The News Hound

[Frank Stastny]

My rebuttal is: Yeah my dad loved being on a fixed income. House paid off, no debt, kids on their own, money in the bank, and just living off his monthly checks like Ss, pensions and interest.

I think most of them do really like it. My point is that most of the ones I talk to use "I'm on a fixed income" as a statement to indicate that they don't have any money and people should feel sorry for them.

It really gets to me when I'm sitting in a $300,000 house on a large acreage with a new car in the drive and a couple of new tractors in the shed.

 

[Frank Stastny]

When you talk about insurance and AARP, do not mention AARP.

Client: We have AARP
Me: How do you like United Health care?
Cleint: We love it...they pay everything...blah blah blah
Me: I have numerous clients with plan F as well, they love it too. However, they do not pay that much to have it.

quote]

That is excellent. I'm going to start using that. The only thing I will change is to replace Plan F with Plan D. A much better value and premium increases aren't as high.

 

[James]

I think most of them do really like it. My point is that most of the ones I talk to use "I'm on a fixed income" as a statement to indicate that they don't have any money and people should feel sorry for them.

It really gets to me when I'm sitting in a $300,000 house on a large acreage with a new car in the drive and a couple of new tractors in the shed.

Sure a fix income but they never say what the fix income is!

 

[Frank Stastny]

Sure a fix income but they never say what the fix income is!

That is exactly correct. There is a big difference between being on a "fixed income" of $1,800 per month and a "fixed income" of $18,000 per month. However, they all love to use the term.

 

[policy doctor]

Employers Healthcare for retirees(article)

AARP to seek review of retiree health care ruling

by Jerry Geisel
Posted on July 03, 2007
Business Insurance.com

PHILADELPHIA--A lengthy legal battle involving whether employers--without running afoul of federal age discrimination law--can provide smaller health care benefits to retired employees eligible for Medicare than to younger retirees may have another round in the courts.

Last month, a three-judge panel of the 3rd U.S. Circuit Court of Appeals in Philadelphia ruled unanimously that the Equal Employment Opportunity Commission has the authority to implement a rule to exempt retiree health plans from the Age Discrimination in Employment Act when those plans reduce benefits to retired workers once they are eligible for Medicare.o continue to provide a two-tier system of retiree health care coverage. However, the rule first proposed in 2003 never was implemented because of a legal challenge by the AARP.

Now Laurie McCann, a senior attorney with the AARP in Washington, says the organization will ask the full 21-judge 3rd Circuit to rehear the case. The deadline for filing the petition is July 19, which Ms. McCann said the organization will meet.

Whether the full appeals court will hear the case isn't known, though legal experts say such reviews are unlikely when a decision handed down by panel of an appeals court is unanimous.

The EEOC proposed its rule to counteract an August 2000 decision by the 3rd Circuit in a case involving Erie County, Pa., that found that retiree health care plans were subject to the ADEA. That decision exposed employers to age discrimination suits.

Without an ADEA exemption, the EEOC feared that if employers had to provide the same level of benefits to older retirees as to younger retirees to avoid age discrimination charges, they would reduce health care benefits for all retirees.

In the more recent case, the 3rd Circuit ruled the EEOC has the authority to issue its retiree health care plan exemption, noting that it met an ADEA test of being reasonable, "necessary and in the public interest."

 

[policy doctor]

SS checks and Part B

Social Security Checks Will Stop Increasing As Medicare Premiums Rise

TSCL Releases New Study

The net amount of Social Security checks will stop increasing for as many as 20% of Social Security recipients within the next six years, says a new study by Advisor editor Mary Johnson. That's because, in relatively few years, rising Medicare Part B premiums will completely consume annual Cost-Of-Living Adjustments for growing numbers of seniors.

Most people who receive Social Security have their Medicare Part B premiums automatically deducted from their benefit checks. A little-known provision of law protects the Social Security checks of individuals from going down when Medicare Part B premiums increase more than the COLA. Specifically, the law says that if the amount of the Part B premium increase is greater than the dollar amount of an individual's annual Social Security COLA, the premium owed by that person would be reduced to the amount required to assure no reduction in the Social Security "cash payment" (net benefit after deduction of the Part B premium) in the following year.

In recent years, for the first time, Medicare premiums have grown large enough to completely consume the amount of COLA received by people with the lowest benefits. The study found that when this happens, over time, the net cash benefit -- the amount a person receives after deduction for the Part B premium -- ceases to grow, but remains "fixed," despite a small annual COLA.

