Patti's Blog - Advocate for Elders, People with Disabilities and Their Families

In The First Four Months Of 2012, More Than 416,000 People with Medicare Saved an Average of $724 on Prescription Drugs and 12.1 Million Used a Free Preventive Service

Excerpt from ENews Park Forest: (click for entire article)

Under the new health care law – the Affordable Care Act --  seniors and people with disabilities in Medicare have saved a total of $3.5 billion on prescription drugs in the Medicare drug benefit coverage gap or “donut hole” from the enactment of the law in March 2010 through April of 2012.  The Centers for Medicare & Medicaid Services (CMS) released data today showing that, in the first four months of 2012 alone, more than 416,000 people saved an average of $724 on the prescription drugs they purchased after they hit the prescription drug coverage gap or “donut hole,” for a total of $301.5 million in savings.  These savings build on the law’s success in 2010 and 2011, when more than 5.1 million people with Medicare saved over $3.2 billion on prescription drugs.

In addition, CMS announced that this year, from January through April, 12.1 million people in traditional Medicare received at least one preventive service at no cost to them – including over 856,000 who have taken advantage of the Annual Wellness Visit provided in the Affordable Care Act.  In 2011, over 26 million people in traditional Medicare received one or more preventive benefits free of charge.

“Thanks to the health care law, millions of people with Medicare have paid less for health care and prescription drugs,” said CMS Acting Administrator Marilyn Tavenner.  “The law is helping people with Medicare lower their medical costs, and giving them more resources to stay healthy.”

GAO: Health Law's Tax Credit For Small Businesses Underperforms

Excerpt from Kaiser Health News: (click for entire article)

A Government Accountability Office report found that only about 17 percent of the businesses that would otherwise be eligible for the maximum tax credit offered health insurance to employees.

The Hill: GAO: Tax Credit In Health Care Law Underperforms
Only about 17 percent of the businesses that would otherwise be eligible for the maximum tax credit offered health insurance, according to government data cited in the GAO report. The tax credits are administered on a sliding scale, covering up to 35 percent of a company's healthcare costs. "While some small employers could be eligible for the credit if they began to offer health insurance, small business group representatives and discussion group participants told us that the credit may not offset costs enough to justify a new outlay for health insurance premiums," GAO said (Baker, 5/21).

How is the Affordable Care Act Changing Medicaid Today? State Adoption of Five New Options

From The Kaiser Family Foundation:

A new brief from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured examines how states in every region have responded to five key opportunities available under the health reform law to help them prepare for the significant expansion of Medicaid in 2014. The options covered in the brief include incentives for states to get an early start on the Medicaid coverage expansion; increased federal funding to upgrade Medicaid eligibility systems; money to improve care for beneficiaries with chronic conditions by providing “health home” services; special funding for chronic disease prevention; and help in developing service delivery and payment models that integrate care for beneficiaries who are dually eligible for Medicare and Medicaid.

The new brief is available online.

Secretaries Duncan and Sebelius remind graduating students of new health coverage options under health care law

Excerpt from HHS.gov: (click for entire article)

Education Secretary Arne Duncan and Health and Human Services Secretary Kathleen Sebelius are reaching out to campus leaders to remind graduating high school, college and university seniors about their new health insurance options under the Affordable Care Act – the health care law.

Because of the new law, many young adults will be eligible to remain on their parent’s health plan until their 26th birthday. The Secretaries sent letters to college and university presidents as well as student associations encouraging them to spread that information to college students.

“The Affordable Care Act now gives students and their families peace of mind about their health insurance,” said Secretary Sebelius. “The President's health law gives hard-working, middle-class families the security they deserve.”

High Profile Judge Hints That Decision To Strike Health Law 'Would Be A Mistake'

Excerpt from Kaiser Health News: (click for entire article)

The Wall Street Journal reports that Judge J. Harvie Wilkinson said the high court should "think twice" about overturning the law. In other health law news, the White House's under-the-radar effort to build support for the overhaul appears to be working.

