Tagged Medicare

Money-Saving Offer For Medicare’s Late Enrollees Is Expiring. Can They Buy Time?

Many older Americans who have Affordable Care Act insurance policies are going to miss a Sept. 30 deadline to enroll in Medicare, and they need more time to make the change, advocates say.

A lifetime of late enrollment penalties typically await people who don’t sign up for Medicare Part B — which covers doctor visits and other outpatient services — when they first become eligible. That includes people who mistakenly thought that because they had insurance through the ACA marketplaces, they didn’t need to enroll in Medicare.

Medicare officials are offering to waive those penalties under a temporary rule change that began earlier this year, but the deal ends Sept. 30.

On Wednesday, more than 40 groups, including consumer health advocacy organizations and insurers, asked Medicare chief Seema Verma to extend the waiver deadline through at least Dec. 31, because they are worried that many people who could be helped still don’t know about it.

They also say more time is needed because of application delays at some Social Security Administration (SSA) local offices, where beneficiaries request the waiver.

“We know there are people who can still benefit from it,” said Stacy Sanders, the federal policy director at the Medicare Rights Center, a Washington-based advocacy group that coordinated the request to Medicare. “We know there have been delays, and those are good reasons to extend it.”

Counselors at the Medicare Rights Center have helped seniors apply for the waiver in Arizona, California, Florida, Minnesota, Missouri, New Jersey and New York, she said.

Since the marketplaces opened in 2014, the focus has been on getting people enrolled, Sanders added. “There’s no reason to expect that people would understand how to move out of the marketplace into Medicare.”

The waiver offer applies not only to people over 65 who have kept their marketplace plans, but also to younger people who qualify for Medicare through a disability and chose to use marketplace plans.

The waiver also allows Medicare beneficiaries who earlier realized their mistake in keeping a marketplace plan and have switched to ask for a reduction or elimination of the penalty.

In all cases, people had to be eligible for Medicare after April 1, 2013.

Officials at the Centers for Medicare & Medicaid, which runs Medicare, would not provide details about the number of waivers granted or pending applications. Nor would they comment on the likelihood of an extension.

Barbara Davis said that when she initially applied, a Social Security representative didn’t know about the waiver. She eventually contacted the Medicare Rights Center, where a counselor interceded on her behalf in June. A day later, a Social Security representative told her she would not have a penalty.

“My advice would be, find out your rights before you apply,” said Davis, 68, who lives with her husband in rural western New York. “Because they don’t seem to want to give you information to help you, you have to know this on your own.”

A Social Security spokeswoman said the agency is processing waiver applications from “across the country” but does not keep track of the number. She declined to comment on whether SSA employees know about the waiver.

Sanders suggested that people applying for the waiver ask Social Security officials for it by using its official name: “time-limited equitable relief.”

Since Medicare’s Part A hospitalization benefit is usually free, some seniors who liked their marketplace coverage thought — incorrectly — that they had nothing to lose by signing up for Part A and keeping their marketplace plan.

Some people receiving Social Security retirement or disability benefits opted to keep their marketplace plan and drop Part B after the Social Security Administration enrolled them automatically in Medicare when they became eligible.

If the temporary waiver expires, the only other way for beneficiaries to get an exemption is by proving they declined Part B because a government employee misinformed them.

The groups writing Verma argue that keeping the waiver in place past Sept. 30 could also help many beneficiaries who may be surprised by a little-known rule that will affect 2018 marketplace policies.

For the first time, insurers will be prohibited from issuing a marketplace plan if they know the member is eligible for Medicare and the 2018 policy is significantly different.

Those who find themselves without a marketplace plan could be in for another surprise: They won’t have insurance for outpatient care until July 1 because Medicare imposes a waiting period before Part B coverage kicks in for latecomers.

Extending the deadline “would lessen a significant hardship for many people … [who] are unaware of the repercussions that could result from keeping their marketplace coverage,” said Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, an industry group.

For information on how to apply for the time-limited equitable relief waiver, go to the Medicare Rights Center’s Medicare Interactive webpage or call the center’s helpline at 1-800-333-4114.

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation and coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Cost and Quality, Insurance, Medicare, The Health Law

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Thinking About A Single-Payer System: Pros And Cons Of ‘Medicare For All’

Opinion writers offer their ideas about the health care plan advanced by Sen. Bernie Sanders (I-Vt.).

