Every year a host of mailings from the Centers from Medicare and Medicaid Services (CMS), Social Security and Medicare Advantage health plans are sent to millions of Medicare beneficiaries. Some of these notices (the color-coded ones) are for people receiving the Part D low-income subsidy (Extra Help) for their prescription drug costs; others are for people in Medicare Advantage plans notifying them of any benefit, formulary and cost-sharing changes for the new year. Additional notices include those to beneficiaries who are in terminating or non-renewing plans, those to higher income beneficiaries about income related Part B and D premium adjustments, and those to people receiving Social Security about benefit payment changes for the coming year due to cost of living increases, variations in the premiums that are withheld, etc.

CMS  has a comprehensive chart (PDF) that lists all such notices for 2012/2013 detailing the mail date, sender, what the mailing and/or color is, the main message, and any action the beneficiary should take upon receiving one of these notices. All notices that are available online are hyperlinked, yet the hyperlinked notices for this year won’t be available later this fall.

A number of important health care bills passed the California State Legislature last week. One bill, AB 999 authored by Assembly Aging and Long-Term Care Committee Chair Mariko Yamada (D-Davis) protects consumers from excessive premium rate increases by modifying the long-term care insurance (LTC) premium rate development process. It also helps consumers make more informed choices about buying a policy by giving them the opportunity to review a policy’s language before purchase. More can be read about this bill in the California Department of Insurance’s recent press release.

The other health care bills, if signed by the Governor this month, will ensure that California is ready to adopt the many health care reforms scheduled to begin in 2014. While federal law under the Affordable Care Act includes many provisions, resources and a platform for improving the quality, coverage and protections in our health care system, it is still up to each state to bring this law into reality, to enforce the new consumer protections, and make sure Californians know about and enroll in to their new coverage options. Health Access recently published a brief summary (PDF) of the legislation.

The Department of Veterans Affairs (VA) is reaching out to providers, health care professionals and advocates, social workers, and other people who have contact with veterans through their jobs in an effort to make sure our veterans know about their VA benefits. Many Veterans, according to the VA, don’t fully understand all the VA benefits they qualify to receive. That’s why the VA is now aiming some of its education to providers who work with this population as a way to spread the word about these benefits and increase the numbers of Veterans who make full use of the benefits to which they are entitled. With more than 22 million military Veterans nationwide, if you are a professional in the health care field your chances of working with a Veteran are quite high.

One upcoming educational activity the VA is sponsoring is a webinar that gives professionals who work with Veterans a basic understanding about VA benefits and some resources they can use to refer Veterans to VA to get their entitled benefits. The next session is on September 11, 2012 from 9:00 – 10:30a.m. PDT. Register at: http://goo.gl/OROVb.

Also, our website section on Medicare and VA benefits and our fact sheet, Medicare and Veterans Administration Medical Benefits Package, gives an overview of the VA benefits and how to apply.

For any questions about the VA sponsored webinar, contact Voncelle James at (202) 530-9219 or voncelle.james@va.gov.

The Million Hearts initiative aims to prevent one million heart attacks and strokes over the next five years by minding the “ABCs.”

Bonnie Burns, a Training and Policy Specialist, was interviewed on KGO’s New Talk bay area radio station regarding CalPERS’ announcement of long-term care (LTC) insurance premium rate increases. Recently CalPERS LTC insurance policy holders received a notice of premium increases of 85% for 2015. Of the 140,000 people in California with these policies, many are understandably upset and feel that the promises made to them when buying their policies are not being met. One woman who has been paying about $3,000/year in premiums, has been notified that she’ll need to pay $15,000/year to keep her policy with the rate increase. This type of increase is unsustainable for most.

In the interview, Burns speaks to this situation and encourages people to contact their local Health Insurance Counseling and Advocacy Programs (HICAP) for assistance. CalPERS will offer some adjustments to people’s polices so they can have a lower premium and still keep some benefits. It will be important for people to understand all their options before making a decision one way or another about their policies.

The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper’s analysis of national survey estimates found that access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist. We also found that children—many of whom qualify for public coverage through Medicaid and the Children’s Health Insurance Program—generally maintained or improved their access to care during the same period. This provides a reason for optimism about the ability of the coverage expansion in the Affordable Care Act to improve access for adults, but it suggests that eliminating the law or curtailing the coverage expansion could result in continued erosion of adults’ access to care.

Regardless of age people should know the warning signs that indicate your mouth teeth and gums may be in jeopardy.  

* Teeth Grinding
* Dental Pain
* Sensitivity
* Mouth Sores
* Bumps
* Swelling
* Red Gums
* Loose Teeth
* Jaw Popping or clicking
* Dry Mouth
* Bleeding Gums

If you notice one or a few of this warning signs make sure to see a dentist right away.  It is important to take proper care of oral health in order to maintain an overall healthier you.

The Affordable Care Act will expand Medicaid eligibility in 2014 to adults with incomes of up to 133 percent of the federal poverty level. To maximize this opportunity, policy makers need to ensure that participation, or “take-up,” among eligible adults exceeds current rates. Using the Current Population Survey 2005–10, it is estimated that the nationwide Medicaid participation rate was 62.6 percent among eligible adults ages 19–64 without private insurance.

Take-up varied widely by state, from 43.0 percent in Arkansas and Louisiana to 82.8 percent in Massachusetts, after adjusting for population demographics. Participation was highest among disabled adults, 75.8 percent, and lowest among childless adults, 38.3 percent. Factors linked to higher take-up rates included low cost sharing for beneficiaries; more generous benefits; and greater use of managed care programs for Medicaid populations.

Factors associated with lower take-up rates included the existence of asset tests in some states. Massachusetts’s health reform was associated with a major increase in Medicaid participation. Our results suggest that when Medicaid is expanded in 2014, take-up may be less than anticipated because new enrollees will be offered a more restrictive set of benefits—known as “benchmark coverage”—compared to those in traditional Medicaid, and the majority of newly eligible adults will be in groups with traditionally low take-up (primarily nondisabled adults). To encourage high participation in the expanded Medicaid program, states will need to offer comprehensive coverage of needed benefits; provide community-based outreach; and consider more dramatic changes to their enrollment processes, such as automatically enrolling people in Medicaid based on their participation in other public programs.

During 2009, 730,000 prisoners were released from federal and state prisons.  This is a 21 percent increase from the number of prisoners released in 2000. Poor health and poor health coverage have been major challenges for former prisoners trying to reintegrate into the community and find work. Discuss  are the challenges and the likely effect of recent federal legislation, including the Second Chance Act, the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act.

It is estimated that with the implementation of health reform, up to 33.6 percent of inmates released annually—more than 245,000 people in 2009—could enroll in Medicaid.   Similarly, it was estimated that up to 23.5 percent of prisoners released annually—more than 172,000 people in 2009—could be eligible for federal tax credits to defray the cost of purchasing insurance from state health exchanges.

This health insurance, combined with new substance abuse services and patient-centered medical home models, could dramatically improve the health and success of former inmates as they return to the community. States should consider several policy changes to ease prisoners’ transitions, including suspending rather than terminating Medicaid benefits for offenders; incorporating corrections information into eligibility determination systems; aiming Medicaid outreach and enrollment efforts at prison inmates; and designing comprehensive approaches to meeting former prisoners’ health care needs.

Proposals to move toward reducing geographic differentials in health care spending have focused on patterns of spending in Medicare. We show in this article that when considering each state as a whole, there is almost no relationship between the level of spending for Medicare beneficiaries and that for other populations. In sharp contrast to these state-level results, there is a strong relationship between Medicare and Medicaid spending in comparing Hospital Referral Regions within each state. We suggest that the strong intrastate regional correlations demonstrate the importance of the supply of hospital beds, specialists, and other health care resources as determinants of use and spending. In contrast, the lack of correlation at the state level suggests that other factors, such as state-level poverty rates, influence use and spending at the state level, and that these other factors influence Medicare and non-Medicare use and spending differently. These findings demonstrate that it is important to broaden our analytic focus from Medicare beneficiaries to the larger population, and to consider the likely effects of changes in Medicare payment policy on the care received by other state residents.

Roughly half of Medicare beneficiaries under age sixty-five are also eligible for Medicaid. These “dual eligibles” have been the subject of much research because of their low income and poor health status. Previous studies suggest that some states seek to shift costly health care services for this group out of state-run Medicaid programs and into the federally funded Medicare program—for example, replacing nursing home care with hospital care. Using state-level data on dual eligibles under age sixty-five, we found support for this hypothesis. In states with below-average per capita Medicaid spending, corresponding Medicare spending was above average. These state-level estimates also revealed a nearly threefold difference in total—Medicare plus Medicaid—price-adjusted spending per person, ranging from $16,309 in Georgia to $43,587 in New York. Such large variations among people with serious diseases suggest inefficiency. Some states may be spending too little for Medicaid, meaning that some patients’ needs are not being met, or some states may be spending too much, meaning that more services are being provided than needed. Such inefficiency exposes patients to unnecessary risk, drives costs up unnecessarily, and highlights the large potential gains arising from improved care coordination for dual eligibles.

