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Part D is a Failure We ALL Pay For

Part D is a Failure We ALL Pay For

The Medicare Part D prescription drug program is a failure that all Americans pay for. While people who have Medicare are most obviously affected by the problems of the Part D program and pay about 25% of the high costs associated with the inefficient program, all tax-payers fund approximately 75% of the total cost. All Americans are responsible for funding a program that is commonly referred to as a disaster. Together, we can work to change Part D so that it is a REAL benefit for Medicare beneficiaries worthy of tax-payer funding and support.

Why is Part D a Failure?
The current Part D program does not build on the demonstrated successes of Medicare. Prescription drug insurance through Part D is only available through private insurance plans. There are dozens of plans in each state and each has different monthly premium costs and co-payment amounts and all cover different lists of medications. Medicare beneficiaries are divided up into dozens of private insurance plans and do not benefit from the bulk negotiating power that Medicare has with 42 million people enrolled.

In addition to not saving through negotiating discounted drug prices, Part D costs more due to the high costs of the private insurance industry. The administrative costs of Medicare are quite low at 2-3%, while the administrative costs for private insurance companies are between 10 and 20%. The decision to provide Part D benefits through private insurance plans significantly adds to the program’s cost while Medicare beneficiaries report dissatisfaction with the private plans and favor a Medicare administered program.

The built in coverage gap, commonly referred to as the “doughnut hole,” is a substantial source of costs for Medicare beneficiaries. In the coverage gap, people pay 100% of their drug costs and continue to pay their monthly insurance premiums. The insurance companies also still get the additional 75% government payment, funded by taxpayers, while not providing any service to the Medicare beneficiary during the doughnut hole period. Insurance companies profit from regular, government subsidized payments while Medicare beneficiaries struggle to pay for full price drugs.

How can Part D become a REAL Medicare Prescription Drug Benefit?
The CCHCC Medicare Task Force supports three major changes to the Part D program. The Task Force advocates that Part D should be administered by Medicare and use the power of 42 million enrollees to negotiate discounted drug prices. In addition, the “doughnut hole” coverage gap should be eliminated and continuous access to medications and predictable costs should be guaranteed.

What can I do to Take Action?
Congress created the Part D program and only Congress can fix it. Tell your representatives in Congress that you support changing Part D so that it is an efficient program that provides a meaningful prescription drug benefit to people with Medicare worthy of tax-payer support.

1. Add your name to the CCHCC Medicare Task Force’s petition.
2. Write a letter to our Representative Tim Johnson and our Senators Dick Durbin and Barack Obama and ask them to do all they can to fix Part D.
3. Carry petitions and help gather more signatures. Contact CCHCC to learn how at 352-6533.
4. Join the Medicare Task Force. Attend our regular monthly meeting and help us continue to call on our representatives in Congress to fix Part D. Call CCHCC for more information.

Click here to download this document (PDF).

GAO Finds Irregularities in Plan B Application

The struggle for over-the-counter access to emergency contraception (EC) has been very difficult. Time and time again the U.S. Food and Drug Administration (FDA) has delayed or denied the switch from prescription only to over-the-counter for EC. The GAO (Government Accountability Office), whose job it is to hold the FDA accountable for any fishy business, recently reviewed the case of the emergency contraceptive, Plan B.  The FDA denied over-the-counter (OTC) status to Plan B, keeping it available through prescription only.  However, the FDA’s decision-making process in this case was highly irregular.  The GAO reviewed this process and noticed four main abnormalities:
  

1) The directors normally responsible for signing off on the denial of OTC status refused to sign the not-approval letter for Plan B.  Plan B was not granted OTC status, making it the only prescription OTC case from 1994 to 2004 that was denied despite the overwhelming recommended approval of FDA’s own scientific advisory committees.

2) High-level management, usually un involved in similar OTC switch cases, was highly involved in the Plan B case.  The Plan B application was the only case from 1994 to 2004 signed by higher level officials who would normally not sign them.

