Medicare Open Enrollment Met With Confusion
NEAL CONAN, HOST:
This is TALK OF THE NATION. I'm Neal Conan in Washington. It's open enrollment season for many health insurance plans, including Medicare, the federal health care program for Americans 65 and over. Some 48 million people are enrolled, and the window to change plans opened earlier than usual, this year, and closes earlier, too.
The new health care law instituted changes for Medicare recipients, and part of that law that would have helped families meet costs for long-term care was scrapped before it ever took effect, which leaves a major gap in coverage, and that's not likely to be the last change: Medicare is on the table as Congress debates deficit reduction.
If you receive Medicare, if your family members do so, what's changed for you? Give us a call, 800-989-8255. Email email@example.com. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
Later in the program, as Occupy Wall Street protests continue across the U.S., in some places they may have worn out their welcome. But first, NPR health policy correspondent Julie Rovner joins us, as she often does, here in Studio 3A. Always nice to have you with us.
JULIE ROVNER, BYLINE: Always nice to be here.
CONAN: And news today, in fact, that rates may actually go down for some people.
ROVNER: Indeed. This was trumpeted by federal officials as some good news. Earlier in the year, it looked like the Medicare Part B premium, that's the optional outpatient portion of Medicare but virtually everybody who has Medicare signs up for it, is going to go up but only very slightly. It looked like it was going to go up by about $10 a month. It's actually only going to go up by about $3.50 a month. It will be $99.90 next year.
Now for some people - the last two years, there has been no Social Security cost of living increase. There is a provision in the law that says in years when there's no cost of living increase, that you can't raise Medicare premiums so that people's total Social Security checks don't go down because their Medicare premiums are taken out of their Social Security checks.
So there has been no change, basically, for the last two years in Part B premiums. So for those people who have seen no change, they'll have this small, three-and-a-half-dollar increase in their premiums.
For new people, people who just got on Medicare and weren't subject to that hold-harmless, as it's called, they've been paying $115 a month in there Medicare premiums. Or for people who were very high-income so whose Social Security check wouldn't have gone down because of this, they'd also been paying that $115 a month Part B premium. So their premiums will actually go down to $99. They'll see a $15-a-month decrease.
CONAN: And some people might say, wait a minute, we're just talking about a few dollars here one way or the other, what's the big deal. Well, first, obviously a lot of senior citizens on fixed incomes, and it is a big deal. And second, we've seen health care costs exploding, and here's - this seems to be under control.
ROVNER: That's right. And, you know, back - it was last month when we saw this employer survey that talked about this big spike that a lot of employers saw this year in premiums, and one of the things that the government said in response is, you know, there are indications that costs seem to be leveling off for next year.
We saw that in the federal employees' health benefits plan, where increases next year are much smaller than they were last year. And again, this is another indication in Medicare where we're seeing smaller-than-expected increases. So there are some indications that there was some kind of a spike.
It may have been from pent-up use during the - really the height of the recession. There were a lot of people who simply did not seek medical care, and so there was some pent-up demand. There also was some thought that it looked like at the beginning of the year we were coming out of the recession, and a lot of insurers increased their premiums in the thought that people, because...
CONAN: In anticipation.
ROVNER: In anticipation of that pent-up demand coming true. And then it didn't because we didn't really move as much out of the recession as we thought. And so therefore, there's a lot of, sort of, scaling back. So this is another indication that perhaps the recession is not ending, which is bad news, but that we're also not seeing this huge spike in health insurance premiums.
CONAN: And that long-care provision, known as the CLASS Act, this was a part of President Obama's health care law that was championed by the late Senator Edward Kennedy. It would have helped older Americans pay for some long-term-care needs. Earlier this month, the administration agreed with some of its critics: It's too expensive.
ROVNER: Yeah, it did, and of course, you know, I think the main problem with this law, as it turned out - or it was a piece of the law. It was really grafted onto the health care law. Again, as you mentioned, its biggest champion was the late Senator Kennedy. He was not here, obviously, to push it ahead.
When it was being put into the health care law, it had an amendment added by Senator Judd Gregg of New Hampshire, who said if the administration could not make it be self-sustaining for 75 years, it could not go into effect. And that was, by some, considered, you know, very fiscally responsible and by others considered a poison pill.
