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eridani's Journal
eridani's Journal
August 28, 2015

People excused from paying Medicare cost-sharing being tricked into paying it anyway


People with QMB are excused, by law, from paying Medicare cost-sharing. Providers are prohibited from charging them. All cost-sharing (premiums, deductibles, co-insurance and copayments) related to Parts A and B is excused, meaning that the individual has no liability. The state has responsibility for these payments for QMBs regardless of whether the particular service is also a Medicaid-covered service.

Despite this prohibition, the CMS study found that providers illegally balance-billed participants for Medicare cost-sharing on a regular basis. Due to a lack of information, confusion regarding the system, or concern over outstanding bills, most QMB enrollees participating in the study paid these bills. Additionally, participants reported that unpaid bills were submitted to collection agencies. Another finding in the study was that participants experienced challenges with the appeals process. The study also found that beneficiaries were dissatisfied with service coverage, particularly for Durable Medical Equipment (DME).

The CMS report shows an alarming trend that low-income beneficiaries enrolled in the QMB program are frequently being illegally balance-billed, and that though they are not liable for the charges, many of the bills were sent on to collections if unpaid, and most beneficiaries actually paid. In addition, the CMS report found that QMB enrollees were less likely to use office visits and hospital outpatient services compared to Medicare-only enrollees in states that employed the “lesser-of” policy for reimbursement, thereby limiting access to essential routine and preventive care for beneficiaries. The report provides troubling information regarding access to care for low-income beneficiaries that underscores the need for continued advocacy efforts for this vulnerable population.
August 28, 2015

Poll Shows Majority of Americans Support Government Negotiation of Drug Prices for People with Medic

This month, the Kaiser Family Foundation (KFF) released its latest Health Tracking Poll describing what Americans think about prescription drug costs. According to the poll, 72 percent of Americans think prescription drug costs are "unreasonable" and 74 percent feel that Americans pay more for the same drugs sold in other countries, including Canada, Mexico, and countries in Western Europe

To address the high cost of medications, 86 percent of respondents are in favor of requiring pharmaceutical companies to provide information on how they set drug prices. When asked whether they think the federal government should be allowed to negotiate with prescription drug manufacturers to secure lower prices on medications for people with Medicare, 84 percent said they were in favor of this policy.

Medicare Rights recently expressed support for two bills that would address high prescription drug cost in Medicare Part D. The Medicare Prescription Drug Savings and Choice Act of 2015 (S. 1884 & H.R. 3261) would create one or more Medicare-administered prescription drug plans and would also allow the U.S. Secretary of Health and Human Services (HHS Secretary) to negotiate Medicare prescription drug prices. The Medicare Prescription Drug Price Negotiation Act of 2015 (S. 31 & H.R. 3061) would also allow the HHS Secretary to negotiate prescription drug prices on behalf of beneficiaries enrolled in Medicare Part D.




August 25, 2015

The Stock Market Drop Exposes the Dangers of Privatizing Social Security


The stock market continued a period of volatility on Monday. Media reports sounded the alarm as the DOW opened 1,000 points down and other indexes took huge hits, only to climb back up a bit later in the day. While that performance, which had some people calling it black Monday, may have knocked a good deal of money out of people’s 401(k) retirement accounts, Social Security benefits remain by and large untouched by such fluctuations.

Some Republicans, however, are interested in changing that.

In June, presidential candidate Jeb Bush said that he thinks the next president will have to try to privatize Social Security. Others have gotten behind the idea as well: Sen. Rand Paul (R-KY) drafted a plan in 2013 that included partial privatization, and Sen. Ted Cruz (R-TX) is in favor of using private accounts. Rep. Paul Ryan (R-WI) has included privatization in his budget blueprints.

The market drop, and ones before, expose the dangers of such a plan, which usually entails diverting some or all of the money workers contribute to Social Security through their paychecks into private investment accounts. That would put individuals in charge of making smart enough investment choices in the market to make big enough returns to support themselves in retirement.

But the reality is that’s not within reach for most individual people. During a market rout like Monday’s, many people will panic and sell. “We know a lot of people do what economists say is irrational, they sell at a low point,” said Dean Baker, co-director of the Center on Economic and Policy Research. Research shows that the best thing to do during a downturn is to hold out if possible. But that’s not how most people will react. “People see something like this and go, ‘I better get out,’” Baker said. “When they see the market start to go up, they say, ‘I better buy in,’ and then they’ve lost a lot.”

This is one of the big problems with privatizing Social Security: individual investors don’t tend to be that savvy in chasing higher returns. “A lot of people make wrong decisions,” Baker said. This is even true when it comes to retirement planning: Many people leave money on the table with their 401(k)s by not taking advantage of employer matches or cash out when they switch jobs and incur taxes. The point of Social Security contributions is to make saving for retirement mandatory, he pointed out. But “if you do that and then just tell people to do whatever you want [with the money], then a lot of people will make mistakes and end up with not very much in retirement.”
August 22, 2015

Financial Burden of Health Care Costs Among Insured

Kaiser Family Foundation
August 20, 2013
Kaiser Health Tracking Poll: August 2015
By Bianca DiJulio, Jamie Firth, and Mollyann Brodie


Among insured: Thinking about your own health care costs, which of the following do you find to be the greatest financial burden?