USA Today: Bernie Sanders Medicare-For-All Plan Is All Wrong For America
My 93-year-old father recently came home from the hospital proudly harboring a life-saving $50,000 aortic valve paid for by Medicare, though he rode home in a wheelchair that Medicare didn’t pay for. This gap in services is growing, as Medicare struggles to cover emerging technologies that are not one-size-fits all while at the same time continuing to provide basic care. If Medicare is converted to single-payer or Medicare for all, as Sen. Bernie Sanders of Vermont proposes, tens of millions more patients will be added to an already faltering system, and the gap between the promise of care and actual care delivered will widen. (Marc Siegel, 9/20)

Los Angeles Times: There Are 3 Types Of Single-Payer ‘concern Trolls’ — And They All Want To Undermine Universal Healthcare
Some of the naysayers are conservatives who simply abhor “big government.” Some have perfectly valid reasons to question the merits of single payer in general or Sanders’ methods in particular. Yet others claim they support universal healthcare in theory (one day, perhaps) but cannot do so now because of a “concern.” They are “concern trolls” — broadly defined as “a person who disingenuously expresses concern about an issue with the intention of undermining or derailing genuine discussion.” (Adam H. Johnson, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Texas Bill To Curb ‘Surprise Medical Bills’ Now In Effect; Blue Cross Will Continue To Run N.C.’s State Health Plan

Media outlets report on news from Texas, North Carolina, Maine, Florida, California, Nevada, Colorado, Michigan, Missouri, New Hampshire, Louisiana and Minnesota.

The Associated Press: Lawsuit Challenges Law That Only Doctors Perform Abortions
The American Civil Liberties Union and Planned Parenthood filed a federal lawsuit Wednesday that challenges a Maine restriction common across most of the U.S. that abortions be performed solely by physicians. The two groups were joined by four nurses and abortion provider Maine Family Planning in challenging the law that prevents advanced practice registered nurses, such as nurse practitioners and nurse midwives, from performing the procedure. (9/20)

Las Vegas Review-Journal: Southern Nevada Medicare Dilemma: Pay More Or Switch Doctors
The recent decision by Southwest Medical Associates to stop covering traditional Medicare patients in Southern Nevada makes 66-year-old Anne Zarate sick to her stomach. That queasy feeling is not just because, as the Las Vegas woman puts it, she’s being “thrown out with 7,000 others in a city where access to medical care is weak at best.” She also sees Southwest’s action as an example of the inability of government to deliver quality health care in the United States. (Harasim, 9/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Policy Points: Looking For Innovation In Medicare And Medicaid; Health Care In Japan

Editorial pages feature an announcement by the head of the Centers for Medicare & Medicaid Services on Trump administration plans, one suggestion for covering more Americans and a look at how Japan handles health care.

The Wall Street Journal: Medicare And Medicaid Need Innovation
More than 130 million Americans are enrolled in Medicare and Medicaid. America’s elderly and most vulnerable citizens depend on these programs. But both face fiscal crises. … The Centers for Medicare and Medicaid Services has a powerful tool for improving quality and reducing costs: the Center for Medicare and Medicaid Innovation. … This administration plans to lead the Innovation Center in a new direction. On Wednesday we are issuing a “request for information” to collect ideas on the path forward. (Seema Verma, 9/19)

New Haven (Conn.) Register: ‘Medicare For All’ Could Be Cheaper Than You Think
Sanders’s plan would come at a steep price: likely more than US$14 trillion over the first decade, based on an estimate I did of a previous version. There is, however, a simpler and less costly path toward single-payer, and it may have a better chance of success: Simply strike the words “who are age 65 or over” from the 1965 amendments to the Social Security Act that created Medicare and, voila, everyone (who wants) would be covered by the existing Medicare program. While this wouldn’t be single-payer – in which the government covers all health care costs – and private insurers would continue to operate alongside Medicare, it would be a substantial improvement over the current system. (Gerald Friedman, 9/20)

Bloomberg: Want A Better Health Care System? Check Out Japan
Senator Bernie Sanders’s new health care plan, called “Medicare for All,” would eliminate private health insurance and have the government pay for 100 percent of all health services. It’s not going to happen, but it does point the way toward a system that could work better: A public-private hybrid akin to what Japan has. (Noah Smith, 9/19)

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Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’

It does not take a hurricane to put nursing home residents at risk when disaster strikes.

Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses.

In some cases, nursing homes failed to prepare for basic contingencies.

In one visit last May, inspectors found that an El Paso, Texas, nursing home had no plan for how to bring wheelchair-dependent people down the stairs in case of an evacuation. Inspectors in Colorado found a nursing home’s courtyard gate was locked and employees did not know the combination, inspection records show. During a fire at a Chicago facility, residents were evacuated in the wrong order, starting with the people farthest from the blaze.

