Long Term Health Care/Custodial care

As a follow up to my blog of November 15th, I would like to discuss custodial and long term care. As I had mentioned earlier the cost of providing basic care to meet the daily needs for yourself or a loved one can be quite exorbitant. Unless you have an involved family that is able and willing to provide care, or have enough financial resources available the cost of providing care for yourself or a loved one is very difficult indeed. This custodial care could include assistance at home with activities of daily living, bathing, dressing, meal preparation, housekeeping, laundry or shopping or attention to these same basic needs in a nursing home or assisted living facility.

This is particularly difficult because when you are disabled or older and income is limited the greatest need is for long term custodial care. Most long term care is provided by families but few families today can sustain the financial and emotional burden of long term care and contrary to popular belief Medicare does not cover all medical costs and only covers about 2% of long term care.

To determine the average cost for Medicare please check the Medicare Rights Center
http://www.medicarerights.org/newmedicarecosts.html


To be eligible for limited nursing home coverage from Medicare certain criteria must be met:

• You must be in an acute care hospital for 3 days prior to entering a Skilled Nursing Facility. An acute care hospital is licensed by the state to provide skilled care.
• The Skilled Nursing Facility must be Medicare certified to provide care by or under the supervision of licensed personnel.
• Your care under Medicare must be skilled care not custodial. Most nursing home care is custodial not requiring licensed personnel for skilled treatment such as intravenous infusion or skilled rehabilitation.
  
  As indicated in my earlier blog the average yearly nursing home cost exceeds $77,000. The cost at average of $19 per hour for home health aide services added onto costs for medication, deductibles, medical supplies or equipment as well as costs to maintain a household can quickly deplete savings when living on a fixed income.

Medicaid, a national program for individuals and families with low incomes and resources is another alternative to paying for long term care. Medicaid is jointly funded by the states and federal government, and is managed by the states. Medicaid is the largest source of funding for medical and health-related services for people with limited income. While Congress and the Centers for Medicare and Medicaid Services set out the main rules under which Medicaid operates, each state runs its own program. As a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.

Over 42 million people a year receive assistance from Medicaid but Medicaid guidelines are based on the poverty levels and to qualify for Medicaid, you must meet income and asset limits set by your state. In most states, income must be below $851 a month (individuals) or $1,141 a month (couples). In some states, you can also qualify if health care costs reduce your income to the state limit. Call your State Health Insurance Assistance Program to find out the Medicaid rules for your state and to check eligibility.

Most people when they reach their 50s should consider adding a long-term care policy to their insurance coverage. Long term care insurance can be costly but can provide you with a payout to cover nursing home costs as well as a variety of in-home health care expenses.

It is however difficult to consider paying these high rates at 50 for insurance you may or may not need for another 25 or 30 years. However if purchased later you will face much higher premiums, as well as run the risk of being denied coverage if you have a pre-existing condition. We all look forward to our retirement and believe we will be able to continue to be healthy and independent well into our later lives. People don’t want to think of getting old and disabled. We buy car insurance on the chance of an accident when only one in 240 will use their car insurance, yet at least one in three will use their long term care insurance.

Many things need to be considered when buying long term insurance:

• Cover the catastrophic need. Lifetime coverage is most desirable, since you will not outlive the benefits.
• Know which policy benefits are important to you.
• Pick a long term care company that is financially strong enough and large enough to be around in 20 or 30 years when you need it.
• Consider Cost of Living Adjustment (COLA) Rider to allow your benefits to keep pace with inflation.
• Pick a premium you can afford and purchase a Long Term Care Insurance plan based on your budget. Remember 50% coverage is better than no coverage. It's important to select a policy where you will be comfortable paying the premium not just today but 20 or 30 years from today.
  
  Long-term care insurance is meant to merely supplement your other income sources such as 401k’s, Social Security and retirement accounts.
  
  For more information check AARP report on long term care.
  
  http://www.aarp.org/research/longtermcare/costs/fs27r_ltc.html
  
  
  

Good Health Habits to Prevent colds and flu

The best way to prevent seasonal flu and pneumonia is to get vaccinated each year.

There also are flu antiviral drugs that can be used to treat and prevent the flu but good health habits like covering your mouth when you cough and washing your hands often can help prevent respiratory illnesses like the flu and colds.

Many people equate the cold winter weather with colds and flu and feel that being cold and wet from the chill of winter is what makes people catch colds and flu. This myth must be true because everyone gets sick in the winter, right? No.

