 This is Think Tech Hawaii. Community matters here. Navigating the journey. And for those of you that have been with us all of this time, again, Merry Christmas and Happy Holiday, you know we have talked about the end of life options and wishes and choices. And all of those things, but the biggest thing that really stands out at the end of life is the cost. And according to the feds, that last days in the hospital are approximately $10,000 a day. Can you imagine a day? Yeah. And that all comes out of, some of it comes out of Medicare and of course Medicare comes out of our pockets the taxes that we pay Medicare. Nothing's free. So now we have all kinds of strange, strange rulings from a Texas federal judge that says Obama carries. So I asked a dear friend, and all of you know I only call to dear friends, I asked a very dear friend, if she would come and explain to us what is going on with Medicare, what are we to look for, how does this affect us, each and every one of us. So my dear friend, Martha Kopler, and Martha is a Medicare specialist, whatever that means. She knows all about Medicare. So tell us what is a Medicare specialist? Well, a Medicare specialist as defined by what I do, is I do a lot of education and workshops throughout the islands, and my focus is making sure people understand all the information they need to before they make decisions about what to purchase. So I'm an educator. So these are the people that are already getting Medicare because they worked and it was taken out of their paycheck. Is that correct? The people who are eligible, that's right, they needed to have taxes deducted while they were working, but also if you're married to someone who was working for 10 years or 40 quarters, you may also be eligible through a spouse. Great. So tell us the background of Medicare. I know that back in the 30s when President FDR wanted us to have Medicare, Social Security didn't call it Medicare. No, there was no Medicare yet. And the American Medical Association fought against it. So to go from that option that they didn't want us to have Social Security up to, so when did we get Medicare out of Social Security? Right, Medicare started, actually was signed into law by President Lyndon Johnson in 1965. And the very first person to actually receive a Medicare card was former President Truman. Great. Oh, I remember that picture. Yes, and his wife best was the second one. Yes, number one and two. And he was considered actually the grandfather of Medicare because prior to 1966, when the benefits first went into effect, if you needed a surgery or you needed some care for chronic condition, you had to basically go and ask friends for money or you had to take everything out of your savings account to take care of your medical care because there was no coverage for people no longer working, no longer have any employer coverage. There was nothing. So what was Medicare, what was healthcare like prior to this, what we call lovingly Obamacare? What was healthcare like prior to that? Well, the Obamacare was intended to address people who had pre-existing conditions because prior to the Affordable Care Act, which was signed, if you had a pre-existing condition, you were subject to underwriting which insurance company could deny you insurance altogether. So this impacted many people who either, you know, maybe they don't qualify for Medicare, they didn't have enough credits or people who have not reached Medicare age yet. They have a pre-existing condition, they were unable to get coverage. So that's what this Affordable Care Act, like I say, lovingly called Obamacare. Yes. So that's what, when that came into being, that covered almost everybody. Right. It covered the people with pre-existing conditions who previously could not necessarily get covered or the premiums would be so expensive, they decided not to have coverage. So the Affordable Care Act, one of the big keys of it was to open it up to people with pre-existing conditions. In addition to that, Medicaid was expanded. So an additional 10 million plus people were also able to get Medicaid coverage who previously weren't allowed to have coverage. Also, what some people don't know is the Affordable Care Act is the reason that adults up to age 26 can stay on their parents' health plan. So there's a lot more to Affordable Care Act, or as you lovingly call it, Obamacare, than just the coverage. There were a lot of other things that were thrown into that particular ACA. What's really important now with the understanding of this ruling by this Texas judge is also Medicare payments are part of the Affordable Care Act. So the reason that people are concerned as it relates to Medicare is because all of your payments have been lumped into the Affordable Care Act. So if it's ruled unconstitutional, how will the Medicare payments be made? How will it be funded moving forward? Oh boy. So let's say you gave me this. What was the Texas ruling? We keep talking about the ruling, so let's see. U.S. District Judge Reed O'Connor ruled that the Affordable Care Act was not constitutional. Not constitutional. His decision was made after 18 Republican state attorneys general and two GOP governors bought their case. They claimed that the Supreme Court upheld an ACA in 2012 because it included an individual mandate or a tax penalty for Americans who did not buy health insurance. After Congress repealed the individual mandate, excuse me, in 2017, excuse me, sir, O'Connor said the rest of the law fell apart. So what does that mean? So basically what this recent judge in Texas, the reason he decided it's unconstitutional is because the penalties were repealed. So prior to that, if you did not sign up for a health care plan, when you complete your taxes, you would have to pay a penalty and you would have to pay that money to the government. So when that was repealed, you still have the Affordable Care Act, you still have the plans that you can