JustCare

Tag: Eligibility

  • Raising Medicare eligibility age could lead to thousands of additional deaths

    Raising Medicare eligibility age could lead to thousands of additional deaths

    A new study, published in the Proceedings of the National Academy of Sciences, by Alison Galvani et al. at Yale, finds that raising the Medicare eligibility to 67, as many Republicans are proposing, could lead to thousands of additional deaths each year.

    The House Republican Study Committee recommended raising the Medicare eligibility age to 67 as a way to reduce Medicare spending. But Galvani found that raising the age would significantly increase the number of older adults who are uninsured. People who are uninsured often skip necessary treatments and forgo filling prescription medicines. They can end up spending more on health care than they would have had they received the care they needed.

    When people don’t get the care they need, they often end up in the emergency room and some die needlessly. In addition, says Galvani, if they have a contagious disease, they can threaten the public health. It “can cause a condition to become both more serious and ultimately more costly. In the case of infectious diseases, forgoing health care can lead to transmission to other people that may have been prevented.”

    Galvani and her team looked at how the two-year increase in the age of Medicare eligibility would contribute to the number of older adults who are uninsured. They then considered how being uninsured increases people’s likelihood of dying. They concluded that around 10,000 people would die needlessly every year if Congress increased the Medicare eligibility age two years.

    To protect themselves politically, the Republicans would increase the Medicare eligibility age slowly–likely by two or three months each year until the age of 67. During that time, Galvani’s team projects that 17,244 older adults would die if Congress raised the eligibility age by two months a year, and 25,847 older adults would die if it raised the eligibility age by three months a year.

    Galvani’s team also looked at the effects of raising the Medicare eligibility age on people with diabetes. They found that more than 325,000 people with diabetes could be unable to get health care if the Medicare eligibility age were raised to 67. Many of them would also struggle to get insulin.

    State governments would also feel the effects of an increase in the Medicare eligibility age. Their spending would likely increase. More people would look to their states for health care coverage and other supports.

    There are far smarter ways to reduce Medicare spending. Galvani’s team has looked at the effects of a guaranteed universal health care model and found that it could save a lot more money than raising the Medicare eligibility age to 67, while also saving lives. In an earlier study, they projected a single-payer system would save $450 billion each year. Raising the Medicare eligibility age would save at most $25,5 billion over five years. A single-payer system would also prevent nearly 70,000 deaths each year.

    “If policymakers want to save lives and costs, our analyses have shown single-payer universal health care is the solution,” says Galvani.

    Here’s more from Just Care:

  • Coronavirus: One in five older adults still not vaccinated

    Coronavirus: One in five older adults still not vaccinated

    The New York Times reports that one in five older adults still are not vaccinated against the novel coronavirus. All are eligible for free vaccines. Now that states have opened up vaccines to everyone over 16, some worry it will make it harder for older adults to get vaccinated.

    The US started providing residents vaccines in December, beginning with people in hospitals and long-term care facilities. Today, about two in three people have had at least one shot. But, because of kinks in the system, many have not.

    People in many places around the country are finding it challenging to schedule a vaccine. People might live on the border of another state, for example, but might not be eligible for the vaccine in that state. Older adults, particularly the most vulnerable of them, are struggling more than others to schedule appointments.

    The good news is that a higher proportion of older adults have been vaccinated than any other subpopulation in the US. The bad news is that one in five of them–20 percent–still have not received a single vaccine dose, even though they are the most likely people to develop grave complications if they become infected with COVID-19. One in three people who have died of COVID are older adults living in long-term care facilities.

    At the urging of President Joe Biden, all states are now opening up eligibility for the vaccine to everyone 16 and older. They are no longer putting vulnerable older adults or essential workers the people who are most at risk, at the front of the line. And, more people are receiving vaccine doses on a daily basis, 3.2 million a day on average, up from 2.2 million a day.

    Unlike in some other countries where homebound elderly are able to get the vaccine in their homes, the overwhelming majority of older adults in the US must travel to get the vaccine. So, even if they can schedule an appointment, they might not be able to get to a vaccine site. Some older adults fear the risk of exposure o from going to a large vaccine site. And, some can’t get a vaccine because of limited supplies in their area.

    It would be interesting to know how well Medicare Advantage plan members are doing in terms of getting a vaccine. Are Medicare Advantage plans helping vulnerable older adults schedule appointments and travel to them? What can we learn from them? Their silence on this issue suggests they are not helping to ensure their members are vaccinated.

    Not surprisingly, people living in counties that supported President Trump’s reelection are less likely to be getting vaccinated. The only good news here is that older Republicans are more inclined to get vaccinated than their younger counterparts. And, of course, they are more at risk.

