The past few months, I’ve been impressed with the coverage of New York Times writer Robert Pear in his coverage of how legislation and politics are affecting health care. His articles are highly detailed and he shows he has done a great deal of homework in preparing them. Underlying his reports, I find, is a concern for what is going to happen to consumers, and both Republicans and Democrats may find themselves the subject of his critical lens and pen. On November 1, 2010, the day before the elections, he presented findings of two federal courts ruling that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage regarding common chronic conditions such as multiple sclerosis, Alzheimer’s disease, and broken hips:

Medicare will pay for those services if they are needed to maintain a person’s ability to perform routine activities of daily living or to prevent deterioration of the person’s condition, the courts said. Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.

The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis, Alzheimer’s disease and broken hips. Skilled care may be reasonable and necessary and covered by Medicare even if the person’s condition is stable and unlikely to improve, the courts said.

The government has not said whether it intends to appeal either decision.

Representative Joe Courtney, Democrat of Connecticut, welcomed the decisions. “People with chronic conditions are being denied care in the mistaken belief that Medicare requires improvement of a person’s condition as a prerequisite for coverage,” Mr. Courtney said Monday. “That’s not in the law. It’s urban legend.”

In the next months I think it will be important for all of us to follow what goes in with Medicaid, Medicare, and other health care legislation, and I think looking for Robert Pear’s byline is one way to obtain good information on crucial details that might be important for yourself or those you love.

William Van Ornum

 

 William Van Ornum is professor of psychology at Marist College and director of research and development/grants at American Mental Health Foundation in New York City. He studied theology and scripture at DePaul University.