These includ Medicare(for older or disabled people),Medicaid(for the poor), SCHIP(FOR CHILDREN) The veterans affairs heakth system and some state programs.
Care is subsidized by Federal or state governments or both
Sunday, November 29, 2009
Tuesday, March 24, 2009
Health Care Reform
A Tumor at the Heart of Medicare
By MARK LANGE
San Francisco
GENERATING efficiency in the health-care market will be one of President Obama’s greatest challenges. To do this, he will have to create meaningful competition between drug companies, and between public and private plans. Congress’s attempt at market-driven health care offers good instruction in what not to do.
Medicare Part D, the prescription benefit that went into effect three years ago, was supposed to let the elderly get their medicines more cheaply by creating competition between private insurers. Yes, the program has undeniably improved access to prescriptions. But the cost to taxpayers has been 3.5 times the market value of those prescriptions, according to a study in the journal Health Affairs.
Part of the problem was that insurance analysts saw a chance to double the size of the managed care industry. Drug companies stood to collect $30 billion in windfalls over the coming decade. So legislation was pushed, paid for and effectively drafted by thousands of lobbyists.
Proposals requiring the government to use the buying power of 40 million Medicare patients to negotiate prescription prices were defeated. Pharmaceutical lobbyists fought for direct federal subsidy of drug benefits, knowing plans would be reimbursed no matter how much prices were inflated. Lobbyists also prevented identical but less expensive drugs from Canada and other countries from coming here. After arm-twisting that reduced at least one member of the House of Representatives to tears, the bill to expand Medicare passed at 5:53 a.m. on a November morning in 2003.
When the program went live in 2006, a fragmented market of 80 insurers — with 1,400 prescription drug plans — lacked the purchasing power to negotiate drug prices. Nor did those insurers have much reason to bargain, since Part D subsidized the most costly patients at 80 percent. So prices under Medicare private insurance plans for the top 10 medications shot up, and in 2006 the five largest drug firms notched a 45 percent spike in profits over the previous year. After insurers rushed to sign as many retirees as possible at attractive rates, they raised premiums 13 percent. Medicare patients in private plans cost taxpayers about 15 percent more than those covered under traditional government programs.
Then the story started to resemble a Dickens novel. State insurance commissioners complained about a nationwide pattern of aggressive, abusive and deceptive marketing practices by sales agents. Free of basic oversight and enforcement, other insurance agents and brokers manipulated the elderly by falsely claiming that they worked for Medicare, selling unrelated and inappropriate policies, bullying the elderly and even forging signatures.
It doesn’t have to be this way. There are a few relatively simple steps Congress could take quickly to redeem Part D, and build momentum for effective, market-driven health care reform.
Congress should begin by requiring private insurers accepting public money to offer a plan option equivalent to what the Department of Veterans Affairs offers, at the same price. Another important step would be mandating that the Department of Health and Human Services negotiate drug prices on behalf of Part D plans. Rather than reimburse private insurers for pharmaceuticals through unlimited direct subsidy, Washington could compare prices paid by Part D plans to Medicaid’s best prices (today both price lists are confidential), and pay at either market or Medicaid rates, whichever is cheaper. Deceptive marketing could be combated by passing a bill to allow states to regulate and police marketing. To further ease confusion, Medicare should clearly outline plans with simple side-by-side comparisons of costs and benefits.
The public can also play an important role. While the larger health-care reform debate unfolds in Washington, the rest of us can keep an eye on the members of Congress who may be the most conflicted about bringing real competition to bear. At sites like www.maplight.org you can see whose campaigns have gotten the plushest contributions from pharmaceutical manufacturing and managed care companies.
This year, total Medicare and Medicaid spending will probably account for nearly a quarter of all federal spending, and by 2016 it could rise to almost a third. Enlisting real competition will be crucial to containing costs. So before offering a new universal benefit for the millions of Americans who lack health insurance, Congress should put an end to manipulative profiteering in Medicare. As challenging as the program’s problems may be, they do not prove that a market-based approach can’t work.
Mark Lange, a technology industry consultant, was a presidential speechwriter from 1989 to 1991.
By MARK LANGE
San Francisco
GENERATING efficiency in the health-care market will be one of President Obama’s greatest challenges. To do this, he will have to create meaningful competition between drug companies, and between public and private plans. Congress’s attempt at market-driven health care offers good instruction in what not to do.
