Elder Law Prof Blog

CCELS releases info on Canadian elder abuse laws

The Canadian Centre for Elder Law Studies has just released a document comparing elder abuse laws in the Canadian provinces.  Get the chart here.  Full documentation coming soon.

For the latest information on elder law issues, visit the CCELS main website at
http://www.ccels.ca/

UNSHARED SACRIFICE--the GOP Budget Proposal

From the Center for Budget and Policy Priorities:

By the end of this week, eight House Committees will have adopted proposals that would reduce spending in a wide range of mandatory (or “entitlement”) programs. These proposals, which next week will be combined into a single reconciliation bill by the House Budget Committee, have been defended as necessary to reduce the deficit and offset hurricane-related costs (though as explained below, neither claim is accurate). Yet the proposals passed out of House committees do not reflect an approach of shared sacrifice, particularly when viewed as part of a budget reconciliation process that also facilitates the adoption of more tax cuts.

Even though poverty, food insecurity, and the number of people lacking health insurance have all been rising, the House bills would ask low-income families to shoulder a large share of the budgetcutting burden, leaving them with less access to needed health care and basic food aid. Children would receive less of the child support they are owed, and many poor individuals with disabilities would have to wait longer to receive the back payments to which they are entitled.

While cutting programs that benefit low-income families and individuals, the House reconciliation proposals shy away from some sensible program cuts that are opposed by powerful lobbying interests, such as Medicare managed care companies. In addition, the House reconciliation proposals would not call for any sacrifice in the form of scaling back the benefits of tax cuts enacted in the last four years, whose benefits overwhelmingly have gone to higher-income taxpayers. In fact, rather than asking those high-income households to share in the sacrifice, the House is planning to pass a new round of tax cuts under the same fast-track reconciliation process being used to push through the program cuts.

These tax cuts, a substantial portion of which are expected to go to high-income households, would further exacerbate income inequality, which is already exceptionally large and growing. And because the new tax cuts would cost more money than the budget cuts would save, the budget cuts would in effect be used not to reduce the deficit or pay hurricane-related costs, but rather to help pay for the new tax cuts.

Read the full report, entitled, "UNSHARED SACRIFICE: Who’s Hurt, Who’s Helped, and What’s Spared Under the Emerging House Budget Reconciliation Plan"

KFF examines impact of low enrollment in Part D program

This Kaiser Family Foundation study estimates the potential impact in monthly Medicare drug premiums if enrollment does not reach 29 million in 2006 as the Congressional Budget Office (CBO) assumed, and if those who do enroll have relatively high total prescription drug costs.

The study, prepared by Avalere Health LLC and based on a model developed by Actuarial Research Corporation, looks at various participation scenarios for the beneficiaries who are projected by the Congressional Budget Office (CBO) to enroll in a Medicare drug plan in 2006. The paper examines the effects of varying enrollment on monthly premiums and federal costs of the Medicare prescription drug benefit, particularly if beneficiaries with relatively low drug spending do not enroll.

This analysis solely focuses on the impact of various participation scenarios, based on beneficiaries’ prescription drug costs, on average Medicare prescription drug plan premiums.  The analysis holds constant other factors that also could affect average plan premiums in the future, including drug prices and utilization, and other market dynamics that could affect plan participation.  These factors were held constant to illustrate the implications of various beneficiary participation scenarios on Medicare drug plan premiums.

The report concludes, inter alia, that average premiums for the Medicare prescription drug benefit could be significantly higher in 2007 than current CBO projections if enrollment is significantly
concentrated among beneficiaries who have high expected drug spending.

The study was prepared for the Kaiser Family Foundation by Jonathan Blum, Jennifer Bowman, and Chiquita White of Avalere Health LLC.

Get the report.

Miers Withdraws Supreme Court Nomination

The AP reports that Harriet Miers has withdrawn her name from consideration for the Supreme Court.

WASHINGTON -- Harriet Miers withdrew her nomination to be a Supreme Court justice Thursday in the face of stiff opposition and mounting criticism about her qualifications.