And the administration took it, and they looked at it, and they tried it lots of different ways, but it had to be voluntary, and so it had to pay for itself. And they could not figure out a way to make it really self-sustaining. And, you know, now a lot of the advocates for this, who considered it really an extremely small first step - and remember this was not just for seniors. This was for everyone.
In fact, you had to pay into it for five years before it would vest. You had to pay premiums for five years before you could get any benefit. So - but the idea was that if you were going to be disabled, or even temporarily disabled, you be able to get benefits. It was a small benefit. It was for community living.
CLASS in this case stood for Community Living Assistance Services and Supports Act. It was just to get non-medical help, if you needed someone to come in and help you in the morning, get out of bed, do your cooking, do some light cleaning. It was to really keep people from having to move into an institution, into a nursing home.
This was the idea, just, sort of, a first step to help keep people out of the long-term medical system.
CONAN: Much more expensive.
ROVNER: Much more expensive, and so there are a lot of advocates who are extremely upset about the demise of this. The administration has said they do not want it repealed. They would like to continue to work and see if it - a way can be devised to make it self-sustaining.
Republicans, largely, who oppose it, would like to repeal it. And that fight is still going on.
CONAN: This relates to an article that we saw in the New York Times. Jane Gross, a former New York Times reporter, like many adult children, a primary caregiver for her ailing mother, who since passed away, she wrote on the New York Times op-ed page that: Medicare fails the elderly. It covers many medical procedures that are not useful, she argues, but not the assistance older people actually need: home aides, help with shopping, bathing - just what you're talking about.
ROVNER: Exactly, and Medicare does not do that. We actually here at NPR, we did a poll a couple of months ago about baby-boomers' preparations for retirement. And, you know, this was - I started doing this beat in 1986, and one of the first stories I did was about long-term care and how ill-prepared people were for long-term care. And this poll showed that very little had changed.
The boomers, I think, know a little bit more about long-term care and what Medicare doesn't pay for, largely because, as Jane Gross points out, they are taking care of their elderly parents. But they still don't know who does pay for long-term care.
Long-term care insurance is extremely expensive, in many cases difficult to get. And it is still a completely unrecognized - something that really does not exist in the system, and you're finding more and more boomers who are now starting to get on Medicare, starting to age. And it's a big hole in the nation's social support system.
CONAN: We want to hear your questions on what's changed in Medicare, what's changed for you, 800-989-8255. Email us, firstname.lastname@example.org. But Julie Rovner, before we get to some calls, I wanted to also ask you: Given that gap in coverage, what can you do? This is the open enrollment season. Is there something you can say, well, I'll pay a little extra and get that kind of coverage?
ROVNER: Not really. There are a few - some specialized - you know, in these Medicare Advantage plans, these private Medicare health plans, there are some plans that offer some extra services. There are some plans known as social HMOs that do offer a broader array, including some limited long-term-care services.
But right now, sort of the default long-term-care plan that we have in the U.S. is Medicaid, that's better known as the plan for, you know, for the poor. And indeed, you have to be poor to get Medicaid, and the way most people get Medicaid is they spend down. They go into a nursing home, they spend all of their money - the average nursing home costs, now, about $80,000 a year.
So you go in, you basically spend all the money you have, and then Medicaid takes over and starts spending for you. Right now, Medicaid spends - Medicaid accounts for about half of the nation's long-term-care bill. That was one of the arguments that the advocates for CLASS were making, that, you know, that even though that CLASS might be, you know, expensive, at least it would be taking some of the pressure off of Medicaid. Which again, you were mentioning at the top, the supercommittee, this deficit reduction panel, is looking at cuts to Medicaid, as well as to Medicare.
So right now, as I mentioned, Medicaid is sort of the default long-term-care plan that the nation has.
CONAN: We've not seen any details from plans put forward by either Democrats or Republicans on that supercommittee. They did hold a public hearing yesterday. But nevertheless, people think there's almost no way that there's going to be any plan that does not include some cuts to Medicare and Medicaid.
CONAN: And so as people look ahead towards these changes, is there any way to protect yourself against them?
ROVNER: Well, right now, you know, obviously if you're in your 40s and 50s, there is long-term-care insurance. As I mentioned, it can be very expensive. It's complicated. For the long-term-care story that I did last month, I actually went and sat in on a long-term-care counseling session with a salesperson for long-term-care insurance. And even I was a little bit befuddled, and I do this for a living.
