Tuesday, September 29, 2015

Should I put my money in joint tenancy with my children?

     I can't tell you how many times I have sat down with a potential client to discuss planning their estate upon their death and I find out they have put one or more of their children on their checking account, CDs or investment account as a joint tenant. I ask them if they intend on favoring that child or group of children over the other ones. The answer is almost always, " No!"

   This is done many times because the client is elderly and concerned about someone in the family having access to funds to pay bills if they become sick or incapacitated. This is the wrong way to do things in almost every case. We have Powers of Attorney to accomplish these purposes. An agent under a Power of Attorney has special responsibilities under the law which are known as fiduciary duties. They can not favor themselves and being an agent under a Power of Attorney is not a license to steal. Do agents sometimes do things they shouldn't do --sure. Agents are legally held to a high standard under the law. 

    The problem with making your child or children joint tenants is that it creates a presumption under the law that it is your intention upon your death that the joint tenant should be the sole owner of the account. If you want that account divided equally among all your children you could have big problems.  A joint tenant can also go into the Bank and withdraw all of the money without your knowledge or permission. I had one client that had 3 children and added each child as a joint tenant on each of three different CDs she owned. Now if one CD needs to be cashed in to bill some medical bills who is the odd man out? 

     There are a number of ways to avoid probate that maybe much better than than the do it yourself method of adding your children as joint tenants. I don't want want your children's financial problems to be your financial problems. If the bill collectors are chasing your kids what makes you think they are  going to stop when their research shows up that joint account with you. What about if your kids don't have enough liability coverage and manage to run over an orthopedic surgeon crossing the street in front of the hospital. When you kill someone who makes $900,000 per year in slow year it is going to get expensive. What if one of your kids decides they don't want to be married anymore? Are you going to have prove to some Court that the money in that joint account is not their's? Why in the world would want any of these worries when they could easily be avoided. Discuss your options with a well qualified Elder Law attorney. You will rest easier knowing your approaching this the appropriate way. 


William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com



Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Friday, September 4, 2015

Does A (Qualified) Longevity Annuity Contract (QLAC) make sense?

Be careful. This may not make good financial sense for you right now. Michael Kitces explains why. 
 
The longevity annuity – also known in some circles as the Deferred 
Income Annuity (DIA) – is similar in principle to an immediate annuity, 
where a lump sum is converted into a lifetime stream of payments. The 
key distinction, however, is that with a longevity annuity, the payments
for life don’t begin immediately. Instead, they start at some point in 
the future. 

While the Qualified Longevity Annuity Contract (QLAC) rules allowing a 
longevity annuity to be owned inside of a retirement account were 
essential to avoid running afoul of the RMD rules, the question still 
arises: a (qualified) longevity annuity can be now purchased inside of a retirement account… but will anyone actually want to?
  
Thus far, the industry statistics suggest that demand for the products is still weak. In 2012, longevity annuity purchases topped $1B for the first time (averaging $250M per quarter), and in the first quarter of 2014 they're up to $620M (an annual pace of almost $2.5B). However, the first quarter of 2014 also saw $57.7B of total annuity sales, which means longevity annuities only make up barely more than 1% of all new annuity transactions. By contrast, even single premium immediate annuity purchases were $2.5B in Q1 of 2014, nearly quadruple the pace of longevity annuities. Nonetheless, interest in longevity annuities does seem to be growing, and more companies are throwing their hats into the ring with new products.
 
 At a more basic level, though, the fundamental challenge is that in a world where consumers are often loath to purchase an immediate annuity - ostensibly out of concern for losing their liquidity and their upside potential - it seems even more of a stretch for a longevity annuity to be compelling, with the same problems but no payments until what may be decades from now. Fortunately, the common "what if I get hit by a bus" fear can be mitigated at least, with the purchase of a return-of-premium death benefit, though such guarantees just lower the payments even further. For instance, the 55-year-old who purchases a longevity annuity for $100,000 will get guaranteed payments of $3,690.30/month starting at age 85 with a return-of-premium death benefit along the way. However, if we calculate the actual internal rate of return being generated on the longevity annuity over the time period, the results turn out to be less compelling, as shown below.
 
Internal Rate of Return (IRR) On Longevity Annuity Starting At Age 85]
As the results reveal, it still takes until age 87 before the couple actually receive back their original principal and begin to generate any actual "return" on their dollars. Even by age 90, the internal rate of return is only 3%, and by age 100 it's still only 5.3%. While 5.3% certainly isn't a "bad" return from an annuity company, over a 45-year time horizon it's still not a very compelling return either, as a combination of both interest rates and mortality credits. Even in today's low-return environment, long-term corporate bonds pay close to those yields, and the long-term return on equities is highly likely to beat 5.3% over 45 years as well (especially given that no cash flows are assumed for 30 years, which provides a significant barrier to fend off market volatility along the way).
 
