Thursday, June 30, 2005
Making Medicaid Meaner...
Congress is considering a crackdown on financial planning strategies increasingly favored by middle-class families to shift the cost of nursing home care for elderly parents onto the federal government.
Senate Finance Committee Chairman Charles E. Grassley (R-Iowa) denounced the practices Wednesday as "legal shenanigans" and vowed to help stop maneuvers he said were turning Medicaid into an asset protection program, instead of what it was supposed to be — an insurer of last resort for elderly people too poor to afford care.
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Tightening the rules could save Medicaid $1 billion to $2 billion over five years, Grassley said, though Medicaid's long-term care bill is projected at $290 billion over the next five years.
But some policy experts say the answer is not to make it harder to get into Medicaid, but to recognize a need for a national long-term care program.
"Solutions that focus only on making Medicaid 'meaner' … do our nation a disservice," said Judith Feder, dean of the Georgetown Public Policy Institute, who was a senior official at the Department of Health and Human Services during the Clinton administration.
"The nation lacks a policy that assures people access to quality long-term care, when they need it, without risk of impoverishment," Feder said.
Wednesday, June 29, 2005
Table of Contents, Vol. 9, Issue 1
End-of-Life Issues for Caregivers of Individuals With
Alzheimer's Disease and Related Dementias
Donna Cohen, PhD
Developing a Complex Theory for Suicide Research:
Suicidology's Challenge for the 21st Century
Donna M. Weinreich, PhD
The Impact of Caregiving for a Relative With Alzheimer's Disease:
A Comparison of Those Caring for Persons Living Alone,
Spousal Caregivers, and Co-Resident Adult Children
Carole B. Cox, PhD, and Kara Albisu, MSW
Perceptions of Resident Behavior Problems and
Their Clinical Management in Long Term Care Facilities
Kevin Brazil, PhD, Adrianne Hasler, BA, Carrie McAiney, PhD,
Cathy Sturdy-Smith, MSc, and Maureen Tettman, BA
Health-Related Quality of Life Among Older Adults With
Activity-Limiting Health Conditions
Kelli L. Dominick, PhD, Frank M. Ahern, PhD,
Carol H. Gold, PhD, and Debra A. Heller, PhD
The Relative Utility of Four Abridged Versions
of the Zarit Burden Interview
Norm O'Rourke, PhD, and Holly A. Tuokko, PhD
Public attitudes toward Medicaid are remarkably positive, and opposition to cuts is reasonably strong, according to a new public opinion survey released today by the Kaiser Family Foundation http://www.kff.org/medicaid/pomr062905pkg.cfm .
While two-thirds of the public think their state has major budget problems, a substantial majority are reluctant to cut Medicaid to balance state budgets, and a majority think the federal government should maintain (44 percent) or increase (36 percent) federal spending on Medicaid; only 12 percent of the public prefer seeing federal funding of Medicaid cut.
Attitudes Towards Medicaid
Nearly three-quarters (74 percent) of adults say Medicaid is a "very important" government program, ranking it close to Social Security (88 percent) and Medicare (83 percent) in the public's mind, equal to federal aid to public schools (74 percent), and above defense and military spending (57 percent). About 8 in 10 Democrats (82 percent) and Independents (79 percent) view Medicaid as an important government program, while fewer, but still 6 in 10 Republicans (61 percent) express that view.
A majority of Americans (56 percent) report having some interaction with Medicaid, either having been enrolled themselves at some point (16 percent) or knowing a friend or family member who has received health coverage or long-term care assistance through the program (40 percent). Additionally, if they needed health care and were eligible, nearly 8 in 10 Americans (78 percent) say they would be willing to enroll in Medicaid. This view is consistent across different party identifications.
The Bush administration acknowledged Tuesday that it must treat more than four times the estimated number of war wounded, just hours after the House Republican leadership killed a measure to increase funding for their care.
Veterans Affairs Secretary R. James Nicholson told a House appropriations subcommittee Tuesday that it earlier estimated that it would need to care for 23,553 wounded soldiers from the wars in Iraq and Afghanistan.
That tally has been revised upward to 103,000, leaving a funding gap of $2.6 billion that Congress needs to close for the 2006 fiscal year that starts Oct. 1.
Tuesday, June 28, 2005
State Medicaid officials this summer will place a cap on the amounts and types of prescription narcotics and antidepressants that patients can receive without their doctors justifying it to officials.
It's a closely watched move aimed at curbing demand for the public health program's most abused — and costly — medications.
Starting Friday, Medicaid will stop covering all name-brand antidepressants, including Prozac, Zoloft and Celexa, without a doctor's express justification. Then on Sept. 1, physicians also will have to get approval before treating Medicaid patients with more than one similar antidepressant, even generics, beyond 68 days.
