Susan Jaffe
Thu, 07 Dec 2023 17:15:00 +0000

Angela M. Du Bois, a retired software tester in Durham, North Carolina, wasn't looking to replace her UnitedHealthcare Medicare Advantage plan. She wasn't concerned as the Dec. 7 deadline approached for choosing another of the privately run health insurance alternatives to original Medicare.

But then something caught her attention: When she went to her doctor last month, she learned that the doctor and the hospital where she works will not accept her insurance next year.

Faced with either finding a new doctor or finding a new plan, Du Bois said the decision was easy. “I'm sticking with her because she knows everything about me,” she said of her doctor, whom she's been seeing for more than a decade.

Du Bois isn't the only one tuning out when commercials about the open enrollment deadline flood the airwaves each year — even though there could be good reasons to shop around. But sifting through the offerings has become such an ordeal that few people want to repeat it. Avoidance is so rampant that only 10% of beneficiaries switched Medicare Advantage plans in 2019.

Once open enrollment ends, there are limited options for a do-over. People in Medicare Advantage plans can go to another Advantage plan or back to the original, government-run Medicare from January through March. And the Centers for Medicare & Medicaid Services has expanded the criteria for granting a “special enrollment period” to make changes in drug or Advantage plans anytime.

But most seniors will generally allow their existing policy to renew automatically, like it or not.

Keeping her doctor was not Du Bois' only reason for switching plans, though. With help from Senior PharmAssist, a Durham nonprofit that advises seniors about Medicare, she found a Humana Medicare Advantage plan that would not only be accepted by her providers but also cover her medications — saving her more than $14,000 a year, said Gina Upchurch, the group's executive director.

Senior PharmAssist is one of the federally funded State Health Insurance Assistance Programs, known as SHIPs, available across the country to provide unbiased assistance during the open enrollment season and year-round to help beneficiaries appeal coverage denials and iron out other problems.

“Many people are simply overwhelmed by the calls, ads, the sheer number of choices, and this ‘choice overload' contributes to decision-making paralysis,” said Upchurch. Seniors in Durham have as many as 74 Advantage plans and 20 drug-only plans to choose from, she said.

Upchurch said the big insurance companies like the way the system works now, with few customers inclined to explore other plans. “They call it ‘stickiness,'” she said. “If we had fewer and clear choices — an apple, orange, grape, or banana — most people would review options.”

In Washington state, one woman switched from a plan she had had for more than a decade to one that will cover all her drugs and next year will save an estimated $7,240, according to Tim Smolen, director of the state's SHIP, Statewide Health Insurance Benefits Advisors.

In Northern California, another woman changed drug plans for the first time since 2012, and her current premium of $86 will plummet to 40 cents a month next year, an annual savings of about $1,000, said Pam Smith, a local director for California's SHIP, called the Health Insurance Counseling & Advocacy Program.

And in Ohio, a woman sought help after learning that her monthly copayment for the blood thinner Eliquis would rise from $102 to $2,173 next year. A counselor with Ohio's SHIP found another plan that will cover all her medications for the year and cost her just $1,760. If she stuck with her current plan, she would be paying an additional $24,852 for all her drugs next year, said Chris Reeg, who directs that state's program.

In some cases, CMS tries to persuade beneficiaries to switch. Since 2012, it has sent letters every year to thousands of beneficiaries in poorly performing Advantage and drug plans, encouraging them to consider other options. These are plans that have received less than three out of five stars for three years from CMS.

“You may want to compare your plan to other plans available in your area and decide if it's still right for you,” the letter says.

CMS allows low-scoring plans to continue to operate. In an unusual move, officials recently found that one plan had such a terrible track record that they will terminate its contract with government health programs next December.

CMS also contacts people about changing plans during open enrollment if they get a subsidy — called “extra help” — that pays for their drug plan's monthly premium and some out-of-pocket expenses. Because some premiums will be more expensive next year, CMS is warning beneficiaries that they could be in for a surprise: a monthly bill to cover cost increases the subsidy doesn't cover.

But many beneficiaries receive no such nudge from the government to find out if there is a better, less expensive plan that meets their needs and includes their health care providers or drugs.

That leaves many people with Medicare drug or Advantage plans on their own to decipher any changes to their plans while there is still time to enroll in another. Insurers are required to alert members with an “annual notice of change,” a booklet often more than two dozen pages long. Unless they plow through it, they may discover in January that their premiums have increased, the provider network has changed, or some drugs are no longer covered. If a drug plan isn't offered the next year and the beneficiary doesn't pick a new one, the insurer will select a plan of its choosing, without considering costs or needed drug coverage.

