What you must understand about Medicare as opposed to Medicaid is that Medicaid provides help to those that have no resources left, where as Medicare assists those who do have resources. With Medicaid you have to be able to prove that you have no resources left in order to get access to the assistance that is possible. No resources includes your savings and investment accounts, though there are times were moderate exceptions are made.
Medicare will take you to a point that is close to where you would need to be to survive on a regular basis in every day common life. Medicaid will pick you up when you don’t know how to get through the day to day processes and help you pay for Medicare deductibles and coinsurance at times. Medicare is open to everyone at a certain point in life, but Medicaid is only open to the less fortunate parts of society.
Medicaid will pay for personal care and homemaker expenses as well as health care and medical equipment when you may need it. When the time comes into get equipment that could help change your life you need to look no further than your Medicaid possible. It will help you try to live a normal life and get your work done in due time so you can enjoy the fruits of your labor.
Medicaid is often tougher to get the answers that you want from than is Medicare because it is a program that is run more on a state than federal level. On the surface this may not seem like a huge change, but it does make a big difference because there are 50 different answers rather than just one. However, some answers still do make sense because of the complex relationship between the state and federal levels for Medicaid.
If you weren’t aware, the state pays for part of your Medicaid coverage and the other part is paid for by the federal government to your state. This makes it to where Medicaid must respond in kind to some issues as opposed to others. Here is one question answered from the Medicare main site that could help you.
“If my prescription drugs are now paid for by my state Medicaid program, will Medicaid still pay for drugs I take that aren’t covered by Medicare prescription drug coverage (such as sleeping pills or prescription vitamins)?
If the State covers that kind of drug for people who get Medicaid but don’t have Medicare, then Medicaid must still cover that drug for you. You need to check with your state Medicaid program to see if it will cover a drug not covered by Medicare.”
“Coverage may start retroactive to any or all of the three months prior to application, if the individual would have been eligible during the retroactive period. Coverage generally stops at the end of the month in which a person's circumstances change. Most states have additional "state-only" programs to provide medical assistance for specified people with limited incomes and resources who do not qualify for the Medicaid program. No Federal funds are provided for state-only programs.”
Did that muddy up the waters for you? It may be difficult on any given day to step in front of a lot of accomplished people and say those words, but it must be what was thought. What the definition is trying to say is that you are eligible from the minute you filled out the application if you find out afterwards that the situation was questionable.
As soon as your condition changes, for the better, you will be taken out of Medicaid as you are no longer in need of its services. However, if the Federal Government refuses payment you can look in to the state run program where you are from. State run programs are often more likely to give to those in their community over all others in the grand scheme of things..
Medicare and Medicaid. You can't pick up a newspaper, look at the news or listen to the radio without hearing about these programs.
The problem is that everything you hear is different depending upon who is saying it. Some of the pundits and politicians have been talking about doing away with the programs and starting over. Others have been trying day and night to bolster and save these essential services and have said that if Medicare, Medicaid and healthcare are balanced right, the programs would save enough money to grow and thrive in the future.
For those of you who depend on Medicare or Medicaid the first thing to remember is that after eons of wrangling about all the programs, lawmakers are getting closer to determining the issues and figuring out answers. According to the lawmakers, Medicare and Medicaid will be saved, and though some things may change, overall, things will be changed - most likely for the better.
Many individuals who are recipients of Medicare or Medicaid are rightly worried. When you hear so much confusing and contradictory information about a program that is your lifeline, it is certainly scary.
To relieve some of the fear and misunderstandings involved here is some positive information regarding Medicare and Medicaid. Lawmakers on both sides of the question have said that they will save Medicare and Medicaid, and the President has said that he will not pass a bill unless this happens. Also, even though there has to be some tough accounting involved, everything that needs to be done to make sure that Medicare and Medicaid are solid and workable and continue covering the millions of seniors and other individuals that depend on the services that these programs provide.
Lawmakers are getting closer to passing the bill and when that happens, everyone will be able to breathe easier and hopefully, put the confusion behind them.
September will be the most difficult month regarding healthcare reform for the Obama administration and the advocates of comprehensive health reform. They knew that it would be a tough month but knowing it and going through it is two different things. This administration and advocates are going through it.
Lawmakers are returning from a break and the President is returning from his vacation. Healthcare reform is not an easy task and has been a tough fight.
On top of everything else, Ted Kennedy – the Lion of the Senate – has now passed away.
Senator Kennedy had served for over 45 years and was a guiding light for lawmakers that were on both sides of the aisle. He was able to explain his point of view tactfully and respectfully so that even those who didn’t agree would still at least listen – and some of them actually heard him and adjusted their thinking on whatever subject was at hand. Of course, there were those times when he could be quite forceful and absolutely nobody missed the point.
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Now that lawmakers and the President are getting back to action, we will see what happens with these bills. One of the important issues when it comes to health insurance reform is the changes to Medicare.
We have been told that seniors and individuals with disabilities will not lose their benefits; however, there is a lot of spirited debate debating regarding their Medicare coverage.
