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Editor’s note: This analysis piece was submitted while Tom Price was in Congressional hearings for HHS Secretary confirmation. All eyes on Capitol Hill are focused on the fight over the “repeal and replacement” of the Affordable Care Act (ACA), also known as Obamacare, by the new Republican-controlled Congress and the Trump administration. But don’t get confused. That’s only the warmup card. The championship round could be the battles over the future of Medicare and Medicaid. While Donald J. Trump and his administration settle in to their new j...
Health care issues are certain to be at the top of president-elect Donald Trump’s agenda when he takes office January 20. But how he handles the controversies sure to erupt around repealing and replacing Obamacare, efforts to turn Medicare into a voucher program, and the nomination of conservative Rep. Tom Price to head the Health and Human Services Department are still to play out over the next few months. Trump and congressional Republicans have made no secret of their united desire to repeal and replace President Obama’s signature hea...
With the nation sharply focusing on the Nov. 8 presidential election, the choice between Republican candidate Donald J. Trump and Democratic candidate Hillary Clinton has been all about personalities, not about policy differences. Facts have taken a back seat to flamboyance. To many, the election choice seems to be between an ethically-challenged, calculating lawyer/politician versus a drunk-uncle-style egomaniac. No surprise then, that both Trump and Clinton have unfavorable ratings above 50 percent in most polls, leaving many voters to hold...
Millions of seniors are struggling to put food on the table, a dramatic spike in the problem, according to two new reports. Despite the recent uptick in the U.S. economy, an astonishingly large number of Americans – 9.6 million over the age of 60 – could not reliably buy or access food at least part of the year. That’s one in every six older men and women. And those numbers are much lower than the reality. Analysts say that large groups of seniors aren’t even being included in those numbers because it’s hard to reach them to find out they aren...
The prices that hospitals ask customers to pay for a series of common procedures have increased by more than 10 percent between 2011 and 2013 – more than double the rate of inflation, according to new data released recently by Medicare. But the amounts paid by Medicare have stayed flat, according to that data. The hospitals’ rising list prices mainly affect the uninsured and people who use hospitals outside their insurance network. The 2013 Medicare billing information was part of a large release of data breaking down spending based on hos...
Check off “budget” on the Republicans “can govern” checklist. Congressional Republicans recently approved a budget bill, the first passed by Congress in six years, and the first since the party took control of both chambers earlier this year. The non-binding document, however, does not go to President Obama for his signature. Instead, it helps guide Congress in framing how it wants to consider all of the government agency appropriations bills. It will also serve as a Republican fiscal policy guideline and sets the stage for the 2016 preside...
For the second time in three years, the U.S. Supreme Court could determine the fate of the president’s health care law with a case coming up for oral arguments in March. While a limited number of seniors are covered under the health care law, a Court decision could have a big impact financially on your health care costs if the High Court rules the law unconstitutional. With President Obama controlling the veto pen over Congress, lawmakers and the White House will continue their health care legislative standoff. Two years ago, the Supreme Court...
Medicare is like a government octopus, with its tentacles stretching into almost every aspect of senior life. With its policies affecting 50 million beneficiaries, this agency has a lot going on simultaneously. Sometimes, policies it puts in place get lost in the shuffle, as it has with its obesity program (see below). Other times, people figure out how to game the system, resulting in huge fraud and abuse. So as often happens at year end, the agency, formally known as the Centers for Medicare and Medicaid Services (CMS), has been issuing...
Last spring the nation was outraged when the enormous backlog of claims at the Veterans Administration was revealed. The number of claims stuck in processing for more than 125 days at that time was 611,000 veterans who were not getting their claims processed. Seven months later, that number, the VA says now, has dropped to 344,000 claims that are still 125 days behind. While there was bipartisan anger over the VA scandal, a recent Washington Post story reveals a dramatically worse backlog over...
Last summer’s viral “ice bucket challenge” focused attention and helped raise money for ALS – amyotrophic lateral sclerosis – a disease that impairs motor function so people often can’t talk or even move. But while public attention focused people on the disease, Medicare changes already in the works could now seriously curtail coverage of communication tools that ALS patients need. Unless it is delayed, beginning Dec. 1, people with ALS could lose access to technological advances that allow them to better communicate, as a result of what Med...
Sovaldi, a new drug, which has been hailed as a breakthrough treatment for the 3.2 million Americans infected with hepatitis C, costs $1,000 a pill. While it is highly effective and has fewer side effects and takes less time than older therapies, it costs $84,000 for a typical patient. But lawmakers want to know why the U.S. price is much higher than in other countries, as well as previously estimated in the U.S. In a letter sent recently, two U.S. senators, Finance Chairman Ron Wyden, D-Ore., and Sen. Charles Grassley, R-Ia., asked Gilead...