In addition, the fiscal burden on Medicare grows as well. Not only will the entire COLA of beneficiaries be required to cover the increase in Part B premiums, but, by law, the government will need to provide further adjustments to the amount of Part B premiums of affected individuals in order to avoid a reduction in their net Social Security benefit. As Medicare premiums grow larger over time, more and more seniors and the disabled will see little, and then no, increase at all in their net benefit in coming years. The Medicare program deficit will grow as the government absorbs the adjusted Part B premium amounts.

This study found that the point at which this occurs is uncomfortably close. Based on Social Security Administration statistics through June 2006, an estimated 2.3 million beneficiaries, more than 4% of Medicare-eligible Social Security recipients, have already started to feel the effects. Even more disturbing, however, some 20% of today's retirees and disabled, about 9.9 million people whose net monthly benefits are $587.50 or lower in 2006, could see their benefit checks stop increasing within the next six years due to Part B premium costs.


Read the entire study here.

Today the problem is starting to affect many individuals who can least afford it -- those with a very low monthly benefit of $322 or lower in 2006, after the deduction for the Part B premium. The Medicare Part B premium increase completely offset their COLAs in 2004 and exceeded their COLAs altogether in 2005.

Compounding the problem, this special provision of law does not extend to Part D premiums. Any increases in drug plan premiums that are automatically deducted from Social Security benefits, and which exceed the amount of COLA, will reduce the individual's net Social Security benefit the following year.

TSCL believes that Congress should act to cut the rate of growth of Medicare Part B premiums, and improve the adequacy of the COLA. Cutting the rate of growth of Medicare Part B premiums is essential to maintain program sustainability and affordability for both beneficiaries and taxpayers now and for the long haul. TSCL continues to lobby for a more adequate COLA that's calculated using a seniors-only Consumer Price Index that better reflects the portion of income seniors spend on health care costs

 

[policy doctor]

Your Weekly Medicare Consumer Advocacy Update

A True Community of Interests

July 12, 2007

• Volume 7, Issue 27

More than nine million children in the United States lack health insurance. Instead of providing them coverage by expanding the State Children's Health Insurance Program (SCHIP), President George W. Bush doesn't even want to give the program enough money to continue coverage for all the children currently enrolled. Leaders in the U. S. House of Representatives, along with most advocates for the nation's poor children, support authorization of $50 billion over the next five years to enable SCHIP to provide health care to two-thirds of America's uninsured children. But unless Congress reauthorizes SCHIP in the coming weeks, the program, which served 7.4 million people last year, will end September 30.

Why does this matter to people with Medicare? For many reasons.

First, America is a country rich enough and decent enough to provide health coverage to all of its people. We are each diminished when children suffer needlessly and die prematurely because their parents cannot afford the health care they need. That is why a more enlightened society would provide Medicare coverage at birth, not at age 65.

Second, the same political forces fighting SCHIP also seek to dismantle the national treasure that is Medicare. These forces rely on the same worn and false ideological arguments to attack both programs: government's active role in health care is a threat to, well, something. Depending on the day, that threat can be to the American way, economic growth, freedom, national security or quality health care. These ideologues argue that private insurers, unfettered by nettlesome government regulation, can do the job better and more cost-efficiently.

But that argument does not stand up to the facts. It's not easy to get most private insurers interested in signing up the very sick, the very poor or the elderly. Is it any surprise that the only way to get private health plans to continue to contract with Medicare is to give them as much as 19 percent more to provide coverage for patients than it costs under the government-administered Medicare program? This giveaway to private interests undermines the entire Medicare program by draining national resources from what is most needed: ensuring Medicare continues to provide good, affordable health care for all its members long into the future.

The Bush administration claims Medicare private plans are paid more because they offer more. When pressed for documentation, Medicare officials told a congressional committee in March that they don't have records of whether members in private plans actually receive promised benefits. They are still collecting what's called utilization data, but that doesn't stop them from insisting that the private sector offers a better deal.

In many cases, people who call the Medicare Rights Center for help found they have to pay more and get less coverage once they sign up for a private Medicare plan. Why would anyone join such plans? Some do so because they can get enhanced benefit packages that work for them. But too many sign up because they are not told what they're getting into. In June, Medicare officials announced that they have required seven of the nation's big insurance companies to "voluntarily" stop marketing private-fee-for-service Medicare plans because the companies had misled people into signing up.

The private plans get a monthly fee from Medicare for each member enrolled regardless of how much care that individual receives. The extra payments to private Medicare plans cost taxpayers an extra $1,000 a year to subsidize each member--about $65 billion over the next five years. The extra payments help fund marketing campaigns, cut-rate premiums and benefit packages designed to persuade people with Medicare--especially the low-cost, healthier and more profitable individuals--to sign up.

