Improving Health Care Access for Older Alaskans: What Are the Options?

This report focuses on the problem older Alaskans who rely on Medicare face getting access to primary care, and discusses some of the options policymakers are considering to resolve the problem. But older Americans across the country also report difficulty getting the primary care they need. The discussion here sheds light on the problem and potential solutions nationwide. Most Americans 65 and older use Medicare as their primary health insurance. Medicare is federal health insurance for people 65 and older, people under 65 with certain disabilities, and people of any age with end-stage renal disease—but this report looks only at access issues for Medicare beneficiaries 65 and older. Doctors don’t have to participate in the Medicare program. But those who do participate have to accept, as full payment, what Medicare pays for specific services. Many primary-care doctors say Medicare doesn’t pay them enough to cover their costs—so growing numbers are declining to see new Medicare patients. Among primary-care doctors nationwide, 61% accept new Medicare patients.1 National surveys sponsored by the Medicare Payment Advisory Commission have found that 17% of Medicare patients in the U.S. had “a big problem” finding family doctors in 2007—up from 13% in 2005.2 In Alaska, a 2008 survey by the Institute of Social and Economic Research (ISER) found that just over half of Alaska’s primary-care doctors were willing to treat new Medicare patients.3 The situation was worse in Anchorage, where 40% of all older Alaskans live. Only 17% of primary-care doctors in Anchorage were willing to treat new Medicare patients as of 2008 (Figure 1).4The Harold E. Pomeroy Public Policy Research EndowmentIntroduction / How Medicare Works / Closed Doors / Older Anchorage Residents and Primary Care / Options for Changing Access to Primary Care: What is Alaska Considering? / Conclusions / Appendi

Cost of lifetime immunosuppression coverage for kidney transplant recipients.

On January 1, 2000, Medicare extended the coverage of immunosuppression medications from 3 years to life for elderly and disabled kidney transplant recipients. This research estimates the impact of extending this lifetime coverage to all kidney transplant recipients on Medicare\u27s cash flows. The study finds that extending coverage to all kidney transplant recipients would have increased Medicare\u27s net cash outflows if the coverage were extended for patients of all income levels. There is evidence that extending coverage to only patients in the lowest income quartile could have resulted in a net cost savings to Medicare

The Affordable Care Act, Medicare Costs, and Retirement Security

Rising Medicare costs have been a major contributor to projected long-run budget deficits, and rising outof-pocket costs have become an increasing challenge to individuals' retirement security. The 2010 Patient Protection and Affordable Care Act (ACA) made substantial changes to Medicare, designed both to improve the program's finances and to reduce the outof-pocket costs faced by retirees. However, the Office of the Actuary (OACT) at the Centers for Medicare & Medicaid Services (CMS) warns that the assumed impact of the ACA may be overly optimistic and that realized savings may be far more muted. As a result, since 2010, OACT each year has released a set of alternative projections to illustrate Medicare expenditures if current-law payment reductions are not sustained.This brief compares the baseline projections in the annual Medicare Trustees Report with OACT's alternative projections

Transitioning From Medicaid Expansion Programs to Medicare: Making Sure Low-Income Medicare Beneficiaries Get Financial Help

The Affordable Care Act allows states to offer Medicaid coverage to low-income adults who would not have qualified under previous law. This population will face higher cost-sharing requirements when they transition to Medicare, although some may be eligible for traditional Medicaid benefits and/or Medicare Savings Programs (MSPs) that will reduce their costs. This report discusses how Medicare beneficiaries can qualify for traditional Medicaid and MSPs. It also provides new state data on the number and characteristics of eligible individuals and discusses the potential impact of expanding traditional Medicaid income and asset rules in the Medicaid expansion states. Finally, the report outlines policy options that would make it easier for Medicare beneficiaries to qualify for traditional Medicaid benefits and MSPs

Medicare Quality Measurement and Reporting Programs: Opportunities for Alliances Under Health Reform

Outlines provisions to expand Medicare quality measurement and reporting and opportunities for RWJF's Aligning Forces for Quality communities to work with providers in coordinating measures with Medicare, offer feedback, and focus on equity and cost data

Prescription Drug Coverage and Elderly Medicare Spending

The introduction of Medicare Part D has generated interest in the cost of providing drug coverage to the elderly. Of paramount importance -- often unaccounted for in budget estimates -- are the salutary effects that increased prescription drug use might have on other Medicare spending. This paper uses longitudinal data from the Medicare Current Beneficiary Survey (MCBS) to estimate how prescription drug benefits affect Medicare spending. We compare spending and service use for Medigap enrollees with and without drug coverage. Because of concerns about selection, we use variation in supply-side regulations of the individual insurance market -- including guaranteed issue and community rating -- as instruments for prescription drug coverage. We employ a discrete factor model to control for individual-level heterogeneity that might induce bias in the effects of drug coverage. Medigap prescription drug coverage increases drug spending by $170 or 22$350 or 13% (in 2000 dollars). Medigap prescription drug coverage reduces Medicare Part B spending, but the estimates are not statistically significant. Overall, a $1 increase in prescription drug spending is associated with a$2.06 reduction in Medicare spending. Furthermore, the substitution effect decreases as income rises, and thus provides support for the low-income assistance program of Medicare Part D.

Medicare Reform: Widespread Confusion, Uncertain Benefits

This report presents the data from CIR's 2004 survey of 600 Medicare recipients about their health care options, ability to access services, and choices about health care spending in the wake of Medicare reform. The findings of this report will assist policy makers and community-based organizations to advocate for programs that will best serve the needs of Medicare recipients

The Obama Administration's 2010 Call Letter for Medicare Advantage and Prescription Drug Plans: Implications for Beneficiaries

Outlines key provisions and changes in the Medicare Advantage or Medicare Prescription Drug plans in 2010. Discusses requirements to improve accountability, promote informed health plan choices, and increase beneficiary protections

"Income-related patient cost-sharing: Simulation for prescription drugs under Medicare"

This paper studies an application of income-related patient cost-sharing. Using data from the Medicare Current Beneficiary Survey, we find that varying patient costsharing rates with patient income in the Medicare prescription drug program can reduce the severity of two problems: high percent-of-income burdens, and unequal medication due to income. We estimate behavioral responses in the Medicare population and incorporate the estimates into a micro-simulation model which uses data that are representative of the actual Medicare population. We find that introducing incomerelated patient cost-sharing into a Medicare drug program can dramatically reduce the severity of the two problems.Patient Cost-Sharing, Medicare