Tag Archives for Medicare

Congress is Close to Passing Prescription Drug Legislation

Published in Pawtucket Times on June 23, 2003

Within days of the July 4th congressional recess, the House and Senate continue their debates on enacting legislation to lower the cost of pharmaceuticals for the nation’s elderly.

The AARP will kick off a media blitz to get a point across to lawmakers that while they may take a short break during recess, the nation’s elderly don’t get a break when it comes to affording the costly medications they need.

“There’s no recess [for seniors] from high prescription drug costs,”  AARP declares in a press release sent to the nation’s media outlets.

In a written statement, Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council, calls on Rhode Island’s congressional delegation to pass meaningful Medicare drug benefits, rather than the legislative proposals being debated in the House and Senate chambers.

“While it is nice that after many years of promises Congress has finally taken on this issue these proposals will cause nothing but heartburn and headaches for seniors if passed,” said Fogarty, noting that many seniors will pay more for the program than they will get back in benefits. He charged that others will even be left without prescription drug coverage when they need it the most.

Under the Senate proposal, seniors would pay a $ 35 monthly premium and then have to meet a $275 deductible before Medicare starts to kick in to pay for half of the drugs costs.  Once senior’s reach a cost cap of $ 4,500 for the last year, they would then have to pick up the entire cost until they reach yet another cap of $ 5,800 in total drug spending. At this point, Medicare would then pay 90 percent of the covered drug costs.

Fogarty noted the Congressional Budget Office found that one-third of seniors would pay more money to enroll in the plan than they would actually get back in benefits.

That’s because a senior with $ 1,000 in annual drug costs would actually end up

$ 1,057 annual for the benefits ($420 in premiums, a $ 275 deductible and half of the drug costs).  A senior with $ 2,000 in drug costs would pay $ 1,557 out-of-pocket for the benefits.

Fogarty also called attention to the major gap in coverage for those whose costs exceed the $ 4,500 limit until they reach that $ 5,800 mark.

Furthermore, Fogarty, who authored the state’s expanded prescription drug program, said a study by Columbia University found that only those annual drug costs about $ 1,100 would benefit through the plan.  

In the House chamber, the Republican proposal also calls for monthly premiums of $ 35 along with a lower annual deductible of $ 250 with Medicaid paying 80 percent of the cost of drugs up to $ 2,000.

There is a gaping hole in coverage (in this legislative package).” Fogarty warned “Seniors would then have to spend at least another $ 1,500 depending on their income, on medications before coverage would again begin.”

According to Fogarty, Consumer Union, the publisher of the widely-read magazine, Consumer Reports, noted the “skimpy benefits [in the House and Senate proposal] and the historically high growth of prescription drug costs means that most who lack coverage today would wind up paying more for prescription drugs in four years than they do now.”

Will seniors see a prescription drug proposal enacted this year?

Probably, said Jason Ormsby, director of policy at the Washington, D.C.-based Allilance for Health Reform.

“There is a tremendous drive that I have not seen in the last there years [to enact a prescription drug bill],” said Ormsby.

He noted the House passed a legislative proposal to assist seniors in paying for costly pharmaceuticals, but it died in the Senate.

“The somewhat similar House and Senate bills will have a good change to pass by the July 4th recess,” Ormsby predicted.  Once passed, the legislative proposal will go to conference committee to iron out the differences between the 600-page House and 350-pshr Senate bills,” he said.

The prescription drug benefits are just a small portion of these massive legislative proposals, he noted.

Robert Greenwood, vice-president of public affairs for the National Pace Association, added: “Many Democrats see the limitation of these bills.  This legislation passed presents a historic opportunity to get this law on the book so it can be amended and improved in future years.”

While not a meaningful drug prescription proposal, it’s the first step in the right direction.

Once enacted into law, the Rhode Island congressional delegation must begin their efforts to improve the law – improve access for all: make out-of-pocket costs and cost sharing affordable; lessen gaps in coverage; more important, put the breaks to the steady increase in high-cost drugs.

