Alternative Recommendations from Long Term Care Commission Members, Including the Center’s Judith Stein
Five members of the national Commission on Long Term Care, including Judith Stein, issued a statement on September 13, 2013 outlining alternative recommendations from the Commission’s majority to address the needs of Americans who require long-term services and supports (LTSS).
When it wrote the Medicare law, Congress called Medicare Part A “Hospital Insurance” and Part B “Supplemental Medical Insurance.” Part A is intended to pay for inpatient hospital care. It is a charade to consider people who stay IN the hospital for more than 24 hours “outpatients,” and pay for their care under Part B. This not only conflicts with the Medicare law and Congressional intent, it also harms the older and disabled people – and their families – who depend upon Medicare and for whom the law was written. They lose their right to Part A hospital coverage, are often left with hospital bills they would not have if they were properly admitted, and completely lose their ability to obtain Medicare coverage for post-hospital nursing home care. CMS’s insistence on continuing this policy places hospital payment mechanisms over the interests and rights of older and disabled people.
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.
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.
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.
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!”