IS CALIFORNIA'S ADULT DAY HEALTH CARE PROGRAM "A BRIDGE TOO FAR?"

It’s sometimes difficult to remember that there actually was a time in our state’s and nation’s history when citizens and government collaborated to build bridges.  These were not just brides over waterways, but also symbolic links to a better quality of life. 

They included programs to offer bridges to a college education; bridges from poverty to employment; bridges to affordable and preventative healthcare; bridges to move people from nursing homes to independent living; and bridges to reward a lifetime of work with a secure retirement.

Today, these bridges to a better future are crumbling just like our transportation infrastructures.   Rivet by rivet, beam by beam, lawmakers are making budget cuts or eliminating these programs.

They are under constant attack and raising revenues is summarily rejected out of fear of the growing “no tax” mindset.  We forget that these programs were viewed as investments that reaped cross-societal and economic dividends.

Every engineer knows that there comes a point in time when a bridge's decaying structure cannot be saved.  A case in point is California’s Adult Day Health Care (ADHC) that provides center-based health and nursing care, therapies, transportation, and other services for low-income seniors and people with disabilities. 

California's 300 ADHC centers serve 37,000 people and give partial respite to family caregivers from their costly and time-consuming daily home care obligations for their relatives. However, advocates believe its foundation has been undermined by Governor Jerry Brown’s June 25^th veto of AB 96.

AB 96 would have created an alternative to ADHC after it lost funding in this year’s budget.  It established the Keeping Adults Free from Institutions (KAFI) program as the new bridge program.

Supporters of AB 96 believed that a deal had been made to eliminate ADHC, but to replace it with KAFI at half the cost.  The Governor stated that he vetoed it because KAFI would duplicate the exact program model he had eliminated and that made no sense. 

The Governor did sign SB 91 allowing ADHC centers to operate without Medi-Cal licensing.  There are no guarantees, but state agencies reportedly are working to keep the basic model alive for those who can pay privately.  In theory, centers could be folded into HMOs or health plans as part of a continuum of care, assuming they survive.

Yet, ADHC providers, patients, and families feel betrayed.  Most centers face closure and up to 7,000 jobs are at-risk.  Experts predict that if recipients lose ADHC services that at least 4,000 prohibitively more expensive nursing home admissions and thousands of emergency room visits will result.

The Federal government approved extending ADHC's targeted elimination date from September 1 to December 1 to help keep recipients out of institutions.  Meanwhile, a Federal lawsuit has been filed alleging that  eliminating ADHC violates Federal law and would cause irreparable harm by placing recipients at-risk of institutionalization, hospitalization, injury, or death.  

The final outcome of this bridge closure is unclear.  Yet, once dismantled the ADHC infrastructures local communities created over decades probably cannot be restored in our fragile economy.

"We Must Destroy Federal Government Spending In Order To Control It"

Seeking to avoid accountability for the Federal budget deficit they created, today Congressional House Republicans are debating and voting upon an even more ideologically extreme budget proposal.  It is called the “Cut, Cap, and Balance Act.” 

The White House's reaction has been to label it as an “empty political statement.” Many see it as a political ploy to give Republican incumbents public cover for their refusal to vote for raising the Federal debt limit. 

Fiscal analysts say it is so extreme that even the so-called Ryan Budget released earlier this year to heavy public criticism wouldn't satisfy its mandate.  Those proposed reductions would not be severe enough.

The bill would require total Federal spending to shrink to less than 20 percent of the national Gross Domestic Product by 2018 and permanently cap it there.  It would cut $111 billion commencing October 1st with the new Federal Fiscal Year and $400 billion more each year over the next decade. 

The bill would prohibit any increase in the debt limit until both houses of Congress approve a constitutional amendment for ratification by the states.  The constitutional amendment would prohibit Congress from raising any taxes without a two-third vote in both houses. 

Does the two-third supermajority vote requirement sound familiar?  Yes, as has been the case in California, it would be virtually impossible for Congress to ever raise any revenues or close special interest tax loopholes.

