Medicare: Other Issues

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From Families USA:

Putting the Accountability in Accountable Care Organizations: Payment and Quality Measurements examines some of the challenges that advocates will face when working with policy makers, insurers, and providers to develop mechanisms that ensure that beneficiaries receive high-quality care at a lower cost. | Determining Shared Savings or Losses (January 2012)

Making the Most of Accountable Care Organizations (ACOs): What Advocates Need to Know provides an overview of ACOs; the promise they hold; and how they could change Medicare, Medicaid, and the health care landscape. It also identifies key challenges in their development and suggests how advocates can get involved in ways that benefit patients. (September 2011)

Better Safety and Quality for Seniors and People with Disabilities discusses the Elder Justice Act, the Patient Safety and Abuse Prevention Act, and the Nursing Home Transparency and Improvement Act, three sections in the Affordable Care Act that will bring historic improvements to the quality and safety of long-term care and result in the most comprehensive federal effort ever to fight elder abuse. (October 2010)

Families USA is part of the Seniors to Seniors coalition–a group that is committed to educating seniors about health reform legislation. Visit their Web site to learn more about how health reform will help people with Medicare. The site includes several short downloadable and linkable videos on topics that are important to seniors.

Medicare's Phony Problem: The 45 Percent Threshold examines the fundamental flaws inherent in the 45 percent threshold and discusses why correcting this nonexistent problem could do serious harm to beneficiaries and to Medicare itself. (March 2007)

Statement: Recent Congressional Actions Hasten Medicare Program's Insolvency (March 23, 2005)

Private Plans: A Bad Choice for Medicare (June 2003)

Bush Budget Would Speed Medicare Insolvency by 15 Years. Half-Trillion-Dollar Diversion From Medicare Trust Fund Would Hasten Bankruptcy from 2025 to 2010. [Press Release]

Breaux-First Medicare Proposal's "A Riverboat Gamble". Statement by Ron Pollack, Executive Director, Families USA. (February 15, 2001)

President's "Helping Hand" Isn't. Families USA analysis shows administration's prescription drug proposal won't reach many of the people it is intended to help. (January 29, 2001)

Letter from Families USA to the chief Democratic sponsor of the new prescription drug legislation introduced in the Senate.

Cost Overdose: Growth in Drug Spending for The Elderly 1992-2010: this report provides an in-depth analysis of the plight of Medicare beneficiaries who must contend with rising prescription drug prices. [Press Release] (July, 2000)

Managed Care Plans Offer No Real Choice for Rural Medicare Beneficiaries (May, 2003)

Still Rising: Drug Price Increases for Seniors, 1999-2000 examines the increasing costs of the 50 drugs that are most commonly prescribed for senior citizens. [Press Release with Key Findings] (April, 2000) 

Update on Patients' Rights and Medicare: Families USA updates the status of Patient's Rights legislation currently pending in Congress and outlines the issue of prescription drug benefits for seniors. (March, 2000)

Medicare Solvency Report Must Not Prompt Raid on Trust Fund. Families USA calls on administration to make clear Trust Fund will not help pay for tax cut.

The Crushing Cost of Medicare Supplemental Policies is a report that documents the skyrocketing costs of insurance premiums between 1995 and 1996, and how out-of-pocket health spending hurts our nation's elderly.[Press Release] (October, 1996)

Strengthening Medicare: The Critical Next Steps by Ron Pollack, Executive Director of Families USA. (1996)

From AARP:

The Status of the Medicare Part A and Part B Trust Funds: The Trustees' Year 2000 Report summarizes and graphically illustrates projections of the Funds' short- and long-term financial health, and describes the Trustees' recommended actions to address long-term financial problems. (April 2000)

Out-of-Pocket Health Spending by Medicare Beneficiaries Age 65 and Older: 1999 Projections This "In Brief" summarizes key findings from a recent AARP Public Policy Institute study that projects out-of-pocket health care spending by Medicare beneficiaries age 65 and older in 1999. (December 1999)