“Every year, our call volume skyrockets in January when folks get invoices for that new premium,” said Reeg, the Ohio program director. At that point, Medicare Advantage members have until March 30 to switch to another plan or enroll in government-run Medicare. There's no similar grace period for people with stand-alone drug plans. “They are locked into that plan for the calendar year.”

One cost-saving option is the government's Medicare Savings Program, which helps low-income beneficiaries pay their monthly premium for Medicare Part B, which covers doctor visits and other outpatient services. The Biden administration's changes in eligibility for subsidies announced in September will extend financial assistance to an estimated 860,000 people — if they apply. In the past, only about half of those eligible applied.

Fixing a mistake after the open enrollment period ends Dec. 7 is easy for some people. Individuals who receive “extra help” to pay for drug plan premiums and those who have a subsidy to pay for Medicare's Part B can change drug plans every three months.

At any time, beneficiaries can switch to a Medicare Advantage plan that earns the top five-star rating from CMS, if one is available. “We've been able to use those five-star plans as a safety net,” said Reeg, the Ohio SHIP director.

Other beneficiaries may be able to get a “special enrollment period” to switch plans after the open enrollment ends if they meet certain conditions. Local SHIP offices can help people make any of these changes when possible.

Reeg spends a lot of time trying to ensure that unwelcome surprises — like a drug that isn't covered — don't happen in the first place. “What we want to do is proactively educate Medicare patients so they know that they can go to the doctors and hospitals they want to go to in the upcoming year,” she said.

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By: Susan Jaffe
Title: Dodging the Medicare Enrollment Deadline Can Be Costly
Sourced From: kffhealthnews.org/news/article/medicare-open-enrollment-deadline-cost-of-not-choosing/
Published Date: Thu, 07 Dec 2023 17:15:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/candidates-clashed-but-avoided-talk-of-abortion-at-4th-gop-primary-debate/

KFF Health News and PolitiFact staffs
Thu, 07 Dec 2023 14:00:00 +0000

Raised voices and sharp words marked Wednesday night's fourth Republican presidential primary debate as four candidates argued about everything from their own electability to the continued front-runner status of former President Donald Trump. Abortion was never mentioned.

Florida Gov. Ron DeSantis, former South Carolina Gov. Nikki Haley, entrepreneur Vivek Ramaswamy, and former New Jersey Gov. Chris Christie faced off in Tuscaloosa, Alabama, just 40 days before the Iowa caucuses. They sparred over antisemitism and the war between Israel and Hamas as well as the conflict in Ukraine. There were references to cryptocurrency and TikTok. Candidates also attempted to tackle inflation, corruption, border issues, and the inner workings of the Department of Justice, among other things.

As he did in the previous three meetings, Trump opted not to participate, this time attending a fundraiser in Florida. The event was moderated by NewsNation's Elizabeth Vargas; Megyn Kelly, host of “The Megyn Kelly Show” on SiriusXM; and Eliana Johnson, editor-in-chief of The Washington Free Beacon.

Our PolitiFact partners fact-checked the candidates in real time. You can read the full coverage here.

Health care — in the form of the Affordable Care Act — took center stage during the debate's last minutes. Until recently, it seemed that the Republican Party had all but abandoned its years-long effort to repeal and replace Obamacare. But Trump resurrected the campaign with a social media post over Thanksgiving weekend describing the GOP's failure to achieve this goal during his first term as “a low point for the Republican Party.”

DeSantis, who seemed to pick up on some of Trump's ACA criticisms, has since promised that he will have a health plan that is “different and better.” He was challenged by debate moderators with the question: “Why should Americans trust you more than any other Republicans who have disappointed them on this issue?” In his response, he offered key buzzwords but few specifics. “You need price transparency. You need to hold the pharmaceuticals accountable. You need to hold big insurance and big government accountable, and we're gonna get that done.”

Ramaswamy followed with his own take, involving similar concepts but different words. “We need to start having diverse insurance options in a competitive marketplace that cover actual health, preventative medicine, diet, exercise, lifestyle, and otherwise.”

Throughout the evening, some of the most heated clashes came as candidates sparred over transgender issues and gender-affirming care. PolitiFact examined some of these claims:

DeSantis: “I did a bill in Florida to stop the gender mutilation of minors. It's child abuse and it's wrong. [Nikki Haley] opposes that bill. She thinks it's fine and the law shouldn't get involved with it.”