In other words, while it might be nice that a longevity annuity can give a significant payment that's "guaranteed for life" beyond age 85, if it's internal rate of return is low enough, the truth is that a simple conservative investment over the same time horizon might have generated even more cash flow over any foreseeable age of death (even with very long life). Similarly, the reality is that delaying Social Security - which itself is implicitly a longevity annuity - still has a far better implicit payout rate as well compared to today's commercial longevity annuities, especially given that Social Security is inflation-adjusted while a longevity annuity also runs the risk that unexpected inflation will significantly degrade the purchasing power of its guaranteed income. (Some contracts do provide inflation-adjusted payments starting after age 85, but still require the retiree to "guess" - and risk being wrong - at what inflation will be between today and when payments begin.)
 
Notwithstanding the not-terribly-compelling implied returns that longevity annuities provide in today's marketplace, the potential remains for longevity annuities to become an increasingly significant part of the retirement income puzzle, especially if/when/as interest rates rise (boosting future payouts), and/or more companies enter the marketplace (potentially making longevity annuity pricing more competitive - i.e., with higher payouts). And for those who dofind a longevity annuity compelling, for at least a portion of retirement income... the new QLAC regulations do at least permit investors to own such contracts inside their retirement accounts. And while the dollar amount contributions remain limited, from a practical perspective a retiree would likely only put a portion of funds into a longevity annuity anyway (as they still need to fend for themselves between now and when payouts begin!).
In the end, though, whether prospective retirees will pursue such trade-offs or not remains to be seen, and thus far it appears the "breakthrough" of the Qualified Longevity Annuity Contract (QLAC) regulations is more about permitting insurance companies to sell longevity annuities inside of retirement accounts than consumers demanding to do so, especially once guaranteed payouts are converted into the equivalent not-terribly-high return they're providing over the ultra-long time horizon. Nonetheless, if guaranteed future payouts get higher in the coming years as rates rise and the marketplace heats up, longevity annuities might get a whole lot more interesting.
 
Read about this on Michael Kitces blog at https://www.kitces.com/blog/why-the-new-qualifying-longevity-annuity-contract-qlac-rmd-regulations-for-dont-mean-much-for-retirement-income-yet/ 

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com

Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Wednesday, August 26, 2015

Video Camera in Grandma's Nursing Home Room

Attorney General Lisa Madigan’s proposal to help ensure the safety and well-being of nursing home residents has been signed into law in Illinois. House Bill 2462, sponsored by Rep. Greg Harris (D-Chicago) and Sen. Terry Link (D-Waukegan), was passed by the General Assembly with overwhelming support and allows residents and their families to place video or audio monitoring devices in resident rooms. "Deciding to place a loved one into a nursing facility is extremely difficult, and as Baby Boomers age, more families will be faced with that decision," said Madigan. "This law makes Illinois one of the first states in the nation to give families peace of mind by allowing them to monitor their loved one's care when they cannot be present." This legislation stemmed from complaints Madigan's office received from nursing home residents and families who are concerned for their relatives' care and security. The new law allows residents of nursing homes and rehabilitation facilities or their family members to purchase and install video or audio monitoring devices in their rooms.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com

Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Wednesday, August 5, 2015

New law coming on "Observation" status for Medicare Patients

The U.S. Senate unanimously approved legislation Monday night requiring hospitals across the nation to tell Medicare patients when they receive observation care, but have not been admitted to the hospital. It's a distinction that's easy to miss until patients are hit with big medical bills after a short stay. The vote follows overwhelming approval in the U. S. House of Representatives in March. The legislation is expected to be signed into law by President Barack Obama, said its House sponsor, Texas Democratic Rep. Lloyd Doggett. It’s called the NOTICE Act, short for "Notice of Observation Treatment and Implication for Care Eligibility." 