There's a better way to spend that money. Congress will be considering cutting these overpayments in the weeks ahead and redirecting the funds to expand SCHIP, to avoid steep cuts in payments to doctors serving patients with Medicare, or expand eligibility to low-income assistance programs for people with Medicare (Medicare Savings Programs).

Those options are worthy alternatives to overpaying insurance companies that are unwilling or unable to provide a dollar's worth of health care for each dollar paid to them by the U.S. government.

Tell your senators and representative to stop the overpayments to private plans. http://www.medicarerights.org/takeaction.html


* * * *

Medicare Part D Appeals Help for Advocates is here!

MRC's new "Medicare Part D Appeals: An advocate's manual to navigating the Medicare private drug plan appeals process" offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.

Register for a FREE copy of this great resource. http://www.medicarerights.org/appealsmanual.html

 

[policy doctor]

New vs older drugs

Older, Less-Costly Diabetes Drugs as Effective as Newer Treatments, According to Study

[Jul 17, 2007]
Older, less-expensive diabetes drugs are equally as effective and safe as newer, costlier drugs, according to a study published online Monday in the Annals of Internal Medicine, the AP/Houston Chronicle reports. For the first in-depth comparison of oral diabetes drugs that have been released in the past decade and those that have been available for decades, researchers led by Shari Bolen of Johns Hopkins University reviewed more than 200 published studies and unpublished information from drug companies and FDA.

Metformin -- sold as Glucophage and generically for about $100 per year -- "was the clear winner," according to the AP/Chronicle. The inexpensive drug was found to work just as well as other medications and does not cause weight gain or dangerously low blood sugar levels. Metformin also lowers LDL, or "bad," cholesterol levels. Consumer Reports published a guide to the results, which rated metformin, as well as glipizide and glimepiride -- sold respectively as Amaryl and Glucotrol -- as "best bets," the AP/Chronicle reports.

The study found that most oral diabetes medications reduce A1c levels, an important measure of high blood sugar, by about one percentage point. Bolen said that despite intense marketing for newer drugs -- which can cost up to $262 per month -- researchers "didn't find any benefit" to taking them unless a patient was unable to tolerate an older drug.

The study was commissioned in May 2005 by the federal Agency for Healthcare Research and Quality, before a study released this year tied the GlaxoSmithKline diabetes drug Avandia to cardiovascular risks. The Hopkins researchers said that evidence is insufficient to address the Avandia issue (Marchione, AP/Houston Chronicle, 7/17).

 

[policy doctor]

Call-in Day for Medicare Advantage

WEEKLY ALERT FROM ALLIANCE FOR RETIRED AMERICANS

Monday is National Call-in Day for Stopping Medicare Advantage Overpayments

Your U.S. Representative needs to hear from informed seniors! Please join other Alliance members across the country by calling your Representative on Monday and urging support for legislation that would create a level playing field for traditional Medicare and private Medicare Advantage (MA) plans. Use this toll-free telephone number -- 1-800-828-0498 -- to call the Capitol Switchboard. Ask to be connected with the office of your member of Congress. Once you are connected, let the staff know that you support ending overpayments to MA insurance companies, and using those savings for increased assistance to low-income seniors and providing health coverage for uninsured children.

Following is a sample script you can use when talking to your Representative's office:

"Please support legislation that stops the overpayments to private Medicare Advantage plans. Use the funds to improve traditional Medicare, strengthen assistance to low-income seniors, and provide coverage to uninsured children. Instead of giving insurance companies billions of extra dollars at the expense of the Medicare program, I urge you to support legislation to equalize payments between traditional Medicare and private Medicare Advantage plans."

An email was sent on Thursday to Alliance members, with a link for contacting Members of Congress with a similar message at: www.unionvoice.org/campaign/Stop_MA_Overpayments. Also on Thursday, members of the Nevada Alliance took part in an event revealing that MA costs each Nevadan an additional $294 per year, 3.5% more than traditional Medicare would cost.

According to a US Action Education Fund study, the private plans cost Nevada's seniors and people with disabilities an additional $4.1 million annually. "Given the misleading and abusive marketing practices directed at our seniors, these subsidies add insult to injury," said Brenda Mitchell, Vice President of the Nevada Alliance. The CBS Evening News focused on those marketing practices on both Monday and Tuesday nights, noting confusion over coverage, premiums, co-pays, and provider networks.

Included in the reports: a Kentucky woman who had to call 9-1-1 to get a Medicare Advantage salesman out of her house, and a Mississippi man who was only able to get off his MA plan 11 days after he died. His family now owes $40,000 in bills that Medicare has not paid. CBS also reported that at least 36,000 seniors have pulled out of their MA plans in just the first four months of this year, and nearly 100 private plans have been ordered by Medicare to change the way they do business. "I'm glad someone called 9-1-1," said George J. Kourpias, President of the national Alliance. "This is an emergency."