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ROVNER: But, you know, other than private long-term-care insurance, there isn't really all that much you can do. Right now, I think there really is a need for more, you know, social insurance, if you will. And, you know, this was a plan that was going - people were going to pay into.
It was intended to be self-supporting. So it - there's really sort of a social need to try and solve this problem. Obviously, people are going to have to pay for it. It's not something that, you know, the government or taxpayers are going to be able to provide free. But certainly people do need to prepare.
Right now, an enormous amount, as one can see, all you need to do is talk to friends or neighbors, enormous amount of long-term care is provided by - is provided free by family friends. And that is certainly important, and one thing that certainly happens is that there is an increasing source of support for these unpaid caregivers.
There are area agencies on aging. There are a lot of local - state and local governments and also funded by the federal government, places to go and get some help. But it's very difficult to get that all tied together.
CONAN: And obviously we're talking about gaps, there are a lot of medical coverage - there is a lot of medical coverage provided by Medicare.
ROVNER: Oh yes, there is an enormous amount of medical coverage provided by Medicare, but there are - I mean, one of the big problems that's going on right now, there's an increasing move when a senior goes to the hospital rather than admit them, they sort of partially admit. They put them under quote-unquote observation.
And if you're not - if you're in the hospital - in fact this just happened to my mother. She was under observation, but she was never an inpatient. Now, she was well enough to just go home, but if you're going to go to a nursing home after you've been in the hospital, you have to have been an inpatient for three days.
Well, if you were only under observation, and then you go to a nursing home, you were never an inpatient, and therefore you don't qualify for Medicare's nursing home stay. So this is a big problem for people who are going to a nursing home after - even though they were in the hospital, they were getting treated, they were getting meals, and yet they get to the nursing home and discover lo and behold, Medicare's not going to cover that nursing home stay because they were never, quote-unquote, "an inpatient."
CONAN: Catch-22. We did a story about that last week. Julie Rovner, stay with us. And I promise we will get to your calls. I apologize for that. Julie Rovner, NPR health policy correspondent. More with her in a moment. If you receive Medicare, if your family members do, what has changed and what's coming up in changes? 800-989-8255. Email us, email@example.com. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. The doughnut hole, Parts A, B, C and D, Medigap, familiar terms to anyone who's navigated the labyrinth of Medicare coverage. There are changes this year, including an earlier open enrollment season.
We're talking with NPR health policy correspondent Julie Rovner about some recent changes and what you might expect going forward. We've put a list together of website that might answer many of your questions about specific situations, including a link to find help in your state. You can find that at npr.org. Click on TALK OF THE NATION.
If you receive Medicare, if you have family members who do, what's changed for you? Give us a call, 800-989-8255. Email firstname.lastname@example.org. You can also join the conversation on our website. Go to npr.org. Click on TALK OF THE NATION.
And as promised, let's get to the phones. John(ph) is on the line calling from Roanoke in Virginia.
JOHN: Hello, there.
JOHN: I'm sitting outside Springtree Nursing Home, where my wife has been for a few weeks. Medicare is not paying for this portion because she was adjudged not eligible for hospice care yet. She had used some while she was in some rehab. She has a terminal cancer.
And one of the big problems is this is very expensive, not like you would pay in a large city, but it's still $272 a day. And I'm having a great deal of difficulty with some of the banks, who have suddenly decided that the power of attorney that we drew up before we retired, they're going to not honor it.
They asked me to load this poor woman into medical transport and bring her to the bank. She's on oxygen 24 hours a day.
CONAN: John, I'm so sorry to hear that, and I'm so sorry for your situation. Julie, is this endemic?
ROVNER: You know, unfortunately there are a lot of - you know, Medicare covers a lot of things, but, you know, getting qualified for certain things are judgments made by certain, you know, medical professionals, and it goes through their bureaucracy.
You know, Medicare does have a hospice benefit, but you have to be adjudged, you know, within - terminal within six months. And obviously if your wife hasn't been, then she does not qualify. Or, you know, things can be appealed, and I know people who have gotten caught in all kinds of appeals processes. So it is - I know it is really frustrating.
There are certainly - there are places where you can turn to for help. There - you know, are things like the Medicare Rights Center and the Center for Medicare Advocacy. There are places where, when you get an adverse ruling from Medicare, there are people who can help you.