Although the cold wet weather of winter is very uncomfortable and the stress of getting around in the snow and ice may reduce our immunity or resistance, it is not the weather that causes our colds and flu. It is germs, bacteria and viruses that cause our misery. As the weather gets colder we spend more time indoors, children return to school and with vacations over more people are huddled closer together as activities move indoors.

This proximity to one another leaves us vulnerable to passing and sharing infections with each other. As the children play at school they pass around germs which they bring home to the family. Cramped buses and trains leave us no where to escape as a sick passenger unwittingly passes germs with each sneeze or cough. At work we cover our mouth when we cough or sneeze but each time we answer the phone, touch the employee coffee pot, our keyboard or the handle to the rest room we share our germs with our coworkers.


Serious respiratory illnesses like influenza, respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by coughing or sneezing.

According to the Center for Disease Control, between 10% and 20% of people in the United States become ill with the flu each year. Infants, the elderly and those with immune system conditions are usually at risk but these organisms can have an impact on seemingly healthy folks. About 3 to 6 million people are affected each year.

The World Health Organization estimates that cost of influenza to the U.S. economy in terms of health care costs and lost productivity can range from $71 billion to $167 billion a year.

Below are some basic good health habits to help keep you and your family healthier this holiday season. These are simple things we each can do daily to protect our selves and others.


• Cover your mouth and nose.

Cover your mouth and nose with a tissue when coughing or sneezing and dispose of the soiled tissues properly. Teach your children to use tissues and be sure they have tissues in their schoolbag. If you have no tissues do the sleeve sneeze. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands..It may prevent those around you from getting sick.

• Clean your hands.

Washing your hands often will help protect you from germs. Wash with soap and water or Clean with alcohol-based hand cleaner.

• Avoid close contact.

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

• Stay home when you are sick.

If possible, stay home from work, school, or activities when you are sick. Just as you try to avoid being near sick people to prevent You will help prevent others from catching your illness.

• Avoid touching your eyes, nose or mouth.

Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Don’t use the phone, computer, or desk supplies of a sick coworker. Advise children not to share drinks or toys with sick friends.

• Practice other good health habits.

Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. All of these actions help maintain your immunity to fight off illness. See your doctor for regular checkups, vaccinations, and appropriate treatment to decrease the duration of symptoms.


For additional information see :

http://www.cdc.gov/flu/

Advance Directives for Health Care

Advance directives are documents signed by a competent person giving direction to health care providers about treatment choices in certain circumstances. As a competent adult, you understand your condition and the results your decision may have. Advance directives allow you to verbalize your wishes while you are in a position to make health care decisions. These advance directives tell your doctor what kind of care you would like to have if you become unable to make medical decisions, such as if you are in a coma. If you have not given any instructions, no one will know what you would have decided.

The Patient Self Determining Act requires many Medicare and Medicaid providers such as hospitals, nursing homes, hospice programs, home health agencies, and Health Maintenance Organizations (HMO’s) to give adult individuals, at the time of inpatient admission or enrollment, certain information about their rights under state laws governing advanced directives.

These include:
· the right to participate in and direct their own health care decisions
· the right to accept or refuse medical or surgical treatment
· the right to prepare an advance directive
· information on the provider’s policies governing the utilization of these rights.

The act also prohibits institutions from discriminating against a patient who does not have an advance directive and requires institutions to document patient information and provide ongoing community education on advance directives.

There are two types of advance directives:

· A durable power of attorney for health care which allows you to name a patient advocate or proxy to act for you and carry out your wishes.

· A living will allows you to state your wishes in writing, but does not name a patient advocate.

A living will is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.


A durable power of attorney (DPA) for health care identifies whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A durable power of attorney for health care is a signed, dated, and witnessed legal document commonly called a “health care proxy”. This document differs from other durable powers of attorney in that it is specifically limited to health care and medically related decisions. It might be necessary to also have a durable power of attorney assigned to handle financial issues as well. A financial DPA can access your accounts to assist in payment of your bills when you lack capacity and are unable to do so.

A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. An example would be a do not resuscitate (DNR) order. Advance Directives can also say that you want a certain treatment no matter how ill you are. An example would be to continue feedings.

Advance directives can take many forms. Laws about advance directives are different in each state. You should be aware of the laws in your state.

Any person 18 years of age or older can prepare an advance directive which allows you to make your preferences about medical care known before you're faced with a serious injury or illness. People who are seriously or terminally ill are more likely to have an advance directive injury or illness to express their wishes and spare their loved ones the stress of making decisions about their care when they are dying. Even if you are in good health an accident or serious illness can occur suddenly and if you already have a signed advance directive, your wishes are more likely to be followed.