get on healthcare.gov, but if you do not sign up for a plan because of the repeal, you don't get a penalty. So this judge is saying if there's no penalty, then the individual mandate doesn't exist, then there is no Affordable Care Act. So very interesting. Well, okay. But that's on the last day of the enrollment period. It was the eve before the last day of the enrollment period. So if people were in the process of enrolling, what happens? Right. What happened? Right, and I'm glad you asked that question, Marcia, because I was actually assisting people with enrollments on the eve when the ruling came out. And actually, while we were actually enrolling people, because you only can enroll through this online process, a little blurb came up and it said, Texas Judge rules, you know, Affordable Care Act, unconstitutional, but continue to enroll, nothing will change with your plan. But a lot of people were very nervous. I received a lot of phone calls. People said, oh, if they ruled it unconstitutional, then I guess there will be no programs. So I'm not going to enroll. I said, no, no. Please don't. Please don't enroll because nothing will change as of this moment. So the plans are still in place. The enrollment portal was still open until the deadline, so you still could enroll. So it was really confusing to people. They thought, oh, it was ruled unconstitutional. No more health plan. So now, if I had enrolled on that day, how long would I have coverage or do we know? Well, that's a good question. We won't know because we don't know if another court will uphold it. We don't know what's going to happen. But when you sign up for these healthcare.gov plans, the open enrollment period is from November 15th to December 15th, and it becomes effective January 1st. So the plans that we've been enrolling for from, I'm sorry, November 1st through December 15th, they become effective January 1st, and they are scheduled to run through December 31st of 2019. So we all have to just wait and see how this ruling impacts the plans for 2019. Could it be retroactive? I mean, since you're already enrolled. Okay, so the different state's attorneys, California for one, are trying to appeal. Yes. So what happens with the appeal? Right, so even if they appeal it, there's still a possibility that this could go all the way to the Supreme Court. So in reality, I think that not much will change for 2019. But looking forward, we probably have to expect some changes. But no one will know what happens until we find out whether or not this is upheld, or if it's overturned, if it does follow all the way up to the Supreme Court. No one really knows. At this point, we don't have a Crystal Paul. So, okay. Now, tell me how this works. The insurance companies. And all of these different plans, I watched all the ads and all the plans are different and we give you this and we give you that. Now, what does Medicare pay for? And what do you pay for with whatever company you choose? Right. And Marsha, that all depends, because you do know that there are a lot of options, especially here in Hawaii. And these Medicare options, like basic Medicare consists of Part A for hospitalization, hospice, things like that. Part B is for your doctor visits, lab work, x-rays, things like that. So that's basic or your core Medicare. What many people do is they pick up a supplement plan, or they'll pick up a Medicare Advantage plan, which will also include their prescription drugs. So what you pay depends on what plan you select. Oh, okay. And that is with the insurance company. Yes, that's correct. The private insurance company will have a contract with Medicare and each year they give you a summary of benefits that explain exactly what your co-pays will be, and that's what you would pay. So all of these different, like HMAA, for instance, and then Medicare Advantage, and I don't know all of those different ones, because I've seen all the ads, and they're all different. So it means that the cost to you is different. Correct. And then let me just clarify, HMAA is a commercial plan. Yes. They don't offer Medicare here. No, they just commercial plan. Oh. Because there's commercial plans, and then there are plans that have commercial business plus Medicare. So each one of these insurance companies, you know, may have a Medicare contract and may not. So not all health insurance plans here in Hawaii offer Medicare. Oh. Very interesting, isn't it? Well, that's not fair. Come on. So if I've been paying into Medicare all this time, Social Security all this time, and now I'm going to buy insurance and doesn't, so do I still have the Medicare as well as this company? That's an excellent question. Now there's two different options. There's Medicare Advantage plans. There's Medicare Supplement plans. When you use a Medicare Supplement plan, you have original Medicare. Right. And you'll show your original Medicare card when you have services along with the Supplement plan card. Then you'll also have a separate Part D drug plan card. You have three cards that you need to present. Now when you join a Medicare Advantage plan, what you've done is actually assigned your Medicare A and B to that private insurance company. You still have A and B, but you've assigned it. So when you go for services, you do not show your original Medicare card. You show the card of the private insurance company that you enrolled with. And they administer your A, your B, and many times your Part D drug as well. Oh, wow. Okay. So we need to take a break, and when we come back, let's see where we go from here with the politics of all of this. Okay. We'll be right back. This is Think Tech Hawaii, raising public awareness. I'm your host, Sharon Thomas Yarbrough, where we motivate, educate, empower, and inspire all women. We are live here every other Thursday at 4 p.m., and we welcome you to join us here at Sister Power. Aloha, and thank you. Aloha, and we're back. We are talking