Nursing home inspectors issued 2,300 violations of emergency-planning rules during the past four years. But they labeled only 20 so serious as to place residents in danger, the records show.

In addition, a third of U.S. nursing homes have been cited for another type of violation: failing to inspect their generators each week or to test them monthly. None of those violations was categorized as a major deficiency, even at 1,373 nursing facilities that were cited more than once for neglecting generator upkeep, the records show.

“That’s the essential problem with the regulatory system: It misses many issues, and even when it identifies them, it doesn’t treat them seriously enough,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “It’s always the same story: We have some pretty good standards and we don’t enforce them.”

In the wake of eight deaths at Rehabilitation Center at Hollywood Hills, Fla., following Hurricane Irma, heightened attention has focused on new federal disaster-planning rules, with which nursing homes must comply by mid-November. Those were prompted by nursing home and hospital deaths during Hurricane Katrina in Louisiana in 2005.

Dr. David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, a nursing home industry group, said facilities have gotten better at handling disasters after each one. Most evacuations go smoothly, he said.

“After each one of these emergencies we’ve learned and gotten better,” Gifford said.

But advocates for the elderly say enforcement of rules is as great a concern, if not greater.

Dr. David Marcozzi, a former director of the federal emergency preparedness program for health care, said that inspectors — also known as surveyors —  should observe nursing home staff demonstrating their emergency plans, rather than just checking that they have been written down.

“If you have not implemented and exercised plans, they are paper tigers,” said Marcozzi, now an associate professor at the University of Maryland School of Medicine. “The emphasis from the surveyor has to be ‘Show me how you do this.’ ”

Gifford said pre-planning and drills, which are important, only go so far in chaotic events such as hurricanes.

“No matter what planning you might have, what we have learned from these emergencies is these plans don’t always work,” he said. Nursing homes take surveys seriously and face closure if they do not fix flaws inspectors identify, he added.

Inspection results vary widely by state, influenced sometimes by lax nursing homes or more assertive surveyors, or a combination, according to an analysis of two types of emergency-planning deficiencies. In California, 53 percent of nursing facilities have been cited for two types of emergency-planning deficiencies, and a quarter have been cited in Texas. No nursing home in Indiana, Mississippi or Oregon was issued violations for those two emergency-planning violations during the past four years.

Asked to explain the rarity of severe citations in emergency preparation, the federal Centers for Medicare & Medicaid Services, which oversees inspections, referred a reporter to its emergency-preparedness mission statement on its website.

The danger of high temperatures for elderly residents, which the Hollywood Hills case shows can be disastrous, has been well known. In a heat wave in 2000, two nursing home residents in a Burlingame, Calif., facility died and six others suffered severe dehydration, heat stroke or exhaustion.

During the past four years, inspectors have cited 536 nursing homes for failing to maintain comfortable and safe temperature levels for residents. Inspectors deemed 15 as serious, including two where patients were harmed, records show.

“There is undoubtedly little, if any, enforcement of the laws since we see the same tragedies repeated time and again,” said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation. Coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Medicare, Public Health

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Perspectives: All About Bernie’s ‘Medicare-For-All’ Plan

Editorial writers offer a variety of opinions on the single-payer health plan proposal advanced by Sen. Bernie Sanders (I-Vt.).

Los Angeles Times: Does Bernie Sanders’ Single-Payer Plan Have A Shot?
Sen. Bernie Sanders’ “Medicare for All” plan, unveiled last week, is an ambitious and (to many) enticing idea: a single, government-run health plan with generous benefits for everyone — just like most industrialized countries have enjoyed for decades. If only it were feasible in today’s United States. (Doyle McManus, 9/17)

Chicago Tribune: Bernie Sanders’ Medicare For All Is A Delusional Promise
Bernie Sanders has a health care plan he calls Medicare for all. He’s underselling it. His proposal really should be called Medicare for all and a pony. It’s everything you could want and then some. … It’s not clear that we as a country can afford Medicare as it currently exists. Merely preserving it without significant cuts would eventually require a tax increase that working people would resent. But instead of looking for ways to economize, the Vermont senator wants to expand the program in a way that the term “vast” barely begins to capture. (Steve Chapman, 9/15)

The New York Times: Buried Inside Bernie Sanders’s Bill: A Fallback Plan
The Bernie Sanders “Medicare for All” plan promises rapid, sweeping change to the American health care system, with the elimination of all private insurance and the creation of a costly new government insurance program that will cover everyone and nearly every medical service. But deep in its back pages is a more modest fallback plan. … During that interim, some younger Americans would be able to buy access to the traditional Medicare program, which is now mainly for those 65 and up. The provisions would also establish an option for Americans to buy access to a Medicare-like government plan that would be sold on the Obamacare exchanges. (Margot Sanger-Katz, 9/15)