Ask your doctor, lawyer or state representative about the law in your state.

Additional information and forms can be obtained from:

AARP Advance Directive Information

601 E Street NW Washington, DC 20049 1

888-OUR-AARP

email: http://www.aarp.org/bulletin/yourhealth/resources_wills.html


U.S. Living Wills Registry

523 Westfield Ave., P.O. Box 2789 Westfield, NJ 07091-2789

1-800-LIV-WILL

email: http://www.uslivingwillregistry.com/


http://www.caringinfo.org/stateaddownload


or call your local health department or state department on aging to get a form.

Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care.

Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. You may also want to have what you have written reviewed by your doctor or a lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders should be notarized if possible, and copies should be given to your family and your doctor.

You may change or cancel your advance directive at any time, as long as you are still able to think rationally and communicate your wishes in a clear manner. Any changes must be made, signed and notarized according to the laws in your state. Make sure that your doctor and any family members who knew about your directives are also aware that you have changed them.

It is a good idea to review your advance directive each year to be sure it still says how you want to be treated and names an advocate you trust.

The Patient's Health Care Bill of Rights

Do you know what to expect from a Health Care Provider or a Health Care Facility?

Do you know your rights as a patient?

In 1997 the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry set up a set of principles that have been adopted by many health care facilities and organizations.

The basics include:

• Respect and Nondiscrimination. You have a right to considerate, respectful and nondiscriminatory care from all health care providers, including your doctors, hospital or medical facility staff or health insurance representatives.

• Information Disclosure. You have the right to know by name all health care providers and to accurate and easily understood information about your health care providers, health care professionals, and health care facilities and health plans. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance must be provided to allow you to make informed health care decisions.

• Choice of Providers and Plans. You have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care. This means you can change doctors or hospitals or health care agencies. You can also change health plans or insurance.

• Access to Emergency Services. If you have severe pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty.

• Participation in Treatment Decisions. You have the right to receive from your physician your diagnosis, prognosis, and treatment options and any information necessary to give informed consent prior to the start of any procedure or treatment. You have the right to be informed of any alternative or experimental protocols. You have the right to refuse to refuse treatment or to refuse participation in research programs, and you have the right to be informed of the medical consequences of these actions including possible dismissal from a study and discharge from a health care facility or physician’s care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.

• Confidentiality of Health Information. You have the right to talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and request that your physician change your record if it is not accurate, relevant, or complete. You have a right to access your medical records and this information must be kept confidential unless disclosure is authorized by you. This is the basis of the Health Insurance Privacy and Portability Act (HIPPA).

• Complaints and Appeals. You have the right to a timely and objective review of any complaint you have against a hospital or health care agency, health care insurer, doctors or other health care personnel. Your individual appeal is usually evaluated by a physician or peer group of health care reviewers that are not affiliated with those involved.
  

Additional information can be found:

President’s Advisory Commission on Consumer Protection and Quality in the Health CareIndustry

http://www.hcqualitycommission.gov/

But as per any right there are also responsibilities. These are the responsibilities suggested by the president’s commission. :

• Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
• Become involved in specific health care decisions.
• Work collaboratively with health care providers in developing and carrying out agreed-upon treatment plans.
• Disclose relevant information and clearly communicate wants and needs.
  Use the health plan's internal complaint and appeal processes to address concerns that may arise.
• Avoid knowingly spreading disease.
• Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
• Be aware of a health care provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
• Become knowledgeable about his or her health plan coverage and health plan options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
• Show respect for other patients and health workers.
• Make a good-faith effort to meet financial obligations.
• Abide by administrative and operational procedures of health plans, health care providers, and Government health benefit programs.
• Report wrongdoing and fraud to appropriate resources or legal authorities
  

Long term Care- The Uncovered cost of health care.

When we consider health care costs, we think of costly procedures or medication. Magnetic Resonance Imaging or MRIs is an example costing $2,000 - $4,000 with doctor’s fees additional. Medications used for anemia such as procrit can run over $6,000 for one course of medication.

What is rarely thought of is the cost of day to day long term care. Most people tend to think they will never need long-term care; however the fact is that more than 60% of Americans are expected to need some form of long-term care at some point in their lives. When they do need long term care, they are not prepared for the financial burden it may cause.

Most Americans believe that their private health insurance or Medicare will cover for all their health care needs. Contrary to this belief, insurance does not cover the greatest need for long term care: custodial care.

