Author Topic: U.S. Cost-Saving Policy Forces New Kidney Transplant  (Read 6639 times)

cschwab

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U.S. Cost-Saving Policy Forces New Kidney Transplant
« on: May 02, 2010, 07:13:05 PM »
SAN DIEGO
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cschwab

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #1 on: May 03, 2010, 03:41:34 PM »
It looks like Melissa Whitaker hasn't quite got her wish.  Senator Richard Durbin from Illinois tried to get an amendment added to the big health care reform bill, S.Amdt. 3102 to H.R. 3590 that would have expanded Medicare drug coverage for transplants.  It looks to me like the amendment didn't make it.
http://www.pharmacypracticenews.com/index.asp?show=currissue&section_id=451&article_id=15000

However, since everybody is required to have insurance, what portion of the bill for a transplant will be paid?  I did find a Rand study that described four different levels of insurance that people will probably be carrying:

"H.R. 3590 expands the insurance options available to potential new purchasers by establishing Health Benefit Exchanges.  The Exchanges will offer four basic plans with different actuarial values: Bronze (60%), Silver (70%), Gold (80%),
and Platinum (90%).  The actuarial value of a health plan is defined as the percentage of the
« Last Edit: May 04, 2010, 03:23:49 PM by cschwab »
Proud member of DialysisEthics since 2000

DE responsible for:

*2000 US Senate hearings

*Verified statistics on "Dialysis Facility Compare"

*Doctors have to review charts before they can be reimbursed

*2000 and 2003 Office of Inspector General (OIG) reports on the conditions in dialysis

*2007 - Members of DialysisEthics worked for certification of hemodialysis
technicians in Colorado - bill passed

*1999 to present - nonviolent dismissed patients returned to their
clinics or placed in other clinics or hospitals over the years

angieskidney

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #2 on: May 05, 2010, 03:31:18 AM »
Wow thanks for that information. I was wondering how the American Health Care reform was going

cschwab

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #3 on: May 08, 2010, 01:10:45 PM »
Bill Peckman, who has a blog at http://www.billpeckham.com/ did provide some more information:

"The Affordable Care Act's out-of-pocket costs for those with incomes up to 400% Federal Poverty Level are limited to the following levels:

o  100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);
o  200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);
o  300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).

As far as upper limits the basic package level (Bronze) must have specified
« Last Edit: May 08, 2010, 01:22:32 PM by cschwab »
Proud member of DialysisEthics since 2000

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*Doctors have to review charts before they can be reimbursed

*2000 and 2003 Office of Inspector General (OIG) reports on the conditions in dialysis

*2007 - Members of DialysisEthics worked for certification of hemodialysis
technicians in Colorado - bill passed

*1999 to present - nonviolent dismissed patients returned to their
clinics or placed in other clinics or hospitals over the years

cschwab

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #4 on: May 08, 2010, 01:13:58 PM »
I tried to come up with a worst case scenario and see how all this applies.  Say we have someone getting older, has kidney disease and has been cutting back on work, so they are making $10,000 a year (about 100% of Federal Poverty Level).  Say the person is on a individual silver health care plan (one set of calculations above mentions using the silver) and is thinking about a transplant.  However, first the person wants to see what it is going to cost.  

Our friend sees the following:

Premiums: $200 a year (2% of income - from above)

out-of-pocket per year(co-pays, deductibles): $1983 (above post)

Transplant surgery: $30,000 (insurance pays $70,000 - silver plan)

The person is looking at paying $2183 a year for health care though (premiums plus out-of-pocket).  I'm hearing the $30,000 for surgery is considered a co-pay, so the person doesn't have to worry about paying their surgery share after hitting the $1983 cap - and also may qualify for Medicaid (it has 0 co-pays, Medicaid kicks in if below 133% of the Federal Poverty Level).  Head hurting yet?
« Last Edit: May 09, 2010, 09:18:37 AM by cschwab »
Proud member of DialysisEthics since 2000

DE responsible for:

*2000 US Senate hearings

*Verified statistics on "Dialysis Facility Compare"

*Doctors have to review charts before they can be reimbursed

*2000 and 2003 Office of Inspector General (OIG) reports on the conditions in dialysis

*2007 - Members of DialysisEthics worked for certification of hemodialysis
technicians in Colorado - bill passed

*1999 to present - nonviolent dismissed patients returned to their
clinics or placed in other clinics or hospitals over the years

angieskidney

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #5 on: May 17, 2010, 02:50:57 PM »
I tried to come up with a worst case scenario and see how all this applies.  Say we have someone getting older, has kidney disease and has been cutting back on work, so they are making $10,000 a year (about 100% of Federal Poverty Level).  Say the person is on a individual silver health care plan (one set of calculations above mentions using the silver) and is thinking about a transplant.  However, first the person wants to see what it is going to cost.  