One approach would be decrease the cost of reform as well as lessening its scope and spend around $600 billion to around $800 billion during the next ten years instead of over $1 trillion which has been proposed as a possibility. Doing this would make it easier on the finances of the federal government, but would be more difficult to actually put into place than doing a comprehensive overhaul of the whole system. Using the lesser figures would actually create a kind of hodge podge of a fix and would not fix two essential issues with the system we have now. There are two many people without health insurance and too many others are getting to the point where, not only can they not afford it, but it is not taking care of their needs at the prices they are paying now.
If there becomes a situation where reform cuts out subsidizing employers regarding health insurance, many people could not afford it anymore. They would be obligated to purchase insurance on their own. If they did not, there is a possibility that they would be fined.
Coverage could be offered to various groups depending on the situation, and hopefully, in time, other groups could be added. The hard part would be who would get this coverage. It is obvious that Medicaid is essential to individuals at or close to the poverty level. Having that program stay solid and be offered to all at that level would be an expensive proposition – around $40 billion in the next ten years. Yet going without it would cause extra problems – people at the poverty level who could not receive Medicaid could end up at the ER for things that could have cost the government hundred or thousands of dollars less had they been covered by Medicaid and allowed to simply see a doctor or a clinic. Essentially, if people in this position are not covered by Medicaid, they still get sick and the bills for those ER visits and other medical services for those who are not covered by Medicaid are partially absorbed by the hospitals as a loss and, you guessed it, paid by the government, thus affecting our taxes.
Medicare is another program that is essential to save. As Boomers are becoming retirement age they will be ready to enroll in hordes, so they will need to be able to have this coverage. Most Boomers are a little more prepared for retirement than the last generation, so there may be a little breathing room as they transition, however, Medicare must be fixed and saved, and the President has promised not to cut this program, rather to save it and make it work.
The challenge now is for congress to find a way to make sure the uninsured are insured, find the money to pay for comprehensive healthcare reform and save these two programs – Medicare and Medicaid – while working to make all this affordable while moving into the future.
For now, we are all waiting to see what congress comes up with.
Seniors throughout he country are extremely concerned and worried about their Medicare benefits. Everytime they hear the words "healthcare reform" they cringe, worried that as money continues to get tighter and cuts are made to many programs, they will lose critical and essential benefits that in many cases keep them alive and out of the hospital.
At a telephone town meeting Tuesday, President Obama answered questions from mostly seniors. One of the things that he said to reassure these older Americans regarding their Medicare benefits was, “Nobody’s trying to change what does work in the system,” Obama told the estimated 180,000 listeners. “We are trying to change what doesn’t work in the system.” There have been many delays when it comes to the healthcare issues, people are getting quite nervous and confused. “Nobody is talking about cutting Medicare benefits. I just want to make that absolutely clear,” the President said emphatically. When he introduced President Obama, AARP CEO A. Barry Rand said: “There’s a lot of misinformation about health care reform—even on what AARP stands for, and what AARP supports. This town hall is part of our ongoing effort to debunk myths and provide accurate information.” He added: “I want to make it clear that AARP has not endorsed any particular bill or any of the bills being debated in Congress today. We continue to work with members of Congress on both sides of the aisle and with the administration to achieve what is right for health care reform.” AARP president Jennie Chin Hansen also cited confusion expressed in questions that have come from thousands of members who have participated in previous AARP town halls. “Like, will the government tell my doctor how to practice medicine?” The idea behind this unique town hall meeting was to calm the fears of individuals - particularly seniors - who are nervous, or downright frightened, about what will happen to their Medicare and Medicaid benefits and ultimately to their health. The president said that overhauling the healthcare system is a high priority, however it is not an easy task and he wants to make certain that it is done right. “I know there are folks who will oppose any kind of reform because they profit from the way the system is right now. They’ll run all sorts of ads that will make people scared.” He pointed to the past and reminded people that this has all happened before, it is not just unique to our time or the current situation. “Back when President Kennedy and then President Johnson were trying to pass Medicare, opponents claimed it was socialized medicine,” he said. “When you look at the Medicare debate, it is almost exactly the same as the debate we’re having right now. Everybody who was in favor of the status quo was trying to scare the American people saying that government is going to take over your health care, you won’t be able to choose your own doctor, they’re going to ration care.” He also added this thought: “You know what? Medicare has been extraordinarily popular. It has worked. It has made people a lot healthier, given them security. And we can do the same this time.”
As the saying goes, stuff rolls down hill. In the situation with all the budget constraints on the federal government, comes constraints on the state and local government. Healthcare is definietly no exception. Lawmakers in Washington are looking at some very deep cuts when it comes to many programs and trying to figure out how to keep them from being deeper than they already are.
One of the programs that is being looked at piece by piece and line by line is Medicare. There will definitely be cuts to that program, period. As a result, as things roll down hill, Medicaid, which is a state program but bolstered by federal dollars, is taking a big hit, too.
Not only are some Medicaid benefits being cut way back, but getting into the program, which is already on the difficult side, has become much tougher indeed. It seems as though unless you are in the most dire straits getting approved for Medicaid is extremely difficult. Even if you are in dire straits and the rope you are hanging onto is beginning to fray - a lot - it is still difficult to get approved.
