NPN benefitsBlog

President Loses On His Veto of Medicare Bill

On July 15, 2008, President Bush vetoed H.R. 6331, the “Medicare Improvements for Patients and Providers Act of 2008". On that same day, the US House of Representatives and the Senate voted to override the President Bush veto of the bill. The House vote was 383–41 and the Senate vote was 70–26. H.R. 6331 became P.L. 110-275.

US Postal Service Tries to Slide One By the Medicare Drug Program

On Monday, the Centers for Medicare and Medicaid Service(CMS) denied a request by the US Postal Service to particpate in the Medicare drug subsidy program under the Medicare Modernization Act of 2003. Postal officials had estimated that it would have been worth some $250 million annually to the agency. However, the Bush Administration declined to allow the Postal Service to participate in the Medicare Part D subsidy program because its retirement programs are funded through Federal Employees Health Benefits Program (FEHBP). The Office of Personnel Management (OPM) which administers the federal employee program had already opted out of the subsidy back in October. OPM officials saw no reason for federal agencies to participate in the Medicare subsidy program so the federal government could basically pay itself to continue providing drug coverage that they had planned to continue and was not about to or could not change. On the face it appears dishonest, at best, for any federal agency to consider accepting Medicare subsidy payments.

Interestingly, the Postal Service spent over $6.5 Billion last year for health care for its employees and some 330,000 Medicare eligible retirees/ survivors through Federal Employees Health Benefits Program (FEHBP). The agency says its health benefit cost for postal service retirees and has doubled since 2000.

In November, pushed by the National Active and Retired Federal Employees Association (NARFEA) and a number of conservative members of Congress, Postal officials applied to CMS to be a Part D provider under the Medicare Modernization Act of 2003. The Postal Service could have then received a subsidy payment equal to 28 percent of their drug costs to encourage them to continue to provide drug coverage. This of course would reduce postal employees and retirees insurance premiums. The Postal Services weakly argued the subsidy would “save postal rate payers [customers] $250 million per year” and noted that they were entiltled to such a savings. Postal authorities were not to clear how getting taxpayers to pay for an unneeded subsidy with already tight Medicare dollars was worth reducing the cost of postage stamps. The post office also has already scheduled a postal rate increase and unlike other federal agencies can use its revenue ( from postal services) to purchase health care and drugs. It just didn’t pass the smell test.

It looks like the Bush Administration made a good call here. One wonders what was really going on with 59 members of Congress looking to run $250 million of the postal expenses through the already underfunded Medicare program. This move does free up $250 million though for Medicare drug support for aged and disabled Americans instead of helping the Postal Service meet its mismanaged budget. To paraphrase the late, great Senator Everett Dirksen of Illinois: “A [quarter] of billion here and a [quarter] of a billion dollars there and pretty soon you’re talking about real money”.

© Daniel Scarborough, 2005

Part B Medicare Premiums Up Again Next Year

Part B Medicare premiums for 2006 are set to increase over 10% according to press reports over the weekend. The increase of $10.30 will raise the Part B monthly premium to $88.50. These costs have increased dramatically over the last few years for aged and disabled beneficiaries. Last year, the Part B premiums shot up 17.4% and in 2004 the premium zoomed 13.5%. Over the last 3 years the Medicare increases have totaled some 41.20%. Cost-of-living increases have not kept up with these huge premium changes.

Bush Waffles Again on Medicare Drug Program and Food Stamps

Each time I look at President Bush's so called Medicare prescription drug coverage benefit, I am amazed at the myriad of negative effects the program will have when it starts next January on many aged and disabled Americans who want and need access to prescription drugs. The other day I saw a bumper sticker that said "Medicare Don't Care", which pretty much says it all.

As I have continued to report here, many see the program as to bureaucratic and denial-oriented to mess with. Now this past weekend, we learn that a document prepared by Health and Human Serves was making its way around Capitol Hill last week that suggests a new interpretation of the law that could eliminate food stamp eligibility for program participants. The food stamp program is administered by state agencies, whose costs are shared jointly with the federal government.

The fact sheet was provided to congressional offices supposedly to help Congress answer constituent questions on the very disorganized program. The guide noted to Medicare beneficiaries: "If you qualify for extra help [drug assistance], your food stamp benefits may decline."

it was surprising to many that the Bush Administration included an interpretation of the Medicare program limiting food stamps. This new interpretation appears to be an about face for Bush. Didn't we had this debate in 2003 and it was't all this supposed to be settled. The USDA even issued rules that said the food stamp program would not be touched.

Food Stamp rules allow people who are aged or disabled to exclude medical expenses of more than $35 from their income when food stamp benefits are figured. Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, defended the new read on the law in comments to the Times. He says "Medicare beneficiaries will get comprehensive help with their drug costs and will have significantly more resources for all their other basic necessities, including food. The savings on prescription drugs will more than offset any loss of food stamps, so "low income seniors will be better off."

