Americans Suffer From Lack of Dental Care. Fluoridation is no fix: NYSCOF
Napans on Medicare, Medi-Cal find few doctors to take them in
By NATALIE HOFFMAN
Register Staff Writer
Wednesday, September 05, 2007
When Napan Hank LeMieux recently phoned the Social Security Administration for assistance with his costly prescription medications, he said, they suggested the 70-year-old diabetic return to work full-time to pay for them himself.
LeMieux is one of tens of millions of Americans with Medicare or Medicaid coverage. Many find themselves either unable to find doctors who accept their coverage or struggling to foot the bill for expensive yet necessary prescription medications.
LeMieux, a cancer survivor, is experiencing what many have dubbed the “doughnut hole,” a result of a Medicare Part D provision leading to a break in prescription drug coverage. LeMieux said Medicare temporarily discontinued drug coverage after doling out a total of $2,400 since January. Unless LeMieux shells out approximately $3,000 toward his remaining 2007 prescription costs, he said, Medicare will not resume coverage until next year. In the meantime, LeMieux — who should be taking seven medications — is taking just five.
LeMieux is not alone. Teresa Zimny, program manager for public assistance with the Napa County Health and Human Services Department, said Napa County has 2,880 Medicare recipients. Many of these men and women face the challenge of working expensive prescription medications into their already tight budgets.
“When you’re a man who is 70 years old and worked hard all your life ... it’s hard to make it when you have $860 worth of (monthly) prescriptions,” said LeMieux, adding that his physician, Dr. Jonathan Wheeler, recently supplied him with free samples of two medications that he would otherwise not have access to.
LeMieux said he has spent five unproductive weeks on the phone with federal and local agencies in his search for help with his prescription expenses. “Everybody bounces you back and forth. ... I got to feeling that I was a number or a statistic. Most seniors don’t know who to go to or what questions to ask. ... No one can help or cares. When you need help the most, there’s none to be had,” he said, adding that many federal and state agencies created to foster health care coverage use terminology and a complex system that often results in confusion and an endless string of referrals.
While Medicare, a federal health program, is generally for men and women age 65 and older, Medicaid, funded by each state in conjunction with federal monies — and known as Medi-Cal in California — is slated for low income women and their dependents, seniors and the disabled.
There are 12,562 Medi-Cal patients in Napa County and 44 percent of these recipients are under 18 years of age, according to Napa County Health and Human Services.
Napan Jerry Hazel, 75, a recipient of both Medi-Cal and Medicare, is suffering from advanced tooth decay. Several years ago, Hazel said, he saw a dentist who ordered multiple tooth extractions and dentures. He said he has searched for an oral surgeon in Napa, but is unable to find one who takes Medi-Cal patients. Still unable to receive care, he regularly takes pain medications for his condition. Hazel said he occasionally seeks treatment for recurring gum infections caused by the lack of proper medical attention.
“Others must be going through what I’m going through. I just gave up all hope. Everyone says, ‘I’m sorry, Mr. Hazel. There’s nothing I can do for you.’”
Hazel, who must stick to eating only soft foods, said embarrassment of the condition of his teeth often prevents him from interacting with others.
The systems in place for Medicare and Medi-Cal patients are malfunctioning not only for patients, but also for physicians, according to Dr. Paul D. Sweigert, an internist and president of Napa County Medical Society.
Sweigert said by 2008, Medicare plans to reduce doctors’ reimbursements by 9.9 percent and cut them by another 5 percent in 2009. Between 2006 and 2011, he said, Medicare payments to physicians will drop an estimated 26 percent while the estimated costs of doing business will increase by 15 percent.
“Right now, Medi-Cal is looking to expand the eligibility criteria but more physicians are declining straight Medi-Cal. I’m not sure where the governor is going with this. ... Clearly, as reimbursement declines, physicians have to earn less with their same costs of practicing medicine or they have to increase the number of patients they see,” he said.