to my dear friend, and you know that, Martha Copeland. And we have talked about, we are talking about this chaos in the middle of Medicare enrollment plan. But now let's talk about the politics involved, because in the original statement I read, it was the Republicans, 18 Republican states that asked for this to overturn for 50 states. Okay, so now let's, so looking forward, let's talk politics, and you do know how to talk politics. She's really sharp. We have a new Congress beginning January 3rd, which is what, two weeks from now. What do you suppose, A, because the Democrats picked up 40 seats, and of the 40 seats, a majority of women. So I really feel that going forward to look at what to do with the ACA, which was probably no longer Obamacare when they get through with it. That's right. So what do you think? What are your feelings about what can happen, or what should happen with the new Congress? Well, I can tell you what I think may happen. Yeah. And just to clarify, there are certain Medicare funding that would be impacted by the Affordable Care Act going away. But this is really the program that was meant to cover preexisting conditions and the expansions of Medicaid and a couple other things. I think that whether you're a Democrat or a Republican, you have a large number of people who have actually been helped by the Affordable Care Act. And I think when you start to think about your constituents, you want to keep them happy, and you want to bring them back, you want them to bring you back. So I think that this impacts such a huge number of people. Just look at the Medicaid expansion. Over 10 million people have benefited from that program, also preexisting conditions. If you've ever known anyone who's had a child with cancer, and they make it through that episode, now they're adults, and they're 26, 27, they're not able to get coverage if preexistence weren't covered. So I think when the Republicans and Democrats alike start to really look at the people who've been helped and as people write in and are very vocal about how the Affordable Care Act has helped them, I think that Republicans will definitely figure out a way to work with the Democrats and create something that will work for everyone. Well, I was just thinking that with the prepondence of females for the first time in the Congress, that whole sense of not entitlement, but a necessity. This is my family, your family. Right. This is what we need for a healthy country. Absolutely. Yeah. So I didn't understand why the Republicans were against it other than the fact that it was Obama. But they had people in there, those 18 states, they had people in those states that needed coverage. I still don't understand that. Yeah. I think part of it, Marcia, is the Act was over a thousand pages. So how many people really read? Maybe me. But not a lot of people who've been very vocal about it have really, I think, read all the pages to understand that it wasn't just covering one thing. It was handling a lot of things. One of them, again, the Medicare funding. So I think that as the Medicare beneficiaries and in Hawaii, there's over 250,000 of them. But as Medicare beneficiaries, if they really understood the impact of affordable care going away, if, again, the parents of children with pre-existing conditions and even individuals themselves with that, and also the Medicaid population, if you really start looking at all the ways it can impact all of us, I think that will put pressure on, you know, again, Democrats and Republicans alike to really come up with a program that's going to work. It's here, and people now are accustomed to it. You do, yeah. And we can't make it go away altogether. No, that's amazing to me that they would even consider that. And you know how they went to the Senate trying to override it or get rid of it, that Senator McCain put up his hand. Yes, he did. I just don't understand how you can represent people and not want them to have health care. Yeah, I think the main concern was the penalty. A lot of people don't like the idea of being forced to do something they don't want to do, and if they refuse, then there's a penalty. So I think that, you know, when the penalty was repealed, I think this judge, you know, this group, you know, decided, hey, the repeal, they repealed the penalty. So now just repeal the rest of it. Here's our opportunity. I don't even think they're really thinking about, you know, the people who've been impacted. And again, when I think of children, I know who've had pre-existing conditions due to maybe an early cancer diagnosis, but they recovered, and they're wonderful, vibrant adults. If the ACA didn't exist, they would not be able to have coverage because they had a pre-existing condition after they lose coverage because they turned 26 and are no longer on their parents' plan. Well, I saw on VICE, on television, North Carolina refused the expansion of the Medicaid. And consequently, they had the highest numbers in HIV because they couldn't get the medication. Oh, my goodness. Oh, that's so sad. Simply because they couldn't get the medication. Because they didn't do the expansion? Yes, because they didn't. That just boggles my mind that one person, because he was a Republican governor, that just didn't make any sense. I mean, health care is not a Democrat. It's not a Republican. It's people. Exactly. It's people. Exactly. And I was just blown away by that one. That's why it shows like your show, Marcia, I think that you're very conversational and very easy to follow, and I think that this will encourage people to actually write to their leaders because that's the way you explain to them what your personal situation is, what may have happened in your life that could impact you in a negative way if this is repealed. So I think that the power of the pen, the email or the text, the power of the email. But yes, as a matter of fact, we are fortunate in that all four of our delegations