Live Webcast on "Individual Mandate" Healthcare Coverage

From the Kaiser Family Foundation:

Requiring individuals to obtain health care coverage — often referred to as an "individual mandate" — is a key part of a major health reform plan being implemented in Massachusetts and is being considered in other states. It is also featured in national proposals in Congress and on the presidential campaign trail. At 1:30 p.m. ET today join kaisernetwork.org's "Ask the Experts" LIVE webcast panel for an in-depth look at individual mandates:

What are the policy arguments for and against a mandate? Is it a necessary part of a strategy to achieve universal coverage and greater accessibility in the non-group insurance market? What would be required to make a mandate work? How have mandates functioned in other areas?

Larry Levitt, vice president of the Kaiser Family Foundation and editor-in-chief of kaisernetwork.org, will moderate the discussion with Michael Cannon, director of Health Policy Studies at the Cato Institute; Sherry Glied, professor and chair of the Department of Health Policy and Management at Columbia University's Mailman School of Public Health; and Len Nichols, director of the New America Foundation's Health Policy Program. E-mail your questions before and during the show to ask@kaisernetwork.org. The webcast is available online at kaisernetwork.org.

In the News: Simply Having Health Insurance is Sometimes Not Enough

Those who need organ transplants or who have hemophilia, Gaucher disease or other costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies.

That has left some very sick people facing health-care tabs of hundreds of thousands of dollars or more, prompting their families to seek help from the government, or to scramble to change jobs or even divorce for no other reason than to qualify for new health insurance. And it has led some advocates for the chronically ill to plan a new lobbying effort in hopes of persuading Congress to require that insurers increase lifetime caps to as high as $10 million.

Statistics on how many people exceed the lifetime caps are hard to come by, but advocates note that the amount of many caps hasn't changed in decades, or at least has not kept up with health-care inflation and the sky-high cost of lifesaving new therapies, making it more likely that people will reach the limit...

... An annual survey by the Henry J. Kaiser Family Foundation found that 55 percent of workers with employer-based coverage had a lifetime limit in 2007, including 23 percent with a cap of less than $2 million. That was up from about 50 percent who faced a cap in 2004.

This is an excerpt from a January 27 article in the Washington Post. Click here to read the complete story.

Media Focus on Delays in Disability Benefits

Delays in the Social Security disability benefits process can be long for people living with MS and other disabilities. Recent media coverage is raising awareness for the issue. The New York Times covered it in December. Now CBS News is investigating the Social Security disability benefits backlog. Click here to view or read the first in a series of CBS broadcasts.

In the News: Recession Could Lead to Healthcare Overhaul

A report today from Congressional Quarterly states that an economic downturn in the United States could threaten access to medical care and serve as the catalyst for comprehensive health care overhaul.

A recession in the economically sensitive American health care system, with market-based treatment costs and employer-provided insurance, would raise the stakes for national overhaul, said Brian Biles, a George Washington University health policy professor and former assistant secretary of Health and Human Services under President Clinton. Biles spoke as part of the forum held Friday by the non-partisan Alliance for Health Reform and Robert Wood Johnson Foundation.

Experts also warned that a comprehensive overhaul would require robust public support and delicate political conditions ... but the overhaul would have to top the congressional agenda and require a singular dedication from the president.

This information was taken from a January 22 CQ.com update.

In the News: USA Today Examines Future of Medicare, Social Security Benefits, and More

USA Today is reporting today that a long-term financing crunch in Social Security, Medicare, and Medicaid will eventually force changes in the programs though the outlook isn't as bleak as some baby boomers fear. Check out the complete article and some telling graphics here.

Congressman C.W. Young Joins the MS Caucus

Congressman C.W. Bill Young (FL) has joined the Congressional MS Caucus, increasing the total to 68 members from the U.S. House of Representatives. Congressman Young is the ranking member of the House Defense Appropriations Subcommittee. He is serving his 19th term in Congress and is the senior Republican in the House of Representatives.

Check the complete list of Caucus members to the left of this post. If your member is not on the list, call and ask them to join.

Some in Industry Echo Need for More Affordable Alternatives to Biotech Drugs

"Quite simply, life-saving drugs are irrelevant if they are not affordable," said Christopher Begley, chairman and chief executive of Hospira Inc., a Lake Forest-based maker of hospital products and specialized medication-delivery devices that is stymied in its ability to make generic versions of biotech drugs.

