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QUALITY AND AFFORDABLE HEALTH CARE
Dr. Martin Luther King, Jr. once said “of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Health Care Reform is one of the most important issues facing our nation.
Hot Facts About America’s Broken Health Care System
- Premium costs are rising three times faster than wages or inflation
- Exploding costs are hurting seniors, working families and employers
- Retirees especially are losing employer-sponsored health care and/or benefits
- Today’s health care system is wasteful and inefficient
- Private insurance companies spend about 15% of their money-our money- on administrative costs compared to less than 3% for large public plans such as Traditional Medicare
- Insurance and drug companies have high profits: Drug maker profits are almost 20%; Health insurance company profits have increased 1,084% in five years
- As costs and restrictions increase, more people are uninsured them
Ninety% of Americans want change in the U.S. health care system.
MD/DC Alliance for Retired Americans Position on Health Care
In principle, The MD/DC ARA supports the creation of a high quality, affordable universal health care which provides comprehensive services, including long term care.
How Seniors Benefit from the New Federal Health Care Law
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Reduces drug costs by phasing out doughnut hole
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Provides a $250 rebate in 2010 for seniors who fall in the doughnut hole. In 2011, when seniors fall in the doughnut hole, they will receive a 50% percent discount on brand-name drugs and government subsidies for generic drugs. By 2020 the doughnut hole will be eliminated.
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Covers Preventive Services – In 2011, seniors in Medicare will receive free annual check-ups. In addition, the law eliminates co-payments or cost-sharing for mammograms, colonoscopies and other preventive screenings.
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Supports Early Retiree Coverage – Provides financial assistance to employer health plans that cover early retirees, bringing down health costs and premiums by as much as $1,200 per family, per year for some plans.
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Encourages Doctors to coordinate care and improve quality
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Creates incentives for providers to work together to better serve patients and reduce wasteful care like repeated tests.
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Extends election period to change Part D Plan – Changes and extends the annual enrollment period for Part D plans. The new enrollment period is October 15 –December 7.
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Significantly Lowers Cost for Struggling Seniors –Expands the Medicare Part D low-income subsidy, which will dramatically help struggling seniors afford their health care costs.
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Enacts CLASS Act creating a new option for long-term assistance for seniors and the disabled- which creates a new, voluntary, self-insured insurance program to help families pay for the costs
of long-term supports and services if a loved one develops a disability. Also, creates new options for states to provide home and community based services in Medicaid, enabling more people with disabilities to access long-term services in the setting they choose.
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Enacts the Elder Justice Act – Authorizes new criminal background checks on longterm care workers who have access to residents or patients and requires greater transparency of nursing homes, including public disclosure of the entities that own, govern, operate and profit from nursing homes. The law also requires better information about the quality of nursing care and improves complaint process.
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Brings Savings to Medicare - By eliminating wasteful overpayments to Medicare Advantage plans and by creating new incentives for coordinated, high quality care across the health care spectrum, the law extends the solvency of the Medicare Trust Fund by 9 years and improves Medicare for generations to come.
The law also:
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Creates a $5 billion reinsurance fund to help employers who provide health benefits to early retirees ages 55 to 64
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Creates a $5 billion high-risk insurance pool to provide insurance to individuals who have been denied insurance due to pre-existing condition and have been uninsured for six months
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Bans Lifetime Limits On Coverage for Seniors and Families
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Prohibits health plans from placing lifetime caps on coverage
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Bans Restrictive Annual Limits On Coverage for Seniors and Families
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Tightly restricts new plans’ use of annual limits to ensure access to needed care. These tight restrictions will be defined by HHS. (Beginning in 2014, the use of any annual limits would be prohibited for all plans.).
INITIATIVES IN MARYLAND
Gov. Martin O’Malley reports that in Maryland more than 22 cents of every tax dollar goes towards some form of healthcare, and it’s expected to rise dramatically in the coming years.
Maryland Expands Access to Healthcare
Over the years, strategic investments have helped Maryland’s bioscience industry grow into one of the world’s largest bioscience research complexes, known for its wealth of federal facilities, institutions of higher learning and concentration of highly trained bioscience researchers. With more than 400 bioscience companies and 50 research-intense federal institutes and centers, it has created jobs. The Maryland Department of Business and Economic Development, is charged with coordinating and consolidating initiatives and resources to make it easier for bio companies to function in Maryland. Subsidies and supports exist for small business to help pay for rising costs of health insurance for their employees.
To address the shortages of nurses, donors from the Maryland Hospital Association and other granting groups, including CareFirstBlueCross, have pledged $15.5 million over 5 years to fund 17 Maryland nursing schools to expand enrollment and add 1,500 students.