President Bush said he reluctantly accepted her decision to withdraw, after weeks of insisting that he did not want her to step down. He blamed her withdrawal on calls in the Senate for the release of internal White House documents that the administration has insisted were protected by executive privilege.

"It is clear that senators would not be satisfied until they gained access to internal documents concerning advice provided during her tenure at the White House -- disclosures that would undermine a president's ability to receive candid counsel," Bush said. "Harriet Miers' decision demonstrates her deep respect for this essential aspect of the constitutional separation of powers -- and confirms my deep respect and admiration for her."

Miers' surprise withdrawal stunned Washington on a day when the capital was awaiting news on another front -- the possible indictment of senior White House aides in the CIA leak case.

Miers told the president she was withdrawing at 8:30 p.m. Wednesday. In her letter dated Thursday, Miers said she was concerned that the confirmation process "would create a burden for the White House and our staff that is not in the best interest of the country."

She noted that members of the Senate had indicated their intention to seek documents about her service in the White House in order to judge whether to support her nomination to the Supreme Court. "I have been informed repeatedly that in lieu of records, I would be expected to testify about my service in the White House to demonstrate my experience and judicial philosophy," she wrote.

"While I believe that my lengthy career provides sufficient evidence for consideration of my nomination, I am convinced the efforts to obtain Executive Branch materials and information will continue."
--------------------------
    STATEMENT BY THE PRESIDENT
    Today, I have reluctantly accepted Harriet Miers'
    decision to withdraw her nomination to the Supreme
    Court of the United States.

   

    I nominated Harriet Miers to the Supreme Court because
    of her extraordinary legal experience, her character,
    and her conservative judicial philosophy. Throughout
    her career, she has gained the respect and admiration
    of her fellow attorneys. She has earned a reputation
    for fairness and total integrity. She has been a
    leader and a pioneer in the American legal profession.
    She has worked in important positions in state and
    local government and in the bar. And for the last
    five years, she has served with distinction and honor
    in critical positions in the Executive Branch.

   

    I understand and share her concern, however, about the
    current state of the Supreme Court confirmation
    process. It is clear that Senators would not be
    satisfied until they gained access to internal
    documents concerning advice provided during her tenure
    at the White House - disclosures that would undermine
    a President's ability to receive candid counsel.
    Harriet Miers' decision demonstrates her deep respect
    for this essential aspect of the Constitutional
    separation of powers - and confirms my deep respect
    and admiration for her.

   

    I am grateful for Harriet Miers' friendship and
  devotion to our country. And I am honored that she
    will continue to serve our Nation as White House
    Counsel.

   

    My responsibility to fill this vacancy remains. I
  will do so in a timely manner.

Ed:  So much for the President's right to name Justices so long as their moral character is not at issue. 

President Bush adds his own brother to Medicaid Commission

From The Hill: 

The Bush administration has shattered the National Governors Association’s (NGA’s) unified front in the ongoing debate about the future of Medicaid by successfully courting two governors to participate on a controversial panel.

Florida Gov. Jeb Bush (R) and West Virginia Gov. Joe Manchin (D) have agreed to sit on the Department of Health and Human Services’ (HHS) Medicaid Commission, which wraps up a two-day meeting today. HHS announced the new panel members Tuesday.

The NGA had rejected offers to participate in the process despite the administration’s holding open two seats on the panel. The governors instead have worked independently to develop recommendations to the White House and Congress about how to reform Medicaid, which has become a major drag on state budgets. HHS Secretary Mike Leavitt assembled the panel after Congress authorized it in the fiscal year 2006 budget resolution.

The defection of two governors from this formerly unanimous position could lend an air of credibility to the Medicaid Commission, which had been shunned not only by the governors but also by Congress.

Read more. 

Senate panel backs $10 billion in health care cuts

The Senate Finance Committee on Tuesday approved $10 billion in Medicaid and Medicare savings as part of a broader effort by congressional Republicans to trim spending and approve additional tax cuts.

Senate Finance Committee Chairman Charles Grassley, an Iowa Republican, said the bill's savings would affect the health industry and not beneficiaries. The bill, approved by a 11-9 party line vote, would improve health care access for children and low income beneficiaries, he said.