"There's no doubt it's time for Congress to pass legislation enabling the FDA to create an abbreviated biogenerics-approval pathway," Begley said. "With the progress made over the course of the past year, we're highly confident we'll see this happen in 2008."
This is an excerpt from a December 26 article in the Chicago Tribune. Click here to read the complete story.


We agree. The cost of biological MS treatments — $16,500 to $29,000 each year — can unfortunately force many people to stop their prescribed therapy because they just cannot afford it. We will keep you updated as this issue moves forward in Congress in 2008.

U.S. House to Convene Next Week

The 2008 Congressional Calendars are available.

The U.S. House of Representatives is scheduled to convene next week for the second session of the 110th Congress. The U.S. Senate is tentatively scheduled to convene on January 22. Check out their complete calendars here...

• House Schedule
  
• Senate Schedule

Medicare Part D Lowers Drug Costs by 17%

A new study has found that Medicare Part D has helped lower out-of-pocket prescription drug costs by 17%, or $9 per month, for those who enrolled in the benefit program in 2006 (the first full year that the program was available).

Those savings translate into an extra 14 days of medicine, or a 19% increase in prescription usage, which could indicate use of medication that otherwise was unaffordable.

According to study authors, the results of drug usage are not surprising, but it does show that the Part D program is working ... calling the Part D impact on Americans "modest but significant."

The results of this study will be published in the February 5 issue of the Annals of Internal Medicine. Read more here.

In the News: Medicare Spending Surges

Spending for Medicare’s prescription drug program and greater enrollment in Medicare Advantage plans accounted for an 18.7% increase in Medicare spending in 2006, the fastest rate of growth in 25 years and double that of just a year before, according to a new report released by CMS actuaries and published in the journal Health Affairs.

All told, Medicare spending rose to $401.3 billion in 2006, up from $338 billion in 2005. But spending for Medicaid fell for the first time by 0.9%, after many of the “dual eligible” beneficiaries were shifted out of the federal-state program and into Medicare.

This is an excerpt from a January 8, 2008, article from Modern Healthcare. The full story is not publicly available.

In the News: Easing the Burden for MS Patients' Families

After Bill Miller was diagnosed with multiple sclerosis, a succession of setbacks strained his family's ability to cope. Caring for Miller — who can't bathe, feed or dress himself — taxed his five siblings emotionally, physically and financially, she said. Then the National Multiple Sclerosis Society's Colorado office stepped in about 18 months ago and found resources for Miller that his family didn't know existed.

When his family couldn't find a nursing home that would take him, the MS Society found a home that met all his needs one week after he had to exit the assisted-living facility. The agency showed the family how Miller could tap federal aid. When he was renting, the MS Society found transportation for him to get to doctors' offices and grocery stores. An agency psychiatric counselor visited him at home; experts advised his family how to qualify for federal assistance.

These are select excerpts from a January 6, 2008, article from the Denver Post. Click here to read the complete story.

2008 Funding Update for Medical Research, Disability Assistance

Little New Funding for Critical Programs
New federal funding allocations for 2008 will impact many programs that people with MS rely on for research and disability assistance. The president signed the Consolidated Appropriations Act for 2008 (H.R. 2764), a large omnibus appropriations package that funds several different federal government agencies and programs, in late December.

• Unfortunately, medical research funding continues to be ignored as H.R. 2764 included only a small increase of 0.46% for the National Institutes of Health (NIH). This amount will not even allow the NIH to keep up with inflation. Currently, the NIH funds the most MS research in the world but at a decreasing rate.


• The Centers for Disease Control and Prevention (CDC) received only a 2.8% increase.


• As the Social Security Administration (SSA) continues to struggle with its disability determination backlog, MS activists advocated for increases in funding to support the agency. SSA was allocated $9.7 billion to carry out its administrative activities, representing a $451 million increase from FY 2007. This modest increase is intended to help address the severe backlog issue.


• No funding was provided for the Lifespan Respite Care Act.

On a positive note, funding for a new comprehensive MS center at West Virginia University was approved and allocated nearly $3.5 million. It will be the first comprehensive care center in West Virginia for people living with MS and families dealing with the disease.

In November, the president vetoed a more promising, stand-alone Labor-HHS-Education appropriations bill (H.R. 3043) that would have given a 3.1% increase to NIH, a 6.6% increase to CDC, and $2 million for respite care. You worked hard on that bill and essentially helped push it through Congress in a strong bi-partisan showing. However, the votes were not there to overcome the president's veto.


