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/