Medicare isn’t fixed – Health – AEI

July 18, 2014

Medicare spending growth will be slow again in 2014 relative to historical standards, and some of the usual suspects are now crediting the Affordable Care Act — Obamacare — for the good news. For instance, a recent post at Vox suggests that the slowdown in Medicare spending can be attributed, in part, to the ACA’s provision penalizing hospitals for excessive readmissions of previously treated patients.

At the time of the ACA’s enactment in March 2010, the Congressional Budget Office estimated that the readmission provision would reduce Medicare spending by $0.3 billion in 2014, and only $7.1 billion over a decade. That’s about one tenth of 1 percent of total Medicare spending over that time period. There has been no information from any source since 2010 suggesting that the savings from the readmission provision has escalated into a major cost-cutting reform. In the context of overall Medicare spending, the readmissions provision is simply inconsequential.

via Medicare isn’t fixed – Health – AEI.

Wyden’s Waiver: State Innovation on Steroids

May 19, 2014

Section 1332 of Title I of the Affordable Care Act offers to state governments the ability to waive significant portions of the ACA, including requirements related to qualified health plans, health benefit exchanges, cost sharing, and refundable tax credits. It permits state governments to obtain funding that otherwise would have gone to residents and businesses through the ACA and to use those funds to establish, beginning in 2017, an alternative health reform framework within statutory limitations. Section 1332 also permits states to apply in a coordinated fashion for waivers from Medicare, Medicaid, the Children’s Health Insurance Program, and “any other federal law relating to the provision of health care items or services.” This article reviews the statutory provisions and related regulations of this new and unprecedented state waiver authority, as well as the legislative history of section 1332. Finally, it reviews the limited activities thus far by states contemplating use of this provision and considers ways this authority may be considered for use by states in the future. Section 1332 has the potential to instigate a new, varied, and unprecedented array of state health sector innovations from both sides of the political divide over health care reform.

via Wyden’s Waiver: State Innovation on Steroids.

FactCheck | Medicare Under Observation

May 14, 2014

Q: Is it true that, under the Affordable Care Act, “Medicare will not pay anything” for patients receiving only “observation” care in hospitals?

A: No. Medicare will pay a significant portion of observation care costs after copayments and deductibles are met. Nothing has changed as a result of the ACA.

via Medicare Under Observation.

Committee Continues Its Fight to #KeepThePromise to Seniors With Medicare Advantage Plans | Energy & Commerce Committee

May 12, 2014

Continuing their efforts to protect seniors, House Energy and Commerce Committee leaders today sent a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner expressing concerns about the health care law’s negative effects on Medicare Advantage. The committee also released an analysis of Medicare enrollment data conducted by the nonpartisan Congressional Research Service which found that Medicare Advantage enrollees are disproportionately minority or lower income seniors. Read the complete memo prepared for the committee online here.

via Committee Continues Its Fight to #KeepThePromise to Seniors With Medicare Advantage Plans | Energy & Commerce Committee.

Medicare Patients Are First Casualty In Emerging Healthcare Revenue Battles

April 28, 2014

Medicare patients don’t really know that CMS uses private bounty hunters paid on contingency to audit and deny hospital claims. Hospitals provide care, then either lose an audit or have to fight through a lengthy appeals process for reimbursement. The perceived risk changes hospital behavior, which can mean that a patient gets blindsided with big out of pocket expenses. Both the RAC system overall and the RAC appeal process are effectively broken. Bart Caponi MD, FACP, FHM

The bills can be substantial because they often include follow up nursing home care and prescription drugs that were administered during the hospital stay ‒ but not covered by Medicare for patients under “observation” status. There is an appeals process, but like most things involving Medicare, it’s long ‒ and primarily designed for the recovery of funds already paid by patients.

via Medicare Patients Are First Casualty In Emerging Healthcare Revenue Battles.

Study: Cuts to Medicare Advantage Top $1,500 Per Senior –

April 17, 2014

Obamacare’s Medicare Advantage cuts will lead to benefit reductions of about $1,500 per beneficiary, according to a new analysis from a conservative think tank.