17% The deductible you pay before insurance kicks in

14% Your health insurance premiums

11% Your prescription drugs

7% Your doctor visits

3% Some other health care cost

44% Paying for health care and health insurance is not a financial burden

(Note: “All equally” and “Don’t know/Refused” responses not shown)

Comment by Don McCanne of PNHP: It is nice to know that health insurance and paying for health care do not create a financial burden for 44% of those who are insured. The system is working well for the almost half of the insured who have decent incomes who remain in good health. But what about the other half?

Being insured is no assurance that you will not face significant financial burdens. The most common are high deductibles, high insurance premiums, high costs of prescription drugs, and, to some extent, physician fees. But shouldn’t the health care financing system be designed to remove financial burdens whenever people need health care? Our system is not working well for patients who have modest incomes and current significant health care needs.

Under a single payer system, there is no need for deductibles to save money by discouraging the use of beneficial health care services, because spending is controlled though other less intrusive, more patient-friendly economic measures. Physician fees are negotiated and paid by the single payer administrator, and prescription drug spending is controlled through negotiation and bulk purchasing. Insurance premiums are eliminated and replaced with equitable, progressive taxes that place a burden on no one. Instead of deliberately building financial barriers into the system, shouldn't we eliminate them?

My comment: Most people are not sick! In every age demographic, 5% of that demographic accounts for 50% of its health care costs, and 15% for 85% of costs. People who are happy with their insurance are mostly not sick--and that is one reason why getting universal health care is so hard.
August 21, 2015

These Former Debt Collectors Decided to Ditch the Industry, Buy Up Medical Debt, and Forgive It


When Paola Gonzalez received a phone call from RIP Medical Debt, she was certain what she heard was a mistake. A prank, maybe. The caller said a $950 hospital bill had been paid for in full: It would not affect her credit and she wouldn’t have to worry about it again. “They wanted to pay a bill for me,” she said. “I was just speechless.”

The 24-year-old student from Roselle Park, New Jersey, has lupus, a chronic autoimmune disease that in 2011 put her in and out of hospitals for a year. Even with insurance she faces a barrage of medical bills that often get pushed aside. “I can’t always work,” Gonzalez said. “I’ll be fine today and sick tomorrow. It’s really amazing that people would help out like this.”

“We decided we should take the debt collector out of the equation.”

Gonzalez is one of many people who have had a debt paid by RIP Medical Debt, a nonprofit founded by two former debt collectors, Jerry Ashton and Craig Antico, that buys debt on the open market and then abolishes it, no strings attached. In the year since RIP Medical Debt started, the group has abolished just under $400,000, according to Antico. On July 4, it launched a year-long campaign to raise $177,600 in donations, which it will use to abolish $17.6 million of other people’s debt.

Millions of people are, in Ashton’s words, “sitting at the kitchen table and you have to decide, ‘Do I buy medication today or do I pay the water bill or do I pay the debt collector?’… We decided we should take the debt collector out of the equation.”

It works like this: typical collection agencies will buy debts from private practices, hospitals, and other collection agencies that don’t find it worthwhile to pursue the debt themselves. The buyers often get a steal, buying a debt for pennies on the dollar while charging the debtor the full amount, plus additional fees.
August 19, 2015

Krugman: Why All The Republican Candidates Are Attacking Social Security


Historically speaking, politicians who have attacked Social Security (oft-described as the "Third Rail" in American politics) have not fared well with the American people. The program, originally designed to provide supplemental retirement security for all Americans, is actually a critical financial lifeline for millions. Many elderly people would either be pushed into squalid, poorly equipped nursing homes, forced to live with their children (assuming they have them) or cast out into the streets without the modest monthly income most paid taxes for all their lives to support and ensure. When George W. Bush began to push to "privatize" Social Security into accounts dependent on the stock market, his efforts were quickly squelched by Democrats and even some Republicans who responded to the public's overwhelming disapproval of such measures. In retrospect this probably saved millions of older Americans from becoming destitute when the Bush economy crashed in 2007-2008, wiping out billions in stock values.

It seems, however, that the near-universal popularity of Social Security has failed to make much of an impression on nearly all of the current Republican candidates for President, who have publicly announced their intent to impose cuts in benefits, privatization, or other drastic reductions to a program that is neither "insolvent" nor in any financial peril:

Thus, Jeb Bush says that the retirement age should be pushed back to “68 or 70”. Scott Walker has echoed that position. Marco Rubio wants both to raise the retirement age and to cut benefits for higher-income seniors. Rand Paul wants to raise the retirement age to 70 and means-test benefits. Ted Cruz wants to revive the Bush privatization plan.
August 15, 2015

As Social Security Reaches 80, Americans' Love for Program Remains Strong


An overwhelming majority of Americans supports Social Security's contribution to the common good, a new AARP survey has found.

