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Opinion: Congress Should Protect Medicare Part D

By Howard Dean

InsideSources.com

In the last 15 years, Medicare’s Part D prescription-drug benefit has become one of the few federal programs most seniors could not live without.

Congress enacted Medicare Part D 15 years after a rancorous political fight in which Republicans and Democrats both made dire predictions about how it would bankrupt our health care system. In the decade-and-a-half since, those fears have proved to be unfounded. Instead, since its inception, Part D has exceeded even the most optimistic projections.

Forty-two million Americans depend on the program to make their prescription drugs more affordable. The program is set up in a way to give Medicare beneficiaries the flexibility they need to choose a plan that meets their needs at the best possible price. That competition has forced plan providers to deliver excellent coverage at mostly affordable prices.

Perhaps the biggest surprise for the early critics of Part D is that the program has actually tamed costs, not sent them skyrocketing. Earlier this year, the Center for Medicare and Medicaid Services projected the average cost of Part D plans will fall for the second year in a row. The decline is even more impressive because other health insurance premiums are rising.

All these attributes help explain why Part D is wildly popular. A poll taken earlier this year found more than 80 percent of the people on Part D are satisfied with the drug coverage. The survey of 2,000 seniors also revealed a widespread belief that the plans are convenient and provide patients with a good value. There are not many federal programs that receive marks like this.

Despite these sterling reviews, there is a glitch in the program that drives out-of-pocket costs much higher for the patients who fall into the so-called “Donut Hole,” a coverage gap that exists for seniors whose drug spending exceeds the threshold for basic coverage but falls short of the threshold at which catastrophic care kicks in. The Donut Hole remains a major flaw in a system that could ensnare an increasing number of seniors.

Congress tried to temper the effect of the Donut Hole as part of the Affordable Care Act. The law reduced the share of Medicare patients who fell into this trap by essentially making it easier to qualify for catastrophic care. But the measure is set to expire at the end of 2019, exposing far more seniors to a dangerous spike in out-of-pocket drug costs. This spike has become known as the “Medicare Cliff,” and Congress needs to step in to prevent millions of Medicare beneficiaries from going over it.

Additionally, the administration outlined a number of reforms earlier this year to address drug costs. Two, in particular, would significantly improve Part D plans for seniors: The first would cap annual out-of-pocket costs for patients, a reform that would benefit seniors with the most serious or chronic illnesses, and the second would require plan sponsors to pass a greater share of the rebates they negotiate along to their subscribers.

There are other steps Congress and the administration could take to improve the program by making medicine more affordable and out-of-pocket payments more predictable. Annual out-of-pocket costs for Part D beneficiaries could be capped, shielding more patients from a coverage gap in the program and ensuring they receive a greater share of the rebates plan providers negotiate with manufacturers.

Targeted reforms could strengthen the program by making medicine more affordable and out-of-pocket payments more predictable for seniors who face fluctuating costs at the pharmacy.

Medicare Part D offers seniors unrivaled value, at a far lower cost to the government than the Congressional Budget Office or Board of Trustees initially projected. But these reforms would make prescription drugs even more affordable for the seniors who need them. And these changes would strengthen the program for the next 15 years

ABOUT THE WRITER

Howard Dean is a former governor of Vermont and a Democratic presidential candidate. He wrote this for InsideSources.com.

Consumer Alert: What Consumers Should Know About Short-Term Health Plans

Ohio Department of Insurance

COLUMBUS — New rules from the federal government are increasing the availability of temporary health insurance products known as short term health plans. Ohio Department of Insurance Director Jillian Froment is urging Ohio consumers to review and consider the specifics of short-term, limited duration plans prior to purchase. Because of the changes at the federal level, the Department has been fielding a number of inquiries and questions related to these products.

“As with all insurance products, Ohioans should carefully review all their coverage options to find a plan that best meets their needs” Froment said. “Short-term health plans can be an appropriate choice for some consumers. However, there is a difference in the level of coverage consumers can find with a product that meets all the requirements of the ACA versus these plans.”

Major medical health insurance plans (employer plans, Medicare, Medicaid or plans purchased on healthcare.gov) offer broad coverage, cannot exclude pre-existing conditions, and will cover many consumer needs, though specific benefits and cost-sharing will vary by plan. Additionally, major medical insurance plans offer protections by prohibiting insurers from using health status when determining premiums. However, while major medical plans offer more comprehensive coverage, they can also be expensive and include high deductibles and out-of-pocket costs – particularly if subsidies are not available.

