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Hope For Closing The Medicare "Doughnut Hole"

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It’s an annual 'lump of coal' for millions of seniors living on fixed income

By Chris Levister –

Retired Perris educator Everett Franklin, recently found himself pleading with his doctors for free drug samples and maxing out his credit cards when he wound up in the dreaded “doughnut hole”.

“It’s damn humiliating to have to beg for medicine,” said Franklin. He’s coping with diabetes and complications from a stroke.

The doughnut hole refers to a costly gap in the Medicare Part D prescription drug coverage plan.

The plan currently covers up to $2,700 per year in prescription drug payments, then stops.

Coverage does not begin again until the recipient’s drug costs exceed $6,100 annually, thus leaving the recipient responsible for paying all drug costs between $2,700 and $6,100.

It’s a gap President Barack Obama says “is placing a crushing burden on many Americans who live on fixed incomes and can’t afford thousands of dollars in out-of-pocket expenses.”

Franklin entered the donut hole, this year in November. At that point his health plan stopped paying 75 percent of his prescription costs. A 90-day supply of his medications costs $2,582 when he’s in the donut hole, said Franklin. He pays a $50 annual insurance premium. His monthly income is a little over $1,700.

Advocates for seniors say the gap in coverage drives many older Americans to resort to the potentially life-threatening option of splitting pills or taking only half of their medication thus reducing the drugs’ effectiveness.

“All year you save and cut back on essentials like eating out or vacationing. You do everything right. At the end of the year, you get a lump of coal in your Christmas stocking,” said Franklin.

The prescription benefit was proposed by former George W. Bush and passed by a Republican-controlled Congress. The gap, intended as a cost saver, was unpopular from the beginning –and hard to understand. AARP, the seniors lobby, says the dreaded gap is the one issue it hears about most from its members.

“Although the benefits have proven popular, you can’t hold a town hall meeting or address seniors on Medicare without hearing complaints about the doughnut hole. It’s a major pocketbook issue,” says Nancy LeaMond, executive vice president for social impact at AARP.

Because the size of the hole is indexed to increases in drug costs, every year it grows more rapidly than the income of most seniors.

The Democrats’ plan would put that into reverse, gradually shrinking and ultimately eliminating the doughnut hole.

The gap in Medicare drug coverage was needed for the government to be able to pay for the program, says Senate Majority Leader Harry M. Reid (D-Nev. ).

“Final passage of the health reform bill will forever end this indefensible injustice for America’s seniors.”

Democrats and President Obama insist that the doughnut hole would disappear gradually over 10 years. Proponents say the government can afford to eliminate the gap because drug companies would foot the expense for the phase out. Critics argue that ‘less’ than half of the $80 billion that drug makers agreed to provide during healthcare reform negotiations over the summer, would be used to fill the gap.

Rep. Dave Camp (R-Mich.), a ranking Republican on the Ways and Means Committee is skeptical.

“They’re shielding the true cost by phasing it in.”

Meanwhile at this Perris senior center holiday party, people like Sharon Engles are keeping up the pressure on lawmakers to close the not-so-sweet doughnut gap.

“It’s disgusting. I ran into the doughnut hole last month. I had to pay $602.03 for one prescription and did not get another one filled.

I couldn’t afford it. I need my asthma meds. But I don’t have the money.”

Tye Dean Carter also of Perris hit the doughnut hole in August.

“A July summary from my plan showed that my meds cost $432.87. My share of that was $39.00. When I went back to pick up the prescription in August, the cost to me was $900,” said Carter.

“How come when a person reaches the doughnut hole, the cost goes wacky? Even with the 50% discount I wouldn’t be able to afford my medications. In my eyes, it’s a big shell game with the drug companies at the steering wheel.”

There is help for people with limited income and resources. If you qualify, Medicare will pay for almost all of your prescription drug costs. For information call Social Security at 1- 800-772- 1213 (TTY 1-800-325-0778) or visit www.socialsecurity.gov on the web.

Medicare seniors with low incomes are spared from having to deal with the gap. But about one-fourth of the other beneficiaries – 3.4 million people – fall into the gap.


