Posts filed under ‘Judith Stein’

The Rush to Destroy Medicare as We Know It

November 29, 2016 – Despite statements during the campaign that he would protect Medicare, the President-Elect is indicating otherwise with his selections of Rep. Tom Price (R-GA) to head the Department of Health & Human Services, and health consultant Seema Verma to head the Centers for Medicare & Medicaid Services.

Price is an ardent foe of the Affordable Care Act, although it has extended the solvency of the Medicare Part A Trust Fund, closed gaps in prescription drug coverage, and expanded preventive benefits under Medicare.

Particularly threatening to Medicare and Medicare beneficiaries, says Center for Medicare Advocacy Executive Director, Judith Stein, “Rep. Price favors letting people opt-out of Medicare. Allowing beneficiaries – most likely the healthiest beneficiaries – to opt out of Medicare is an example of what Newt Gingrich in 1995 called letting the program ‘wither on the vine.’ The key to future solvency is a larger coverage pool, not a smaller one. That’s just how insurance works.”

In addition, Mr. Price’s proposals to rely on tax credits as incentives to purchase insurance ignore the fact that a huge number of families don’t make enough income for such credits to be worthwhile. Further, CMS nominee Verma favors Health Savings Accounts – another private option that would break up the Medicare community. “All of these proposals,” continued Ms. Stein, “will be sold to Medicare beneficiaries as ‘preserving’ and ‘protecting’ Medicare. In fact, they will end Medicare and turn it over to the private insurance industry.”

 

November 29, 2016 at 5:44 pm Leave a comment

Medicare Is Withering on the Vine

In 1995 Newt Gingrich predicted that privatization efforts would lead Medicare to wither on the vine. He said it was unwise to get rid of Medicare right away, but envisioned a time when it would no longer exist because beneficiaries would move to private insurance plans.

Well … that’s what’s happening.  Not just by happenstance, but rather according to a determined, strategic plan. The plan has included the following:

  1. Government subsidies to private plans, renamed “Medicare Advantage,” ranging from 14% –  2% above traditional Medicare per-beneficiary costs;
  2. Additional benefits added to private Medicare Advantage, benefits that weren’t added, and aren’t allowed, in  traditional Medicare;
  3. Part D prescription drug coverage wrapped into Medicare Advantage, but not into traditional Medicare;
  4. Increases in traditional Medicare Part B premiums, especially for the middle class;
  5. Limits on access to Medigap insurance to supplement traditional Medicare and on benefits for those who can obtain a Medigap policy.

It didn’t take a crystal ball.  It took a vision, planning and persistence.

The Center for Medicare Advocacy also has vision, planning and persistence. We do all we can to keep Medicare focused on the needs of older and disabled people, not the insurance industry. We speak out with expertise and with  the stories of real people.

With your support, we’ll keep insisting that Medicare is fully present for the families that rely on it – now and in the future. We’re ready to keep Medicare from withering on the vine.

Will you help?

November 28, 2016 at 4:48 pm Leave a comment

Telling It Like It Is: The Ryan Plan Would Kill Medicare

The title of Paul Krugman’s piece in today’s NY Times says it all. The Medicare Killers tells the truth about the Trump/Ryan plan to turn back the clock on Medicare and give it away to the private  insurance industry. A good deal for insurance companies, but a very bad deal for the 60 million older and disabled people who access health care through Medicare. Importantly, as Krugman writes, this is not necessary.  It’s just the latest ploy to privatize Medicare.  Call it what it is.

Help the Center for Medicare Advocacy speak out against false claims and misinformation that could rob older people and people with disabilities of necessary health care – and diminish Medicare for generations to come. Spread the word. Tell the truth about Medicare.

November 18, 2016 at 4:35 pm Leave a comment

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

As We’ve Been Saying!