Successful Changes to Medicare Coverage
Medicare received some much-needed attention and maintenance, including changes that MS activists pursued for the past few years. Congress successfully passed a broad-reaching Medicare package—the Medicare, Medicaid, and SCHIP Extension Act of 2007 (S. 2499)—also in late December. It includes:

• Inpatient Rehabilitation Facilities
  A new Medicare rule change will help preserve access to rehabilitation services. Previously, 75% of patients using inpatient rehabilitation facilities (IRF) would need to meet certain conditions for the facility to maintain its status as an IRF and its level of Medicare reimbursement. If the 75% was not met, it could limit access to IRFs for Medicare patients and potentially close those facilities all together. The Medicare legislation permanently freezes the percentage at 60%, a more achievable level. This is a great win for people living with MS.
  


• Medicare Therapy Caps
  Medicare beneficiaries with MS will have continued access to physical and occupational therapy services through June 2008, due to an extension of the Medicare therapy caps exceptions process. It was set to expire on December 31, 2007. The cap for 2008 is $1,810, which a person with MS can quickly reach early in the calendar year. We will continue to advocate for a full repeal of Medicare therapy caps and fight to extend the exceptions process.

The overall Medicare package also approves a 0.5% increase in physician payments through June 2008, extends the State Children's Health Insurance Program (SCHIP) until March 2009, and makes a number of other Medicare "fixes."

Looking Forward to MS Activism in 2008

2007 was a year of tough fights, but we have many successes to celebrate. Thanks to your hard work and MS activism, we opened up a new funding stream for MS research in the Department of Defense and built a new bi-partisan Congressional Multiple Sclerosis Caucus on Capitol Hill. But we still have a great deal of work to do in 2008:

• MS treatments remain very costly and out of reach for too many people.
• Too many important federal agencies continue to be under funded such as the NIH, CDC, SSA, and the Food and Drug Administration.
• Stem cell research in the federal arena has made progress, but we have not yet reached our goal of advancing it potential through expanded federal funding.
• We must eliminate discrimination against people living with disabilities by passing the ADA Restoration Act.

To accomplish these goals in 2008, we must continue to inform members of Congress about MS and related policies. In 2007, you sent nearly 100,000 emails to your legislators. Some MS activists sent 40, 60, even 80 messages about MS issues. One man took action 100 times — now that’s MS activism. Thank you. MS activists are among the most passionate and effective grassroots groups in this country. We are confident that your efforts will continue to make better public policy for people living with MS and their families.

Thank you for being an MS activist this year. Join the movement at www.nationalMSsociety.org/advocacy

Medicare Expects Smooth Transition for Part D Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) recently announced that Medicare beneficiaries who have chosen to change their health and drug coverage for 2008 should experience very few difficulties when getting their covered prescription drugs through Medicare Part D.

According to CMS, steps have been taken to ensure that pharmacies can obtain accurate enrollment information in 2008, particularly for low-income beneficiaries. The CMS has implemented better processing requirements for all enrollees, and a point-of-sale facilitated enrollment process should help provide immediate coverage for people with Medicare who have Medicaid or have qualified for extra help, but aren’t enrolled in a Medicare drug plan.


CMS recommends these four tips when visiting the pharmacy:

1. Bring your red, white, and blue Medicare card, a photo ID, and your new drug plan membership card – these items will help the pharmacist in verifying your coverage.
2. Bring an enrollment acknowledgement, confirmation letter, or the name of your new drug plan if you have not received a plan membership card – your enrollment search might take longer, but these items will assist the pharmacist in verifying your coverage.
3. Keep copies of your receipts – in the rare instance where the pharmacist cannot confirm enrollment, you can work with your new plan prospectively to obtain reimbursement.
4. Don’t leave the pharmacy counter without your medicine – if you cannot pay out of pocket, call 1-800 MEDICARE for assistance or ask the pharmacist to dial the special hotline for these cases.

For more information, visit http://www.medicare.gov/

Happy New Year

With the presidential elections heating up, 2008 will be an interesting year for healthcare policies and reform initiatives. Before the Iowa caucuses tomorrow, check out the candidates' positions on healthcare issues at www.health08.org

As a nonprofit organization, the National Multiple Sclerosis Society is nonpartisan and does not endorse any political candidates. We do encourage all legislators to join the movement and support issues that will help move us closer to a world free of MS and other disabilities, including:

• Increased MS research
• Disability rights
• Access to quality health care
• Increased long-term care resources
• Accessible, affordable insurance

Are you registered to vote? Voting in the primary and general elections is one way to help advance MS issues. Many state deadlines for voter registration started in December. Click here for the voter registration deadline in your state: www.vote411.org