By John Mills
A few weeks ago President Obama signed into law a new healthcare reform bill which will expand health insurance coverage for 32 million people who are currently uninsured. This law will be phased in over the next decade but it offers a lot to help family caregivers both in the short term and the long term.
The benefits of the law fall into two categories – provisions which help the care recipient through Medicare and other public programs and those that help the caregiver through expanded health insurance coverage and better consumer protections. The biggest advantages to care recipients come through better coverage under the Medicare prescription drug program and through expanded health insurance options for pre-Medicare retirees.
Family caregivers will see their biggest benefits come from the fact that health insurance will begin to be de-coupled from employment starting in 2014. Many family caregivers face the difficult choice of whether to stay employed and hire professional caregivers to look after their loved ones or to leave their jobs and care for them full time. This decision is made more difficult by the fact that people who leave their jobs risk losing the health insurance benefits that go with them. By providing new health coverage options and subsidies to help pay for them, family caregivers will have one less thing to worry about when making these difficult choices.
Below is an outline of the key provisions of the healthcare reform law and how they are likely to impact family caregivers.
What Goes Into Effect during 2010 and 2011
The expansion of coverage provided by the new healthcare reform law will not be available until 2014 but there are many portions of the law which will go into effect during 2010 and 2011.
Improvements to Medicare Prescription Drug Coverage - The bill provides a $250 “bonus” to all people in a Medicare Prescription drug program in 2010 that hit the “doughnut hole,” the coverage gap that currently begins at $2,830. It also begins closing the “doughnut hole” in 2011 and completely eliminates it by 2020.
Helping Sandwich Generation Caregivers – The bill helps sandwich generation caregivers, those caring for sick parents or relatives and their own children, by:
Eliminating pre-existing conditions for children thereby ensuring sick children can get insurance coverage.
Permitting children up to age 26 to stay on their parents insurance policies regardless of whether or not they are full-time students. Most insurers currently cover dependents not in school only up to age 19 and those in school up to age 23.
Prohibiting lifetime benefits caps on health insurance.
Temporary Early Retiree Program – The law creates a temporary voluntary reinsurance program for employers to help cover early retirees within 90 days of enactment. This should help pre-Medicare retirees find affordable coverage. The program ends in 2014 when the expanded coverage provisions come online.
Medicare Advantage Changes – The law changes the way that Medicare Advantage plans are paid by bringing payments into line with the costs of the regular Medicare program. These payment changes may impact the benefits provided under these plans so review plans carefully at renewal time.
2011 and Beyond
The bulk of the new benefits and subsidies for health insurance will begin in 2014. The lead time is necessary to accumulate funds to pay for the cost of the new coverage.
Expanded Health Insurance Coverage – Starting in 2014, expanded health insurance options will be available for individuals and small business through Health Insurance Exchanges. These are state-based marketplaces that are modeled on the Massachusetts Health Connector system where individuals and small businesses are able to purchase health insurance. The goal is to provide individuals and small businesses with transparency in benefits and pricing so they can compare health insurance and purchase the coverage that best fits their needs.
Health Insurance Subsidies. In order to help families afford the mandatory insurance premiums, starting in 2014 subsidies will be available on a sliding scale, up to a level of $88,000 per year for a family of four. The amount of the subsidies will also be on a sliding scale, meaning that people with lower incomes will receive larger benefits.
Individual Mandate - Almost all Americans will be required to get insurance coverage or face fines—a system similar to the one that’s already in place in Massachusetts. The fines start small at $95 in 2014, but rise rapidly to $695 in 2016. Low-income individuals are exempted from the mandate but most of them will be eligible for coverage through Medicaid or other subsidies.
Consumer Protections – The law has a number of consumer protections including:
Elimination of pre-existing conditions.
Prohibition on recissions, a procedure where insurance companies retroactively cancel coverage.
Expanded appeals for denial of medical services including the ability to appeal decisions to an external review board.