Short-term, limited duration plans are different. These plans provide coverage for less than 12 months, a shorter period than a traditional health insurance plan, and are not required to provide the same level of benefits that major medical plans provide. In addition, short-term, limited duration plans can generally refuse to issue coverage or charge higher premiums based on health status. These types of plans also have more exclusions on what the plan will cover and are not required to cover pre-existing conditions, though some may.

For instance, short-term, limited duration plans may not include, or may place limits on, things like coverage for:

• Dependent children

• Biologically based mental illnesses

• Pre-existing conditions

• Maternity

• Prescription drugs

Short-term plans may also include a fixed “per day” payment rate for things like a hospital stay. It is important for consumers to have a general sense of how much a hospital stay costs in order to understand how much the plan will or will not cover in the event of a hospital stay. The gap between what a short-term plan pays and what the hospital charges may be significant. Consumers can find information about their local hospital’s general pricing on their website. Other limitations may apply, so it is important to review policies carefully with a licensed insurance agent in order to help find the plan that meets their needs.

There are several key facts to know if considering a short-term plan, including:

• These plans are not required to cover essential health benefits (like maternity, prescription drug, mental health, or comprehensive hospital benefits) and do not meet minimum coverage requirements. Though the penalty for not having qualifying health insurance will be removed starting January 2019, it is important for consumers to understand they may incur penalties for the remainder of 2018 if they do not maintain qualifying coverage.

• Consumers should ask about the plan’s limitations, cost-sharing, maximum amounts the plan will pay as well as exclusions to fully understand the plan being considered.

• Ohio insurance regulations require plans to provide information to consumers about any limitations or restrictions related to networks and access to providers, if applicable.

• Consumers can appeal any claim denials, or other adverse decisions, initially to the insurance company and then to the Department, if necessary.

• Consumers can purchase these plans directly from the insurer or through a licensed insurance agent. Consumers can find a list of licensed insurance agents on our website at www.insurance.ohio.gov.

Consumers with questions about health insurance or short-term, limited duration plans can call the Ohio Department of Insurance at 1-800-686-1526.

Opinion: The Time Has Come to Shout It From the Rooftops

By Dana J Hubbard

InsideSources.com

Wow, the Senate hearing for Brett Kavanaugh and his resulting confirmation to the Supreme Court laid bare a simmering divide between women and men (albeit a political divide in this case). On one side, you have predominantly men (with some white women) convinced that Christine Blasey Ford is lying about him sexually assaulting her. If not lying, they may say that she cannot possibly remember something that happened to her so long ago. After all, some have argued, she didn’t call the police at the time.

On the other side, I would venture to guess that the majority of women in this country believe Ford. We do because we can relate to her. Women have themselves been victimized this way and if not, they surely know someone to whom this has happened. Women believe Ford when she says she remembers it well. We know that this is something that gets ingrained in our memories.

I’m a woman, mother of daughters, and a criminologist at Cleveland State University. My area of research/teaching is women and crime. Estimates are that one in four women in the general population have been sexually abused. These, of course, are the assaults that women report. REPORT!

There are many reasons women do not report. One, we second-guess ourselves, blame ourselves, and therefore do not want to be called liars. We talk to ourselves, “did this really happen,” “did I fight back strongly enough,” “maybe I’m just overthinking things,” “maybe I was drunk and don’t remember it well,” “was I flirting,” “did I want to kiss him and he didn’t understand that I didn’t want it.”

We understand that we will receive judgment, blame and harassment for coming forward. Many times this judgment comes from the police we are supposed to report it to. In Ford’s case, she has received death threats and had to move her residence. Under these circumstances, why would women bother to tell?

Another reason we don’t report is that harassment by men is part of our regular lives. Whether it’s on the bus, on a dance floor, walking by a group of guys, being stared at, looked up and down, we are constantly reminded that what we have can be taken from us in an instant. We rehearse in our minds all the ways men can victimize us and how to stay safe. Women live in a world where we need to protect ourselves from men. We know that most men are good and would never do this but we know that there are predators out there and it’s hard to tell who are the good ones sometimes.