When you or a loved one is stricken with a chronic or degenerative condition such as diabetes, cancer, a stroke or Alzheimer's performing simple Activities of Daily Living becomes impossible without the assistance of another person. Chronic illnesses and disabilities require personal care, meal preparation, assistance with bathing and ambulation. This type of care is custodial care not medical care therefore it is usually not covered by health insurance.

Custodial care is a term for care provided to patients on an on-going maintenance basis. Most care at home and the majority of care in nursing homes is considered custodial. Non-medical care that helps an individual with his or her activities of daily living, preparation of special diets and self-administration of medication not requiring constant attention of medical personnel.

MetLife Mature Market Institute reports that the cost of private and semi-private nursing home rooms in the United States increased an average of more than three percent, in 2007.
The average cost of a private room in a nursing home this year was $213 a day ($77,745 a year), compared with $206 a day in 2006. A semi-private room cost $189 a day in 2007, compared to $183 a day last year. This rate generally reflects just room and board in a nursing home with therapies, tests, physician visits and medication charged in addition to the basic rate.

Alaska had the highest nursing home rates ($510 daily or $15,300/monthly) in 2007, while Baton Rouge, La., had the lowest rates ($123 daily or $3690/monthly). I am from New York which averages $ 340 a day or $10,300/ monthly.

Assisted living rates nationwide were $2,969 monthly in 2007 ($35,628 yearly) in 2007. Assisted living rates were highest in the Washington, D.C., area ($5,031 monthly) and lowest in Indianapolis ($1,963 monthly).
Another study by MetLife reported that the national average cost of Home Health Aide Services nationwide was $19/hour and the national average hourly rate for a companion or homemaker is $18/hour. The highest rates being in Rochester Minnesota at $30/hour for Home Health Aide and $25/hour for Companion or homemaker. The lowest rate in Shreveport, Louisiana was $13/hour for Home Health Aide and $12 for a companion or homemaker.

• To find out the cost in your area for Home Health Aide, Assisted Living Facilities and Skilled Nursing Home rates check the following MetLife Studies:

Assisted Living
http://www.metlife.com/WPSAssets/12768452431193759307V1F2007NH.AL.pdf
Home Health Aide
http://www.metlife.com/WPSAssets/56853157701190812646V1F2007ADSHCCStudy.pdf
Skilled Nursing Homes
http://www.metlife.com/WPSAssets/21052872211163445734V1F2006NHHCMarketSurvey.pdf

Medicaid will eventually pay for your long term care expenses; however the benefits only begin after the majority of your assets have been depleted.

In my home state of New York Medicaid does cover custodial care for Home Attendant Services, Housekeepers and Homemakers but Medicaid and most public long-term care (LTC) programs vary from state to state. In most states Medicaid covers custodial care only as long as it is provided within a nursing facility. Custodial care at home is typically covered only under LTC insurance - not by Medicaid in most states.

Medicare, on the other hand, covers only medically necessary, skilled care and will cover at-home custodial care only if it is provided in conjunction with skilled care. This means that as long as there is a need for a registered nurse or therapist to visit intermittently limited Home Health Aide services can be covered by Medicare. Medicare can cover nursing home for up to 100 days a year if there is a skilled need for short term rehabilitation or intravenous antibiotics therapy.

This leaves private pay or long term care insurance as the primary options for care. Even if you are financially independent custodial care can be costly. A Home Health Aide in Rochester Minnesota to cover just custodial care for a loved one or yourself for 24 hours a day would cost $ 720/day or more than a quarter of a million dollars a year. Consider also that almost 60% of the nursing home residents were institutionalized more than a year with the average stay in a nursing home being 2.5 years. In Alaska that length of stay could run almost a half a million dollars.

Long term care options will be discussed in a future article but check out the following sites for information on Long Term Care.

Long Term Care
http://www.investopedia.com/articles/04/112904.asp?partner=answers

http://www.mrltc.com/

Medicare
http://www.medicare.gov/

Medicare Long term care
http://www.medicare.gov/LongTermCare/Static/Home.asp

National Clearing house founded by the US Dept Health and Human Services.
http://www.longtermcare.gov/LTC/Main_Site/index.aspx

War on Health Care

President Bush 2008 Budget has vowed to spend taxpayers’ dollars wisely. He also vowed to make health care fairer, more affordable, more accessible, and flexible.

http://www.whitehouse.gov/infocus/budget/2008/index.html

On October 22, a request was made for a further $45.9 billion in war-related spending for fiscal year 2008. This request is on top of $147 billion already requested for the Department of Defense and $3.6 billion for other agencies for the fiscal year. If appropriated by Congress, the vast majority would be spent on Iraq. Total spending for the Iraq War would rise to approximately $611 billion.