Long Term Care. The bill includes the CLASS Act, which provides a public, voluntary long term care program that working people can purchase. The program would cover home care, respite care, home modifications, transportation, and assistive technologies.
What’s Next
The lesson of social insurance programs is that they always remain works-in-progress. Social Security and Medicare have been modified and expanded a great deal since they were first enacted.
It is likely that there will be expansion and changes to the new healthcare reform law in the coming years. With the aging of the population and people living longer, some of those changes may include additional assistance for the cost of long term care and family caregivers.
John Mills is founder of www.eCareDiary.com, a website for family caregivers. He was a member of the Clinton Task Force on National Health Reform, and legislative director to U.S. Rep. Eliot Engel, D-N.Y.
Our health is, really, all we have. If you think about it, if you don't have your health, you have inconvenient complications, a reduced quality of life and/or something worse. Whether it's a teenager, a middle-aged adult or the elderly, it is important to "take the reigns" and ensure you are the driver when it comes to your health.
We've written before about the importance of being your own health advocate. One of the best ways of doing this is to educate yourself (they don't say 'Knowledge is power' for nothing, after all). How can you do this? One way is to be prepared. In just five easy steps, you can achieve this in a cinch:
- Do research ahead of time - learn about symptoms you think you may be experiencing, read up about (a) condition(s) you may have.
- Write down a list of things you'd like to address, such as concerns you may have, any major life changes that you've experienced, questions you may have.
- Prior to going to the doctor, be sure to sit down and think about these things so you are able to make the most out of the short time you are there.
- Bring a list of medications (including vitamins and supplements!) you are currently taking and anything else you'd like to address.
- Be sure to bring something to take notes on and/or even a voice recorder (with the permission of your doctor, of course).
We love the idea of making a list. Making a list will not only help you to remember the things you'd like to address, but it will also help you stick to the point and communicate clearly. From young children to seniors, many people are afraid of going to the doctor because it can make them feel vulnerable, but having a list of questions and being educated can help anybody regain some control and feel more confident.
That's why we've come up with a series of checklists to jump-start your journey to health advocacy. From "Questions to Ask About Drug Treatment" to "Questions to Ask About Cholesterol" and more, our Resources serve to empower you to "take the wheel" and never look back. See for yourself.
My grandpa Jack (or "Jacko" as we called him) was a rebel. He was a whippersnapper as a child and went on to be kicked out of not one, but two high schools as a teen. I guess you could say that this carried over into his adult years and as he aged, but he rebelled in a different way. Jacko never went to the doctor. I think that a big part of the reason why he never went was fear; he was afraid of what could be. Jacko was happy with not knowing, but is this how things should be? Not if you can help it!
Now, answer a few questions: what kind of relationship do you have with your doctor? Are you comfortable asking questions to clarify something if you don't understand it? Do you feel as though you are being heard and your needs are being met? Everybody - especially aging seniors, like Jacko - should be their own health advocate, and you should truly view the relationship you have with your doctor this way. Developing a collaborative partnership with your doctor can be crucial to your health and wellbeing. Here are some helpful hints to get you started:
Be prepared. Write down a list of things you'd like to address, such as concerns you may have, any major life changes that you've experienced, questions you may have, medications you are currently taking and anything else you'd like to address. Prior to going to the doctor, be sure to sit down and think about these things so you are able to make the most out of the short time you are there. Making a list will not only help you to remember the things you'd like to address, but it will also help you stick to the point and communicate clearly.
Take notes. Along with your list of items to address, bring a pad of paper or a tape recorder (with your doctor's permission) to log what is said during your appointment. This will help you to share the details of what was said in case you have a hard time remembering afterwards or you are not comfortable with restating medical terminology that was discussed.
