Sheldon Hersh, MD, President, NACDEP
NACDEP -- seeking to turn healthcare disparity into
The monograph, Dually Eligible People with Medicare and Medicaid, is drawn from my 26 years of experience as a geriatrician in New Orleans treating this population on a day-to-day basis. Working with dually eligible people has been professionally and personally rewarding. I have been fortunate to share a small part of the rich life experience and deep humanity these people bring into my office every day. NACDEP is my way of saying "thank you" and giving something back to this community.
NACDEP offers a vision of hope for the financing of health care for our most vulnerable elderly and disabled citizens. The "doom and gloom" scenario of 77 million baby-boomers rushing headlong into our nursing homes and bankrupting our healthcare system does not have to become a reality. A large portion of healthcare costs is being driven by a relatively small population of elderly and disabled people --"the elderly and disabled poor" described by Senator John Breaux. This population consists of six million dually eligible people with Medicare and Medicaid benefits who consume one-third of all Medicare and Medicaid expenditures at a cost greater than $120 billion each year.
The idea for NACDEP was borne in 2000 out of frustration when I was forced to stop making house calls to dually eligible people because Louisiana Medicaid joined two-thirds of the states and essentially eliminated Medicare-Medicaid crossover payments. This decreased the reimbursement for a house call to poor, elderly and disabled, dually eligible people by 81%.
In 2000, Louisiana decreased reimbursement and access to inexpensive primary geriatric care in the community for dually eligible people. In 2002, Louisiana increased reimbursement and access to expensive nursing home care for these same people. Cutting off medical funding at the inexpensive front end in the community and giving it to the more expensive back end in the nursing home is financially unwise. These actions will only increase the national $34 billion Medicaid nursing home bill for dually eligible people.
As our society becomes more diverse our challenge in the 21st century
will be to wipe out disparities in health care. The first step on this
road must be to restore equal access to health care for our most vulnerable
elderly and disabled citizens. What's good for dually eligible people
is good for the nation. Restoring Medicare-Medicaid crossover payments
across the country will increase access to primary geriatric care in the
community, decrease nursing home costs, and decrease disparities in health
care for frail elderly and disabled citizens. I ask you to support NACDEP
and help make this wish a reality.