Category: Medicaid

Modest health goals for new US Congress

Volume 400, Issue 10369
17 December 2022 

 

WORLD REPORT  With Congress almost evenly split between Republicans and Democrats, consensus on any major health legislation is unlikely.  Susan Jaffe reports. 

When a new US Congress convenes in January, 2023, the slim Republican majority in the House of Representatives and the Democrats’ even smaller margin in the Senate will not enable either party to make major changes in the health-care system. With President Joe Biden promising to use his veto power to defend his health-care agenda, no significant fixes are expected. But there appears to be bipartisan support for some less ambitious legislation on issues that will overcome congressional gridlock.[Continued here.]…

Medicaid Weighs Attaching Strings to Nursing Home Payments to Improve Patient Care

By Susan Jaffe  | Kaiser Health News | June 10, 2022 | This KHN story also ran on Fortune logo

The Biden administration is considering a requirement that the nation’s 15,500 nursing homes spend most of their payments from Medicaid on direct care for residents and limit the amount that is used for operations, maintenance, and capital improvements or diverted to profits.

If adopted, it would be the first time the federal government insists that nursing homes devote the majority of Medicaid dollars to caring for residents.

“The absolutely critical ingredient” for good care is sufficient staffing, Dan Tsai, a deputy administrator at the Centers for Medicare & Medicaid Services and Medicaid director, told KHN. [Full story in Kaiser Health News, Fortune, Yahoo News and St. Louis Post-Dispatch]  

 

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3 States Limit Nursing Home Profits in Bid to Improve Care

“If they choose to rely on public dollars to deliver care, they take on a greater responsibility,” says New York Assemblyman Ron Kim. “It’s not like running a hotel.” 
By Susan Jaffe | KAISER HEALTH NEWS | October 25, 2021 |  This story also ran on

Nursing homes receive billions of taxpayers’ dollars every year to care for chronically ill frail elders, but until now, there was no guarantee that’s how the money would be spent.

Massachusetts, New Jersey and New York are taking unprecedented steps to ensure they get what they pay for, after the devastating impact of covid-19 exposed problems with staffing and infection control in nursing homes. The states have set requirements for how much nursing homes must spend on residents’ direct care and imposed limits on what they can spend elsewhere, including administrative expenses, executive salaries and advertising and even how much they can pocket as profit. …With this strategy, advocates believe, residents won’t be shortchanged on care, and violations of federal quality standards should decrease because money will be required to be spent on residents’ needs. At least that’s the theory. [Continued on Kaiser Health News, Fortune, NBC News, Yahoo Finance, and Chicago Sun-Times]…

The Push For Nursing Home Reform In The Middle Of A Pandemic

Sept. 20, 2021 | Today on NPR‘s news program “1A,”  reporter Susan Jaffe discusses her Kaiser Health News story about new state laws protecting nursing home residents in response to the COVID-19 pandemic. Changes affect staffing, visitation rights, virtual communications, “essential support persons,” and more. A  resident of a Connecticut nursing home quoted in this KHN article is also a guest. …

Chiquita Brooks-LaSure: innovative US federal health director

Volume 398, Issue 10300
14 August 2021

 

PROFILE  
Chiquita Brooks-LaSure, President Joe Biden’s choice to lead the Centers for Medicare and Medicaid Services, presides over an agency with a US$1 trillion budget that provides health insurance to more than 154 million people. Tackling health-care inequities is one of her top priorities. “These disparities have long existed, but COVID-19 has illuminated them in a way that is really unprecedented”, she said. [Full story here.]

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Zooming Into the Statehouse: Nursing Home Residents Use New Digital Skills to Push for Changes

By Susan Jaffe  | Kaiser Health News | June 9, 2021 | This KHN story also ran onand

Patty Bausch isn’t a Medicaid expert, lawyer or medical professional. But she still thinks Connecticut legislators need her input when they consider bills affecting people like her — the roughly 18,000 residents who live in the state’s nursing homes.

With help and encouragement from Connecticut’s Long Term Care Ombudsman Program, Bausch signed up and testified remotely before a legislative hearing this year. Nursing home residents who have been using digital technology to reach out to family and friends — after the covid pandemic led officials to end visitation last year — could also use it to connect with elected officials once the legislature moved to remote hearings. Speaking into an iPad provided by the ombudsman’s office, Bausch testified without ever leaving her room at the Newtown Rehabilitation & Health Care Center, where she has lived since having a stroke three years ago. The combination of a virtual legislature and nursing home residents equipped with internet access has created an opportunity most nursing home residents rarely have — to participate in their government up close and in real time.  [Continued on Kaiser Health News, Next Avenue and Connecticut Public Radio.]…

Biden’s first legislative victory: $1·9 trillion for COVID-19

Volume 397, Issue 10279
20 March 2021

WORLD REPORT US President Joe Biden’s first legislative triumph will fund the COVID-19 response and economic recovery, and address social determinants of health. Susan Jaffe reports from Washington, DC. 

