Every day, 20 people die while waiting for an organ transplant. Just one donor can save and heal up to 75 lives through organ and tissue donation. Today, there are more than 114,000 patients waiting for a lifesaving organ transplant and many more who need cornea, tissue, bone marrow, blood, and platelet donations. There are 2 ways to become a donor:
Deceased organ donors—can donate both kidneys, liver, both lungs, heart, pancreas, and intestines.
Living organ donor—can donate one kidney, one lung, or a portion of the liver, pancreas, or intestines.
Over 80% of people on the transplant list need a kidney transplant, usually due to permanent kidney failure or End-Stage Renal Disease (ESRD). Medicare covers kidney transplants for both the person getting the transplant and the donor. If you’re getting the transplant, you pay 20% of the Medicare-approved amount for doctor services. You pay nothing if you’re the living donor.
Celebrate National Donor Day on February 14 by giving the gift of life. Sign up to become an organ donor today.
Republicans are still in charge of the White House and the Senate, but the “Medicare-for-all” debate is in full swing. Democrats of every stripe are pledging support for a number of variations on the theme of expanding health coverage to all Americans.
This week, KHN’s “What the Health?” podcast takes a deep dive into the often-confusing Medicare-for-all debate, including its history, prospects and terminology.
This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Paige Winfield Cunningham of The Washington Post and Rebecca Adams of CQ Roll Call.
Among the takeaways from this week’s podcast:
Medicare-for-all is a new rallying cry for progressives, but the current Medicare program has big limitations. It does not cover most long-term care expenses, and includes no coverage of hearing, dental, vision or foot care. Medicare also includes no stop-loss or catastrophic care limit that protects beneficiaries from massive bills.
Though recent comments by Sen. Kamala Harris on eliminating private insurance with a move to Medicare-for-all stirred controversy, private insurance is indeed involved in many aspects of the government program. Private companies provide the Medicare Advantage plans used by more than a third of beneficiaries, the Medicare drug plans and much of the bill processing for the entire program.
Many consumers — and politicians — are confused by the terms being thrown around in the current debate about Medicare-for-all. The plan offered by Sen. Bernie Sanders (I-Vt.) and some of his supporters would be a “single-payer” system, in which the government would be in charge of paying for all health care — although doctors, hospitals and other health care providers would remain private. Others often use the term Medicare-for-all to mean a much less drastic change to the U.S. health care system, such as a “public option” that would offer specific groups of people — perhaps those over age 50 or consumers purchasing coverage on the insurance marketplaces — the opportunity to buy into Medicare coverage.
Sanders’ vision of Medicare-for-all is based on Canada’s system. But even there, hospitals and doctors are private businesses, drugs are not covered everywhere, and benefits vary among the provinces.
The health care industry is nearly united in opposing the talk of moving to a Medicare-for-all program because of concerns about disruption to the system and less pay. Currently, Medicare reimbursements are about 40 percent lower than private insurance.
If you want to know more about the next big health policy debate, here are some articles to get you started:
Vox’s “Private Health Insurance Exists in Europe and Canada. Here’s How It Works,” by Sarah Kliff
The Washington Post’s “How Democrats Could Lose on Health Care in 2020,” by Ronald A. Klain
The American Prospect’s “The Pleasant Illusions of the Medicare-for-All Debate,” by Paul Starr
The Week’s “Why Do Democrats Think Expanding ObamaCare Would Be Easier Than Passing Medicare-for-All?” by Jeff Spross
Vox’s “How to Build a Medicare-for-All Plan, Explained By Somebody Who’s Thought About It for 20 Years,” by Dylan Scott
The New York Times’ “The Best Health Care System in the World: Which One Would You Pick?” By Aaron E. Carroll and Austin Frakt
The Nation’s “Medicare-for-All Isn’t the Solution for Universal Health Care,” by Joshua Holland
The New York Times’ “’Don’t Get Too Excited’ About Medicare for All,” by Elisabeth Rosenthal and Shefali Luthra
Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too.
