Asclepios
Time to Vote for Health Care, Medicare Reform
November 5, 2009 • Volume 9, Issue 44
The House of Representatives has released the final version of its health care bill— the Affordable Health Care for America Act(H.R. 3962)—which improves upon their original proposal to expand access to affordable health care to all Americans. The legislation makes comprehensive changes to Medicare, and takes a new patient-centered approach to health care, removing obstacles and out-of-pocket expenses that hinder access to Medicare services. Some of these changes include:
- The new legislation will close the Part D coverage gap, known as the “doughnut hole,” by 2019, four years earlier than originally proposed. In addition to this phase-out, the over 3 million individuals who fall into the doughnut hole each year will benefit from a 50 percent discount on their brand-name drugs beginning on July 1, 2010. With this legislation, fewer individuals will struggle to afford the medication they need.
- The bill also waives the deductible and cost-sharing for preventive benefits, exactly the kind of care people with Medicare need in order to remain active members in their communities. With this new provision, more people with Medicare will have access to vaccines, as well as preventive care, such as screenings for diabetes and glaucoma. Currently, Medicare currently pays 80 percent of these costs, leaving the remaining 20 percent to be paid by the consumer. H.R. 3962 would change this so that Medicare pays for these services in full.
- H.R. 3962 expands access to health care to individuals with limited incomes and modest savings. The bill expands the eligibility requirements for the Medicare Savings Programs (MSPs), which help pay the Part A and B premium and cost-sharing, and the Low-Income Subsidy (LIS), which helps pay the Part D premium, by increasing the amount of allowable assets ($17,000 for an individual/$34,0000 for a couple) for these programs. With this change, individuals who have modest savings can pay for their medical care and prescription costs.
- One objective of health care reform is to encourage a more patient-centered approach, focusing on the quality of care rather than the quantity. H.R. 3962 will encourage doctors to form accountable care organizations, which are designed to improve the quality of care to patients and to coordinate the medical care they receive.
These are among the many comprehensive changes that exemplify Congress’s commitment to expanding access to affordable health care. Now is the time to write and ask your congressional representative to vote for H.R. 3962, the Affordable Health Care for America Act.
Medical Record
“There are several major ways that this landmark legislation will improve the Medicare program. Firstly, the legislation narrows and eventually eliminates the coverage gap in the Part D prescription drug benefit by 2019, four years earlier than in the bill as originally introduced. During the phase-out of the coverage gap, people who are in the gap will also benefit from a new mandatory 50 percent discount on brand-name drugs starting almost immediately in 2010. Currently, over 3.4 million people with Medicare hit the coverage gap each year and must struggle to pay the full price for their medicines. We frequently receive calls on our consumer hotlines from individuals who must skip doses, split their pills, or forgo medications altogether because of the high out-of-pocket costs of prescription drugs when they are in the coverage gap.” (Letter of Support for HR 3962, Medicare Rights Center, November 2009)
“In addition to instituting cost efficiencies in Medicare, the House bill (like the Finance Committee bill) takes important steps toward restructuring Medicare’s payment system to promote effective, high-value health care. It reduces Medicare payments to hospitals with high readmission rates to encourage them to do a better job of preventing avoidable readmissions. It creates an alternative payment model to reward Accountable Care Organizations—physician-led organizations that take responsibility for the cost and quality of the care they deliver. It expands efforts to assess the feasibility of paying for qualified patient-centered medical homes and of bundling payments for hospitals and post-acute providers. To the extent that these approaches prove successful, the bill would require the Secretary of Health and Human Services to implement them on a larger scale. The bill also contains numerous provisions to improve program integrity and reduce fraudulent payments in both Medicare and Medicaid. Because Medicare has served in the past as a leader in developing and testing effective payment reforms that are later adopted widely by private insurers, these reforms have the potential to slow health care growth not only in Medicare but throughout the U.S. health care system.” (House Health Reform Bill Expands Coverage and Lowers Health Cost Growth, While Reducing Deficits, Center on Budget and Policy Priorities, October 2009.)
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Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
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Medicare Part D Monitoring Project
The Medicare Rights Center would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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The Louder Our Voice, the Stronger Our Message
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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 is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
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