By narrowly approving a massive COVID-19 response and economic relief package last week, Democrats in Congress handed President Joe Biden his first legislative victory after only 50 days in the White House. The US$1·9 trillion, 628-page, American Rescue Plan Act is a signature achievement so monumental that it has been compared to President Lyndon B Johnson’s sweeping Great Society legislation that raised many Americans out of poverty, with a safety net of social and health services, including the Medicare and Medicaid insurance programmes.

…As the government begins to roll out these benefits, Biden promised “fastidious oversight to make sure there’s no waste or fraud, and the law does what it’s designed to do. And I mean it: we have to get this right… because we have to continue to build confidence in the American people that their government can function for them and deliver.” [Full story with “where the money goes” sidebar here.]

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US Supreme Court poised to keep the Affordable Care Act

Volume 396, Issue 10263
21 November  2020

 

WORLD REPORT A lawsuit to overturn the Affordable Care Act may be floundering after Supreme Court justices questioned why the law should be dismantled. Susan Jaffe reports from Washington, DC.

The fate of the Affordable Care Act (ACA) is again in the hands of the US Supreme Court, after close calls in lawsuits in 2012 and 2015. But last week’s hearing was different: justices who once voted to overturn the law— along with President Donald Trump’s recent court appointees—bombarded opponents with sceptical questions. 

After oral arguments in the case, known as California v. Texas, legal experts believe President Barack Obama’s signature health reform law is not in mortal danger.  [Continued here.] 

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US election 2020: the future of the Affordable Care Act

Volume 396, Number 10260     31 October 2020 

WORLD REPORT   President Donald Trump pledges to replace the Affordable Care Act while his Democratic opponent Joe Biden offers detailed proposals to improve it. Susan Jaffe reports from Washington, DC.

Since winning the presidency in 2016 in large part by promising to eliminate Obamacare, otherwise known as the Affordable Care Act (ACA), Donald Trump has promised more than a dozen times that his replacement plan would be ready soon. The plan would be released in 2 weeks, a White House spokeswoman said 2 months ago.

“We’re going to have a health-care plan that will be second to none”, Trump said in 2017. “It’s going to be great and the people will see that.” And at last week’s final presidential debate, he vowed “to terminate Obamacare, [and] come up with a brand new beautiful health care”.

A decade after the ACA—President Barack Obama’s signature achievement—became law, repealing and replacing Obamacare is again central to Trump’s re-election. And improving and expanding the law is a crucial part of the campaign of his challenger, former Vice President Joe Biden. [Continued here.]     

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Pandemic Deals Another Blow To Nursing Homes: Plummeting Occupancy

BY SUSAN JAFFE  |  CONNECTICUT HEALTH INVESTIGATIVE TEAM   |  SEPTEMBER 16, 2020    
       

While the deadly coronavirus seems to be subsiding in Connecticut for now, its impact on nursing homes has not. More than 6,700 beds are empty, and it may take many months of financial struggle before occupancy climbs back to pre-pandemic levels.

Of the approximately 200 nursing homes in Connecticut that receive payments from Medicaid, the government health insurance program for  low-income people, only 15 were 

 70% or less occupied in January, according to the Connecticut Health Investigative Team’s analysis of state data. By August, almost five times as many facilities saw occupancy drop to that level or less….

Owners say the state and federal governments aren’t doing enough to shore up their industry and protect residents during the pandemic. And in some cases, policies intended to control the virus can make things worse.  [Continued here, with map and table of dangerously low occupancy nursing homes.]…

USA sets goal to end the HIV epidemic in a decade

Volume 393, Number 10172   

16 February 2019       

 

WORLD REPORT   The unexpected announcement in the State of the Union address could set the start of a realistic agenda to end HIV/AIDS in the USA, provided funds are secured. Susan Jaffe reports.

Nearly an hour into his 90 min State of the Union address, President Donald Trump called for a government-run health-care programme “to eliminate the HIV epidemic in the United States within 10 years”.

Although the president has promised to get rid of the Affordable Care Act (ACA) along with its health insurance marketplaces and Medicaid expansion, these and other policies did not appear to dampen his enthusiasm. [Continued here.]…

NYC guarantees health care to all

 Volume 393, Number 10169   

26 January 2019       

 

WORLD REPORT   The mayor of New York City is not counting on Congress for solutions to its health-care problems, Susan Jaffe reports.