Patients would think that they were admitted because they were in a room and staying overnight and therefore covered by Medicare for an inpatient stay. Instead, the reality was they were not admitted. A large part of this problem was because of attempts at cost control by Medicare included what are known as RAC reviews in which contractors which had been hired by Medicare would challenge the hospital as to the necessity for admitting the patient. The contractors would be paid based on the amount they could deny in payments to hospitals in these reviews. If the hospital admitted someone and the hospital charge was denied by Medicare the hospital was stuck with no payment and could not back charge the patient. As a result, the hospitals became every cautious about admitting patients and instead would treat them as on observation status. This lead to other problems because patients that were discharged to nursing homes would not have the three stay in a hospital prior to admission to the nursing home and would not be eligible for the potential 100 days of Medicare coverage in the nursing home that require a prior 3 day stay in the hospital. The patients were spending 3 days in the hospital it's just they were not admitted. Most patients were never informed until weeks later that they were on observation status. This again resulted in the not only the hospital going after the patient for the hospital care as observation but patient being private pay vs a Medicare patient during potentially the first 100 days in the nursing home.

The law would require hospitals to provide written notification to patients 24 hours after receiving observation care, explaining that they have not been admitted to the hospital, the reasons why, and the potential financial implications. Meanwhile, the number of claims hospitals submitted for observation care continues to skyrocket. According to the most recently available data from CMS, total claims increased 91 percent since 2006, to 1.9 million in 2013. Long observation stays, lasting 48 hours or more, rose by 450 percent to 170,219 during the same period, according to a Kaiser Health News analysis.

In 2013, Medicare officials attempted to control the use of observation care by issuing the so-called “two-midnight rule,” which would require hospitals to admit patients who doctors expect to stay at least two midnights. But Congress delayed its enforcement after hospitals said the rule was confusing and arbitrary.


William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com

Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Saturday, May 30, 2015

Who should be my agent for my Power of Attorney?

In Illinois, we have powers of attorney for Property. These are documents that allow others to handle financial matters for us. We have powers of Health Care. In some states these are know as a health care proxy. These documents allow your agent to make health care decisions for you if you can not.

Many people are overly focused on spreading around the resposibilities for these positions between their children. You should be most concerned first whether your children would be capable of handling the responsibilities or whether you need to find another relative or friend.

Some people are great with money--responsible and can keep records in order. Others you would never let get close to your checkbook. Financial train wrecks. Some people can make difficult end of life decisions while others would be paralized in making those decisions. 

So the answer is PICK THE BEST PERSON FOR THE JOB. You don't do anybody any favors in asking them to do a job that is beyond their ability. You certainly don't help yourself. Don't worry about hurting someone's feelings because you don't pick them. If I am your attorney I want you to use the most capable person because if you have a problem and need to use the POA then I want to be working with the most capable person. Sometimes the best or only capable person is going to be the agent on both the Power of attorney for Property and the power of attorney for Health Care.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com

Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Friday, May 29, 2015

What kind of evidence do I need to prove I am disabled to Social Security?

Let's start with the simple stuff. YOU NEED MEDICAL EVIDENCE. No matter how compelling your story is about why you can't work, you must have medical evidence to support your claim. I have seen Judges who I honestly believe thought the person applying for disability (the claimant)  was disabled but denied the claim because there was not enough medical evidence.

The Social Security Administration likes detailed information about your medical examinations by your doctors and the medical testing that has been done on you. SSA LOVES MEDICAL TESTING.  The reason they love medical testing is because that way they don't have to believe your doctor or you about your medical condition. They are obsessed with the idea that you or your doctor is exaggerating your condition to get benefits. SSA uses doctors under contract to them or the state agency (DDS) which they contract with in  claims for disability benefits. SSA or DDS will send you out for a medical exam if there is not enough medical evidence in your records that they obtain. Generally, these exams are a joke. They are done by doctors on a contract with them and the doctors know that SSA is looking for evidence that you are NOT disabled in order to deny your claim. I doubt the doctor will touch your body during the exam other than to give you a what is know as a straight leg raising test in which the doctor raising your extended leg to determine if and what what level that irritates a nerve in you low back. Most if not all of the information will be collected by a nurse or tech. I am telling you this because if you expect that this exam is going to make up for the lack of evidence in your file you are sadly kidding yourself.

With the expanded Medicaid from Obamacare more people now have "some" access to medical care that did not have that before.  Use the available resources because if you are disabled you probably need some level of medical or mental health care on an ongoing basis. If you are not seeing a doctor you have no medical evidence in most cases. When you visit the doctor review with the doctor all of your current medical issues. If the doctor is not documenting your continuing problems SSA is not going to believe that the issues are continuing but rather that they just come and go. Be honest with your doctor. Some people are embarrassed or afraid of going to doctors for fear of what they may find. The doctor is your partner in your healthcare and you need to be brutally honest and direct in discussing these issues. There is nothing that you are going to tell the doctor that they have not heard before.

