Drugs, Medicare costs, Social Security Administration

COBRA, Retiree Plans, VA Benefits Don’t Alleviate Need To Sign Up For Medicare

By Susan Jaffe  | Kaiser Health News | December 14, 2016 | This KHN story also ran on     

When Cindy Hunter received her Medicare card in the mail last spring, she said she “didn’t know a lot about Medicare.” She and her husband, retired teachers who live in a Philadelphia suburb, decided she didn’t need it because she shared his retiree health insurance, which covered her treatment for ovarian cancer.

Cindy Hunter, who is battling ovarian cancer, says she mistakenly thought she didn’t need to enroll in Medicare because her husband’s retiree insurance would cover her. (Steph Brecht/Courtesy of Cindy Hunter)

“We were so thankful we had good insurance,” she said. So she sent back the card, telling officials she would keep Medicare Part A, which is free for most older or disabled Americans and covers hospitalization, some nursing home stays and home health care. But she turned down Part B, which covers doctor visits and other outpatient care and comes with a monthly premium charge. A new Medicare card arrived that says she only has Part A.

Her story isn’t unique.

When Stan Withers left a job at a medical device company to become vice president of a small start-up near Sacramento, Calif., he took his health insurance with him. Under a federal law known as COBRA, he paid the full cost to continue his coverage from his previous employer. A few years earlier, when he turned 65, he signed up for

This KHN article also ran in The Philadelphia Inquirer.

Medicare’s Part A. With the addition of a COBRA plan, he thought he didn’t need Medicare Part B.

Hunter and Withers now know they were wrong and are stuck with medical bills their insurance won’t cover. …Advocates for seniors and some members of Congress want to fix the problem, backed by a broad, unlikely group of unions, health insurers, patient organizations, health care providers and even eight former Medicare administrators.  [Continued on Kaiser Health News or NPR or The Philadelphia Inquirer]

Affordable Care Act, Drugs, FDA, NIH, The Lancet

Biomedical research bill becomes law, but critics raise concerns over long-term implementation

Susan Jaffe | Washington Correspondent for The Lancet | 14 December 2016

The 21st Century Cures Act that President Barack Obama signed into law this week dedicates – but doesnthe-lancet-usa-blog-logo1‘t guarantee – billions of dollars to accelerating the discovery of new drugs and medical devices and getting them to patents more quickly, as well as supporting opioid addiction treatment and reforms in mental health care.

President Barack Obama signs the 21st Century Cures Act, Tuesday, Dec. 13, 2016. (Photo by Susan Jaffe)

The overwhelming support for the law marks a stark contrast from the Affordable Care Act, another landmark health reform bill Obama signed in the second year of his presidency.  Republicans promise to repeal it as soon as the new Congress convenes next month and Donald Trump is sworn in as president. But before the promised elimination of the ACA, Congress took nearly $5 billion from its Prevention and Public Health Fund to pay for most of the law.[Continued here.]

 

Drugs, Long term care, Medicare costs

Seeking Dental Care For Older Americans

Since Medicare doesn’t cover most dental care, seniors often go without treatment.

By SUSAN JAFFE  | Health Affairs | December 2016 | Volume 35, Number 12

The last time Evelyn Sell went to the dentist was nearly three years ago, when he told her his staff would no longer be able to lift her out of her wheelchair and into the dentist’s chair. “That really threw me for a loop,” said Sell, 87, a retired preschool teacher who lives in Kingsley Manor, a retirement community in Los Angeles. “I didn’t know what I was going to do about dental care.”

Care at home: During a recent visit to Kingsley Manor, a Los Angeles, California, senior living community, dental hygienist Maria Ladd uses an intraoral camera to take photos of resident Ruth Wilson’s teeth. (Photo: Susanna Castillo)

…Then earlier this year, she found the solution. A flyer in her mail informed her that the management of her assisted living facility had partnered with the Virtual Dental Home project run by Pacific Center for Special Care at the University of the Pacific in San Francisco. Sell could have a dental hygienist come to her home. She was one of the first residents to sign up.