    There is some concern that allowing anyone of any age or type of work to get the vaccine compromises health equity. The more privileged are able to move ahead in line. Others suggest that young people could be helpful in ensuring that their older family members and friends get vaccinated. With everyone now eligible, getting vaccinated can be a family affair!

    Here’s more from Just Care:

     

  • Senator Sanders proposes reining in drug prices and expanding Medicare

    Senator Sanders proposes reining in drug prices and expanding Medicare

    Burgess Everett writes for Politico about Senator Bernie Sanders’ plan to rein in Medicare prescription drug prices and use the savings to improve and expand Medicare through the reconciliation process in Congress. President Biden has also called for expanding Medicare. But, fearing a loss of revenue, some stakeholders are sure to push back hard.

    Sanders proposes both Medicare drug price negotiation and an expansion of Medicare to people 55 or 60 and older, with coverage of dental care, vision care and hearing aids. All these changes would be included in the infrastructure bill that Congress is now working on.

    Investing in infrastructure is part of the next reconciliation bill, which will have a big impact on our budget and therefore only needs to pass Congress by majority vote. Any reforms that do not have a budgetary impact are subject to the filibuster and cannot be passed without at least 60 votes. The infrastructure legislation will also raise taxes on corporations and the wealthiest Americans.

    Sanders projects that Medicare drug price negotiation would save $450 billion over ten years. It would pay for the additional dental, vision and hearing benefits he is proposing with $100 billion to spare. He estimates that they will cost $350 billion over ten years.

    Lowering the age of Medicare eligibility has significant public support. According to a Fall 2020 GoHealth survey, seven in ten people polled who were not on Medicare favor lowering the age of eligibility. Nearly six in ten people with Medicare support this policy. If Medicare eligibility were lowered to age 60, Medicare would cover as many as 23 million more people.

    Hospitals are sure to object to lowering the age of Medicare eligibility. Medicare rates are significantly lower than commercial insurance rates. Hospitals fear the potential loss of revenue. But, they should recognize that they don’t make as much money as they think they do in the commercial market. Among other things, many face 20 percent denial rates from commercial insurers and have higher administrative costs than they do with traditional Medicare.

    Here’s more from Just Care:

  • 2020 Omnibus budget bill improves Medicare

    2020 Omnibus budget bill improves Medicare

    The 2020 Omnibus budget bill that President Trump just signed into law includes key provisions that improve Medicare. The combined $1.4 trillion appropriations bill and $900 billion Covid relief bill will help millions of older and disabled Americans in a host of ways. On the healthcare front, it will make it easier to get Medicare coverage.

    Among other things, the bill speeds up the time it takes to become eligible for Medicare. People who enroll late in Medicare will be able to gain coverage without a lengthy waiting period. For decades now, people who waited to enroll in Medicare were penalized for delaying their enrollment and often had to go without coverage for several months.

    The Medicare provisions in the law were provisions in the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477).  Senators Bob Casey and Todd Young and Representatives Ruiz, Bilirakis, Schneider, and Walorski sponsored that bi-partisan legislation.

    No longer will people be forced to go without coverage for several months because they delayed enrolling in Medicare. Beginning in 2023, if you sign up for Medicare in the fifth, sixth or seventh month of your initial enrollment period or during the general enrollment period, your Medicare coverage will begin the following month.

    In addition, the Medicare general enrollment period will change to align with the Medicare annual open enrollment period. It will begin October 15 and run through December 31.

    CMS will also now have greater authority to give people a Special Enrollment Period (SEP) for “exceptional circumstances.”

    All of these changes improve Medicare. They promote health and economic security for older and disabled Americans.

    Here’s more from Just Care:

  • How would lowering the Medicare eligibility age to 60 help?

    How would lowering the Medicare eligibility age to 60 help?

    Vice-President Joe Biden recently advocated for lowering the Medicare eligibility age to 60 in order to help older workers. In a JAMA opinion piece, Zirui Song, MD, looks at how lowering the Medicare eligibility age to 60 could benefit individuals, employers, states and the federal government. Among other things, he fails to consider that, unlike Medicare for All, it would leave people under 60 with high cost, unreliable health care coverage.

    Of note, the majority of the public supports lowering the age of Medicare eligibility. In fact, more than three in four people support lowering the Medicare eligibility age to 50. It’s not clear that they appreciate that lowering the Medicare eligibility age could drive up health care costs for everyone who is not eligible, among other concerns.