But Democratic opponents said they are worried the emphasis would shift to beneficiaries later in the legislative process when the Senate and House of Representatives try to work out differences.

"I am concerned about the fate of the bill," Sen. Max Baucus of Montana, the top Democrat on the panel. "Although many of its policies are sound, I am not confident that most will survive a conference with the House."

Grassley said the full Senate could take up the measure as early as next week.

The legislation is part of a broader effort in the Senate to cut spending by about $35 billion over five years with most of the reductions from health care and other mandatory programs. But conservatives are pushing for even bigger savings throughout a greater number of government programs.

Read more at Reuters.com.

NPR: Bush Medicaid Proposal Criticized

The Bush administration and the nation's governors want to close loopholes that allow middle- and upper-class senior citizens to stash assets in order to qualify for Medicaid-paid nursing home care. But consumer advocates say some of the changes could disqualify innocent seniors who help their grandchildren pay for college or give to their churches, then need care later on.

Listen to the story.

Kaiser Foundation updates listing of Health Policy Fellowships

A wide range of fellowship offerings for undergrads, graduate students, and post docs:  http://www.kaiseredu.org/policy_index.asp

Japan contemplates cutting health benefits for elderly

From the Malaysia Star/Bloomberg:

Japan's government plans to reduce medical insurance coverage for some elderly citizens to curb ballooning costs that are forecast to reach as much as 40 trillion yen, or US$345bil, in 10 years. 

The Government said it aimed at cutting payments made under the state-run medical insurance programme by 7.5% over the next 10 years, and by 12.5% over the next 20 years, the Health and Welfare Ministry said in a statement. 

The ministry's proposal will raise payments for those between 70 and 75 years old to 20% of total medical bills from 10%. 

Those aged between 70 and 75 with higher income will pay 30%, up from 20%. People between 65 and 69 will benefit under the proposal, paying 20% of total medical costs from 30%. 

Government medical insurance payouts are expected to total 28.3 trillion yen in the year ending March 2007, the ministry forecast. 

Under the new plan, the ministry said it aimed at cutting 3 trillion yen off medical costs in the year ending March 2016, which was 7.5% less than the current forecast.

 

 

EU/UK: Employers run risk of failing EU ageism rules

Age discrimination remains widespread among employers, raising doubts over their ability to cope with European Union rules due to be introduced next year, according to a study published today. A survey of more than 2,500 managers and personnel professionals reported that 59 per cent of respondents claimed to "have been personally disadvantaged at work because of their age" while 22 per cent of managers admitted that age considerations had made "an impact on their own recruitment decisions". The study by the Chartered Management Institute and the Chartered Institute of Personnel and Development found that many workers, who will be expected to work longer to top up their pensions and fill skill shortages, had unrealistic retirement expectations. The report said: "While 69 per cent anticipate that the age of retirement for the average person in 10 years' time will be 66 or older, 80 per cent expect they will retire by the age of 65." Employers' organisations have warned that age discrimination laws proposed by the government to comply with EU directives are unnecessarily complex and could prompt a deluge of employment tribunal cases. They are particularly concerned about plans to set a default retirement age of 65. If employees ask to work longer, employers will be required to prove they have considered this request but would not have to give reasons for refusing.

Read more of this story at Financial Times.com.

More than half of Katrina victims were elderly

From the AP via Newsday:

A majority of people killed by Hurricane Katrina were older residents unable or unwilling to evacuate in the rising floodwaters, according to a study of almost half the bodies recovered in Louisiana.

About 60 percent of the nearly 500 victims identified so far were age 61 or older, the Louisiana Department of Health and Hospitals reported.

"The elderly were much more likely to be in hospitals and nursing homes as well as possibly homebound and not able to access transportation in order to evacuate from the storm," said agency spokesman Bob Johannessen.

More than 215 bodies out of 1,048 recovered statewide were found in or around hospitals and nursing homes, according the state. Two nursing home operators have been charged with negligent homicide in 34 deaths at one facility, and others are under investigation.

A breakdown of the studied deaths by ZIP code shows large numbers were found in neighborhoods devastated by water rising from levee breaks, particularly in the lower Ninth Ward, a low-lying largely impoverished neighborhood of New Orleans, and the historic Gentilly neighborhood.