The project is one of several innovative demonstrations that providers and researchers are developing to serve vulnerable uninsured or underinsured patients. Despite their promise, however, these efforts meet only a fraction of the need. A comprehensive solution would likely require federal legislation, but bills to broadly expand Medicare’s dental coverage have languished in Congress. So some advocates for older adults are working on a third front, seeking changes to Medicare coverage policy based on the idea that dental care can be an integral part of the medically necessary care Medicare covers. [Continued here] 

Affordable Care Act, The Lancet

Clinton versus Trump on health care

lancet cover 2Volume 388, Number  10057 

5  November 2016 

WORLD REPORT   The presidential candidates have different ideas about improving US health care.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

The future of the Affordable Care Act, President Barack Obama’s signature health law, depends largely on the next occupant of the White House. Trump, the Republican candidate for president, wants to repeal and replace the law. Clinton, his Democratic opponent, wants to improve and expand it.  [Continued here] 

 

Long term care, Medicare Advantage, Medicare costs

Medicare Bars New ‘Seamless Conversion’ Efforts For Some Seniors

By Susan Jaffe  | Kaiser Health News | October 28, 2016 |  This KHN story also ran in 

The federal government is temporarily blocking more health insurance companies from automatically moving customers who become eligible for Medicare into Medicare Advantage plans while officials review the controversial practice.

They also will issue rules soon for plans that already have permission to make these switches, known as “seamless conversion,” according to a memo from Michael Crochunis, acting director of the Medicare Enrollment and Appeals Group at the Centers for Medicare & Medicaid Services.

Under current rules, an insurer can transfer customers who have purchased policies through an Affordable Care Act insurance exchange or other commercial plans when they become eligible for Medicare, typically at age 65. An insurer must give an individual 60 days’ advance written notice of the switch; if a person doesn’t opt out, that enrollment takes effect automatically.

… The decision to prohibit additional insurers from pursuing Medicare Advantage conversions comes after Kaiser Health News and The Washington Post identified problems with the practice in July. Some seniors did not know they had different coverage until receiving out-of-network providers’ bills for thousands of dollars. Others got the news when they received a Medicare Advantage membership card they hadn’t requested — with the name of a new primary care doctor they didn’t know. [Continued in Kaiser Health News and The Washington Post]

CDC, Global Health, NIH, The Lancet

US global health leadership hangs on election result

lancet cover 2Volume 388, Number  10055 

22  October 2016 

WORLD REPORT   On most issues, the US presidential candidates have polar opposite views; engagement in global health is no different.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

Americans will choose their next president in less than 3 weeks and yet some global health experts still wonder what would happen to the international health programmes that the USA has championed in recent decades if the Republican contender, Donald Trump, is elected. The uncertainty comes despite the Ebola virus and Zika virus threats that made global health front-page news.  [Continued here] 

Affordable Care Act, Medicare costs

Officials Warn Some Older Marketplace Customers To Switch To Medicare

By Susan Jaffe  | Kaiser Health News | October 14 2016 |  This KHN story also ran in 

Ever since the Affordable Care Act’s health insurance marketplaces opened for business in 2014, the Obama administration has worked hard to make sure Americans sign up. Yet officials now are telling some older people they might have too much insurance and they should cancehealthcare-gov-letterl their marketplace policies.

The federal Centers for Medicare & Medicaid Services is targeting two groups. First the agency is sending emails each month to about 15,000 people with subsidized marketplace coverage. The messages arrive a few weeks before their 6
5th birthday, which is also the age most people become eligible for Medicare. The email reminders will go to enrollees in the 38 states that use the federal marketplace.

“In most cases you won’t want to keep your Marketplace plan because once your Medicare coverage starts, you’ll no longer be eligible for any premium tax credits or other cost savings you may be getting for your Marketplace plan,” the notice says.  “To avoid an unwanted overlap in Marketplace and Medicare coverage … tell us you want to end your Marketplace plan.”