Under the Affordable Care Act, individual health insurance will probably become more generous and more like employment-related insurance. Currently, individual insurance typically has less generous benefits than employment-related insurance. This study compared out-of-pocket spending on health care between individual and employment-related insurance, controlling for numerous characteristics such as health status. Then it simulated the impact of full implementation of provisions of the Affordable Care Act on adults who currently have individual insurance, including important subgroups—adults with chronic conditions, the near-elderly (ages 55–64), and low-income populations. If adults who had individual insurance during 2001–08 had instead had benefits similar to those under the Affordable Care Act, their average annual out-of-pocket spending on medical care and drugs might have been $280 less. The near-elderly and people with low incomes might have saved $589 and $535, respectively. An important improvement would have been the reduced probability of incurring very high out-of-pocket spending. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many.

For the last several years, Washington Democrats have been demanding a “balanced” approach to deficit reduction that consists of spending cuts and more revenue from tax increases. With the president’s re-election in November and the Democrats picking up additional Senate and House seats, they feel the wind at their backs and are now claiming an electoral mandate for balanced debt reduction. Today, three months after the election, how have they done so far in implementing this alleged mandate?

In just three months, we have seen a “fiscal cliff” deal that increased spending by $330 billion and raised taxes by $600 billion, a $50 billion Hurricane Sandy relief bill that included billions of pork that was completely unrelated to Sandy, and a debt ceiling deal that empowers the federal government to take on an unlimited amount of new debt for almost four months without any new spending restraint.

Members of a consortium of leading US health care systems, known as the High Value Healthcare Collaborative, used administrative data to examine differences in their delivery of primary total knee replacement. The goal was to identify opportunities to improve health care value by increasing the quality and reducing the cost of that procedure. The study showed substantial variations across the participating health care organizations in surgery times, hospital lengths-of-stay, discharge dispositions, and in-hospital complication rates. The study also revealed that higher surgeon caseloads were associated with shorter lengths-of-stay and operating time, as well as fewer in-hospital complications. These findings led the consortium to test more coordinated management for medically complex patients, more use of dedicated teams, and a process to improve the management of patients’ expectations. These innovations are now being tried by the consortium’s members to evaluate whether they increase health care value.

With the presidential and congressional races approaching full swing, the American people are being bombarded with one campaign slogan after another. The problem is that peppering voters with clever catchphrases in stump speeches and television ads does nothing to secure America’s energy or economic future.

With outrageous gasoline prices being matched only by the nation’s troubling unemployment rate, it is time for Republicans and Democrats to dispense with the political jockeying and get serious about an energy policy that can improve the lives of all American families.

The good news is that there is plenty of common ground on which to build a principled compromise.

In a story that should be a wake up call to policy-makers, outsourcing has gone public. As David Barboza of The New York Times reported on Saturday, seeking out low-wage workers off shore isn’t just for iconic American brands such as Apple, General Electric and Levi-Strauss; the phenomenon is increasingly prevalent among public agencies across the nation.

To illustrate the point, Barboza focuses on efforts to replace the eastern span of the San Francisco-Oakland Bay Bridge in California.  After the bridge was damaged in the 1989 Loma Prieta earthquake, officials decided a major overhaul of the Depression-era structure was necessary. The course of action for the 8.4 mile crossing was two-fold: strengthen the iconic double suspension four-tower west span and entirely replace the cantilever box east span.

Initial cost estimates said strengthening of the east span would cost about $700 million, but that for only $200 million more, a new bridge could be built that would withstand a major earthquake and act as a ‘lifeline’ for emergency services.

Some 22 years after the Loma Prieta quake, construction is still underway (it began about a decade ago) and the price tag is now an estimated $7.3 billion.

During the extended, decade-long planning phase, with projected costs soaring and a public outcry against profligacy, the State of California began looking for ways to economize. It opted against accepting any federal money for the project (even though the bridge span is, in fact, the final miles of Interstate 80) on the grounds that federal aid would trigger ‘Buy America’ provisions, driving up the costs further.  Instead, as Barboza writes, construction of major parts of the bridge were contracted out to Chinese companies.

At the time, it sort of made sense — the housing bubble placed a premium both on building materials and the labor needed to turn girders and rebar into a useable structure. A few years later, taxpayers aren’t griping about costs, they’re livid about the thousands of jobs and cutting edge industrial knowhow that sailed across the Pacific.