Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts

Tuesday, April 8, 2014

Healthcare cuts canceled amid election-year opposition from congressional Democrats.



Healthcare cuts canceled after Dem complaints



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The Obama administration announced Monday that planned cuts to Medicare Advantage would not go through as anticipated amid election-year opposition from congressional Democrats.
The cuts would have reduced benefits that seniors receive from health plans in the program, which is intended as an alternative to Medicare.
Under cuts planned by the administration, insurers offering the plans were to see their federal payments reduced by 1.9 percent, which likely would have necessitated cuts for customers.
Instead, the administration said the federal payments to insurers will increase next year by .40 percent.
The healthcare law included $200 billion in cuts to Medicare Advantage over 10 years, in part to pay for ObamaCare.
The Centers for Medicaid and Medicare Services (CMS) on Monday said changes in the healthcare market meant it did not need to make those cuts to Medicare Advantage this year.
It cited an increase in healthy beneficiaries under Medicare, which it said has lowered projected costs for that program.
CMS separately is delaying a risk assessment proposal that was set to take affect under ObamaCare.

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Obama administration proposes 1.9% cut in Medicare Advantage payments

February 21, 2014 8:08 pm by
Barack ObamaMedicare Advantage plans could see payment reductions of 1.9 percent next year under proposed rates announced Friday by the Centers for Medicare & Medicaid Services.
Insurers, who have led a fierce lobbying campaign against payment reductions, have said the combination of the health law’s lower payment rates, new fees on health plans and other factors, including automatic federalspending cuts known as "sequestration," mean that Medicare Advantage plans will see their Medicare payment rates drop by 6 percent – or even more -- in 2015.
CMS said Friday its preliminary estimate is "the combined effect of the Medicare Advantage growth percentage and the fee-for-service growth percentage."
America's Health Insurance Plans said they are reviewing the details of the announcement to determine the total impact of the federal payment rates. In a statement, AHIP President and CEO Karen Ignagni was critical of the proposed rates, saying, "The new proposed Medicare Advantage cuts would cause seniors in the program to lose benefits and choices on which they depend."

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Obama flip-flops on Medicare drug coverage


(REUTERS/Jonathan Bachman)
(REUTERS/Jonathan Bachman)
The Obama administration, in an abrupt about-face, said on Monday it would drop proposed changes to Medicare drug coverage that met wide opposition on grounds they would harm health benefits for the elderly and disabled.
Late last week, more than 370 organizations representing insurers, drug makers, pharmacies, health providers and patients urged the Centers for Medicare and Medicaid Services (CMS) to withdraw changes it had proposed for Medicare Part D.
One of the federal government’s most successful and cost-effective healthcare programs, Part D provides drug benefits for the elderly and disabled through private insurers to 36 million enrollees.
Critics said the changes, if adopted in coming months, could not only undermine Part D benefits but impact drug benefits available through Medicare Advantage, a program that allows Medicare beneficiaries to obtain their major medical coverage through private insurers.
“Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time. We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years,” CMS Administrator Marilyn Tavenner advised in a letter sent on Monday to members of the Senate and House of Representatives.
The proposals were opposed by both Republicans and Democrats in Congress. The Republican Party had already begun to look for ways to leverage popular anger over the changes into campaign attacks on Democratic incumbents who could be vulnerable in November’s election showdown for control of Congress.
Elated critics of the proposed changes said the government had effectively agreed to start over in the face of broad, bipartisan opposition.
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New York Times SundayReview