By encouraging patients to seek primary and preventive care instead of more expensive emergency care, city officials expect to save money and keep people healthy. 
     “From this moment on, in New York City, everyone is guaranteed the right to health care—everyone”, declared New York City Mayor Bill de Blasio as he unveiled his so-called NYC Care plan this month. People who cannot pay or are ineligible for health insurance—including undocumented immigrants—will be able to get the most comprehensive and affordable health coverage in the country, at little or no cost, the mayor said, speaking in both English and Spanish.  “This is a way of getting people health care here and now, regardless of what happens on the state or the federal level”. [Continued here.]  
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Medicare Advantage Plans Cleared To Go Beyond Medical Coverage — Even Groceries

By Susan Jaffe  | Kaiser Health News | April 3, 2018 | This KHN story also ran on 

Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage [private insurance] coverage when new federal rules take effect next year. 

The Institute for Aging in San Francisco helps seniors get to doctor appointments and social activities. (Photo/Susan Jaffe)

…But patient advocates including David Lipschutz. senior policy attorney at the Center for Medicare Advocacy, are concerned about those who may be left behind. “It’s great for the people in Medicare Advantage plans, but what about the majority of the people who are in traditional Medicare?” he asked. “As we tip the scales more in favor of Medicare Advantage, it’s to the detriment of people in traditional Medicare.”  [Continued at Kaiser Health News,  The Philadelphia Inquirer,  The Washington Post and CNN Money]

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Home Care Agencies Often Wrongly Deny Medicare Help To The Chronically Ill

By Susan Jaffe  | Kaiser Health News | January 18, 2018 | This KHN story also ran on     

Colin Campbell    (Heidi de Marco/KHN)

Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing “almost impossible,”he said.

Campbell, 58, spends $4,000 a month on home health care services so he can continue to live in his home just outside Los Angeles. Eight years ago, he was diagnosed with amyotrophic lateral sclerosis, or “Lou Gehrig’s disease,” which relentlessly attacks the nerve cells in his brain and spinal cord and has no cure.

The former computer systems manager has Medicare coverage because of his disability, but no fewer than 14 home health care providers have told him he can’t use it to pay for their services. That’s an incorrect but common belief….  [Continued at Kaiser Health News and NPR]…

US Children’s Health Insurance Program in jeopardy

 Volume 390, Number 10114   
 23/30 December 2017

 

WORLD REPORT    Without adequate federal funding, CHIP is on the verge of collapse in several states. Susan Jaffe, The Lancet’s Washington correspondent, reports.

“Whoever would have thought that health care for children—that has support on both sides of the aisle—would be in this situation?” asked Deborah Oswalt, executive director of the Virginia Health Care Foundation.  [full story here]

 

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Counting On Medicaid To Avoid Life In A Nursing Home? That’s Now Up To Congress.

By Susan Jaffe | KAISER  HEALTH  NEWS | July 31, 2017 |This story also ran in 

Ten years ago, a driver ran a stop sign as Jim McIlroy rode into the intersection on his motorcycle. Serious injuries left McIlroy paralyzed from the chest down. But, after spending some time in a nursing home, he returned to his home near Bethel, Maine.

McIlroy does most of his own cooking since Maine’s Medicaid program paid for a stovetop that he can roll his wheelchair underneath to reach the food-prep area. His

Esther Ellis received a new mattress earlier this year from Partners in Care, a nonprofit that runs four of the dozens of sites in California’s Multipurpose Senior Services Program, a Medicaid-funded home services program. (Heidi de Marco/KHN)

new kitchen sink has the same feature. Wheelchair-friendly wood flooring has replaced McIlroy’s wall-to-wall carpeting.

The alterations plus a personal care aide — all paid for by Medicaid — enable McIlroy to stay in his house that he and his wife, who has since died, “worked really hard to own,” he said. The arrangement also saves Medicaid roughly two-thirds of what it would cost if he lived in a nursing home.

McIlroy depends on the federal-state program’s growing support of home-based care services — along with 2 million elderly or disabled Americans who rely on them to live at home for as long as possible.

However, that crucial help could face severe cuts if congressional Republicans eventually succeed in their push to sharply reduce federal Medicaid funds to states. [Continued at Kaiser Health News and USA Today] 

 

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Innovative Day-Care Program Seeks To Keep Frail, Low-Income Seniors In Their Homes

By Susan Jaffe | December 21, 2010 | Kaiser Health News in collaboration with

 Several mornings a week, a white van stops at Geraldine Miller’s house just east of Baltimore to pick her up for ElderPlus, a government-subsidized day-care program for adults on the campus of the Johns Hopkins Bayview Medical Center.

Because videoMiller, who is 75 and uses a walker, has trouble getting down the stairs from her second-floor apartment, the driver comes inside to help. When she feels wobbly, he lends her an arm. When she feels strong, he faces her and steps down backward on the steps so he can catch her if she falls. When it rains, he shelters her with an umbrella. This is the sort of extra care that makes ElderPlus different.  ElderPlus is part of PACE, the Program for All-Inclusive Care for the Elderly, which provides comprehensive medical and social services to frail, low-income seniors with serious health problems.   [Continued at Kaiser Health News or The Washington Post.]   Video: “Picking Up The Pace”

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