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 Leave a comment

Fair Prices for Prescriptions = Fair Pay for Physicians!

Year after year congress has passed a short-term physician payment package instead of permanently fixing the unfair payment formula for doctors who treat Medicare patients.

This year could be different

Today, in Congress, there’s a real solution for this ongoing problem.  Senator Rockefeller’s Medicare Drug Savings Act of 2013, which will allow Medicare to negotiate prescription drug prices for low-income beneficiaries, will save Medicare $140 billion over 10 years – almost the exact amount needed to permanently fix the physician payment formula and fairly pay doctors who treat Medicare patients.

Join us. Tell Congress you support finally fixing the formula by which Medicare pays physicians (it’s called “SGR”), but that the cost of doing so cannot be shouldered by older and disabled people.

In particular, Congress should not:

  • Cap coverage for necessary care,
  • Increase premiums, copays, and other costs for Medicare beneficiaries,
  • Allow help for low-income people on Medicare to expire.

The timing couldn’t be more perfect.  Senator Rockefeller’s Medicare Drug Savings Act is the solution.  Congress can permanently fix the physician formula and pay for it by allowing Medicare to obtain the best possible price on prescription drugs for low-income individuals.

It’s a Win-Win Situation

Write your Senators and Representatives today:

  • Remind them of your support for Senator Rockefeller’s bill, and
  • Tell them to use the prescription drug savings to fairly pay physicians who treat Medicare beneficiaries!

November 22, 2013 at 7:23 pm Leave a comment

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

Don’t Believe Us? Listen to the George W. Bush CMS Director!

And we quote: Mark McClellan, CMS Administrator in the G. W. Bush Administration:
“If the exchanges’ tech problems are resolved by November, no one will even remember what happened this week,” McClellan said, comparing the Affordable Care Act rollout to when the Medicare Part D prescription drug benefit took effect.
“Millions of seniors in different programs were enrolled into new [private] drug plans, and the computer system fumbled the handoff for tens of thousands of people who really urgently needed their prescriptions,” he said. “By comparison, the frustration of not being able to shop online in the first days of the Obamacare exchanges is small potatoes.”

[From Politico 10/4/2013]

October 4, 2013 at 5:44 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

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).

Read the full press release and recommendations

September 17, 2013 at 2:42 pm 1 comment

CMS Continues to Insist Hospital INpatients are OutPatients

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.

July 12, 2013 at 6:55 pm 1 comment

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