Sixteen community health care centers have been established to provide primary care to uninsured and other needy persons. Further, in July 2009, landmark legislation took effect in Maryland that will improve the affordability and access to healthcare for 100,000 more Marylanders. The legislation changes the eligibility criteria for Medicaid recipients, raising the income cap for a family of three from $7,100 to $20,500. In addition, the legislation brings an infusion of funding for Medicaid dental services, expanding access to quality dental care to more Maryland children and low-income families. Maryland is one of the first states in America to help small businesses insure their employees and is providing coverage for mental health services.
Health Promotion and Disease Prevention
Health promotion and disease prevention programs and information is made available for persons age 60 and over throughout the State of Maryland. Physical and mental health risk assessments, counseling and referral, physical fitness activities and wellness education are key components of this statewide program.
A new addition to health promotion in Maryland is Evidence-Based Programming. These types of programs have been documented, through research, to produce proven results. The Department recently received a three-year grant from the Administration on Aging to implement the Chronic Disease Self Management Program (CDSMP) developed by Stanford University. The program, called “Living Well: Take Charge of Your Health”, helps people learn skills to manage their symptoms and get the most out of life. Through the grant, Living Well is being offered in eight counties: Baltimore, Howard, Montgomery, Prince Georges, Kent, Caroline, Talbot, and Worcester.
Senior Prescription Drug Assistance Program (SPDAP)
The Senior Prescription Drug Assistance Program (SPDAP) is a subsidy program established by the Maryland General Assembly in 2005 to provide financial assistance to moderate-income Maryland residents who are eligible for Medicare and are enrolled in a prescription drug plan. (Call 1-800-551-5995)
Senior Health Insurance Assistance Program
The Senior Health Insurance Assistance Program (SHIP) meets one of the most universal needs of Medicare beneficiaries, including those under 65 years of age — understanding their health insurance benefits, bills and rights. The Maryland SHIP program provides trained staff and volunteer counselors in all 24 counties. Counselors provide in-person and telephone assistance in the following general areas, such as Medicare Prescription Drug Coverage Program (Medicare Part D), disability, long term care insurance, and assistance with denials, appeals and grievances. The Maryland Department of Aging receives funding for this program from the Centers for Medicare & Medicaid Services, the State of Maryland and local governments. SHIP counseling services are confidential and free of charge. (Toll free, Maryland: 1-800-243-3425)
Maryland SMP (Senior Medicare Patrol)
Maryland SMP (Senior Medicare Patrol) is an anti-health care fraud project administered by the Maryland Department of Aging through the U.S. Department of Health and Human Services and the Administration on Aging. The mission of Maryland SMP is to develop a program that enlists senior volunteers to teach Medicare and Medicaid clients how to recognize and report health care fraud, waste, abuse, or error. (Tel. 1-800-243-3425 or 410-767-1100)
Senior Care
The Senior Care System provides case management and funds for services for people 65 or older who may be at risk of nursing home placement. Senior Care allows seniors to live with dignity and in the comfort of their own homes and at a lower cost than nursing facility care. Senior Care provides a comprehensive assessment of an individual's needs, a case manager to secure and coordinate services, and a pool of gap filling funds to purchase services for individuals who meet program eligibility requirements. Services may include personal care, chore service, medications, medical supplies, adult day care, respite care, home delivered meals, transportation, and emergency response systems.
Senior Centers
The hub of most nutrition and health promotion activities, Senior Centers provide a vital link for older individuals, encouraging them to take charge of their health and stay involved in their community. They provide fitness programs, free and low cost-health screenings and wellness seminars.
Medicaid Waiver for Older Adults
The purpose of the Medicaid Waiver for Older Adults is to enable individuals who are aged 50 and over who require long-term care services to remain in a community setting (at home or assisted living facility) even though their advanced age or disability would warrant placement in a long term care facility. It is administered by the Maryland Department of Aging and a network of 19 Area Agencies on Aging. In FY 2010, the program received funding to support an active enrollment of approximately 3,500 participants but many more need these services. For inquiries or assistance at any time regarding the above, please call the Maryland Department of Aging at 1-800-243-3425, weekdays between 8:00 a.m. and 5:00 p.m.
Women’s Programs
Maryland Senators Mikulski and Cardin have identified health care discrimination that women face. As a result, they have fought to make sure that NIH and the Food and Drug Administration provide information and resources for women and that women are included in clinical drug and treatment trials. They have also identified abuses by health insurance companies to deny women coverage or to charge women more for lower benefits and foster the discontinuation of these practices.
Other Initiatives
New initiatives include: strengthening Maryland’s world renowned EMS System and replacing our aging Medevac helicopter fleet; expanding substance abuse treatment for an additional 27,000 low income Marylanders; curbing predatory hospital bill practices by mandating a uniform charity care policy; and protecting our previous expansion of Medicaid for low income Marylanders. In addition, legislation to end health care (genetic) discrimination in the long-term care industry was initiated.
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