According to testimony by the Congressional Budget Office, if one includes debt service costs in long-term U.S. deployment scenarios, the total cost for U.S. operations in Iraq and Afghanistan will reach between $1.765 trillion and $2.365 trillion by 2017.

The United States accounts for half of all the military spending in the world.
Congress and the White House allocate $522 billion a year to the Defense Budget. The country with the next highest military budget is China with $63 billion dollars per year.


To put it in perspective the proposed spending budget for the Iraq War for the year 2008 is $155.5 Billion but if these tax dollars were put into Health Care could provide 44,330,909 People in the United States with Health Care.

President Bush vetoed the SCHIP Child Health Insurance which could have provided health care for 5 million children. The cost of the Iraq war for the year 2007 is $ 137.6 billion which if spent for children’s health could have covered 58,681,896 children for a year.

To find out the trade off in education, housing, or health care for our defense budget by state or congressional district check out the following site:

http://www.nationalpriorities.org/Trade-Offs.html

Is this the best use of taxpayers’ money, Mr. Bush?
$611 Billion for the Iraq War- YES
Children’s Health Insurance- NO

Children's Health Care -Trick or Treat

On Halloween, President Bush announced that the State Children's Health Insurance Program (SCHIP) reauthorization bill currently pending in the Congress was a "trick." Congress passed bipartisan legislation to expand SCHIP and help children get the coverage they need. The bill would have covered almost 4 million additional children. The federal cost of the program would have been an additional $35 billion over 5 years. The program has helped reduce the number of uninsured, low-income children by one-third. However due to inadequate funding another 6 million children who qualify for SCHIP or Medicaid remain uninsured as a result.

Is the SCHIP reauthorization bill a "trick" or is the president just failing to medically “treat” millions of children? Make your opinion known.

House passes new SCHIP Bill

With 9 million uninsured children currently in the US the House voted to provide health insurance for children.

On October 25 the House of Representatives for the third time this year passed a new bill to reauthorize and expand the State Children’s Health Insurance Program (SCHIP), One day after it was introduced. However it again failed to attain a majority that would prevent a veto by the president.

The House approved the new legislation by a 265-142 vote. That vote also fell short of the two-thirds that would be needed to override a presidential veto.

The new bill mirrors the earlier version which was vetoed by Bush, but contains a number of changes made in an effort by Democratic leaders to attract greater support for the program.

The new bill clarifies that states would receive federal funding for children enrolled in the program only if their families have incomes of 300 percent of the poverty level or less, up to $51,510, for a family of three.

The bill would phase out coverage of childless adults after one year, rather than two.

The bill clarifies that states would not receive federal funding for payments made to non-citizens. The Social Security Administration would be required to verify name, Social Security number, and place of birth of enrollees and applicants.

Like the vetoed bill, the new bill would add $35 billion to the program over five years to insure more children whose parents do not qualify for Medicaid but cannot afford private insurance.

Total funding for SCHIP would be $60 billion. Supporters of the legislation estimate it would allow 10 million children to participate in the program, up from the 6.6 million currently covered.

The extra $35 billion proposed by the bill would be funded by a federal tax increase on tobacco products. Most significantly, the bill would increase the tax on cigarettes by 61 cents, to $1 per pack. It would impose additional tax increases on other tobacco products, including cigars and pipe tobacco.

This cigarette tax increase to support funding for the new program is strongly opposed by the Bush administration as per Michael Leavitt secretary of Health and Human Services.

Opponents of the earlier bill expressed concerns that the bill to add $35 billion to the State Children's Health Insurance Program would cover adults and families who earn up to $83,000 annually, as well as illegal immigrants.

The new version would strengthen the original bill's eligibility cap at 300 percent of poverty but phase childless adults off the program within one year instead of two, and clarify language stating that illegal immigrants will not be eligible.

As per the White House news release the president’s concerns with the new bill are
· The new legislation continues to allow States to avoid covering poor children first.
· The new legislation continues to cover children in families earning more than $62,000 per year (300 percent of the Federal poverty level).
· The new legislation continues to raise taxes to move 2 million children covered by private health insurance onto government-run programs.
· The new legislation continues to allow SCHIP to cover ineligible individuals.
· The new legislation shifts more responsibility to the Federal government.
http://www.whitehouse.gov/news/releases/2007/10/20071025-6.html

With Election Day looming in days and the support of 75-80% of Americans SCHIP is a priority and may be up for another vote as early as Thursday.

