Dr. Atul Gawande to Lead New Insurance Company for Amazon, JP MorganChase and Berkshire Hathaway

Dr. Atul Gawande, the well respected and well known author of Being Mortal, a bestseller which pushed for a more patient centered approach to health care has been appointed as CEO to lead the new insurance company announced by Amazon, Berkshire Hathaway and JP Morgan Chase.  The company is a new effort to reform health care and the hiring of Dr. Gawande is a sign of the direction they want to take.

Dr. Gawande does not have business experience but has been in the trenches on health care especially for those with serious illnesses.  In his book, Being Mortal, which was at the top of the bestsellers list,  Dr. Gawande has supported providing more person-centered care,  with a better quality of life especially at the end of life.  He supports hospice and palliative care at the end of life rather than expensive over treatment which does not extend life by much and could provide less than comfort.  He write

The three large companies wanted to establish an insurance company to “operate as an independent entity that is free from profit-making incentives and constraints.”  The companies have 1.2 million workers so as large employers they may be able to steer health care coverage for those employees in a new way.

Many Democrats Push Medicare for All as Trump Efforts to Harm ACA Hurt Medicare Too

In Congressional campaigns across the country, many incumbent Democrats and challengers in Republican districts are rebelling against problems in the health care system and are pushing a Medicare for All plan that would be simpler and cut out private insurance costs.   The plan would also allow for negotiations on prescription drug prices.  The failure to allow negotiation of drug costs for Medicare is a reflection of the campaign contributions of pharmaceutical companies.

In recent days the Trump Administration has indicated it will seek to further de-stabilize  health coverage under the Affordable Care Act  (ACA) by refusing to defend in court provisions that protect patients with pre-existing from being denied coverage.    Previously Trump rejected the individual mandate to have coverage which has led to increases in insurance premiums in the ACA.

While Trump as a candidate said he was not going to cut Medicare, his actions with the ACA harm Medicare because some uncompensated hospital costs will come from Medicare since there may be more people without health insurance.   The recent report in early June by the Medicare Trustees reported that Medicare is now likely to not be able to pay its full costs in 2026, three years earlier than last year’s report.  Higher payments to Medicare Advantage plans and for ever increasing drug costs also are stretching Medicare finances.

The Trump economic plan says that the major tax cut enacted will increase employment and lead to higher wages that will benefit Social Security and Medicare.  In other words, the program’s finances will be resolved by increased economic growth.  That has not happened so far and a huge federal budget deficit will likely result instead, increasing political pressure to cut both programs.

So, the fall election pits two diametrically opposed ideas:  Medicare for All vs. the Republican House plan to turn Medicare into a fixed voucher plan, shifting more costs to beneficiaries.    Candidates for Congress need to be challenged on where they stand on the future of Medicare and Social Security.   They are the two pillars which stand against income inequality in older age especially, and it is critical that they be preserved and strengthened for beneficiaries.



RFK Inspired the Young to Change the World 50 Years Ago

For many of us old enough to remember we are observing media retrospectives of the events of our youth 50 years ago during the tumultuous, watershed year of 1968.  It seems strange now in my mid 60s to think that we were serious or even knowledgeable about the world as teenagers, However, today’s Parkland teenagers remind us of our own passions and desire to change the world when the divisive war in Vietnam dissolved the American pride our parents achieved after winning World War II.  

Bobby Kennedy had been a hero to me as my views on public issues first were formed. Two months after the assassination of Martin Luther King, Bobby Kennedy’s assassination during the Presidential campaign was a devastating political and human event.   My brother woke me up to tell me that Bobby Kennedy had been shot. I had gone to bed after he won the California Democratic primary. His death seemed so personal. My parents were the same age as Robert and Ethel Kennedy. I was the same age as his son, Robert Jr.  

There was no internet or social media then.  We were glued to the television on a Saturday watching RFK’s funeral in New York and as the funeral train make its way as people solemnly lined the tracks from New York to Washington and Arlington National Cemetery.

Everyone thought that the country was coming apart.   Some wanted Senator Edward Kennedy to run for President in his brother’s place, but in conversations people had at the time, friends would say, “He will be shot too.”   We got used to political shootings just like we hold our breath waiting for another school shooting today. And, every week there was a Defense Department press release reporting that hundreds of young Americans had been killed in Vietnam the previous week.

Bobby was a regular visitor to Albany.  In 1957, he spoke to the New York State Democratic party in Albany in place of JFK and  said, “Brother John would be much happier here than in his sickbed, for he loves a good gathering of Democrats and he knows that there are no finer Democrats anywhere in the country than those gathered here in Albany tonight.”