Related link: Medical Assistance Administration, State of Washington
From the New York Times:
Two-thirds of the states use consultants to help them get more federal Medicaid money, often by using "questionable billing practices," and then reward those consultants by giving them a share of the money as a contingency fee, Congressional investigators said on Monday.
These consultants are driving up Medicaid costs by recommending financial tactics that violate federal law or policy, the investigators, from the Government Accountability Office, said in a report to Congress.
The full GAO Report is available here.
Monday, June 27, 2005
There's a new world record for the 100-meter dash in the 95-99 year-old age group. A Japanese sprinter who took up running at age 65 knocked two seconds off the mark, covering the distance in 20.2 seconds.
I'm pretty sure I can't run that fast, and I'm only 46.
Alberta Health Minister Iris Evans will announce Monday the creation of a special committee to look at how to fix Alberta's system of extended care for seniors, including the right of families to lodge complaints on behalf of their loved ones.
Evans has asked Conservative MLAs Len Webber of Calgary and Ray Prins of Lacombe-Ponoka to hold a series of public consultations across the province over the coming weeks. They are to report back to Evans and Seniors Minister Yvonne Fritz by Labour Day.
Government sources said Evans is "extremely concerned" with the findings of Auditor General Fred Dunn's review of long-term care facilities in the province, made public last month.
American taxpayers spend nearly $100 million a year to fund the Congressional Research Service, a "think tank" that provides reports to members of Congress on a variety of topics relevant to current political events. Yet, these reports are not made available to the public in a way that they can be easily obtained. A project of the Center for Democracy & Technology through the cooperation of several organizations and collectors of CRS Reports, Open CRS provides citizens access to CRS Reports already in the public domain and encourages Congress to provide public access to all CRS Reports.
When the federal government's new prescription drug benefit kicks in next year, it will not cover a category of drugs commonly used to treat anxiety, insomnia and seizures. That means those disabled and elderly people on Medicare who take Xanax, Valium, Atvian and other types of the drug benzodiazepine will have to look elsewhere for coverage or switch to a different, less addictive medication. Finding other alternatives may not be easy for the 1.7 million low-income, elderly people who take the drug and will be automatically enrolled in the new prescription drug plan. They will depend on the states to continue paying for their benzodiazepines - "benzos" for short - on Jan. 1, but with no guarantee.
Related link: Mental Health Issues and the Elderly
Wednesday, June 22, 2005
Lack of health insurance coverage among millions of Americans remains one of this nation’s most pressing social challenges, but one that is often not well understood. Common knowledge about who the uninsured are, why they are uninsured, the difference health coverage makes, as well as the impact on all our lives of having a large uninsured population — is riddled with misconceptions and myths. Basic facts about the uninsured, outlined here under the most common myths, are essential to understanding how we might address the growing numbers of Americans without health insurance.
New KCMU Brief Finds Most Elderly Do Not Have Assets Sufficient to Pay For a One Year Nursing Home Stay
Individuals cannot qualify for Medicaid nursing home care or home and community-based services unless they meet their state's asset eligibility standards. Currently, states are required to examine all transfers for less than fair market value that occurred within 36 months prior to an individual's application for Medicaid. This issue paper examines the assets of elderly people living in the community, focusing on those most at risk of using nursing home care. The paper finds that most elderly people living in the community do not have assets, excluding home equity, sufficient to finance a nursing home stay of one year or more. Of the one million elderly at high risk for nursing home use, 84 percent have asset levels that would be exhausted within one year of nursing home care.
From the CSM:
The grandchildren never really warmed to their new grandfather. As Giorgio Angelozzi, "adopted" by the Riva family here last year, lectured the children on good manners, just days after moving in, they developed a sudden interest in computer games and hid in their bedrooms with headphones firmly on.
This modest family in Spirano, near Milan, took the 80-year-old in after he offered his services as a live-in grandfather in the classified pages of a national newspaper. His tale of years of loneliness, with only cats and Latin poetry for company - relayed on TV networks and gossip magazines, and covered in the Monitor - sent a wave of guilt across Italy.
But eight months and a large dental bill later, the nonno appears less innocent.
Mr. Angelozzi lived with the Rivas, who paid for an operation, new glasses, and a vacation. Then things soured. He ran away in May, leaving a dentist bill for more than $3,600.
A few weeks later he produced a couple of large checks, saying he wanted to settle his debts. But he had stolen the checks from a family near Piacenza, south of Milan, who put him up while on the run.
From the AP/Las Vegas Sun:
Tuesday, the AMA refused to back a ban on
prescription drug ads, despite rising concerns about the dangers of
certain heavily marketed painkillers and antidepressants.