Our friend sees the following:

Premiums: $200 a year (2% of income - from above)

out-of-pocket per year(co-pays, deductibles): $1983 (above post)

Transplant surgery: $30,000 (insurance pays $70,000 - silver plan)

The person is looking at paying $2183 a year for health care though (premiums plus out-of-pocket).  I'm hearing the $30,000 for surgery is considered a co-pay, so the person doesn't have to worry about paying their surgery share after hitting the $1983 cap - and also may qualify for Medicaid (it has 0 co-pays, Medicaid kicks in if below 133% of the Federal Poverty Level).  Head hurting yet?

That sounds like the Trillium Plan in Ontario Canada. I don't know numbers like you do but everything is covered for me except medications which include transplant medications so then I had to apply for Trillium which worked on a percentage scale as well that goes by your income. I fall into the poverty level (below the $10,000 a year scale) so I had to pay $300 for every quarter (or is it 3rd? I forget now) but since I got on disability in 2001 they covered it and then Trillium kicked in so I ended up paying nothing anymore for my medications (I was on Trillium between 2002 and 2005). However because it all sounds complicated a lot of people don't apply. Much less even hear about it. Because I didn't know about it (before 2001) I had lost my first transplant because I could not afford my meds. I was having a hard time and after paying 50% of my college loan off and doing well, I had to turn down a promotion at my job, claim bankruptcy and move into subsidized housing. It was a low point in my life but the lowest part was not being able to afford my medications for my gift of life and not knowing where to turn (I know now but I was young and didn't have the information I do now. It is actually the reason I know where to get info now within my area). This time they tell me I won't lose my disability and this time I also know about the trillium system.

Don't mean to confuse anyone but just wanted to express that even if the system is confusing it is the bottom line that matters. Who pays doesn't matter as much as will we have to pay. And IF it will be paid! That is even MORE important! But if the American Health Care new system doesn't do all the work for you then you will have to understand it more than Canadians have to understand their system.

She lived in Seattle for a while without electricity or hot water. The bank repossessed her car, and she filed for bankruptcy. Her grandmother eventually bought her new hearing aids, and she went back to work. But she was laid off a year later.

« Last Edit: May 17, 2010, 02:58:37 PM by Angie »

cschwab

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #6 on: May 18, 2010, 02:53:18 PM »

I can totally relate to that story even though I am in a different country. I fell between the cracks though and the story is not a common one for Canada yet in the USA I hear this happens quite a lot which is unacceptable!!


Have to keep our corporations bottom-lines healthy!  That CEO needs that Swiss chalet!  Even if it means people going broke with over 60% of bankruptcies medically related:

"In our most recent study, medical bills and illness contributed to 62.1 percent of all personal bankruptcies. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent. The striking conclusion from our study is that private health insurance is a defective product that leaves millions of middle-class families vulnerable to financial ruin."
http://www.pnhp.org/news/2009/july/testimony_of_steffie.php
Proud member of DialysisEthics since 2000

DE responsible for:

*2000 US Senate hearings

*Verified statistics on "Dialysis Facility Compare"

*Doctors have to review charts before they can be reimbursed

*2000 and 2003 Office of Inspector General (OIG) reports on the conditions in dialysis

*2007 - Members of DialysisEthics worked for certification of hemodialysis
technicians in Colorado - bill passed

*1999 to present - nonviolent dismissed patients returned to their
clinics or placed in other clinics or hospitals over the years

angieskidney

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #7 on: May 22, 2010, 12:46:57 PM »
"In our most recent study, medical bills and illness contributed to 62.1 percent of all personal bankruptcies. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent. The striking conclusion from our study is that private health insurance is a defective product that leaves millions of middle-class families vulnerable to financial ruin."
http://www.pnhp.org/news/2009/july/testimony_of_steffie.php


Funny thing is that is exactly when I had to claim bankruptcy was between 2001 and 2007 (was 2002 for me actually when I filed and 2003 when I was discharged from my debt through bankruptcy) 100% due to me having to go on dialysis and give up my 12 hr 5 days a week shift job of 9 years.  Here I was aiming to buy a house and then all my dreams went down the drain.