Julie Rovner: Yahoo News’ “What Trump Got Wrong About ‘Right to Try,’” by Kadia Tubman
Joanne Kenen: STAT News’ “The Modern Tragedy of Fake Cancer Cures,” by Matthew Herper
Rebecca Adams: The Texas Tribune’s “Thousands of Texans Were Shocked By Surprise Medical Bills. Their Requests for Help Overwhelmed the State,” by Jay Root and Shannon Najmabadi
Paige Winfield Cunningham: STAT News’ “The ‘Big Pharma’ Candidate? As He Runs for President, Cory Booker Looks to Shake His Reputation for Drug Industry Coziness,” by Lev Facher
To hear all our podcasts, click here.
And subscribe to What the Health? on iTunes, Stitcher or Google Play.
About 25 million Americans who are aging in place rely on help from other people and devices such as canes, raised toilets or shower seats to perform essential daily activities, according to a new study documenting how older adults adapt to their changing physical abilities.
But a substantial number don’t get adequate assistance. Nearly 60 percent of seniors with seriously compromised mobility reported staying inside their homes or apartments instead of getting out of the house. Twenty-five percent said they often remained in bed. Of older adults who had significant difficulty putting on a shirt or pulling on undergarments or pants, 20 percent went without getting dressed. Of those who required assistance with toileting issues, 27.9 percent had an accident or soiled themselves.
The study, by researchers from Johns Hopkins University, focuses on how older adults respond to changes in physical function — a little-studied and poorly understood topic. It shows that about one-third of older adults who live in the community — nearly 13 million seniors — have a substantial need for assistance with daily activities such as bathing, eating, getting dressed, using the toilet, transferring in and out of bed or moving around their homes; about one-third have relatively few needs; and another third get along well on their own with no notable difficulty.
For older adults and their families, the report is a reminder of the need to plan ahead for changing capacities.
“The reality is that most of us, as we age, will require help at one point or another,” said Dr. Bruce Chernof, president of the SCAN Foundation and chair of the 2013 federal Commission on Long-Term Care. Citing Medicare’s failure to cover so-called long-term services and supports, which help seniors age in place, he said, “We need to lean in much harder if we want to help seniors thrive at home as long as possible.” (KHN’s coverage of aging and long-term care issues is supported in part by the SCAN Foundation.)
Previous reports have examined the need for paid or unpaid help in the older population and the extent to which those needs go unmet. Notably, in 2017, the same group of Johns Hopkins researchers found that 42 percent of older adults with probable dementia or difficulty performing daily activities didn’t get assistance from family, friends or paid caregivers — an eye-opening figure. Of seniors with at least three chronic conditions and high needs, 21 percent lacked any kind of assistance.
But personal care isn’t all that’s needed to help older adults remain at home when strength, flexibility, muscle coordination and other physical functions begin to deteriorate. Devices and home modifications can also help people adjust.
Until this new study, it hasn’t been clear how often older adults use “assistive devices”: canes, walkers, wheelchairs and scooters for people with difficulties walking; shower seats, tub seats and grab bars to help with bathing; button hooks, reachers, grabbers and specially designed clothes for people who have difficulty dressing; special utensils designed to make eating easier; and raised toilets or toilet seats, portable commodes and disposable pads or undergarments for individuals with toileting issues.
“What we haven’t known before is the extent of adjustments that older adults make to manage daily activities,” said Judith Kasper, a co-author of the study and professor at Johns Hopkins’ Bloomberg School of Public Health.
The data comes from a 2015 survey conducted by the National Health and Aging Trends Study, a leading source of information about functioning and disability among adults 65 and older. More than 7,000 seniors filled out surveys in their homes and results were extrapolated to 38.8 million older Americans who live in the community. (Those who live in nursing homes, assisted living centers, continuing care retirement communities and other institutions were excluded.)
Among key findings: Sixty percent of the seniors surveyed used at least one device, most commonly for bathing, toileting and moving around. (Twenty percent used two or more devices and 13 percent also received some kind of personal assistance.) Five percent had difficulty with daily tasks but didn’t have help and hadn’t made other adjustments yet. One percent received help only.
Needs multiplied as people grew older, with 63 percent of those 85 and older using multiple devices and getting personal assistance, compared with 23 percent of those between ages 65 and 74.
The problem, experts note, is that Medicare doesn’t pay for most of these non-medical services, with some exceptions. As a result, many seniors, especially those at or near the bottom of the income ladder, go without needed assistance, even when they’re enrolled in Medicaid. (Medicaid community-based services for low-income seniors vary by state and often fall short of actual needs.)
