Medicare Watch

Senate votes down House Budget Resolution

Yesterday, the United States Senate rejected the House budget resolution that would turn Medicare into a voucher program, block grant Medicaid and repeal the Affordable Care Act (ACA).  The House budget resolution, introduced by Congressman Paul Ryan, Chairman of the House Budget Committee, replaces Medicare, for those under 55, with a “voucher” system, also known as a “premium support,” that supplies individuals with a fixed amount of money to purchase insurance through private companies.  However, the voucher amount would not be enough to purchase coverage as good as what is currently provided under Medicare.  The Congressional Budget Office (CBO) estimates that this would double out of pocket costs for people with Medicare and that the voucher’s value would diminish over time because it would not keep pace with the rate of growth of healthcare costs overall, which is a major driving force of Medicare spending.  

While Medicare has garnered much of the attention in the debate, the vote last night also symbolized a major victory for Medicaid, which supplements Medicare for many older Americans and people with disabilities.   Currently, the federal government provides ongoing financial support to state Medicaid programs, setting minimum standards of eligibility and guaranteeing coverage for all those who are eligible.  Under the House budget resolution, the government would only provide a capped amount to states (a block grant), and states would determine eligibility and coverage rules.  The resolution would result in reductions in Medicaid coverage and more restrictive eligibility rules, meaning optional coverage categories and programs, many of which people with Medicare rely on, would  be cut. The vote to defeat block grants in the Senate is one that aligns to public opinion, according to the Kaiser Family Foundation May tracking poll.  Sixty percent of those polled supported keeping Medicaid as it now stands with only 35 percent stating that they support a block grant type of program. 

However, while yesterday’s Senate vote on the House budget resolution is important for Medicare and Medicaid, it represents only one in what will likely be a series of votes that may have adverse implications on the programs and the people the programs serve.  Medicare and Medicaid still face significant cuts through other proposals that could surface in Congress again in the near and long term and result in Medicare vouchers or Medicaid block grants. 

Read Medicare Rights Center President Joe Baker’s statement on the senate vote on the House budget resolution.

Read the Kaiser Health Tracking Poll – May 2011.  

Read Medicare Rights Center’s fact sheet “Decoding the 2012 House Budget Resolution.”

Early Returns on the Affordable Care Act’s Closure of the Coverage Gap Demonstrate Program’s Success

According to the Centers for Medicare & Medicaid Services (CMS), 271,000 people with Medicare have already used the Part D coverage gap discount established by the Affordable Care Act (ACA).  On average, individuals saved $613, resulting in $166 million in total drug savings so far.  Those living in Florida and Texas saved nearly $30 million combined.  The ACA phases out the Medicare prescription drug coverage gap, also known as “the doughnut hole.” While in the doughnut hole, people with Medicare must pay out of pocket for the full cost of their drugs.  This year, Medicare consumers receive a fifty percent discount on brand name drugs and a seven percent discount on generic drugs when they enter the coverage gap.  The amount of the discount will steadily increase over the next ten years until 2020 when the coverage gap is completely eliminated.  At that time, individuals with Medicare will be responsible for the standard 25 percent cost-sharing for both brand name and generic drugs.

There are several other ACA provisions that take effect in 2011 that reduce out of pocket costs for people with Medicare.  Beginning back in January, Medicare no longer charges cost-sharing for certain preventive benefits for qualified individuals including diabetes screening, mammograms, and smoking cessation.  Also, Medicare will now cover an annual Wellness Visit during which patients and doctors can determine care plans aimed to help prevent conditions that put patients’ health at risk. 

Read CMS Deputy Administrator and Director Jonathan Blum’s blog entry about the ACA closure of the Medicare prescription drug coverage gap.  

Find out how many people in your state received discounts under the prescription drug coverage gap discount program.  

Read Medicare Rights Center’s fact sheet “Health Reform and Medicare: The Doughnut Hole in 2011.”

Read Medicare Rights Center’s fact sheet “Health Reform and Medicare: Closing the Doughnut Hole.”

Read Medicare Rights Center’s fact sheet “Health Reform Check-Up: Better Preventive Care for People with Medicare.

Medicare Reminder

Medicare will not generally pay for routine eye care, but it will pay for some eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare will cover:

• Surgical procedures to help repair the function of the eye due to these conditions. For example, Medicare will cover surgery to remove the cataract and replace your eye’s lens with a man-made intraocular lens.
• Eyeglasses or contacts only if you have had cataract surgery during which an intraocular lens was placed into your eye. Medicare will cover a standard pair of untinted prescription eyeglasses or contacts if you need them after surgery. If it is medically necessary, Medicare may pay for customized eyeglasses or contact lenses.
• An eye exam to diagnose potential vision problems. If you are having vision problems that indicate a serious eye condition, Medicare will pay for an exam to see what is wrong, even if it turns out there is not anything wrong with your sight.

Learn more about Medicare’s coverage of eye care at www.MedicareInteractive.org.

Spotlight

Consumer Reports has released a new guide to Medicare and health reform titled “Medicare: 6 things you need to know now,” which features Medicare Rights Center. 

Read the guide online or request a print copy.