Community Health Clinics Provide Critical Safety Net

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By Chris Levister –

A fight has broken out in San Bernardino, Fresno, Sacramento and other cities across California over how to spend millions of federal stimulus dollars earmarked for low- income community health centers known as Federally Qualified Health Centers (FQHC). Health providers are concerned that state policy makers are employing unfair tactics and gimmicks to use enhanced federal Medicaid matching funds from the “American Recovery and Reinvestment Act of 2009 to plug budget holes rather than strengthen critical health safety net services. Dr. Temetry Lindsey, President and CEO of Inland Behavioral and Health Services (IBHS) operates three (FQHCs) in San Bernardino County.

First Lady Michelle Obama announced the release of $850 million in stimulus grants in Washington, June 29, 2009. The funds are earmarked to help community health centers such as the Inland Behavioral and Health Services (IBHS) provide care to the most needy residents. IBHS officials say a fight has broken out over how California is using those federal grants to close budget gaps.In 2009 the not-for-profit received roughly $800,000 in stimulus money to expand low income health services in light of San Bernardino County’s soaring uninsured population.

The funds were allocated as a result of a 35% increase in uninsured patients in 2008. Lindsey says the stimulus money was earmarked to pay for a portion of that increased care and expand the center’s information technology capacity.

She said in the midst of the 2009 budget meltdown, lawmakers made deep cuts to state funded health programs and used accounting gimmicks and faulty one-time solutions which ended up costing IBHS $117,000 in lost revenue over a two year period.

“Where we received a dollar in federal stimulus money to expand services, California withheld two dollars in state funding. On one hand we are required to sustain current service and staffing levels. At the same time accepting the stimulus funds we are obligated to expand services.”

In what amounts to a temporary fix, Lindsey says IBHS was forced to elevate several part-time positions to full time.

“State funds intended to hire additional nurses, outreach workers and other staff were cut. We were able to hire an additional physician. In a nutshell, we’re upside down. Even with the stimulus funds we’re forced to do more with less.”

She said the state cuts cripple efforts to address a host of health problems community health centers can fight through preventive care. Lindsey says legal challenges and other stop actions taken by FQHCs nationwide have failed to gain traction.

“There’s a real concern over how much time, energy and money you should dedicate to fighting the elephant in the room.”

Last June First Lady Michelle Obama announced the release of $850 million in stimulus grants to centers such as IBHS. The stimulus law set aside about $2.5 billion for free and low-cost health clinics.

Two earlier sets of grants awarded just under $500 million to FQHCs.

A report by the Legislative Analyst’s Office stated that the Governor’s proposed 2010 reductions to the Expanded Access to Primary Care program, Medi-Cal and other key clinic programs will further limit access to state funded primary and preventative health care, and create new barriers for the thousands of low income individuals that count on these programs.

Three Federally Qualified Health Centers (FQHCs)in San Bernardino County provide free and low cost health and dental services to the region's most vulnerable populations.California once again will look under sofa cushions and scour every sector of state government to find another $20.7 billion to balance its budget over the next 19 months. The governor has to present his spending plan for the 2010-11 fiscal year to the Legislature by January 10, and is likely to include more deep cuts to health care, education and prisons.

“We’re bracing for more cuts,” said Lindsey.

Lawmakers will have to cut just about every area of government –except for a couple. The state accepted federal stimulus funds for education and Medi-Cal, so the state can’t cut those programs.

That means cuts to other programs will be much deeper.

In late March 2009 Schwarzenegger signed a bill to change eligibility requirements for Medi-Cal, the state’s Medicaid program. Those changes allowed the state to receive more than $10 billion in federal stimulus funding.

However in May the Centers for Medicare and Medicaid ruled that action violated home healthcare workers compensation requirements. The legislature was ordered to rescind the cuts or lose $6.8 billion in stimulus funding.

“It’s been well documented that San Bernardino County is an area of immense need with fewer health resources than the rest of the state,” said Lindsey.

In spite of the evidence on the important role community clinics play medically, economically and socially in serving the area’s most vulnerable population Lindsey says, Governor Schwarzenegger’s latest budget recommendations ignore the devastating impact on the ability of FQHCs to continue to provide a health care safety net.