However, is there actually a such thing as an area of the world that this doesn't happen? I am in Canada and same thing happens here..

cschwab

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #8 on: May 29, 2010, 03:21:12 PM »
I guess it isn't just a phenomenon that happens here!  I'm sorry to hear you had to go through it on top of everything else.  I would be curious to know how often it happens compared to here?
Proud member of DialysisEthics since 2000

DE responsible for:

*2000 US Senate hearings

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*Doctors have to review charts before they can be reimbursed

*2000 and 2003 Office of Inspector General (OIG) reports on the conditions in dialysis

*2007 - Members of DialysisEthics worked for certification of hemodialysis
technicians in Colorado - bill passed

*1999 to present - nonviolent dismissed patients returned to their
clinics or placed in other clinics or hospitals over the years

angieskidney

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #9 on: June 01, 2010, 04:19:46 PM »
I guess it isn't just a phenomenon that happens here!  I'm sorry to hear you had to go through it on top of everything else.  I would be curious to know how often it happens compared to here?

I guess in Canada not as often. I just fell in the cracks of the government making a dumb ass rule that made me not able to apply for medical forgiveness of my loan even though I paid off 50% in 3 years which was ahead of schedule since according to my budget I would be all paid off in 11 years. Going on dialysis screwed that up and then I had to claim bankruptcy because I could not even pay normal bills. If I Had known that bankruptcy did NOT include my college loan I could have consolidated instead but the bankruptcy was also putting that on the table and then after going through with it told me it couldn't be included. That made me so mad.  But yeah if the College Loan would have understood or if I just would have never went to College in the first place I could have managed my finances. It just would have been tight because I went from making over 2G a month to less than 300 a month..

Unemployment Insurance only lasted so long because it is used to get back into work .. not stay off of work for 6+ years like I did on dialysis. Thank God for disability but I still owe $10G for that College loan (what I have remaining .. not including interest) which they want paid in one lump sum or else through my income taxes (I get nothing back now as they take it all from me).

As you can see my situation is different than from the story. But I could relate because I had lost everything due to going on dialysis. But the other part of the story I could relate to was losing my drug coverage. That is not the same in all Provinces or Territories in Canada but is true for mine that it is not included in your Provincial Health Care that covers hospital stays (non-private as private costs you) and doctor visits (no longer counting eye glass doctors or dental as they stopped covering that). What happened was I had to switch from child disability to adult but my mom didn't want "government handouts" and denied me going to the adult kind. I was still living under her roof and even though I was turning 18 I was very shy and dependent on her and let her handle it and the nurse (how things worked back then but are different now) that came to the house to figure this out let my mom make all the decisions for me. Then a year later my mom kicks me out of the house and I have no drug coverage since the disability wasn't continued (I only had my parents for as long as I lived there). I tried to reapply to disability but they said I was not disabled because I had a transplanted kidney.

Because of lack of transplant meds that was how I lost my first transplant. Again I fell between the cracks that normally people here do not fall between.

The problem here with falling between the cracks is the medical and government system do not believe you because "that just doesn't happen".

cschwab

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Re: U.S. Cost-Saving Policy Forces New Kidney Transplant
« Reply #10 on: June 03, 2010, 05:57:00 PM »
Wow!  That is quite a mess you had to deal with!  Sounds like you tried to do everything right , but still wound up on the short-end.  I have to wonder if these knuckleheads (both north and south of the Canadian border) making these decisions about drug coverage etc.. are all related, maybe it is some sort of genetic defect - didn't stop to think it just might cost more having you back on dialysis.
Proud member of DialysisEthics since 2000

DE responsible for:

*2000 US Senate hearings

*Verified statistics on "Dialysis Facility Compare"

*Doctors have to review charts before they can be reimbursed

*2000 and 2003 Office of Inspector General (OIG) reports on the conditions in dialysis

*2007 - Members of DialysisEthics worked for certification of hemodialysis
technicians in Colorado - bill passed

*1999 to present - nonviolent dismissed patients returned to their
clinics or placed in other clinics or hospitals over the years