The Obama administration’s proposed cuts to Medicare Advantage plans — the private insurance plans that cover almost 30 percent of all Medicare beneficiaries — are fair and reasonable. As it happens, they are also mandated by law. Yet Republicans, sensing a campaign issue, are telling older and disabled Americans that the administration is “raiding Medicare Advantage to pay for Obamacare.” The health insurance industry, for its part, is warning that enrollees will suffer higher premiums, lower benefits and fewer choices among doctors if the cuts go into force.
Some of this could in fact happen, although the industry has cried wolf before and continues to thrive. But the key point is this: Over the past decade, enrollees in Medicare Advantage have received lots of extra benefits, thanks to unjustified federal subsidies to the insurance companies. Now they will have to do with somewhat less, unless the insurers are willing to absorb the cuts while maintaining benefits. Enrollment in these private plans, offered by companies like UnitedHealth and Humana, has more than doubled since 2006, in part because of lower premiums and extra benefits, like gym memberships, that are not included in traditional fee-for-service Medicare.
What made these perks possible was, in effect, a subsidy from taxpayers and other Medicare beneficiaries. The federal government paid the private plans, on average, 14 percent more in 2009 than it would cost to treat the same people in traditional Medicare. The insurers used this extra money to reduce enrollees’ costs and add benefits.
The 2010 Affordable Care Act rightly required that these subsidies be reduced, although it stopped short of completely eliminating them. The reductions began to take effect in 2012, and have not, so far, visibly harmed beneficiaries or the plans. Since enactment of the law, Medicare Advantage premiums have fallen by 10 percent, the opposite of what some expected, and enrollment has increased by nearly 33 percent, according to the administration. But as the law intended, federal payments to the private plans dropped — from 7 percent more than services under traditional Medicare in 2012 to 4 percent more last year. The administration now proposes to further reduce the payments to Medicare Advantage plans in 2015. The loudest criticism has come from Republicans, but plenty of Democrats have chimed in.

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Thursday, April 3, 2014

National mental health and disability advocacy groups joined together to decry Forced Treatment Provision hidden in the patch to Medicare regulations that has nothing to do with Medicare (H. R. 4302)


Expensive pills


March 29, 2014
There is a little known bill in the works which would force people in crisis into forced psychiatric treatment. Mad in America reported on March 28, 2014 that mental health advocates are urging protest against a forced treatment addition to a new Medicare bill. Many national mental health and disability advocacy groups have joined together to urge people to contact their senators in order to protest a section of a bill which was rushed through the House of Representatives by voice vote this week. This bill, Section 224 of HR4302, is up for a vote in the Senate on Monday.
Raymond Bridge, public policy director of the National Coalition for Mental Health Recovery has said: “In its rush to fix a problem with Medicare, the House passed a bill including a highly controversial program, involuntary outpatient commitment, with no debate and no roll call vote.” It appears to Bridge that the Senate may pass a version of the House bill which includes this troublesome provision on Monday. Daniel Fisher, M.D., Ph.D. has commented about this bill, saying: “It would bring America back to the dark ages before de-institutionalization, when people with mental health conditions languished in institutions, sometimes for life.”

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Mental Health Advocates Decry Forced Treatment Provision in "Doc Fix" Bill