Medicare Part D, the prescription benefit that went into effect three years ago, was supposed to let the elderly get their medicines more cheaply by creating competition between private insurers. Yes, the program has undeniably improved access to prescriptions. But the cost to taxpayers has been 3.5 times the market value of those prescriptions, according to a study in the journal Health Affairs.
Part of the problem was that insurance analysts saw a chance to double the size of the managed care industry. Drug companies stood to collect $30 billion in windfalls over the coming decade. So legislation was pushed, paid for and effectively drafted by thousands of lobbyists.
Proposals requiring the government to use the buying power of 40 million Medicare patients to negotiate prescription prices were defeated. Pharmaceutical lobbyists fought for direct federal subsidy of drug benefits, knowing plans would be reimbursed no matter how much prices were inflated. Lobbyists also prevented identical but less expensive drugs from Canada and other countries from coming here. After arm-twisting that reduced at least one member of the House of Representatives to tears, the bill to expand Medicare passed at 5:53 a.m. on a November morning in 2003.
When the program went live in 2006, a fragmented market of 80 insurers — with 1,400 prescription drug plans — lacked the purchasing power to negotiate drug prices. Nor did those insurers have much reason to bargain, since Part D subsidized the most costly patients at 80 percent. So prices under Medicare private insurance plans for the top 10 medications shot up, and in 2006 the five largest drug firms notched a 45 percent spike in profits over the previous year. After insurers rushed to sign as many retirees as possible at attractive rates, they raised premiums 13 percent. Medicare patients in private plans cost taxpayers about 15 percent more than those covered under traditional government programs.
Then the story started to resemble a Dickens novel. State insurance commissioners complained about a nationwide pattern of aggressive, abusive and deceptive marketing practices by sales agents. Free of basic oversight and enforcement, other insurance agents and brokers manipulated the elderly by falsely claiming that they worked for Medicare, selling unrelated and inappropriate policies, bullying the elderly and even forging signatures.
It doesn’t have to be this way. There are a few relatively simple steps Congress could take quickly to redeem Part D, and build momentum for effective, market-driven health care reform.
Congress should begin by requiring private insurers accepting public money to offer a plan option equivalent to what the Department of Veterans Affairs offers, at the same price. Another important step would be mandating that the Department of Health and Human Services negotiate drug prices on behalf of Part D plans. Rather than reimburse private insurers for pharmaceuticals through unlimited direct subsidy, Washington could compare prices paid by Part D plans to Medicaid’s best prices (today both price lists are confidential), and pay at either market or Medicaid rates, whichever is cheaper. Deceptive marketing could be combated by passing a bill to allow states to regulate and police marketing. To further ease confusion, Medicare should clearly outline plans with simple side-by-side comparisons of costs and benefits.
The public can also play an important role. While the larger health-care reform debate unfolds in Washington, the rest of us can keep an eye on the members of Congress who may be the most conflicted about bringing real competition to bear. At sites like www.maplight.org you can see whose campaigns have gotten the plushest contributions from pharmaceutical manufacturing and managed care companies.
This year, total Medicare and Medicaid spending will probably account for nearly a quarter of all federal spending, and by 2016 it could rise to almost a third. Enlisting real competition will be crucial to containing costs. So before offering a new universal benefit for the millions of Americans who lack health insurance, Congress should put an end to manipulative profiteering in Medicare. As challenging as the program’s problems may be, they do not prove that a market-based approach can’t work.
Mark Lange, a technology industry consultant, was a presidential speechwriter from 1989 to 1991.
Monday, January 5, 2009
VA Aid and Attendance For Spouse
Are VA Aid And Attendance Benefits Available For The Spouse Of A Veteran And, If So, How Much Can The Spouse Expect To Receive?
August 20th, 2008 · No Comments
(The following is based upon a real discussion that recently took place on an elder law listserv for attorneys. It illustrates the misinformation that is often inadvertently provided to consumers by government agency personnel concerning the availability of and eligibility criteria for needs-based public benefits.)
Question: I recently contacted the Veterans Administration (VA) about applying for Aid & Attendance Benefits (VA A&A Benefits) for my client, who is the surviving spouse of a World War II Veteran. I was told that in order to get VA A&A Benefits, the surviving spouse had to be collecting a VA pension based on the deceased spouse’s military service. The deceased spouse never received a VA pension, but he received VA medical benefits and died in a VA nursing home. Am I receiving correct information about my client’s eligibility for VA A&A Benefits? Also, if my client qualifies for VA A&A Benefits and later enters an assisted living facility, will the VA A&A Benefits make her ineligible for Medicaid by putting her over the assisted living income cap even after she spends down all of her assets and is otherwise eligible for Medicaid?