…Beneficiaries shoulder a lot of responsibility, even though there is no requirement they all be told what to do and when. Only the individual can terminate marketplace coverage when he or she becomes eligible for Medicare. Inaction means paying back any coverage subsidies received after they should have joined Medicare.  [Continued in  Kaiser Health News or The Washington Post]

Drugs, FDA, The Lancet

EpiPen’s price-gouging response “sickens” Congressional panel

Susan Jaffe | Washington Correspondent for The Lancet | 28th September 2016

The latest drug company chief to appear before Congress did not dodge questions by taking refuge in the Fifth Amendment’s protection against self-incrimination, as did Martin Shkreli, the former CEO of Turing Pharmaceuticalthe-lancet-usa-blog-logo1s.  But after a nearly four-hour congressional hearing last week investigating spikes in Mylan’s EpiPen prices, Maryland Democrat Elijah Cummings told Mylan CEO Heather Bresch, “You might as well have taken the Fifth, too, with the kind of information that we’ve gotten here today.” [Continued here]  
The Lancet

Hillary Clinton proposes mental health care reforms

Susan Jaffe | Washington Correspondent for The Lancet | 7th September 2016

 Former Secretary of State and Democratic presidential candidate Hillary Clinton unveiled her “Comprehensive Agenda on Mental Health” last week, addressing the millions Americans with mental health problems.  “Too many Americans are the-lancet-usa-blog-logo1being left to face mental health problems on their own, and too many individuals are dying prematurely from associated health conditions,” according to her proposal. “The next generation must grow up knowing that mental health is a key component of overall health and there is no shame, stigma, or barriers to seeking out care.” [Continued here]
Appeals, Medicare costs, Observation care

Protecting California’s Seniors From Surprise Hospital, Nursing Home Bills

By Susan Jaffe  | Kaiser Health News & California Healthline | August 29, 2016CA Healthline logo-chl

Californians with Medicare coverage would no longer be surprised by huge medical bills stemming from “observation care” in hospitals under legislation that state lawmakers approved overwhelmingly last week and sent to Gov. Jerry Brown to sign into law.

The sticker-shock can happen when people go to the hospital but health care providers are not sure what’s wrong. If the patient is not sick enough to be formally admitted, but still not healthy enough to go home, they can stay in the hospital for “observation care,” which Medicare considers an outpatient service. That can mean higher out-of-pocket expenses for the patient….And because observation patients have not spent the required minimum of three straight days as an admitted patient, Medicare will not cover their follow-up nursing home expenses after discharge. Observation care doesn’t count….“I don’t think the average person knows the difference,” said Sen. Ed Hernandez (D-West Covina). Hernandez introduced the legislation requiring hospitals starting Jan. 1 to tell all patients if they are getting observation care.

…The legislation also would require the nation’s first minimum nurse-to-patient staffing ratios in observation care units for hospitals that have separate units for those patients. “We are still the only state that has these very specific mandated ratios for every unit of the hospital that have to be adhered to every minute of every day,” said Jan Emerson-Shea, a spokeswoman for the California Hospital Association, which represents 400 hospitals. Those staffing rules, however, excluded observation care units.

“We wanted to make sure hospitals didn’t use observation care as a loophole to avoid any of the minimum nursing staffing requirements,” said Sen. Hernandez. [Continued in California Healthline or San Jose Mercury News]

Long term care, Medicare Advantage, Medicare costs

Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans

By Susan Jaffe  | Kaiser Health News | July 27, 2016 |  This KHN story also ran in 

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.

Neither the plan nor Medicare now would cover her medical costs. She owed $16,622.

“I was panicking,” said Hanttula, who lived in Carlsbad, N.M., at the time. After more than five hours making phone calls, she learned that because she’d had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, the company automatically signed her up for its own Medicare Advantage plan after notifying her in a letter. Hanttula said she ignored all mail from insurers because she had chosen traditional Medicare.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days. [Continued in The Washington Post and Kaiser Health News]

Affordable Care Act, Medicare costs, The Lancet

Democrats back Clinton, progressive platform at DNC in Philadelphia

Susan Jaffe | Washington Correspondent for The Lancet | 29 July 2016

Vermont Sen. Bernie Sanders stressed the need for unity when he addressed the convention on its first day, citing the Democratic party platform as evidence of the gains his supporters have achieved. “It is no secret that Hillary Clinton and I disagree on a number of issues … that’s what democracy is about,” Sanders told the convention. “But I am happy to tell you that at the Democratic Platform Committee, there was a significant coming together between the two campaigns and we produced, by far, the most progressive platform in the history of the Democratic Party.” [continued here] [listen to podcast here]