Many Canadians reluctant to seek mental health treatment

Psychiatric News reports:

Even though universal health insurance is available in Canada, many Canadians still seem reluctant to seek mental health services, according to a study in the September Canadian Journal of Psychiatry. 

The lead researcher was Helen-Maria Vasiliadis, Ph.D., a Canadian Institutes of Health Research postdoctoral fellow at the Harvard School of Public Health. 

Canada's first national survey on mental health and well-being was conducted in 2002 and included detailed questions about service use. It was called the Statistics Canada Canadian Community Health Survey: Mental Health and Well-Being. Vasiliadis and colleagues have now analyzed service-use data from that survey. 

Most Canadians with a mental disorder, including dependence on illicit drugs, did not seek help for it during the year preceding the survey, Vasiliadis and coworkers found. 

Only 34 percent of respondents with depression reported past-year use of professional mental health services. The corresponding percentages were 42 percent for mania, 38 percent for panic disorder, 29 percent for social anxiety, and 29 percent for agoraphobia, and 37 percent for drug dependence. 

Women, single persons, and divorced individuals were more likely to seek help for a mental disorder than were men and individuals with partners. People with less education and people born outside of Canada were found to take less advantage of mental health services than individuals with more education and born within Canada.

The article, Service Use for Mental Health Reasons: Cross-Provincial Differences in Rates, Determinants, and Equity of Access (Helen-Maria Vasiliadis, PhD, Alain Lesage, MD, Carol Adair, PhD, Richard Boyer, PhD) was published in the September issue of the Canadian Journal of Psychiatry.

House Medicaid Reform bill aims for middle class, discourages charitable gifts by seniors

Read the full text here.

APA Concerned About Formulary Restrictions

In this week's Psychiatric News:

Widespread misinterpretation of the results of the National Institute of Mental Health's Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) has led to concern that the study results could be used to restrict the availability of antipsychotic medications in Medicare or Medicaid formularies.

Data from the first phase of CATIE, which compared the effectiveness of four newer, more expensive second-generation antipsychotic drugs and an older, first-generation medication available in cheaper, generic formulations, were published in the September 22 New England Journal of Medicine (see story beginning on page 1). Reports in major daily newspapers across the country noted that the four newer medications compared with the first-generation antipsychotic, perphenazine, were found to be "no more effective or better tolerated." In fact, the study found significant differences in efficacy of one drug in particular, as well as differences in the tolerability of the five drugs studied.

The issue of restricted formularies in entitlement programs is particularly timely because the new Medicare Part D prescription drug benefit begins on January 1, 2006. Currently, Part D will pay for all of the newer, more expensive antipsychotics (Psychiatric News, July 15), and most state Medicaid programs have included open access to all antipsychotics. However, cost-control mechanisms have increasingly been used in the last three years. "From a public policy perspective, it would be a dire mistake to conclude that restricting access to any of the currently available antipsychotic medications, either by formulary limitations or by other means such as tiered pricing and `must fail' policies, is in the best interest of patients," said APA Medical Director James H. Scully Jr., M.D., in a letter to Mark McClellan, M.D., Ph.D., administrator of the Centers for Medicare and Medicaid Services (CMS).

"APA is concerned that some of CATIE's early findings have been erroneously interpreted and reported in the press as grounds for a restrictive formulary and utilization-review policy of medications based on cost rather than medical judgment," Scully wrote. "Critical facts have been lost," he continued. "The study demonstrated that all of these medications have substantial benefit, but none is without side effects." The study also showed, he added, that four times as many patients on the older, cheaper drug discontinued their medication because of extrapyramidal symptoms, compared with those taking newer medications. Indeed, Scully told McClellan, CATIE validated "clinicians' belief that to offer the greatest benefit and the least-adverse side effects for the individual patient, it is often necessary to try two or more medications." He concluded, "APA strongly urges CMS to continue to allow physicians and patients to work together to select a treatment plan that is most beneficial for the individual patient and not restrict access to the full range of medications based on arbitrary concerns and questionable reporting of data."