Remember make your voice heard VOTE Election Day November 6th

Want to make a difference?

In a survey by the Commonwealth Fund America consistently ranks behind Europe and Australia in major aspects of health care. http://www.aflcio.org/issues/healthcare/facts.cfm

Everyday in the news there are concerns over health care. America has the ability to provide the best health care in the world, yet everyday there are Americans that can not receive health care because of lack of insurance or coverage

We sit frustrated and feeling helpless wondering what one person can do to change things. It is easy to sit and complain that the government is mishandling health care and your health care concerns are not being addressed.

Kaiser Family Foundations has set up a site to compare side by side the opinions and positions of all the major candidates on health care issues.
http://www.health08.org/sidebyside.cfm

The most effective way to have our elected representatives address our concerns and set up laws to provide safe affordable quality health care is to understand the positions and proposals of the candidates. Then make a well informed decision on whose ideology best represents yours and

Vote

If your ideas are still not addressed then let your elected representatives know your concerns in writing or on-line.

Children Health Insurance
http://www.thepetitionsite.com/takeaction/469109231

Single-Payer National Health Insurance
http://www.protesthealthcare.org/

Medicare cost increases
http://www.capitolconnect.com/takeaction_aarp/

http://www.ama-assn.org/ama/pub/category/13097.html

Cancer Treatment cutbacks
http://www.protectcancerpatients.org/home/?CFID=453399&CFTOKEN=49429041


As a nurse I’ve joined professional organizations that have the financial and political clout to lobby in congress to express their opinions. Professional organizations, unions or national organizations for diseases are great places to meet and discuss your ideas with other like minded people and have the back up millions of voices instead of one.

10 million union members are represented by:
http://www.aflcio.org/issues/healthcare/

2.9 million Registered Nurses are represented by
http://nursingworld.org/MainMenuCategories/ANAPoliticalPower/ANAPAC.aspx

50 thousand physician members are represented by
http://www.ama-assn.org/

For anyone over the age of 50 and their spouses.
http://www.aarp.org/

Don’t stand alone. There is strength in numbers. Join your local political groups, go to town meetings, write editorials, or set up fund raisers for research or services.

Medicare costs increase

Most Medicare patients will pay $2.90 more per month in Part B premiums next year -- to $96.40. A majority of patients could also face hikes of $5 to $10 in monthly premiums for Part D, the Medicare prescription drug program, unless they enroll in less expensive plans.
There will also be increases in deductibles for hospital admissions and doctors' visits.

This increase in Part B of 3.1% is the lowest since 2000, but will provide only temporary relief for seniors. The smaller-than-usual hike is artificially low next year because:

Firstly, the Centers for Medicare and Medicaid Services fixed an accounting error that otherwise would have added $2.50 to beneficiaries' monthly premiums.

Secondly the new premium is based on the assumption that physicians will take a 10% cut in their Medicare reimbursement rates next year.

Physician groups have warned that patient access to care will be jeopardized. As per a survey by the American Medical Association of 8,955 physicians unless planned fee cuts are restrained:

• 77% of the physicians surveyed say they'll limit the number of new Medicare patients
• 68% of the physicians surveyed say they will limit the number of their established Medicare patients
  
  
  Congress, as it has for the last 5 years is expected to overturn the cuts or allow a modest increase. The cost will be passed on to beneficiaries in subsequent years to reflect the additional expense.
  

Government costs for health care are expected to soar in the long term unless drastic reform is undertaken.

This is especially true as the first baby boomer applied this month for Social Security. The baby boomer generation is a generation of nearly 80 million born from 1946-1964. Major changes in the health care sytem need to occur before the oldest of the baby boom generation enters the Medicare system.

• Center for Medicare and Medicaid Services (CMS) projects that by 2016, national health care spending will be over $4.1 trillion, and Medicare's share of that will be 21%.

The enrollment of baby boomers plus the prescription drug benefit, which reduces private out-of-pocket spending and increases public spending, are the main factors.

• Medicare officials said that the annual deductible for physician services will increase by $4 to $135 next year.
• The deductible for Medicare Part A, which covers inpatient hospital and hospice care as well as short stays in nursing homes, will increase from $992 to $1,024 next year.
• Medicare beneficiaries have typically paid 25% of their Part B premium cost, while federal taxpayers have covered the rest. By 2009, when means testing is fully phased in, affluent seniors will pick up 35% to 80% of their premium costs.