Tuskegee Airmen Honored at Rose Parade

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The Tuskegee Airmen were honored in the Tournament of Roses Parade. The late Howard A. Tibbs was one of the original Airmen. His wife Betty and son Phillip traveled to California to see the float honoring the Airmen and to see Ohio play. Sixteen of the original group were able to take part in the parade and ride the float that was commissioned by the West Covina Rose Float Foundation.

Mayor's Challenge Aids Youth & Families

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Riverside Mayor Ron LoveridgeTargets four key goals to augment life and opportunities for children and families

Mayor Ron Loveridge recently set four locally-defined goals and targets to augment the quality of life and opportunities for children and families as part of the National League of Cities Action Challenge for Children and Families.

However, his challenge has received mixed emotions from the community.

In a press release, he said the Challenge was created to promote city leadership and accountability, while encouraging mayors to build on innovative local strategies that enrich the well-being of children, youth and families. Nationwide, over 100 Mayors from major metropolitan cities have joined the Challenge. Mayor Loveridge’s goals include:

· Opportunities to learn and grow: Establish service-learning opportunities for students in Riverside.

· A safe neighborhood to call home: Reestablish “At Home in Riverside” program promoting neighborhood livability and school success.

· A healthy lifestyle and environment: Promote fitness and walking by establishing a “100 Mile Club” at Riverside elementary schools.

· A financially fit family in which to thrive: Partner with United Way to provide financial planning workshops throughout the City.

“The success of cities is measured in large part by the opportunities we provide for families, children and youth to build a strong foundation”, said Mayor Ron Loveridge. “The four elements of the Action Challenge encompass the building blocks needed to create a thriving city.”

Loveridge’s announcement has been met in the Black community with raised eyebrows and some skepticism and applause. It is a wait and see by some.

“Our youth need something now not just in the summer. We use to hire nearly 20 kids at the recreation centers. Those jobs are and have been gone for some time and the youth are going other places to make money, sometimes it creates trouble. We will just wait and see what this new initiative develops,” said one person who asked not to be identified.

However, Sylvia Martin James, one of the city leaders and a retired teacher said, “the first steps have been taken. Look at the parks, families know they are welcome.

This is a move to create environments that families feel they are welcome.”

During the summer, Mayor Loveridge partnered with the United Way to provide free financial literacy workshops to families in the community. Throughout the Challenge, Mayor Loveridge will continue making strides in each target area; positively impacting the quality of life for youth and families in Riverside.

“The Mayor’s plan is for the entire city, but it’s the Blacks and Hispanic kids that are suffering if no provisions are made to include them,” stated the unidentified person. For more information, please visit Mayor Loveridge’s website at www.riversideca.gov/mayor.

Cheryl Brown contributed to this article.

Kwanzaa Celebrated in the Inland Empire

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By Cheryl Brown –

For forty-three years the Jacocks have been celebrating Kwanzaa, a culturally known holiday developed by Dr. Maulana Karenga. Bill “Ratibu” Jacocks and his wife Wilmer “Amina” Carter, now a California Assemblymember, have celebrated Kwanzaa from the beginning first in their home and after outgrowing the space moved to other venues. This year, the event, attended by about 150 people, was held at the Rialto Senior Citizen’s Center.

Ratibu Jacocks and A. Majadi begin this year’s Kwanzaa celebration.The Kwanzaa celebration focuses on traditional African values of family, community responsibility, culture commerce and self-improvement and is guided by seven principals. It is celebrated December 26th to January 1st with each night celebrating a different principle, Umoja (Unity), Kujichagulia (Self Determination), Ujima (Collective work and responsibility), Ujamaa (Collective economics), Nia (Purpose), Kuumba (Creativity), and Imani (Faith).

The program, sponsored by the Inland Empire Kwanzza Group, opened with a Drum Call by A. Majadi, Executive Director of the Boys and Girls’ Club.

Emcees were Imani Baylor and Aallyah Bey with the welcome from Dr. Mpigani Kweli and singing the Black National anthem led by Lauren Smith.

Singers Jazmine Bey and spoken word by Josiliyn McDaniel, Sarah Shabazz, and Chantel Earl.

Also on program were the Black Student Leadership Alliance from Carter High School, Shonda “Shandi” Hutton, and rounding out the evening was Ratibu lighting the candles.


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BVN National News Wire