Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – Center Comments on “Junk Plans;” Report Examines Oral Health; Observation Status in the News

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  1. The Sabotage of Health Care Continues – Center Comments on "Junk Plans"
  2. State of Decay: Report Examines Oral Health for Older Americans
  3. NPR Observation Status Story: How Medicare's Conflicting Hospitalization Rules Cost Me Thousands Of Dollars

The Sabotage of Health Care Continues – Center Comments on "Junk Plans"

p>This week, the Center working with other advocacy organizations, submitted comments for the Administration’s proposed rule on Short-Term Limited Duration Insurance. This refers to the “fake insurance” or “junk plans” that we have been highlighting for the last few months. Our Comments come on the heels of the Notice of Benefit and Payment Parameters for 2019 final rule. Both of these rules amount to an assault on the Affordable Care Act (ACA) and its benefit and coverage protections. 

In the comments, the Center expresses concerns over the harm this so-called “insurance” would do to consumers and the Marketplace.

These junk plans:

  • Don’t protect people with pre-existing conditions;
  • Have high out of pocket costs;
  • Don’t have to cover ACA essential health benefits;
  • May discriminate based on age or gender;
  • May impose lifetime and annual limits.

In addition, consumers who choose to remain in the individual market – including those who are older or have pre-existing conditions – will be left with higher costs. These worthless plans will hurt individuals and families who need quality comprehensive coverage.

Also this week, we heard reports that the Administration is examining weakening the ACA’s non-discrimination protections. Specifically, there are potential changes to Section 1557, which prohibits discrimination in health care.

As we stated in our comments to the recent Conscience proposed rule, these “repeated attempts to undermine our nation’s health care system must end. All Americans deserve access to affordable, quality health coverage.”

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State of Decay: Report Examines Oral Health for Older Americans

Oral Health America (OHA) recently published the fourth volume in a series of reports titled A State of Decay, surveying the state of oral health for older Americans.  The first volume in the series focused on the cost of services and financial reimbursement rates as the primary barrier to accessing oral healthcare.  Since then, the series has expanded to highlight both public health and healthcare delivery factors contributing to older adults’ oral health. 

The reports combine data gathered in surveys of state dental directors with publicly available data about the oral health status of adults aged 65+ in each of the 50 states.  Each state is ranked based on its scoring on six variables.  Variables assessed in the 2018 report are: the percentage of older adults with severe tooth loss (6 or more teeth) because of disease or decay; the percentage of older adults who visited a dentist within the past year; whether the state’s Medicaid program covers 13 dental services commonly used by older adults; the existence of community water fluoridation; a State Oral Health Plan (SOHP); and the development and completion of Basic Screening Surveys (BSSs) that include older adults.

The purpose of A State of Decay is to shine a light on the success and adversities of oral health outcomes for seniors at the state and national level.  It is designed for use by both professionals and consumers.  The reports are available online and for download at: astateofdecay.org. The website includes resources (e.g., toolkit, infographic, fact sheet) for advocates who are trying to improve the conditions and outcomes of oral health for seniors in the United States. 

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NPR Observation Status Story: How Medicare's Conflicting Hospitalization Rules Cost Me Thousands Of Dollars

On April 20, 2018, Alison Kodjak of NPR published the story of trying to navigate her own Mother’s “Outpatient” Observation Status and follow-up care.  After four nights in the hospital, all coded as observation, Alison’s Mother, Catherine Fitzgerald, was discharged, still unable to walk, and in need of follow-up care at a skilled nursing facility, care she was told that Medicare would not cover, because her Mother had not been admitted to the hospital as an inpatient.

“I picked a handful of rehab centers from a list after a quick search of reviews on my iPhone,” said Alison. “One was full, one rejected her because she was listed as "Medicaid pending," and finally, Genesis Healthcare said they would take her — on the condition that I come by with a $12,000 check that day.”

Alison’s story is not new, and not uncommon. Center for Medicare Advocacy Executive Director Judith Stein says in the article “the use of observation status has grown dramatically in the past decade, in part because Medicare has become far more aggressive in going after hospitals the agency said were inappropriately – and expensively – admitting patients who didn't need hospital care.”

Observation status is not about care, it is about money, and it is an outdated coding system. Jonathan Blum, the former Medicare director at CMS, suggests another fix in the article: Get rid of the three-night requirement altogether. "It's really an artifact," he said. "It was put in place as a budgetary control and it was designed when the average length of a hospital stay was seven, eight or nine days."

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