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Insurance Commissioners Reject Calls To Limit Seniors’ Medigap Policies

By Susan Jaffe  KAISER HEALTH NEWS in collaboration with      Dec. 6, 2012

The nation’s insurance commissioners have some stern advice about proposals to shrink Medicare spending by asking seniors with supplemental Medigap policies to pay more out of pocket for their health care: Don’t do it.

The health law requires the National Association of Insurance Commissioners to advise the administration about whether seniors would use fewer Medicare services — and therefore, cost the government less money — if the most popular Medigap plans were less generous.

“Everything we’ve looked at has shown that increasing cost-sharing does stop people from seeking medical care,” said Bonnie Burns, a training and policy specialist at California Health Advocates who serves on an NAIC committee that has studied the issue for more than a year. “The problem is they stop using both necessary and unnecessary care.” [More in The Washington Post] or longer version from Kaiser Health News]

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By Susan Jaffe  |  KAISER HEALTH NEWS  |  December 4th, 2012 , 5:30 a.m.

KHN logoIf young adults can’t afford health insurance policies available in 2014 under the health care law, state insurance officials are worried they won’t buy them.  And that could drive up the cost of insurance for the mostly older, sicker people who do purchase coverage. MORE

 

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lancet cover 2    Volume 380, Issue 9855, Pages 1727 – 1728, 17 November 2012

WORLD REPORT    Implementation of the Patient Protection and Affordable Care Act is unlikely to run smoothly despite the Nov 6 election result. Susan Jaffe reports from Washington, DC.

Just 3 days after President Barack Obama’s re-election preserved his signature legislative achievement, the Patient Protection and Affordable Care Act (ACA), his administration reset a deadline for states to take a crucial step toward implementing it. The delay in the wake of the health law’s dramatic affirmation—first by the US Supreme Court and then at the polls—is another reminder that the way forward may still encounter obstacles, even if the most serious threat was eliminated on Nov 6. [MORE]   [PDF]

 

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By Susan Jaffe             November 15th, 2012  KAISER HEALTH NEWS

Health care providers who appealed to Medicare judges won more often than patients did,  according to a report by the inspector general at the U. S. Department of Health and Human Services.    

Hospitals, physicians, medical equipment suppliers and other providers also filed 85 percent of the cases decided by the administrative law judges in fiscal year 2010.   Some providers get plenty of practice, with 96 “frequent filers” responsible for one-third of the 40,682 appeals submitted to the judges, the IG found.   [MORE]

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November 9, 2012, 6:17 pm                 

By SUSAN JAFFE

Medicare beneficiaries battered by Hurricane Sandy have one fewer problem to worry about: Federal officials have extended the Dec. 7 deadline to enroll in a private medical or drug plan for next year for those still coping with storm damage.


The extra time also applies to any beneficiaries who normally get help from family members or others to sort through dozens of plans, but who have been unable to do so this year because they live in areas affected by the storm. Neither beneficiaries nor those who provide them assistance will be required to prove that they experienced storm damage.  

Medicare officials have not set a new deadline but have encouraged beneficiaries to make their decisions soon if possible.[MORE]

More Time to Enroll in Medicare If You Live in Storm Areas

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Susan Jaffe | November 5. 2012 | Kaiser Health News produced in collaboration with a6a1a-usa2btoday2blogo2b2012

Medicare officials are trying a novel approach during this open enrollment season to gently nudge a half million beneficiaries out of 26 private drug and medical plans that have performed poorly in the past three years. It begins with letters informing seniors they are enrolled in a plan that received low ratings.

The effort marks the first time that Medicare officials have tried to steer beneficiaries away from some private drug and medical plans, while still allowing them to operate. Officials have also warned the plans that they might be canceled in the future. [More]    [List of the 26 plans and areas served available here].

 

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A new law passed in July to strengthen the work of the US Food and Drug Administration may hit some serious barriers to implementation. Susan Jaffe reports from Washington, DC.

image WORLD REPORT   Volume 380, Issue 9852, Pages 1458 – 1459, 27 October 2012

The massive drug and medical device safety bill that won extraordinary near-unanimous support in the US Congress—despite a budget crisis and a contentious political campaign—is facing major challenges less than 3 months after President Barack Obama signed it into law in July. And in the process, prospects may be fading for additional reforms. [MORE]

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By Susan Jaffe

October 15, 2012, 6:00 AM   KAISER HEALTH NEWS

Today, Medicare beneficiaries can begin choosing their drug and medical coverage for 2013, and most seniors are expected to stick with the same policies they have already, despite price changes and a rating system that shows some plans may be better than others. Seniors have been reluctant to change plans, even if there are cheaper or better-rated alternatives, according to recent studies and seniors advocates.  Beneficiaries also tend to stay with the same insurers: This year more than a third of those in Medicare Advantage plans, which provide medical and drug coverage, chose policies from just two insurers, UnitedHealthcare or Humana.