This claim has two parts, and each needs more context.

In May 2023, the Florida Legislature passed a bill that banned gender-affirming surgeries for minors. Experts told PolitiFact that gender-affirming surgeries are not the same as genital mutilation. And the law didn't ban just surgeries — it banned all gender-affirming medical care, including puberty blockers and cross-sex hormones, which are supported by most major U.S. medical organizations.

Surgeries are rarely provided as part of gender-affirming care for minors.

In a June CBS interview, Haley said that when it comes to determining what care should be available for transgender youth, the “law should stay out of it, and I think parents should handle it.” She followed up by saying, “When that child becomes 18, if they want to make more of a permanent change, they can do that.”

Haley's campaign pointed to a May ABC appearance in which she said that a minor shouldn't have a “gender-changing procedure” and opposed “taxpayer dollars” funding one.

Haley: “I said that if you have to be 18 to get a tattoo, you should have to be 18 to have anything done to change your gender.”

During the debate, Haley likened her position on gender-affirming care for minors — that it should be up to parents until the child is 18 — to age requirements for getting a tattoo: “I said that if you have to be 18 to get a tattoo, you should have to be 18 to have anything done to change your gender.”

We've heard that comparison before. For what it's worth, two-thirds of U.S. states allow minors to get tattoos if their parents consent. And medical experts have told us gender-affirming care is in many cases considered medically necessary, while tattoos are cosmetic.

Ramaswamy: “I think the North Star here is transgenderism is a mental health disorder.”

PolitiFact rated Ramaswamy's claim False after he introduced it at the second primary debate.

In the past, the medical community viewed the experience of being transgender as a “disorder,” but they no longer agree on that categorization. In the past decade, diagnostic manuals published by the World Health Organization and the American Psychiatric Association contained updated language to clarify that being transgender is not a mental illness. Experts told us that persistent gender dysphoria can cause other mental health issues, but it is not itself a mental health disorder.

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By: KFF Health News and PolitiFact staffs
Title: Candidates Clashed But Avoided Talk of Abortion at 4th GOP Primary Debate
Sourced From: kffhealthnews.org/news/article/fourth-gop-primary-debate-transgender-rights-avoid-abortion/
Published Date: Thu, 07 Dec 2023 14:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/food-sovereignty-movement-sprouts-as-bison-return-to-indigenous-communities/

Jim Robbins
Thu, 07 Dec 2023 10:00:00 +0000

BOZEMAN, Mont. — Behind American Indian Hall on the Montana State University campus, ancient life is growing.

Six-foot-tall corn plants tower over large green squash and black-and-yellow sunflowers. Around the perimeter, stalks of sweetgrass grow.

The seeds for some of these plants grew for millennia in Native Americans' gardens along the upper Missouri River. It's one of several Native American ancestral gardens growing in the Bozeman area, totaling about an acre. Though small, the garden is part of a larger, multifaceted effort around the country to promote “food sovereignty” for reservations and tribal members off reservation, and to reclaim aspects of Native American food and culture that flourished in North America for thousands of years before the arrival of European settlers. Restoring bison to reservations, developing community food gardens with ancestral seeds, understanding and collecting wild fruits and vegetables, and learning how to cook tasty meals with traditional ingredients are all part of the movement.

“We are learning to care for plant knowledge, growing Indigenous gardens, cultivating ancestral seeds — really old seeds from our relatives the Mandan, Hidatsa, and Arikara: corn, beans, squash, and sunflowers,” said Jill Falcon Ramaker, an assistant professor of community nutrition and sustainable food systems at Montana State. She is a member of the Turtle Mountain Band of Anishinaabe.

“A lot of what we are doing here at the university is cultural knowledge regeneration,” she said.

But it also has a very practical application: to provide healthier, cheaper, and more reliable food supplies for reservations, which are often a long way from supermarkets, and where processed foods have helped produce an epidemic of diabetes and heart disease.

Many reservations are food deserts where prices are high and processed food is often easier to come by than fresh food. The Montana Food Distribution Study, a 2020 paper funded by the U.S. Department of Agriculture, found that the median cost in the state of a collection of items typically purchased at a grocery store is 23% higher on a reservation than off.

“With food sovereignty we are looking at the ability to put that healthy food and ancestral foods which we used to survive for thousands of years, putting those foods back on the table,” Ramaker said. What that means exactly can vary by region, depending on the traditional food sources, from wild rice in the Midwest to salmon on the Pacific coast.