Bipartisanship has surfaced, at least briefly, on Capitol Hill. More than 130 lawmakers, from both parties, are urging the Obama Administration to expand coverage for a lung-cancer test under Medicare – screening they see as vital for vulnerable seniors. But the decision could cost Medicare billions of dollars. In a letter to the Centers for Medicare and Medicaid Services, the lawmakers called for a timely decision on coverage for low-dose CT scans for older patients at higher risk of d...
Dying patients may find it more difficult to get certain medications under new rules Medicare has recently put in place. Meanwhile, another set of rules could make it easier for seniors to get Medicare to pay for home health care services. Medicare has recently issued different sets of rules for payments involving hospice care and home health care services, as a result of a lawsuit settlement. But both of the rules changes are complicated and confusing and seniors may need some help in working their way through the changes. In an effort to crac...
The White House, after an aggressive pushback from seniors, patients, pharmaceutical companies and lawmakers from both parties, recently scrapped most of a proposed plan to limit Medicare coverage for certain classes of drugs including those used to treat depression and schizophrenia. In January, the Centers for Medicare and Medicaid Services proposed broad changes to the Medicare Part D prescription-drug program that covers medicines for about 39 million beneficiaries. Medicare officials had said the proposal would save money and reduce the...
When do you fix a government program that’s not broken? That’s the question many in Washington are asking, after Medicare recently proposed a series of changes to its Part D prescription drug program – a program that, by most everyone’s view, is working very well. The Centers for Medicare and Medicaid Services (CMS) proposed new rules recently that would fundamentally change the program's private insurance coverage for certain drugs, alter the pharmacy networks that some plans cover and limit the number of policies available to benefic...
Put the president’s health care law aside, at least for now. Temporarily forget that the nation just went through the government shutdown ordeal. Get ready for the next crisis. It’s already on its way. Democratic and Republican lawmakers on Capitol Hill have until December 13 to reach an agreement to fix the nation’s budget woes. Senate Budget Committee Chairman Patty Murray, D-Wash., and House Budget Committee Chairman Paul Ryan, R-Wis., are coordinating a 29-member panel to reach consensus by that time. In short, the outlines of the probl...
Sign-up for the Affordable Care Act starts in October with the bulk of the law, known as Obamacare, taking effect starting in January 2014. For most seniors, no action is necessary as Medicare will cover most of their needs. But for those between 50 and 65 years old, and for wealthy seniors, all the talk about the Affordable Care Act is extremely confusing. So let’s try and answer some of the important questions you and your family may have here. Some of the details will be different in each state – specifically the prices of the different hea...
Ever forget to take your pills or simply fail to measure your blood sugar or some other routine health care daily chores? Would it help you remember if you knew that a nurse was coming by regularly to check in and make sure you were doing what you were supposed to do? Simple things sometimes can be revolutionary. A Medicare experimental program, being tested in Doylestown, Pa., that brings a nurse to regularly visit you for continued care – even when you aren’t seriously ill – has been given an 18 month reprieve from being shut down. If it is...
While the Obama administration battles with the Republican House of Representatives this summer in the public relations fight over getting people to sign up for the new health care insurance coverage, key decisions affecting millions of poor folks are being made at the state level with major consequences. Supporters and opponents are squaring off in efforts to sell or roll back the implementation of the Affordable Care Act, known as “Obamacare.” Both sides want to get the tactical advantage in advance of when people start to sign up for health...
After five days in the hospital with a fractured spine, Jean Arnau was discharged and needed to transfer to a skilled nursing facility for rehabilitation. Only then did her family find out that she had never been formally admitted as an inpatient to the hospital. While the care the 84-year-old Rhode Island woman got was exactly the same, she had been classified as an outpatient under “observation” – a status that cost her thousands of dollars more than she would have paid if she had been admitted as an inpatient. The same thing happened to Lo...
President Barack Obama took a political gamble at the beginning of April by proposing to curb the growth of Medicare and Social Security. In upsetting his liberal political base, Obama hopes his concessions will draw rank and file Senate Republicans into a budget deal that, so far, has proven elusive. Obama released his proposed $3.778 trillion budget recently, for the fiscal year beginning in October – the first salvo in a long process full of political gamesmanship, partisan rhetoric and hopefully, ultimately, an agreement on a broad d...
