Posts filed under ‘Help for Low Income People’

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

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

Proposed Home Health Co-Pay is a Big Mistake

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.

April 22, 2013 at 2:56 pm Leave a comment

Priorities: People – and Medicare – Before Drug Company Profits

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.

April 17, 2013 at 2:35 pm Leave a comment

Annual Medicare Payment Limits for Home Health – Even Worse Than Co-Pays for Beneficiaries

The Center for Medicare Advocacy has represented Medicare beneficiaries since 1986. As one of the few advocacy organizations in the nation solely serving Medicare beneficiaries, we strongly oppose home health episodic payment caps or any other such defined payment limits. The counterpart to this notion, caps on outpatient therapy, has created significant barriers to necessary care for thousands of our clients with long-term and chronic conditions. We have no doubt that episode caps would be harmful to some of those in greatest need of home care. Thus, we are adamantly opposed to such limits in the home health context.

The Center has long opposed Medicare home health co-payments, and continues to do so. Like caps, co-payments will limit access to in-home care for those most in need of these services. However, we are increasingly concerned about proposals to introduce home health payment limits. There is no question that home health payment limits would be disproportionately harmful for people with conditions such as traumatic brain and spinal cord injuries, Alzheimer’s, Parkinson’s disease, MS, and other such illnesses and disabilities. Without the possibility for ongoing home health care, these individuals may well need costly nursing home or hospital care.

For example:
• Our client, Mrs. Berkowitz, who is 81 years old and receives skilled physical therapy and home health aide services for her Multiple Sclerosis and related health needs, will require a nursing home if payment caps are instituted for Medicare home health.
Payment caps contradict and undermine growing efforts to promote better care, at lower costs, by encouraging and investing in home and community-based services.

Payment caps would also undermine the settlement just arrived at with the U.S. Department of Health and Human Services in the national class action law suit, Jimmo vs. Sebelius. The Jimmo Settlement makes it clear that Medicare coverage is available for home health patients who need skilled nursing or therapy to maintain or slow deterioration of their conditions. Jimmo holds the promise of continuing care at home for people with long-term conditions who would otherwise often need more intense and expensive institutional care. Medicare home health payment caps, however, would create a barrier to this care and provide a disincentive to home health agencies to offer care to this particularly vulnerable population.

December 3, 2012 at 9:58 pm Leave a comment

Medicare Helps People With Chronic Conditions Stay Home

Few people understand the value of Medicare’s home health coverage. In fact, many people who qualify for Medicare instead pay out-of-pocket, go without needed care, look to Medicaid for payment, or even enter nursing homes unnecessarily. Learn about Medicare home health coverage from nationally known beneficiary advocates. This Wednesday, September 12th!

Medicare Home Health Coverage for People With Long-term and Chronic Conditions
Presented by: Judith Stein, Executive Director/Attorney and Margaret Murphy, Associate Director/Attorney

September 12 from 2:00 – 3:00 PM EDT

Unknown to most people with Medicare, and contrary to what is often stated by the Centers for Medicare & Medicaid Services (CMS), the Medicare home health benefit can provide long term coverage for those who qualify. This webinar will help advocates understand the potential of this important coverage so that people with long-term and chronic conditions can obtain the nursing, therapy and home health aide care they need to remain at home. The presenters will explain:

* Prerequisites to obtaining Medicare home health coverage;
* Real and imagined limitations to coverage;
* Advocacy tips for obtaining and maintaining coverage;
* How to appeal home health coverage denials.

Register at http://www.naela.org/store/SearchResults.aspx?EventType=WEB

Download Speaker Bios at http://www.naela.org/app_themes/public/PDF/Meeting%20PDFs/Webinar/2012sep12webinarbio.pdf

September 10, 2012 at 7:54 pm Leave a comment

Cut Through the Rhetoric: Questions to Ask After the Supreme Court ACA Decision

Originally Published at Nieman Watchdog, in ASK THIS, June 14, 2012 (available at http://niemanwatchdog.org/index.cfm?fuseaction=ask_this.view&askthisid=00569), we offer reporters and editors a checklist for stories when the Supreme Court rules on the Affordable Care Act (ACA):

1. Did the Court strike down (or uphold) the entire law?

2. If the entire law is struck down:
  • What will happen to the Medicare Part D Donut Hole coverage, preventive benefit coverage improvements, Part D income-based premiums?
  • Will young adults receiving coverage up to age 26 on their parents’ plans immediately lose their coverage? Will they be able to get coverage elsewhere?
  • Will children with pre-existing conditions lose their coverage? If so, how will they get coverage in the future?
  • What will happen in states that have started to implement the law, for example by setting up “exchanges”? Will some states try to proceed without ACA?
  • What will happen to those who would have been covered by the Medicaid enhancements under the law?
3. Did the Court decide some components are “severable,” (able to proceed although other components of the law are invalid)?
  • If so, what was struck down?
  • What is left?
4. If the individual mandate is struck down (the requirement that people maintain minimum coverage or pay into the system), what does that mean for health care reform?
  • Can the law still work without this requirement?
  • Can the law be amended to make it work, without a minimum coverage mandate?
5. If the law is struck down in whole or part:
  • What demographic groups will be most harmed?
  • What will be the effect on costs to the federal government, states, and individuals?

Unless the entire law is upheld, people in need of health care will lose. Be ready to recognize what will be lost – and by whom.

June 15, 2012 at 2:59 pm Leave a comment

Protecting Medicare and the Middle Class: Themes From The State of the Union

As described in his State of the Union address, the President’s blueprint for a lasting economy is both necessary and commendable. An essential part of that blueprint is ensuring all Americans have access to high-quality, affordable health care. As the President stated, we need to ensure that Medicare “remain[s] a guarantee of security” for older Americans and individuals with disabilities. When private insurance let older people down in the 1960s, Americans embraced the President’s theme of “shared responsibility” to care for our most vulnerable citizens by creating Medicare. While the economic security of the middle class has declined for decades, Medicare has dramatically enhanced the economic and health security of hundreds of millions of older Americans and people with disabilities.

And yet, the future of Medicare hangs in the balance as members of Congress discuss ways to privatize Medicare and diminish the security it provides for middle class families.

“We applaud the President’s commitment to continuing Medicare as a community program that families can rely on,” states Judith Stein, founder and executive director of the Center for Medicare Advocacy. “Medicare is an American success story. It has served American families and adapted with the times for more than four decades. It has provided a critical economic lifeline for families” she continued. “We can not afford to risk the security of the next generation by giving Medicare away to private insurance companies.”

The Center for Medicare Advocacy also echoes the President’s call to uphold the consumer protections and health coverage in the Affordable Care Act. “The Affordable Care Act greatly enhanced Medicare,” says David Lipschutz, policy attorney at the Center for Medicare Advocacy. “Since it was signed into law, millions of older and disabled Americans with Medicare have received more help in paying for their prescription drugs, putting money back into their pockets. Among other things, the Affordable Care Act has also added no-cost preventive benefits for people with Medicare and extended the solvency of the program.”

Medicare is a tried and true American value that provides high-quality, cost efficient health care for our grandparents, parents, neighbors and friends. “Pretending to protect Medicare by shifting costs from the federal government back to older people and their families would negate Medicare’s original purpose: to protect older people and their families from illness and financial ruin due to health care costs,” said Judith Stein. “We thank the President for defending Medicare’s guarantee of security and resisting calls for a private voucher system that would further endanger the middle class and destroy the national treasure we’ve known as Medicare.”

January 25, 2012 at 5:22 pm Leave a 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.

Judith A. Stein, Executive Director

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