WBUR: Bernie Sanders’s Single-Payer Swoon
Bernie Sanders filed his “Medicare for All” bill to erect a single-payer system, plugging his plan from a prime perch on The New York Times op-ed page. … Normally, this is where we’d cue the pitfalls-of-single payer part. But first, we need to hose down the fevered scaremongers on the right who oppose single payer for dumb reasons, insisting that would turn us into a goose-stepping Amerika. (Rich Barlow, 9/18)

The Washington Post: The Democrats Have Become Socialists
When Bernie Sanders launched his bid for the Democratic nomination, he was often asked whether he, a democratic socialist, would actually become a Democrat. Now, more than a year after he ignited a movement with his unsuccessful bid, that question is moot. The Democrats have become socialists. (Dana Milbank, 9/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Medicare Unveils Design And Publicity Campaign For New Beneficiary Cards

The cards won’t start arriving until April, but federal officials are beginning an outreach campaign so seniors are not confused when they get their new card.

NPR: Medicare Is Mailing 60 Million New Cards To Prevent Identity Theft
It’s an administrative task for the ages. Medicare is getting ready to issue all 60 million of its beneficiaries new cards with new ID numbers as way to combat identity theft and fraud. The rollout begins next April, but the agency is already beginning its outreach campaign. (Kodjak, 9/14)

The Associated Press: Medicare Card Gets A Remake To Help Protect Senior Citizens
Medicare cards are getting a makeover to fight identity theft. No more Social Security numbers plastered on the card. Next April, Medicare will begin mailing every beneficiary a new card with a unique new number to identify them. … One goal is to make sure seniors know what’s coming so they’re not confused by the change — and in the meantime, are reminded to guard their old cards that, if lost or stolen, can leave them vulnerable to financial and legal consequences. The government recorded 2.6 million cases of identity fraud involving seniors in 2014, up from 2.1 million in 2012. (Neergaard, 9/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Policy Points: Three GOP Senators ‘Bedside Miracle;’ Immigration As A Public Health Issue

Columnists offer their opinions on a range of health policy topics, including the Obamacare alternative being advanced by Sens. Lindsay Graham (R-S.C.), Bill Cassidy (R-La.) and Dean Heller (R-Nev.), the impact of immigration policy and how to make sense of issues during the upcoming open enrollment period.

Bloomberg: The Latest (Dim, Distant) Hope For Health-Care Reform
Health-care reform is like one of those ill people in a Victorian novel. They are pronounced close to death, with no possibility of a cure … and then they linger on for hundreds of pages of breathless plotting, while the reader wonders: “Is this it? Could they possibly live after all that suffering?” The latest bedside miracle is the Graham-Cassidy-Heller proposal, which would cut spending, cap spending, and shift spending away from states that expanded Medicaid to those that haven’t. (Megan McArdle, 9/13)

WBUR: Trump’s Aggressive Immigration Policies Have Created A Public Health Disaster
We are seeing only the tip of the iceberg of public health disasters stemming from the Trump administration’s aggressive detention and deportation policies. Lower birth weights have been reported in Latina mothers affected by immigration raids, and a spike in adverse mental health symptoms has been reported in many immigrant communities. (Dr. Sondra S. Crosby, Gilbert E. Benavidez and J. Astrian Horsburgh, 9/14)  

Los Angeles Times: Making Sense Of Covered California And Medicare During Open Enrollment
It’s that time of year when we all have to start thinking about health insurance plans and options. Not only do I need to figure out if my current plan will be offered again next year, and with what changes, but my husband is over 65, so I also have to research the latest Medicare plans as well. As a columnist, research is my thing, but this insurance stuff makes my head spin. (Barbara Venezia, 9/13)

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Single-Payer Perspectives: An Opening Bid Or A Way To Change The Subject

Editorial writers offer their thoughts on the single-payer approach to health care that appears to be gaining traction in the ongoing policy debate.