CONAN: John, we wish you and your wife the best of luck.
JOHN: Well, and in parting, I caution everybody that's listening to check out their powers of attorney and the rules in their banks. One of the banks says, in their brochure, they have the right to refuse any and all powers of attorney.
CONAN: Thank you for the advice, John, appreciate ir.
CONAN: Let's go next to - this is Shelley(ph), Shelley with us from Tulsa.
SHELLEY: Yes, I kind of have a different take on the whole conversation because I'm 37 years old but on permanent disability. So therefore my health coverage is covered through Medicare. And my question is: What exactly is the rationale to the prescription drug coverage gap, or the doughnut hole, so to speak, and what patients are supposed to do when they hit that early in the year, and they're faced with making, you know, tough decisions?
Do I buy medication, or do I feed my children?
CONAN: And they're trying to close that doughnut hole, Julie Rovner, but it remains there.
ROVNER: That's right. Well, of course, the rationale was purely political. It's that they wanted to make this - when they were writing the law back in 2003, they wanted to make it attractive enough that everybody would get something for the premiums - because again this was going to be a voluntary benefit. So they wanted to get a lot of people to sign up.
But they wanted to really cover people who had truly catastrophic drug bills. So what they ended up doing was they made it - they front-loaded it. They gave everybody a couple of thousand dollars worth of coverage. And then they back-loaded it and gave everybody who had a really huge amount of drug bills coverage. And that left them with this gap in the middle that became known as the doughnut hole.
And indeed, last year's health law is closing that doughnut hold gradually. So this year when you hit the doughnut hole, you get a 50-percent discount on your brand-name drugs, and you get a 14-percent discount on your generic drugs, which is up from seven percent. I guess next year you get 14 percent, up from seven percent this year. And slowly it is being closed.
But indeed, nobody would have designed - if they'd had enough money, they wouldn't have left that hole there in the first place. So that's why it's there. It's not sort of any kind of - it wasn't there to do anything logical, it was just there because that's what was left when they were finishing what they wanted - how they wanted to design the benefit.
CONAN: And Shelley, are your choices literally do I buy the drugs I need, or do I buy food?
SHELLEY: Yes, those are my choices. You know, I have congestive heart failure, and Plavix, as anyone that has a heart condition knows, is extremely expensive. And if you go off of it, you at a very high risk of a recurring heart attack and/or do I provide for my children and the needs that they have.
So it is a very real, real possibility, and it's a very real difficult situation, and I just don't know where to turn. I mean, do you guys have any - are there any programs out there or suggestions for people that are in my situation.
ROVNER: Although I believe that Plavix is one of the big drugs that's about to go off of patent. You might want to check that, which would - yeah, so there's a - when there's a generic, that should help a lot, and certainly I would think that the 50-percent discount helps.
But yeah, I mean, it is certainly a problem. And, you know, we really shouldn't forget there are, you know, several million people on Medicare who are not seniors, who are disabled and by and large getting by on not very much money and for whom - many of them do have among, you know, the most expensive drugs. And it is a real hardship for them.
CONAN: Shelley, good luck.
SHELLEY: Thank you.
CONAN: There are - as we mentioned, there's Medicare, and there are these Advantage programs. Is that what people are signing up for in this open enrollment period?
ROVNER: You can. That's - what the open enrollment period is for is to sign up either for - sign up and/or change your Part D drug program - Part D is a prescription drug program, or join a Medicare Advantage program. That would be either an HMO or a PPO. This would be - this is a plan that would do - take care of all of your health care needs.
So if you have a Medigap plan, that would be a supplemental insurance plan that takes care of your deductibles and copayments. You would go see whatever doctor you want. Rather than have that, you would have a plan, you would be in an HMO or a PPO, and you could drop your Medigap, and so during the open enrollment period, you could join or change a Medicare Advantage plan.
And they are pretty popular right now. It's almost up to about one in five Medicare beneficiaries are in one of these Medicare Advantage plans. They're available to almost everybody in the country. There's almost, I believe - I'm not sure there are any counties anymore where there isn't at least one Medicare Advantage plan.
Congress is cutting back on the payments. They were being substantially overpaid, to the tune of about 14 percent extra. And this was something the Republicans did back in the drug bill to try and get more people into the plans. They were giving the plans extra money to provide extra benefits so more people would get in.