As a professor, I ask my students every semester: What are they most afraid of and what precautions do they take?

I first ask the men. The men generally have a hard time thinking about this; they have never thought about this before. After a bit of thought, they report that it is different when you live in the city than the suburbs. Cities can be dangerous. Those who live in the inner city report that they fear being assaulted or murdered. The men in the suburbs often fear that that the people they love will be attacked.

When I ask them what precautions they take, the answers again differ by where they live. For those in the inner city: carry a weapon and be aware of your surroundings. For the men in the suburbs: lock doors. The men often have a hard time thinking of other precautions.

When I ask the women in the class about their most feared event, it is almost always rape. I then ask them to report what precautions they take to stay safe.

These are some of the answers the women in the class typically give: carry mace; don’t walk alone; don’t walk at night; if you have to walk alone, call someone while you do so that they know where you are; carry keys in your fingers with key facing out; park under a street light; lock your car doors as soon as you get in the car; and the list goes on and on.

This exercise is illuminating, not to me or to the women students, but to the men in my class. They most certainly never realized all the fear and all the precautions women take. I get the sense that they think the women are being paranoid.

Men and women live in very different social worlds. Their experiences are drastically different when it comes to crime, victimization and safety. The Kavanaugh hearing is a perfect example of this. Women know deeply that this attempted rape happened to Christine Ford. We know it because it has happened to us. If it hasn’t happened to us, we know someone who it has happened to. We know that the typical rape is not a stranger jumping out of the bushes but someone we meet at a party.

The Kavanaugh confirmation and the MeToo movement have shed light on the experiences of women. Men should know how women move through this world; carefully and strategically. Men, for the most part, do not live in a world where they are in danger of getting raped. Women need to explain this to men. Men need to take an interest and realize the different worlds. While I understand the risks that women take by telling someone about our victimization, maybe the time has come to yell it from the rooftops!

ABOUT THE WRITER

Dana J Hubbard is an associate professor at Cleveland State University. She wrote this for InsideSources.com.

The Conversation

Thinking about borrowing against your home to send your kids to college? Think again

October 31, 2018

Authors

Jacob William Faber

Assistant Professor, New York University

Peter Rich

Assistant Professor, Cornell University

Disclosure statement: Jacob William Faber receives funding from The Russell Sage Foundation and the William T. Grant Foundation. Our work on this project was supported by the Russell Sage Foundation (Award 83-14-09).

When the time comes to send their children off to college, many parents in the U.S. take out loans, draw from savings and earnings and – as some financial advisors recommend – borrow against their homes.

In a study we published earlier this year, we found a hidden danger that parents face when they borrow heavily to pay for their children’s college education.

We are sociologists who specialize in housing and the Great Recession and structural inequalities in access to education.

For our study, we leveraged foreclosure data and tax return data to show that, between 2006 and 2011, a 1 percent increase in college attendance among 19-year-olds was followed consistently by about 19,000 additional foreclosures the following year nationwide.

Odds of foreclosure double

We also used three independent data sets tracking individual households over time to confirm the connection between college attendance and foreclosure. We found that the odds of foreclosure are twice as high among homeowners with a child in college, even after we account for their income, mortgage interest rate, the presence of other children, race, householders’ education and marital status, and region.

These foreclosures are not explained by the sub-prime lending that led to the Great Recession and the unemployment that followed, according to our research.

Our analysis also accounts for other concurrent changes in economic, demographic and housing conditions, as well as state-level changes in tuition and student debt accumulation.

Tuition rises

The value of a college education is well-established. Compared to workers with a high school degree or less, college degree holders receive a substantial wage premium that pays lifelong dividends in health, security and wealth accumulation.

This may explain why, between 1980 and 2014, college enrollment among high school graduates has increased 16.3 percentage points even as average inflation-adjusted tuition for two- and four-year institutions more than doubled.

The sharp rise in tuition coincided with a well-documented increase in student debt and an effort by many institutions of higher learning to institute a sliding scale for tuition, based on need. This scale uses an algorithmically determined net tuition price, which is adjusted by grants and other financial aid.

Even with these offsets, families often still confront a large “expected family contribution.”

Interestingly, we find that the statistical relationship between college attendance and foreclosures is consistent across income levels. This suggests that, all else being equal, sliding scale tuition and need-based offsets may not be enough to make college affordable for poor, middle-class and even affluent households.