Consider the case of a 60 year old woman who was disabled in an accident. Her doctors took her off work indefinitely and she has no income except for $200 of assistance money which will run out very soon because of the new cuts from 18 months down to 12. She has no money to go to the doctor and has applied for Medicaid. She suffered injuries in the accident - which happened at work - but Worker's Comp is fighting against paying because she had some pre-existing conditions. Of course, what 60 year old man or woman doesn't? Meanwhile, she is in constant pain, in need of surgery and walking around on crutches or a cane with a fractured hip and two badly injured knees just for starters. She has high blood pressure (which has sent her to the ER 6 times in 3 months because it was at stroke level or higher), osteoporosis, arthritis, degenerative disc disease and possibly diabetes. She has doctor's letters, medical records and more that were sent to Medicaid. She applied for Medicaid and was turned down.
This individual did everything by the book and is having to go through hoops all over again trying to get help. This is before the new budget cuts that are on the way.
This is not to say that Medicaid is unfair or that it is a bad program. It is a good program and was designed for people like this 60 year old lady who has fallen through the cracks - badly. Each state deals with their own Medicaid program so it can be a little easier or a little harder depending on the state a person is in. Even if you have all your ducks, doctor's notes and medical information in a row, it can be tough to get Medicaid.
Do not give up, re-apply, call and talk to your worker and do whatever is necessary to give them the information so that you will get approved. Eventually, most people do get approved. It is simply a tedious road sometimes to getting the coverage you need.
Just as congress is trying to pass legislation which will give Medicaid a boost, Alaska has been put on a moratorium by the federal government and CMS due to noncompliance when it comes to enforcing Medicaid rules. This is temporary, however there is no guess as to how temporary it will be.
Because of this moratorium, many people who need to sign up for Medicaid need to wait until this is over. The review raised concerns that the state Medicaid agency has not taken necessary safeguards "to protect the health and welfare of the recipients of the services."
Until the review is done, there can be no more individuals added to the Medicaid rolls. The review has been called for because of several areas of non-compliance. For instance, form 27 to 2009 the state reported 27 Alaskans died while waiting for initial assessments and 227 died while waiting to be reassessed.
The system should work much faster than that. The state says that it was behind in assessments because it did not have enough nurses. The review also found the state is not in compliance with requirements for all waivers.
"CMS has determined, in order for us to develop our business processes and refine those that we have in place, that a moratorium is necessary," Rebecca Hilgendorf, director of Senior and Disabilities Services said.
Theresa Bovey, CEO of Trinion Quality Care Services, which provides in-home personal care in Anchorage, says this moratorium could have a huge impact on those who need Medicaid and won't be able to get it now.
It is hopeful that these issues can be resolved quickly and enrollment can begin again after the moratorium is lifted, however, the review is not scheduled until March. In the meantime, the state must create a plan that shows what they will do to improve their Medicaid services. This plan must be presented to CMS before they will consider ending the moratorium.
When looking for information to write each week there is a process of combing every piece of news and information possible. Right now, it is a critical time for the folks that depend on Medicaid or need to get it. I have friends with serious disabilities who have been denied in applying for Medicaid coverage.
We are not talking about small disabilities. We are talking about traumatic brain injury, degeneration or deterioration of joints and spines so they are unable to sit or stand for long periods and either use a cane, but usually a wheelchair.
It is unbelieveable that in this day and age they can't get the help they need. However, with the news that Medicaid may get a boost and be able to help more people, possibly those who are truly disabled and living under the poverty level, barely hanging on, would be able to be approved the next time around.
I am including the article below because I feel it will be encouraging to those people who are disabled and stuck right now. It was written by Michelle Diament from disabilityscoop.com and I feel it was worth reprinting. I hope it is encouraging to those who are trying to get Medicaid.
July 14, 2009
There was a health care reform bill introduced Tuesday by Democratic leaders in the House of Representatives. The bill would expand Medicaid and require mental health coverage for all Americans, however it leaves long term care quite lacking.
The bill was brought forth collectively by three House committees — Education and Labor, Ways and Means and Energy and Commerce — which have jurisdiction over health care.
As currently written, the bill would allow Americans to keep their current health insurance coverage and doctor, but would also provide a so-called “public option,” essentially a government-run insurance program that individuals or business could buy into.
Mental health coverage would be required under the bill no matter which insurance option is selected. Plus, insurers will not be allowed to deny anyone coverage due to a preexisting condition.
Medicaid would be expanded under the House bill to include families with incomes at or below 133 percent of the federal poverty level. Furthermore, reimbursement rates for primary care services provided to people on Medicaid would increase, with the federal government picking up the tab.
“We can’t afford to leave people in a system that looks to recruit the healthy and leave the sick uninsured, underinsured or uncertain about their insurance,” said Rep. John Dingell, D-Mich. “The current broken health care system will not fix itself and the people who made billions from it have no reason to change their ways unless we make them.”
Long-term care is not emphasized in the House bill. Neither the Community Living Assistance Services and Supports (CLASS) Act — which would create a government long-term care insurance program — or the Community Choice Act — which would allow people with disabilities the option to use Medicaid funding to pay for community-based rather than institutional care — are included.
Just last week Health and Human Services Secretary Kathleen Sebelius sent a letter to a Senate committee expressing the Obama Administration’s support of including the CLASS Act in health care reform legislation.
House committees will consider this proposal beginning this week. In order for any changes to take place, legislation must be approved by the House and Senate and be signed into law by the president who has indicated he would like to wrap up health care reform before Congress leaves for its August recess.