Beneficiaries in every state will have access to at least one drug plan with premiums of less than $20 a month, and a choice of at least five plans with premiums of less than $25 a month. The national average monthly premium for the basic Medicare drug benefit in 2008 is projected at $25. The open enrollment period for Medicare D drug program for 2008 begins Nov. 15 and ends Dec. 31.


The majority of beneficiaries could avoid any premium increase in 2008 by enrolling in a lower-cost stand-alone plan in their region or utilizing a Medicare Advantage plan with lower prescription drug premiums.

For additional info search the Center for Medicare and Medicaid website:

http://www.cms.hhs.gov/apps/media/press/factsheet.asp

or Kaiser Family Foundation: Health Care Trends

http://www.kff.org/insurance/upload/7692.pdf

or American Medical Association

http://www.ama-assn.org/

Health Insurance for children

The State Children’s Health Insurance Program SCHIP

In an attempt to address the growing number of children in the US without health insurance the State Children’s Health Insurance Program (SCHIP) was created. This is a national program that provides health insurance for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private insurance.

On October 1, 1997 this program went into effect and was administered by the Centers for Medicare and Medicaid Services (CMS). This program provided the State Children’s Health Insurance Program (SCHIP) with $ 24 billion in federal matching funds over 10 years to help states expand health care coverage to over 5 million of the nation's uninsured children. This was the largest expansion of health insurance coverage for children in the United States since Medicaid began in the 1960s.

SCHIP is jointly financed by the Federal and State governments and is administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. SCHIP provides a capped amount of funds to States on a matching basis for Federal fiscal years 1998 through 2007. SCHIP covered 6.9 million children at some point during Federal fiscal year 2006, and every state has an approved plan.

States are given flexibility, and an enhanced match is paid to states. Some states have received Section 1115 demonstration authority to use SCHIP funds to cover the parents of children receiving benefits from both SCHIP and Medicaid, pregnant women, and other adults.

In 2007, researchers from Brigham Young University found that children who drop out of SCHIP cost states more money because they shift away from routine care to more frequent emergency care situations. In a 2007 analysis by the Congressional Budget Office, researchers determined that "for every 100 children who gain coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children." The CBO speculates this is because the state programs offer better benefits and lower cost than the private alternatives.

The program cost $40 billion federal dollars over 10 years. Despite SCHIP, the number of uninsured children continues to rise, particularly among families that cannot qualify for SCHIP. An October 2007 study found that 68.7 percent of newly uninsured children were from families 200 percent above the federal poverty level.

A proposal was made to expand SCHIP from $5 billion yearly by $35 billion over five years and was recently passed in the Congress. However it was vetoed by President George W. Bush. An attempt to override the president’s veto was made by the House of Representatives today, October 18, 2007 failed by a vote of 273 to 156 for a 13 vote shortage of the two-thirds majority needed for override.

Additional info available http://www.cms.hhs.gov/LowCostHealthInsFamChild/

Facts on Health Insurance Coverage

Most Americans have health insurance through their employers. But, employment is no longer a guarantee of health insurance coverage. As America moves from an industrial economy to a service economy, employers are placing an increased reliance on part-time and contract workers who are not eligible for coverage; fewer workers have access to employer-sponsored health insurance.

As health insurance costs rise small employers become unable to afford health benefits and larger companies may require employees to contribute a larger share toward their coverage. As a result, an increasing number of Americans have opted not to take advantage of job-based health insurance because they cannot afford it.

Who are the uninsured?

The number of uninsured increased by almost 7 million people since 2000 in which the large majority of the uninsured (80 percent) are native or naturalized citizens.

The increase in the number of uninsured in 2005 was focused among working age adults. The percentage of working adults (18 to 64) who had no health coverage climbed from 18.5 percent in 2004 to 20.5 percent in 2005 -- an increase of over 800,000 uninsured workers. Nearly one (1) million full-time workers lost their health insurance in 2005.

Nearly 82 million people – about one-third of the population below the age of 65 spent a portion of either 2002 or 2003 without health coverage .The percentage of people (workers and dependents) with employment-based health insurance has dropped from 70 percent in 1987 to 59.5 percent in 2005.

In 2005, nearly 15 percent of employees had no employer-sponsored health coverage available to them, either through their own job or through a family member. 27.4 million workers were uninsured because not all businesses offer health benefits, not all workers qualify for coverage and many employees cannot afford their share of the health insurance premium even when coverage is available.

The number of uninsured children in 2005 was 8.3 million – or 11.2 percent of all children in the U.S.

The number of children who are uninsured increased by nearly 400,000 in 2005, breaking a trend of steady declines over the last five years.