are on board for the expansion, for the expansion or for a keeping it, I guess is a better word. But that's a good idea. Okay, so you understand that you need to write to Senator Brian Schatz, Senator Maisie Hirono, congressman Ed Case and congressmember Kelsey Gabbard. They're in the phone book, their addresses are there, online, their address, they, you do need to write to them because not only does this protect us in Hawaii, but it protects all across the country, and we know they're on board, but they need to hear from you, especially if you have a child or anybody with a pre-existing condition. Yes, so you need to do that. And I think we, yeah, because we can't, we have an obligation not to let this happen. Absolutely, and I just want to share that because I work in the Medicare space and sometimes that can be a challenge to navigate if people need assistance and sometimes the challenge is so huge, I encourage people to write to their leaders. And I got to tell you, you know, Hirono shots, they come through. They do. They come through. So don't think that, oh, I'm just going to write it and it's a waste of time. Absolutely not. They actually respond. And my son, when summer worked for Senator Hirono in her office and he answered the phones and he said, yes, each and every call is important if a person does not have access to, you know, writing a letter and email or text, make the phone call. Well, we do talk to Andy Weiner regularly on the show and he is the Chief of Staff for Senator Brian Schatz. So we will, our next call, we will definitely nail him on this one. Perfect. Yes. He is really receptive to our calls. I mean, we, you know, he's in D.C. Even though he'd love to be here again. It's cold, it's measurable, you know. But they do respond. Yes, they do. I've been very pleased and I've had some cases, the Medicare cases that were really, really tough and it's so rewarding to be able to tell the Medicare beneficiary that it worked and everything has been settled and you have your benefits. So definitely our folks work. How would you lose your benefits other than this nonsense but through... Well, what can happen is, you know, I just had an individual who had been outside of the country and they needed to, you know, they came back and then they wanted to get their Medicare Part B so that they could pick up one of the private plans and they had difficulty with the process for applying for Part B because they had been out of the country so certain documents they needed needed to be translated from the foreign language because they had their documents but they were not in English so they had a really difficult time working through that. So we had to actually appeal to a higher ground and they were successful but it took six months. So in the meantime they had no coverage. Oh, wow. That can happen, yeah. Oh my goodness. And that's scary. That's very scary. Yeah, what else can you... how else could you lose coverage? Another way you can lose coverage is some people, real quick, I had a gentleman call me up, he was in the hospital, he said, no, what's a bad day? I said, what? He said, I'm paralyzed from the neck down. And I said, that's a bad day. He said, no. He said, I just found out I was supposed to sign up for Medicare Part B when I was 65. I didn't sign up because I have commercial coverage and I paid my premium every month. He said, but Medicare is primary if you work for a company less than 20 and other conditions aren't met. So I got to get my B. So he didn't have coverage for 15 days. So he had a bill of $150,000 because he didn't know how to sign up for his B. Oh dear. So he had another plan. But when he reached 65 he didn't... Because he had less than 20 employees, he was self-employed, Medicare becomes primary. Many people don't know that. So you may have a payroll service, pro-service or alt-trans or something like that, so that may differ for you. But if you're self-employed and you don't have any other circumstances you're required to get Medicare because it becomes primary. So even if you have other coverage, Medicare will be primary and if you don't have Medicare, it cannot pay and your secondary coverage cannot pay. Now, we're almost out of time so what I'm about to ask you is a big question. In my lifetime I have watched Medicare grow and grow and grow in that they cover more things, they do more things that we didn't dream about years ago. So in 25 words or less tell us all of the things that Medicare does or can you tell me? Sure, I'm really excited about all of the preventive services that Medicare covers so you can get an annual wellness check from Medicare, no charge whatsoever, you just call and say I want my annual wellness check and also... Any doctor? Any doctor that takes your plan. So the other thing is they are now realizing that people have a need for care that's non-medical so they're starting to cover things like transportation, you just need a ride to pick up your medications or to the doctor, also certain services and support like maybe you need light chore cleaning, light chores done or light housekeeping so they're starting to add those to some of the Medicare plans so some good stuff is coming in the future. I'm really excited. Ah, housekeeping, huh? Yes, especially housekeeping. Light chores and housekeeping. Yes, yes, housekeeping. Oh, I love it, I love it. And grab bars in the bathroom covering that for you makes sense because you might be a fall risk. Just a grab bar can make a huge difference so Medicare is looking at that and they've opened up the doors for some of these services called long-term service and supports. Non-medical. Non-medical. Wow, how wonderful. Oh, our tax dollars at work. Martha, thank you so much. It's always a pleasure being with you and you will come back as this thing moves along and tell us how we're progressing. Absolutely, thank you for having me. Thank you so much and we'll see you next time.