Archive for January, 2011

Challenge to Medicare: Don’t Require People to Get Better to Get Coverage and Care

On January 18th, the Center for Medicare Advocacy, with co-counsel Vermont Legal Aid, filed a national class action law suit in federal district court to eliminate Medicare’s long-standing practice of denying coverage and access to care for people who are not going to improve, or improve sufficiently, or improve quickly enough.

This inappropriate “Improvement Standard” keeps people with long-term and chronic conditions from obtaining medically necessary health care and therapeutic services such as nursing, physical, occupational, and speech therapy. That is what happened to the lead plaintinff, Glenda Jimmo.

Ms. Jimmo, a 71-year-old resident of Vermont, was denied Medicare coverage for home health nursing and aide services on the grounds that she was stable despite the fact that she had diabetes, peripheral vascular disease, on-going circulatory problems, skin lesions, and is legally blind and has a below-the-knee amputation.

The lawsuit, Jimmo vs. Sebelius, No. 5:11-cv-17 (D. Vt.), was filed in Vermont federal court on behalf of five individual Medicare beneficiaries from Vermont, Connecticut, Rhode Island, and Maine, and five organizations, National Multiple Sclerosis Society, Parkinson’s Action Network, Paralyzed Veterans of America, National Committee to Preserve Social Security and Medicare, and American Academy of Physical Medicine and Rehabilitation. The federal government has 60 days to file it’s Answer to the lawsuit.

Improvement is NOT a legal standard upon which to determine eligibility for Medicare coverage. The Center for Medicare Advocacy hopes the Jimmo case will eliminate this harmful policy and practice once and for all.

January 24, 2011 at 5:03 pm Leave a comment

Health Care Reform: A Family Value – Support it!

While some work to repeal Health Care Reform, others are already benefiting from its provisions.

People who have already benefited from health reform are at both ends of the age spectrum. Young and old, they reflect the family value of the law, particularly given these tough economic times when jobs are lost, unavailable, and employers are increasingly dropping benefits.

Here are some stories the Center for Medicare Advocacy has heard in just the last day:

1. A Connecticut State Health Insurance and Assistance Program (SHIP) counselor writes: “I know a lot of our seniors will benefit from the government slowly getting rid of the Donut Hole in prescription drug coverage.” This is echoed by many others including:
• An older Connecticut woman and her niece, from Delaware, both went into the Donut Hole in 2010 and both received $250 as a result of health care reform to help out.
• A gentleman from Florida reached the Donut Hole in both 2009 and 2010, and expects to do so again in 2011. He appreciated the $250 help in 2010 and, given his heart and other health problems, he will certainly benefit from health reform’s 50% discount on Brand name drugs in 2011.

2. Another individual writes:
• “I have a sister who is 25 years old and was unable to find a job that would provide health care coverage due to the economy. She has very serious ear problems and required two major surgeries to replace her ear drum in both ears. If she was not able to be on our parents’ health insurance plan, she would not have been able to afford the surgeries and would have gone completely deaf. It is very difficult to be a young person out of college during these times. Even if you can find a job, it is very difficult to find a full time job with health benefits. I consider myself extremely lucky that I did find a job with benefits, but do know many who had no health insurance for some time. These young people need the cushion of being on their parents’ insurance until 26 when they can find a stable job with health benefits because in this economy, less and less employers are offering benefits to young people.”

The importance of health reform allowing young adults to obtain coverage on their parent’s health insurance plan is reiterated by another individual:

• “ I can personally speak for the kids 26 and under part of this. I have two kids under 26. One does not live at home. He is 22 and working at a job without health insurance. He would have no health insurance without being able to stay on my insurance. He was able to have an expensive blood test to find out if he has a potentially life threatening blood disorder because he had my health insurance to cover it.”

3. Four of the Center for Medicare Advocacy’s own employees have young adult children who have lost their jobs or are employed, but their employers do not provide health insurance. Again, these young people only have health insurance as a result of health care reform which allows them to be covered by the Center’s health insurance. At least one of these young adults has an on-going mix of mental health and medical problems that require on-going health care.

Health care reform is helping families struggling to deal with illnesses, age, unemployment, and underemployment. The law advances family values.

January 4, 2011 at 6:48 pm Leave a comment

Health Policy Expertise

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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January 2011


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