Reality, Rumors and Medicare

Asclepios - Your Weekly Medicare Consumer Advocacy Update - Medicare Rights Center Opponents of health care reform continue to spread the false and malicious rumor that health care legislation would set up government “death panels” to decide whether older adults deserve life-sustaining treatment. Despite clear evidence that no such panels are authorized under any health reform bill, the rumor has not died. In fact, this falsehood has morphed from a fringe conspiracy theory and is now being mouthed by leading figures in the media. Patients who face the diagnosis of a potentially fatal illness and their family members are ill-served by such fear-mongering. In reality, Medicare provides much more discretion to the doctor to decide the course of treatment in consultation with the patient than do private insurance companies. Take, for example, the treatment options available to a person with Medicare who has been diagnosed with cancer. Sometimes, the best option for treating cancer is to use a drug that was approved by the Food and Drug Administration for the treatment of another type of cancer or for cancer at a later, more serious, stage. Such “off-label” drug use is widely accepted in the medical community. Medicare will cover such off-label cancer treatments if there is support in reference compendia that review the research on safety and efficacy or, during a review of the specific case, when studies published in respected, peer-reviewed journals (reviewed by expert doctors) support the use. The flexibility that is built into the legal standard for Medicare coverage is essential to ensure access to life-sustaining cancer treatments. Last year, Congress extended this legal standard for cancer treatments to drugs purchased at a pharmacy under the Part D drug benefit. (Previously, it had applied only to drugs covered under Part B—mostly chemotherapy received in the doctor’s office.) The legislative change was included in the Medicare Improvements to Patients and Providers Act, which passed over a veto by then-President Bush, 70-26, with 21 Republicans voting for the bill. Many state laws require private insurance companies to use the same standard to decide whether they will cover cancer treatments. Health reform legislation being considered in the House of Representatives, as well as legislation passed by the Senate Health, Education, Labor and Pensions Committee preserves those benefit mandates. Of course, the question of coverage mandates for Medicare or private insurance is irrelevant to people who have no insurance, or who have insurance that leaves them paying the lion’s share of treatment costs. For the uninsured and underinsured, a cancer diagnosis often means bankruptcy or going without treatment. By setting minimum standards for health benefits (including an out-of-pocket limit), helping low- and moderate-income people afford their premiums, and preventing insurers from denying coverage based on pre-existing conditions (like a history of cancer), health reform legislation extends to all Americans the health security that people with Medicare enjoy. As the example of cancer shows, ensuring access to life-sustaining treatment is complicated. Securing legal or regulatory mandates is just the first step; real access is often secured only when patients and advocates fight for what they need. If the energy now being devoted to spreading false rumors about government “death panels” were redirected to securing comprehensive, affordable health coverage for all Americans, including those with life-threatening conditions, we would all be better off. Medical Record “[Health reform legislation] gives actually people with Medicare more options, more information, more choices, as the president said, and puts them more in control at the end of life or beforehand as they plan for that kind of care. So the mischaracterization of this has really been used to scare seniors and to drum up anti-reform efforts. And it's really a good thing overall, providing seniors and people with disabilities on Medicare more options and choices.” (Medicare Rights Center President Joseph Baker on NewsHour with Jim Lehrer, August 2009) “Medicare beneficiaries are less likely to report not getting needed services. Twelve percent of elderly Medicare beneficiaries reported going without care, such as prescribed medications or recommended tests, because of cost restraints. Of individuals with employer-based plans, 26 percent reported experiencing these cost/access issues.” (Meeting Enrollees' Needs: How Do Medicare and Employer Coverage Stack Up?,Commonwealth Fund, May 2009) “The provisions contained in the off-label laws in 19 states require that, in order for certain drugs to be covered, they must be recognized for treatment of the specific type of cancer or indication by either standard reference compendia or medical/peer-reviewed literature.” (State Laws Requiring Third-Part Reimbursment for Off-Label Use of Prescription Drugs for Cancer Treatment, National Cancer Institute, June 2002) “More than two years after it first filed an appeal, the Medicare Rights Center has secured coverage under the Medicare Part D prescription drug benefit for a New York woman’s ovarian cancer treatment. . . .The victory, handed down in an April 20, 2009 decision by the Part D independent review entity, follows passage last summer of the Medicare Improvements for Patients and Providers Act (MIPPA). (Medicare Rights Center Secures Coverage for New York Woman’s Cancer Treatment, Medicare Rights Center, April 2009)

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