Medicaid is a program for individuals who can't afford to pay for medical care. You may be covered by Medicaid if you have high medical bills; you receive Supplemental Security Income (SSI); or you meet certain income, resource, age, or disability requirements.
This is the official idea behind Medicaid. It was designed to help take care of medical costs that you can't manage on your own due to one or some of the reasons above.
Medicaid differs a little from state to state. It's foundation is the same, however, it depends on the state's terms, conditions and budget.
The following is a description of Medicaid coverage in one particular state:
In general, the following services are paid for by Medicaid, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-pay if you are in a managed care plan.
smoking cessation agents
treatment and preventive health and dental care (doctors and dentists)
hospital inpatient and outpatient services
laboratory and X-ray services
care in a nursing home
care through home health agencies and personal care
treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled
family planning services
early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
medicine, supplies, medical equipment, and appliances (wheelchairs, etc.)
clinic services
transportation to medical appointments, including public transportation and car mileage
emergency ambulance transportation to a hospital
prenatal care
some insurance and Medicare premiums
other health services
If you are eligible for Medicaid, you will receive a Benefit Identification Card which must be used when you need medical services. There may be limitations on certain services.
For you to use your Benefit Identification Card for certain medical supplies, equipment, or services (e.g., wheelchair, orthopedic shoes, transportation), you or the person or facility that will provide the service must receive approval before the service can be provided (prior approval).
The information above is a sample of what types of services a person can expect from Medicaid, and in many cases these services help provide what Medicare does not, so that the cost of medical care is not overwhelming for a senior or other individual.
If you think you qualify for Medicaid, contact your state's Medicaid office to begin the process of finding out. Even with budget cuts, Medicaid can help defer medical costs not paid by Medicare.
There is a lot of controversy these days about what should go and what should stay in the huge U.S. budget which affects each state's and county's budget. Somewhere in that mirage of confusion, site Medicaid.
Though many of the proposed Medicare cuts and the ones already in progress are frightening and difficult, at best, to deal with, the thought of more Medicaid cuts puts more pressure on the people that need the program most.
Seniors and individuals with very low income often depend on Medicaid to get basic medical care. Nothing fancy or frilly. A few doctor's visits, maybe some tests and some medication. Medicaid is what is supposed to help these individuals who can't afford Medicare Supplements and who need to have regular medical care - even minimal care - to stay reasonably healthy.
When hearing what people on Medicaid have to say, they say it is a lifesaver - literally - in many cases. They say that without it they would be in a hospital somewhere very sick or dying at the state's expense. The unfortunate situation is that as budgets get leaner, criteria for people to qualify for programs gets tighter and more people who need this help are left out.
The problem is that rather than helping keep the benefits for people, once someone has lost them, the state and county end up paying untold thousands of dollars for emergency room visits that take the place of doctor visits. Keeping people on Medicaid and allowing new ones to get on it save the state and county money, short term and long term.
There is a lady who is 59 years old and lives with her children. Her only income is assistance since she is too young for Medicare and she has a disability that will probably continue the rest of her life. She has applied for Medicaid which she said was an escapade of jumping through hoops, and after she turned in every single paper (about 1/2 inch worth) she was denied. The woman can hardly walk. Her blood pressure is out of control, she has been in and out of the emergency room because her blood pressure has been so high they are worried about her having a stroke, and instead of accepting her to Medicaid to get the care she needs, she was turned away. So at age 59 she goes to sleep, fearful that she won't wake up, and there's nothing she can do unless things get so bad she goes back to the emergency room.
There are seniors that are worse off, who choose between groceries and medicine and use less of both, keeping them hungry, undernourished and undermedicated, while their condition gets worse.
In these times, it is understandable for cutbacks to happen. It is simply a matter that some of them don't make sense. In the richest country in the world we are letting seniors and others starve and suffer just to save a few dollars - and then it cost thousands more to care for the individuals anyway.
It is important for everyone to have a chance to feel as good as possible and get good care. Hopefully as budget cuts continue, the president and lawmakers will remember that there are people living on much less than $250,000 or even $25,000 per year through no fault of their own. It is important to think about their dignity and well being when putting programs on the chopping block.
Recently, we have all been overwhelmed with talk about the proposed healthcare reform that many Democrats want to pass. President Barack Obama and volunteers that comprise of e-mail lists of the volunteers used during the elections and supporters of Barack Obama during the campaign have been on a major mission to pursuade patients, doctors, and politicians to join them.
The idea is to “cover all Americans”, mostly through government mandates to purchase insurance.
We currently have little information but still, there are already many supporters of the plan, but some others are not comfortable with parts of the proposed plans. Many who support the plan bring up the fact that there are many in this country who are uninsured.
This is where Medicare and Medicaid come up.
Medicare is a system of insurance that assists the elderly who are eligible for social security payments. While no system is infallible, many who are on Medicare are satisfied with it. For the elderly who wish to get what they consider better care, they are able to get supplemental insurance from many private insurers, often at a discount. Many senior citizens choose this option, and many who live in a single-payer system would also prefer to supplement their insurance with this option. Medicare is also available to the disabled.