Pharmaceutical Companies Increase Lobbying Efforts in States

While the pharmaceutical industry has long been influential in Washington, D.C., it is redirecting many of its lobbying resources toward states in order to achieve its goals more quickly, according to a recent report in The Wall Street Journal. Representatives of the drug companies' trade group, the Pharmaceutical Research and Manufacturers of America, note that state legislatures move much faster than Congress, and are much easier to influence given that legislation may evolve from its beginning stages to a signed piece of legislation in under 90 days.

In 2004, the last year for which data is available from the Center for Public Integrity, drug companies spent over $44 million lobbying states. Campaign contributions from the manufacturers and their employees to state candidates have simultaneously increased, rising from $4.6 million to $8.8 million from 2000 to 2006, according to the National Institute on Money in State Politics.

A recent campaign to make pharmacists' switching patients from name-brand to generic epilepsy pills more difficult has used such a strategy to propose legislation in various states, bypassing expensive clinical testing required by the FDA for the rule to be considered at the national level. "We will be ready to stand up to big drug companies not just in Washington, D.C., but in every state," said Ruben Burks, Secretary-Treasurer of the Alliance.

Two Senior CMS Officials Resign
Two senior officials at the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicare and Medicaid, have resigned. Acting CMS Administrator Leslie Norwalk will step down as of today, July 20. Her departure was originally scheduled to occur just after a July 18 hearing of the Senate Finance Committee on the nomination of Kerry Weems to permanently fill the post of CMS administrator. The hearing has been postponed until an unannounced date. S. Lawrence Kocot, senior adviser to the CMS administrator, will also be leaving today (Friday).

Alliance Legislative Conference: And the Winners Are?
In just over 6 weeks - September 4-7, 2007 - the Alliance will be holding its National Legislative Meeting in Washington, D.C. The theme this year is "Building for America's Future." The President's Award will be presented to Elmer Blankenship, President of the Indiana Alliance, for his lifetime of public service on behalf of older Americans. The Leadership award will be presented to Sen. Debbie A. Stabenow (D-MI) in recognition of her years of outstanding leadership in the U.S. Congress on behalf of older Americans. To obtain copies of the official registration form, either call 1-888-373-6497, email Joni Jones at [email protected] or visit our website at www.retiredamericans.org. The conference will be held at the Hilton Washington and Towers. Hotel reservations must be made by calling the Hilton and Towers directly at 1-888-324-4586. Be sure to ask for the Alliance for Retired Americans National Legislative Meeting attendee rate.

Did You Know ...
In 1999, when 65 was the full retirement age, 66 percent of men and 71 percent of women applying for Social Security took early benefits. By 2005, when full retirement age had risen by one year to 66, a full 85 percent of men and women applying for Social Security took early benefits (CNN's Moneyline).

 

[policy doctor]

Newspapers Highlight Medicare Issues

[Jul 20, 2007]

Several newspapers recently published articles about Medicare. Summaries of the coverage appear below.

* Errors: About 138,000 Medicare beneficiaries nationwide are "stuck in bureaucratic gridlock" while prescription drug plan premiums are "erroneously" deducted from their Social Security checks, the Milwaukee Journal Sentinel reports. The problem stems from a computer glitch between CMS and Social Security Administration databases. An additional 141,000 beneficiaries who owe drug plan premiums are having difficulties getting the money deducted from their Social Security checks. CMS said it expects to have most of the deduction problems fixed within a few months and those owed money will be reimbursed (Gabler, Milwaukee Journal Sentinel, 7/18).

* House calls: Medicare has "taken the lead" in providing coverage for physician house calls to frail and elderly beneficiaries, as well as those with disabilities, the Dallas Morning News reports. Medicare covers 80% of the cost of house calls to homebound beneficiaries, and Medicaid or private supplemental insurance covers the remainder for some beneficiaries. Medicare is conducting a three-year project to determine whether house calls to the sickest beneficiaries improve care and reduce health care costs (Moos, Dallas Morning News, 7/18).

* Reimbursements: Reductions to Medicare physician payments in 2008 could cause physicians to limit the number of new beneficiaries they treat, a spokesperson for the American Medical Association said on Wednesday, the Minneapolis Star-Tribune reports. Medicare reimbursements are scheduled to be reduced by 10% in January 2008. Rebecca Patchin, an anesthesiologist and member of AMA's Board of Trustees, said three-fifths of 9,000 physicians surveyed by AMA said they would stop accepting Medicare beneficiaries if the cuts take effect (Draper, Minneapolis Star-Tribune, 7/18).