QI program saved

From the Center for Medicare Advocacy:

On October 20, 2005 Congress passed, and President Bush signed into law, H.R. 3971, which, among other things, extends the QI program for two years until September 30, 2007. Medicare beneficiaries who have incomes between 120% and 135% of federal poverty levels and countable assets less than $4,000 for an individual or $6,000 for a couple qualify for the QI program. Some states, like Connecticut, have no asset test for the program. The benefit for those who qualify is payment of the Medicare Part B premium by the state Medicaid program. The program is funded entirely with federal dollars. Importantly, people who receive QI benefits are also automatically eligible for the low-income subsidy that assists with costs under Medicare Part D. A few senators who champion the cause of low-income people have indicated plans to introduce legislation to make the QI program permanent.

CBPP analyzes impact of budget reconciliation measure on low income persons--state by state information

Although the House of Representatives has postponed a vote on altering the Congressional budget resolution to require House committees to make deeper cuts in mandatory (i.e., entitlement) programs, the House leadership has made clear that it is committed to achieving the additional cuts.  The leadership has said it will direct House committees to increase the total cuts in mandatory programs to $50 billion over five years — up $15 billion from the $35 billion that the budget resolution approved in April calls for — regardless of whether the House votes to amend the budget resolution to require the deeper cuts.  A substantial portion of these additional reductions is likely to be achieved by cutting more deeply into programs that provide basic assistance to vulnerable, low-income familiCbppbanner2es andindividuals.

The leadership has not officially released details concerning how the $15 billion in added cuts would be achieved, but   media accounts consistently report that the House Ways and Means Committee   will be responsible for $7 billion to $8 billion of the additional cuts and   the Agriculture Committee will be expected to come up with additional reductions of approximately $1.5 billion.  The remaining $5.5 billion to $6.5 billion of added cuts apparently will come from the Education and Workforce Committee and the Energy and Commerce Committee.

Get the full report from the Center of Budget and Policy Priorities.

State by state analysis.

Proposed GOP budget cuts Medicaid and Medicare but adds to federal budget deficit

Today's Seattle Post-Intelligencer outlines key Medicare and Medicaid related provisions of the GOP budget proposal:

An effort to wring $10 billion in savings from the Medicaid and Medicare programs as part of a GOP budget proposal would actually increase the deficit by $4 billion during the current budget year. Higher Medicare payments to doctors and new Medicaid money for victims of Hurricane Katrina exceed the savings that would come from lower Medicaid drug reimbursements to pharmacies and other cost-cutting steps in the two federal health care programs.

Doctors would be big winners under the bill. It would set aside $11 billion to forestall a 4.4 percent cut in Medicare payments to physicians that it is scheduled to take effect Jan. 1. Instead, they would get a 1 percent increase, a reprieve that would last only one year. But Congress is generally regarded as unlikely to let future payment cuts take effect, a stand that promises to cost upward of $150 billion over the next decade.

The plan released by the chairman of the Senate Finance Committee would become part of a $35 billion measure of spending curbs that is headed for debate in the full Senate next month. Despite the short-term increase in the deficit, the proposal announced by Sen. Charles Grassley, R-Iowa, was a big step forward for Senate GOP leaders. For them, putting in place the budget blueprint that passed in April is a central piece of their fall agenda. Grassley has been caught between the moderate and conservative wings of his committee over the plan. Earlier this year, moderates such as Sen. Gordon Smith, R-Ore., rebelled over a $10 billion proposal to curb Medicaid costs. In recent days, conservatives protested a plan to provide Katrina victims with expanded Medicaid coverage.

Grassley predicted his committee would pass the measure on a party-line vote even though Democrats back many of its changes to the health care programs. But Democrats are withholding support, unhappy that conservative Republicans have delayed a separate bill to provide more generous Medicaid benefits to Katrina victims. Democrats also object to Republican budget plans to use fast-track budget rules to advance $70 billion in tax cuts but only cut entitlement spending by $35 billion. Grassley's plan would trim Medicaid by $7.6 billion over five years but add $3.3 billion, including $1.9 billion for Medicaid coverage for hurricane victims. An additional $800 million would help parents with severely disabled children retain Medicaid coverage and still earn wages above the poverty line.

