Posts filed under ‘Access to Health Care’

It Isn’t That Complicated: You Don’t Have to Improve

As the New York Times reports today, people don’t have to improve to qualify for Medicare-covered care in most settings.  Unfortunately, older and disabled people are constantly told otherwise – and refused care as a result. The Centers for Medicare & Medicaid Services could fix this pretty easily.  Just issue a CMS Ruling stating definitively and clearly that skilled nursing and therapy can be covered to maintain a patient’s condition or slow deterioration.  It’s the law. Disseminate the Ruling to all Medicare providers and adjudicators.  Post it on the CMS website.

If there’s the will, there’s the way.



September 12, 2016 at 8:05 pm Leave a comment

Proposed Budget Seeks to Reduce Dramatic Rise in Part B Costs: Advocates Remain Concerned About Underlying Causes

October 27, 2015 – Congress is considering the Bipartisan Budget Act of 2015. This proposed budget agreement would reduce an expected spike in the Medicare Part B deductible and premiums for 2016. The premium increase, expected to be over 50% for beneficiaries who do not already have premiums taken from their Social Security, will instead be about 15%. Similarly, the Part B deductible would increase approximately $20.00 rather than the previously projected $75.00.  The cost of limiting the increases will be paid for by a loan from general revenues. Medicare beneficiaries will pay back the loan over time from set increases to future premiums.

“While we have concerns about the way in which the Part B cost-sharing resolution is paid for, we are glad people who rely on Medicare can breathe a bit easier – knowing their premiums and deductible will not skyrocket next year,” said Judith Stein, founder and executive director of the Center for Medicare Advocacy.

Although relieved that Congress seems poised to address next year’s Medicare Part B cost-sharing, the Center for Medicare Advocacy remains concerned about the expenses underlying these increases. “We continue to urge law-makers to join Congressman Courtney in asking Secretary Burwell to investigate and fix the underlying reasons for the huge increase in Part B costs. Much of the increase seems to come from parallel increases in billing inpatient hospital care to Part B through the use of so-called ‘outpatient’ Observation Status.”


October 27, 2015 at 8:54 pm Leave a comment

Hold The Applause

We agree it’s important to find a permanent solution to the physician payment formula (“Sustainable Growth Rate” or SGR), but the Bill passed by the House of Representatives today is not the answer. It isn’t balanced. It asks too much from beneficiaries without providing enough in return. It asks nothing from pharmaceutical or insurance companies. It continues the ever-increasing privatization of Medicare by increasing costs for beneficiaries for traditional Medicare and Medigap plans. It adds unnecessary costs for the Medicare program and taxpayers.

Of the portion of the SGR costs that will be off set, roughly half (approximately $35 billion of the total $70 billion over 10 years) would come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care, including:
• Adding deductibles to Medigap plans purchased by new Medicare beneficiaries starting in 2020;
• Further means-testing premiums for higher-income beneficiaries; and
• Overall increases in Part B premiums.

While the SGR package would make the low-income, Qualified Individual (QI), program permanent, which we strongly support, and would minimally increase and temporarily extend important funding for beneficiary education and outreach, it does not address other key issues that serve as barriers to care. For example, instead of repealing the annual outpatient therapy caps, the process to seek an exception to the cap is extended for another two years. Instead of addressing hospital Observation Status, the Bill further extends enforcement of the so-called “two-midnight” rule.

In short, Medicare beneficiaries would pay too much, with too little in return. Major drug and insurance industries pay nothing, and stand to gain a great deal. As the SGR debate moves to the Senate, we hope further balance and improvements for beneficiaries will be made.

March 26, 2015 at 9:22 pm Leave a comment

2015 Marks the 50th Anniversary of Medicare – Help Ensure its Future

Since 1965, Medicare has opened doors to health care and increased economic security for hundreds of millions of older people, people with disabilities, and their families.

2015 will also usher in a new Congress. Many of its leaders and members will likely champion plans to further privatize Medicare. These proposals will likely surface despite increasing reports that Medicare costs and the federal deficit are declining, and that traditional Medicare costs less than private Medicare. Once again we will likely hear about plans to transform Medicare to “Premium Support” (a voucher towards the purchase of private insurance). We will probably read about proposals to increase the age of Medicare eligibility, decrease the value of Supplemental Medicare Insurance (Medigap), redesign Medicare to make it “simpler” (but less useful for most beneficiaries). We urge you to listen carefully for these and other such plans. And respond!

Since 1986, the Center for Medicare Advocacy has been on the front lines, advocating for people who depend on Medicare and for a comprehensive Medicare program for future generations. As we mark Medicare’s 50th anniversary, help us ensure its promise to advance access to healthcare. Help us explain what’s true and what’s not, where real savings exist, and when the true interests of beneficiaries are at stake. Help us ensure a real Medicare program lasts for another 50 years.

Be part of our Medicare Truth Squad. Ask us if you have questions. Spread the word – on Twitter, Facebook – in conversations! The future of a comprehensive Medicare program may depend on it.

December 30, 2014 at 6:56 pm Leave a comment

Profits Over People

In “Fighting to Honor a Father’s Last Wish: To Die at Home” (the New York Times, September 25, 2014) author Nina Bernstein eloquently lays out the heartbreaking story of Joseph Andrey, whose last year of life was spent shuttling between inadequate care in every possible care setting.  Often the services he received were provided in the most expensive available setting, regardless of the wishes of the family.  Mr. Andrey finally died back in his home, but that final year of his life, quite likely the lowest quality-of-life year he ever endured, cost over a million dollars in Medicare, Medicaid and private funds.

It doesn’t have to be this way.

Unfortunately, too often it is. I have devoted over 30 years as a lawyer to Medicare advocacy, yet I could not help my uncle when his Medicare coverage was prematurely ended in the hospital and the nursing home. This resulted in his ending up at home with inadequate care, and he, too, experienced many of the dreadful occurrences that befell Mr. Andrey. A day after his death, and almost a year after his premature discharge, we won his Medicare appeal. Like too many others, he died after poor care and unfair denials from his private Medicare plan. Another victim of profits over people.

September 26, 2014 at 8:10 pm Leave a comment

Corporations Don’t Bleed

Too often people with low and moderate incomes fail to get the health coverage they need.  Women are frequently harmed the most.  In addition to their own health concerns, they are usually the gender responsible for family-planning and family care-taking.

The Supreme Court’s decision in Hobby Lobby reduces women’s rights and erodes women’s access to health care.  In Hobby Lobby, the Court found that “closely held” corporations needn’t provide health insurance for their employees if it would violate their religious beliefs  Incredibly, the decision advances corporate rights over women’s rights.  And it advances the notion that corporations are people too – with religious beliefs!

Corporations don’t bleed; they don’t get pregnant; they don’t take care of children and parents.  Women do.

Congress:  Take action.  Reconsider the Religious Freedom Restoration Act at the heart of the Hobby Lobby decision.

Women, Men, people who bleed, get sick, and take care of others who do:  Speak out against this injustice.

July 2, 2014 at 4:47 pm Leave a comment

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 1 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.

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