Finally, the Center’s long-time concerns about costly misuse of public Medicare funds may be gaining attention. For years we’ve been pointing to Medicare overpayments for prescription drugs and to private Medicare Advantage plans. These huge expenditures help pharmaceutical and insurance industries, not older and disabled people. If these costs were reigned in, billions of dollars would be freed to cover necessary health care and sustain the Medicare program. This week these matters received some much needed publicity:

Prescription Drug Pricing

An excellent and well-timed (given #Epi-gate) article appeared in this week’s Journal of the American Medical Association discussing the reason drug costs are so high in the U.S. According to the article, the major cause is the “granting of government-protected monopolies to drug manufacturers, combined with restriction of price negotiation at a level not observed in other industrialized nations.” Thus, state the authors, “providing greater opportunities for meaningful price negotiation by governmental payers” is one of the conclusions. A “possible solution” is described as “Price negotiation: Enable Medicare to negotiate drug prices for individual Part D plans and to exclude coverage for expensive products that add limited clinical benefit; experiment with value-based drug pricing and rational prescribing reimbursement models for Medicare.” For more information, see http://jama.jamanetwork.com/article.aspx?articleid=2545691#.V8OQC8OH7Hg.twitter

Medicare Advantage Overpayments

NPR recently published an article from the Center for Public Integrity entitled “Medicare Advantage Audits Reveal Pervasive Overcharges” (August 29, 2016) by Fred Schulte. The article reports on recently-released federal audits of 37 Medicare Advantage (MA) plans relating to overpayments made in 2007. According to the author, these “audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression.”
As discussed in previous Alerts, including one in May 2016 entitled “Government Auditor Finds Billions in Improper Payments to Medicare Advantage Plans Coupled with Inadequate Oversight by Federal Regulator,” MA “upcoding” – when an MA plan reports an enrollee as being more sick than they actually are in order to obtain a higher risk-adjusted payment from the Medicare program – remains a problem that policymakers must address, particularly as they weigh policy proposals that would shift additional costs on to Medicare beneficiaries.

August 31, 2016 at 9:45 pm Leave a comment

Joining Forces With The John A. Hartford Foundation to Help Hospital Patients

July 14, 2016 – The Center for Medicare Advocacy (CMA) is thrilled to be partnering with The John A. Hartford Foundation to improve care for older adults with long-term and chronic conditions. With the Foundation’s generous two-year grant, CMA will be able to focus on solutions for older adults caught in the web of hospital “outpatient” Observation Status, which reduces access to key health and therapeutic care.

Over the two-year grant period, CMA, will gather existing resources and collect stories from beneficiaries, produce and update advocacy materials, and conduct extensive outreach and education that will improve observation status policy through regulatory change, improved federal guidance, and increased awareness by legislators. The grant funding for this project will also strengthen CMA’s advocacy on other important issues, including increasing access to oral health care for older adults.

“Outpatient” Observation Status is a policy created by the Centers for Medicare & Medicaid Services to classify certain very short hospital stays for billing purposes. The intent was to identify, and pay less for, these stays.

Medicare hospital patients are increasingly classified as “outpatients” on Observation Status, rather than admitted inpatients. This is true even for patients who are in the hospital for many days, for diagnosis, tests, nursing, physician care and treatment. Unfortunately, Observation Status results in myriad unintended consequences. For example, Medicare coverage for post-hospital nursing home care is often entirely unavailable for Observation patients since it requires a 3-day prior inpatient hospital stay. Thus, Observation Status “outpatients” are ineligible for Medicare nursing home coverage even if they were in the hospital for many days or weeks.

Hospital Observation Status has profound consequences for the quality and cost of care available for older, vulnerable Medicare patients. It also harms hospitals and nursing homes, the Medicare appeals process, the integrity of the Medicare program – and shifts costs to State Medicaid budgets. With support from The John A. Hartford Foundation, CMA will be able to enhance efforts to reduce the harm caused by Observation Status and to advocate for better care for older adults.

“We are very pleased to support the passionately driven and highly expert staff at CMA, led by the indomitable Judith Stein,” said Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation. “As our Foundation works to create age-friendly hospitals and health systems, CMA’s important policy work will raise visibility and diminish the negative impact of the Observation Status classification of older hospitalized adults through outreach and education.”

July 14, 2016 at 8:05 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

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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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