Central to the effort, especially in Montana, are bison, also referred to as buffalo. In 2014, 13 Native nations from eight reservations in the U.S. and Canada came together to sign the Buffalo Treaty, an agreement to return bison to 6.3 million acres that sought “to welcome BUFFALO to once again live among us as CREATOR intended by doing everything within our means so WE and BUFFALO will once again live together to nurture each other culturally and spiritually.”

Nearly a decade later, dozens of tribes have buffalo herds, including all seven reservations in Montana.

The buffalo-centered food system was a success for thousands of years, according to Ramaker, who directs both the regional program, known as the Buffalo Nations Food Systems Initiative — a collaboration with the Native American Studies Department and College of Education, Health and Human Development at Montana State — and the Montana-specific effort, known as the Montana Indigenous Food Sovereignty Initiative. It wasn't a hand-to-mouth existence, she wrote in an article for Montana State, but a “knowledge of a vast landscape, including an intimate understanding of animals, plants, season, and climate, passed down for millennia and retained as a matter of life and death.”

With bison meat at the center of the efforts, the BNFSI is working to bring other foods from the northern Plains Native American diet in line with modern palates.

The BNFSI has received a $5 million grant from the U.S. Department of Agriculture to carry out that work, in partnership with Nueta Hidatsa Sahnish College in New Town, North Dakota.

Life on reservations is partly to blame for many Native people eating processed foods, Ramaker said. Food aid from the federal government, known as the Commodity Supplemental Food Program, has long been shipped to reservations in the form of boxes full of packaged foods. “We were forced onto the reservations, where there was replacement food sent by the government — white flour, white sugar, canned meat, salt, and baking powder,” she said.

Experts say processed foods contribute to chronic inflammation, which in turn leads to heart disease, cancer, and diabetes, which occurs at three times the rate in Native Americans as it does in white people.

Studies show that people's mental and physical health declines when they consume a processed food diet. “In the last decade there's a growing amount of research on the impact of good nutrition on suicide ideation, attempts, and completion,” said KayAnn Miller, co-executive director of the Montana Partnership to End Childhood Hunger in Bozeman, who is also involved with the BNFSI.

All Native American reservations in Montana now have community gardens, and there are at least eight gardens on the Flathead Reservation north of Missoula, home to the Confederated Salish and Kootenai Tribes. The tribe is teaching members to raise vegetables, some of them made into soup that is delivered to tribal elders. This year members grew 5 tons of produce to be given away.

Ancestral seeds are part of the effort. Each year the BNFSI sends out 200 packets of seeds for ancestral crops to Indigenous people in Montana.

Creating foods that appeal to contemporary tastes is critical to the project. The BNFSI is working with Sean Sherman, the “Sioux Chef,” to turn corn, meat, and other Native foods into appealing dishes.

Sherman founded the award-winning Owamni restaurant in Minneapolis and in 2020 opened the Indigenous Food Lab, through his nonprofit, North American Traditional Indigenous Food Systems. The lab, in downtown Minneapolis, is also a restaurant and an education and training center that creates dishes using only Indigenous foods from across the country — no dairy, cane sugar, wheat flour, beef, chicken, or other ingredients from what he calls the colonizers.

“We're not cooking like it's 1491,” Sherman said last year on the NPR program “Fresh Air,” referring to the period before European colonization. “We're not a museum piece or something like that. We're trying to evolve the food into the future, using as much of the knowledge from our ancestors that we can understand and just applying it to the modern world.” Among his signature dishes are bison pot roast with hominy and roast turkey with a berry-mint sauce and black walnuts.

In consultation with Sherman, Montana State University is building the country's second Indigenous food lab, which will be housed in a new $29 million building with a state-of-the-art kitchen, Ramaker said. It will open next year and expand the ongoing work creating recipes, holding cooking workshops, feeding MSU's more than 800 Native students, and preparing cooking videos.

Angelina Toineeta, who is Crow, is studying the BNFSI at Montana State as part of her major in agriculture. “Growing these gardens really stuck out to me,” she said. “Native American agriculture is something we've lost over the years, and I want to help bring that back.”

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By: Jim Robbins
Title: Food Sovereignty Movement Sprouts as Bison Return to Indigenous Communities
Sourced From: kffhealthnews.org/news/article/native-indigenous-food-sovereignty-movement-bison-sioux-chef/
Published Date: Thu, 07 Dec 2023 10:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/colorado-blames-biden-team-and-drugmakers-for-delaying-canadian-imports/