Starting last September, Kuhn had been on one “spell of illness.” Last spring, doctors transferred him to a nursing home to see if they could reset the Medicare clock. But in four days, he had to be hospitalized again.
By spring, he was completely out of Medicare days. Borzak, the cardiologist, said no hospital wanted to implant the LVAD in an uninsured man. The only way to reinstate his Medicare days was to keep him out of the hospital for 60 days, but that would likely kill him.
Borzak said the family isn’t upset with the hospitals: “They’re frustrated with the insurance cap.”
The cap has been in the Medicare act since its creation in 1965, said Gerard Anderson, a Johns Hopkins health policy expert. “Medicare is a program for acute illness, not long-term illness.”
Medicare was set up that way so that it didn’t pay for long-term costs such as nursing homes. In 1986, President Ronald Reagan proposed the Medicare Catastrophic Coverage Act to fix the “glitches.” Congress passed the glitch act in 1988, but seniors rebelled because the act would raise their premiums. It was repealed in 1989 leaving catastrophic cases like Kuhn’s without long-term coverage.
Last week, Kuhn’s condition worsened and he was put on a ventilator. “He’s getting weaker every day,” said his brother, Fred. “It’s affecting his liver and kidneys.”
On Wednesday, Borzak said Kuhn’s condition had improved slightly and he planned to call doctors at Jackson and Shands with an update, to see if they considered Kuhn healthy enough for surgery.
But if a hospital had taken on Kuhn’s case a few weeks ago, Borzak noted, he might already be on the road to recovery: “The biggest culprit is the black Medicare hole that he fell in.”