Tag Archive for Reform (x)

ElizabethGHoward | 02/02/2011
No comments

Medicare Advisory Panel recommends co-pay for home health

The Medicare Payment Advisory Commission wants a copayment to discourage misuse of home health care services.

The congressionally appointed commission voted 13-1 to recommend that lawmakers impose the new charge. Two commissioners abstained and one was absent.

According to the Associated Press, home health services, which are currently covered under Medicare, cost taxpayers approximately $20 billion a year.

The co-pays, commission chairman Glenn Hackbarth said, would help avoid the benefit turning into a “long-term care social support system.”

Concerns with Medicare fraud and a tight budget have motivated the commission to look for cuts. Home health care was originally considered a “cost saver.” Now increasing costs and big differences in how communities around the country use the benefit have given lawmakers reason to make changes.

Exemption from the recommendation would include low-income patients covered by Medicaid, as well as those just discharged from the hospital. According to the AP, more than 30 million beneficiaries in traditional Medicare would be directly subject to the fee.

The recommendation was strongly opposed by AARP lobbyists who support a strong network of home providers to assist the more than 3 million seniors and disabled people on Medicare who are not able to easily leave home.

In September, AARP strongly supported The Home Health Care Planning Improvement Act of 2010, House Bill 4993 and Senate Bill 2814, which was a bi-partisan effort to expand the roles of nurse practitioners and physician assistant to allow them to certify home healthcare plans for Medicare patients.

In rural parts of the country, areas where the nation suffers from shortages of physicians, many Americans see nurse practitioners as their primary care provider.

Category: Medicare News, Senior Healthy Living | Tags: , , , , , ,
Lucy Dylan | 07/29/2010
No comments

3 Million More Americans Uninsured in 2009

As the health care debate raged onwards in 2009, the number of uninsured American adults rose by 3 million from 2008. Overall, approximately 46.3 million people in this country do not have health insurance covered.  In Texas, over one out of every four people was uninsured in 2009, compared to the 15.4 percent nationally.

The Center for Disease Control (CDC) survey found that almost 60 million people went without health insurance for at least part of the year, and 33 million of the uninsured had gone without for over a year.  People who were fortunate to keep their private coverage ended up paying more, while high-deductible plans also grew in popularity—especially among people who purchase their own health insurance plans.

Massachuetts, uninsured, COBRA, unemployment, healthcare, insurance, reform, Obama, cost-control, Affordable Health Care Act

3 Million More Uninsured in 2009

Fewer children are going without health insurance plans because they are enrolled in public policies.  See my previous article onCHIP and enrollment strategies the government may be using to get more kids into the program. However, almost one third of Americans between the ages of 18 and 24 did not have health insurance, the highest percentage of any other age group. Still, the fact that the ranks of the uninsured actually expanded in 2009 are worrisome to me.

Although individuals can still pay out of pocket for services, health insurance remains the most crucial portal to receiving adequate health care.  People who are enrolled in health insurance plans, regardless of the level of coverage, have far more access to preventative medical services. There is no denying that adequate medical care is expensive—rising medical costs in addition to the economy make insurance critical to obtaining health services.  If you are uninsured, you are more apt to delay health care until your illness is severe. According to research by the Harvard Medical School, around 45,000 Americans die every year because they are uninsured and therefore cannot receive adequate health care.

This study highlights the importance of health insurance in the United States today.  For the most part, people without health insurance are more likely to have lower incomes, and face an uphill battle when it comes to paying for care out of pocket.  Increasing rates of uninsured Americans is undoubtedly linked to the recession, which keeps them away from receiving the care they need. The fact that so many Americans remain uninsured—whether by choice or by economic necessity—proves very relevant to the 2010 Affordable Care Act. Escalating rates of un-insurance and skyrocketing medical costs are huge problems in the United States today.

When 2014 rolls around, enrolling the uninsured in new health insurance plans will be a daunting task.  The Affordable Care Act will broaden insurance to over 30 million citizens, who will likely need a little prodding when it comes time to enroll.  Canvassing campaigns in low-income neighborhoods aim at enrolling uninsured children in CHIP or Medicaid,working as a test run for the 2014 expansion of health insurance coverage.

As in my last blog about Massachusetts Health Care Reform, it is not the broader coverage that I am concerned about. Hopefully, the government will take cues from Massachusetts and ensure that the reform will not grow so costly that expenses outweigh coverage benefits.

Category: Medicare News, Medicare Tips | Tags: , , , , , , , , , , ,
Lucy Dylan | 07/27/2010
No comments

Response to The Hill’s Healthwatch Blog

Starting this year, the Affordable Care Act will affect all Americans, regardless of age, income, and gender. So why don’t our country’s senior citizens understand healthcare reform?

