A recent report on the Politico.com site (5/18) says the feds are picking up the full tab for Medicaid expansion expenditures through the year 2016. After that the feds plan a cutback, dropping that level down from 100 to 90 percent. This prospective scenario has raised the ire of conservatives who say that such financial responsibility winding up on the states’ backs (according to Rachana Pradhan writing in Politico) “are just too big a burden, and they see vindication in the sign up numbers, proof that costs will be more than projected as they have warned all along.”
Conservatives like Florida Gov. Rick Scott are quoted by Politico as saying, “The expansion of Obamacare will cost our state taxpayers $ 5 billion.” “Name the healthcare program – – I think the only one is Medicare Part D – that cost less than what they initially anticipated. . . . Historically, if you look at the numbers, with the growth in Medicare costs. Medicaid costs, it’s always multiples.”
Meanwhile, the legislature in Florida is bitterly divided over Medicaid policy. At one point Gov. Scott had advocated Medicaid expansion, but later had second thoughts.
Other governors are worried as well. In Utah, for example, Gov. Gary Herbert is scratching his head, trying to figure out a way for his state to expand Medicaid. According to Pradhan’s Politico account, “Herbert met with HHS Secretary Sylvia Mathews Burwell in late April and later voiced worries that any form of expansion could mean Medicaid consumes an even bigger chunk of the state budget starting in 2017.”
Meanwhile ACA advocates say “(Medicaid) expansion is providing significant health and economic benefits to states that more than offset costs.”
The Medicare Payment Advisory Commission is saying that Medicare Advantage, on average, expends “about 2 percent more per person,” according to a recent report in The Hill, over “traditional Medicare.”
The report, by Peter Sullivan, also adds, that The Centers for Medicare and Medicaid Services (CMS) had suggested a rate cut of .95 percent in those instances in which the government contracts with private insurers to dispense care to senior citizens.
Now, CMS says a 1.25 increase is forthcoming. The Obama administration also chimed in, “the new rate is not because of a change in policy but because of changes in actuarial estimates,” so says Sullivan’s Hill article.
Tom Coburn, U.S. Senator from Oklahoma, who is also a physician, expresses concern in a new Wall Street Journal article (online, Dec. 3). Currently, the Senator frets over what he and co-author physician, Phil Roe, see as an outright dangerous provision of the Affordable Care Act. Chiefly, the (IPAB) Independent Payment Advisory Board.
Coburn and Roe contend, “This is why, on Thursday, several members of the House will file an amicus brief asking the U.S. Supreme Court to take up Coons v. Lew. This lawsuit, filed by the Goldwater Institute on behalf of Dr. Eric Novack, an orthopedic surgeon, and Nick Coons, an Arizona businessman, challenges the constitutionality of IPAB.”
Additionally, in their WSJ article, Sen. Coburn and Dr. Roe claim the IPAB can actually regulate expenditures, ”by lowering physician reimbursements — thus driving more doctors away from treating Medicare patients — or by reducing the services eligible for reimbursement. Coburn and Rose describe this as “rationing care.”
Also, according to the WSJ report, “Groups as varied in their missions and beliefs as the American Medical Association, Easter Seals, National Right to Life, Vietnam Veterans of America and the Children’s Rare Disease Network are among the hundreds that have called for IPAB’s repeal.”
A recent online post (Oct. 28) in Forbes features another article by physician John C. Goodman. Dr. Goodman says senior citizens should still be concerned about Medicare ramifications of the Affordable Care Act. This latest report by Dr. Goodman describes a perhaps lesser-well-known provision in Obamacare which imposes pervasive budgetary constraints on Medicare expenditures. In prior years, Medicare was solely an entitlement. Meaning, the federal government was compelled to fund care both seniors and the disabled received. Now, the ACA imposes spending limits.
Dr. Goodman’s Forbes account additionally says, “One bad result is that that Medicare beneficiaries are likely to be pushed into a second tier health care system – where access to care will become increasingly difficult, as seniors less financially attractive to providers than become Medicaid patients.” Dr. Goodman adds, “The new law gives an Independent Payment Advisory Board the power to recommend cuts in reimbursement rates for providers of health care. Congress must either accept these cuts or propose its own plan to cut costs as much or more. If Congress fails to substitute its own plan, the board’s cuts will become effective.”
Seniors face an unexpected healthcare broadside: charges for “observation care.” According to a May 21 report in Human Events, older Americans are finding their healthcare skimped on.
Earlier in May, the Obama White House bragged that the Affordable Care Act was increasing care quality for seniors. Nationally, hospital readmission rates are declining because Section 3025 of the ACA penalizes hospitals if a senior is re-admitted within 30 days.
When a senior previously was treated by a hospital and returns (after only a few days) to that hospital, the facility found a way to avoid the penalty. Hospitals simply put the patient under observation. Just a word on a chart? Yes, but a powerful one. Unless the patient is there at least two nights, “The hospital won’t bill Medicare for a stay and the patients gets clobbered with the cost. Many seniors don’t even know they were under observation until they get the bill,” says Human Events.