According to Families USA
Of the 30 brand-name drugs most frequently used by the elderly, all but four have been on the market for over three years. The prices of those 26 drugs increased, on average, by 3.6 times the rate of inflation, or 21.6 percent, from January 2001 to January 2004. Inflation for the same period was 6 percent. Of these 26 drugs:
- One increased in price by 9.4 times the rate of inflation, which represented a 56.3 percent price increase over three years.
- Over two-thirds (18 of the 26 drugs) had price increases of three or more times the rate of inflation during the three-year period.
- All but one, Norvasc (10 mg.), increased by more than two times the rate of inflation.
Drug companies' spending on direct-to-consumer advertising increased over 800% from 1995 to 2003.
Tuesday, June 21, 2005
Gov. Mitt Romney doesn't just want to make health insurance universal. He wants to make it compulsory.
In an opinion piece published in today's Herald, the possible presidential contender pushes the ball way upfield in the healthcare debate by calling ``for a personal responsibility principle'' in health insurance.
``Everyone must either become insured or maintain an adequate savings account to cover their medical expenses,'' Romney writes.
The argument: that would cut out free-riders who use today's system without paying for it. ``We cannot expect some citizens to pay for others who can afford to pay some or all of their own way,'' he writes.
I wonder if the Governor has read this article by the National Center for Policy Analysis, which concludes:
Realistically, the federal government cannot require the purchase of health insurance and leave insurers, providers and state legislators free to increase the price without limit. Mandating health insurance is an open invitation to federal regulation of the entire health care system.
--the average cost of health insurance premiums for a family of four, 2004 (including COBRA portion of the premium): $9,950 (up 11% from previous year)
--the average inflation adjusted income of a family of four, 2003: $43,318 (cumulative decline of 3.25% since 2001)
--average annual health insurance premium, individual (including COBRA portion): $3,695
--annual income of a full time day care center employee, 2003: $7.18/hour ($14,360/yr)
--average annual increase in cost of health insurance, 1996-2004: 8.2%
Because the more you know...
See also Uninsured in America: Life and Death in the Land of Opportunity
Pharmaceutical companies’ impending fight against proposals that would pinch Medicaid spending on medicines will pit the industry against the nation’s governors and congressional Republicans who are its traditional allies.
As the debate over reducing Medicaid spending moves ahead, the brand-name-drug industry appears poised to urge Congress to look elsewhere for the savings. In a written statement issued Friday, Pharmaceutical Research and Manufacturers of America (PhRMA) Senior Vice President Ken Johnson emphasized that drug costs constitute a small fraction of Medicaid’s expenses that will drastically diminish when Medicare begins covering drugs for senior citizens and the disabled next year.
Note: CMS is prohibited by law from negotiating with the pharmaceutical companies for lower drug prices for Medicare beneficiaries.
Related link: Pharmaceutical company profit margins 2001 (see page 37)
From the Kentucky Post:
Legal Aid of the Bluegrass, based in Covington,Kentucky, has received the ABA's Hodson Award for Public Service. It was nominated for the Award by the Northern Kentucky Bar Association for the service it provides to low income people in family and domestic violence law, immigration, elder law and nursing home advocacy, consumer protection, housing assistance and public assistance. The nomination said the organization does so despite cuts from the government and a need to seek out private grants year-in and year-out.
The Hodson Award, named in honor of the distinguished public service career of the late Major General Kenneth J. Hodson, a former Judge Advocate General of the U.S. Army, and a founding member of the Division, recognizes sustained, outstanding performance or a specific and extraordinary service by a government or public sector law office
Monday, June 20, 2005
The AMA's House of Delegates will decide by Wednesday whether the doctors' group should approve new policy that would put the AMA on record in opposition to state and federal legislation that "presumes to know the patient's wishes" in cases like Schiavo.
Michael Williams, M.D., a neurologist at Johns Hopkins in Baltimore, who chairs the American Academy of Neurology's ethics committee, said here that several states have reacted by enacting or by considering legislation that presumes a desire for "artificial hydration and nutrition" in perpetuity in lieu of an advance directive or living will to the contrary.
Current AMA policy states that it "is not unethical to discontinue all means of life-sustaining medical treatment in accordance with a proper substituted judgment or best interests analysis" and further states that courts should "determine who is to make treatment decisions, including appointing a guardian, rather than making treatment decisions."
The AMA is also considering a proposal from the American Association of Public Health Physicians that would require health insurers, including Medicare and Medicaid, to obtain written advance directives from all new patients at time of enrollment in health plans.
Moreover, the Public Health Physicians are asking the AMA to amend the group's Principles of Medical Ethics to "explicitly recognize the rights of the patients and legally responsible family members when patients are unable to speak for themselves in determining the care provided."