 SSA LOVES SPECIALISTS. We all believe specialists because they concentrate in a particular area of medicine know more about that area of medicine. SSA thinks the same thing. If you are not being seen by specialists in the area of medicine that causes you the most significant element of your disability it makes your proof more difficult. Encourage you primary care doctor to give you referrals to specialists who may be more current or knowledgeable about the particular medical issues that are preventing you from working. Your level of care and your condition may improve.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Thursday, May 28, 2015

What is Probate?

In it's simplest terms, Probate is a legal process to get a person's assets after their death to those are entitled to those assets. If a person dies with a valid will the assets would go to persons designated by the "testator". Testator is the legal name for the person making the will. If the person died without a will then the assets will go to the persons under state law that our lawmakers have decided should receive the property. That is why we something say that if you don't make a will, the state has one for you. It might not be the one you want but it is there. 

In probate, the legal process is dealing with 3 elements. First, it is determining who will receive our property under the terms of our will and if we don't have a will who will receive our assets under the state law that provides for people without a will. Second, the process is designed to try and make sure that the people we owe money to at our death get paid in most situations before the property is distributed to those that are entitled to those assets. The third element of the process is to insure that if there are any disputes as to who is entitled to our assets or whether and how much money we owe is resolved by the Court before all the assets are distributed. In most cases, this third element does not come into play because the first and second element have clear answers.

Obviously, this is an oversimplification as there are a number of very specific steps and time frames  in the process but it gives you conceptually a better idea of the framework of the process. This is a not a do it yourself process. I have been called in a few times by someone trying to navigate this legal process without an attorney only to find they have made errors or assumptions which get them into trouble. When you have to clean up someone's mess it is always more expensive than if the person had come to you in the first place. Please consult an attorney --not aunt Betty or your cousin that had business law in college.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Wednesday, May 27, 2015

How do I change my will?

This is usually done in one of two ways. First, a person may amend their will. In estate planning we call an amendment a "codicil". It is an addition and/or modification to the existing document. When a codicil is done you now have two documents which must be read together. So when you do a codicil  you do not destroy your original will. You need both to understand what the writer wanted to do with his property at his death. The Court will need all codicils and the will. For a codicil to be valid it must meet all the formalities required of a will and be signed and witnessed in the exact same manner as is required of a will. In a codicil reference is usually made to the original will.  This is not a do it yourself project. Always consult with an attorney if you are considering making changes in your current will before you take any action.

Depending on the changes (complexity and number) it might be more efficient to prepare a new will. The new will ordinarily have a provision at the beginning stating that the testator (person making the will) is revoking any prior will. This new will will now be the document that controls the disposition of your property at your death. Again this is not a do it yourself project because if these documents are not prepared properly they may not work as you intended and you won't know what mistake you are making.

The biggest mistake is when people pull out their will prepared by an attorney,  signed and witnessed properly and start marking it up with changes. In Illinois, this will result in the changes being ignored by the probate court or worse yet, the Court determining that you made so many or extensive changes that the entire will is revoked and you have no will at all. You may never realized that you destroyed the effectiveness of the document and that none of the changes will be effective. Always consult an attorney.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Thursday, May 21, 2015

Studies Confirm Brain Plaque Can Help Predict Alzheimer’s

Two linked studies, published Tuesday in JAMA, also support the central early role in Alzheimer’s of beta amyloid, the protein that creates plaques. Data from nearly 9,500 people on five continents shows that amyloid can appear 20 to 30 years before symptoms of dementia, that the vast majority of Alzheimer’s patients have amyloid and that the ApoE4 gene, known to increase Alzheimer’s risk, greatly accelerates amyloid accumulation.

The findings also confirm that amyloid screening, by PET scan or cerebral spinal fluid test, can help identify people for clinical trials of drugs to prevent Alzheimer’s. Such screening is increasingly used in research. Experts say previous trials of anti-amyloid drugs on people with dementia failed because their brains were already too damaged or because some patients, not screened for amyloid, may not have had Alzheimer’s.

The findings also confirm that amyloid screening, by PET scan or cerebral spinal fluid test, can help identify people for clinical trials of drugs to prevent Alzheimer’s. Such screening is increasingly used in research. Experts say previous trials of anti-amyloid drugs on people with dementia failed because their brains were already too damaged or because some patients, not screened for amyloid, may not have had Alzheimer’s.

Read more about this in the New York Times in a story written on May 19,2015 by Pam Belluck.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.



Monday, May 11, 2015

How to Feel More Confident About Retirement

Here some keys to feeling more confident about your retirement

1.Save in a retirement account. 

2.Get out of debt.