Republicans would also eliminate protections utilized over the past 25 years that exempt core basic assistance programs for the poor from across-the-board cuts.  Instead, it would make all programs subject to them if the spending limit is exceeded.

Supporters falsely claim that they are protecting Social Security and Medicare.  And it is partially true because it doesn’t cut either program in 2012 and does not explicitly subject them to automatic cuts. 

However, lawmakers facing the challenges of cutting trillions of dollars to meet annual spending limits would have no choice other than to make those reductions.  Otherwise, key government operations simply could not function. 

Social Security, Medicare, and Medicaid are the largest programs in the Federal budget and they could not escape massive reductions.  The math does not add up.

By 2021, combined expenditures for these programs will be 45 percent greater than all other programs combined, apart from interest payments.  They would be drastically cut under any scenario.

President Obama has vowed to veto the bill and his spokesman calls it “the Ryan plan on steroids.”  Furthermore, it is unlikely to pass the Senate. 

Yet, the real story is that the endless, aggressive political assault on programs for seniors, the poor, and people with disabilities will continue throughout the 2012 election year.  The Republicans will seek to demonize Federal spending programs.

The core strategy is to generate public fear in campaign ads and Republican congressional candidate talking points by pitting middle-income Americans against the poor, elderly, and disabled:  “Cut spending for them, but don’t cut anything affecting me or raise my taxes” will be the message.

A Good Idea Gone Bad

Competitive bidding sounds like a good idea, right? Get the lowest price and the best deal. Save money. What could go wrong?

Plenty, especially when it's Medicare running the process and durable medical equipment (DME) vendors doing the bidding. The Centers for Medicare and Medicaid Services (CMS) Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) is causing havoc in the home healthcare industry.

The Medicare Modernization act of 2003 (MMA) required Medicare to replace the Home Medical Equipment (HME) payment fee schedule for certain items with a "competitive acquisition" or government contracting program. The program was implemented on January 1, 2011 in nine cities (including the Riverside/Bakersfield area) and will expand to 91 metropolitan areas later this year in round 2.

In California, round 2 cities include: Bakersfield, Fresno, LA-Long Beach-Santa Ana, Sacramento-Roseville, San Diego-Carlsbad-San Marco, SF-Oakland-Fremont, San Jose-Sunnyvale-Santa Clara and Visalia-Porterville.

So what's wrong with the competitive bidding program? Well, for starters it is driving suppliers out of business, limiting choice for consumers, lengthening hospital stays and causing much grief for consumers.

As a result of the bidding process, many vendors who provide a variety of home healthcare products and DME were awarded contracts to supply a single item or none at all. In some areas, out-of-state vendors won contracts to supply products, forcing consumers to drive long distances or rely on mail order to obtain supplies and products they previously purchased locally.

Hospital discharge planners are delaying releases because they cannot match patients to contracted providers with the appropriate products such as wheelchairs, oxygen equipment and sleep therapy devices.

One Medicare recipient was waiting for her diabetes test strips for more than two weeks and could no longer receive them from her original provider since the company was not contracted. Another patient needs oxygen 24 hours a day and relies on portable oxygen to visit her physician. Her HME company did not win a contract and the user needs physician approval to switch to a different company. She has no access to oxygen and cannot visit her physician.

So what can we do? For starters, Consumers in the Riverside-San Bernardino area who have been affected by this program need to tell their stories. At the AAHomecare’s website (http://www.aahomecare.org/) They can click on the ‘Competitive Bid Problems?’ button and provide feedback on how their access to home healthcare products and services has been affected by the program.

We also need to get behind HR 1041 and urge its passage before the program expands to round 2 later this year. HR 1041 would roll back the flawed pilot project and institute an up-to-date and fair pricing schedule defining what Medicare will pay for certain equipment. The bill has 132 cosigners, none from California. Advocates, consumers and others who are concerned, should write their representatives in Congress and urge them to cosign the bill.

A lot of Californians are already experiencing difficulties as a result of this program. Many more will unless we join the national effort to stop it. The time to advocate is now!