Asclepios
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Beach Reading
August 2, 2007 • Volume 7, Issue 30When senators break for their August vacations tomorrow, they should bring along copies of the Children’s Health and Medicare Protection (CHAMP) Act, legislation passed just yesterday by their colleagues in the House. There are many great provisions in it, not only for the five million children who will get health insurance under the bill, but also for people with Medicare. This landmark legislation:
- Eliminates the doughnut hole in Part D drug coverage for millions of older adults and people with disabilities living on less than $1,276 per month. The bill substantially raises the amount of financial assets a person can have and still qualify for Extra Help under the Part D drug benefit. (Individuals can have up to $17,000 in savings, couples can have up to $34,000 and life insurance and 401k plans will not count.) Low-income people with Medicare will no longer be penalized for having spent a lifetime working to have very modest savings for their retirement.
- Pays the Part B premiums, which are expected to exceed $100 per month next year, for these low-income people with Medicare. The CHAMP Act ensures that everyone eligible for Extra Help is also eligible for the Medicare Savings Programs, which pays the Part B premium.
- Makes Medicare coverage of mental health services, like counseling, more affordable. The bill ends discriminatory treatment of mental illness under Medicare by providing parity in coverage with physical ailments. Medicare will pay 80 percent of the cost of mental health services, the same rate that applies for doctor’s visits.
- Ensures access to doctors under Medicare. The bill averts a scheduled 10 percent cut in Medicare payments to doctors in 2008 and another 5 percent cut slated for 2009. The cuts threatened to force doctors to stop treating people with Medicare.
Worried about the cost of these improvements?
The bill shores up Medicare’s financing by phasing out overpayments to private Medicare plans, which cost taxpayers on average 12 percent more than providing care through Original Medicare. Insurance companies, who have reaped record profits from their Medicare subsidies, tried unsuccessfully to derail the House bill by threatening to slash benefits if their overpayments were eliminated. The House bill takes steps to avert that prospect by ensuring that all plans spend a minimum of 85 percent of the money they receive from Medicare and plan enrollees on medical care. The CHAMP Act also includes provisions designed to end the deception and fraud that has characterized the marketing of private Medicare plans.
Tonight, the Senate is expected to pass its bill to expand health insurance for low-income children. Unfortunately, the Senate legislation includes none of these much-needed improvements to Medicare. When they come back from recess in September, the Senate and the House will have to reconcile these two bills and vote on a common piece of legislation. In the meantime, senators should take a close look at the CHAMP Act; it’s a good read and an even better deal for people with Medicare.
Medical Record
“The CHAMP Act also protects Medicare from privatization and promotes fiscal responsibility by reducing overpayments to private plans. Existing overpayments to private plans cost taxpayers tens of billions of dollars. According to non-partisan analysts, private plans are paid, on average, 12% more than traditional Medicare—and overpayments to certain plans exceed 50%. These overpayments are the result of a decade-long campaign by President Bush and Republicans in Congress to privatize Medicare by undermining traditional Medicare and promoting private insurance. Republicans believe that the greater the number of beneficiaries enrolled in private plans, the easier it will be to privatize Medicare. Full-fledged privatization would eliminate Medicare's guaranteed benefit and force beneficiaries to fend for themselves. The result will be higher costs, fewer benefits, and less health care for seniors and people with disabilities”(“Current Legislation—Children’s Health and Medicare,” House Speaker Nancy Pelosi’s web site, August 2, 2007).
“Humana Inc., the second-largest provider of Medicare Advantage health plans, said earnings more than doubled as the company increased enrollment in the sponsored coverage by 18 percent and profit margins swelled” (“Humana Second-Quarter Profit More Than Doubles,” Bloomberg.com, July 30, 2007).
“I was being scheduled for bladder surgery so I asked the representative if there would be continuity of service and could I continue follow-up with my own urologist. He said yes. After I had bladder surgery and was sent home with an in-dwelling catheter, the plan would not allow the nurses caring for me to continue because their company was not on the plan. When I requested a nurse from their company plan to visit, I was advised she would come out as soon as possible. Thank God, my husband was a retired army nurse, [and] he did my cleansing and catheter cares. I had to return to my surgeon to have my suprapubic catheter removed because no nurse was visiting my home. Three weeks after my catheter removal, the nurse showed up for her first visit” (Story submitted to the Medicare Private Health Plan Monitoring Project, Medicare Rights Center, 07/03/2007).
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Medicare Private Health Plan Monitoring Project
The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a private health plan. With information about what the issues are with Medicare Advantage plans, we will be able to demand that those problems be fixed.
Submit your story at www.medicarerights.org/maplanstories.html.
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
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