The Washington Post: Bernie Sanders’ Single Payer Plan Is Here. Think Of It As An Opening Bid.
Bernie Sanders is releasing his latest single payer health care plan today, and while there are some small differences between this one and what he has proposed in the past, the biggest difference is that this time, he’s got lots of company. Fifteen Democratic senators are co-sponsoring his bill, including most of those considering running for president in 2020. Support for some kind of universal coverage is now the consensus position among Democrats. And Sanders’ single payer plan is the one that has gotten the most attention, so it’s going to be the one against which other plans are measured. (Paul Waldman, 9/13)

The New York Times: How The Bernie Sanders Plan Would Both Beef Up And Slim Down Medicare
In his big new single-payer health care bill, Senator Bernie Sanders says he wants to turn the country’s health system into “Medicare for all.” But his bill actually outlines a system very different from the current Medicare program. The Sanders plan envisions changing Medicare in two important ways. First, it would make it more generous than it has ever been, expanding it to cover new types of benefits and to erase most direct health care costs for consumers. Those changes would tend to make it more expensive. (Margot Sanger-Katz, 9/13)

Axios: How Single Payer Helps Republicans Change The Subject
Since the collapse of the GOP effort to repeal and replace the Affordable Care Act, single payer has gained new life on the left. Sen. Bernie Sanders released his “Medicare for all” plan yesterday, and a majority of House Democrats have signed on to another version proposed by Rep. John Conyers. (Drew Altman, 9/14)

Richmond Times-Dispatch: And Now, The Push For Single-Payer
Apparently, the thinking in Democratic Party circles goes something like this: Since Obamacare has been such a smashing success, let’s inject even more government into health care. … Several leading contenders for the party’s presidential nomination have come out in favor of single-payer health care, and some Democratic skeptics are now coming around. (9/13)

Fortune: What It Would Take To Make Bernie Sanders’ Single Payer Health Care Plan Work
Senate Democrats, including nearly all of the party’s potential 2020 presidential candidates, haven’t so much been jumping on Bernie Sanders’ single payer, “Medicare for all” health care bandwagon as they have been elbowing past each other to snatch a prominent political seat on it. But the increasingly popular idea, unveiled by Sanders and at least 16 Democratic co-sponsors in the Senate Wednesday, is already brushing up against scrutiny from the medical industry and some health care analysts who question how the proposal would be paid for and implemented in practicality. (Sy Mukherjee, 9/13)

The Wall Street Journal: Bernie’s Socialism Goes Mainstream
Hillary Clinton’s memoir of her presidential campaign is getting most of the media attention this week, but that’s the politics of progressive nostalgia. If you want to know where the Democratic Party is going, Bernie Sanders showed the way Wednesday with his proposal for a complete government takeover of health care.. (9/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Advocates Pressing Medicare To Promote Advance Directives Among Beneficiaries

Some lawmakers and organizations want the government to help get the word out about advance directives and to encourage people to create them. Also, a look at some of the experimental programs being run by Medicare to change how doctors are reimbursed.

Modern Healthcare: Healthcare Groups, Lawmakers Push Medicare To Promote Advance Directives
Although the CMS reimburses clinicians for advance care planning during Medicare patients’ yearly wellness visits, the agency has yet to encourage patients to set up these plans. It shows: Two-thirds of American adults do not have advance directives to guide their healthcare if they become unable to communicate. … But even if a person has an advance directive, it may be hard to use. (Amdt, 9/13)

Modern Healthcare: Providers Find Success In CMS’ Multipayer Model
Dr. Katherine Clark was tired of the fee-for-service status quo. Every day, she would go through the same motions: see patients, treat their ailment and not see them again until they had a new health issue. But those patients weren’t getting better in the long run, and she wanted the cycle to end. That required a change in how she and other members in her practice were paid. … When the practice was accepted into the CMS’ Comprehensive Primary Care Initiative, it moved from the standard care pattern to one that put more emphasis on preventive screenings and follow-ups. Not only did she notice an overall improvement in quality of care, her practice also achieved notable savings under the model. (Dickson, 9/13)

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Viewpoints: At HHS, ‘Waste Scores A Victory’; Home Care Costs; Misreading The Opioid Crisis

A selection of opinions on health care from around the country.

The Washington Post: Tom Price Decides He Doesn’t Want Medicare To Save Money
The coming crisis is as predictable as it is worrying. Nearly a fifth of every dollar spent in this country is spent on health care. Without reform, that number will only rise as the baby boomers retire. Younger generations will suffer, as money is taken from building roads and educating children to paying for Medicare to cover boomers’ health costs. … Yet waste scored a victory when Health and Human Services Secretary Tom Price decided to stop or scale back “bundled payment” experiments the Obama administration had begun. (9/12)