Medicaid is a health insurance program for low-income people. States are required to cover many that wish to have insurance whose income is at or below the poverty level. They may cover those that make more as well, and often cover people with higher income levels if they are minors, are pregnant, infants, and others, and are required to cover children under 6 and pregnant women who make 133% of the poverty level or below. Children in foster care and some children who are adopted also receive Medicaid. Most states go beyond these federal mandates and choose to cover a much wider group of people.
The idea that all people who do not have insurance are too poor to afford it is not entirely true. Those that are too poor to afford insurance are covered by a state program, in the same way that people that are too poor to afford food are covered by programs to assist in that matter.
There may be some who have fallen on hard times and have bills to pay, but the idea of “repossessing” medical care will remain in science fiction movies and has not been a way of life for the American people, and people have bills of all sorts, not just those that are medical. The idea that someone is too poor to afford medical care, either in insurance form or with actual doctors, is more of a matter of personal opinion, as most who are actually poor are already covered with a government program.
This is where the issue comes in. I had a friend with two children and a mother who was ill. She took care of all of them - alone. They all went without health insurance for several years, even though the mother was very ill and had been in a serious accident leaving her with brain damage. With all that, high blood pressure and some other serious problems, the mother was denied medicare. The friend, who was taking care of her family made just enough so that they couldn't get medical help but she didn't qualify at work. When her son had to have emergency knee surgery, they finally gave her CHIP for her kids and gave her mother PCN which is a very, very, very scaled down version of Medicare - totally bare bones. Basically, it helped with her prescriptions.
At any rate, people think that the poor and the elderly are all insured and taken care of. That is not true. It is a fact that over 50% are, but it is also a fact that those who make even $10 too much are often denied care even if their doctor pleads for it.
Hopefully everyone from the president down on the left or the right will leave politics out of the heathcare issue and make sure everyone who needs it is taken care of with the new legislation.
When you have one pot of money and it is finite, it can be hard to split it up in a way that makes everyone happy. Let's take what the government is going through with the budget right now. It would be great if they had unlimited amounts of money, if the automakers and banks weren't in big trouble and if Medicare/Medicaid and Social Security were at least stable.
But the picture isn't that pretty, and the fact that we are in the middle of a recession doesn't help either. Add to that bad mortgages, foreclosures all over the place and handing over money to the banks without an accounting of where it has gone and the picture gets worse.
As to the banks supposedly showing profits recently from the bailouts, take a look at Dr. Martin Weiss’ article, Big bank profits are bogus! Massive public deception! He writes, “Was the bad-debt disease magically cured? Did the economy miraculously turn around? Not quite. In fact, we have overwhelming evidence that the condition of the nation’s banks has deteriorated massively since then.
“How can our trusted authorities be so blatantly deceptive and still keep their jobs? Perhaps you should ask Fed Chairman Ben Bernanke. Not long ago, for example, he declared that the total losses from the debt crisis would not exceed $100 billion, while conveying the hope that most of those losses could be soon written off. Also around that time, the International Monetary Fund (IMF) estimated the losses would be $1 trillion, with only a small percentage written off. The IMF’s latest estimate: $4 trillion in losses, with only one-third of those written off so far. Bernanke’s error factor: He was 4,000 percent off the mark, in a world where 50 percent errors can be lethal.”
And the critics talk of Medicare’s $1 trillion in costs last year to cover 42.5 million seniors. This cost was inflated by the privatized HMOs, PPOs inserted into Medicare along with the rule that Medicare could not bargain with Big Pharma on drug pricing as does Medicaid. These are a few of the negative impacts inflicted on Medicare by the Bush administration and others. In fact, Medicare began in 1964 under Lyndon Johnson as a classic single-payer health insurer. Listen closely, President Obama. It was only later that the privateers were ushered in to gobble up 12.6 percent of its premium revenue for “administration.” What if Medicare got some of that bank bailout money?
Yet the Times reports, “as a result, the administration said, the Medicare fund that pays hospital bills for older Americans is expected to run out of money in 2017, two years sooner than projected last year. The Social Security trust fund will be exhausted in 2037, four years earlier than predicted, it said.” The question is to whom will that money run out to?
Though there are many priorities here, this is a country that touts taking care of the neediest among us first. "Give me your poor...your huddled masses..." The country was founded on these ideas. All of the rest of this stuff we are dealing with now came later and some of it did not have to come at all.
The new president has said that this is our time, this is the time for change. It seems that he and lawmakers are trying to figure out what to change first and how to do it so that everyone comes out at least somewhat stable. I wouldn't want to be in their position - the president and lawmakers were left with quite a mess to clean up and figure out and it hit them all at once. It doesn't matter who is or was to blame. The blame game can go back decades and waste time that we don't have. It is time to fix things once and for all, and it is time for everyone to stop whining and get the job done.
The New York Times, Washington Post, and Wall Street Journal's world-wide newsbox all had lead articles with regard to a new government report that paints a dire picture of the financial situation of the nation's two largest benefit programs. The recession, of course, has not helped with the already stressed Medicare system, especially the fund for hospital care which will run out of money (purportedly, depending upon who you get your information from) in 2017, two years earlier than the government had predicted a year ago.