Also, according to the Human Events report, “The Obama Administration plans to expand the readmissions penalties in 2015 to apply to many more conditions.”
More insight from Politico’s Brett Norman: Medicare payments revealed in April for the first time by the Obama administration discloses tens of billions of dollars paid to physicians. It is an imposing revelation casting a broad, bright light on some of the top billing doctors around the U.S. Norman adds, “Physician groups have long resisted such a specific accounting of individual providers’ pay, and they continue to warn that the raw payment information –lacking the right context – could ruin the careers of quality docs.”
Yet the omnibus release brings what the federal health officials tout as a measure of transparency to a disreputable system. Academics and media outlets are anticipated to immediately begin dissecting the information attempting to identify potential causes of waste or fraud. Such disclosure is welcomed by researchers, consumer advocates, businesses and non-profits seeking to increase access to details they contend are needed to improve healthcare. Yet, the AMA (American Medical Association) opposes the “data dump.” In a statement issued early on April 9, the AMA said releasing the information absent “context” will “likely lead to inaccuracies, misinterpretation, false conclusions and other unintended consequences.” “Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care,” says AMA President Ardis Dee Hoven.
According to Politico, the non-profit research Altarum Institute says national health spending increased by 6.7 percent in over a year. A portion of such growth is due to the newly insured under the healthcare law. Much of the acceleration in growth occurred in 2013, before the new coverage kicked in. By January, 2014, the healthcare spending share of the GDP reached a record of 17.7 percent.
Beginning Monday, March 31, 2014, the U.S. Senate is scheduled to take up Medicare payment legislation; the House concurrently is working on redefining the full-time work week, at least as it would be under the ACA. Senate Majority leader Harry Reid has also scheduled a test-vote for what’s known as the “doc fix”, a bill – one that supposedly prevents a 24 percent reduction in federally-based reimbursements to doctors treating Medicare patients. The proposed legislation is a “patch” and not a lasting remedy to the “Sustainable Growth Rate” (SGR) – this is what causes the regular cuts in provider pay that Congress must then undo via legislation.
Republican and Democratic leaders claim they’ve previously sought a way to repeal it – permanently – but the short-term legislation was needed to avoid the chance of seniors losing medical care if the current patch is allowed to expire, and reimbursement rates plunge.
The Senate is also considering a bill to extend unemployment benefits additionally by five months. The legislation, co-authored by five Republicans, cleared a crucial test, and therefore may pass.
As of March 31, 2014, the House was also scheduled to continue wrestling with the issue of perceived over-stepping by the Obama White House, with a vote on the “Save American Workers Act”. It’s being pushed by Rep. Todd Young, R. Ind. The bill repeals the 30 hour definition of full time employment under the ACA. Critics of the 30-hour starting point say it’s caused employers to cut hours and furlough employees, all to avoid the new employer mandate – requiring employers to provide health insurance to full-time employees.
The Hartford Courant says the health care industry is vexed over a drawn-out shift in Medicare policy, translating into insurance companies being paid less per person to manage federally backed Medicare Advantage coverage. The U.S. Centers for Medicare and Medicaid Services proposed its most recent reductions in February, 2014, affecting plans insurers will offer to prospective customers in the fall of 2015. Less government money for insurance companies actually squeezes their profits. As a result, Cigna is cutting 950 employees globally, 70 of whom are located in Connecticut.
Insurers can attempt to preserve their bottom lines in several ways: narrowing physician networks, changing plan benefits, or increasing out of pocket costs for policyholders.
In a non-descript healthcare clinic in Louisville Kentucky, provider adjustments caused by Obamacare are being felt – so much so overworked staff strive just to keep up with increased patient demand. As of late, patients’ ailments seem to fit the usual categorical profiles: diabetes, high blood-pressure, chronic pain, and quite significantly – no health insurance.
Even those who work in the healthcare industry requiring care, feel the effects. One dental hygienist in Louisville is overdue for at least two specialized medical procedures. While she has a new plan, it comes with a much higher premium. Only a handful of doctors and hospitals accept it. She’s also discovered her local Walgreens doesn’t accept her new Humana coverage. While she quit smoking and went on a candy binge, receiving a dark chocolate bar from Humana, with a “Heart Healthy” label on the outside was little comfort. The candy bar was offered as a consolation – for her policy’s cancellation. Others have obtained subsidized insurance, though have not paid the first month’s premium. As a result they may return to being uninsured.
The Affordable Care Act still faces stark challenges in states like Kentucky. The obstacles range from vigorous political foes – who plan on keeping up their attacks until Election Day, to watchful consumers – who feel both the costs of new ACA plans are too high, and the choice of hospitals and doctors too narrow.
Yet, for all its shortcomings, the new healthcare law is beginning to change the face of medicine in places like Kentucky. More than 350,000 people, have signed up for Obamacare in the state.