3) The GAO received conflicting accounts of when Plan B was officially not approved for OTC status, possibly even before the scientific reviews were complete. The Director and Deputy Director off the Office of New Drugs, along with other officials, told the GAO that they were notified in December 2003 and January 2004 that the Plan B OTC application would not be approved.  However, the GAO reports that the Acting Director of the Center for Drug Evaluation and Research (CDER) did not have his rationale for Plan B’s OTC status denial fully developed until May 2004.

4) The Acting Director’s rationale for signing the not-approval letter was novel and very different from traditional FDA behavior.  He used the argument that data regarding older adolescents could not be used to apply to younger adolescents.  However, not only did medical professionals agree that the data could indeed be applied, but the very doubt was never brought up previously for similar cases.

This case is significant because it shows that the decision-making process for changing Plan B to OTC was unusual, to say the least.  It seems to indicate that, despite medical science, tradition, precedent, and an overwhelming positive response from committee members, government higher-ups refused to grant Plan B OTC status because of their own agenda.  Once again, this is an instance of the government trying to regulate women’s bodies and women’s choice!

Download the full GAO report here (PDF).

Common Health Care Terms (English/Spanish)

English/SpanishHotline Advocate Translation Vocabulary Guide

Review the vocabulary guide to familiarize yourself with the phrases and words that wehave available. This list is intended tobe a helpful reference on health care related terms and phrases for translators who are generally comfortable with the Spanish and English languages.

Key CCHCC Terms:

Advocate – el Asistente

Affordable – Precio razonable

Behavioral Health Resource Guide – la Guía de Recursos de Salud Mental

Empowerment – Empoderamiento

Health Care system – Sistema de salud

Physical Health Resource Guide – laGuía de Recursos de Salud Física

Rights – Derechos

Resident – Miembro de la comunidad

Self-help packet(s) – los Paquete(s) de autoayuda

CCHCC Campaigns:

Access to Care Crisis – Campaña paraEliminar el Crisis de Acesso

Dialysis Patients’ Rights – Derechosde Pacientes de Diálisis

Disability Rights – Derechos de Personas con Incapacidades

Gun Regulation – Regulación de Armas de Fuego

Hospital Obligations and Community Rights – Obligaciones de los Hospitales y Derechos de la Comunidad

Interpreter Services in Health Care – Servicios de Interpretes en el Sistema de Salud

Medical Deb and Hospital Pricing – Comissión de Cuentas Medicas

Medicare Rights – Los Derechos de Beneficiarios deMedicare

Women’s Health Taskforce – Comissiónde la Salud de la Mujer

CCHCC Programs:

Adult Dental Access Program – Programa de Acesso Dental para Adultos

Dental Referral Program – elServicio de Referencia de Ayuda Dental

Hotline – la Línea de Ayuda

Medicare 100/Plus Program – Programa de Medicare 100/Plus

SSI Advocacy and Rights Project – Proyecto para Ayudar a Personal con elPrograma de SSI

General:

Account number – el Número de cuenta

Available – Disponible

Check – el Cheque

Deny care/deny appointment – Negarcuidado

Discount – el Descuento

Hospialdiscounted cost program – el Cuidado médico a un precio rebajado

Emergency room – la Sala deemergencia

Immediate care – el Cuidado urgente

Membership – la Membresia

Renew – Renovar

Return a call – Regresar una llamada

Appointments:

At least – Por lo menos

Amount – la Cantidad/ la Suma

Appointment – la Cita

Cancel – Cancelar

Charge – Cobrar

County – el Condado

Miss – Perder

Office (doctor/dentist) – el Consultorio

Office (CCHCC) – la Oficina

AppointmentPhrases:

Reschedule – Volver a programar (una cita)

Did you miss your appointment? – Perdió su cita?

The next available appointment is in/on __. – La próxima cita disponible es en__.

