Implementing the Medicare Drug Benefit: The Stories Ahead

Medicare now covers nearly 42 million beneficiaries who are elderly, or who have a severe disability or end stage renal disease. The Medicare Modernization Act of 2003 made many changes to the program – including the addition of an outpatient prescription drug benefit (“Part D”), which will become effective in January 2006. Understanding this new benefit is of paramount importance to the many people who advise senior citizens, and to millions of Medicare beneficaries who will be scrutinizing different prescription drug plans available in their area.

Pay-for-Performance: Taking Health Care Quality Improvement to the Next Level

Pay-for-performance programs have been touted by some as a way to improve the overall quality of care provided to patients, while being criticized by others who fear unintended consequences in attempting to change physician behavior. The Medicare Payment Advisory Commission has recommended that pay-for-performance be incorporated into Medicare reimbursement policy in a number of areas. Recent laws, including the Medicare Modernization Act, have mandated pay-for-performance demonstration projects, including one for chronically ill Medicare patients.

Medicare Basics From (Part) A to D

Medicare covers nearly 42 million beneficiaries who are elderly, or have a disability or end stage renal disease. Spending on Medicare benefits accounted for 17 percent of the nation’s total health care spending in 2004. The Medicare Modernization Act of 2003 made many changes to the program including the addition of a prescription drug benefit (“Part D”), which will begin full implementation in 2006.

How Good is the Quality of Care in Medicare?

The federal government’s responsibility to provide access to health care for the nation’s 41 million Medicare beneficiaries implies another obligation: to spend taxpayer dollars wisely. This means assuring that the $250 billion+ spent for Medicare goes for services that are safe, timely and effective.

Checking Up: What Are Your Hospital’s Vital Stats?

A newly launched website known as “Hospital Compare” is the most comprehensive attempt yet by the Centers for Medicare and Medicaid Services (CMS) to display voluntary, self-reported information by hospitals on steps that can be taken to reduce the impact of three major causes of morbidity and mortality – heart attack, heart failure, and pneumonia – in a consumer-friendly format.

Health Care in the 2006 Budget: What’s Next? What to Watch for in the Coming Debates

President Bush’s FY 2006 budget could have long-lasting effects on several health programs. If enacted as is, the budget would trim $60 billion in the growth in Medicaid spending over the next 10 years. At the same time, the budget offers $11 billion in new money to enroll children in Medicaid and the State Children’s Health Insurance Program. It would provide $74 billion in tax incentives to help the uninsured buy coverage. Some congressional budget leaders have signaled their intention to find budget savings in another entitlement program – Medicare.

Understanding Resolutions, Reconciliation, and Other Budgetary Rules of the Road

The budget season is upon us. The Congressional Budget Office’s January 2005 “Budget and Economic Outlook” provides an overview of where Congress will start, and the President’s budget request will arrive next week. The journey down the sometimes bumpy, sometimes difficult-to-understand road to a federal budget for FY 2006 is beginning.

The Reality and Potential of Evidence-Based Medicine

Evidence-based medicine offers a win-win proposition: improve the quality and effectiveness of care while at the same time identifying opportunities to reduce waste of valuable health care resources. But what evidence should employers, health care providers and consumers pay attention to? And how should this information be disseminated to those who need it?

Examining Medicare’s Two-Year Waiting Period for Individuals with Disabilities

In addition to providing health insurance coverage for 35 million seniors, Medicare covers about 6 million disabled beneficiaries under age 65 who are entitled to cash benefits under the Social Security Disability Insurance (SSDI) program. SSDI is designed to assist adults who are unable to work due to severe, long-lasting disabilities. However, disabled people who wish to receive coverage under Medicare must first qualify for SSDI cash benefits and wait five months before receiving the benefit. These individuals must then wait an additional two years before becoming eligible for Medicare.

Previewing Medicare Advantage

Congress made major changes in the Medicare managed care program, now named “Medicare Advantage,” affecting plans and beneficiaries in 2005 and 2006. The Department of Health and Human Services (HHS) has proposed regulations to implement this part of the new law, and comments on the draft regulations are due by October 4, 2004.