The Wall Street Journal's Law Blog: Judge Wilkinson Hints That Overturning Obamacare Would Be A Mistake
And last month, receiving the Federalist Society's Lifetime Service Award at Georgetown University, Judge Wilkinson hinted that the high court he nearly joined should think twice before striking down the symbol of everything contemporary conservatives revile -- the health care overhaul President Barack Obama signed into law over near-unanimous Republican opposition (Bravin, 5/3).

GAO Report Examines Individuals With Pre-Existing Conditions

Excerpt from Health Reform Source: (click for entire article)

The Government Accountability Office (GAO) estimates the number of people with pre-existing conditions on a state-by-state basis. The report finds that “Depending on the list of conditions used to define pre-existing conditions in each of the five estimates, GAO found that between 36 million and 122 million adults reported medical conditions that could result in a health insurer restricting coverage. This represents between 20 and 66 percent of the adult population, with a midpoint estimate of about 32 percent.” Beginning in 2014, the Affordable Care Act “prohibits health insurers in the individual market from denying coverage, increasing premiums, or restricting benefits because of a pre-existing condition.

CMS Releases Community First Choice Option Final Regulations; But Seeks More Input on When Housing is "Community-Based"

Excerpt from NSCLC: (click for entire article)

As it continues implementation of the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) has released final regulations for the Community First Choice option (CFC). CFC provides an incentive for state Medicaid programs to offer more extensive home and community-based services (HCBS): specifically, CFC increases the federal Medicaid match by six percent for HCBS that meet CFC standards.

CFC could be a game-changer for Medicaid beneficiaries in need of HCBS; because CFC is provided through a state-plan amendment rather than a waiver, CFC benefits must be made available throughout a state, not limited by (for example) enrollment caps or geographical restrictions. CMS estimates that ultimately 30 percent of eligible persons who would want CFC coverage, will be residing in states that offer it.

HHS announces new Affordable Care Act options for community-based care

Excerpt from HHS.gov: (click for entire article)

New opportunities in Medicaid and Medicare that will allow people to more easily receive care and services in their communities rather than being admitted to a hospital or nursing home were announced today by Health and Human Services Secretary Kathleen Sebelius.

HHS finalized the Community First Choice rule, which is a new state plan option under Medicaid, and announced the participants in the Independence At Home Demonstration program. The demonstration encourages primary care practices to provide home-based care to chronically ill Medicare patients.

Both are made possible by the Affordable Care Act. Studies have shown that home- and community-based care can lead to better health outcomes.

Updated “Talking About Medicare” Consumer Guide Now Addresses Changes From Health Reform

From the Kaiser Family Foundation:

To help the nearly 50 million Medicare beneficiaries and their families and caregivers make informed decisions about their health coverage, and millions more learn about Medicare before they become eligible for the program, the Kaiser Family Foundation has updated its online consumer guide with key information about the Medicare program, the benefits it provides, and the choices available to beneficiaries.

The updated guide provides answers to basic questions, including:

•     When and how should someone enroll in Medicare?
•     What benefits does Medicare provide, and what doesn’t Medicare cover?
•     What factors should beneficiaries consider when choosing between original fee-for-service Medicare and a private Medicare Advantage plan? What should people on Medicare consider when comparing Medicare Advantage plans in their area?
•     How should people on Medicare compare available Medicare Part D prescription drug plans?
•     What do supplemental insurance policies, known as Medigap, cover?
•     Is extra help available to low-income Medicare beneficiaries?

The guide reflects recent changes to Medicare, including major provisions of the 2010 health reform law. It also includes an updated resource list that provides state-specific contacts. It is available online at www.kff.org/talkingaboutmedicare.

Separately, the Foundation also has created an online Medicare Quiz that encourages people to learn more about the Medicare program, who it serves and how it is financed.

Meet Tracy and Sami W. from Appleton, WI

From HHS.gov:

Tracy doesn't have to worry about her son Sami being denied coverage because of pre-existing conditions, thanks to the Affordable Care Act. 

MyCare is an initiative to educate Americans about new programs, benefits, and rights under the health care law.

April 25, 2012

MyCare: Tracy and Sami W. in Appleton, WI

Learn more at www.healthcare.gov/mycare/