The Social Security trust fund is in a bit better shape but will still start spending more money than it receives in 2016 and will be depleted by 2037, four years sooner than projected last year. lawmakers are arguing over whether the country can really afford to expand health insurance coverage, the report sparked calls for the administration to start working on a plan to prevent the two entitlement programs from becoming insolvent.
There is a great deal of work going into the Medicare situation as well as trying to create a similar healthcare system for everyone who does not have health insurance or access to health insurance, to strengthen the Medicare system that definitely needs bolstering and create a health care system that millions of people need.
Lawmakers feel that tax dollars from workers, such as payroll tax, deductions for social security and other funds will be able to help finance all of these ideas. In addition there are some Lawmakers pushing hard to stop subsidizing and just flat-out give banks and othe institutions "bailout money" why not give out less or none at all , for that matter, to fund more of the domestic issues especially. Another idea has been to patner the banks with the insurance companies and help them work together to develop a policy that would be fiscally responsible. If the polcy worked out well, it could very possibly help bolster Medicare and the the vast majority - if not all - of the people in the country that are uninsured.
The current administration is trying to create big changes in Medicare as they try to overhaul and reform the healthcare system. This could mean something quite new for seniors and may be a template for reforming healthcare in this country in general.
The idea is to create less waste in the entire healthcare system and strengthen Medicare, as well as covering the uninsured.
Medicare covers about 45 million Americans who are elderly or disabled, and its policies are followed by many private insurance companies when they set up their internal systems. The new approach and ideas for seniors would helMedicare p medical professionals stress and help patients with follow-up care by their family doctors and nurses so that more chronically ill patients could avoid being hospitalized and re-hospitalized when chronic problems such as high blood pressure get out of control.
There would be changes for doctors and hospitals, too. Primary care doctors who care for patients on a more constant basis would be paid more, while specialists would be watched more closely, especially as they order more tests and procedures. Hospitals could have to pay penalties if they did not provide adequate follow-up care, therefore having the same patients continually being readmitted for the same problem.
Medicaid would also see similar changes, which would affect most of the 50 million low income people that they cover.
“Medicare is going to be the driver to achieve quality reforms, in large part because the other players tend to follow Medicare,” said Sen. Max Baucus, D-Mont., the Finance Committee chairman. Baucus aims to have a bill on the Senate floor this summer that would restrain costs and cover the estimated 50 million uninsured.
The committee meetings that are slated will iron the details out, and some of the meetings have already started. This effort is aimed at helping even out who pays for these benefits and how. The sickest 10% of the patients account for nearly 2/3 the cost that Medicare spends per year. These are frail individuals who usually have more than one serious chronic condition such as high blood pressure, diabetes and heart disease. The cost is so high because they are seeing several specialists for each issue. If the changes that are being examined can be put into place, they could be seeing one doctor who could control and coordinate the other treatment they receive, eliminating duplicate procedures and eliminating waste.
If and when lawmakers are able to straighten the health care fragmentation out, it is very possible that everyone could get good care and save money at the same time.
The current administration inherited a lot of problems, not the least of which is the healthcare issue – both Medicare/Medicaid and private health care plans. Trying to balance all these out is difficult at best and, though people are looking at the “first 100 days”, 3 months is not actually a lot of time to deal with these issues on top of the other national and international issues this country faces, not to mention that even Superman and all his super-hero friends could not come up with a plan to solve all these problems in 3 months – period.
However, Obama and lawmakers are trying to iron things out. Healthcare is extremely critical because of the number of families without it and the number of seniors who depend upon it.
There have been many ideas explored to try to solve the problems inherent in the system at this point, but no solutions yet. One of the ideas on the table is something called entitlement reform, which means that Social Security and Medicare/Medicaid would be rationed (no examples given yet) and supposedly save the system, the government and the taxpayers trillions of dollars, partially by eliminating or rationing services – including education and prevention programs to keep people from getting worse and having to use the system in the first place.
Proponents of this entitlement reform in the form of rationing, feel that this would then balance the budget because of the trillions of dollars saved. They blame President Obama for not offering this type of reform, but instead trying to initiate universal health options so that everyone in this country would be able to have at least some sort of health care – even if it was very basic.
They seem to forget that Obama did not create the problem; he inherited it and is simply trying to fix it somehow with the help of Congress. Lawmakers are working on adjustments to try to make all of this work, however this will take time. As promised, the president and lawmakers hit the ground running minutes after inauguration. Is it possible that the pundits who say that the only answer to the healthcare issues is rationing can just give the actual lawmakers enough time to work on this mess – that has taken decades, especially the last 8 years – to get to this point? It’s like gaining 50 pounds in 5 years and expecting to lose it in 3 weeks. It is impossible for that to happen. It took time to get to that point. It will take some time to get fixed.
A quote from Charles Krauthammer of the Washington Post, a proponent of rationing sums it up this way:
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“It is estimated that a third to a half of one’s lifetime health costs are consumed in the last six months of life. Accordingly, Britain’s National Health Service can deny treatments it deems not cost-effective —- and if you’re old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.
Rationing is not as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by a myriad of similar criteria.
Social Security was the third rail of American politics. Not anymore. Health care rationing has ascended —- which is why Obama, the consummate politician, knows to offer the candy (universality) today before serving the spinach (rationing) tomorrow. It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.”
Charles Krauthammer may be right in the end, however, exploring other avenues that could possible help more people in a broader way and bring in premiums to offset costs might not be a horrible answer, either.