Internet will soon be good source for information on nursing homes

Published in The Pawtucket Times, May 2003

A growing number of Americans are doing their shopping for products and services, via the Internet.  But if the federal government has its way consumers in five states will rely on Medicare and Medicaid programs and their family members, will be able to cruise the world wide web to find the best nursing facilities to meet their specific needs.

Rhode Island is among five states chosen by the Centers for Medicare and Medicaid Services (CMS) for a pilot project that will identify collect, and publish nursing home quality information on the Internet for easy access and comparison of facilities.

The other states are Colorado, Maryland, Ohio and Washington.  Eventually, this federally-funded initiative will be expanded nationwide.

People covered by Medicare and Medicaid have the power to choose the best care to meet their individual needs, but they have to have more reliable information to choose quality care, HHS Secretary Tommy G. Thompson, who oversees the Medicare and Medicaid programs. “Our efforts will help beneficiaries all across the country to compare the performance of their local nursing homes, and will provide the recognition that high-quality nursing homes deserve”.

In April 2002, the newly compiled performance information becomes available online at www.medicare.gov and will also be disseminated through Rhode Island Quality Partners, an agency contracted by the federal government to oversee the quality of health services provided to Rhode Island Medicare beneficiaries.

So what information can consumers find when shopping for the right nursing facility on the world wide web?

Currently, the CMS’s website provides nursing facility-specific information compiled from state annual surveys.

As a result of this five state pilot project, consumers will be able to see data culled from the Minimum Data Set (MDS), a standardized medical collection form that every nursing home is required to complete on every patient upon admission and on a regular schedule thereafter.

For those seeking a long-term placement, CMS will bring together comparative state-wide information that indicates quality care is being provided.  When shopping you will be able to find out how many residents are being physically restrained, how many have pressure sores, how many are taking anti-psychotic drugs without a psychiatric diagnosis, how many have lost weight, how many have acquired an infection, and finally how many residents can no longer take care of themselves.

For those seeking short-term stays after hospitalization, CMS will provide state-wide MDS data compiled from nursing facilities that can tell you how many residents are in pain, how many residents fail to recover from delirium, along with how many are re-hospitalized and improvement in walking.

Dr. David R. Gifford, principal clinical coordinator with Rhode Island Quality Partners, told All About Seniors that CMS chose Rhode Island for the pilot project because of the state’s interest in public reporting of consumer information.  He noted that CMS was aware of Lt. Gov. Charles Fogerty’s legislation, recently enacted that now requires reporting of nursing facility quality information.

“We’re very pleased to be involved in the pilot project because it allows us to help shape the national data dissemination effort,” Gifford adds.

How will consumers not computer savvy gain access CMS’s new quality measures?

Dr. Gifford notes that each state participating in the pilot project must develop other avenues for non-computer users to tap into the MDS data compiled on its website.

Roberta Hawkins, Executive Director of the Alliance for Better Long Term Care and the state’s ombudsman, applauds the new federal effort to help consumers in choosing nursing facilities.

However, Hawkins is concerned that the MDS does not always provide “insight into the personality of a nursing facility.”

“MDS won’t tell you if a facility’s staff are compassionate to residents.”  she says.  Additionally, the newly compiled CMSA information will not provide you with specifics about how some facilities specialize in taking care of ethnic populations.”  she added, specifically, if staff speak a foreign language, sever ethnic cuisine, or plan culturally-related activity programming.

Additionally, Hawkins notes that while CMS’s website may tell you how many persons have bed sores, a higher incidence of bed sores may only reflect that a newly admitted resident came to the facility with bed sores or that a facility specializes in taking care of that medical condition.

At best, internet information can only provide a snapshot of care being provided by facility staff, warns Hawkins.  “Today’s best nursing homes may become next weeks providers of poor care,” she adds, when key staff in leadership positions leave the facility.

Take advantage of CMS’s website to cull nursing facility specific information compiled from state annual surveys.

When in doubt, call the Alliance for Better Long-Term Care at 785-3340.

