Health-care costs of 'dual-eligibles' draw budget-cutters' attention
Taunya English's story is part of a project on health in the states a partnership of WHYY, NPR and Kaiser Health News.
U.S. Sen. Pat Toomey of Pennsylvania and colleagues on the congressional super committee are facing a big task and a tight deadline to come up with a plan to trim the country's debt.
Escalating health costs are in the cross-hairs, and one patient group is getting lots of attention.
Several proposals aim to control health spending for the 9 million Americans enrolled in both of the country's big public health plans--Medicaid and Medicare. Policy wonks call them "dual-eligibles."
"So you are talking about people who are poor and old or poor and disabled, either way that's a recipe for getting sick and incurring costs," said Robert Field, a professor of health management and policy at Drexel University.
"The dual-eligibles are expensive and have been for a long time, so it's a natural place for the super committee--or anyone that's trying to cut costs--to look," he said.
Medicaid is primarily a program for low-income people. Medicare covers the elderly as well as young people who are disabled.
Homesetead, Pa., resident Denise Weis has vision problems, heart trouble, diabetes and asthma. She's being treated for anxiety and depression.
"I'm on insulin for my diabetes, and Metformin, that's another diabetes drug. I take Zoloft for my depression, Exforge for my high blood pressure, that's all I can think of right now," she said.
Half of dual-eligibles have five or more chronic health problems.
Six years ago, Weis said, it became impossible to keep the kinds of retail and custodial jobs she'd worked all her life.
Lawmakers say they're looking for ways to reduce the health expenses, but Weis interprets that mission as a plan to cut benefits, or shift costs on to beneficiaries.
Her disability check is $827 a month. Weis says she can't afford to pay more.
Policy expert Robert Field said most of the proposals are to end disjointed care.
"What they really need is top-quality care that is well-coordinated, people who can see the overall picture and not just deal symptom by symptom but deal with comprehensive problems," he said.
Insurance companies say the government could save billions by moving dual-eligibles into managed-care plans. They say it would give them an incentive to keep patients healthy, not just process payments.
Officials in 37 states--including Pennsylvania and Delaware--say they want to join a pilot project to test out that theory.