We will all have to see what happens as things get hammered out, and when they do, if Charles is right, I’ll be eating my spinach right along with everybody else.
A lot of people think that Medicare and Medicaid are the same thing. They are however, not the same, not even close. Yet both in our minds and in the news media, Medicare and Medicaid are always lumped together.
On July 30, 1965, President Lyndon Johnson signed both Medicare and Medicaid into law as part of Title XIX, The Social Security Act. Both are related to healthcare. Both have substantial Federal involvement. There are some individuals who are eligible for both. That is where similarities end.
Medicare
Before 1965, only those who were in the workforce could get employer-subsidized health insurance. Thus, the retired (and the non-working) were effectively prevented from acquiring medical insurance coverage. The Medicare Program was planned, like social security, as a pay-in-advance-of-need system where the worker paid a certain amount each month into a government-run fund. At age 65, when the worker retired, this pot of money called Medicare would provide all his or her medical coverage funding. Initially, the Medicare Fund was maintained and accounted separately but quickly the Federal government lumped it into the General Fund.
Twenty-five years later (1990), the GAO measured how much Medicare was actually costing versus what was projected. Medicare then cost more than 800% over projections! This was a medical insurance plan whic intended to pay for itself but instead had become a Federal entitlement that was never intended.
Medicaid
Medicaid was always intended as an entitlement - a social welfare and protection plan funded jointly by State and Federal government funding. Initially, the Program covered low-income and non-working people, children and indigent people.
Medicaid as specific qualifications. To qualify, you must make less than a minimum income level, plus you must meet one of the categorical requirements such as age, pregnancy, disability, blindness, HIV, legal citizenship, etc. In contrast to Medicare, Medicaid recipients pay nothing into any fund. It always was and is an entitlement.
Beware when we tout single payer health insurance funded by the government as a means to provide universal health care that will reduce costs. The upward spiral of healthcare costs will reach the stratosphere - the truly unsupportable - for two reasons. 1) As entitlements expand, costs go UP certainly not down. 2) The government is a notoriously inefficient provider of, well, anything. When Government takes over an activity, the bureaucracy and its associated costs expand exponentially. Just think of the postal service or HIPAA. If you need additional proof of how costly government-run programs are, just remember the initial estimate for cost of Medicare and compare to the reality.
As time has progressed, there has been more attention given to Medicare and Medicaid. The current lawmakers are making some cutbacks wile at the same time trying to make both of these work. We will see what happens in the near future as some of the legislation that is being worked on is rolled out. In the meantime, at least there is an attempt to bring both programs forward into te 21st century.
Medicare is looking for a way to create more seamless transitions from the hospital to home, skilled nursing care, or home health care. These transitions include helping te patients stay well enough that they don't have to return to the hospital.
For years, it has been said that most people who are readmitted into the hospital do not have to be - more often than not - they should be able to go home (or to a skilled nursing care facility), and with the proper care, they should be able to stay home and progress. The Centers of Medicare & Medicaid Services has collected a great deal of data that indicates that many hospital readmissions of Medicare patients are preventable and the agency announced a program in 14 communities aimed at eliminating these “unnecessary” hospital readmissions.
The Care Transitions Project has been created by CMS to improve health care processes so that patients, their caregivers, and their entire team of providers have what they need to keep patients from returning to the hospital for ongoing care needs, according to CMS.
There are several important components to keeping a individual from returning to the hospital. Two of the most important components are having excellent home care to help the patient stay healthy. Bcing up and coupling this type of care with regular follw-up visits with the doctor will ensure that the patient's health will improve.
The total cost of unplanned hospital readmissions exceeds $17 billion annually, and varies widely across states. One of five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, and half of non-surgical patients are readmitted to the hospital without having seen an outpatient doctor in follow-up, according to a Commonwealth Fund-supported study in the New England Journal of Medicine.
By promoting seamless transitions from the hospital to home, skilled nursing care, or home health care, this community-wide approach seeks, not only to reduce hospital readmissions but to yield sustainable and replicable strategies that achieve high-value health care for Medicare beneficiaries
“Our data show that nearly one in five patients who leave the hospital today will be re-admitted within the next month, and that more than three-quarters of these re-admissions are potentially preventable,” said CMS Acting Administrator Charlene Frizzera.
“This situation can be changed by approaching health care quality from a community-wide perspective, and focusing on how all of the members of an area’s health care team can better work together in the best interests of their shared patient population.”
CMS will monitor the success of this project by watching the rates at which patients in these communities return to the hospital. Re-admission rates for hospitals have been tracked by CMS for some time, and will be available to consumers later this year through the Hospital Compare Web site at http://www.hospitalcompare.hhs.gov.
“The Care Transitions Project is a new approach for CMS,” added Barry M. Straube, M.D., chief medical officer for CMS and its Office of Clinical Standards & Quality director.
“Rather than focusing on one global problem and trying to apply a one-size-fits-all solution across the country, Care Transitions experts will look in their own backyards to learn why hospital re-admissions occur locally and how patients transition between health care settings. Based on this community-level knowledge, Care Transitions teams will design customized solutions that address the underlying local drivers of re-admissions.”