Bush’s “just guns, no butter” policy hurts senior programs

Published in the Pawtucket Times on March 31, 2003

President Lyndon B. Johnson’s “Guns and Butter” policy is not in fashion today.

In a recent Washington Aging Report, radio commentator Bill Benson predicted future federal funding of program and services for seniors will take a back seat to President Bush’s worldwide fight against tourism, the high-tech war against Iraq and tax breaks for the upper income Americans.

In his Marh 24 commentary, Benson, a former assistant secretary with the U.S. Administration on Aging and now a principal at Health Benefits ABC – sees tough times ahead for the federal funding of programs and services, especially the creation of a meaningful Medicare pharmaceutical assistance program.

“Guns and Butter” was coined nearly 40 years ago, describing President Lyndon B. Johnson’s two-front war. Back then, a large infusion of federal dollars allowed the Democratic president to fight a war abroad – in Vietnam – along with a war on the domestic front, against poverty and social ills, especially those facing the elderly.

“By the end of 1965, with Vietnam escalating, we had the Medicare program and the Older Americans Act,” noted Benson, adding Medicaid was also created at this time to help millions of low-income older people afford the cost of nursing home care.

Benson’s radio commentary charged the Bush administration and the Republican-controlled Congress are fully committed to funding the “guns” but not “butter” policy initiatives.

“It would be one thing if the commitment to guns over butter was for the president while we topple Saddam and occupy Iraq, and combat terrorism everywhere. “Instead, it looks like the Bush administration is committed to making butter a scarcer commodity for years to come,” said Benson.

According to Benson’s proposed budget for the next fiscal year suggests it won’t be both “guns and butter,” especially in light of the president’s efforts to pursue large tax cuts for upper-income Americans.

What about the spending for guns?

According to the Washington Post, Bush’s proposal for the fiscal year begins on Oct. 1, calls for defense spending that is 16 percent more than the combined total of all other discretionary spending excluding what he would spend on homeland security.

And that figure does not take into account the cost of the war in Iraq, nor expenditures to combat terrorism, Benson says.

Meanwhile, Benson said the Washington Post noted secretary of defense Donald Rumford has proposed a $20 billion increase for defense for each of the next six years, would follow what have been six straight years of real increases in defense spending. The result by 2010 would be annual spending for defense of more than half a trillion dollars.

Combine increased defense with the cost of the Iraq war.

Benson noted the White House estimated the cost for Iraq and related matters will be nearly $75 billion over the next six months.

Benson said that by 2011, the first baby boomer s will turn age 65, and will begin placing huge demands up on Medicare, Social Security and other services for the elderly.

“President Bush’s FY 2004 budget calls for $ 400 billion spread over 10 years for a prescription drug plan for senior,” said Benson.

On the other hand, the Congressional Budget Office estimates Medicare beneficiaries will in fact spend more than $1.8 trillion over the same 10 years for prescription drugs.

That means, said Benson, the president’s plan would cover only a bit more than 20 percent of wat seniors will actually spend. And that is if the $ 400 billion actually goes for drug coverage when there will be many other demands for additional Medicare dollars.

Bush also purposes to cut funding for the Older Americans Act – a federal program that supports such services as Meals on Wheels, transportation for the elderly and ombudsmen to investigate problems in nursing homes -by $24 billion, Benson said.

With a worldwide war on  terrorism combined with the ongoing war in Iraq, the debate regarding “guns and butter” spending must begin in earnest.

Hard choices must be made in times of war, but seniors must continue to press both the Bush administration and Congress for adequate federal funding to create a meaningful Medicare pharmaceutical assistance program, and to shore up the ailing Medicare, Medicaid and Social Security programs.

In this new era of huge defense spending, the Bush administration and Congress will have to make very painful choices in allocating its limited discretionary funds to support a wide variety of domestic policy initiatives.

Only an intense lobby of aging advocates and seniors will keep programs and services benefiting the nation’s elderly on the radar screens of federal officials and lawmakers.