By Ron Haberkorn
I proudly enlisted in the U.S. Army and fought in Vietnam, but my longest and biggest battle has been against lupus. I was diagnosed in 1981. Little was known then about lupus and it still remains a mystery in the medical community today. Unfortunately, there is no known cure.
Lupus is an autoimmune disease that can affect various parts of the body, especially the skin, joints, blood, kidneys, lungs, heart, nervous system and/or other body organs or systems. It acts as if the body is allergic to itself. It is estimated that over 20,000 Coloradans and 1 million Americans have been diagnosed with lupus, and 16,000 Americans are diagnosed each year.
For me, lupus has damaged the lining around my heart and has put me in the hospital numerous times. On average, I only have about five hours of energy a day. The stress of living with the disease has exacted a mental and physical toll, and the care for lupus patients like me is expensive. Some require regular dialysis for years; others need kidney transplants.
Fortunately, I’ve lucked out and now that I am 65, Medicare Part B provides vital coverage for my treatments and hospital visits. Most injectable and infused drugs for patients with lupus, cancer, rheumatoid arthritis and other chronic conditions must be administered by trained health care professionals. This class of treatments is covered under Medicare Part B.
Doctors purchase, store and provide these medicines in the physician’s clinic. The doctor is then reimbursed by Part B according to a formula based on the drug’s average sales price plus a small add-on to cover related expenses for acquiring, storing and administering the drugs.
That add-on is set at 6 percent of the drug’s sales price. However, sequestration cuts essentially bring down the reimbursement to just over 4 percent. Now lawmakers are considering even deeper cuts to Part B drug payments in the 2014 budget.
Older Coloradans like me who suffer from chronic diseases that afflict us for decades consider Medicare Part B coverage indispensable for our quality of life. That’s why we are worried about some in Washington who believe a smart path to a balanced budget runs through cuts in seniors’ health care. Such a wrongheaded solution will not only hurt older Americans, but could actually increase health care costs rather than spark savings.
Medicare Part B protects 670,000 Coloradans – a number that is rapidly expanding as the baby boom generation ages. In my case, it literally is a life saver, and those who advocate Medicare cuts need to understand the devastating effects such moves would have on the lives of Coloradans like me.
Here are the most concerning effects of Part B cuts here in Colorado: Reducing payments to doctors means that fewer of them will be able to afford to treat Medicare patients – compounding the problem that Colorado already has fewer doctors per-capita than the national average, with only 254 practicing physicians per 100,000 residents. Even a minor contraction in the available supply of caregivers could leave our fellow citizens in a lurch.
Unfortunately, the cuts are already hitting community health clinics hard, especially in rural areas. A recent survey conducted by the American Society of Clinical Oncology found that nearly 50 percent of oncology practices are sending Medicare patients elsewhere for treatment, primarily to a more expensive hospital setting due to sequestration. Twenty-two percent reported that they either have closed or will have to close clinics if sequestration cuts continue.
If clinics close, we all lose. Patients of all ages, particularly folks in rural areas, will be forced to travel even greater distances to seek treatment in hospital outpatient settings instead of a local physician clinic.
Talk about penny-wise and pound-foolish. Such a shift could actually drive up health care costs because patients treated in the hospital tend to have higher costs than those treated in clinics. One study of Medicare chemotherapy patients found that total care costs were 14 percent more for patients receiving care in the hospital outpatient setting compared to the doctor’s office.
So it is easy to understand why Medicare Part B is so critical for me and hundreds of thousands of other Coloradans with chronic diseases, and why we are troubled by lawmakers who believe that Part B cuts are a sensible and humane way to balance the federal budget.
Cuts to Medicare Part B drug payments will end up restricting access to vital medical services here in Colorado and all across the country. Our Congressional delegation should stand up for Colorado seniors living with chronic conditions and fight to keep further cuts to Medicare Part B out of the 2014 budget.
If you have been diagnosed with lupus or are feeling fatigued and think you may have lupus, please know you are not alone. I am here to help you in any way. For more information or resources about lupus, please visit www.lupuscolorado.org.
Ron Haberkorn and his wife live in Colorado Springs.