According to Mike Lillis from THE HILL’S Healthwatch blog, a recent study by the National Council on Aging (NCOA) discovered that few seniors knew about and understood the ins and outs of health care reform.  The NCOA distributed a 12 question survey to 636 seniors. No senior got all the survey questions right, indicating the widespread lack of knowledge about reform.

The Hill Healthwatch Blog, how much do Americans know about healthcare reform, what do Americans know about healthcare reform, healthcare reform senior citizens, National Council on Aging, Affordable Care Act

Response to The Hill's Healthwatch Blog

The NCOA reported that more than 40 percent of respondents believed that the Affordable Care Act would reduce their Medicare benefits—even though that’s not the case at all.  Almost 40 percent of the seniors surveyed didn’t even know how to respond to that question—another scary statistic. Less than 20 percent of those seniors understood that the Affordable Care Act did not slash payments to doctors who primarily treat Medicare beneficiaries. Finally, only about a third of those surveyed had heard about the free annual wellness appointment now supplied by Medicare.

Most seniors were aware of the new law’s basics: for example, more than 40 percent of the seniors answered that the Affordable Care Act would extend health coverage to more Americans. Many respondents were well aware of the government’s initiative to close the “doughnut hole,” or prescription drug coverage gap.

Lillis argues that such misinformation may pose a threat to the Democrats in the upcoming midterm elections in November.  The Affordable Care Act is on the hot stove of American politics, and with widespread misunderstanding of the law, the Democrats may have difficulty using health care reform to sway voters.  Seniors are important to the success of the Democrats in November.

However, providing seniors with resources that they trust is another matter unto itself. According to the NCOA, seniors simply did not trust the information they had about the new health care reform.  Seniors felt that information about the Affordable Care Act was biased and unreliable, pushing the agenda of one group or another. Political jargon can often clutter the facts, making it difficult for all people, including seniors, to seek unbiased information about the reform. Ultimately, seniors—and citizens in general—deserve accurate information about the laws so that they can understand the law’s impact on them and formulate their own thoughts and opinions about reform. Perhaps the NCOA’S new program, “Straight Talk for Senior on Health Reform” can improve seniors’ understanding of health reform—and possibly impact November’s results?

Category: Medicare News, Medicare Tips, Prescription Drug Coverage | Tags: , , , , , , , ,
Mona Lisa Vito | 07/22/2010
No comments

Public Option Not Dead On the Hill

A coalition of House Democrats is gearing up to propose legislation which revives the public option President Obama had originally hoped to carry through this year’s healthcare overhaul. The legislation House Democrats plan to introduce today would establish a government-administered insurance option available to consumers as part of The Affordable Care Act’s insurance exchanges.

public option, health insurance exchanges, healthcare reform, affordable care act of 2010, barack obama, kathleen sebelius, lynn woolsey, congressional budget office estimate

Public Option Not Dead On the Hill

The bill, sponsored by Rep. Lynn Woolsey (D-CA), has 125 co-sponsors and is similar to the public option originally passed by the House Education and Labor Committee earlier this year but adjusted to fit within the framework of insurance exchanges which eventually made it into the reform debate’s final product. Woolsey says the non-partisan Congressional Budget Office has scored this legislation better than the public option in the House’s original healthcare bill. This bill sets public option reimbursement rates at 5% above Medicare rates.

Though most proponents admit it’s unlikely the bill would come to a vote this Congress, its co-sponsors argue if passed it would help bring down the deficit. For this reason, although it is unlikely the bill will pass this year its co-sponsors defend its introduction on a symbolic basis. By reintroducing it, they hope to remind legislators and votes alike that the public option is a viable option.

Category: Medicare News | Tags: , , , , , , ,
Lucy Dylan | 07/15/2010
No comments

Fighting Medicare Fraud

Medicare Fraud Identity Theft

Medicare Fraud Identity Theft

One issue plaguing the Medicare reforms is Medicare fraud. Every year, both seniors and the government lose quality health care and billions of dollars to corrupt providers.  Medicare fraud isn’t new (see my previous blogs on fraud and scams), but as the new health care reforms have passed, fraud has been in the spotlight. Medicare fraud affects everyone, from the government to seniors to taxpayers.

Cutting costs for health care is integral to health care reform. According to the United States government, taxpayers lose over 60 billion dollars every year due to Medicare fraud.  The government uses taxpayer money to finance Medicare, so when people abuse the system, it is the taxpayers who pay the price.

