Susan Jaffe

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POLITICO PRO 12/23/11 4:46 PM EST

When Congress gets back from the holidays, lawmakers are going to have to figure out how to find enough money to delay cuts in Medicare payments to doctors for a full year — but the patients have already started to pay for their share in their 2012 premiums.

Lost in the Capitol Hill debate is the fact that the federal government contributes only 75 percent of the cost of doctor visits and other outpatient services covered by Part B of the Medicare program. Under federal law, seniors chip in for the remaining 25 percent in the form of monthly premiums. The amount is based on estimated expenses for the coming year. And in calculating that share, Medicare officials anticipated that Congress would cancel the pay cut.

That means the patients will effectively pay part of the cost of a Sustainable Growth Rate “fix” before it’s been fixed…. more

Seniors already paying for full-year ‘doc fix’

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By Susan Jaffe

KAISER HEALTH NEWS in partnership wth National Public Radio

DEC 07, 2011

Federal officials are extending the Dec. 7 deadline for three days for some people who have had trouble enrolling in a Medicare prescription drug or private health plan because of the crush of last-minute sign-ups. …Seniors can only get extra time if they get on a call-back list. If they reach a live person, today’s deadline applies and they should be prepared to make a decision…. more

Medicare Offers Extra Enrollment Time For Seniors Who Call Today

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Officials Looking To Cut Federal Spending Eye Medigap Policies

By Susan Jaffe KAISER HEALTH NEWS in collaboration with Nov. 21, 2011

Margaret Fisher is among the millions of seniors with private, supplemental health insurance that takes care of most of the medical bills Medicare doesn’t cover. If she has a health crisis, she reasons, it won’t become a financial crisis, too.

But officials looking for ways to cut the federal deficit are suggesting that these Medigap policies help explain why the government’s Medicare bill is rising so fast. If these private policies were less generous, they figure, seniors might reduce their trips to the doctor or find cheaper care, which in turn would save the government money.Fisher, 86, a cancer survivor from Gaithersburg who has had two hip replacements, says that strategy could backfire… [Continued on Kaiser Health News and in The Washington Post]

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By Susan Jaffe November 7, 2011

KAISER HEALTH NEWS in collaboration with

Three weeks after suffering a heart attack, Bernie Hollander came to a recent meeting at Leisure World in Silver Spring with his wife, Rose, to learn about the Medicare drug plans being offered next year. “I’m a heart patient, I’m a diabetic – I have a lot of problems,” said Hollander, 81, who lives in the retirement community. But getting the expensive medications he needs isn’t one of them. e was at the meeting to get updated advice from Leta Blank, head of the Montgomery County Senior Health Insurance Assistance Program (SHIP).

Although drug coverage is optional, millions of Medicare beneficiaries enroll in a plan, and choosing the right one can be tricky. Seniors who want drug coverage must sort through dozens of policies covering different drugs from different pharmacies at different prices. Federal SHIP counselors can help untangle the details. MORE [view video here]

During open enrollment season, seniors can get help picking a Medicare drug plan

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By SUSAN JAFFE | POLITICO September 8, 2011

The American Hospital Association has a strategy for heading off any more Medicare payment cuts: Tell Congress to get the money from Medicare beneficiaries instead.

The association is urging its nearly 5,000 members to lobby Congress to raise the Medicare eligibility age from 65 to 67, in addition to other money-saving alternatives, according to spokeswoman Marie Watteau. MORE

Medicare eligibility age should go up, hospitals say

Drugs, Health IT, HHS, Medicare, Medicare costs

Doctors skittish about health technology despite promise of big federal bucks

By Susan Jaffe | Center for Public Integrity | July 7, 2011

The goal is to bring the last outposts of the nation’s health care system into the computer age, linking medical providers so that they can coordinate and improve patient care and — in the process—reduce unnecessary health care spending. But convincing everyone to use electronic health records has not been easy. …Neither reward nor punishment has

persuaded some small practice doctors — a troubling omen for the Obama administration, which believes that conversion of paper records to electronic form is a crucial step toward health care reform. [Continued]

Affordable Care Act

Consumers add their 2 cents to health law’s plan labels

By Susan Jaffe | June 23, 2011 | Kaiser Health News in partnership with

BUFFALO, N.Y. – At an office tucked next to Macy’s at the Boulevard Mall, Susan Kleimann pushes two sets of papers across a table to a woman in her 40s wearing a gray sweatshirt. “We aren’t testing you,” assures Kleimann, who runs a market research firm in Bethesda, Md. “We are testing health plan information.”

Kleimann explains that they will be comparing the two documents describing two hypothetical insurance plans. “What you tell us today will help us improve the information and be sure that consumers can easily understand what they read about different health plans,” she says. While a video camera captures every moment, the woman accepts the task with gusto. She says getting rid of some columns will make the form clearer and changing the blue ink to black will be easier on the eyes. But the last page is trouble. “This is really wordy,” she says. “I would have to put it down and go get a bowl of ice cream and go back to it later.”

Starting next March, all insurers and employers will have to make it easier for consumers faced with the ordeal of picking a health plan. Under the 2010 health law, they’ll have to provide health policy information that the average enrollee can understand and use to compare with other plans. The forms were developed by a group assembled by the National Assn. of Insurance Commissioners, and policymakers are getting feedback the same way advertisers learn the best way to sell orange juice: consumer-focus-group testing.