The precariousness of their lives is illustrated in a companion report on financial strain experienced by older adults who require long-term services and supports. Slightly more than 10 percent of seniors with high needs experienced at least one type of hardship, such as being unable to pay expenses like medical bills or prescriptions (5.9 percent), utilities (4.8 percent) or rent (3.4 percent), or skipping meals (1.8 percent). (Some people had multiple difficulties, reflected in these numbers.)
These kinds of adverse events put older adults’ health at risk, while contributing to avoidable hospitalizations and nursing home placements. Given a growing population of seniors who will need assistance, “I think there’s a need for Medicare to rethink how to better support beneficiaries,” said Amber Willink, co-author of both studies and an assistant scientist at Johns Hopkins’ Bloomberg School of Public Health.
That’s begun to happen, with the passage last year of the CHRONIC Care Act, which allows Medicare Advantage plans to offer supplemental benefits such as wheelchair ramps, bathroom grab bars, transportation and personal care to chronically ill members. But it’s unclear how robust these benefits will be going forward; this year, plans, which cover 21 million people, aren’t offering much. Meanwhile, 39 million people enrolled in traditional Medicare are left out altogether.
“We’ve had discussions with the [insurance] industry over the last couple of months to explore what’s going to happen and it’s a big question mark,” said Susan Reinhard, director of AARP Public Policy Institute, which publishes a scorecard on the adequacy of state long-term services and supports with several other organizations.
So far, she said, the response seems to be, “Let’s wait and see, and is this going to be affordable?”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.
Former Rep. John Dingell, the Michigan Democrat who holds the record as the longest-serving member of the U.S. House, died Thursday night in Michigan. He was 92.
And while his name was not familiar to many, his impact on the nation, and on health care in particular, was immense.
For more than 16 years Dingell led the powerful House Energy and Commerce Committee, which is responsible for overseeing the Medicare and Medicaid programs, the U.S. Public Health Service, the Food and Drug Administration and the National Institutes of Health.
With nearly 60 years of service, Dingell was the longtime “dean of the House,” an honor accorded to the longest tenured member. As a young legislator, he presided over the House during the vote to approve Medicare in 1965. As a tribute to his father, who served before him and who introduced the first congressional legislation to establish national health insurance during the New Deal, Dingell introduced his own national health insurance bill at the start of every Congress.
And when the House passed what would become the Affordable Care Act in 2009, leaders named the legislation after him. Dingell sat by the side of President Barack Obama when he signed the bill into law in 2010.
Dingell was “a beloved pillar of the Congress and one of the greatest legislators in American history,” said a statement from House Speaker Nancy Pelosi. “Yet, among the vast array of historic legislative achievements, few hold greater meaning than his tireless commitment to the health of the American people.”
He was not always nice. He had a quick temper and a ferocious demeanor when he was displeased, which was often. Witnesses who testified before him could feel his wrath, as could Republican opponents and even other committee Democrats. And he was fiercely protective of his committee’s territory.
In 1993, during the effort by President Bill Clinton to pass major health reform, as the heads of the three main committees that oversee health issues argued over which would lead the effort, Dingell famously proclaimed of his panel, “We have health.”
Dingell and his health subcommittee chairman, California Democrat Henry Waxman, fought endlessly over energy and environmental issues. The Los Angeles-based Waxman was one of the House’s most active environmentalists. Dingell represented the powerful auto industry in southeastern Michigan and opposed many efforts to require safety equipment and fuel and emission standards.
In 2008, Waxman ousted Dingell from the chairmanship of the full committee.
But the two were of the same mind on most health issues, and together during the 1980s and early 1990s they expanded the Medicaid program, reshaped Medicare and modernized the FDA, NIH and the Centers for Disease Control and Prevention.
“It was always a relief for me to know that when he and I met with the Senate in conference, we were talking from the same page, believed in the same things, and we were going to fight together,” Waxman said in 2009.
Dingell was succeeded in his seat by his wife, Rep. Debbie Dingell, herself a former auto industry lobbyist.
Every minute, heart disease takes the life of a woman in the United States, even though nearly 80% of cardiac events can be prevented. Heart disease doesn’t affect every woman in the same way, but there are signs to look for and ways to help prevent it.
Medicare covers cardiovascular disease screenings every 5 years for people with Part B. Quitting smoking also helps lower your risk of heart disease, and Medicare covers smoking and tobacco use cessation counseling for people with Part B.