Sweigert said in spite of these issues, Napa County doctors and patients enjoy advantages that most across California do not. In addition to the low-cost, high quality health services offered by Community Health Clinic Ole, he said, Napa County joined forces with the Partnership HealthPlan of California in the late ’90s — resulting in improved health care access for Medi-Cal patients and a streamlined reimbursement process and less paperwork for physicians.
Still, the numbers of uninsured climb while Medicare patients struggle to find physicians who will take them on as patients. All the while, he said, the costs of health care continue to rise.
“We continue to fumble along without a solution to this. When Medicare beneficiaries start to lose access to health care, then we might see some kind of action, but where that is headed, I can’t say. ... It’s fascinating that we continue to operate with the growing number of uninsured in our country,” he said.
Dr. Robert Moore, medical director of Community Health Clinic Ole, said the majority of patients seen at his facilities are uninsured. Approximately 25 percent are Medi-Cal recipients and about 10 percent are Medicare patients, he said.
Moore said although there is limited access for Medi-Cal patients in Napa, Clinic Ole has several local offices that take Medi-Cal coverage, including sites in Napa, Calistoga, St. Helena, the Day Homeless Center and the South County Shelter. All together, he said, the facilities serve about 22,000 patients.
Sister Ann Community Dental Clinic — located inside of Clinic Ole — accepts Medi-Cal and is also experiencing a rapidly growing demand for services, he added.
Moore said Clinic Ole can offer these services because is a community health clinic, making it eligible for federal funding. To qualify as a community health clinic, an organization must meet several qualifications, including a board of directors comprised of at least 50 percent patients and a sliding fee scale for patients. In addition, Moore said, qualifying clinics must be focused on a particular population, such as low income patients — and not owned by a hospital.
“The problem is that we have a fragmented health system in this country. ... We have a non-health care system,” Moore said.
Disheartened but not defeated, LeMieux has a piece of advice for others facing the “doughnut hole” and other health care crises.
“You have to do your homework. If you don’t get answers from one source, go to the next,” he said.
By NATALIE HOFFMAN
Register Staff Writer
Wednesday, September 05, 2007
When Napan Hank LeMieux recently phoned the Social Security Administration for assistance with his costly prescription medications, he said, they suggested the 70-year-old diabetic return to work full-time to pay for them himself.
LeMieux is one of tens of millions of Americans with Medicare or Medicaid coverage. Many find themselves either unable to find doctors who accept their coverage or struggling to foot the bill for expensive yet necessary prescription medications.
LeMieux, a cancer survivor, is experiencing what many have dubbed the “doughnut hole,” a result of a Medicare Part D provision leading to a break in prescription drug coverage. LeMieux said Medicare temporarily discontinued drug coverage after doling out a total of $2,400 since January. Unless LeMieux shells out approximately $3,000 toward his remaining 2007 prescription costs, he said, Medicare will not resume coverage until next year. In the meantime, LeMieux — who should be taking seven medications — is taking just five.
LeMieux is not alone. Teresa Zimny, program manager for public assistance with the Napa County Health and Human Services Department, said Napa County has 2,880 Medicare recipients. Many of these men and women face the challenge of working expensive prescription medications into their already tight budgets.
“When you’re a man who is 70 years old and worked hard all your life ... it’s hard to make it when you have $860 worth of (monthly) prescriptions,” said LeMieux, adding that his physician, Dr. Jonathan Wheeler, recently supplied him with free samples of two medications that he would otherwise not have access to.
LeMieux said he has spent five unproductive weeks on the phone with federal and local agencies in his search for help with his prescription expenses. “Everybody bounces you back and forth. ... I got to feeling that I was a number or a statistic. Most seniors don’t know who to go to or what questions to ask. ... No one can help or cares. When you need help the most, there’s none to be had,” he said, adding that many federal and state agencies created to foster health care coverage use terminology and a complex system that often results in confusion and an endless string of referrals.