The Wall Street Journal: Why Home Care Costs Too Much
As baby boomers age into long-term care facilities, Medicaid costs will go through the roof. Americans already spend—counting both public and private money—more than $310 billion a year on long-term support services, excluding medical care, for the elderly and the disabled. Medicaid accounts for about 50% of that, according to a 2015 report from the Kaiser Commission on Medicaid and the Uninsured. Other public programs cover an additional 20%. … There’s an urgent need to find ways of providing good long-term care at a lower cost. One fix would be to deregulate important aspects of home care. (Paul Osterman, 9/12)

The Wall Street Journal: The Way We Pay Doctors Is Hurting Health Care
For several decades, specialists in the U.S. have been paid considerably more than primary-care physicians. On average, orthopedic surgeons, cardiologists, radiologists and plastic surgeons make about twice as much as internists, pediatricians and family medicine doctors. True, most specialists train for a longer period of time than primary-care providers, but the degree of divergence in compensation has little to do with market forces or input costs. The difference has consistently been tied to how we pay for care with our emphasis on volume, procedures and technology, rather than prevention, care coordination, evaluation expertise and outcomes. (Howard Forman, 9/12)

Los Angeles Times: The Great Medi-Cal Paper Waste
Remember the telephone book? That giant, multi-thousand-page behemoth that used to land on your doorstep once a year? Well, neither do we, barely. The heyday of the phone book is long gone, and yet communications with friends and businesses is easier than it’s ever been before. Can it be that California officials haven’t noticed that? A new federal rule that took effect in July allows health insurance plans to stop automatically printing and mailing lengthy Medi-Cal provider directories, some of which are the size of phone books, to all new enrollees and make the information available digitally. Anyone without online access or who preferred having a hard copy could still request one. (9/12)

The Washington Post: Poor, Middle Class Saw Solid Gains Last Year, But We’ll Need Better Policy To Keep It Going
Poverty fell, middle-class incomes rose, and the share of Americans without health coverage ticked down to a historical low last year, according to data released Tuesday morning by the Census Bureau. This trifecta of gains for poor and middle-income households, as well as the uninsured, shows that the seven-year expansion, along with the Affordable Care Act, has continued to lift the living standards of many American households. However, last year’s gains were even stronger for those at the top of the income scale, suggesting that the inequality of economic outcomes continues to grow in America. (Jared Bernstein, 9/12)

The Washington Post: The Media Gets The Opioid Crisis Wrong. Here Is The Truth.
Lawmakers and the media have devoted much of their attention recently to deaths from opioid overdoses, as well as to the broader “deaths of despair” that include suicides and deaths from alcoholic liver disease and cirrhosis. But despite the intense focus on the topic, misinformation about the epidemic runs rampant. By conventional wisdom, tackling this crisis would require extending Medicaid and improving how it functions, cracking down on prescription painkillers and getting more health-care resources into rural communities. (Anne Case and Angus Deaton, 9/12)

San Antonio Press-Express: ‘Bad Paper’ Denying Vets Needed Services
Like [Mike] Gerardo, thousands are discharged from the military though the behaviors that got them this attention are service connected. Suffering from PTSD, for instance, often means self-medicating with drugs and alcohol. These service members are deemed problems and are discharged without being provided the services other “wounded” vets are accorded. (9/12)

WBUR: How To Talk To Your College-Age Kids About Depression And Suicide
School’s back in session, and parents ushering kids to college for the first time will undoubtedly deliver some emotional nuggets of advice. But they should also have a potentially life-saving talk with their kids in the first semester of college to avert a possible tragedy — suicide. (Nancy Rappaport, 9/13)

The New York Times: The Nazis’ First Victims Were The Disabled
I sit facing the young German neurologist, across a small table in a theater in Hamburg, Germany. I’m here giving one-on-one talks called “The Unenhanced: What Has Happened to Those Deemed ‘Unfit’,” about my research on Aktion T4, the Nazi “euthanasia” program to exterminate the disabled. “I’m afraid of what you’re going to tell me,” the neurologist says. (Kenny Fries, 9/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Talk About Single Payer: What About Workers Who Like Their Plans; ‘Pivotal Moment’ For U.S.

Opinion writers examine the “Medicare for All” movement and other aspects of the national health care debate.