The ratings are based on information reported by the plans, from Medicare records, and a yearly survey of some beneficiaries. Participation in the surveys is voluntary and anonymous but insurers are concerned that too many seniors opt out.  [more]

Enrollment Season Opens For Medicare Advantage And Drug Plans

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image Volume 380, Issue 9848, Pages 1133 – 1134, 29 September 2012

WORLD REPORT  Comprehensive domestic health-care reform is one of the top defining issues in the campaign, overshadowing global health. Susan Jaffe reports from Washington, DC.

President Barack Obama and his rival Republican Mitt Romney would agree that the American health-care system is unsustainable, providing some of the world’s most expensive and yet fragmented care. But as they campaign for the presidency, the two candidates offer profoundly different solutions.

“The Affordable Care Act helps make sure you don’t have to worry about going broke just because one of your loved ones gets sick”, said Obama, describing his signature legislative achievement at a recent campaign stop in Colorado. “I don’t think a working mom in Denver should have to wait to get a mammogram just because money is tight”, he continued. “That’s why we passed this law. It was the right thing to do.” [more, as PDF]  

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Volume 380, Issue 9846,  15 September 2012

 

WORLD REPORT   Additional new health benefits for women began under the US Affordable Care Act last month, which experts hope will remain after the Nov 6 election. Susan Jaffe reports from Washington, DC. 

Republican presidential candidate Mitt Romney promises to dismantle President Barack Obama’s landmark health-care reform law if elected. But as the presidential campaign progresses, various provisions of the law continue to kick into gear…. [more]
Panel: Abortion and the Affordable Care Act

In the final days of the congressional health reform debate, abortion coverage nearly derailed the legislation…. [more]

 

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Medicare pilot program meant to revise policy that leaves seniors with costly bill

By Susan Jaffe  |  August 9, 2012  |  KAISER HEALTH NEWS produced in collaboration with    WaPo-4sidebar 163x25pix

Concerned that a growing number of seniors have been unexpectedly forced to pay thousands of dollars for nursing home care after a stay in a hospital, Medicare has launched a pilot project to test whether it can relax hospital-payment rules to help the growing number of seniors who are shelling out thousands of dollars for follow-up nursing-home care.

The issue involves what should be an easy question: Is the Medicare beneficiary an inpatient or an observation patient?  The answer can mean the difference between Medicare-covered follow-up nursing-home care or a senior facing an unexpected whopper of a bill.  [Continued in The Washington Post and in KHN]

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MEDICARE TIP SHEET         July 17, 2012                  Published by Association of Health Care Journalists              

Don’t look only to Washington policymakers for strategies to control medical costs and improve care for our aging population. New pilot  projects that could accomplish these goals, which are at the heart of health reform, are being tested in communities across the country. In this tip sheet, reporter Susan Jaffe provides an overview of projects sponsored by the Center for Medicare and Medicaid Innovation, directs journalists to helpful resources and supplies an extensive list of potential story ideas. [access requires AHCJ membership or available on request here]

Latest Innovations in Medicare

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MEDSCAPE MEDICAL NEWS     July 11, 2012

By Susan Jaffe

 Washington, DC — As expected, the Republican-controlled US House of Representatives voted today 244 to 185, mostly along party lines, to repeal the Affordable Care Act (ACA) — for the 31st time. And once again, President Barack Obama promised to veto the legislation repealing his landmark health law should it reach his desk, which is unlikely, given the Democrat-controlled Senate. However, Republicans have several other strategies available to delay or block implementation of the law.   MORE

Repeal Isn’t Only Way to Block Health Law, Says House GOP

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                                                                                                                                          7 July 2012lancet cover 2

The US Supreme Court decided last week that most provisions in the 2010 Patient Protection and Affordable Care Act were constitutional. Susan Jaffe reports from Washington, DC.
Last week’s historic ruling by the US Supreme Court preserving nearly all of President Barack Obama’s landmark health law may have finally settled some legal questions, only to shift a re-energised debate about improving the American health-care system to the political arena.In addition to providing health coverage to some 32 million uninsured Americans, other changes in the Patient Protection and Affordable Care Act will affect nearly every patient as it overhauls the US$2·7 trillion health-care system.  MORE

 

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By Susan Jaffe     |    June 14, 2012     |   KAISER HEALTH NEWS in partnership with 

Billions of dollars in drug savings for Medicare beneficiaries may come to an end if the Supreme Court overturns the 2010 federal health law, a drug industry spokesman said Tuesday. The law provides “the necessary legal framework” for drug companies to slash brand-name drug prices by half for seniors and people with disabilities when they enter a coverage gap in their Medicare drug plans, said Matthew Bennett, a spokesman for the Pharmaceutical Research and Manufacturers of America.  Eventually the discounts grow so that the gap, known as the doughnut hole, is closed by 2020. But if the law goes, the discounts may go, too.

More than 5.1 million Medicare beneficiaries enrolled in the Part D drug plans saved more than $3.2 billion on prescription drugs from March 2010 through December 2011 because of the health law provision, according to the Centers for Medicare & Medicaid Services.  In the first four months of this year, seniors saved another $301.5 million.  [MORE at msnbc]  [MORE at Kaiser Health News]