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November is a Month Full of Healthcare Challenges

November is a significant month for healthcare. And while you might think you can sit on the sidelines and watch the action, there is actually some participation required.

Hopefully, the month started with active participation in the elections of Nov. 2. It’s no secret that these mid-term elections resulted in major changes to the make up of both the Congress and Senate. The new Republican Congress has already declared its top priority as the repeal of healthcare reform legislation – this calls into question what if any provisions of the 2,000-plus pages will become reality. The shaping of these changes will in part be based on citizens voicing their opinion on the direction healthcare reform should continue to take. Of course, this is something that is likely to take many more months to settle.

November 15: The lame duck Congressional session began Nov. 15. It also marked the start of the open enrollment period for older Americans to change their prescription drug plans. The open enrollment period to choose a new Medicare Part D plan will continue until Dec. 31 when the plan that is selected will be locked for most Medicare beneficiaries for the entire 2011 calendar year. Obviously, this requires seniors to actively evaluate which plan offers the most value and then enrolling in that plan. Seniors can go to Medicare.gov to evaluate which plan offers them the most or have their local pharmacist complete an assessment of the plans for them.

Mid-November: Some time between the middle and end of the month, the Deficit Commission is set to present their report. The commission is tasked with proposing ways to reduce the Federal deficit, which could reach $1.6 trillion by the end of this year. To balance the budget by 2015, excluding interest payments on debt, means officials would need to find roughly $240 billion in annual savings, according to commission documents. Given this significant amount, even changes to Medicaid and Medicare are possible. The Congressional Budget Office has estimated that if laws don't change, federal spending on healthcare alone will grow from five percent of gross domestic product in 2010 to 10 percent in 2035. Because of these numbers, big changes to Medicare and Medicaid are more than possible. The most likely change is expansion of the means testing on Medicare premiums.

November 30: But as a physician and someone who cares deeply for older Americans, perhaps the most significant date for the month does not occur until the very last day of November. That is when an over 20 percent cut to Medicare providers is set to go into effect unless Congress does something. This cut had been set to go into effect at the beginning of 2010 but was delayed several times during the year. A long-term fix to these reductions would cost over one quarter of a trillion dollars which may be difficult to come up with at a time when there is so much concern over government spending…although, if these cuts are put into place, finding a physician to care for older adults will certainly be a challenge. Older adults would be wise to develop a relationship with a group practice especially one that is part of a large health system as they would be least likely to abandon Medicare beneficiaries.

And while November is certainly a big month for healthcare, it may just be the beginning of even bigger months to come. For as the new Congress begins work on reshaping the healthcare landscape, there will certainly be lots to watch, learn about, and actively participate in well beyond what’s occurring this month.

Dr. Richard G. Stefanacci is an internist/geriatrician and associate professor of health policy at University of the Sciences. He can be reached at r.stefan@usp.edu.


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