WASHINGTON, March 28, 2014 /PRNewswire-USNewswire/ -- The bill rushed through the House of Representatives by voice vote yesterday to patch Medicare regulations includes a highly controversial provision that has nothing to do with Medicare, and that would subject people in crisis to forced treatment. Studies have shown that such force causes trauma and drives people away from treatment, mental health advocates warned.
Today, an array of national mental health and disability advocacy groups joined together to decry this provision, which they view as a regressive attack on hundreds of thousands of Americans with serious mental health conditions.
"In its rush to fix a problem with Medicare, the House passed a bill including a highly controversial program, involuntary outpatient commitment, with no debate and no roll call vote," said Raymond Bridge, public policy director of the National Coalition for Mental Health Recovery (NCMHR), a coalition of 32 statewide organizations and others representing individuals with mental illnesses. "And it seems that the Senate may pass a version of the House bill including this troubling provision on Monday," Bridge added.
The 123-page Protecting Access to Medicare Act of 2014, H.R. 4302, includes a four-year, $60 million grant program (Sec. 224) to expand involuntary outpatient commitment (IOC) – also called Assisted Outpatient Treatment (AOT) – in states that have laws authorizing IOC. The laws allow courts to mandate someone with a serious mental illness to follow a specific treatment plan, usually requiring medication. The facts show that involuntary outpatient commitment is not effective, involves high costs with minimal returns, is not likely to reduce violence, and that there are more effective alternatives.
Assisted Outpatient Treatment is central to the controversial Helping Families in Mental Health Crisis Act (H.R. 3717), proposed by Rep. Tim Murphy in December 2013.
"This legislation would eliminate initiatives that use evidence-based, voluntary, peer-run services and family supports to help people diagnosed with serious mental illnesses to recover," said Daniel Fisher, M.D., Ph.D., a psychiatrist and an NCMHR founder. "It would bring America back to the dark ages before de-institutionalization, when people with mental health conditions languished in institutions, sometimes for life."
The provisions of H.R. 3717 would exchange low-cost, community-based services with good outcomes for high-cost yet ineffective interventions, according to the NCMHR; the National Disability Rights Network (NDRN), the non-profit membership organization for the federally mandated Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP) for individuals with disabilities; and the National Council on Independent Living (NCIL), which advances independent living and the rights of people with disabilities through consumer-driven advocacy.

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Monday, February 24, 2014

GOP lawmakers, trade groups rail against proposed Medicare Advantage cuts


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The Washington Times


Republican lawmakers cried foul Friday night over an Obama administration proposal to cut payment rates to private insurers who administer Medicare Advantage, a popular alternative to the government-run health program for seniors.
The Centers for Medicare and Medicaid Services (CMS) announced a proposed cut of 3.55 percent to insurers like Humana Inc. and United HealthGroup Inc., although the reductions would not become final until spring. 
Although not a surprise, the proposed cuts come after an intense lobbying effort by the insurance industry against slashing rates, citing the potential for higher costs to seniors, and GOP lawmakers this year are sure to use the cuts as further ammo against the Affordable Care Act and its Democratic supporters.
“The health law cut more than $300 billion from the popular Medicare Advantage program, potentially forcing hundreds of thousands of beneficiaries to find new health care plans, despite the president’s promise,” said Rep. Joe Pitts, Pennsylvania Republican and chairman of a House panel on health. “The cuts announced today will only exacerbate the effect this will have on the health care of millions of our nation’s seniors, leaving them with higher costs and fewer choices.”
About 15 million people, or slightly less than a third of all Medicare recipients, are enrolled Medicare Advantage plans, while the rest rely on the government’s fee-for-service model to reimburse doctors.
CMS officials insisted late Friday that the program is on the right course. It said Medicare Advantage premiums have fallen by 10 percent since the Affordable Care Act passed in 2010, while enrollment has increased to an all-time high 15 million enrollees.
“We believe that plans will continue their strong participation in the Medicare Advantage program in 2015 and beneficiaries will continue to have a wide array of high quality, high value, low cost options available to them while at the same time we are making certain that plans are providing value to Medicare and taxpayers,” said Jonathan Blum, CMS’s principal deputy administrator.

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Tuesday, December 24, 2013

'Sticker Shock' over Obamacare Bolsters Single-Payer Argument




New reporting by AP underscores systemic problems with healthcare system based on for-profit insurance model

- Jon Queally, staff writer
As the political uproar surrounding the Affordable Care Act has played out over recent months, one single fact remains: the private insurance model—on which the law widely known as Obamacare is based—is more complicated, more expensive, and provides less coverage than a simple, "everybody in/nobody out," single-payer model that almost every other advanced country in the world enjoys.