To make an appointment – Hacer una cita

MedicalTerms:

Antibiotics – los Antibióticos

Asthma – Asma

Blood pressure (high/low) – laPresión arterial (alta/baja)

Broken – Roto/a

Diabetes – Diabetes

Heart condition – la Insuficienciacardíaca

Hurt – Doler(se)

Infection – la Infección

Medical history – la Historia médica

Medical records – los Documentos dela historia médica

Numb – Adormecer

Pain – el Dolor

Over the counter drugs – los Medicamentos sin receta

Sangrar(se) – Bleed

Surgery – la Cirugía

Swollen – Hinchado/a

Billing:

Bill – la Cuenta/bill

Community Care Program (Carle) – Programa de atención comunitaria

(Health)Insurance – el Seguro (médico), la Aseguranza

Medical debt – la Deuda médica

Money order – el Giro (postal)

Monthly payment – el Pago mensual

Payment – el Pago

Payment Plan – el Plan de pago

Sued – Está siendo demandado por elhospital por no pagar sus deudas/billes

Dental:

Bite – Morder o->ue

Break/ (Chip) – Romper (una puntadel diente)

Burn (sensation) – Escoser(se)o-> ue

Cap – la Tapa

Cavity – la Carie

Crown – la Corona

Chew – Masticar

Decay – Descomponderse

Denture – la Dentadura

Filling – el Empaste

Floss – el Hilo

Gums – las Gomas/Encías

Gum disease – la Enfermedad de lasencías

Jaw – la Mandíbula

Numb – Adormecer

Oral surgery – la Cirugía oral

Plaque – la Placa dental

Pressure – la Presión

Pull a tooth – Sacar lun diente

Rinse – Enjugar (la boca)

Root canal – el Conducto radicular

Sealant – el Sellador

Tingle – el Hormigueo

Treatment – el Tratamiento

Treatment plan – un Plan detratamiento

Vibration – la Vibración

X-ray – los Rayos x/la Radiografía

To have an x-ray – Hacer(se) unaradiografía

Screening Appointment:

Household income – el Ingresso domestico

Proof of residency – una Prueba de domicilio

Screening process – el Proceso para cualificar al programa

Waiting list – la Lista de espera

Waiting period – el Periodo de espera

Click here to download this handout as a PDF.

Interpreter Services in Health Care

Did You Know?

Almost 11 million people (4.2% of the U.S. population) speak English “not well” or “not at all,” and over 21 million (8.1%) speak English less than“very well.”

People with Limited English Proficiency (LEP) should be provided with trained medical interpreters in health care settings. Failure to provide these services can lead to serious medical errors and even malpractice liability.

Federal laws and guidelines require that all health care providers who receive federal funding provide meaningful access to services to people withLimited English Proficiency.

Federal funding is available to help states and health care providers pay for language interpreters and other language services.

A Growing Population with Limited English Proficiency

In the United States, 18%of the population speaks a language other than English at home. It is critical that the this growing population with Limited English Proficiency be able tocommunicate with their health care providers.

In Illinois, 9.1% of the state population (almost 1 in 10 people) has Limited English Proficiency, a 60%increase in the size of limited English proficiency population of the state in1990. Illinois thus has the 10thlargest non-English speaking population.

And Champaign County in particular has a higher percentage of people with limited English proficiency than the rest of the state. In Champaign County, there are nearly 20,000 people over the age of 5 years who do not speak English well, a total of 11.8% of our County’s population (compared to 9.1% in the state of Illinois).

Interpreters and Language Services Are Essential to Health Care

Failure on the part of health care facilities to provide interpreters and other language services creates a barrier to, and diminishes the quality of, health care. For instance, language barriers in health care may result in: inability to access needed health care, misdiagnosis, unnecessary or inappropriate testing and treatment, less frequent use of primary and preventive care services and more frequent visits to the emergency room, and sometimes even death from medical error and miscommunication.