Bloomberg: Incentives Are All Wrong For Single-Payer Health Care
There’s an obvious problem with moving Americans to a single-payer system: Most people with private health insurance are pretty happy with their current arrangements. They are not looking to trade in that coverage for a new government program of uncertain quality, along with unknown higher taxes. When President Barack Obama was selling the Affordable Care Act, he promised Americans that they could keep their health insurance if they wanted to. When this didn’t turn out to be true for everyone, there was a significant backlash. (Tyler Cowen, 9/12)

The New York Times: Why We Need Medicare For All
This is a pivotal moment in American history. Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right? Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers? We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can’t get the health care they need. This is not what the United States should be about. (Sen. Bernie Sanders, 9/13)

Milwaukee Journal Sentinel: Baldwin: Why I Support Medicare For All
Every American should have affordable health coverage, and there is more we can do to make that a reality. I always have believed that our goal must be universal health care coverage for everyone, and my support for Sen. Bernie Sanders’ Medicare for All legislation being introduced this week is a statement of that belief. (Sen. Tammy Baldwin, 9/12)

Bloomberg: How Democrats Have Steered Clear Of GOP’s Mistakes
Are Democratic advocates for single-payer health care the mirror image of repeal-and-replace Republicans, substituting a feel-good slogan for actual policy development? Probably not. It’s tempting to believe that’s a likely outcome of Bernie Sanders’s crusade for single-payer, which is picking up momentum within the party despite the fact that Sanders seems mostly indifferent to the details of the issue. But I think it’s a big mistake to equate Sanders with repeal-and-oh-we’ll-figure-it-out-later Republicans. (Jonathan Bernstein, 9/12)

The Washington Post: Democrats Are Rushing To Embrace Single Payer. Can It Be A Political Winner?
One of the most important political trends of the last couple of decades is what is often referred to as “asymmetric polarization,” which means that while Democrats were getting more liberal, Republicans were getting much, much more conservative. That trend, however, may be entering a new phase. In many policy areas, it’s almost impossible for the GOP to get any more conservative than it has become, while Democrats are continuing to move left. Nowhere is this clearer than on health care. (Paul Waldman, 9/12)

The Washington Post: Single-Payer Won’t Pass Now. But Its Popularity Proves Our Morals Are Changing.
Single-payer universal health care — once cast as a radical daydream — has moved with staggering swiftness from purported fantasy to palpable possibility. Today, Sen. Bernie Sanders (I-Vt.) released his long-awaited single-payer bill, and a slew of senators now numbering in the double digits have announced their support. This bill will serve as a potent Senate counterpart to Rep. John Conyers Jr.’s (D-Mich.) single-payer bill, now co-sponsored by 117 representatives — a historic and unprecedented majority of House Democrats. Far from being an impossibility, the idea that we might create a right to health care is starting to feel like an inevitability. (Adam Gaffney, 9/13)

The Washington Post: I Watched My Patients Die Of Poverty For 40 Years. It’s Time For Single-Payer.
Sarai was 25 years old when she died of Wilson’s disease, an inherited disorder that causes liver failure. A liver transplant could have cured her, but she was uninsured and was denied an appointment at two prominent Chicago transplant hospitals, including my own. … Her death certificate named liver disease as her cause of death, but that’s not true. The real cause was inequality. If the United States had a Medicare-for-all health insurance system, she might have been saved. (David A. Ansell, 9/13)

Los Angeles Times: If The GOP Would Only Give Up On Repeal And Replace It Could Actually Make Healthcare More Affordable
Time is rapidly running out before health insurers have to commit to the policies and premiums they’ll offer next year to roughly 20 million Americans not covered by an employer-sponsored health plan. Although those premiums are expected to jump 10% or more in many states, Congress can rein in that increase significantly — if it acts quickly. Doing so, however, will require Senate Republicans to stop flirting with yet another partisan proposal to “repeal and replace” the Affordable Care Act, and start focusing instead on steps to make coverage more affordable that can win broad support. (9/12)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Rule Changes For Medigap Supplemental Plans Leaves New Beneficiaries With Tough Choices

Medigap Plans F and C, which are quite popular among Medicare beneficiaries, will close to new enrollment in 2020. In other Medicare news, federal officials have proposed some changes in home health payment policies, and public health officials ponder a rise in sepsis cases among beneficiaries.

Chicago Tribune: Why Seniors Should Choose Wisely When Selecting Medigap Supplement Insurance
In 2020, people who are on Medicare and don’t already have what’s known as Plan F or Plan C Medigap insurance won’t be able to buy it because the federal government will close those plans to new participants. That means that when people go onto Medicare at 65, or if they switch Medicare-related insurance during the next couple of years, they are going to have to be diligent about scrutinizing insurance possibilities before some of those doors start to close. (MarksJarvis, 9/8)

