Big changes are underway for Medicare participants, after historic legislation put them in motion this month.

More than 1.8 million Georgians who are Medicare enrollees will see lower-cost premiums and deductibles, and can save money on some prescription drugs.

Leigh Purvis, senior director of health care costs and access at the AARP Public Policy Institute, described a few of the changes.

"The first is that recommended vaccines will now be free for Medicare beneficiaries," Purvis pointed out. "The second is that insulin costs will now be limited to $35 per month for people who are in Medicare prescription drug plans. And the third is that drug companies are now going to be penalized for increasing their prices faster than the rate of inflation."

She explained Medicare "Part B" premiums are deducted from people's monthly Social Security payments. Since this year's Social Security's cost-of-living adjustment increased benefits by 8.7%, she noted people who are already enrolled in both programs will see more money in their pockets each month.

Purvis added more than 100,000 people in Georgia use insulin to manage their diabetes, and lowering the cost will help those who have struggled to afford insulin.

"As long as that insulin is covered by their prescription drug plan," Purvis explained. "That's really important because we know that previously, some people were facing, on average, monthly costs of around $50. And some people were paying more than $100. "

Purvis added this year, Medicare will start phasing in annual limits on how much people have to spend out of pocket on their prescriptions. As of 2025, the new limit will be $2,000 a year.

"And that is real savings, because we know that there are people out there who have been spending upwards of $10,000 per year on their prescription drugs," Purvis observed. "Now, people in Medicare prescription drug plans will have a relatively low and meaningful out-of-pocket limit on their prescription drug costs every year."

Medicare price negotiations will start with 10 drugs. People will learn what they are by this fall, and the negotiated prices will take effect in 2026. Medicare will add more drugs every year, and patients could see as many as 60 prescription drugs with negotiated prices by 2030.

Health-care professionals say low pay and a worker shortage have led a dramatic number of nursing homes in rural Iowa to close their doors. They hope increased government funding and more focus on rural health care this year will help.

Looking at a graph that shows the number of nursing-home employees between January 2019 and January 2020, the bright red line goes almost straight down. The pandemic was a big reason for that, but Iowa Health Care Association President and CEO Brent Willet said there are other economic factors at work, and the staffing shortages have already resulted in double-digit closures.

"It is alarming," he said. "The latest figures are, we've had 17 nursing homes in Iowa close in the last 12 months. Fifteen of those 17 have been in rural parts of the state."

Willet said nursing homes can't offer competitive wages to people who are willing to take these demanding jobs, especially in rural areas where the population is declining. He said he remains optimistic, though, adding that the Iowa Legislature will reconsider those wages this year, since more than half of nursing-home funding comes from state and federal governments.

Willet said it's also becoming harder for people in rural nursing homes to get the support they need from other medical-service providers in town. He said this adds to the problems already caused by staffing shortages, simply because those services dwindle along with the population.

"Like dialysis, like their primary-care doctor," he said. "As those services become harder and harder to come by, it creates additional challenges pertaining to costs and logistics to care for people in their home community."

The national long-term care facility numbers are also alarming. The Centers for Medicare and Medicaid Services reported recently that 129 nursing homes closed in 2022 - although this year, the numbers are starting to improve.

Health-care professionals and advocates in Connecticut have said it will take sweeping reforms to bolster the state's flailing public health system.

At the labor union 1199 SEIU's Health-Care Policy Symposium, experts spoke of the system's long-time underfunding and staffing shortages. A union-related group, called Expand Services to Save Lives, wants to see part of the state's multi-billion-dollar surplus used to address the issues - including $30 million to recruit and retain public-health workers.

Rebecca Simonsen, vice president and director of the public division at 1199 SEIU, said the state needs to revitalize this system of critical services.

"State health-care services generally serve the most at-risk, highest need, complex residents," she said. "Often folks without insurance, often folks that have been turned away from the private sector. And we created these services because, as a state, we believe that every resident's life should be valued."

In 2022, the state received a $32 million grant from the Centers for Disease Control and Prevention for public-health workforce development. She added that even if the group gets everything it's seeking from this legislative agenda, it wouldn't be the entire solution.

One area of the staffing crisis to be addressed is retention of nurses, more of whom are leaving the field due to burnout and higher patient limits. The union wants to see a pipeline created for nursing students to prepare them for public-sector jobs.

Brian Williams, an organizer for 1199 SEIU and a certified addiction counselor with the Connecticut Department of Mental Health and Addiction Services, said it's time to commit to action instead of acknowledging the problem.

"We cannot continue to say, 'Hey, you know, we have a nursing crisis, we have a nursing crisis.' We have to create incentives to actually expand the pool of nurses," he said. "And this is one of the proposals that we have that we believe will have an impact."

The group also proposed a $12 million investment to add workers to the department to address what was described at the conference as an ongoing mental-health crisis.


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Iowa lawmakers are considering a bill which would dramatically reduce the use of cellphones in vehicles.

Right now, it is illegal in Iowa to send or read text messages while driving, but drivers can use a cellphone for navigation, which often takes more attention than texting. Senate Bill 60 would tighten the rules further, prohibiting drivers from operating a phone if it takes more than a single touch to activate or deactivate it.

Sen. Claire Celsi, D-West Des Moines, said she is personally motivated by the measure after attending the wake of a constituent's 12-year-old child who was killed by a distracted driver.

"It really affected me," Celsi recounted. "The dad just said, 'Please, please, please make this illegal. Please help people like us never to have to go through a loss like this.' So, that's what really spurred me to join onto the bill this year. It's a Republican bill, but I completely support it."

The Iowa Department of Public Safety said drivers who use handheld devices are four times more likely to be in a collision causing injuries than those who are not using their phones. The bill is headed to a Senate committee.

Celsi acknowledged she used to oppose hands-free cell phone measures, because she felt the costs were prohibitive, but she said technology has caught up, and prices have come down.

"You can buy something at Walmart for $20 that can help you go hands free in your car," Celsi pointed out. "I think it really demands now that we reexamine the issue and do something about distracted driving in our state."

The Insurance Institute for Highway Safety said about half of states prohibit the handheld use of cellphones when driving, and all but Montana prohibit text-messaging while driving.