In our community, we know that too many people with limited English proficiency have faced significant barriers to accessing health care and have suffered injury, illness, and inappropriate treatment as a result of inadequate language services at our local hospitals and other major clinics. For instance, we know that in our community, non-English speaking patients calling the hospitals and other major clinics for care have been hung up on, or transferred to housekeeping or the kitchen where Latino/a workers were present. Patients with limited English proficiency in our community have been prescribed the wrong dosage and frequency of their prescription medication, been forced to give childbirth without an interpreter, and have suffered many other health care injustices as a result of inadequate local language services.

The Law and Our Rights

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color, or national origin by any person or institution receiving federal funding for programs or activities. The federal government and the courts have determined that the prohibition of discrimination based on national origin includes protections for people of different nationalities who do not speak English well.

In health care settings, this means that providers who receive federal funding (such as Medicare, Medicaid, and SCHIP) must work to ensure that patients with limited English skills have meaningful access to any program services and benefits that are offered to other patients. This includes virtually all hospitals, clinics, doctor’s offices, nursing homes,managed care organizations, state Medicaid agencies, and home health care agencies. Further, the Title VI protections extend to all the operations of the organization or business, not just those that receive federal funding.

The Office of Civil Rights (OCR) requires all recipients of federal funding to:

1.Provide translation services at no cost to the Limited English Proficient(LEP) individual.

2. Have written policies regarding language access services and staff who are aware of the policies.

3. Determine the language needs of prospective patients at the earliest possible opportunity.

4. Systematically track LEP clients and clients’ needs.

5. Identify a single individual or department charged withensuring the provision of language-accessible services.

6. Provide written notices to clients in their primary language informing them of their right to receive interpretive services.

7. Not use minors to translate.

8. Use family and friends astranslators only as a last resortand only with informed consent.

9. Ensure the availability of a sufficient number or qualified interpreters on a 24-hourbasis – including telephone services.

10. Use only qualified and trained interpreters with demonstrated proficiency in both English and the other language, knowledge of specialized terms and concepts in both language, and the ethics of interpreting.

* These services are to be provided to ALL LEP patients, not just recipients of Medicare, Medicaid, and Kid Care.

Are YOU Getting the Interpreter and Language Services You Need?

Have you or someone you know ever needed health care and …

  • Not been provided an interpreter by the health care provider?
  • Been provided an inadequate  or untrained interpreter?
  • Had to rely on a family member or minor to interpret?
  • Been denied care because you do not speak English well?
  • Been treated rudely because you do not speak English well?
  • Suffered greater illness or injury because of language barriers or miscommunication?

If so, or if you want to support the effort to bring more and higher quality interpreter services to our local health care system, then we need you to get involved!

Get involved:

For more information,to report a personal account of inadequate interpreter or other language services in the health care system, or to get involved in community efforts to address these problems, contact Champaign County Health Care Consumers at (217) 352-6533 or at cchcc@healthcareconsumers.org

We are grateful to The Access Project and the National Health Law Program for use of their Language Services Action Kit.

Click here to download this fact sheet as a PDF.

Access to Emergency Contraception

Plan BEmergency Contraception (EC) is a safe and effective form of back-up birth control that can prevent pregnancy if taken within 120 hours – or 5 days – of unprotected sex, contraceptive failure, or sexual assault. EC is most effective the sooner it is taken, ideally within the first 24 to 48 hours;therefore timely access to this important medication is essential to all women.

Previously, women of all ages needed a prescription from a doctor in order to access EC. However, in August of 2006 the U.S. Food and Drug Administration approved EC, brand name Plan B, for sale over-the-counter without a prescription for women 18 years of age and older. In 2013, EC was made available to women of all ages without needed a prescription.

In order to provide local women with more information about accessing EC, the Campaign for Access to Emergency Contraception has conducted a survey of local pharmacies to find out which ones carry over-the-counter EC and how much it costs.

Click here to see the survey!

We have also compiled a list of other local points of access for EC, such as Planned Parenthood, McKinley Health Center, and the Urbana School Based Health Center.

Click here to see other local points of access!