Health Care

Advocate: Medicare changes benefit seniors

Most senior citizens stand to benefit from the national health care law passed earlier this year, according to the head of a national Medicare advocates' group.

Elderly Americans will have more access to preventive medical care and the new law will gradually close the so-called "doughnut hole" in prescription-drug benefits, said Joe Baker, president of the Medicare Rights Center, a New York-based group that advocates for seniors and disabled people on Medicare.

Baker came to Kansas to give a keynote speech at this week's Senior Expo in Salina, but made a swing through Wichita to meet with area lawmakers about ways to better serve the area's senior population.

He said seniors were targeted with misinformation about the health law by its opponents when the measure was under debate in Congress — for example, assertions that the bill would reduce Medicare benefits and that "death panels" would decide whether seniors would receive treatment.

"The false information, unfortunately, has had a very long shelf life," Baker said. "There are still people out there who think there are death panels in health care reform and it's not true — it was never true. What we're trying to do and I think a lot of responsible people who work with seniors are trying to do is kind of get the information out.

"The important thing for people with Medicare to remember is that there are no cuts to benefits in Medicare from health reform."

Annette Graham, director of the Sedgwick County Area Agency on Aging, said there is a lot of concern among local seniors about the effect of the new law on Medicare supplement insurance and the continued availability of Medicare and health services.

"I think a lot of that (incorrect) information that had gone out earlier still resonates with some of them," Graham said. "It's a challenge to get them to hear and be open to the positives that are happening."

Baker said the new law includes three major benefits for seniors:

* Closing the doughnut hole — Under the current Part D benefit for prescription drugs, Medicare covers 75 percent of the cost for prescriptions up to $2,830 a year and 95 percent for prescription spending more than $6,440 a year. The patient has to pay out of pocket the total cost of the $3,610 in prescriptions that falls in the gap in coverage, the so-called "doughnut hole."

The new law gradually phases out the uninsured portion of prescription costs so that in 10 years, all prescriptions for Medicare recipients will be covered to at least the 75 percent level, with the 95 percent level kicking in about where it is today. Starting next year, recipients who take brand-name drugs will get a 50 percent discount on prescriptions that fall in the doughnut hole and 7 percent off cheaper generic medications.

* Free preventive care — Starting next year, Medicare recipients will be able to receive, at no charge, an annual wellness visit to identify potential health problems and risks before they blossom into full-blown disease. In addition, Medicare will begin to cover screening tests such as colonoscopies and mammograms that are particularly important for seniors. "If we can catch things early, not only will folks have a better quality of life, it will help get costs down," Baker said.

* Cost reduction — The new law reduces many types of payments to providers for Medicare services, which officials say will push back the day when the program runs out of money. It also provides administrators with more authority to address fraud.

The new law breaks away from the current "pay and chase" system in which the government pays suspect claims and then tries to recover the money when fraud is proven, Baker said.

"I think that's going to really help the government tamp down fraud," he said.

Baker, a former director of the Health Care Bureau in the New York Attorney General's Office, said it is much easier to avoid paying fraudulent claims than to try to get the money back, since the scammers often move the money offshore before an investigation can be concluded.

The augmented benefits for seniors have not drawn much controversy, but Republican opponents of the law question whether the projected cost savings are real.

Trustees of Medicare's Hospital Insurance Trust Fund have estimated that the savings under the health care bill will push back the projected insolvency from 2017 to 2029.

That, said Baker, gives the system an extra 12 years of "breathing space" to work on more ways to reduce costs. "There's still more work we have to do," he said.

But Sen. Pat Roberts, R-Kan, an opponent of the health care law, is concerned that the system may be unable to control costs to the extent predicted and that the projections may not be met, said Sarah Little, an aide to the senator.

A Republican analysis of the trustees' report, supplied by Roberts' office, leans more heavily on statements by the trustees' auditors.

"Despite this significant improvement, however, the fund is still not adequately financed over the next 10 years," the auditors said. "HI (hospital insurance) expenditures have exceeded income annually since 2008 and are projected to continue doing so under current law through 2013."

Roberts also is concerned that cuts in payments to health care providers might not be sustainable, which could reduce seniors' access to services under Medicare, particularly in rural areas, Little said.