National Wear Red Day is February 1st. Support the women in your life and #WearRedandGive.
Although love songs might tell you otherwise, a broken heart can’t kill you—but heart disease can. Heart disease is the leading cause of death in the United States for both men and women, taking about 610,000 lives each year.
You might not be able to avoid Cupid’s arrow, but you can take steps to help prevent heart disease. Start by scheduling an appointment with your doctor to discuss your risks and how to lower them.
Medicare covers a cardiovascular disease screening every 5 years at no cost to you. The screening includes tests to help detect heart disease early and measures cholesterol, blood fat (lipids), and triglyceride levels. If you’ve had a heart condition, like a heart attack or heart transplant, Medicare covers cardiac rehabilitation programs that include exercise, education, and counseling.
If you’re at risk for a heart attack or stroke, there are steps you can take to help prevent these conditions. You might be able to make lifestyle changes (like changing your diet and increasing your activity level or exercising more often) to lower your cholesterol and stay healthy.
February is American Heart Month, so give your heart some love by visiting the Million Hearts Learn & Prevent center. Here, you can find your possible risks for heart disease, and resources, like heart-healthy recipes to help keep your heart strong. Million Hearts is a national initiative to help keep people healthy and improve health outcomes.
While you’re celebrating with loved ones this Valentine’s Day, don’t forget your heart needs some love, too.
Not sure if Medicare will cover your medical test or service? Medicare’s free “What’s covered” app delivers accurate cost and coverage information right on your smartphone. Now you can quickly see whether Medicare covers your service in the doctor’s office, the hospital, or anywhere else you use your phone.
“What’s covered” is available for free on both the App Store and Google Play. Search for “What’s covered” or “Medicare” and download the app to your phone. Once “What’s covered” is installed, you can use it to get reliable Medicare information even when you’re offline.
The app delivers general cost, coverage and eligibility details for items and services covered by Medicare Part A and Part B. Search or browse to learn what’s covered and not covered; how and when to get covered benefits; and basic cost information. You can also get a list of covered preventive services.
Easy access to accurate, reliable Medicare coverage information is just one new feature of the eMedicare initiative. To stay up to date on eMedicare improvements and other important news from Medicare,sign up for our email listand follow us on Facebook.
You should have received your new Medicare card in the mail by now. If you have your new Medicare card, start using it right away! Also remember to destroy your old Medicare card so no one can get your personal information.
If you’re still waiting on your new card, here’s what to do next:
Look around the house for any old or unopened mail. Your new Medicare card will come in a plain white envelope from the Department of Health and Human Services.
Sign in to MyMedicare.gov to get your number or print your official card. If you don’t have a MyMedicare.gov account yet, visit MyMedicare.gov to create one.
Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. There may be something that needs to be corrected, like your mailing address.
Your health care provider may also be able to look up your new number. And don’t worry, you can still use your current Medicare card to get health care services until January 1, 2020.
Continue to beware of scams! New numbers can still be used to commit health care fraud. Protect your Medicare card just like your credit cards. Only give your Medicare Number to doctors, pharmacists, other health care providers, your insurer, or people you trust to work with Medicare on your behalf.
Learn more about how you can fight Medicare fraud.
More than 3 million people in the United States have glaucoma. Glaucoma is a group of diseases that can cause permanent vision loss and blindness. Some forms of glaucoma don’t have any symptoms, so you may still have glaucoma even if you don’t have any trouble seeing or feel any pain. If you find and get treatment for glaucoma early, you can protect your eyes from serious vision loss.
January is glaucoma awareness month, and it’s the perfect time to check and see if you’re at high risk. You’re at high risk for glaucoma if one or more of these applies to you:
You have diabetes.
You have a family history of glaucoma.
You’re African American and 50 or older.
You’re Hispanic and 65 or older.
Medicare will cover a glaucoma test once every 12 months if you’re at high risk. Talk to your doctor or eye doctor for more information about scheduling a test. To learn more, read about glaucoma, or watch our glaucoma awareness video.
WASHINGTON, D.C. — Each of the seven California Democrats who flipped Republican congressional seats in the midterm election campaigned for more government-funded health care — with most of them calling for a complete government takeover.