Health Care as Campaign Issue: Ready to Rally?

After being buried under stories about the war in Iraq, terrorism and joblessness, health care seems poised to make a comeback as a campaign issue. President Bush has announced that his goals for a second term will include making health care more available and affordable. Details are expected in August. Sen. Kerry and running mate Sen. John Edwards mention the Kerry health proposals often in their appearances.

Evaluating Proposals to Expand Health Insurance: Find the Right Balance

After passing a Medicare drug benefit in 2003, a number of key lawmakers have turned their sights to expanding health insurance coverage, to reduce the 43 million Americans who remain uninsured. Proposals to expand coverage vary widely, including tax credits and limited public coverage expansions.

Medicare Drug Discount Cards: How Do They Work?

On June 1, 2004, Medicare beneficiaries were able to use their new drug discount cards for the first time. But around the country, many Medicare beneficiaries, family members and service organizations were asking questions about how to choose a card and exactly how the cards will help beneficiaries reduce their drug costs.

Medicare Prescription Drugs and Low-Income Beneficiaries

Low-income Medicare beneficiaries are a vulnerable population because of their disproportionately high medical and long-term care needs. Among low-income beneficiaries are nearly seven million individuals who are considered “dual-eligibles,” with coverage from both Medicare and Medicaid. They represent around one in six Medicare beneficiaries and one in seven Medicaid beneficiaries.

Health Care as a Campaign Issue: A Winner in 2004?

National polls and opinion surveys consistently show that health care is an important issue for voters. In a June 2003 survey by Harris Interactive, health care ranked third after economy/jobs and war/defense as an issue needing government action. A Gallup poll in September 2003 found that 85 percent of respondents considered presidential candidates’ positions on health care issues to be either extremely important or very important in influencing their votes.

Low-Income Medicare Beneficiaries: How the Reform Bills Address Their Drug Needs

Dual eligibles are low-income Medicare beneficiaries who are also eligible for Medicaid. They are a vulnerable population because of their disproportionately high medical and long-term care needs. At any given time, nearly seven million individuals are considered dual eligibles, representing around one in six Medicare beneficiaries and one in seven Medicaid beneficiaries.

Medicare Reform Legislation: An Update

After years of discussion and debate, both Houses of Congress passed bills providing for Medicare prescription drug coverage in July, 2003. In September 2003, conferees from both the House and Senate resumed their attempt to iron out the differences between the two bills and enact the most extensive expansion of the Medicare program since its inception.

Roadmaps to Coverage: Exploring Options for the Uninsured

Rising unemployment, persistent double-digit increases in health premiums and record state budget deficits are only the latest in a wide array of barriers that are keeping tens of millions of Americans from getting health insurance coverage.

Changing Medicare: Proposals to Strengthen the Program

Medicare has made invaluable contributions to the health and financial security of the elderly and other vulnerable populations. However, its long-term financial stability is the subject of spirited debate, and various aspects of the program are being reassessed. Now, more than ever, with active consideration of an additional prescription drug benefit, proposals to improve and strengthen the program should receive serious attention.

Medicare 101: Prepare Yourself for the Debate

Much of the early health reform discussion in the administration and new Congress will focus on Medicare. On the agenda: Both the possible addition of a prescription drug benefit and the need for structural changes to the program itself.

Health on the Hill: What Health Legislation Can We Expect from the New Congress?

The 107th Congress adjourned with many health issues unresolved. The House passed a Medicare drug bill, but the Senate didn’t follow suit. Medicare provider givebacks likewise got through the House, but not the Senate. The Senate, but not the House, passed a bill to restrain health costs by making generic versions of prescriptions drugs available sooner. Tax incentives for health insurance that would have been part of an economic stimulus package never saw the light of day.

Chapter 2 – Medicare

The federal health insurance program for people age 65 and older and for other adults who qualify due to having a permanent disability or end-stage renal disease.