And even within the debate about whether or not Obamacare is a "step forward" or a "step back" for healthcare delivery in the U.S., what's become increasingly clear—as was predicted by progressive critics of the Obamacare model—is that though portions of the law undoubtedly improve the kinds of coverage that some people receive, others are still excluded from the system entirely and among those who are now purchasing insurance for the first time in their lives many will face "sticker shock" at the high premiums or out-sized deductibles.
As new reporting by the Associated Press highlights:
As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplace and making what seems like a logical choice: They're picking the cheapest one.
Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they're on the hook for most of the initial cost.
The prospect of sticker shock after Jan. 1, when those who sign up for policies now can begin getting coverage, is seen as a looming problem for a new national system that has been plagued by trouble since the new marketplaces went online in the states in October.
What the AP goes on to describe is how the economic hardships that most middle- and low-income Americans experience on a daily basis compel them to choose insurance policies with the lowest monthly premium, but don't realize that the huge deductibles attached to those plans mean that they may have huge medical bills to pay before their coverage kicks in.
In addition, because the state-level exchanges from which participants in Obamacare must purchase their plans are so complicated, many consumers—especially those with little experience navigating the private insurance marketplace—won't possess the technical or financial savvy to calculate the best plan for themselves or their family.
"I am so deeply clueless about all of this," said 29-year-old Adrienne Matzen, an actor in Chicago, told the AP. She's been  mostly without insurance since she turned 21, but must now figure out how to receive coverage she can afford while living with two chronic illnesses and earning less than $20,000 a year.
Someone like Matzen—who ultimately may or may not be individually better off under the ACA—exemplifies why the overall system is still so far from the ideal that progressive critics of Obamacare say is possible.  The choices available to her  depend on the state she lives in, her ability to navigate the choices, and a host of other complex factors.
As the AP reports: "The complexities of insurance are eye-glazing even for those who have it. Only 14 percent of American adults with insurance understand deductibles, according to one recent study."
On the other hand, a single-payer or Medicare-For-All approach, according to its proponents, would cut out both the complexity and an enormous part of the expense that has historically plagued private insurance industry and will remain under Obamacare.
This summer, Gerald Friedman, a professor of economics at the UMass Amherst, released a study showing that a single-payer system like the one described in Rep. John Conyers' HR 676 could save as much as $592 billion a year in U.S. healthcare costs.
According to his fiscal assessment, those savings would be more than enough to cover all 44 million people the government estimates will be uninsured in the coming year while also improving the existing coverage for everyone else. “Paradoxically, by expanding Medicare to everyone we’d end up saving billions of dollars annually,” Friedman said of his findings. “We’d be safeguarding Medicare’s fiscal integrity while enhancing the nation’s health for the long term.”
And as Dr. Steffie Woolhandler, a spokeswoman for Physicians for a National Health Program, recently explained on Democracy Now!:
[Single payer/Medicare for all] means you would get a card the day you’re born, and you’d keep it your entire life. It would entitle you to medical care, all needed medical care, without co-payments, without deductibles. And because it’s such a simple system, like Social Security, there would be very low administrative expenses. We would save about $400 billion, which would allow us to afford the system. I mean, I just want to remind you that when Medicare was rolled out in 1966, it was rolled out in six months using index cards. So if you have a simple system, you do not have to have all this expense and all this complexity and work.
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Thursday, December 12, 2013

House Passes Budget Easing $63 Billion in Spending Cuts


Photographer: Andrew Harrer/Bloomberg
Representative Paul Ryan, a Republican from Wisconsin, left, and Senator Patty Murray, 

The U.S. House passed the first bipartisan federal budget in four years, which would ease $63 billion in automatic spending cuts and avert another government shutdown. The legislation now heads to the Senate.

The House voted 332-94 today for the $1.01 trillion compromise budget crafted by Senator Patty Murray and Representative Paul Ryan, the chairman of a special bipartisan panel. President Barack Obama said he’ll sign the final measure.

The agreement’s main accomplishments are to ease automatic spending cuts that neither party likes by $40 billion in 2014 and about $20 billion in 2015 and cushion the military from a $19 billion reduction starting next month. The accord doesn’t include changes to taxes or spending on entitlement programs such as Medicare and Social Security.