South Florida is the hotbed of these schemes, full of phantom pharmacies and providers, where criminals can earn tremendous amounts of money by cheating the government. Scammers sometimes purchase businesses like pharmacies, along with Medicare licenses and patient records, and use that information to charge Medicare for drugs and other services. According to a report by ABC news, one man’s Medicare card was used to purchase two prosthetic legs—even though the man had both of his legs, Medicare was slow to respond. Because Medicare moves very slowly, even when dealing with something like fraud, it is easy for con men to get away with their crimes.

Con men and fraudsters aren’t the only ones to participate in Medicare fraud schemes. Some corrupt health care providers overcharge Medicare for certain services that may or may have been performed improperly. Not only does this swindle the government out of millions of dollars, but also can harm the health of Medicare beneficiaries.  Most doctors and other providers are not involved in any of these scams, but the minority who do fraudulently charge Medicare waste government cash and harm senior health.

Preventing Medicare fraud could save the government—and taxpayers—billions of dollars annually, making it imperative to crack down on scammers and corrupt providers.  In the current system, responses to fraud are often slow and cumbersome, with little action taken. When Medicare cracked down on fraudulent equipment sales in South Florida, Medicare durable medical equipment claims dropped by $1.76 billion. By making more of an effort to combat fraud, it will be possible to save billions of dollars.

Recently the Department of Health and Human Services proposed that individual workers found responsible for Medicare fraud should be removed from the Medicare program.  Currently, only people who are still working for a company convicted of Medicare fraud can be excluded from the program, so employees can leave the company in order to evade exclusion.  Two Representatives from Florida proposed legislation that cracks down on individual executives, preventing them from working with Medicare after they have been convicted.

President Obama plans to sign a memo that would create a “do not fraud” list to combat Medicare fraud.  Consequently, the government would not send payments to deceased people, suspended contractors, or other delinquents to cut down on fraudulent payments. According to the Washington Post, within a three year time span, CMS sent approximately $182 million to dead people. CMS will use an online tool that will detect fraud, and provide more comprehensive background tests on providers, hoping to cut down on fake payments.

In general, I feel that the crackdown on such scams will be beneficial to the Medicare system. By preventing employees responsible for fraud from again working with Medicare, and keeping more detailed records of payments and providers, the government can save billions of dollars that will be better used elsewhere.  Hopefully these measures will improve the current health care environment in the United States.

Category: Medicare News | Tags: , , , , , , , , , ,
Mona Lisa Vito | 07/12/2010
No comments

What About Entitlement Reform?

On May 13, 2009 the trustees of Medicare and Social Security released a report detailing the impending insolvency of our nation’s two biggest entitlement programs: Medicare in 2017 and Social Security in 2037. Projections have pushed these bankruptcy dates up from the previous report’s estimates of 2019 for Medicare and 2041 for Social Security. The percentage of federal spending sucked up by these two entitlements has been increasing for years. In 1990 they made up 28 percent of federal spending. This number is expected to soar to nearly 40 percent by 2019. By the numbers, converted to today’s dollars, over the next 75 years Social Security and Medicare will cost approximately $103.2 trillion, while taxes and premiums toward the trusts’ replenishment will total only $57.4 trillion. This will leave a gap of an astounding $45.8 trillion. The frightening reality is that no provision exists under the current policy regime to address the programs’ projected bankruptcy, meaning that once current assets are exhausted benefits will fall. Medicare will be literally unable to pay all its hospital bills just seven short years from now. The first Social Security beneficiaries to be hit by this failure will be disabled Americans whose fund will run out of money in 2020.

Entitlement Reform: What happens when Medicare and Social Security Are Bankrupt?

Entitlement Reform: What happens when Medicare and Social Security Are Bankrupt?

This threat has been looming in the background for years, and though successive administrations have “kicked the can” down the road we must confront the fact that the financial health of our two major entitlement programs has withered more during this recession than at any time since the mid-1990s. Though the economic downturn has contributed significantly to the programs’ rate of decline given the fact that worsening unemployment figures mean fewer workers are paying into the trusts’ funds through payroll taxes, the pressure of baby-boomers aging into the programs has pushed their financial health to the breaking point independent of current economic conditions.

These facts point glaringly to the need for entitlement reform. Obama administration officials have suggested that if the legislature were to act the programs’ insolvency could be bridged in three ways: by raising workers’ Social Security payroll taxes by 2 percentage points, by reducing benefits by 13 percent, or by a combination of the two.

Category: Medicare News, Medicare Tips | Tags: , , , , , , , ,