3. Eliminate unnecessary purchases. 

4.Calculate how much you will need for retirement. 

5.Take stock of your retirement income sources.

Read the details in article on April 25, 2015 written by 

Emily Brandon

Emily Brandon is the senior editor for Retirement at U.S. News. You can contact her on Twitter @aiming2retire, circle her on Google+ or email her at ebrandon@usnews.com.

and found at US news and World report .
William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Monday, April 6, 2015

Women Often Don’t Get Quick, Proper Treatment For Heart Attacks

Each year more than 15,000 women under the age of 55 die of heart disease in the United States. And younger women are twice as likely to die after being hospitalized for a heart attack as are men in the same age group. Studies show that women tend to wait much longer than men to get emergency care for heart attacks. So Judith Lichtman, an epidemiologist at the Yale School of Public Health, tried to figure out why. In a recent study published in Circulation: Cardiovascular Quality and Outcomes, Lichtman and her colleagues conducted in-depth interviews with 30 women, ages 30 to 55, who had been hospitalized after a heart attack. It turned out that many of them didn't really know what a heart attack is supposed to feel like.

Read about this in Kaiser News at http://kaiserhealthnews.org/morning-breakout/women-often-dont-get-quick-proper-treatment-for-heart-attacks/

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Wednesday, March 18, 2015

Oncologists Reveal Reasons for High Cost of Cancer Drugs, Recommend Solutions

Increasingly high prices for cancer drugs are affecting patient care in the U.S. and the American health care system overall, say the authors of a special article published online in the journal Mayo Clinic Proceedings.

“Americans with cancer pay 50 percent to 100 percent more for the same patented drug than patients in other countries,” says S. Vincent Rajkumar, M.D., of Mayo Clinic Cancer Center, who is one of the authors. “As oncologists we have a moral obligation to advocate for affordable cancer drugs for our patients.”

Dr. Rajkumar and his colleague, Hagop Kantarjian, M.D., of MD Anderson Cancer Center, say the average price of cancer drugs for about a year of therapy increased from $5,000 to $10,000 before 2000 to more than $100,000 by 2012. Over nearly the same period the average household income in the U.S. decreased by about 8 percent.

In the paper, the authors rebut the major arguments the pharmaceutical industry uses to justify the high price of cancer drugs, namely, the expense of conducting research and drug development, the comparative benefits to patients, that market forces will settle prices to reasonable levels, and that price controls on cancer drugs will stifle innovation.

“One of the facts that people do not realize is that cancer drugs for the most part are not operating under a free market economy,” says Dr. Rajkumar. “The fact that there are five approved drugs to treat an incurable cancer does not mean there is competition. Typically, the standard of care is that each drug is used sequentially or in combination, so that each new drug represents a monopoly with exclusivity granted by patent protection for many years.”

Drs. Rajkumar and Kantarjian say other reasons for the high cost of cancer drugs include legislation that prevents Medicare from being able to negotiate drug prices and a lack of value- based pricing, which ties the cost of a drug to its relative effectiveness compared to other drugs.
Their recommendations include:
  • Allow Medicare to negotiate drug prices.
  • Develop cancer treatment pathways/guidelines that incorporate the cost and benefit of cancer drugs.
  • Allow the Food and Drug Administration or physician panels to recommend target prices based on a drug’s magnitude of benefit (value-based pricing).
  • Eliminate “pay-for-delay” strategies in which a pharmaceutical company with a brand name drug shares profits on that drug with a generic drug manufacturer for the remainder of a patent period, effectively eliminating a patent challenge and competition.
  • Allow the importation of drugs from abroad for personal use.
  • Allow the Patient-Centered Outcomes Research Institute and other cancer advocacy groups to consider cost in their recommendations.
  • Create patient-driven grassroots movements and organizations to advocate effectively for the interests of patients with cancer to balance advocacy efforts of pharmaceutical companies, insurance companies, pharmacy outlets and hospitals.
Read about this at the Mayo Clinic News Network in an article written by Joe Dangor

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.





Monday, March 16, 2015

The Trouble With Advance Directives

Ever since Congress passed the Patient Self-Determination Act in 1990, health professionals and consumer advocates have urged Americans, especially older adults, to draw up advance directives and distribute them to families and doctors. The documents allow people with terminal illnesses to accept or reject medical interventions and to appoint surrogate decision makers if they become incapacitated.

The campaign does seem to have paid off in one sense: Among Americans over age 60, the proportion who had advance directives when they died rose to 72 percent in 2010 from 47 percent in 2000, according to data from the national Health and Retirement Study.