Much of the Medicaid savings, about $5 billion, would come from changing the payment formula for pharmacies to take into account rebates and discounts. The bill would tighten Medicaid rules to limit the ability of people to shed assets to qualify for Medicaid nursing home coverage. On Medicare, the measure would save $5.8 billion. More than $6 billion would come from providing lower payments to insurers whose pool of patients contains fewer very sick patients. Despite White House opposition, the bill would save $5.4 billion by eliminating a fund created under the 2003 Medicare prescription drug bill to give regional insurance companies incentives to offer the new drug benefit.

Read the rest.  Then look at the budget bill yourself. 

Ed:  Although the proposed budget does NOT change the medical assistance asset transfer look back period, a "reform" that many middle class voters and their advocates had feared, it does make a number of changes in the asset transfer rules for a total "savings" of 305 million.  Cutting out funding for two Alaskan "bridges to nowhere", in contrast, would save 423 million. 

 

Industry Programs May Best Medicare Drug Benefit

From MyZiva.com:

The November 15 enrollment date for the Medicare drug benefit is drawing near, but a new study shows that some lower-income seniors may want to consider signing up for assistance programs sponsored by drug companies instead. Researchers found that the Medicare drug benefit provides the most savings on annual drug costs only for seniors living at or near the federal poverty line. However, once annual income approaches 135 to 150 percent of the poverty line, the line between drug companies’ programs and Medicare begins to blur; for those with income surpassing 150 percent of the federal poverty line, industry programs are the far better choice – 77 percent of savings compared to 31 percent with Medicare. Furthermore, late enrollment in the Medicare drug benefit invokes a penalty of higher monthly premiums. Drug company programs do have their limitations, however – the range of drugs offered may be limited, and most people are utterly unaware of the existence of such programs. Click here to view the Reuters news article on this topic.    

The study, Impact of the Medicare Modernization Act on Low-Income Persons Dawn E. Havrda, PharmD, BCPS; Beth A. Omundsen, MD; William Bender, MD; and Mary Ann Kirkpatrick, PhD appears in the Oct. 18 issue of Annals of Internal Medicine.

Canada: NACA urges improvements in long term care facilities.

Via CCN Matthews:

Canada's National Advisory Council on Aging (NACA) urges governments, care institutions and other stakeholders to work together to improve the lives of seniors in long-term care facilities. The need for improvements is discussed in a statement to be released during the Canadian Association on Gerontology's meeting in Halifax, October 20-22nd. The Council supports the recommendations put forward by the Canadian Healthcare Association (CHA) in its 2004 Policy Brief on the subject.

Despite the existence of exemplary models, Council also finds there are serious issues in long-term care and unacceptable disparities across the country: lack of public funding and affordability; lack of quality care and accountability; lack of dignity and choice for residents; lack of respect for volunteers and families. "It should not cost $20 per day to have mom in a Yukon residence and $137 per day if she is in New Brunswick. There should be no second-class facilities for Canada's seniors," claims Bubs Coleman, spokesperson for NACA.

Among Canadians aged 75 and over, only 14% lived in long-term care facilities in 2001. The group of older, more vulnerable residents, however, is growing and will likely continue to need more long-term care. The NACA therefore supports the policy framework of the CHA as a means to address current problems. Long-term care systems across Canada need to be flexible enough to meet regional realities, while delivering comparable services.

The National Advisory Council on Aging is an advisory body to the federal Minister of Health on all matters related to the aging of the Canadian population and the quality of life of seniors. It was created May 1, 1980.

See the document at: www.naca-ccnta.ca/expression/18-4/exp18-4_toc_e.htm

CMS Finally Rolls Out Part D Tools for Consumers

Two weeks after Medicare beneficiaries began receiving their mailed notices about the Part D program, CMS has set up a new area within its website intended to help beneficiaries make appropriate choices.  Tools for beneficiaries include:

• Landscape of Local Plans        

• Compare Medicare Prescription Drug Plans        

• Formulary Finder

• Medicare & You 2006 (with corrected content)

• Hurricane Katrina Information for people with Medicare and Medicaid and providers

Get the full skinny here.