Better off? Aren't we back where we started: trading food for drugs?

Medicare Drug Benefit: Is It Worth the Hassle?

Congress passed the Medicare Reform legislation last year with much fanfare to help low income people with disabilities and people who are aging with up to $600 prescription drugs. The free drug offer expires today and 75% of the people who are eligibile have not applied. Critics charge that the program is simply to difficult to access. Basically it just slipped by most aged and disabled people.

Meanwhile, The New York Times, indicates the government has sent some 20 million applications for the new Medicare drug prescription financial assistance program. The drug coverage becomes available to people on Medicare in January, 2006.

The new benefit provides a 75% subsidy of about $1,250 a year for a drug benefit, and some $2,300 a year in extra financial assistance. It is a substantial benefit !!

The real problem is that only about 5% of the 14 million people are eligible are expected to participate in this program. The GAO found in a study last year that only about 1% of eligible people bother to apply for these kinds of programs. Indications are that the complicated 7-page process for applying is just too difficult for many people to negotiate. Dr. Mark B. McClellan, Administrator of the Centers for Medicare and Medicaid Services, said he believed that the application was "simpler than that used for any other means-tested program."

One thing that may keep people away from completeing and aubmitting it is the warning on the application:

You can be punished for perjury if they knowingly submit incorrect information. In signing the form, a person declares, "I understand that anyone who knowingly gives a false or misleading statement about a material fact in this information, or causes someone else to do so, commits a crime and may be sent to prison or may face other penalties.

People I've spoken to say it may to much of a hassle to apply. I'm having some difficulty understanding the whole thing myself and I do this kind of advocacy for a living. One wonders if this complication is by design.

Medicare To Cover Expensive Heart Devices

Medicare is about to expand its coverage. No it's not another empty political ploy. It's about heart implant devices. The New York Times reports that the federal government has learned it can dramatically increase the survival rate for people on the Medicare programs by providing coverage for implantable cardioverter-defibrillators (ICDs) for people with heart disease.

The New England Journal of Medicine has published an article by Dr. Mark McClellan ( head of the federal Centers for Medicare and Medicaid) that says that the Medicare eligible persons who are eligible for ICDs may double or triple.

The decision to cover these could be expensive since Medicare already pays about $30,000 to have the a device implanted, but the devices can reduce heart failure by 23%.

New Medicare Drug Benefit Guidelines Lacking

The "new" (issued on Dec 31) U. S. Pharmacopeial Convention's final Medicare drug benefit guidelines still omit many vital therapies, physician organizations complain. The American Medical News says many are worried that the decision not to undertake a major expansion of its drug category listing will cause some drug plans not to cover many important medicines as well. Doctors treating Medicare beneficiaries with osteoporosis, for example, might encounter plans that will not cover key bone disease agents. Doctors worry that patients could needlessly be put at risk.

The U.S. Pharmacopeial Convention does not suggest actual drugs but health care providers that use the USP Model Guidelines (a list of categories and classes that prescription drug plans may use as they design their formularies) have an easier time getting their plans approved by the Centers for Medicare & Medicaid Services. USP might as well suggest the drugs though.

Commenting in the American Medical News, Douglas E. Henley, MD, executive vice president of the American Academy of Family Physicians says "In the Medicare program, there's a need for a rational, national standardization, whether it's for the prescription drug benefit, CPT coding, reimbursement policy or whatever, Allowing plans to have great flexibility on covering some of these important medications would be a cause for concern, and we would hope that CMS would ... give more national guidance to the various plans so that there's a greater degree of standardization."

The new MEDICARE PRESCRIPTION DRUG BENEFIT MODEL GUIDELINES can be found for your review at USP's website.

Medicare Adds New Prevention Programs

Collaborating with the American Heart Association, the American Cancer Society and the American Diabetes Association, Medicare will begin cardiovascular screening and tests to check for diabetes. The new programs will also include a physical examination is only for people who enroll in Medicare on or after 1/1/05

"Treating disease is one thing, but preventing it is even better,"Health and Human Services Secretary Tommy Thompson explained at a news conference yesterday about the new program that started on Jan 1.

Q&A: Medicare Premiums for 2005?

Q. What are the Medicare premiums and coinsurance rates for 2005?

A. A listing of the Medicare premium, deductible, and coinsurance rates that will be in effect next year can be found at The Official U.S. Government Site for People with Medicare

What's Going On?

Less than 30 % of eligible persons. who are disabled or aged are enrolled in Medicare Savings Programs, which can help pay for their Medicare premiums, deductibles and coinsurance A Detailed Description of CBO’s Cost Estimate for the Medicare Prescription Drug Benefit,Congressional Budget Office, July 2004).