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President Obama Supports Medicare
Thank you, President Obama, for proposals that strengthen Medicare. We are so pleased, and relieved, to have a leader in the White House who’s drawn a line, refusing to pretend the elimination of Medicare and Medicaid are necessary to protect America’s future. Instead, he’s called for real, shared responsibility and is continuing efforts to provide affordable health care for all.
The President’s framework for fiscal responsibility protects the integrity of Medicare and Medicaid by building upon the progress made in the Affordable Care Act to cut overall health care costs. His proposals strengthen both programs while achieving savings by addressing Medicare physician payment reforms; reducing overpayments; improving care for those who are eligible for both Medicare and Medicaid; and focusing on wasteful spending and cost growth.
The President was explicit about his vision for Medicare and Medicaid when he said:
…”let me be absolutely clear: I will preserve these health care programs as a promise we make to each other in this society. I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs. I will not tell families with children who have disabilities that they have to fend for themselves. We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations.”
The Center for Medicare Advocacy applauds the President for his work to preserve Medicare, Medicaid and the well-being of American families who are already struggling in today’s economy. We thank the President for recognizing that fiscal responsibility for the federal government does not mean eliminating programs like Medicare and Medicaid that work to provide access to health care for vulnerable populations. Nor does it mean saving federal dollars by shifting costs to states, families and taxpayers.
What a breath of fresh air!
Rationing Medicare & Health Care?
The budget released on April 5th by the House of Representatives purports to benefit Main Street Americans.
Once again we’re hearing proposals to “reform” Medicare and to cut the federal deficit. These plans are not about reform or even dedicated to deficit reduction. They are about a long held desire to do away with Medicare, shifting costs to American families who are already struggling.
Newt Gingrich said in the 1990s that he might not be able to eliminate Medicare, but he could watch it wither on the vine. This time, the House of Representatives’ Republican budget actually does eliminate Medicare, replacing it with vouchers to purchase private insurance.
This proposal is reckless and extreme. As with Medicare Advantage and Medicare Part D, it will cost beneficiaries and taxpayers more than the traditional Medicare program. With a capped annual voucher to purchase insurance, Medicare beneficiaries will pay more out-of-pocket, get less coverage, and have less access to health care.
Sounds like rationing to us.
What’s The Benefit of De-Funding Health Care Reform?
The House of Representatives will vote today on an amendment to the 2011 Continuing Budget Resolution that would prevent all spending to implement the Affordable Care Act, the health reform law enacted almost one year ago. “This amendment is not in the interest of Medicare, the current fiscal crisis, or families,” says Judith Stein, executive director of the Center for Medicare Advocacy. “Defunding health care reform would endanger children who have pre-existing conditions, deprive uninsured young adults from coverage under their parents’ plans, limit Medicare coverage for preventive services, and end important consumer protections for Americans of all ages.” The amendment to defund health care reform would also eliminate tax credits to small business for providing health coverage to their employees, and would increase the deficit by over $200 billion over the next 10 years.
The Center for Medicare Advocacy has already seen how health reform has improved the lives of millions of people. For example:
• Our clients who are Medicare beneficiaries no longer have to pay cost-sharing for preventive services, and they are now eligible for an annual wellness visit.
• Those with high prescription drug costs will pay less out of pocket for their medicine when they enter the prescription drug donut hole or coverage gap.
• Fewer older people with both Medicare and Medicaid had to change their prescription drug plan in order to be in $0-premium Medicare drug plan.
• Four of our own Center staff members have young adult children who are now covered by the Center’s health plan; without the coverage they would be uninsured.
If the House votes to defund implementation of health reform, all of these people, and millions like them throughout the country, will lose the protections they have already received.
“This amendment is driven by ideology, not serious concern for the welfare of Americans, Medicare, small business, or the American economy,” continues Ms. Stein. We urge Congress not to move backwards by depriving Americans of increased access to fair, affordable health care. Implementation of the Affordable Care Act should be fully funded and should go forward so that, by 2014, all Americans have health insurance, regardless of their age, income, or health status.
Come On! Let’s Get On With Insuring People and Focusing On Our Many Real Problems.
From The White House Blog
The Senate and the Affordable Care Act
Posted by Stephanie Cutter on February 02, 2011 at 08:53 AM EST
Instead of moving forward to create jobs and strengthen our economy, Senate Republicans want to refight the battles of the past and vote to repeal the Affordable Care Act – the new health reform law.
It’s important to remember what repealing the Affordable Care Act would mean to millions of Americans. Without the new law:
• Over 1.2 million young adults will lose their insurance coverage through their parents’ health plans.
• Up to 4 million small businesses that would have been eligible for health care tax credits will pay higher taxes.
• 44 million Americans on Medicare will be denied free preventive care and seniors who hit the donut hole will pay more for their prescription drugs.
• Insurance companies will have free rein to once again deny coverage to people, including children, with pre-existing conditions, cancel coverage when people get sick, and limit the amount of care people get, even when they need it.
• Insurance companies will be free to once again raise premiums by double digits with no recourse or accountability.