While Medicare, a federal health program, is generally for men and women age 65 and older, Medicaid, funded by each state in conjunction with federal monies — and known as Medi-Cal in California — is slated for low income women and their dependents, seniors and the disabled.
There are 12,562 Medi-Cal patients in Napa County and 44 percent of these recipients are under 18 years of age, according to Napa County Health and Human Services.
Napan Jerry Hazel, 75, a recipient of both Medi-Cal and Medicare, is suffering from advanced tooth decay. Several years ago, Hazel said, he saw a dentist who ordered multiple tooth extractions and dentures. He said he has searched for an oral surgeon in Napa, but is unable to find one who takes Medi-Cal patients. Still unable to receive care, he regularly takes pain medications for his condition. Hazel said he occasionally seeks treatment for recurring gum infections caused by the lack of proper medical attention.
“Others must be going through what I’m going through. I just gave up all hope. Everyone says, ‘I’m sorry, Mr. Hazel. There’s nothing I can do for you.’”
Hazel, who must stick to eating only soft foods, said embarrassment of the condition of his teeth often prevents him from interacting with others.
The systems in place for Medicare and Medi-Cal patients are malfunctioning not only for patients, but also for physicians, according to Dr. Paul D. Sweigert, an internist and president of Napa County Medical Society.
Sweigert said by 2008, Medicare plans to reduce doctors’ reimbursements by 9.9 percent and cut them by another 5 percent in 2009. Between 2006 and 2011, he said, Medicare payments to physicians will drop an estimated 26 percent while the estimated costs of doing business will increase by 15 percent.
“Right now, Medi-Cal is looking to expand the eligibility criteria but more physicians are declining straight Medi-Cal. I’m not sure where the governor is going with this. ... Clearly, as reimbursement declines, physicians have to earn less with their same costs of practicing medicine or they have to increase the number of patients they see,” he said.
Sweigert said in spite of these issues, Napa County doctors and patients enjoy advantages that most across California do not. In addition to the low-cost, high quality health services offered by Community Health Clinic Ole, he said, Napa County joined forces with the Partnership HealthPlan of California in the late ’90s — resulting in improved health care access for Medi-Cal patients and a streamlined reimbursement process and less paperwork for physicians.
Still, the numbers of uninsured climb while Medicare patients struggle to find physicians who will take them on as patients. All the while, he said, the costs of health care continue to rise.
“We continue to fumble along without a solution to this. When Medicare beneficiaries start to lose access to health care, then we might see some kind of action, but where that is headed, I can’t say. ... It’s fascinating that we continue to operate with the growing number of uninsured in our country,” he said.
Dr. Robert Moore, medical director of Community Health Clinic Ole, said the majority of patients seen at his facilities are uninsured. Approximately 25 percent are Medi-Cal recipients and about 10 percent are Medicare patients, he said.
Moore said although there is limited access for Medi-Cal patients in Napa, Clinic Ole has several local offices that take Medi-Cal coverage, including sites in Napa, Calistoga, St. Helena, the Day Homeless Center and the South County Shelter. All together, he said, the facilities serve about 22,000 patients.
Sister Ann Community Dental Clinic — located inside of Clinic Ole — accepts Medi-Cal and is also experiencing a rapidly growing demand for services, he added.
Moore said Clinic Ole can offer these services because is a community health clinic, making it eligible for federal funding. To qualify as a community health clinic, an organization must meet several qualifications, including a board of directors comprised of at least 50 percent patients and a sliding fee scale for patients. In addition, Moore said, qualifying clinics must be focused on a particular population, such as low income patients — and not owned by a hospital.
“The problem is that we have a fragmented health system in this country. ... We have a non-health care system,” Moore said.
Disheartened but not defeated, LeMieux has a piece of advice for others facing the “doughnut hole” and other health care crises.
“You have to do your homework. If you don’t get answers from one source, go to the next,” he said.
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