    If not done right, lowering the Medicare eligibility age could further endanger traditional Medicare. It would be particularly problematic if Congress lowered the Medicare eligibility age and did not also put an out-of-pocket cap in traditional Medicare so that it protects people from financial risk and is on a more level playing field with Medicare Advantage plans. As it is, Medicare Advantage plans attract the healthiest people with Medicare, and traditional Medicare attracts a disproportionately high proportion of people in poor health. Without an out-of-pocket cap, traditional Medicare is too costly for many people.

    Not only would it give people 60-64 a choice of good health care coverage, it would bring down Medicare’s per capita costs and lower premiums for people 65 and older.

    Dr. Song explains that because Medicare pays lower rates to doctors and hospitals than commercial health insurers, lowering the Medicare eligibility age would reduce health care spending by about 30 percent. It would also lower health insurance costs for employers and reduce premiums and average spending for working people under 60 years old. It would remove the  highest-spending group of people with employer coverage from the employer pool. Older people use more health care services than younger people.

    Dr. Song does not consider that lowering the Medicare age without the federal government negotiating fair health care prices for everyone could drive up health care costs for people under 60. He focuses instead on the fact that the per capita costs of Medicare would fall as a younger cohort of people, likely with fewer health care costs, would be joining. More younger and healthier people would be contributing to Medicare premiums, which do not vary with age. People with Medicare over 65 should benefit as premiums would decline.

    Dr. Song opines that lowering the Medicare eligibility age would also save the federal government money on subsidies for people in the state health insurance exchange plans. Fewer people would be in these plans. And, the remaining group would be younger, reducing costs. These savings could help offset the costs of opening Medicare to 60-64 year olds.

    Lowering the age of Medicare eligibility would also save both the federal and state governments money on Medicaid for people 60 to 64. In addition, the federal government would be giving fewer tax breaks for employer health care coverage because many people would give up this coverage for Medicare. As a result, the federal government would garner billions more in tax revenues.

    Would Medicare end up with a pool of members in poorer health? Dr. Song does not conclude that people in poorer health would disproportionately enroll in Medicare over other options, although that is quite likely if Medicare offers them coverage at lower cost than commercial insurance. Dr. Song does suggest that lower income populations should benefit from lowering the Medicare eligibility age because they will have a lower-cost health insurance option through Medicare.

    Dr. Song believes that people in small employer plans would be more likely to opt for Medicare at age 60 than people in large employer plans because Medicare has more generous benefits than most small employer plans. He believes that people in large employer plans would likely stick with those plans because he think they tend to have better benefits than Medicare.

    Of course, Medicare for All would do far more to ensure a lower cost better quality health care system than lowering the Medicare eligibility age by five years. And, more than half the public (56 percent) supports making Medicare available to all. Lowering the Medicare eligibility age by five years keeps high administrative costs and high health care prices in place. It does not do anywhere near enough to ensure all Americans have access to the health care they need.

    Here’s more from Just Care:

  • Medicaid coverage of home and community-based care

    Medicaid coverage of home and community-based care

    If you would like to remain in your home as long as possible–sometimes called “aging in place“–Medicare will be of only limited help. Medicare pays for only a small amount of home care in situations where it would be difficult for you to leave home on your own and you require skilled nursing or therapy services. That said, Medicaid can be of enormous help if you qualify.

    No matter where you live, if you qualify, Medicaid covers home and community-based services (HCBS). These services include coverage to fill gaps in Medicare and to allow you to remain in your home or a community-based setting, such as an assisted living facility. Medicaid provides services that Medicare will not cover. (Medicare always pays first if it covers the service.) How much care you get and the types of care you get depend upon the state you live in.

    Medicaid services that Medicare does not cover include:

    • Personal care, such as cooking or grocery-shopping
    • Homemaker services, such as cleaning
    • Home modifications
    • Help with chores
    • Case management
    • Adult day care

    Medicaid services that Medicare also covers, include:

    How can you qualify for Medicaid HCBS? You should plan ahead and understand the rules in your state. You may be able to move some of your assets into a trust to help you qualify or spend down your income and assets if they are above the Medicaid eligibility threshold, depending upon where you live. You also may be able to set aside some money for your spouse, if you are married, to bring down your assets. If you own your home, you need to understand how the value of your home will affect your Medicaid eligibility.

    Of course, you will need to meet your state’s eligibility requirements for Medicaid home and community-based services, which generally means that you need nursing home level care. Also, keep in mind that your state may have a limit on the number of people for whom it provides home and community-based services. If so, you may be put on a waiting list.

    Contact your local Medicaid office or Area Agency on Aging to learn more.

