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]

Affordable Care Act, The Lancet

Republican Party lays out platform for Election 2016

Susan Jaffe | Washington Correspondent for The Lancet | 15 July 2016

Cleveland, OH – The Republican Party’s platform committee approved a blueprint this week that reflects the core principles of its most conservative wing, describing how a Republican presidential candidate would govern if elected.

gop_platform_committee_071116

                                                                                           Photo:SUSAN JAFFE

Several delegates said they don’t expect the presumptive Republican presidential nominee, Donald Trump, to agree with every point and that’s OK.

“With Mr. Trump, on a lot of these issues, he’s with us,” said Melody Potter, a member of the Republican National Committee from Charleston, West Virginia. “We know for a fact that Hillary Clinton is not with us.”

…Reporters attending the platform committee meetings this week were not allowed to see copies of the roughly 50-page document delegates discussed. But some delegates were willing to mention some health care provisions.  [Continued]  

Appeals, Medicare costs

HHS Proposes To Streamline Medicare Appeals Process

By Susan Jaffe  | Kaiser Health News | June 29, 2016 | This KHN story also ran on     nprlogo_138x46

The Department of Health and Human Services Tuesday proposed key changes in the Medicare appeals process to help reduce the backlog of more than 700,000 cases involving denied claims.

The measures “will help us get a leg up on this problem,” said Nancy Griswold, chief law judge of the Office of Medicare Hearing and Appeals.

If there weren’t a single additional appeal filed and no changes in the system, it would take 11 years to eliminate the backlog, Griswold said in an interview. [Continued on NPR or KHN]  

Appeals, Drugs, Medicare costs

Senate Panel Kills Medicare Program That Offers Help On Enrollment, Billing Issues

By Susan Jaffe  | Kaiser Health News | June 17, 2016 | This KHN story also ran on     nprlogo_138x46

A program that has helped seniors understand the many intricacies of Medicare as well as save them millions of dollars would be eliminated by a budget bill overwhelmingly approved last week by the powerful Senate Appropriations Committee.

The State Health Insurance Assistance Program, or “SHIP,” is among more than a dozen programs left out of the bill by the committee. Cutting these “unnecessary federal programs” helped provide needed funding for other efforts, Sen. Roy Blunt, R-Mo., chairman of the appropriations committee’s health and labor subcommittee, said in a statement last week.

Ending SHIP saves $52 million, which will help pay for a $2 billion increase for the National Institutes of Health, restore year-round Pell Grants, and increase resources to prevent and treat opioid abuse, among other things.

SHIP counselors are in every state, the District of Columbia and the U.S. territories offering free advice on how to choose from an array of drug and health insurance plans, challenge coverage denials, and receive financial subsidies for premiums, co-payments and deductibles. …Ohio’s SHIP program saved seniors $20.8 million in 2015 and was ranked first in the nation by the Department of Health and Human Services, the state’s lieutenant governor announced in February. [Continued on Kaiser Health News or NPR]

 

NIH, The Lancet

US presidential candidates urged to support health research

lancet cover 2Volume 387, Number  10037 
18 June  2016 

WORLD REPORT   Advocates for medical research are eager to hear how the presidential candidates would advance the search for new treatments.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

As the most tumultuous presidential primary season in recent times comes to an end, biomedical researchers, physicians, and advocacy groups want the candidates campaigning for the White House to address some of the substantive matters they worry about: National Institutes of Health (NIH) funding, advancing Alzheimer’s disease research, speeding up drug development, and a host of research related issues.

… In New Hampshire last year, the campaigns provided a preview of the kind of discussion between candidates and voters that research and patients’ advocacy groups would like. It revealed a stark difference between Clinton and Trump on funding for Alzheimer’s research and support for those caring for the 5·4 million Americans stricken with the disease. [Continued here]

 

Appeals, Medicare costs, Observation care

Medicare Releases Draft Proposal For Patient Observation Notice

By Susan Jaffe | KAISER  HEALTH  NEWS | June 15, 2016 |This story also ran in usat 4sidebar

In just two months, a federal law kicks in requiring hospitals to tell their Medicare patients if they have not been formally admitted and why. But some physician, hospital and consumer representatives say a notice drafted by Medicare for hospitals to use may not do the job.

The lawdraft obs notice 061517 was a response to complaints from Medicare patients who were surprised to learn that although they had spent a few days in the hospital, they were there for observation and were not admitted. Observation patients are considered too sick to go home yet not sick enough to be admitted. They may pay higher charges than admitted patients and do not qualify for Medicare’s nursing home coverage.

The NOTICE Act requires that starting Aug. 6, Medicare patients receive a form written in “plain language” after 24 hours of observation care but no later than 36 hours. Under the law, it must explain the reason they have not been admitted and how that decision will affect Medicare’s payment for services and patients’ share of the costs. The information must also be provided verbally, and a doctor or hospital staff member must be available to answer questions

And patients could have questions, said Brenda Cude, a National Association of Insurance Commissioners consumer representative and professor of consumer economics at the University of Georgia. She said the notice is written for a 12th-grade reading level, even though most consumer materials aim for no more than an eighth-grade level. It “assumes some health insurance knowledge that we are fairly certain most people don’t have.”    

…The form does not meet the expectations of Rep. Lloyd Doggett, D-Texas, who co-sponsored the law. “I am concerned that the proposed notice fulfills neither the spirit nor the letter of the law,” Doggett said in an interview. [Continuted at Kaiser Health News or USA Today]