The woman in the gray sweatshirt is among eight people who received a $75 stipend to sit in a windowless room and spend 90 minutes reviewing the forms and answering questions. The one-on-one sessions, spread over two days last month along with an identical round in St. Louis, are sponsored by Consumers Union. Two representatives from the group, a Kaiser Health News reporter and other observers silently watch from a darkened hideaway room behind a one-way mirror; sound from the session is piped in through an audio system. [FULL story from Kaiser Health News] [ABRIDGED from Los Angeles Times]

Affordable Care Act

New labels will soon help consumers choose health plans

By Susan Jaffe, May 7, 2011, KAISER HEALTH NEWS in collaboration with The Chicago Tribune

Cars have sticker prices, ketchup bottles have nutrition-facts labels, and soon health plans will get coverage labels.

For the first time, consumers shopping for a health policy will be able to get a good idea of how much of the costs different plans will cover for three medical conditions: maternity care, treatment for diabetes and breast cancer. And because buying insurance is more complicated than buying a can of soup, the proposed insurance labels are two pages long. ….The new “coverage facts labels” are required under the health overhaul law, which directed the National Assn. of Insurance Commissioners to draft them. [MORE]

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By Susan Jaffe | April 26, 2011

KAISER HEALTH NEWS in collaboration with

Despite tough economic times, there are some things the government can’t give away.

Starting this year, seniors enrolled in Medicare no longer have to pay for more than a dozen tests and other services to help prevent or control cancer and other costly and debilitating diseases. These benefits, which also include an annual wellness exam, are part of the new federal health-care law.

But big crowds aren’t lining up for free mammograms or colonoscopies, although early data indicate that the free wellness checkup is luring patients. CONTINUED

Obama administration delaying some rules for appealing health insurance denials

By Susan Jaffe | March 30, 2011 | Kaiser Health News produced in collaboration with

The Obama administration is delaying until next January its enforcement of some new rules designed to protect patients who appeal insurers’ decisions to deny or reduce health care benefits… not affected by the latest government announcement is the timeframe given to consumers to file an appeal. Under most plans, beneficiaries have 180 days after receiving a denial notice to request a review…. more

Medicare Advantage, Medicare costs, Medigap

Younger, Disabled Medicare Beneficiaries Have Trouble Getting Supplementary Insurance

By Susan Jaffe KAISER HEALTH NEWS | March 7, 2011 This story was produced in collaboration with

Joe Hobson, 63, crosses the street in front of his Arlington apartment. (Jessica Marcy / Kaiser Health News).

One night three years ago, Joe Hobson finished reading a book, went to sleep and woke up blind. The problem,a rare hereditary disease, forced him to give up his 20-year communications job, along withits generous health insurance. Now 63, the Arlington man is covered by Medicare, the federal program for elderly and disabled Americans.

Like many people with Medicare, Hobson would like to buy supplemental, or Medigap, insurance to help cover his out-of-pocket costs, such as co-payments and deductibles. But Medigap prices can be prohibitive for disabled beneficiaries younger than 65. The cheapest plan for such people in Northern Virginia is $338 a month, according to Brad Rothermel,an Annandale insurance agent who has helped Hobson look for a policy. That’s three times the premium of a plan with much better benefits that is available to a 65-year-old. And the private insurers that offer Medigap policies are free to reject Hobson or charge him extra because of his preexisting health conditions.[Continued in KHN] andin The Washington Post]

Drugs, Long term care, Medicaid, Medicare, Medicare costs, Physical therapy

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 Miller, 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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Little-provision provision of overhaul law requires companies to tell it like it is

By SUSAN JAFFE updated Dec. 16, 2010

KAISER HEALTH NEWS in partnership with

Choosing a health insurance policy should be easier if consumers use the simple chart and other information that state insurance commissioners approved Thursday.

“It will force the insurance companies to reveal information in a consistent way,” says Bonnie Burns, a policy specialist for California Health Advocates, a consumer health advocacy group. “And it should make it easier for people to understand what they’re getting and not getting.”

Under a little-known provision of the health overhaul law, insurers will be required to provide their benefits information on a standardized chart using the same plain English terms as other companies to help shoppers understand and compare complicated policies. MORE

Speak plain English, health insurers told

Appeals, Observation care

Medicare rules give full hospital benefits only to those withinpatient status

By Susan Jaffe | September 7, 2010 | Kaiser Health News produced in collaboration with

After Ann Callan, 85, fell and broke four ribs, she spent six days at Holy Cross Hospital in Silver Spring. Doctors and nurses examined her daily and gave her medications and oxygen to help her breathe. But when she was discharged in early January, her family got a surprise: Medicare would not pay for her follow-up nursing home care, because she did not have the prerequisite three days of inpatient care.

“Where was she?” asks her husband, Paul Callan, 85, a retired U.S. Army colonel. “I was with her all the time. I knew she was a patient there.”

Yet some hospitals keep patients under observation for days, and that decision can have severe consequences. Medicare considers observation services outpatient care, which requires beneficiaries to cover a bigger share of drug costs and other expenses than they would when receiving inpatient care.And unless patients spend at least three consecutive days as an inpatient, Medicare will not cover follow-up nursing home expenses after discharge…. more

Appeals, Observation care

What To Do If You’re In Observation Care

By Susan Jaffe | September 7, 2010 | Kaiser Health News produced in collaboration with

How do I know what my hospital status is? What can I do if the hospital won’t change my observation status to inpatient? If the nursing home or hospital says Medicare won’t cover my nursing home stay, what can I do? Answers to these and other questions here.

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