Communities in the following regions have been selected to participate in the project:
Providence, R.I.;
Upper Capitol Region, N.Y.;
Western Pennsylvania;
Southwestern New Jersey;
Metro Atlanta East, Ga.;
Miami, Fl;
Tuscaloosa, Ala.;
Evansville, Ind.;
Greater Lansing Area, Mich.;
Omaha, Neb.;
Baton Rouge, La.;
North West Denver, Colo.;
Harlingen, Texas; and
Whatcom County, Wash.
The work of the Care Transitions Project will respond to the unique needs of each of the 14 communities, says CMS.
Each of the CTP communities is led by a state Quality Improvement Organization (QIO). QIOs work throughout the country as part of CMS’s quality program to help health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all Medicare beneficiaries get the high-quality, high-value health care they deserve.
Each QIO in the project is required to work with partners to implement the following:
a) Hospital and community system-wide interventions;
b) Interventions that target specific diseases or conditions; and
c) Interventions that target specific reasons for admission.
The following QIOs serve as Care Transitions leaders throughout the country:
Quality Partners of Rhode Island;
IPRO Inc. (in New York);
Quality Insights of Pennsylvania;
Healthcare Quality Strategies Inc. (in New Jersey);
Georgia Medical Care Foundation Inc.;
FMQAI (in Florida); AQAF (in Alabama);
Health Care Excel (in Indiana);
MPRO (in Michigan);
CIMRO of Nebraska;
Louisiana Health Care Review;
Colorado Foundation for Medical Care;
TMF Health Quality Institute (in Texas); and
Qualis Health (in Washington).
The Care Transitions Project will continue in all 14 communities through summer 2011. For more information about the Care Transitions Project, visit http://www.cfmc.org/caretransitions/. To learn more about the work that QIOs are doing across the country, visit http://www.cms.hhs.gov/qualityimprovementorgs.
Drugstore company Walgreen Company, known as Walgreen's Drug Stores, said on Monday it would pull almost half its pharmacies in Washington State from the U.S. Medicaid program to protest against the state's plan to cut reimbursements for drugs.
Cash-strapped Washington State plans to insist on cheaper, generic drugs for low-income Medicaid clients whenever available and equivalent to brand-name drugs, and is also cutting the rate of reimbursements on all drugs to pharmacies which supply them.
Cutting the reimbursement rate of generic and brand-name drugs would severely impact the "economic viability of doing business in Washington," Walgreen said in a statement. However, this is not only being considered in Washington State. There are several other states going through the same financial issues - especially with Medicaid. Washington State is simply the first state that Walgreen's will be pulling many stores out of, severely limiting choices for some seniors who have dealt with Walgreen's for many years when it has come to their medication and other Medicaid needs.
Walgreen, one of the largest U.S. pharmacy chains, is to withdraw 44 of its 111 pharmacies in the state of Washington from the Medicaid program. Medicaid provides health insurance to low income individuals.
Unlike Medicare, the federal health program for seniors, Medicaid is partially funded by states. In order to cut the costs of the program, Washington state announced last week it would cut Medicaid reimbursements for brand-name prescription drugs by 6 percent, effective on Wednesday.
Walgreen said it would withdraw the 44 pharmacies from Medicaid as of May 1, a month after Washington introduces its plan. It said those pharmacies represent more than 60 percent of its total Medicaid business in the state.
There is a chance other pharmacies such as CVS Caremark Corp and Rite Aid Corp will follow suit in pulling out of Washington's Medicaid program
In the near future, Louisiana could face an even larger shortfall than expected in the money needed to provide health care to the poor, elderly, uninsured and children. Tax collections inflated by the recovery from the 2005 hurricanes are the source of the problem, state Health Secretary Alan Levine said Monday.
Instead of paying 67.6 percent of Medicaid costs in Louisiana, the federal government is expected to only pay 63.1 percent beginning October 2010. Federal funding cuts also are projected for a children’s health-care program. The difference in the percentages amounts to millions of dollars.
“The problem is nobody — and I mean nobody including myself — thought the reduction … would be this large,” Levine said.
Governor Bobby Jindal and his administration is proposing a $26.7 billion budget that trims the state’s health-care costs by more than $400 million in the fiscal year that starts July 1. The reduction would decrease the state Medicaid budget from $6.5 billion to $6.18 billion, affecting hospitals, nursing homes, physicians and others.
The federal “stimulus” package is helping with some health-care expenses. From October 2009 to December 2010, states do not have to bear the cost of changes in the percentage of Medicaid expenses that the federal government pays. The “stimulus” will get the state through part of the 2010-2011 fiscal year, Levine said.
But once the money runs out, the state will have to deal with a shortfall that now is larger than anticipated, he said.
The Federal Funds Information for States estimates Louisiana stands to lose $268 million in health-care dollars in a single federal fiscal year. “This is a massive, massive impact to Louisiana,” Levine said.
The decrease is in the percentage of costs that the federal government picks up for the Medicaid and Children’s Health Insurance programs.
There are other states that are going through very similar plights, however, since Louisiana - and a few surrouding states - is still recovering in many ways, especially financially from Hurricane Katrina, there are difficult issues that have to be ironed out to get the situation together economically so that Medicaid coverage will drop as little as possible and the people that truly need it will be able to have it continuously.