So when they join the Golden State’s delegation this week, they will make it the largest state bloc to support “Medicare-for-all” in the U.S. House of Representatives. And Democrats, of course, will control the House.
Despite this political shift, the reality is that there’s probably not going to be much progressive health care legislation coming out of Congress in the next two years — a point on which even Democratic lawmakers agree.
“We need to do the things that are doable — that aren’t pie in the sky,” said U.S. Sen. Dianne Feinstein, a Democrat and the dean of the California delegation.
Democrats will hold 46 of the state’s 53 congressional seats in the House. It’s the largest contingent of Democrats the state has ever sent to Congress, according to membership rosters on the congressional History, Art & Archives website. All but seven of them have publicly supported, at one time, some form of government-financed health care — whether a sweeping Medicare-for-all program that would provide health insurance to all Americans, or an optional “public option” plan for those who want it.
California’s Democratic junior senator, Kamala Harris, who is contemplating a presidential bid, also supports Medicare-for-all, calling it “the moral and ethical thing to do.”
But the U.S. Senate will remain under Republican control, and Republican President Donald Trump has lambasted the idea of more government involvement in health care. Because of that political reality, Feinstein and others have said, the state’s freshman lawmakers who are eager to push forward on Medicare-for-all or a public option ought to refocus.
In a midterm election where health care ranked as the No. 1 concern of many voters, congressional newcomers Josh Harder, Katie Porter, Katie Hill, Harley Rouda and Mike Levin won their elections after campaigning for Medicare-for-all, the concept of one government-run health care program made popular by Sen. Bernie Sanders (I-Vt.) during his 2016 presidential bid.
Meanwhile, candidates Gil Cisneros and T.J. Cox promoted a public option, which would allow consumers to voluntarily buy in to a government-financed health care plan, such as Medicare or Medicaid.
None of the seven freshmen Democrats agreed to an interview to discuss their ideas about health care in the new Congress, nor would they provide a spokesperson. It’s unclear whether they’ll make a big push for the progressive causes they pitched on the campaign trail.
In a twist, a mid-December ruling by a Texas judge that declared the Affordable Care Act unconstitutional could actually help Democrats. Instead of arguing for Medicare-for-all, they can now pivot to protecting the law and its popular provisions, including protections for people with preexisting conditions.
“A conservative judge in Texas may have given new Democratic representatives in California a lot more leeway on health care than they had a week ago,” said Dan Schnur, a University of Southern California professor and former Republican strategist. “There’s a lot of potential health care legislation that’s going to be very popular in their districts.”
In the weeks leading up to the election, Harder, who beat Republican incumbent Jeff Denham in the Central Valley, was already tempering expectations about how effective Democrats could be next year.
“I think the reality is under a Trump presidency, it’s probably not going to be passed in the next two years,” Harder said about Medicare-for-all. “But we need to be making it very clear what we’re standing up for, and we’re standing up for the fact that every individual needs to be covered.”
A day after she won her congressional seat, Porter, who made Medicare-for-all an integral part of her campaign, told supporters it would have to wait.
“I think until we pass campaign finance reform, doing anything on health care is going to be a big challenge,” she said.
Part of the challenge for Porter, along with the rest of her new colleagues, is that they hail from swing districts. Each of them flipped Republican seats, and they will need to adopt a more centrist tone if they want to stay in Congress, political observers say.
“The reality of advocating for single-payer and the actuality of what it means is sobering,” said Lanhee Chen, director of domestic policy studies at Stanford University. “If you’re vulnerable, on Day One, by the nature of demographics of your district, I think it becomes harder to embrace.”
And while California voters ushered in a new class of progressives, they also gave a sixth term to Feinstein, who has openly warned against the cost and feasibility of a Medicare-for-all system. And likely incoming House Speaker Nancy Pelosi (D-San Francisco) has said she intends to focus on fixing lingering issues with the federal health care law, not push ahead with Medicare-for-all.
Other centrist Democrats say Congress ought to work out how to stabilize the health care markets or allow Americans 55 and older to buy into Medicare, which is currently open to those 65 and older. Feinstein, for example, also supports giving Medicare the ability to negotiate the price of drugs.
“Let’s build off of the gains we made in the Affordable Care Act,” said Rep. Ami Bera (D-Elk Grove), “but let’s also address some of the things Republicans did to undermine the ACA markets.”
This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.