cost of prescription drugs for people under Medicare Part D, is phasing out wasteful overpayments to private Medicare Advantage plans and added over a decade to Medicare’s long-term solvency.

Happy Anniversary, ACA. As my grandmother would say, “You should live and be well!”

March 25, 2013 at 5:23 pm 2 comments

Annual Medicare Payment Limits for Home Health – Even Worse Than Co-Pays for Beneficiaries

The Center for Medicare Advocacy has represented Medicare beneficiaries since 1986. As one of the few advocacy organizations in the nation solely serving Medicare beneficiaries, we strongly oppose home health episodic payment caps or any other such defined payment limits. The counterpart to this notion, caps on outpatient therapy, has created significant barriers to necessary care for thousands of our clients with long-term and chronic conditions. We have no doubt that episode caps would be harmful to some of those in greatest need of home care. Thus, we are adamantly opposed to such limits in the home health context.

The Center has long opposed Medicare home health co-payments, and continues to do so. Like caps, co-payments will limit access to in-home care for those most in need of these services. However, we are increasingly concerned about proposals to introduce home health payment limits. There is no question that home health payment limits would be disproportionately harmful for people with conditions such as traumatic brain and spinal cord injuries, Alzheimer’s, Parkinson’s disease, MS, and other such illnesses and disabilities. Without the possibility for ongoing home health care, these individuals may well need costly nursing home or hospital care.

For example:
• Our client, Mrs. Berkowitz, who is 81 years old and receives skilled physical therapy and home health aide services for her Multiple Sclerosis and related health needs, will require a nursing home if payment caps are instituted for Medicare home health.
Payment caps contradict and undermine growing efforts to promote better care, at lower costs, by encouraging and investing in home and community-based services.

Payment caps would also undermine the settlement just arrived at with the U.S. Department of Health and Human Services in the national class action law suit, Jimmo vs. Sebelius. The Jimmo Settlement makes it clear that Medicare coverage is available for home health patients who need skilled nursing or therapy to maintain or slow deterioration of their conditions. Jimmo holds the promise of continuing care at home for people with long-term conditions who would otherwise often need more intense and expensive institutional care. Medicare home health payment caps, however, would create a barrier to this care and provide a disincentive to home health agencies to offer care to this particularly vulnerable population.

December 3, 2012 at 9:58 pm Leave a comment

The Medicare Debate

Medicare was in the spotlight in the Vice Presidential debate as the candidates outlined their respective plans for the program millions of American families rely on. Unfortunately, some pervasive myths were also highlighted regarding the impact of health care reform and the Ryan plan on Medicare and the 49 million Americans who count on it. [Check out the Center for Medicare Advocacy's Facebook and Twitter pages (Follow @CMAorg) for a full list of Medicare Myths and Facts from the debate.]

One of the myths that was repeated during the debate is the familiar claim that the Affordable Care Act cuts Medicare by $700 billion – the same claim that has been debunked time and again. In fact the $700 billion in savings are largely a result of rolling back unnecessary, wasteful overpayments to private Medicare insurance plans. Congressman Ryan’s budget plans have included these same $700 billion reductions; however, instead of ending overpayments to private insurance companies with the savings, Ryan’s plans would give private insurance companies an even larger share of Medicare expenditures.

The Ryan Plan to end Medicare would provide each individual with an annual allowance with which to purchase a health plan in the private market, would raise costs for current and future beneficiaries, and would repeal important Medicare benefit improvements, added by the Affordable Care Act (ACA). The ACA Medicare improvements include extending the solvency of the Medicare Trust fund, lowering prescription drug costs, adding new coverage for preventive services, and eliminating cost-sharing for most such services, such as mammograms and prostate screenings.

Mr. Ryan and other policy-makers often talk about waste, fraud, and abuse in Medicare. Yet too often these same policy-makers plan to extend private Medicare to restructure the entire Medicare program. They claim this will save money for Medicare, taxpayers, and beneficiaries. But a new study, once again, confirms just the opposite.

In a forthcoming issue of the International Journal of Health Services, researchers report that “Medicare has overpaid private insurers by $282.6 billion, or 24.4 percent of all MA payments, since 1985. In 2012 alone…MA plans are being overpaid by $34.1 billion, or 6.2 per¬cent of total Medicare spending”. This means nearly a quarter of all payments to private insurance companies in Medicare, subsidized with taxpayer dollars, have been unnecessary overpayments that have gone to profit margins and administrative costs, not health care services. Talk about waste!

The authors of the International Journal study conclude that the decades-long experiment with privatizing Medicare should end. Instead, policies should be developed to focus on the real issues of overall health costs and access to coverage. However, if the Ryan plan takes effect, the wastefully expensive private Medicare program will be expanded. Meanwhile, the cost-effective traditional Medicare program will be allowed to wither, and beneficiaries will become responsible for dramatic increases in out-of-pocket costs.

Mr. Ryan’s plan continues wasteful overpayments to private insurance companies at the expense of beneficiaries and taxpayers. It is not a plan to preserve Medicare, protect older and disabled people, or reduce health care costs.

October 12, 2012 at 8:35 pm Leave a comment

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We provide effective, innovative opportunities to impact federal Medicare and health care policies and legislation in order to advance fair access to Medicare and quality health care.



Judith A. Stein, Executive Director

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