    Here’s more from Just Care:

  • Trump’s Budget Director prepared to gut Social Security

    Trump’s Budget Director prepared to gut Social Security

    President Trump’s Budget Director is not standing behind President Trump’s repeated campaign promise to protect Social Security. This is no surprise. Trump chose Mick Mulvaney as  director of the Office of Management and Budget (OMB), notwithstanding Mulvaney’s historic commitment to gutting Social Security and Medicare.

    Vox reports that at Mulvaney’s Senate confirmation hearing, instead of supporting President Trump’s promise to not touch Social Security, Mulvaney spoke about his belief in the need to cut Social Security. In response to a question about the sharp contrast between his position and the President’s claimed position, Mulvaney said: “The only thing I know to do is to tell the president the truth.”

    To be clear, Mulvaney’s view of the “truth,” would be deemed by many to be far from the truth. Just as we have the ability to fund the Pentagon and to support deep tax cuts for the wealthy if we so choose, we have the ability to raise taxes on the wealthiest Americans and use that money to shore up Medicare and Social Security for all Americans.

    Mulvaney wants to raise the age of Social Security eligibility, leaving people in their early sixties who are unable to find gainful employment with little if any retirement security.

    If you believe that we need to expand Social Security, please sign this petition.

    Here’s more from Just Care:

  • New poll shows major support for expanding Medicare and Social Security

    New poll shows major support for expanding Medicare and Social Security

    A new poll conducted by Lake Research Partners for the National Committee to Preserve Social Security and Medicare shows major voter support for expanding Medicare and Social Security. Voters strongly oppose cuts to these programs.

    On Medicare, voters almost unanimously support allowing drug price negotiation to bring down the cost of prescription drugs. While this support has been strong for years, it is even stronger today. Most likely, the huge drug price increases, particularly for life-saving medications, is driving this new surge in support.

    Voters also strongly oppose raising the age of Medicare eligibility, as Speaker Paul Ryan plans to do. A recent report by Peter Arno for the National Committee to Preserve Social Security and Medicare Foundation shows that raising the Medicare eligibility age would leave as many as 4 million people uninsured if the ACA is repealed.

    What’s perhaps most noteworthy in the poll results is that Republicans, Democrats and Independents all overwhelmingly support drug price negotiation, 91% of Republicans and 94% of both Democrats and Independents, with 81% of Republicans strongly favoring it and 85% of both Democrats and Independents strongly favoring it.

    Almost two out of three voters (65 percent) oppose raising the age of Medicare eligibility to 67. Three-quarters of Democrats (75 percent) oppose it, along with two-thirds of Independents (65 percent) and more than five in ten (52 percent) Republicans.

    Voters across party lines also continue to strongly support expanding Social Security benefits, as well as giving people credit for caring for a family member, and lifting the cap on income for Social Security contributions. Moreover, they oppose raising the Social Security retirement age and means-testing benefits.

    Almost three out of four (73 percent) voters support increasing Social Security benefits. Only 19 percent oppose increasing benefits. More than eight in ten (84 percent) Democrats, two in three (66 percent) Republicans, and seven in ten (70 percent) Independents support increasing Social Security benefits.

    Most people support paying for the Social Security benefit expansion by lifting the cap on Social Security contributions so that wealthy Americans pay the same rate into Social Security as everybody else. Almost eight in ten (79 percent) voters support  this, and almost seven in ten (69 percent) strongly favor this. By party, 86 percent of Democrats, 72 percent of Republicans, and 81 percent of Independents favor this policy change.

    If you agree that Congress should keep its hands off Medicare, please sign this petition.

    Here’s more from Just Care:

  • Up to 4 million will be uninsured if Medicare eligibility age raised to 67

    Up to 4 million will be uninsured if Medicare eligibility age raised to 67

    In a recent report published by the National Committee to Preserve Social Security and Medicare Foundation based on research by the Actuarial Research Corporation, we demonstrate that Speaker Paul Ryan’s proposal to raise the age of Medicare eligibility from 65 to 67 would harm the health of 65- and 66-year old adults as well as the financial health of the institutions that care for them.

    If Congress raises the Medicare eligibility age to 67, between two and four million people 65 and 66 years old would be left uninsured, depending on whether or not the ACA is repealed. Currently, Medicare covers almost everyone 65 and over, with only 1.1 percent of people over 65 uninsured. But if the eligibility age for Medicare increases by two years, even if the ACA is not repealed, the percentage of uninsured would increase seventeen-fold to 18.7 percent or 1.9 million people 65 and 66. If the ACA is repealed, the percentage of uninsured would increase to 37 percent or 3.8 million people, more than one in three people 65 and 66.