It is hard for one not living at the time to know of the impact RFK had after JFK was assassinated.  Bobby resigned as Attorney General and and ran and won a seat as our Senator from New York. With the state and country still in grief in 1964 over JFK’s assassination, Bobby was  mobbed like a rock star as he campaigned all over the state. Thousands came to see him in Troy and Albany and in small towns across the North Country. My father who worked for the local media stood near him on Public Square in Watertown as thousands turned out.   In Glens Falls, he was five hours late but so many waited faithfully for him, even in pajamas, after he arrived past midnight in Glens Falls he said, “I promise that win or lose, the day after election day, I’m coming back to Glens Falls.”  And, he did.

In the four and a half years after JFK’s death, Bobby’s political persona changed.  He had been the political operative for his brother. On his own, he spoke of idealism and wanted to inspire people “to seek a newer world”  in a time of terrible turmoil during the Vietnam War. There was a kind of a soul force to him as he quoted the Greeks and urged calm following Martin Luther’s King’s murder.  For a man born in privilege, power and money, he had a remarkable ability to relate to blue collar workers, the poor and the minorities. He went to Mississippi to see the shacks where poor African Americans lived.  He was with Cesar Chavez and championed the farmworkers in California.

Most of all he was the one who appealed to and embraced the young.  Like JFK who started the Peace Corps and the push to the moon, he had optimism for the future because of young people.  He urged them to do great things. In South Africa, he made his famous Day of Affirmation speech to South African youth living in a country divided by Apartheid and saw young people as the hope for change,

“This world demands the qualities of youth; not a time of life but a state of mind, a temper of the will, a quality of the imagination, a predominance of courage over timidity, of the appetite for adventure over the love of ease.”

The Kennedys inspired many young people at the time like me to pursue careers in community action and public service.  Out of college in the 1970s, I “enlisted” in the war on Poverty, I moved to Albany to work in state level grassroots advocacy, a path that eventually led to public service as director of a state agency.

In 1968, Bobby Kennedy had a chance to heal the nation, to end the Vietnam War, to seek racial peace. He was calling on America to be its best, forward thinking, patriotic and strong.  He believed in American democracy despite its flaws in that era of Vietnam and racial tensions. He was intent on trying to address them. We missed him all through the years of our youth.   How we still need someone like Robert Kennedy who can try to appeal to our best and heal this badly divided nation.


Michael Burgess, Delmar

Former Director, New York State Office for the Aging




New $3.2 Billion Health Foundation Created from Fidelis Sale

The State’s Catholic Bishops have announced plans to create the Mother Cabrini Health Foundation and fund it with $3.2 billion, part of the proceeds of the sale of the company to a for profit insurer.  The foundation has appointed a board chaired by Al Kelly, CEO of VISA who has been a major supporter of Catholic programs in New York.    The new foundation would likely make grants available for health care institutions and non profit organizations serving low income persons’ health needs.

The foundation would be the 9th largest in the state.  Currently, the New York State Health Foundation has been operating for several years with proceeds of the sale of the Blue Cross insurance company.   That foundation has been a major donor for community health care projects across the state.

“The foundation will seek to transform the lives of underserved New Yorkers from all corners of the state and set a national model for addressing the health and wellness needs of low-income communities,” Cardinal Timothy Dolan said. The foundation would serve New Yorkers “of every color, every religion and every background.”

The announcement also stated, “The charity will look to invest in health care and health-related causes, such as the social determinants of health. The foundation would look to invest in preventive health, behavioral health, nutrition, obesity, substance abuse treatment, early intervention services for children, home and community-based services in rural areas and education among other areas.”

Groceries, Medical Rides, Home Delivered Meals May be Offered by Medicare Advantage in Future

from Kaiser Health News

by Susan Jaffee

Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage coverage when new federal rules take effect next year.

The Centers for Medicare & Medicaid Services (CMS) expandedhow it defines the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers.

“Medicare Advantage beneficiaries will have more supplemental benefits making it easier for them to lead healthier, more independent lives,” said CMS Administrator Seema Verma.

Of the 61 million people enrolled in Medicare last year, 20 million have opted for Medicare Advantage, a privately run alternative to the traditional government program. Advantage plans limit members to a network of providers. Similar restrictions may apply to the new benefits.

Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment.

CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care.