“It’s progress,” House Speaker John Boehner said in a floor speech before the vote. “It’s doing what the American people expect us to do,” which is to “stick to our principles but find common ground.”

The budget deal replaces about half of the automatic cuts to defense and non-defense discretionary spending in 2014 and 25 percent of the reductions in 2015, which means most of the automatic cuts enacted in 2011 still take effect. It includes $23 billion in deficit reduction.

“This agreement is better than the alternative, but it misses a huge opportunity to do what the American people expect us to do, and that is to put this country on a fiscally sustainable path,” said Representative Steny Hoyer of Maryland, the second-ranking House Democrat.

Doctors Spared


The accord also spared doctors for three months from cuts in the Medicare payment rates set to start in January. The measure doesn’t extend emergency benefits for 1.3 million unemployed workers, an omission that frustrated Democrats, who say they plan to continue the fight when Congress returns in January from a holiday break.

The deal won bipartisan support because it doesn’t touch entitlement programs Democrats have pledged to protect or the corporate tax breaks Republicans favor.

It also doesn’t raise the U.S. debt ceiling, setting up a potential fiscal showdown after borrowing authority lapses as soon as February.

Lawmakers and some economists said adopting a formal budget will provide some certainty to the U.S. economy after three years of spending feuds that led to a government shutdown, rattled investors and prompted a downgrade in the nation’s credit rating.

Beth Ann Bovino, chief U.S. economist for Standard & Poor’s Corp., said in a recent newsletter that adoption of a bipartisan budget will be a boon to the U.S. economy.

Uncertainty Reduced


“The budget would reduce a key risk, political uncertainty,” she wrote. “The private sector will probably be more confident when planning investment and spending for next year, which would directly boost growth.”

The deal is far from the $1 trillion to $4 trillion grand bargain on taxes and spending that previous budget negotiators sought. The plan would set U.S. spending at about $1.01 trillion for this fiscal year, higher than the $967 billion required in a 2011 budget plan.

Much of the deficit reduction will come in later years, according to an analysis by the nonpartisan Congressional Budget Office. The plan would lower the deficit by $3.1 billion in 2014 and $3.4 billion in 2015 and exceed $20 billion a year in 2022 and 2023, the CBO said.

Medicare Payments


A big portion of the savings is tied to extending the cuts in Medicare provider payments into 2022 and 2023, rather than letting them expire in 2021 as under current law.

The accord may help lawmakers repair their image after a 16-day government shutdown in October that caused congressional approval ratings to fall to the lowest level recorded by the Gallup Organization polling group.

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House approves budget deal, handing major victory to Boehner





The House on Thursday approved a two-year budget deal that turns off $63 billion in sequester spending cuts, handing a major victory to Speaker John Boehner (R-Ohio.).
Large majorities in both parties backed the bill in a 332-94 vote.
Only 62 Republicans defected despite harsh criticism of the deal by conservative groups that said it did too little to cut spending, compared to 169 Republicans who backed it. The Democratic vote was 163-32.
Heritage Action, the Club for Growth and other groups said they would negatively score votes in favor of the legislation, but those threats failed to create a stampede against the bill.
Instead, members rallied around Boehner, who had strongly pushed back at the criticism from the outside groups, who he charged had “lost all credibility.”
During the debate, he said the does everything conservatives want.
“If you're for reducing the budget deficit, then you should be voting for this bill,” Boehner said. “If you're for cutting the size of government, you should you be supporting this budget.
“If you're for preventing tax increases, you should be voting for this budget. If you're for entitlement reform, you ought to be voting for this budget. These are the things I came here to do, and this budget does them,” he said.
Boehner was aided by House Budget Committee Chairman Paul Ryan (R-Wis.), who negotiated the budget deal with Sen. Patty Murray (D-Wash.).
While the 2012 GOP vice presidential candidate also came under fire from the right, Ryan’s credentials with conservatives helped GOP leaders win votes.
While the deal did not represent the “grand bargain” of entitlement reforms and tax hikes Boehner and President Obama flirted with in 2011, Ryan argued it represented a victory for conservatives since it will reduce deficits by $23 billion over 10 years.
The bill cuts the deficit, avoids tax hikes, and makes permanent reforms to save money, such as stopping welfare checks to criminals, Ryan said.
He also said it reflected the reality of divided government in Washington, where Republicans hold only the House, and that it would prevent another government shutdown.
Near the end of the debate, Ryan noted that as the GOP's vice presidential candidate in 2012, he was part of the GOP effort to return Republicans to the White House.
“We tried defeating this president,” he said. “I wish we would have.”
“Elections have consequences,” Ryan added. “And I fundamentally believe — this is my personal opinion, I know it's a slightly partisan thing to say — to really do what we think needs to be done, we're going to have to win some elections.
“And in the meantime, let's try to make this divided government work.”