Too often, though, an advance directive hardly seems to matter. Stories abound of documents misplaced, stashed in safe deposit boxes, filed in lawyers’ offices. 

Frequently, “the directive never gets to the right place, or isn’t referred to when a decision needs to be made,” said David M. English, chairman of the American Bar Association’s Commission on Law and Aging. Emergency medical personnel operate under standing orders to attempt resuscitation, whatever an advance directive says. (Only a state do-not-resuscitate or Polst form can prevent that.)

The Polst form does a better job than advance directivesof keeping dying people out of hospitals, research has shown. Completed by health care professionals in consultation with patients, this document can stipulate that only comfort measures be applied, or full life-prolonging interventions — or various options in between.

But a Polst can’t always substitute for an advance directive. It is meant for people with with serious illnesses that could result in their death within a year. Most people over 65 are still too healthy to have a Polst.

My advice is to always start by giving a copy of your Power of Attorney to your primary care physician. If you have a very serious illness consider a Polst.

Read about this in a New York Times article on March 13, 2015 written by Paula Span at http://nyti.ms/18Hg8hP

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.


Sunday, March 15, 2015

Still problems at the VA

Now, patients, veterans groups and doctors say delays in receiving care are still common, and they accuse department officials of failing to provide opportunities to see private doctors. Critics, including Republican lawmakers on Capitol Hill, say far too few senior managers have been held accountable for mismanagement at the hospital in Phoenix and at others around the country.

“Very little has changed,” Dr. Sam Foote, an internist who was one of the first whistle-blowers to reveal problems with wait times at the Phoenix hospital, said in an interview on Thursday.

The continued problems at the hospitals underscore the grim reality that overhauling a federal department with almost 300,000 employees scattered across the country is a difficult and tedious process. That truth will almost certainly ensure that Mr. Obama fails to make good on his 2008 campaign promise to fix the “broken bureaucracy of the V.A.” before he leaves office.

 Revelations about widespread problems at the hospitals started in Phoenix with the reports that 40 veterans had died while they were stuck on waiting lists to see doctors. The department’s inspector general later said that at least 1,700 veterans in Phoenix were “at risk of being forgotten or lost” in the hospital’s convoluted scheduling process.

Read about this in the New York Times in an article written by Michael Shears and Dave Philipps on March 13, 2015. 

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Sunday, March 1, 2015

New Dietary Guidelines, Better Science-Low Fat-Low Salt Diets Don't Prove Up

For decades, many dietary recommendations have revolved around consuming a low percentage of your daily calories from fat. It has been widely thought that doing so would reduce your chance of having coronary heart disease. Most of the evidence for that recommendation has come from epidemiologic studies, which can be flawed.

But last week, the government started to address that problem, proposing new guidelines that in some cases are more in line with evidence from randomized controlled trials, a more rigorous form of scientific research.

Just recently, a study was published in the journal Open Heart in which researchers performed a systematic review and meta-analysis of the randomized controlled trials that were available when those guidelines were announced. They wanted to explore what evidence those creating the guidelines might have been able to consider at the time. The study did show that cholesterol levels went down more in the groups that ate low-fat diets. Some have used this as justification for a low-fat diet. But the difference between them was small. And these groups didn’t have different clinical outcomes, and that’s what we really care about.

Small changes in cholesterol levels from dietary changes also aren’t surprising to those who follow the research. About 70 percent of people are thought to be “hyporesponders” to dietary cholesterol. This means that after consuming three eggs a day for 30 days, they would see no increase in their plasma cholesterol ratios. Their cholesterol levels have almost no relationship to what they eat.

In 2013, researchers published a systematic review of all studies from 2003 or after. In most studies, all people didn’t respond. In the rest, only a minority of patients responded to changes in dietary cholesterol. A government committee urged repeal of the guideline that Americans limit their cholesterol intake to 300 milligrams a day, saying, “Cholesterol is not a nutrient of concern for overconsumption.

Then there is the issue of salt. A systematic review of randomized controlled trials of salt intake was published last year. Eight trials involving more than 7,200 participants looked at whether advising patients to cut down on salt, or reducing sodium intake, affected outcomes. None of the trials, including ones involving people with both normal and high blood pressure, showed a reduction in all-cause mortality.

Since pretty much all calories come from fat, protein or carbohydrates, reducing your consumption of one means that you have to increase your consumption of another. So, as the guidelines have recommended cutting down on meat, especially red meat, this meant that many people began to increase their consumption of carbohydrates. Many now believe that excessive carbohydrate consumption may be contributing to the obesity and diabetes epidemics. A Cochrane Review of all randomized controlled trials of reduced or modified dietary fat interventions found that replacing fat with carbohydrates does not protect even against cardiovascular problems, let alone death.