Young adults (18-to-24 years old) remained the least likely of any age group to have health insurance in 2005 – 30.6 percent of this group did not have health insurance.

Based on a three year average (2003-2005), people of Hispanic origin were the least likely to have health insurance. An average of 32.6 percent of Hispanics were without health insurance during that period.

Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more. A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.

Why is the number of uninsured people increasing?

Millions of workers don't have the opportunity to get health coverage. A third of firms in the U.S. did not offer coverage in 2005.

Nearly two-fifths (38 percent) of all workers are employed in smaller businesses, where less than two-thirds of firms now offer health benefits to their employees.

Rapidly rising health insurance premiums are the main reason cited by all small firms for not offering coverage. Health insurance premiums are rising at extraordinary rates. Over the past five years the average annual increase in inflation has been 2.5 percent while health insurance premiums for small firms have escalated an average of 12 percent annually.

Even if employees are offered coverage on the job, they can't always afford their portion of the premium. Employee spending for health insurance coverage (employee's share of family coverage) has increased 143 percent between 2000 and 2006.

Losing a job, or quitting voluntarily, can mean losing affordable coverage – not only for the worker but also for their entire family. Only seven (7) percent of the unemployed can afford to pay for COBRA health insurance – the continuation of group coverage offered by their former employers. Premiums for this coverage average almost $700 a month for family coverage and $250 for individual coverage, a very high price given the average $1,100 monthly unemployment check.

How does being uninsured harm individuals and families?

Lack of insurance compromises the health of the uninsured because they receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates than insured individuals.

Regardless of age, race, ethnicity, income or health status, uninsured children were much less likely to have received a well-child checkup within the past year.

The uninsured are increasingly paying "up front" -- before services will be rendered. When they are unable to pay the full medical bill in cash at the time of service, they can be turned away except in life-threatening circumstances.

About 20 percent of the uninsured (vs. 3 percent of those with coverage) say their usual source of care is the emergency room. The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices.

Studies estimate that the number of excess deaths among uninsured adults age 25-64 is in the range of 18,000 a year.

What additional costs are created by the uninsured population?

The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis.

Hospitals provide about $34 billion worth of uncompensated care a year.

Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage.

The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300.

Getting Everyone Covered will Save Lives and Money

The impacts of being uninsured are clear and severe. Many uninsured individuals postpone needed medical care which results in increased mortality and billions of dollars lost in productivity and increased expenses to the health care system. There also exists a significant sense of vulnerability to the potential loss of health insurance which is shared by tens of millions of other Americans who have managed to retain coverage.

According to data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey

SOURCE: National Health Interview Survey, 2006

In 2006, 14.8 percent of Americans, or 43.6 million, were currently without health insurance.

The visit rate for patients with no insurance was about twice that of those with private insurance in emergency departments. Lack of insurance compromises the health of the uninsured because they receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates than insured individuals

Conversely, patient visits to physician offices were higher for individuals with private health insurance compared to those with no insurance.

Among working-age Adults (those ages 18-64), 19.8% did not have health insurance in 2006. An increase in the percent uninsured from 18.9% the year before. Over 8 in 10 uninsured people came from working families – almost 70 percent from families with one or more full-time workers and 11 percent from families with part-time workers

Approximately 9.3% of children under the age of 18 did not have health insurance in 2006, an increase in the uninsured from 8.9% in 2005.

Almost a third (32.1 percent) of Hispanic people were uninsured when interviewed in 2006.

While 10.4 percent of non-Hispanic white persons and 15.9 percent of non-Hispanic black persons were uninsured when interviewed.

A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service such as accidents or dental care.

To learn more about other topics, visit the Data and Statistics page for more survey data, tools, and other resources from across CDC.

This document is also available as a printable .pdf file.Health Insurance Coverage Facts on Health Insurance Coverage

Every American should have health care coverage, participation should be mandatory, and everyone should have basic benefits.

Health Care 101

What are your major problems with the health care system?
Tired of the confusion over health insurance, coverages, services covered?
There is help through the maze.

I'm a Registered Nurse in New York City with 30 years of experience in the Heath Care Industry. I have worked for years in hospitals and home care agencies. As a case manager I evaluated the needs of patients to provide necessary services.

Health Care options are numerous and diverse. Even the most educated people have difficulty understanding the health care system. In my years as a nurse I have found that many people when faced with the stress of illness are uncertain of where to turn. The prospect of dealing with a health insurance company to justify the care they feel is necessary and covered is not what most people expect as part of their treatment.

Please send me your concerns and stories.