A Profile of Uninsured Persons Age 62-64 (April 1998)

From the AARP Public Policy Institute:

What Share of Beneficiaries' Total Health Care Costs Does Medicare Pay? projects total personal health care expenditures in 2000 for the Medicare population in the aggregate. This Data Digest identifies the sources of payment for these expenditures and examines how sources for elderly beneficiaries differ from those for younger beneficiaries with disabilities. (September 2002)

From the Alliance for Health Reform:

Covering Health Issues Campaign 2000 and Beyond is a source book for Journalists that will also prove useful to Advocates The chapter on Medicare covers issues such as Origins, Intents and Scope, and Gaps in Coverage. (March 2000)

From the Commonwealth Fund

Health Insurance and Health Care Access before and after SSDI Entry sheds new light on the experiences of people with disabilities and raises the question of why many people who are eligible for Medicare are denied coverage when they are perhaps most in need of it. While the cost of eliminating the waiting period seems high, it represents only a small percentage increase in Medicare spending, and it could help states reduce their spending on public coverage programs. (May 2009)

In the United States, nearly 7 million people under the age of 65 qualify for Medicare due to severe and permanent disabilities. However, these individuals must wait two years after they are deemed eligible for Social Security Disability Insurance (SSDI) to receive this coverage. Too Sick to Work, Too Soon for Medicare: The Human Cost of the Two-Year Medicare Waiting Period for Americans with Disabilities examines the detrimental effects of this waiting period through the stories of 21 individuals. (April 2007)

Medicare, now in its 40th year, has achieved its two basic goals—protecting elderly and disabled Americans from burdensome medical bills and ensuring that they get needed health care. Medicare at Forty looks back at Medicare's successes, describes its challenges as health care costs rise and waves of baby boomers face retirement, and suggests policy options to ensure the health and financial security for all Americans. (Winter 2005-2006)

Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults explores the effect that gaining Medicare coverage has on insured and uninsured adults. The study found that gaining access to Medicare coverage substantially improves use of appropriate preventive health services such as cancer and cholesterol screening among previously uninsured older adults, and it reduces the difference in use of preventive health care between those who are and are not covered under Medicare by at least half. (August 2003)

Medicare Beneficiaries: A Population at Risk discusses findings from the Kaiser/Commonwealth Fund 1997 Survey of  Medicare Beneficiaries. (December 1998)

Shaping the Future of Medicare: invited testimony based on this report was given before the National Bipartisan Commission on the Future of Medicare, hearing on "Medicare and the Baby Boomers." (April 1998)

From the Commonwealth Fund and the Christopher Reeve Paralysis Foundation:

Nearly 6 million Medicare beneficiaries qualify because they have severe and permanent disabilities, but unlike older Americans, who typically enroll and become eligible for coverage within months of turning 65, beneficiaries with disabilities must wait two years before their coverage takes effect. Many beneficiaries face enormous problems during this period. The authors of Waiting for Medicare: Experiences of Uninsured People with Disabilities in the Two-Year Waiting Period for Medicare talked to these individuals in focus groups and in-depth telephone interviews. (October 2004)

From the Congressional Budget Office:

Letter from the Congressional Budget Office (CBO) to Senator Don Nickles (R-OK) regarding whether disease management programs can reduce the overall cost of health care and how such programs might apply to Medicare. According to the results of the CBO analysis, there is insufficient evidence to conclude that disease management programs can generally reduce overall health care spending. (October 13, 2004)

From The Federal Government:

www.medicare.gov is government's official site for information on the Medicare program.