The findings (pdf), released on the eve of program's 80th anniversary, show how vital the program continues to be.

"As we celebrate Social Security on its 80th anniversary, our survey found that it remains as important as ever to American families," said AARP CEO Jo Ann Jenkins.

The organization's national survey of public opinions found that 80 percent of all age groups are currently depending on or plan to depend on Social Security for their retirement income.

Sixty-six percent said that it's "one of the very most important government programs"—and that's a perception that's remained consistent over the past twenty years, the organization found.

Though Democrats were more likely (74 percent) to say that it's one of the very most important programs, a majority of Republicans—56 percent—agreed.

In addition, 82 percent of respondents said they "think it's important to continue to contribute to Social Security for the common good."
August 8, 2015

GOP Plan To Slash Social Security Thwarted


Protests by Social Security advocates and objections by Democratic U.S senators who support increasing its payments stopped an amendment to kick 200,000 people off retirement and disability benefits if those individuals had outstanding felony arrest warrants.

“Dropping the Social Security cuts from the Highway bill is the first encouraging sign we’ve seen from this Congress, when it comes to Social Security and Medicare, this year,” said Kim Wright, National Committee to Preserve Social Security and Medicare spokeswoman, speaking of the proposal that surfaced Tuesday and was deleted on Wednesday. “We certainly hope they’ve finally realized using these programs as an ATM for everything else under the sun simply won’t fly with seniors who’ve paid into these programs their entire working lives.”

The punitive proposal to slash the benefits of Social Security recipients who may have an outstanding warrant or parole violation—which in many cases is due to unpaid court fees, not criminal activity, according to senior law experts like Justice In Aging—arose as part of a 1,000-page transportation bill as a way to raise $2.3 billion for highway projects.

The proposal has roots in the mid-1990s tough-on-crime heyday in Congress that led to a massive expansion of U.S. prisons and mandatory sentencing. As the Huffington Post reported today, it was “similar to a provision from the 1996 welfare reform law designed to stop benefits to ‘fleeing felons,’ a scheme that was broadened in 2005 and eventually stymied by federal courts. The program had ensnared some innocent people who happened to have the same names as felons and also stopped benefits to some people guilty of things such as writing bad checks in the distant past. In 2009, the Social Security Administration agreed to pay $500 million in back benefits to 80,000 people wrongfully cut off.”
August 7, 2015

Letter of Support for Medicare Prescription Drug Price Negotiation Act of 2015

Please ask your representatives to support S. 31 & H.R. 3061

Dear Senator Klobuchar and Representative Welch:

On behalf of the Medicare Rights Center, I am writing to express support for the Medicare Prescription Drug Price Negotiation Act of 2015 (S. 31 & H.R. 3061). This critical legislation would allow the U.S. Secretary of Health and Human Services to negotiate prescription drug prices on behalf of beneficiaries enrolled in Medicare Part D.

Under current law the Secretary is expressly prohibited from negotiating prescription drug prices under Medicare Part D. Yet, this authority is granted to other federal agencies, including the Veterans Administration (VA). As a result, the VA benefits from significantly lower prescription drug prices than Medicare.

Allowing the Secretary to negotiate Medicare drug prices will translate into lower prices for seniors and people with disabilities through lower premiums and cost-sharing. In addition, reining in unreasonable prices on pharmaceuticals in Medicare will translate into savings for the federal government. Thank you for your leadership on this important issue.


Joe Baker
Medicare Rights Center

August 4, 2015

Krugman: The Disappearing Entitlements Crisis


A few years back elite policy discourse in the United States was totally dominated by the supposed entitlements crisis. Serious people all assured each other that history’s greatest menace was the threat posed by the unstoppable growth of Medicaremedicaidandsocialsecurity, which could only be tamed by dismantling the legacy of the New Deal and the Great Society, while of course cutting top marginal tax rates.

A few of us argued, however, not just that it was foolish to worry about long-run budget issues in a time of depression and zero interest rates, but that the long run fiscal problems weren’t really that intractable. I used to say that all we needed were death panels and sales taxes — that if we got serious about cost control on health care, the rise in entitlement spending due to an aging population would shrink to a level that could be covered by moderate increases in revenue, meaning that no fundamental dismantling of the welfare state was necessary.

Sure enough, health spending began moderating after the passage of the ACA — and as Bruce Webb points out, if you believe the reports of the Social Security and Medicare trustees, we’re basically already there.

In 2009 the Trustees projected a gigantic rise in Medicare spending, which was obviously unsupportable (although Social Security never looked like a big problem).

The truth is that there never was an entitlements crisis. But now there isn’t even an excuse for pretending that such a crisis exists. I know that a large part of the commentariat is professionally and personally invested in fiscal crisis rhetoric — admitting that it’s no longer relevant would suggest that they have, all along, been silly rather than Serious. But next time you see someone solemnly intoning that we must destroy Medicare to save it, remember that there is no there there.

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Hometown: Washington state
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Member since: Sat Aug 16, 2003, 02:52 AM
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About eridani

Major policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity
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