And the Democrats, and they - well, they took back some of that money. But so far, we haven't seen really big cutbacks on benefits or really big hikes in premiums. So people are still sticking with them, and the companies are still offering them, and they're still pretty popular.
And this year for the first time, there is a star system. Medicare has a star system that's rating them for quality. And there are consumer advocates. So you want to look for a plan that has either four or five stars.
Now, there's apparently only nine plans with five stars. So you're unlikely to find a five-star plan in your area unless you live in California. But I guess there's a fair number of four-star plans. So if you're looking for a plan, a Medicare Advantage plan to join, you might look for one with four stars.
CONAN: And where do you find those ratings?
ROVNER: You find them right on Medicare's website, if you go to Medicare.gov. And the drug plans have ratings, too, which are largely based on consumer...
ROVNER: Yes, on their consumer service but also on how well people adhere to their drug regimens. But I think the stars are probably more important when it comes to these Medicare Advantage plans.
CONAN: May's(ph) on the line calling from Santa Rosa, California.
MAY: Hi, am I on?
MAY: Hi. I wanted to thank that lady for talking about the importance of support in your home with various, you know, basic chores and everything. And I am an example of what she said in the sense that Schwarzenegger made it his top priority to kill the ill, as it were, when he took office and really went after what's called the in-home support program.
And I'm on permanent disability, and he essentially (unintelligible) the program. It's almost impossible for us to get people in our home now, and the people that we can get in our home now, it's worse than having nothing.
And so, I mean, I see myself going to the doctor much more frequently and just, you know, losing body parts because I don't have this basic help that I used to have. And it's real ugly, and it's a real sort of behind-the-scenes way to kill people, you know, when they're down and out. And so I really appreciate her bringing that point up.
CONAN: And I just have to say, in fairness, since Governor Brown has been in office, have you seen him move to restore that money?
MAY: I don't know. So far, I have not seen that. On the other hand, there were a number of court battles over eight years, with Schwarzenegger continuing to just take strike after strike after strike.
CONAN: Again, there's a Democrat in office now.
MAY: Right. And I guess what I'm trying to say is he doesn't seem to be aware of the fact that there was a problem. I wrote - it took me 11 months because of my disability, but I wrote a letter to a senator, telling her what's going on now because it's so - the problem is so, well, it's a good way to kill, you know, people who are ill, and it's evil, you know? But she is right. That's the, you know, you can lower medical bills if people get appropriate care in their home, you know, because the people are not killing themselves in getting injured and operating well past the point that they can actually function. So it's a rather little cost for - you know what I'm saying?
CONAN: I understand what you're saying, May. And...
MAY: Yeah. And the second thing I'd like to say, if I can, is that in terms of prescription and stuff, I pay for all my medicines, and, yeah, it's like food versus medicine. Because I can't use most prescription drugs from the drug companies I - homeopathics have a miraculous effect on me, but let me tell you it's really expensive and my (unintelligible) prescribed is someone who knows what he's doing. But Medicare would never go near any of that stuff. And so...
CONAN: Let me just ask Julie Rovner about that alternative therapies like homeopathic drugs, quote, unquote, "drugs." These are not covered by Medicare because they can't find any studies that support their value.
ROVNER: That's right. They need to be approved by the FDA in order to be covered.
CONAN: And that's not forthcoming.
ROVNER: I don't believe the FDA has approved any homeopathic remedies.
CONAN: Let's go next to John(ph), John is on the line with us from Sacramento.
JOHN: Hi. Thanks a lot for taking my call. I'm a practitioner that makes artificial limbs for the last 20 years. And I've been taking Medicare, Medi-Cal and VA insurance the whole time. One the things that I see happening in my industry is that Medicare will challenge about 10 or 20 percent of the things that we do, and most of these things are pretty minor. And what they'll do is if they don't think it's necessary to have it, medically necessary to have that anymore, they will drop it. And you can't get reimbursed for that anymore. But a lot of times, I'd say half of the time, they reimburse that judgment and they reinstate.
And it's just like - it seems to me like Medicare is just trying to keep control of the fraud and the check and balance, and so they put things under review. But a lot of times, they reverse it and reinstate it when the lobbyist or the industry starts complaining, and it's relatively quick. I've seen things changed in, like, one month after they drop it, or two months. It's not really that painful.