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Thursday, October 31, 2013

ObamaCare implementation agency paid out $23 million on behalf of dead people


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Four colors of pills

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Attribution-Share Alike 3.0 Unported.
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The Hill

 By Jonathan Easley


The agency responsible for implementing ObamaCare erroneously paid out millions of dollars on behalf of dead people in 2011, according to a report released Thursday by the Office of the Inspector General (OIG).

The Centers for Medicare and Medicaid Services (CMS) paid $23 million to providers, suppliers, Medicare Advantage organizations and prescription drug plan sponsors on behalf of beneficiaries who died between 2009 and 2011, the OIG found.

That’s less than one-tenth of one percent of total Medicare expenditures, and the report says CMS “has safeguards to prevent and recover” those payments.

The OIG offered a handful of recommendations, such as taking action against providers and suppliers that had high numbers of claims with service dates after a beneficiary’s death, as a way to minimize further inappropriate payments.

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Medicare paid $23 million for dead patients in 2011 and $29 million for drug benefits for illegal immigrants from 2009 to 2011, according to a report Thursday from the Health and Human Services inspector general.
The investigators said Medicare has safeguards to try to stop payments to dead patients, but it still ended up sending out the $23 million anyway.
The Centers for Medicare and Medicaid Services (CMS) — the same agency that is struggling to fix the broken Obamacare website — acknowledged the problems and said it will try to take steps to fix them.
“We agree that in cases where the information indicates an individual is not lawfully present in the United States, that individual should not be permitted to enroll or to remain enrolled in a Part D plan during the period where he or she is not eligible to receive federal benefits,” Marilyn Tavenner, administrator of CMS, said in response to the report about illegal immigrants getting benefits.
The payouts aren’t large — they amount to just a fraction of a percent of what Medicare pays each year in benefits. Still, the investigators said the agency should take steps to crack down.
In one of its reports the inspector general said 4,139 illegal immigrants were able to make 279,056 drug benefit claims.

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Dead farmers reap millions in subsidies, GAO audit shows


The federal government is still paying out millions of dollars a year in subsidies to dead farmers, according to a government audit released Monday that said the Agriculture Department doesn’t do the routine checks required to make sure it is paying benefits to the right people.
The Government Accountability Office said one agency, the Natural Resources Conservation Service, made $10.6 million payments from 2008 to 2012 on behalf of more than 1,100 people who had been dead at least a year. Another arm of the department, the Risk Management Agency, paid out $22 million to more than 3,400 policyholders who had been dead at least two years.
Some of the payments may have been legal because they were for work completed before the farmers died, but the GAO said the problem is that the two agencies don’t perform routine checks — such as looking at the Social Security lists — to verify their information.
“Until and unless NRCS and RMA develop and implement procedures to have their payment or subsidy data records matched against SSA’s complete death master file, either through coordination with FSA or on their own, these agencies cannot know if they are providing payments to, or subsidies on behalf of, deceased individuals; how often they are providing such payments or subsidies; or in what amounts,” the investigators wrote.

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