Keep a health journal. Buy a notebook to jot down the aforementioned items in. Keep it at your bedside and update it each time you get sick or have a new symptom, or just to keep track of how you're feeling each day. And, of course, bring your notebook to appointments and take notes. These helpful insights can provide you and your doctor with context that may help down the road.
Ask questions and give feedback. Again, you are your own advocate and it is your right to play an active role when you visit your doctor. If you need something to be clarified, don't ever hesitate to share any questions you may have with your doctor. In fact, write down all of the questions you have in your notebook to ask at the end of the appointment. You should also feel free to give feedback - let your doctor know if he or she is being too medical, or if they are not explaining things in enough detail. If you do not feel comfortable asking your doctor questions or giving feedback, it may be a sign that you need a new doctor with whom you will feel comfortable because two-way communication is imperative in a doctor-patient relationship.
Whether you adopt all or just a few of these points, the take-away from all of this is to just go. This is so important that we're dedicating an entire series of entries geared toward helping you to assess your relationship with your doctor and empowering you to take the next steps to being an advocate for yourself in the doctor's office. Whether it is finding a new doctor or preparing questions to ask at your next appointment, there are some small steps you can take to promote a solid doctor-patient relationship. Do you have a family member or friend like Jacko? What would you recommend to motivate them to visit their doctor regularly? Share your ideas now!
Adults, seniors, men, women - patients from just about every walk of life can and do develop chronic heart disease, a condition in which it is increasingly difficult for the heart to pump oxygen-rich blood throughout the body. A new study has indicated what we've seen for years - given they are seeking the appropriate treatment for their condition, patients with chronic heart disease fare better at home versus the hospital.
According to U.S and World Report, an estimated five million North Americans suffer from the disease, and this number is undoubtedly to the growing prevalence of obesity and diabetes. In the United States, worsening chronic heart failure is the cause of more than one million hospital admissions a year, and patients have a 50 percent risk of readmission within six months of discharge, according to the authors of a study published in the Sept. 28 issue of the Archives of Internal Medicine.
We want to hear from you! What are the greatest factors contributing this finding? Why do heart disease patients benefit from being treated in their homes rather than the hospital?
According to Dr. Jerry Avorn, M.D., the elderly face a double jeopardy from drug side effects-they are more likely to get them and the side effects are more likely to go unrecognized. "'Ageism' is the tendency to attribute all sorts of problems-such as fatigue, depression, incontinence, forgetfulness, or unsteadiness on the feet-in elderly people to the process of getting old. In fact, not one of these problems is part of the normal aging problems." Dr. Avorn goes on to say that the new onset of any symptom can be the side effect of a medication and can often be remedied by simply bringing it to the attention of your physician.
So what can be done to avoid ageism in senior care? If you are experiencing unusual symptoms, don't be so quick to chalk it up to old age. Getting older may, in some cases, mean more health issues, but not necessarily. In fact, healthy aging may not have any side effects or symptoms. Here are some tips on how to avoid ageism:
- The best advice is to ask your doctor. Describe your symptoms and be sure to note whether or not you feel that it may not be associated with aging.
- If you start taking a new medication or alter your diet, document it. Keep a medical journal so you can reference it and identify whether or not your symptoms began before or after your change, and how long they lasted.
- Practice describing how you feel and getting in touch with your body. If something hurts, in what way does it hurt and how much? Does it feel like a sharp pain or just an aching? Is it consistent or on and off? Does it occur at the same time each day or sporadically?
Do you have any tips and tricks that you use to document and describe new symptoms? Share them here!
Congress is finally paying much-needed attention to the issue of long-term care as part of a national healthcare overhaul. Senator Edward M. Kennedy introduced the C.L.A.S.S. (Community Living Assistance Services and Support) Act, which is a bill that would establish a national long-term care insurance program that would allow participants to use daily benefits for anything from home care to nursing homes.
Click here to learn more about the C.L.A.S.S. Act bill. What do you think about establishing a national long-term care insurance program? Sound off here - we want to hear from you!