The American Action Forum, founded by former Congressional Budget Office Director Douglas Holtz-Eakin, said almost all Medicare Advantage beneficiaries will feel the effect of cuts to the program.

The federal Medicare agency recently backed off a proposal to make additional cuts to Medicare Advantage—the second year in a row it has proposed and then abandoned such reductions. But the AAF analysis says the reductions mandated in the Affordable Care Act will still affect benefits for most seniors who use the program.

via Study: Cuts to Medicare Advantage Top $1,500 Per Senior –

How CMS Is Trying to Wreck the Virtues of Medicare Part D | National Review Online

February 19, 2014

CMS officials have laid out a misguided approach for “improving” this rare successful federal entitlement. First, bureaucrats want to limit choice and, thus, competition. How? By restricting the number of plans that can be offered in each geographic region, which means seniors will have fewer options to choose from.

Next, CMS officials have decided to stop allowing Part D plans to negotiate contracts with pharmacies to fill prescriptions in exchange for lower prices. Instead, plans can go ahead and negotiate provider agreements, but CMS will guarantee that any other pharmacy can serve the beneficiary as well — on the same terms. In other words, no pharmacy will be guaranteed the volume necessary to make up for the lower prices. That means the end of the program’s rock-bottom prices, with seniors likely to see their drug costs go up by as much as 20 percent, according to a recent AAF study.

Higher costs for drug plans means higher costs for taxpayers, seniors, and the disabled.

via How CMS Is Trying to Wreck the Virtues of Medicare Part D | National Review Online.

Percentage of Medicare Beneficiaries at Risk of Losing Part D Plan | Insights | American Action Forum

February 19, 2014

The administration’s proposed Medicare Part D rule, released in January 2014 will have a far-reaching and harmful impact on beneficiaries enrolled in the popular prescription drug program. The most damaging to plan enrollees is CMS effectively doing away with preferred networks in Part D, which negotiate prices that are key to keeping monthly premiums and drug prices low. This decision could force as many as 14 million enrollees out of their current plans, and into a new, higher cost plans.

The map and table below display, respectively, the percent and total number of Medicare beneficiaries in each state that are at risk of losing their drug coverage in 2015, if the rule is allowed to go into effect.

via Percentage of Medicare Beneficiaries at Risk of Losing Part D Plan | Insights | American Action Forum.

The ACA’s cuts to Medicare threaten home health care jobs, patients | Other Views |

February 6, 2014

steep Medicare home health cuts implemented as part of the Affordable Care Act put this growth at considerable risk. Newly implemented administration policies, which slash home health care funding by 14 percent over the next four years, are already resulting in a downturn in job growth, according to the U.S. Bureau of Labor Statistics.

Now, unfortunately for our patients and our state’s economy, these new cuts will force approximately 40 percent of all home health providers to operate at a net loss – meaning they will face the risk of bankruptcy and closure. The federal Medicare agency’s own estimate means that this regulation will directly affect nearly 5,000 small-business providers that today serve nearly 1.5 million seniors and are responsible for nearly 500,000 jobs from coast to coast.

In North Carolina, estimates indicate that nearly 28 percent of our home health agencies will be forced to operate at a net loss by 2017. These agencies at greatest risk serve 29,224 seniors and employ 11,356 North Carolinians – who will likely find their care and their jobs in peril.

via The ACA’s cuts to Medicare threaten home health care jobs, patients | Other Views |

Humana Can Recover Fast From Obamacare Bug–Ahead of the Tape –

February 5, 2014

Humana estimates the insurance industry could one day reap revenue of about $100 billion annually from ACA exchanges. But revenue from Medicare Advantage is already above that and could reach about $600 billion as more baby boomers enroll. That demographic boost aside, growth could be strong simply because less than 30% of eligible people buy these add-ons today.

Unfortunately, the news from Washington on Medicare Advantage hasn\’t been good either. There has been a 13% cut in reimbursements over two years. One interpretation of such news on top of ACA uncertainty might be that insurers reliant on government programs like Humana make for riskier bets.

But the bungled Obamacare rollout suggests private-sector expertise is indispensable. Anyone who doubts that can visit

via Humana Can Recover Fast From Obamacare Bug–Ahead of the Tape –


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