For many families, investments in education and homeownership – pillars of the American dream – require taking on tremendous amounts of debt with the promise of improved economic status. In an era of widening inequality, increasing income instability and retracting social welfare policy, this promise has become far less secure. A question policymakers and college financial offices ought to ask is whether it’s a good idea for families to basically put up their homes to pay for their children’s college education.

This question is particularly relevant given the decades-long trend of increasing tuition.

Some have suggested that college spending must be reined in. Others argue that college financial aid must become more generous. Both approaches would help reduce the pressure for families to borrow against their homes to send their children to college.

Proposals for free tuition for low- and moderate-income households are also an important part of the solution. The need for such efforts is even more evident in light of the fact that many states have increased tuition since the Great Recession. Further, state funds for higher education are still below pre-recession levels in all but five states – Indiana, Montana, Nebraska, North Dakota and Wyoming.

What can be done

The fact that so many foreclosures are connected to college attendance also shines light on why the federal policy response to foreclosures was relatively ineffective. Foreclosure prevention needs to look at more than mortgage terms. Rather, foreclosure prevention must also deal with a broader range of financial burdens that cause families to overextend themselves financially.

Anti-predatory lending policies, which have been shown to rein in unscrupulous lenders, should also be expanded and strengthened. And mortgage lender reporting requirements, under assault from a business-first and consumer-last administration and Republican Congress, must continue.

As novel as our findings may be, they might not fully reflect the consequences of rising college costs. For instance, the growing amounts of student debt may pose a threat to housing stability for college graduates in the future.

Indeed, research has shown that higher rates of student loan debt are associated with lower rates of homeownership. In essence, what this could mean is one generation will be barely holding onto their homes to put their kids through college, while their kids may find themselves so saddled with student loan debt that they are ultimately unable to buy a home.

Coalition Empowers New Americans to Make Their Voices Heard at the Polls

October 31, 2018

COLUMBUS—During a telephonic town hall meeting Tuesday, voting rights experts from All Voting is Local, the Council on American Islamic Relations and Community Refugee and Immigration Services educated new citizens about the electoral process — part of broader advocacy to empower Ohio voters who speak Arabic, Chinese, Nepalese, Somali and Spanish.

Advocates notified by phone or text an estimated 30,000 new American voters to participate in the telephone town hall. The call offered an opportunity for voters to ask questions about the voting process and to learn about the coalition’s effort to recruit multilingual poll workers to staff polling places on Nov. 6.

“We know new American voters are among the most enthusiastic — they’re eager to participate and contribute their voices to our democracy, but they may have questions about how it all works,” said Mike Bricker, Ohio State Director for All Voting is Local. “Voter education is foundational to a sound electoral process. We want to be certain that all voters have the information they need to access the ballot, regardless of where they are from or the language they speak.”

“Voting is the most important duty of a citizen,” said Usjid Hameed, public affairs coordinator for CAIR-Columbus and a Puffin Democracy Fellow with the Andrew Goodman Foundation. “We need to do our part as community members and organizations to ensure that everyone has the tools and resources they need to participate in our democracy. Our society is at its best when everyone has their voice heard.”

All Voting is Local and CAIR have worked to recruit poll workers throughout Ohio, part of a campaign to tackle the nationwide shortage of poll workers. The campaign, “Be the Difference, Be a Poll Worker” has used billboards, print, digital and radio ads in various languages to ensure polling places throughout Ohio are staffed with enough trained workers. Since September, organizers have recruited 461 poll workers in Ohio.

To learn more about the poll worker recruitment effort please visit, www.BeAPollworker.com

All Voting is Local fights for the right to vote through a unique combination of data-driven organizing, advocacy and communications. It is a collaborative campaign housed at The Leadership Conference Education Fund, in conjunction with Access Democracy; the American Civil Liberties Union Foundation; the American Constitution Society; the Campaign Legal Center; and the Lawyers’ Committee for Civil Rights Under Law.

CAIR is America’s largest Muslim civil liberties and advocacy organization. The CAIR-Ohio affiliate has three chapters in Ohio – Columbus, Cleveland and Cincinnati. Their mission is to enhance the understanding of Islam, encourage dialogue, protect civil liberties, empower American Muslims, and build coalitions that promote justice and mutual understanding.

Hubbard
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