From the Georgetown University Long-Term Care Financing Project:

The 21st Century Challenge: Providing and Paying for Long-Term Care is the title of the first conference in a series of events designed to establish a debate about the financing of long-term care. The conference included insights from caregivers, policymakers, and researchers about the challenges of providing and paying for long-term care. Kaisernetwork.org has provided a webcast and transcripts of speeches made at the conference. (May 2003)

From the Government Accountability Office:

The Medicare appeals process has been the subject of widespread concern in recent years because of the time it takes to resolve appeals of denied claims. Two federal agencies play a role in deciding appeals—HHS and the Social Security Administration (SSA). The new Medicare law mandates that SSA transfer its responsibility for adjudicating Medicare appeals to HHS. Medicare: Incomplete Plan to Transfer Appeals Workload from SSA to HHS Threatens Service Appellants evaluates this transfer plan. (October 2004)

From Health Affairs:

Putting Limits on ‘Medigap’ explains how Medigap works and explores the arguments for and against changing its coverage options. Some have proposed that people with comprehensive Medigap plans should pay more for Medicare Part B premiums, while others recommend putting limits on what Medigap covers. (September 2011)

Medicare Doesn’t Work As Well for Younger, Disabled Beneficiaries As It Does for Older Enrollees found that nonelderly (under age 65) beneficiaries experience more problems with cost and access, including greater difficulty affording medications. The Affordable Care Act includes reforms that could remedy the problem by improving access to care and limiting out-of-pocket costs for this group. (August 2010) Subscription Required

Medicare Governance and Provider Payment Policy examines the decision-making processes governing Medicare and how they tend to become overly politicized by both Congress and the White House. The report makes several recommendations for protecting Medicare payment decisions from political interference, including establishing a new, independent Medicare policy board. (September 2009)

How Much “Skin in the Game” Do Medicare Beneficiaries Have? The Increasing Financial Burden of Health Care Spending examines the financial burden among beneficiaries between 1997 and 2003. Results suggest that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries. (November 2007)

Medicare versus Private Insurance: Rhetoric and Reality compares the Medicare program to private insurance and finds that private insurance often suffers by comparison. For example, this 2001 survey demonstrates that Medicare beneficiaries report greater satisfaction with insurance coverage and with their access to care, and they report fewer instances of financial hardship resulting from medical bills.
(October 2002)

"The Not-So-Sad History of Medicare Cost Containment As Told in One Chart: Solutions for Risings Costs Do Exist, and They Work" points to the relatively slow growth rate of federal Medicare expenditures-compared to private health spending per capita-as evidence that government regulations can and have worked in some instances. The author also asks whether cost control via government regulation is synonymous with rationing and shows that cost control can be painful or painless. (January 2002)

From The Journal of Women, Politics and Policy:

Health Coverage and Expenses: Impact on Older Women’s Economic Well-Being explores gender-based differences in health and long-term care use, spending patterns, and the financial burden of out-of-pocket expenses among Medicare beneficiaries. The study reveals that women’s health care expenses were higher than men’s, and older women had an even greater overall financial burden with less income at their disposal. It concludes that controlling health spending and developing options to help finance long-term care for Medicare enrollees are key to improving the economic security of older women. (August 2009)

From The Kaiser Commission on Medicaid and the Uninsured:

Selected changes to current Medicare policies and practices could help ensure further access to health care and contribute financial security for the nearly 200,000 Medicare beneficiaries displaced by Hurricane Katrina. Displaced by Hurricane Katrina: Issues and Options for Medicare Beneficiaries identifies issues and challenges for individuals on Medicare who were affected by Hurricane Katrina and offers options to address the problems they have encountered. The brief also identifies areas to be considered in future disaster planning efforts. (November 2005)

Medicare At A Glance: What is Medicare and How is it Financed? (July 1998)

From KaiserEDU.org

The National Academy of Social Insurance (NASI) recently hosted the Medicare Academy for interns and students of public policy. The presentations are available through webcasts and include discussions of current policy issues in Medicare, the financial future of the program, and the new prescription drug benefit. (July 2006)

From The Kaiser Family Foundation:

Medigap Reform: Setting the Context provides national and state-level data on Medigap enrollment and premiums. Categories of data include the percentage of Medicare beneficiaries with a Medigap policy, the percentage of enrollees in plans with first dollar coverage, and the costs of monthly premiums. (September 2011)