Read about this in the New York Times on February 23, 2015 in an article written by Dr. Aaron Carroll. Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine. He blogs on health research and policy at The Incidental Economist, and you can follow him on Twitter at @aaronecarroll.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.



Monday, February 16, 2015

THE PRESIDENT’S 2015 TAX PROPOSALS ARE TO CHANGE PERMANENT ESTATE TAX LAWS HE MADE IN 2012

President Obama wants to back out of the deal he made with Congress in 2012 for permanent estate tax law changes made at that time. Obama wants to go back to to the estate tax exemption levels and rates present in 2009. So his budget proposal includes additional revenue assuming those changes. He is using this to support for his call for increased federal budget spending. These proposal include among others:

Restoring the estate, gift, and generation-skipping transfer (GST) tax parameters in effect in 2009.  As noted above, this proposal has been on the President’s radar for quite some time now. In 2009, the top tax rate was 45%. The exemption amounts were $3.5 million for estate and GST taxes, and $1 million for gift taxes, with no indexing for inflation. Portability of the deceased spouse’s unused estate and gift tax exemptions would remain available. Additionally, prior donors would not have to worry about a clawback for estate and gift taxes incurred by reason of the exemption’s decrease.

Eliminating the stepped-up basis at death and treating transfers of appreciated property as sales. Under this new proposal, the donor or deceased owner of an appreciated asset would realize a capital gain at the time the asset is gifted or bequeathed to another. The gain would be taxable income to the donor or the deceased’s estate. There are several exclusions, deductions, and other rules which would be implemented along with this proposal. 

Modifying the annual gift tax exclusion. The proposal would eliminate the present interest requirement for §2503(b) annual exclusion gifts. However, there would be an annual limit of $50,000 (indexed for inflation) per donor on certain types of transfers that would qualify for the annual gift tax exclusion, including most transfers in trust.   

Read about this at Bloomberg BNA Estate Tax Blog at Bloomberg Estate tax Blog
 
William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.


Tuesday, February 10, 2015

Disruptions Mount As Illinois Shifts Medicaid Patients To Managed Care

Officials at the Illinois Department of Healthcare and Family Services say they have tried to avoid disruptions of care as the state shifts 2.2 million of its 3.1 million Medicaid patients to managed care, a system in which the state pays a fixed amount for each patient instead of reimbursing providers for each test and treatment.

But some patients are reporting difficulties keeping their doctors and confusion navigating plans as they try to make the shift.The reports include wrong information on websites for insurance plans and hospitals; hours on the phone with insurers, hospitals and a state contractor who helps with enrollment; conflicting letters in the mail; changes to prescriptions, and other frustrations.

Some doctors say the state is reassigning their patients to new offices and has created new administrative requirements that burden their practices, delay care for patients and slow payments from insurers.

“I hope this works out and is better for patients and more efficient for the state, but right now it’s been extremely challenging for all parties,” said Dr. Donald Luyre, a vice president of the Illinois Academy of Family Physicians and CEO of Elmhurst Clinic.

The 2011 law required 50 percent of the state’s Medicaid population to be enrolled in managed care by Jan. 1 of this year. Illinois had enrolled about 1.6 million as of Feb. 1, said Department of Healthcare and Family Services spokesman John Hoffman. Parker has said the department plans to enroll 600,000 more this spring.


Officials have said the change will improve patient care and stabilize spending in a budget that is projected to grow to about $20 billion for fiscal year 2015. Managed care’s per-patient payments encourage providers to try to keep people healthy, which in turn should reduce costly emergency room visits and inpatient hospital stays, proponents of the system say.

Read about this in a copyrighted story by Wes Ventelcher of the Chicago Tribune date February 10, 2015 reprinted at http://kaiserhealthnews.org/news/disruptions-mount-as-illinois-shifts-medicaid-patients-to-managed-care/


William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.


Thursday, January 29, 2015

Why has there been an increase in Social Security Disability Claims?

The Social Security Disability Insurance (SSDI) program is an integral part of the Social Security system that provides vital economic security to workers and their families. Media coverage has painted a highly inaccurate picture of this program, in an effort to encourage damaging changes that would hurt people with disabilities.

Growth in the SSDI program has long been predicted by the Social Security Chief Actuary and is due almost entirely to two demographic factors: the aging of the baby boomers and women entering the workforce. According to the SSA, program growth has peaked and is projected to level off.