    These uninsured older Americans will be hard-pressed to get needed care, particularly if the ACA is repealed. To the extent they have chronic conditions, insurers may no longer agree to cover them and, even if coverage is available, it is unlikely to be affordable for most people; if it’s affordable, it is likely to cover only limited benefits, with annual and lifetime caps. They will, therefore, end up using emergency services at far greater cost to our health care system and the institutions that provide them care.

    Doctors and hospitals in particular will find themselves covering the cost of care for most of these newly uninsured Americans (without reimbursement), putting these health care providers at financial risk. To the extent they raise their rates to absorb these costs, insurance premiums will rise further, escalating health care costs for insured Americans.

    Medicare is far better than commercial insurance at guaranteeing coverage, containing costs, and giving people with costly conditions access to the care they need. We should be expanding Medicare to everyone in the U.S., not driving up health care costs and the number of uninsured by raising the eligibility age.

    Screen Shot 2017-01-30 at 3.36.33 PM

    Here’s more from Just Care:

     

  • Republican New Year’s Resolution: Dismantle Medicare

    Republican New Year’s Resolution: Dismantle Medicare

    The New Year is a time of resolutions.  Consistent with that tradition, the Republican New Year’s Resolution is clear: Dismantle Medicare, ending Medicare as we know it. What’s most scary is that with Republican majorities in both the U.S. House of Representatives and the Senate, they have the power to make good on their intention to destroy Medicare.

    To be sure, you are not likely to hear the Republican leadership talk about gutting Medicare.  Instead, they euphemistically talk about “saving” Medicare. Simply put, they are “saving” the government money by cutting Medicare spending and forcing older adults and people with disabilities to spend more out of their own pockets for their care–if they can even afford the medical care they need. Let there be no doubt that, in the view of the Republican politicians, Medicare (and Social Security, for that matter) need not continue to guarantee people’s health and retirement security.

    The truth is that Medicare doesn’t need “saving.” As the wealthiest nation in the world, the United States can afford a greatly expanded Medicare that offers far more coverage and covers far more people than it does today. In 1965, when Medicare was enacted, the nation’s Gross Domestic Product was, in real terms, a quarter of what it is today ($4.1 trillion in 1965 versus $16.7 trillion today.)

    Expanding Medicare is the way to provide high quality, cost effective access to care for everyone in the U.S.  Because we rely on for-profit insurers, the United States is unable to rein in health care costs or to drive the system changes that we need to improve our quality of care. Other countries have, essentially, Medicare for All, and pay a fraction of what we pay, frequently with better health outcomes.   We spend three times more per capita than Japan on health care, for example, and live, on average, around five fewer years!

    Ryan and the Republican leadership’s Medicare plan will only drive up costs and undermine quality further. They want to return the country to pre-Medicare days, allowing insurers the freedom to offer inadequate coverage or no coverage at all. “Free choice” in their world simply means freedom to fall into medical bankruptcy or to forego needed care. Medicare was enacted because commercial insurers were unwilling to offer older adults good coverage at an affordable price.

    The Republican plan will simply empower commercial insurers by giving people a voucher to help cover the cost of their commercial insurance. At the same time, it will disempower older adults and people with disabilities who will not be able to buy reliable cost-effective coverage they can count on. To make matters worse, the Republican plan proposes to raise the age of Medicare eligibility to 67; and, though it would permit people to use their vouchers to buy Medicare, the program will, foreseeably, wither on the vine, as a result of a vicious circle: Medicare will be available only to the oldest and least healthy part of the population, and so will become more and more expensive, covering people with the greatest health care needs, while commercial insurers cherry pick the healthy.  Even fewer healthier people will opt for Medicare, and the price will go up even more.

    Rather than giving all Americans the option of cost effective coverage through a robust federal Medicare program, people in Medicare today and their children and grandchildren increasingly will, under the Republican plan, be forced into a commercial insurance plan that they cannot rely on to meet their health care needs.

    We need to expand Medicare, not end it, if we care about the lives of people in the U.S. If the Republicans end Medicare, we are destined to have an unsustainable health care system that increasingly rations care based on people’s ability to pay. Medical bankruptcies will rise. And, life expectancies in the U.S. will continue to be shorter than in other countries.

    To stop the Republicans, I urge everyone who is old or hopes to be old someday to make your own Medicare resolution for 2017. Tell your elected leaders: Hands off Medicare except to expand it.

    Sign this petition and ask your friends to join you. Mobilize and make your voices heard. Then, as a resolution for 2018, we can all resolve to elect leaders who listen to us and have the good sense to expand, not destroy, Medicare.

    Here’s more from Just Care: