Tag Archives: Medicare

Choking on the Doughnut Hole

Little Rock      Driving through Mississippi back and forth on my regular route from New Orleans to Greenville to Little Rock and then back again, when I hit the long rural stretches since we belong to the noncommercial radio religion, I listen often to Mississippi Public “Think” Radio.  On Wednesdays, I’ve come to know their lineup well in these stretches from McComb until I pick up the WDSV signal near Greenville.

First, there is the Fix-It show, where I learned how to get vermin out of the attic and walls by using peppermint essential oil, not peppermint extract they were clear, and spraying it there.  Then there’s the tech show where we got a good explanation on how the hardware syncs up with the software when you turn on your computer and sometimes an update can make it all go haywire.  And, Jimmy Stewart comes on who I sometimes tell mi companera is my doctor with his call-in show on medical questions.  He’s a doctor and professor in Jackson, and pretty much can take on all comers and their questions.  This show he helped me understand why your hands sometimes fall asleep when you’re asleep.  Another time he advised all of us to brush our tongues along with our teeth, because they are germ factories.  He’s a fount of great medical information!

The last show took a hard turn though.  He got a call from an elderly woman that blew up the phone lines with various suggestions.  She was caught in the doughnut hole on her Medicare Part D coverage.  It would cost her $500 a month that she didn’t have for a critical heart medicine.  Another caller chimed in from deep in the doughnut hole about the cost of insulin that she had to have, and why it was so expensive when the patent should have been long gone and generics should have replaced the high drug prices.  Other callers lamely suggested writing to the drug companies and begging for help or various funds.  Dr. Jimmy didn’t handle it well.  He tried, as always to be empathetic, but it came off as if he was defending both the hole and the drug companies even while admitting that this was an inexcusable mess.  Trust me, he’s better on medical advice that political wisdom.

The doughnut hole in Medicare drug coverage is a case study on the callousness and ineffectiveness of the crazy ideological Congressional process and the power of drug lobbyists.  Basically, there is a lapse of coverage once a beneficiary has paid their deductible and hit a threshold of coverage.  She is then forced to pay 100% out of pocket up to several thousand dollars until coverage begins again.  This has been going on since 2006.  Supposedly, the gap has been closed or is closing since January of this year, but as the callers indicate, the pain persists and given the percentage payments for some of the higher priced drugs, people can’t climb out of the hole still.

Now, after you hit $4020 in a year, a Medicare patient will be paying 25%, so as it’s not a hole, but it’s a big hit, and it takes money to get there that people don’t have.  As the Times pointed out recently, the new policy will take longer to climb out of as well.  In 2019, catastrophic coverage kicked in at $5100 of your out-of-pocket costs, now in 2020 it will be $6350, which they correctly call “a big jump.”  Furthermore, out-of-pocket costs are never capped, but require an ongoing 5% of the total – which adds up! – throughout the year.  This is not a solution to the doughnut hole but a continuing shift of the costs, all of which fall on the elderly poor patients, like Dr. Jimmy’s callers, and not on the Congressman trying to make the drug companies and the lobbyists happy and pretend they are fixing something that is broken.

Why give people this darned doughnut, when they really need an apple fritter that fills the gap, tastes great, and actually includes some delicious fruit along with the flavor of the fry?


Please enjoy Logan Ledger – (I’m Gonna Get Over This) Some Day

Thanks to WAMF.


The Horrors of Estate Recovery

New Orleans    The horrors visited on low-and-moderate income families are numerous and their damage inestimable and often devastating now and onward to future generations.  Even knowing this, it is still shocking to find additional examples hidden right before our eyes.

A case in point is estate recovery.  The Medicaid Estate Recovery Program in its present form is a legacy of the Clinton Administration.  Prior to 1993, estate recovery for repayment of Medicaid debts was voluntary, but President Bill Clinton signed the bill that year making it mandatory as a part and parcel of his deficit-reduction act and the false rhetoric of changing “welfare as we know it” and the mythical hype of personal responsibility as an antidote for poverty.  Much of the recovery was linked to the aging boomer population and the soaring costs of long-term care in nursing homes.

Medicaid, remember is not Medicare.  Medicare is available for those individuals over the age of sixty-five.  Medicaid is for the very poor.  Since the expansion of Medicaid through Obamacare, the Affordable Care Act, many understand how critical the program is for both the poor and lower waged workers.   In short, let there be no doubts on this score, this was a program deliberately designed and made obligatory in order to punish the poor by trying to raid whatever small estates that they might have when they die in order to impoverish their relatives as well as the deceased.

According to an article in the October issue of The Atlantic, the full level of the mean-spiritedness of this program is revealed, contrary to former Speaker Newt Gingrich and the Clintonista myth of the poor’s irresponsibility, in the almost infinitesimal level of recovery involved relative to the total cost of the Medicaid program or the long=term care program and its cost recovery, and the disproportionate horror it brings to the families trying to pay the bills.  As the story is reported in The Atlantic,

“…the overwhelming majority of estates are not worth hundreds of thousands of dollars.  In 2005, the Public Policy Institute of the AARP published a study of the first decade of mandatory estate recovery, Massachusetts, it found, recovered of $16,442 per estate in 2003,…offsetting a little more than 1 percent of long-term-care costs that year….In Kentucky…the average amount collected from an state was $93; the state recovered just 0.25 percent of its long-term-care costs.  The total amount states recouped jumped from $72 million in 1996 to $347 million seven years later – but even so, estate recoveries accounted for less than 1 percent of Medicaid’s total nursing-home costs in 2003.”

If it’s not just to hurt the poor and their hapless heirs, what’s the real point of this program?   It probably cost more cumulatively for states to administer the recovery program, than they are able to recover!

The Atlantic detailed one story after another of lower income families losing their homes or farms or their folks’ couple of acres and heirlooms passed on through the generations because of this predatory recovery.  The irony of the same program paying hundreds of thousands of dollars for operations and expecting no recovery compared to nursing home care is obvious.  The outrage that allows wealthy families to shield millions from taxation to bequeath to their heirs, while the poor are forced to become poorer and leave their own poverty as their inheritance to their children is equally obvious.

What excuse can there be for such a horror?