Modern Healthcare: CMS’ Proposed Home Health Payment Model Alarms Providers. Would It Boost Access For Medically Complex Patients?
The CMS has proposed the largest overhaul of Medicare home health payment in many years, out of concern that the current reimbursement system discourages providers from serving patients with clinically complex or chronic conditions. Critics say Medicare’s system now gives home health providers incentives to select patients who need higher-paying therapy services, such as joint replacement, rather than those needing help with traumatic wounds or poorly controlled chronic conditions or who are dually eligible for Medicaid and Medicare. (Meyer, 9/8)

Modern Healthcare: Aggressive Diagnoses And Care Spark Big Rise In Medicare Sepsis Discharges
The number of Medicare inpatient discharges for sepsis has been on a steady rise, and in 2015 it beat out major joint replacements as the most common discharge for the first time. On first glance, the results are jarring considering how the federal government and providers have made concentrated efforts in recent years to curb sepsis. But patient safety experts claim that the rise likely stems from changes in clinical practice over the last 15 years to diagnosis more patients with infections as septic sooner so they can treat the infection quickly before it develops into severe sepsis and becomes life-threatening. (Castellucci, 9/7)

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Perspectives: On Obamacare, Is Trump ‘Throwing In The Towel’ Or Using ‘Bureaucratic Sabotage’?

Editorial writers take on a variety of health policy issues, ranging from what’s next for the Affordable Care Act, to whether bipartisan reforms are possible and even who is really to blame.

The Washington Post: Are Trump And Republicans Finally Throwing In The Towel On Obamacare?
The single biggest win that President Trump has scored for his economically struggling supporters thus far is his failure to repeal Obamacare. This fact is sitting right at the center of one of the biggest and most-discussed stories in Washington right now — the possibility that Trump may be in the midst of rethinking his approach, and pivoting toward a more sustained effort to make bipartisan deals with Democrats — yet the centrality of it is largely passing unnoticed. (Greg Sargent, 9/8)

USA Today: Trump Shows GOP How It’s Done: Scrap Absolutism, Deal With Reality
Turns out as well that repealing the Affordable Care Act, aka Obamacare, is not popular either — especially when the Congressional Budget Office has found that every variation on a replacement would cost people more, take away consumer protections, and insure far fewer — up to 24 million fewer in one case. Those protesting repeal at town meetings included conservatives and Trump voters as well as liberal Democrats. Those seeking a bipartisan compromise to stabilize markets and improve the law include more than a few Republican senators and governors. Those trying to get Congress to abandon repeal and move on include … Trump. At least as of Friday. (Jill Lawrence, 9/10)

The Washington Post: Obamacare Doesn’t Deserve A Bailout
Those who cheered for Senate Republicans to fail have been celebrating ever since, and we’re now hearing calls for bipartisan solutions. While most reasonable people would welcome a bipartisan outcome to this mess, the solutions proffered thus far would do little more than shore up the bad policies already in place with another slate of bad policies. We need legitimate, long-term reforms. (Sen. Orrin Hatch, 9/8)

Sacramento Bee: Is Bipartisan Health Reform Possible?
As a doctor, I know many Americans are concerned about the future of health care. Nobody should have to worry that an unexpected medical bill could threaten their family’s financial security. … As Congress returns from summer recess, we have a clear decision to make: Can we work together to fix health care? … But in order for Congress to make improvements, both sides need to honestly discuss the law’s shortcomings. (Rep. Ami Bera, 9/8)

St. Louis Post-Dispatch: Trump Administration Tries Bureaucratic Sabotage To Kill Obamacare
While attention was focused last week on President Donald Trump’s move to end the Deferred Action for Childhood Arrivals program, his administration was moving to sabotage another, much-larger Obama-era achievement: the Affordable Care Act. The Department of Health and Human Services is cutting the budget for outreach programs intended to help Americans sign up for health insurance coverage in 2018. In addition, HHS has cut the sign-up period that begins Nov. 1 from 90 to 45 days. (9/10)

The Washington Post: The ‘Progressives’ Are To Blame, Too, For Mismanaging Our Government
As I have written countless times, the semi-automatic expansion of programs for the elderly (mainly Social Security, Medicare and long-term care under Medicaid) is slowly crowding out many other government programs, from defense to the Centers for Disease Control and Prevention. The paradoxical result is that government spending will grow larger even while it grows less effective. The conventional wisdom in Washington is that the Republicans are responsible for this mess. Their fixation with sizable tax cuts leaves government perpetually dependent on massive borrowing. There is much truth to this. … The other half is the refusal of Democrats — “liberals” and “progressives” — to cut almost any Social Security and Medicare benefits. They’re essentially off-limits, even though life expectancy has increased and many elderly are well-off. (Robert J. Samuelson, 9/10)

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