Policy Workshop to Examine Implications of Medicare’s Funding Warning examines the controversial policy created by the Medicare Modernization Act of 2003, which states that Medicare trustees must issue a funding warning when they project that general revenues exceed 45 percent of total Medicare spending. This workshop was held to discuss the implementation of the warning, what it means, and how it works. (March 2008)

Financing Medicare: An Issue Brief assesses Medicare’s predicted expenditures for upcoming decades and the fiscal challenges associated with the program’s growth. The brief also discusses the revisions that may be made to policies if spending trends remain the same, such as an eventual increase in the payroll tax or a cut in spending for services such as physician visits. (January 2008)

The Burden of Out-of-Pocket Health Spending among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003 compares the ratio of out-of-pocket health care spending to income among people under age 65 to the ratio for people age 65 and older over the period from 1998-2003. It finds that those over 65 spend far more on health care and have substantially lower incomes than do adults under 65. (September 2007)

The Medicare Prescription Drug Improvement and Modernization Act Implementation Timeline presents important dates and deadlines for key implementation activities related to the new Medicare prescription drug benefit. (March 2005)

Medicare and Medicaid provide health coverage and long-term care services to roughly one-third of the 53 million people with cognitive, developmental, physical, and mental disabilities. Navigating Medicare and Medicaid, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates explains the critical role the two programs play in the lives of people with disabilities. The guide is intended to be understandable to people who are completely unfamiliar with Medicare and/or Medicaid. (February 2005)

The program rules for Medicare and Medicaid with regard to work are complex. Recently, Congress has enacted additional legislation to remove more of the disincentives to working and to continuing to receive health care coverage through these two programs. Keeping Medicare and Medicaid When You Work, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates explains many of the complex issues and policies that can be used to help people with disabilities keep their health coverage and seek employment. (February 2005)

The Medicare Health Plan Tracker is an interactive tool that provides basic information about Medicare Advantage (Medicare HMO and other private) plans. Data include plan participation and beneficiary enrollment at the national, state, and county levels, as well as payment rates for 2005 and previous years. (January 2005)

Talking with Your Parents about Medicare and Health Coverage, a consumer guide updated for 2003, helps seniors and their adult children sort through the basic facts about Medicare and the choices seniors make related to health coverage and paying for care. This guide answers questions on a range of issues, including Medicare coverage, supplemental insurance, Medicare managed care, and ways of paying for prescription drugs. It also includes state-by-state resources that can be used to obtain more specific help with questions. (March 2003)

The Current State of Retiree Health Benefits: Findings from the Kaiser/Hewitt 2002 Retiree Health Survey presents findings from a study of large private-sector employers conducted between July and September of 2002. Information was collected on a variety of topics, including costs, premiums, retiree contributions, benefit design, prescription drug benefits, recent changes, changes expected within the next three years, and the implications of a Medicare drug benefit for employers. (December 2002)

Talking With Your Parents About Medicare and Health Coverage, a recently updated guide from the Kaiser Family Foundation, provides adult children with the basic facts about Medicare, managed care options, supplemental health insurance, and long term care in order to better equip them to discuss these subjects. It also includes a state-by-state list of key agencies that can answer specific questions on these topics. It's a good piece for advocates that explains the programs in clear language-a useful primer for new staff. (August 2001)

The Kaiser Family Foundation has released the 2001 edition of its Medicare Chart Book, which provides data on a range of topics pertaining to the Medicare program and the people it serves. The Chart Book includes information on financing Medicare, Medicare beneficiaries, Medicare spending, Medicare and prescription drugs, the Medicare+Choice program, and supplemental insurance. It also includes the Medicare fact sheets that Kaiser published in 2001. (Fall 2001)

Americans Know Medicare Faces Problems, But Not Ready to Make Hard Choices: a national survey on Medicare reveals Americans' knowledge and opinions about the proposed options for Medicare reform. (October 1998)

From the Kaiser Family Foundation and the Commonwealth Fund:

Medicare's Disabled Beneficiaries: The Forgotten Population in the Debate over Drug Benefits was conducted to provide policymakers with better information on disabled beneficiaries' need for prescription drug coverage. The report concludes that Medicare beneficiaries with disabilities have few coverage options for prescription drugs besides Medicaid. (September 2002)

From the Kaiser Family Foundation and Health Affairs:

Outlook for Health Spending, the first report resulting from a continuing Health Affairs and Kaiser Family Foundation partnership,  has leading health policy experts examining new projections of future health care spending, including implications of the new Medicare prescription drug benefit. This partnership will publish a series of Web exclusives to speed dissemination of critical health care data. Web casts and related links are part of the package. (February 2004)

From Mathematica Policy Research, Inc.:

New Medicaid Drug Use and Cost Data Highlight Issues for States after Medicare Part D examines a number of Medicaid prescription drug issues that states still need to address after the movement of dual eligibles into Medicare Part D. (June 2007)

Prescription Drug Use and Expenditures among Dually Eligible Beneficiaries in particular examines three important subgroups: the elderly, people with disabilities, and full-year nursing home residents. The analyses indicate great variation in use and expenditures across states that cannot be explained by differences in use of cost-containment strategies. (Summer 2007)

The Medicare Coordinated Care Demonstration (MCCD) aims to improve health outcomes and reduce Medicare costs for chronically ill beneficiaries by encouraging adherence to self-care and medication regimens and improving communication among physicians. Coordinating Care for Medicare Fee-for-Service Beneficiaries: An Early Look evaluates the first three years of the program and concludes that it may be difficult to change beneficiaries' adherence to such regimens. (December 2005)

From Mathematica and AARP:

The Medicare Prescription Drug, Improvement and Modernization Act, enacted in December 2003, made several significant changes in the Medicare Advantage (MA) program that were expected to have a long-lasting impact on Medicare spending. Early Effects of the Medicare Modernization Act: Benefits, Cost Sharing, and Premiums of Medicare Advantage Plans, 2005 examines the early effects of changes in the MA program. (April 2005)

From Mathematica Policy Research:

Medicare Spending on the Chronically Ill: The Alliance for Health Reform has published an issue brief examining the extent and cost of care for the chronically ill in the American health system. The brief lists the most common chronic conditions, examines how the healthcare costs for such conditions are paid for, and discusses the need for reforming the way the medical system is structured to be more responsive to those living with chronic conditions. (June 2001)

From The Medicare Rights Center:

Nearly 8.3 million of the 43 million Americans with Medicare receive their medical care through private insurance companies, also called Medicare Advantage (MA) plans. Too Good to Be True: The Fine Print in Medicare Private Health Plan Benefits examines the effectiveness of these plans and concludes that private plans often fail to deliver coverage that a patient could obtain from original Medicare. (April 2007)

The Medicare Options Comparison Chart is a valuable tool that allows consumers to sort through their Medicare options.

From the National Council of Jewish Women

Facing the Crisis in Women’s Health Care addresses the special challenges that many American women face in affording and obtaining comprehensive health care. The article discusses women’s health needs and barriers to care, the growing number of uninsured, and the emerging issues for women in Medicaid and Medicare. (Summer 2006)

From The National Senior Citizens Law Center:

Medicaid Division of Assets and Income Rules for Long-Term Care -- Spousal Impoverishment (April 1999)

Medicaid Buy-In Programs for Low-Income Medicare Beneficiaries: Some low-income Medicare beneficiaries are entitled to have their Medicare premiums paid for by the Medicaid program. This report gives details. (April 1999)

From the Robert Wood Johnson Foundation:

Disparities in Health and Health Care among Medicare Beneficiaries highlights the importance of understanding health care within local context, and of efforts to explore and address the underlying causes of disparities within and across regions. The study’s major findings include: the rate of leg amputation is four times greater for blacks than for whites; and, for evidence-based services such as screening mammography and testing for diabetes, disparities across states and regions are substantially greater than the differences by race. (June 2008)

From The Urban Institute:

Restructuring Medicare: Impacts on Beneficiaries (January 1999)

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