Notably, Congress has not uncovered any evidence of fraud in the SSDI program beyond the cases SSA itself uncovered, after several years of investigation. Nor has Congress found any evidence that people who should not be eligible are wrongly approved. Senator Coburn has been quoted on the topic and appears to mischaracterize what his 2012 investigation actually found. That investigation reviewed only 300 appeals decisions from just 3 counties, and his staff questioned the quality of about 25% of the written decisions but did not claim the decisions were wrong. In fact, the investigation did not find that a single individual was approved who should have been denied.

The Social Security Administration does a good job of identifying potential fraud in the program, despite its woefully inadequate recent funding levels and resources. SSA’s administrative budget is only about 1.4 percent of benefits paid out each year. However, Congress has provided nearly $1 billion less than requested over the past three years. SSA’s program integrity work has suffered too, receiving $421 million less than authorized over the last two years. The result? SSA has lost more than 11,000 employees since 2011 – a heavy blow to the agency’s ability to serve the American people.
 
Eligibility criteria for the SSDI program are extremely strict and only people with the most significant disabilities qualify for benefits. An applicant must prove with medical evidence the inability to engage in “substantial gainful activity” (defined as earning less than $1,070 monthly in 2014), due to a physical or mental impairment expected to result in death or last for at least one year. Most applicants are denied; only about 40% are approved, a fact which belies claims that there is a “systematic bias” toward approving applicants who are not actually disabled.

People with disabilities turn to the program as a last resort, often having attempted to continue working after it is no longer healthy to do so and having spent down their savings before applying. There is no evidence that people are leaving the labor force to receive SSDI. While it is true that SSDI applications increased during the recent economic downturn, approval rates also declined. In fact, the current approval rate is the lowest it has been in 40 years. It is very difficult to get these benefits and there is more myth and misunderstanding about the process than you could ever imagine.

Learn more about this by visiting the website of the National Organization of Social Security Claimants Representatives of which I am a member.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Tuesday, January 13, 2015

2015 Ideas and Advice

Since we are at the beginning of new year now is a great time to review some basic ideas concerning Elder Law, Estate Planning and Social Security Disability. So I will start a series of blog articles which will explore some things we need to review.

Let's begin. About a year and a half ago, I had a client come in because he wanted to make some changes in this estate plan. I had not seen the client in about 7 years.  I had originally prepared a revocable living trust as the primary means for transferring his property to his children. First, he was confused about what changes he wanted because he apparently had a conversation with his children and they had some ideas as to their vision as to how the property should come to them. He really couldn't explain it to me because he was not focusing on what needed to be accomplished. 

My most important two question are "What are you trying to accomplish? and "Why?". Tell me that and I will give you advice and ideas on different ways of accomplishing what you want. Focus on the big picture and don't get consumed by the details like my client. We made some changes but we had a flexible plan. 

My client had another problem. When the stock market dropped in 2008 he cashed and put his money into CD's. The only problem is that he put the CD's in his name alone instead of the trust we had created. In using a revocable living trust you want your assets in the trust. I didn't discover this until I started asking him about how his assets had changed in the past 7 years. The client had undone much of the good we had done by creating and funding the trust. I told him he needed to get those assets back in the trust in order to avoid probate which was one of the primary purposes in creating and funding the trust originally. A month later he unexpectedly died. He never got it done. Now we needed to open a probate estate and then also deal with the administration of the trust termination.

There are a couple of lessons. Focus on what you want to accomplish. Your children may have ideas but unless there lawyers they probably are operating under some false impressions. They may have gotten their advice from cousin Louie, the used car salesman. Next lesson, every 3 years pull out the documents and review them. If you are not sure what they mean and how they work because you have forgotten the explanation you received from your lawyer, make an appointment and go over them again. Finally, if you are going to change how title to assets is held discuss it first with your attorney.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

Sunday, January 4, 2015

As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care

The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expired in 2014— just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

For the last two years, the federal government has required state Medicaid agencies to pay at least as much as Medicare pays for primary care services. Family doctors, internists and pediatricians have thus received Medicare-level payments for primary care, with the federal government making up the difference in costs.

In his budget request in March, President Obama proposed a one-year extension of the higher Medicaid payments. Several Democratic members of Congress backed the idea, but the proposals languished, and such legislation would appear to face long odds in the new Congress, with Republicans controlling both houses.

Concern is that doctors will restrict the number of medicaid patients they will service because the payments will be much smaller. Read more about thiis in the New York Times at http://nyti.ms/1xqqRJc

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.