Answer: No, unfortunately you did not receive correct information. In order for your client to receive VA A&A Benefits, she must have been married to the veteran when he died. The veteran must have served at least 1 day in the military during a war time period and have served at least 90 days total in the military. Further, in order to qualify medically your client must either need assistance from another to help her with her activities of daily living, or be unsafe in her own environment without supervision. It is presumed the client needs the assistance if she lives in an assisted living facility; however, the client would still need a physician’s affidavit documenting her medical needs. If she meets all of those criteria, the client must still meet the asset and income requirements. The client’s income cannot exceed $998 per month in 2008. However, in order to qualify financially under the program, she can reduce her gross income by deducting all medical expenses, including the cost of the assisted living facility. In many cases, the assisted living facility costs alone, when deducted from her income, will reduce her income down to below $0.00. With regard to assets, the standard is whether the applicant has sufficient means to pay for her own needs, including her care needs. The informal asset limit is $80,000.
Assuming your client receives the maximum from the VA, she will get $998 per month in 2008. With regard to Medicaid, all of the VA A&A Benefits are excluded from income in New Jersey in determining eligibility for assisted living facility Medicaid. In other states, a portion of the VA A&A Benefits are considered to be “pension” and are included in the income cap calculation and the other portion is considered to be “aid and attendance” which is exempt from the income calculation. The “pension” portion is $624 per month and the A&A portion is $373 per month. In states other than NJ, once Medicaid is approved, you or the client must to notify the VA that she is receiving Medicaid by using VA Form 21-0779. Then, the VA will reduce the A&A to $90 per month which takes the place of the normal personal needs allowance. All of the $90 per month received from the VA is exempt from the Medicaid income calculation.
Tags: Assisted Living Facilities · Veterans Benefits
August 20th, 2008 · No Comments
(The following is based upon a real discussion that recently took place on an elder law listserv for attorneys. It illustrates the misinformation that is often inadvertently provided to consumers by government agency personnel concerning the availability of and eligibility criteria for needs-based public benefits.)
Question: I recently contacted the Veterans Administration (VA) about applying for Aid & Attendance Benefits (VA A&A Benefits) for my client, who is the surviving spouse of a World War II Veteran. I was told that in order to get VA A&A Benefits, the surviving spouse had to be collecting a VA pension based on the deceased spouse’s military service. The deceased spouse never received a VA pension, but he received VA medical benefits and died in a VA nursing home. Am I receiving correct information about my client’s eligibility for VA A&A Benefits? Also, if my client qualifies for VA A&A Benefits and later enters an assisted living facility, will the VA A&A Benefits make her ineligible for Medicaid by putting her over the assisted living income cap even after she spends down all of her assets and is otherwise eligible for Medicaid?
Answer: No, unfortunately you did not receive correct information. In order for your client to receive VA A&A Benefits, she must have been married to the veteran when he died. The veteran must have served at least 1 day in the military during a war time period and have served at least 90 days total in the military. Further, in order to qualify medically your client must either need assistance from another to help her with her activities of daily living, or be unsafe in her own environment without supervision. It is presumed the client needs the assistance if she lives in an assisted living facility; however, the client would still need a physician’s affidavit documenting her medical needs. If she meets all of those criteria, the client must still meet the asset and income requirements. The client’s income cannot exceed $998 per month in 2008. However, in order to qualify financially under the program, she can reduce her gross income by deducting all medical expenses, including the cost of the assisted living facility. In many cases, the assisted living facility costs alone, when deducted from her income, will reduce her income down to below $0.00. With regard to assets, the standard is whether the applicant has sufficient means to pay for her own needs, including her care needs. The informal asset limit is $80,000.
Assuming your client receives the maximum from the VA, she will get $998 per month in 2008. With regard to Medicaid, all of the VA A&A Benefits are excluded from income in New Jersey in determining eligibility for assisted living facility Medicaid. In other states, a portion of the VA A&A Benefits are considered to be “pension” and are included in the income cap calculation and the other portion is considered to be “aid and attendance” which is exempt from the income calculation. The “pension” portion is $624 per month and the A&A portion is $373 per month. In states other than NJ, once Medicaid is approved, you or the client must to notify the VA that she is receiving Medicaid by using VA Form 21-0779. Then, the VA will reduce the A&A to $90 per month which takes the place of the normal personal needs allowance. All of the $90 per month received from the VA is exempt from the Medicaid income calculation.
Tags: Assisted Living Facilities · Veterans Benefits
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