• As many as 32 million Americans who would have gained insurance under the new law will go without coverage.
• Families will pay higher premiums. For example, compared to what they would have paid without the law, the Affordable Care Act could save a family of four with an income of $33,525 as much as $14,900 per year.
By rolling back the Affordable Care Act, Republicans are also voting to add a trillion dollars to the deficit. The non-partisan Congressional Budget Office has concluded that repealing the Affordable Care Act would add nearly a quarter of a trillion dollars to the deficit in the first decade – $230 billion – and more than a trillion dollars in the second decade.
And according to independent experts, repealing the Affordable Care Act would prevent 250,000 – 400,000 jobs from being created each year.
President Obama and his team are committed to moving forward and delivering the benefits of the new law to the American people. We know that health reform is already delivering tax credits to small business owners like Betsy Burton of Salt Lake City, Utah. Thanks to the new law, young Americans like Kayla Holmstrom of Brookings, South Dakota are able to stay on their parent’s health plan. James Howard of Katy, Texas, a brain cancer patient, has the treatment he needs. And Cathy Lynn Howell from Marblehead, Ohio finally has insurance after being locked out of the insurance marketplace because of her pre-existing condition.
We featured all of these Americans in our Voices of Health Reform project and they are just a few of the millions of people who are already benefitting from the Affordable Care Act. And we’re committed to moving forward, strengthening the health care system for all of us and delivering the benefits of reform to the American people.
Stephanie Cutter is Assistant to the President and Deputy Senior Advisor.
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.
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.
What is a Quality Medicare Advantage Health Plan?
It’s open enrollment season again, and Medicare beneficiaries and their families are barraged with mail, TV and radio commercials, and print ads describing the Medicare Advantage and prescription drug plan (PDP) options in their area. This year, Congress and Medicare would like people to consider the quality ratings of plans when making their choice for 2011. Beneficiaries can find quality information about plans on the Medicare Plan Finder tool. Plans are evaluated on a 5-star rating system that looks at medical care as well as customer relations, including complying with CMS rules about marketing and about appeals.
Quality ratings are so important that the new health reform law, the Affordable Care Act, awards quality bonuses, starting in 2012, to all Medicare Advantage plans if they score at least 4 out of 5 stars on the Medicare 5-star rating system. Quality ratings are so important that CMS, the Medicare agency, even moved up the starting date of and expanded eligibility for the quality bonus payments to Medicare Advantage plans. In fact, Medicare has created a demonstration project for 2011 that will give Medicare Advantage plans a bonus payment if they achieve 3 out of 5 stars on the star system.
But what does it mean to be rated “a high-quality Medicare Advantage Health Plan?”
Ask Arcadian Health Plans, a parent company that has been in existence since 1997, and that offers Medicare Advantage plans in 15 states. On November 17th Arcadian sent out press releases to many of the communities in which they offer Medicare Advantage plans to announce that they had been awarded the 2011 Senior Choice Gold Award by HealthMetrix Research “for excellent value among Medicare Advantage plans.” See, e.g., Southeast Community Care’s Medicare Advantage Part D Plan is Rated the #1 Value for Medicare Beneficiaries in the Roanoke Area, http://www.prnewswire.com/news-releases/southeast-community-cares-medicare-advantage-part-d-plan-is-rated-the-1-value-for-medicare-beneficiaries-in-the-roanoke-area-108768449.html; Texas’ Community Care’s Medicare Advantage Part D Plan Is Rated the #1 Value for Medicare Beneficiaries http://pr-usa.net/index.php?option=com_content&task=view&id=540001&Itemi.
Yet, two days later, on November 19th, CMS announced it was sanctioning Arcadian Health Plans and two other health plan sponsors and not allowing them to market or enroll new beneficiaries. Arcadian is being sanctioned for violations in marketing the plans they offer to beneficiaries. For example, Arcadian has given beneficiaries incorrect information about whether their doctor is in the plan network or whether their prescription is on the plan’s formulary. Arcadian plan agents may even have enrolled people into health plans who had not consented to, let alone known about, the enrollment. And, according to the letter CMS sent to the plan, CMS has been looking at Arcadian’s marketing activities since 2008.
See, http://op.bna.com/hl.nsf/id/bbrk-8bcule/$File/Arcadian%20Sanctions%20Letter.pdf.
If CMS is going to suggest that beneficiaries consider enrolling in particular, “highly-rated,” Medicare Advantage plans or PDPs because of the quality of coverage and services they provide, and if these plans are going to get extra bonus payments, we need to be clear about what a high quality plan is – and is not!
Perhaps Arcadian’s press releases are another example of marketing violations that should be investigated by CMS.
Our NY Times Letter to the Editor – Improvement Standard Impacts Coverage and Care
The Center for Medicare Advocacy reiterates last week’s New York Times story: the Medicare Improvement Standard is an unjust danger to people in need of care!
http://www.nytimes.com/2010/11/08/opinion/l08medicare.html?_r=1&emc=tnt&tntemail0=y
CMA Health Policy Blog 