Medicare Blog | Medicare News | Medicare Information

On Monday the first court ruling, since President Obama signed it in March, was filed against the health care overhaul invalidating part of the act. Henry E. Hudson, a Virginia judge appointed by President George W. Bush, ruled that the keystone provision in the Obama health care law is unconstitutional. Judge Hudson issued a 42-page ruling stating the law’s requirement to have insurance is not under the authority granted to Congress under the Commerce Clause; and, that allowing Congress to have such authority "would invite unbridled exercise of federal police powers.” The health care law’s mission to require the 30 million who are currently uninsured be insured and stating that requiring those healthy individuals to pay for insurance will help cover the cost of those with pricy medical conditions. He reasons that the law requiring car insurance is different because no one is required to have a car, only required to have insurance if they choose to have one. Hudson is the third district court judge to determine the merits of the two dozen lawsuits challenging the health care law; the other two judges upheld the law and are currently in appeals. This leads critics to wonder if the lawsuits are as much as political assault as a constitutional. If not deemed authorized under the Commerce Clause, Congress could also use the taxation powers granted by the Constitution to justify requiring insurance, assessing it as an income tax penalty With the health care laws set to begin in 2014, Republicans are calling to slow down the implementation. Judge Henry Hudson is also known for sentencing the NFL quarterback Michael Vick to 23 months in jail for his involvement in a dog fighting ring.

Bonus Pre-Test for ACOs

The Centers for Medicare and Medicare Services (CMS) reported that half of the ten physical groups testing the Medicare bonus plan for quality and spending control earned money for the fourth year in a five-year experiment. This bonus plan is a pre-test for accountable care organizations (ACOs) which will start in 2012 under the health care reform law. In order to earn a bonus, doctors must cut spending by 2% after that the physician groups may claim up to 80% of savings up to 5% and Medicare keeps the rest. The American Hospital Association urges ACOs to be more lenient with their requirements, since only half of the groups received bonuses. ACO regulations are expected to be released in January with one of the physician groups describe the bonus plan as a "valuable learning experience.” The CMS hoping to include these 10 physician groups in the Medicare ACO under health care reform.

Woodmen of the World Plan N Released in Ohio

Effective December 15, 2010 Woodmen of the World Plan N is available in Ohio – please see the Ohio Notification and Ohio Rates or call 1-800-998-7715 to get contracted.

Forethought Medicare Supplement Filed in GA, MN, NE, NV, ND, SD, and TN

Happy Holidays

Sources: KHN, The New York Times, Wall Street Journal, ModernHealthCare

On Wednesday the Senate agreed to avoid planned steep cuts in Medicare pay for doctors by shifting money from the President's health care overhaul law to cover it. When passing the health care laws, Medicare cuts were used to pay for most of the cost and now lawmakers are reversing the money to delay the scheduled 25% cut to doctors, which would have begun January 1, 2011. This measure was important in stabilizing Medicare as an estimated two thirds of doctors were planning to stop taking new Medicare patients under this cut. This would also affect Tricare recipients, which covers military service members and their families as well as retirees. The $19 billion to pay doctors in 2011 will come from tightening the rules on tax credits in health care laws to prevent wasteful spending. Lawmakers will use the next year to come up with a way to pay doctors for quality care instead of quantity of tests and treatments. These doctor pay cuts are part of a 1990 budget-balancing law, which was an attempt to keep Medicare spending in line using automatic reductions. President Obama has said it is time for a permanent solution and not another temporary fix and he looks forward to working with Congress on this next year.

Fears of Possible Backlash to ACOs

Beginning in 2012 accountable care organizations (ACOs), which are groups of doctors and hospitals that coordinate efficient, quality care to Medicare patients, will be formed. This week the Medicare Payment Advisory Commission (MedPAC) warns that there might be a backlash in the ACO-assignment process, with beneficiaries feeling pushed into certain managed care without seeing any benefits in the change. In order to entice beneficiaries, they might need to offer incentives like reduced beneficiary cost sharing or sharing in the savings; as well as, offering the choice to switch from an assigned primary care provider to another not in the ACO program. Also, the American Medical Association said the government needs to make safe harbors from antitrust enforcement and anti-kickback laws as currently laws favor hospital-based systems with employed physicians as opposed to small physician practices.

Cold and Flu What Works and What Falls Short

As winter begins in the next few weeks, cold and flu season is out in full force, which puts a damper on our busy schedules. Emily Sohn and Rachel Johnson, Ph.D., M.P.H.'s research on what works and what falls short is good to keep in mind as your throat becomes itchy.