Although insurers are still in the early stages of designing their 2019 policies, some companies have ideas about what they might include. In addition to transportation to doctors’ offices or better food options, some health insurance experts said additional benefits could include simple modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating and other personal care needs.

“This will allow us to build off the existing benefits that we already have in place that are focused more on prevention of avoidable injuries or exacerbation of existing health conditions,” said Alicia Kelley, director of Medicare sales for Capital District Physicians’ Health Plan, a nonprofit serving 43,000 members in 24 upstate New York counties.

Even though a physician’s order or prescription is not necessary, the new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules.

Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

The new rules “set the stage to continue to innovate and provide choice,” said Cathryn Donaldson, of America’s Health Insurance Plans, a trade group.

“CMS is catching up with the rest of the world in terms of its understanding of how we keep people healthy and well and living longer and independently, and those are all positive steps,” said Ceci Connolly, chief executive officer of the Alliance of Community Health Plans, which represents nonprofit health insurance plans. Some offer non-emergency medical transportation, low-cost hearing aids, a mobile dental clinic and a “grocery on wheels,” to make shopping more convenient, she said.

UnitedHealthcare, the largest health insurer in the U.S., also welcomes the opportunity to expand benefits, said Matt Burns, a company spokesman. “Medicare benefits should not be one-size-fits-all, and continued rate stability and greater benefit design flexibility enable health plans to provide a more personalized health care experience,” he said.

But patient advocates including David Lipschutz. senior policy attorney at the Center for Medicare Advocacy, are concerned about those who may be left behind. “It’s great for the people in Medicare Advantage plans, but what about the majority of the people who are in traditional Medicare?” he asked. “As we tip the scales more in favor of Medicare Advantage, it’s to the detriment of people in traditional Medicare.”

The details of the 2019 Medicare Advantage benefit packages must first be approved by CMS and will be released in the fall, when the annual open enrollment begins. It’s very likely that all new benefits will not be available to all beneficiaries since there is “tremendous variation across the country” in what plans offer, said Gretchen Jacobson, associate director of the Kaiser Family Foundation’s Program on Medicare Policy. (Kaiser Health News is an editorially independent program of the foundation.)    

Addressing a patient’s health and social needs outside the doctor’s exam room isn’t a new concept. The Institute on Aging, for example, is a California nonprofit that offers health, social, and psychological services for seniors and adults with disabilities. It has helped people in San Francisco and Southern California move from nursing homes to their own homes and provides a variety of services to make their new lives easier, from kitchen supplies to wheelchair ramps.

“By taking a more integrated approach to address people’s social and health needs, we have seen up to a 30 percent savings in health care costs compared to the costs of the same individuals before they joined our program,” said Dustin Harper, the institute’s vice president for strategic partnerships. The agency serves 20,000 Californians a year, including former nursing home residents, who qualify for Medicare or Medicaid, the federal-state health insurance program for low-income people, or both.

In addition to next year’s changes in supplemental benefits, CMS also noted that a new federal law allows Medicare Advantage plans to offer benefits that are not primarily health-related for Medicare Advantage members with chronic illnesses. The law and the agency’s changes are complementary, CMS officials said. They promised additional guidance  in the coming months to help plans differentiate between the two.

KHN’s coverage related to aging and improving care of older adults is supported in part by The John A. Hartford Foundation.

Drug Companies Fail to Get Congress to Remove Change that Closes Medicare Drug Plan “Donut Hole” in 2019

Drug companies failed to get Congress to reduce a change in the Medicare drug plan that requires them to pay 70% of drug costs for seniors in the Medicare donut hole in 2019.  They currently pay 50%  but Congress moved to close the coverage gap a year earlier than in current law and raised the drug companies share of the costs in order to pay for the change.   AARP and other senior organizations had lobbied against the drug companies and thwarted them from defeating the change which was in the major appropriations bill passed to fund the government for the rest of the fiscal year.

The donut hole is a coverage gap in the Medicare Part D drug plan.  After reaching a certain level of annual drug costs, $3750 in 2018, beneficiaries have to pay most of the cost of drugs in the gap until they reach $5000 in costs and then receive catastrophic coverage and only pay 5% of drug costs for the remainder of the year.   The Affordable Care Act (ACA) included provisions to gradually reduce and eliminate the donut hole by 2020.   Congress had recently included changes to eliminate the coverage gap in 2019 and the pharmaceutical lobby had launched a vigorous effort to defeat the change.

This was a rare defeat for the drug company lobby which has made extensive campaign contributions to members of Congress and gained the support and allegiance of some powerful members of Congress.