New Mexico State Senator Dede Feldman's Blog

Mad Medicaid Cuts Slip under the Radar at Year’s End

Mad Medicaid Cuts Slip under the Radar at Year’s End

     Just when you thought you’d heard all about the end-of-the-year tussle in the Congress-- about the attempt to sneak ANWAR onto the Defense Appropriations bill, and the illegal wiretaps that handed the administration a defeat in immediately renewing the Patriot Act--there’s a little something that snuck under the radar screen.

     It’s the fact that the Senate budget (passed with a tiebreaking vote by VP Cheney) will enable huge health care cuts for children and low-income Americans, which preserves the profits of private Medicare health plans.

     The bill’s doomsday provisions didn’t escape our own Senator Jeff Bingaman, however, who has increasingly become a voice of reason in bringing some sanity to the mad Medicaid and Medicare wars. He delivered a great stopgap speech on the floor of the Senate last week—to no avail. Here are some facts, as revealed in the speech:

     Provisions in the bill may lead to a reduction in benefits to low income Americans by 15-35% and impose increased co-payments and premiums.

     Eligibility for nursing home care under Medicaid will be restricted, with as much as $6.5 billion cut out of the federal portion of the budget, meaning millions more from the state portion of the program will not be spent.

     The already-hard hit Indian Health Service would begin charging co-pays and premiums for its population—intensifying the crisis in Indian health services that is especially severe in Albuquerque, where patients then arrive at UNM Hospital emergency room. This measure alone will decimate Indian health care.

     And, hamstringing the ability of hospitals and other safety net providers to pick up the slack, the Medicare Disproportionate Share Hospital Program (DSH) will suffer a $3 billion cut.

     Meanwhile, the $10 billion fund within the new Medicare prescription drug bill to allow participation by private health plans, as intermediaries between seniors and their benefits, was untouched.

     The entire package will cut $26.5 billion from Medicaid and $22.3 billion in Medicare over the next 10 years.

     The AARP, and 140 health care organizations, 35 others who are part of the Consortium for Citizens with Disabilities, the American Cancer Society, the National Council of La Raza and many other organizations are opposing the cuts.

     Stay tuned for Rep. Heather Wilson’s vote on the package in January.

     Wondering where the money saved will go? Don’t switch the station lest you miss the full details of the Administration’s tax cut package, due in after the first of the year.

     Meanwhile, Robin Hood—in Reverse—Wishes you Holiday Cheer—as Rome Burns.

Medicare's Wild Rumpus Continues...

Mrs. Shirley Forman on Senator Feldman's article Medicare's Wild Rumpus Costs State Plenty

Dear Senator Feldman:

Your article on the op-ed page of the November 21st Albuquerque Journal hit the nail on its head really hard!! I am in full agreement with your comments. The cartoon with it was a painful "hoot".

I've been trying to figure out the Medicare Durg plan and have been having a really tough time of it. I attended the forum that Heather Wilson ran at the Pueblo Cultural Center a couple of weeks age and was very disappointed -- only a few providers attended and the information they brought was very sparse; it was mostly hype. Few had formulary lists, but did send them to me when I asked. I also telephoned two more providers and asked them regarding their formularies; one didn't have a list ready at all, and another had a list of only 75 drugs. When I asked that one about four of my drugs (I use twelve, of which eleven are generics), I was told that none of those four, though they are very commonly used, were on their list!

I received an almost-complete list from the AARP plan, and after some very careful number crunching, I came up with the fact that their plan would cost me several hundred dollars more a year than I am spending now. I don't like HMO's and wouldn't trust those of Lovelace or Presbyterian, so they're out.

I am 84 yeas old, living at the Woodmark, an assisted living facility here in Albuquerque. The medications I am taking are doing a pretty good job of keeping me alive and functioning, though I am currently wearing steel braces on my legs (to keep me from falling), and using a walker. I am on of the few people living here who is still in rather good command of my mental faculties, and if figuring out this new Medicare Drug plan is difficult for me, what is it doing for people who are not as mentally healthy as I am? Yes, most of them do have family members or friends to help with financial affrairs, but what about those who don't have this backup? I know of several; one woman said she doesn't care, since she's almost 95 and how much longer does she have anyway?

Why worry about "catastrophic illness" at this stage of our lives? I, for one, have distributed my living will and instructions for my final days/weeks/months to my three daughters, my doctors, hospitals, and current caregivers, and they all know that any "catastrophic illness" is to be met with pain relief, tender care, and nothing else.

I could go on, but I'm sure you get the picture. Your comments would be very much appreciated.

ARE WE PREPARED FOR A “BIRD FLU” EPIDEMIC IN ALBUQUERQUE

ARE WE PREPARED FOR A “BIRD FLU” EPIDEMIC IN ALBUQUERQUE OR A NATURAL DISASTER LIKE HURRICANE KATRINA?

That’s a question constituents often ask—and the answer is not that simple.

      Emergency planners in New Mexico “hope for the best but plan for the worst.” Each disaster—from the anthrax letters in 2001 to our own bosque fire in 2003-- provides new learning to allow local, state and federal governments to better deal with emergencies.
          
      Since 9/11, significant federal funds became available to the State of New Mexico to enhance the State’s capacity in emergency preparedness, prevention, response and recovery, planning, training and education. The New Mexico Department of Health created the Office of Health Emergency Management to administer bioterrorism and hospital preparedness grants from the federal Health and Human Services Department (http://www.health.state.nm.us/ohem). And, the New Mexico Department of Public Safety, Office of Emergency Management, administers monies from the federal Department of Homeland Security (the most recent grant was announced last week) to assist Local Emergency Managers and Local Emergency Planning Committees in the critical first, local response (http://www.dps.nm.org/emergency).

     We all saw how Hurricane Katrina demonstrated the need for closer coordination between local, state and federal responders (“Brownie,” where were you?). But those shortcomings should not diminish the many heroic and unselfish actions by our emergency responders.
     The New Mexico Disaster Medical Assistance Team, housed at the UNM Center for Disaster Medicine, was deployed prior to Katrina reaching the Gulf Coast and provided vital medical care under extremely difficult circumstances in New Orleans and Baton Rouge, Louisiana. Albuquerque and the State of New Mexico again demonstrated its generosity to those in need by opening the Albuquerque Convention Center on September 4, 2005 as a Red Cross shelter to ninety-two evacuees from the aftermath of Katrina. The New Mexico Department of Health created a Volunteer Health Registry to identify health professionals available for deployment if needed. I am proud of these efforts.  Subsequent briefings also identified the benefit that prior planning and the creation of partnerships between public and private sectors played in the local response.

     The threat of Avian or “Bird” Influenza mutating into a killer virus easily spread between humans is now receiving a lot of attention. Only the extremely elderly among our population remember the world’s last great pandemic flu in 1918-1919 which killed millions world-wide and an estimated five thousand New Mexicans out of a total estimated State population of 360,000 persons.
     The New Mexico Department of Health held a pandemic influenza flu conference in Albuquerque on October 29, 2005 to plan for a State response. Shortly thereafter the federal government issued its National Strategy of Pandemic Influenza and the federal Health and Human Services Department’s Pandemic Influenza Plan (http://pandemicflu.gov). Clearly our already overtaxed hospital system would be stretched thin by the “surge” created by a pandemic flu outbreak. Plans are underway to create alternative health care sites for  those who may be affected but who do not need the acute care services of a hospital.

     No one can predict specific future emergencies. Plans can only anticipate general contingencies. The bottom line is that government agencies and a well informed public will need to work cooperatively to respond to whatever emergencies, natural or man-made, may appear.  Knowing this, a few years ago, I sponsored the Emergency Licensing Act and co-sponsored the Public Health Emergency Response Act. These important, but little known laws lay out a process for quick action and coordination in a medical emergency or bioterrorist attack. I know that I rest a little easier with them on the books—but let me know what you think.  For more information on the Emergency Licensing Act (SB 136 enacted in the 2002 Regular Session) and the Public Health Emergency Response Act (HB 231 enacted in the 2003 Regular Session,)    go the New Mexico Legislature’s website at www.legis.state.nm.us and click on “Bill Finder”. Then click on the date of the Regular Session, select the appropriate chamber of the Legislature and type in the bill number. A page will appear for that particular bill. Click on “Final Version” for the bill signed by the Governor.

12/1/05

Medicare’s Wild Rumpus Costs State Plenty

                                                            

                                                                                  

Dede Feldman

       

        As children’s author Maurice Sendack said in Where the Wild Things Are, “Let the Wild Rumpus Begin.” And begin it has.

        All over  New Mexico this week, seniors-- and many others with disabilities and chronic conditions--are frantically thumbing through indecipherable brochures, worrying over whether they will loose their current RX benefits, and viewing TV ads touting 50 different local plans, each with its different premiums, deductibles, formularies and pharmacy networks.  Their children are in a different kind of hell, They are scanning websites, trying to make heads or tails of something called a “Medicare Calculator” and puzzling out the differences between a MAP (a Medicare Advantage Plan) and a PDP  (a Prescription Drug Plan).  Some are calling Social Security to see whether they qualify for low-income subsidies; others are talking to their pharmacists, who, overwhelmed, are on the verge of throwing up their hands about their new, enhanced, role as social workers and confidants.

       The state’s Human Services Department has already spent $5.3 million in administrative costs to adapt the federal program to New Mexico’s population.  The Department of Aging and Long Term care has run approximately 80 town halls all over the state to explain the program.  The state’s toll free number for benefits counseling (1-800-432-2080) has received three times the usual number of calls.  On the other end of the line are over thirty volunteers specifically recruited for this purpose.  Each call requires individual counseling based on the prescriptions taken, the place lived, the income and lifestyle of the caller.  It is an unbelievable administrative—and human-- burden on our state.  And that doesn’t even count what is euphemistically called  “the claw back”—a payment of approximately $28.6 million (so far) that the state will have to pay the federal government for its assumption of payment for people with disabilities who qualify for both Medicaid (a state program) and Medicare (a federal program).

       “They could not have made it more confusing if they tried,” said Secretary Debbie Armstrong, of the Department of Aging and Long Term Care.   

       This week, at a local town hall in the North Valley, which was ably facilitated by the Senior Citizen’s Law Office and attended by almost as many insurance salespeople as seniors, there was visible confusion and dismay among potential enrollees.  Apparently, this is true at the national level as well.  According to a survey done by the Kaiser Family Foundation in cooperation with the Harvard School of Public Health, only 31 percent of seniors had a favorable opinion of the program.  Now that may not be surprising given that many retirees already have some prescription drug coverage provided by their former employers, or have bought supplemental policies to help with specific problems, But, according to the survey, even those who lacked any prescription coverage at all are reluctant to enroll, with only 28% saying they would do so.

       Enrollment in the program is voluntary—and there is no rush to enroll before the May 2006 deadline.  But here’s the rub.  If a senior declines to enroll, lets say because he or she’s healthy and doesn’t need the help now, or because he or she can’t justify paying a $30 monthly premium, there is a penalty of 1% of the average monthly premium for each month he or she delayed enrollment, for as long they are enrolled in a Medicare drug plan.

       And while seniors are now grappling with these and other enrollment dilemmas, a whole new tangle of coverage problems awaits--from new co-pays disabled people who previously paid nothing, to “donut holes” that will leave beneficiaries high and dry in their most urgent hours of need.

       In the face of all the confusion, what are the state, and the individual senior citizen to do?

       For individual counseling, I’m encouraging my senior constituents to call the state’s toll free number at 1-800-432-2080.  For those who are not intimidated by a government web site, with charts, calculators, listings and interactive features, go to www. Medicare.gov. (God bless and good luck). I hope your blood pressure doesn’t rise so much that you’ll need to double the dosage of whatever you’re taking. 

       Don’t forget your local pharmacist who will be able to tell you what networks he or she participates in—and, if there’s not too long a line, offer other help as well. Whatever you do, wherever you go, have a list of drugs you take handy, and what you’ve spent on them over the past few years.

      In any case, take your time to select a plan. For state retirees, the best advice is to stick with the New Mexico Retiree Health Care Authority’s plan.  Its RX benefit is equivalent to or better than any offered under Medicare Part D.

      For the state of New Mexico, the burden is heavy.  Not only must state and local agencies, non-profits, relatives and others guide the approximately 250,000 Medicare beneficiaries who are eligible here through the enrollment process, they must also pay at least $28.6 million to make up for any possible savings the Medicaid program might have experienced from the feds paying for drugs for the so- called “dual eligibles.”  And that number may rise dramatically in the months to come, tapping into our already strained Medicaid program.

       For the first time in our nation’s history, the states are subsidizing a federal health care program, and many predict a lawsuit against the Center for Medicaid and Medicare Services (CMMS). Texas and New Hampshire have already said they will not pay the “claw back,” ringing the gong for round one of a marathon boxing match between the states and the federal government over who pays for the escalating costs.  Sitting at ringside are the pharmaceutical companies, taking bets, pocketing the money.

                              

      

Dede Feldman is a Democratic Senator from District 13 in the North Valley of Albuquerque. She is vice-chair of the legislature’s Health and Human Services Committee

Medicare’s Wild Rumpus Costs State Plenty

Speech to the League of Women Voters Health Care Reform

Speech to the League of Women Voters Health Care Reform Forum Senator Dede Feldman

      

       First, Thanks to the League of Women Voters and MacNeil/Leherer productions which has made this program possible. It is an honor to be on the same stage with Dr. Henry Simmons and the National Coalition on Health Care. And, of course, the MacNeil news hour is one of my favorite programs and Dr. Simmons and other national figures now focusing on health care reform, like Uve Reinhart— are my heroes.

      When I was initially told I’d have about 30 minutes to speak— I gasped and thought about the last time I did that which was when I’d had about four cups of coffee and we needed to kill some time on the floor of the Senate. But actually, I’m glad to get more of a chance to talk about health care reform than I usually do.

      Looking at the skyrocketing costs of premiums, the increasing expenditures and costs of Medicaid, the increasing rates of uninsured Americans and especially the coming tidal wave of elderly Americans— it is hard not to throw up your hands or at least get very cynical in suggesting remedies….

      Here are just two of the suggestions I have gotten via e-mail to cure our problems:

      First, from a LA Times column by Barbara Eherenreich, the author of Nickeled and Dimed in America, who suggests that we simply outsource our health care like big industries are now outsourcing the manufacture of many goods and the provision of many services. She says … “many U.S. residents reimport their prescription drugs from abroad or travel to Manila and Singapore for “low-cost, high-quality care,” Ehrenreich says. Before long, “Motel 6-style hospitals might be “springing up in Tijuana for the American working class,” she adds. Ehrenreich notes that the “abolition of the American health care system [would] lead to some difficult readjustments,” including that U.S. doctors, nurses and technicians would have to find work in the medical tourism field abroad. However, she adds that “for the estimated two million to three million insurance company functionaries whose sole business it is to turn down your claims, these folk may be a bit harder to re-employ because they have no counterpart in any civilized, health-providing nation”.

      Or, this from an Onion magazine piece in 1999, which seems even more timely today… datelined Washington, DC,   “Overwhelmed by a dearth of funds and a glut of recipients, the Social Security Administration unveiled a new Early Death Incentives Plan Monday. Under the terms of the program, senior citizens willing to sacrifice additional years of life will be eligible for larger payouts. Under the Early Death incentives plan retirees can double their monthly social security payouts by signing an agreement to perish within five years, or quadruple their payouts by dying within three.”

      Well, it’s tempting to resort to that type of cynicism here in NM where we have the second highest number of uninsured people in the country and where one in five New Mexicans are covered by a shrinking Medicaid system — due to our high poverty rate. As you know, we are one of the poorest states in the union with over 18% of our residents living below the federal poverty level and nearly half below 200% of the federal poverty level (which for a family of three would make it $32,180 per year). Remember, that’s half our population, most coming with families whose members already have jobs, albeit low-paying ones.

      But we can’t afford to be cynical.  That’s a waste of time— the present system is unsustainable—and we must act before it gets even worse.

      And just to give New Mexico kudos—and the thousands of health care advocates and legislators who have been active here during the past 15 years—we have made progress. Recognizing these economic facts of life, the legislature has worked pro-actively and incrementally to provide comprehensive health care coverage for all of its residents here in this rural state.  And, up until last year, I thought we had some basic philosophical agreements—embedded in law—that bode well for progress in this area.  After all, here’s the official health policy of the state of New Mexico, adopted when the Health Policy Commission was created in the early nineties:

"It is the policy of the state of New Mexico to promote optimal health; to prevent disease, disability and premature death; to improve the quality of life; and to assure that basic health care services are available, acceptable and culturally appropriate, regardless of financial status. This policy shall be realized through the following organized efforts:

*     Education, motivation and support of the individual in health behavior;

*     Protection and improvement of the physical and social environments;

*     Promotion of health services for early diagnosis and prevention of disease and disability;

*     Provision of basic treatment services needed by all New Mexicans".

      

      For the nine years that I have served on the HHS Committee, many of those as its chairman, we have considered health care reform as a major initiative, and made important incremental progress with several major initiatives that I believe have increased access, coverage and quality of health care.  There has been interest in universal coverage, but the specific single-payer approach advanced since 1990 has never garnered sufficient political will for passage…but that does not mean we have made no progress.

      Just going back to 1991, let me remind you of some of the important reforms we have enacted:

In 1991:

*     Health Policy Commission was created, establishing a state health policy.

*     The minimum Healthcare Protection Act passed.

In1993:

*     We created the Health Care Task Force that led to an evaluation of universal coverage plans

     and a study of children's insurance needs.

In 1994:

*     We increased Medicaid eligibility from 135% to 185% of the federal poverty level---- and later

       to $235%

*     Created the Health Insurance Alliance

*     Authorized managed care for Medicaid

*     Created the N.M. Health Service Corps and a Professional Loan Repayment fund

In 1995:

*     We created a Medical Care Savings Account

In 1997:

*     We enacted the Health Care Purchasing Act (IBAC)

In 2000:

*     We enacted the Mental Health Parity Act

In 2002:

*     We created the Senior Prescription Drug Program (through RHCA)

*     We mandated the development of a preferred drug list (PDL) under Medicaid

*     We established a Medicaid Reform Committee

In 2003:

*     The Governor's Task Force on Health Care Coverage and .Access was created and the

       Medicaid reform committee program changes and studies from the previous year were

       mandated. In the same year we enacted H955 -- A 2 year study requiring a

       comprehensive study of the public and private cost of providing health care to all New

       Mexicans purchasing of health insurance in the IBAC.

In 2005:

*     We enacted the Small Employer Insurance Program (SEIP) to allow small employers

       to "buy into" the state's health insurance program.

*     Made the Health Insurance Alliance more affordable for 20 somethings.

*     We allowed coverage by their parents’ plan even if they were not full time students.

*     We authorized offering of insurance to part time employees.

*     We created the Behavioral Health Cooperative.

*     We started the State Coverage Initiative (SCI) – a Medicaid expansion and premium

       assistance plan for low income, working New Mexicans.

      Right now, we are in a crucial period for health care reform in New Mexico that’s why this forum is so timely as the national picture becomes more dismal further Medicaid cuts loom… and the international economic picture worsens for America due to its ideological and bureaucratic inability to deal with health care realities. But, as employers begin to move away from hardened positions of the past we have an opportunity. With that in mind, we in the legislature in 2003, commissioned a study directed by HB 955 of the public and private costs of providing health care to all New Mexicans. Sometimes if all the parties can agree on the facts misconceptions can be dispelled and progress can begin. During the course of this study we learned lots to guide our policy decisions for years to come:

      

In 2002:

*     According to the most recent year with verifiable figures we spent close to $8 billion

     dollars on health care in New Mexico

*     75% of the spending was publicly financed (federal and state unding)

*     64% of the spending was paid for by the federal government

*     The economic impact of federal spending alone totaled nearly $5 billion dollars, and

     represented 25% of all federal spending in the state

*     Every 10% cut in health care spending reduces state output buy $285 million, reduces

     earnings by over $234 million and the state loses over 9,400 jobs

*     Clearly the amount spent on healthcare in the state is enormous, and the economic

      impact is profound, but are we spending our money as wisely as we should be, and

      achieving the effect of  insuring all New Mexicans while holding costs down?

*     The complexity of health care delivery, administration and financing requires an ongoing

      evaluation.  To that end, the Legislative Council has contracted with NMSU to complete

      year two of this important study.  With more years of consistent, baseline information,

     the legislature will be able to identify trends and project the impact of many policy

      initiatives on the state.

*     The Legislative Health and Human Services Committee is committed to continuing to

      explore ways to achieve "universal coverage" (and I use those words carefully) for all

      New Mexicans. This year we have heard testimony regarding a market-based approach

     to reaching this goal, and at our November meeting will be devoting significant time to

     a discussion of other approaches, including testimony from the "Health Securities for

     New Mexicans" campaign, the "Health Care for All"  campaign, and the recommendations

      of the Governor's Insure New Mexico Council (of which I am a member).

      I am personally very interested in some of the new approaches put forward by the National Coalition on Health Care Reform and Ken Thorpe and presented at the National Press Club in DC this summer. This study presents some insights on how to control costs, expand public programs, and mandate employer and individual coverage.  There are others too, like the emerging Wisconsin model which creates a purchasing pool, incorporates consumer-driven incentives, assesses employers, and requires Health Insurance Purchasing Accounts.

      Momentum is clearly building for a much more sweeping and comprehensive solutions to the healthcare challenge facing our state and our nation. We have spent years trying to achieve the mandate established in our state health policy, and, I believe, have made great strides toward accomplishing it.  But, the demands are great and growing greater. It is surely time to think in larger terms and respond to the growing plight of our uninsured in the state.  Perhaps we need to reaffirm our belief in sharing risk—pooling together—as a bedrock American, democratic value. Clearly, I have learned that this is not a given—but perhaps we should, somehow, make this choice more explicit. Then we will be able to work together more productively toward a healthier New Mexico.