The first suggestion of what works is Vitamin D. Laboratory studies have indicated that Vitamin D may help your immune system to identify and destroy bacteria and viruses that can make us sick. However, the Institute of Medicine released a report on November 30th stating that Vitamin D is best for bone health and there is not yet enough evidence that improves immunity and reduces infection. Still, many experts recommend a vitamin D supplement or you can also get it from fatty fish, fortified milk, and from the sun. Another suggestion to try is green tea, which has potent plant antioxidants that gives it immune-boosting effects. Lab studies suggest that polyphenols called catechins may kill influenza viruses and to maximize the benefits you should use below-boiling water, steeping green tea no more than a couple of minutes, and adding only a little lemon or honey to help the bitterness (adding milk will bind the polphenols, making them no longer effective). Probiotics (or “good bacteria") have been shown to suppress the bad bacteria and activate the immune system when they reach the lower intestine. However, although the level probiotics boost the immune system is low, you can help by eating yogurts or kefir labeled with a "Live & Active Cultures" seal. The last suggestion is soluble fiber, which can help fight inflammation. Eating a lot of citrus fruits, apples, carrots, beans, and oats helped mice in a recent study from Brain, Behavior, and Immunity recover from a bacterial infection in half the time than the mice that ate a mixed fiber diet.

The two things that fall short are Airborn and Glaceau's Vitamine water "Defense." Airborn contains excess of 1667% of the daily recommended value of vitamin C. With the exception of smokers, pregnant women, breastfeeding women, and the elderly most people get enough of the nutrients (vitamins A, C, E, zinc, and selenium) in the supplement with the food we eat. Adding more to our diet is not always better; in fact, it can be ineffective. Additionally Glaceau's Vitamine water “Defense" claims to be formulated with the nutrients required for optimal functioning of the immune system; however, a 20-ounce bottle contains 150% of the daily recommended value of vitamin C. The bottle of water also has 125 calories.

Forethought Released in Texas

Sources: KHN, The Associated Press, The Hill, EatingWell

President Obama’s National Commission on Fiscal Responsibility and Reform, which began in February, drew more support than previously thought and many say it will be seen as a blueprint for future actions on how to deal with the aging American population and the rise of health care. Ten of the eighteen members of the commission are in support of the plan; however, five have said publically and one privately that they will not vote for it. The commission needs fourteen votes to bring to Congress to vote. Also, the commission split on votes shows a divide in Congressional Republicans, with Senate Republicans planning on voting yes while the House Republicans planning to vote no. This can be seen as a reflection of Republicans taking over the House of Representatives after the election, while they still remain a minority in the Senate. House Republicans just elected in also feel an obligation to turn their political platform during the election into policy immediately. The National Commission on Fiscal Responsibility and Reform votes today, Friday December 3, 2010 and the plan overhauls the tax code, federal health programs, and Social Security.

The High Price for Retirement Health Care

OResearch from the nonpartisan Employee Benefit Research Institute (EBRI) shows that sixty-five year olds who retire this year need to have saved more than $100,000 to cover their out-of-pocket health care costs including co-pays, premiums, and other non-reimbursed medical expenses while on Medicare. The researchers also revealed that costs are likely to be more for women (approximately $152,000) than men (approximately $124,000), since women tend to live longer than their male counterparts. Researchers believe that the health care reform bill will help cut some of those costs; however, the costs will remain high for expenses from the retiree. The EBRI research warns that Americans should be setting aside money for this expense and that four in ten Americans plan to delay retirement because of high costs and low income.

Civil Right to Live at Home

The right to live at home has been established in law and federal policy, based on the Americans with Disabilities Act (ADA) which bans the discrimination on the basis of disability. Yet states are slow to create new programs to allow people who live in institutions such as nursing homes and state hospitals, but can live successfully on their own, do so. With states facing record budget cuts, and the federal policy being written for states to do home care within their existing budgets, Medicaid directors are nervous about the new policy that living at home is a civil right questioning where state responsibility ends and individual responsibility starts. Directors also question how they can assure people get good care at home, as sending inspectors to thousands of homes is way more involved than sending to a few nursing homes. Still, nearly 400,000 Americans are currently on the waiting list across the country hoping to have the choice to live at home and receive care.

Gerber Life Medicare Supplement New Rates for MD, CO, MO, and NH

Effective December 1, 2010 new rates for Maryland – please see the MD Notification and MD Rates.

Effective December 15, 2010 new rates for Colorado and Missouri – please see the CO Notification, CO Rates, MO Notification, and MO Rates.

Effective January 1, 2011 new rates for New Hampshire – please see the NH Notification and NH Rates.

New Deductibles for 2011 Now Available

Marketing materials that reflect the new 2011 deductibles are now available. Please consult your marketing director for more information. Or, call 1-800-998-7715 to get contracted for 2011 today!

Sources: KHN, The New York Times, MSNBC, The Hill, NPR