But, you know, I guess the other thing I want to say, just for all the listeners, I'm sensitive to people's ailments and things like this and money and finances. But people nowadays, with health care being a business, people have to be better health care consumers and learn about what's available and what's not available and then prepare for that.
CONAN: John is, of course, right. People should better educate themselves. Nevertheless, there's also, Julie, a fundamental belief that if you're sick and you go to the hospital, if you go to the doctor and there's a government health program to pay for it, it should take care of you.
ROVNER: Yes, there is. And as to the first thing the caller was talking about, you know, there is an enormous amount of, not just out-and-out fraud, but, you know, what's considered improper payment in Medicare. And people do get frustrated, on the other hand, you know, there are stories every day about fraud. There's an enormous amount of organized crime now, you know, what used to be drug crime is now moving into Medicare crime and Medicaid crime because that's where the money is. I mean, we spent...
CONAN: Willy Sutton principle.
ROVNER: Exactly. Hundreds of billions of dollars on these programs, so it's a great place for criminals to go. So you can see why the - and the government is forever getting beat up by members of Congress who say you're not doing enough to the find the fraud in these programs. So it's a push and pull to give people what they're entitled to, frankly, but not let people take advantage of the programs.
CONAN: We're talking Medicare with NPR health policy correspondent Julie Rovner. You're listening to TALK OF THE NATION from NPR News. And let's go to Seth(ph). Seth on the line from Salt Lake City.
CONAN: Hi. Go ahead, please.
SETH: I'm actually an insurance agent here. I work with a lot of different plans. And I want to say you've done a very good job. Everything you've said is spot on, so you've done your research well. But one the biggest problems I'm running into as an agent is trying to educate people about not only the different types of plans, but what your options are with long-term care. They always say, well, my kids will take care of me or my parents never had to go to a facility. And it seems to be because heart attacks and cancers and things like that that kind of killed you quickly are going away and they're treated. A lot of people don't realize how prevalent long-term care is nowadays.
And I was wondering if you had - if you knew anything the government was doing as far as what they're expecting for long-term care or just how you've talked to people about it and how to handle it, and whether it's quite frankly coming down to do you want to pay $100 a month for a policy so that a nurse can clean up after your or do you have some family members that can? So I was wondering if you've found out anything about long-term care information or just how to talk to people about it so that we can get more people educated and help them become health insurance consumers like the other guy was mentioning.
CONAN: Mm-hmm. Julie?
ROVNER: Well, just, you know, in talking to people just from the poll that we did - and I went out. This was - the poll was not random, obviously, but in the story that I did, I went and talked to some of the people randomly about why they thought, you know, what they did - people I certainly know from long experience. A, people don't like to think about the possibility that they might need long-term care, which I'm sure you must know as an agent. You know, you never want to think about something bad that's going to happen. And you're absolutely right, they think, well, I hope my kids will take care of me or, you know, I hope that I'll die fast or, you know, I hope I won't need that.
And I - you do. You run in to people who say, I'd rather kill myself than go into a nursing home. You really do hear that. But, you know, I've got the statistics in front of me. There are 10 million people who currently need long-term care. By 2020, it's going to be 15million, and by 2050, it's going to be 26 million. There are a lot of baby boomers. We don't have as many kids, and the kids that we do have tend to live far away. It is clearly a huge problem that is, you know, facing us square in the face, and there's not a lot of baby boomers who are doing a lot about it. I think you're absolutely right.
SETH: Have you heard anything about what they're planning to do? Because I know there's indemnity plans for short-term care. There's...
CONAN: I don't know about you, Seth, but I'm planning to live forever.
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SETH: Of course. Yeah.
ROVNER: And you're a baby boomer, are you not, Neal?
CONAN: I am. I am.
SETH: Oh, well there you go.
CONAN: Seth, that's the solution. I think that we figured it out.
CONAN: Thanks very much for the call. We appreciate it. Julie Rovner reports on solutions other than living forever as NPR's health policy correspondent. She was kind enough to join us here in Studio 3A to talk about Medicare. Thanks very much as always, Julie.
ROVNER: You're welcome.
CONAN: Up next: Occupy Wall Street protests spread and, in some places, wear out their welcome. We'll talk with NPR's Margot Adler about support and resistance for the movement. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News. Transcript provided by NPR, Copyright NPR.