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 | NewsObserver.com

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 | NewsObserver.com.


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

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 HealthCare.gov.

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


Leading Employer Organizations Urge CMS to Keep Medicare Advantage Rates Flat in 2015 | AHIP Coverage

February 4, 2014

The U.S. Chamber of Commerce and the National Association of Manufacturers recently sent letters to the Centers for Medicare & Medicaid Services (CMS) expressing concern about the impact additional cuts to Medicare Advantage (MA) would have on beneficiaries and urging the agency to keep Medicare Advantage payment rates flat in 2015. Below are highlights from their letters:

“The 6.7% cut to MA rates last year impacted current (2014) rates by increasing out-of-pocket-costs, reducing benefits, and limiting access to health care providers. Also, for the first time in five years, 5% of MA plans withdrew from the market.”

via Leading Employer Organizations Urge CMS to Keep Medicare Advantage Rates Flat in 2015 | AHIP Coverage.


How Hospitals Pass Their Obamacare Penalties on to Patients – Olga Khazan – The Atlantic

December 10, 2013

Perhaps most importantly for hospitals, though, the Affordable Care Act required Medicare to start penalizing hospitals that frequently readmit the same patients, and in 2012 some 70 percent of hospitals took a financial hit for their high readmission rates. Observation status doesn\’t count as admission, so using it helps hospitals avoid the penalty.

Here’s the problem for the patients: Medicare beneficiaries seen as inpatients are only charged their inpatient deductible, which was $1,184 in 2013, for hospital stays, but those under observation status can be on the hook for thousands of dollars more because they’re billed separately for every procedure and drug.

What’s more, a patient’s follow-up treatment in a nursing home, which doctors frequently recommend after an ER visit, isn’t covered by Medicare unless the person has first been a hospital inpatient for three days, and observation status doesn’t count.

via How Hospitals Pass Their Obamacare Penalties on to Patients – Olga Khazan – The Atlantic.


Will ObamaCare Finally Cause American Seniors to Turn Against Government Health Care? | John Goodman’s Health Policy Blog | NCPA.org

December 4, 2013

On November 16, The Wall Street Journal reported that UnitedHealth Group has dropped thousands of doctors in at least ten states from its Medicare Advantage networks. This is a consequence of the federal government’s cutting payments to Medicare Advantage plans ― by $156 billion over ten years ― to fund ObamaCare. Earlier this month, Evan Gahr of the Daily Caller wrote an article describing how plans nationwide are shrinking, and citing a report by consultants at Avalere which projected reduction in Medicare Advantage plans, especially in rural areas.

via Will ObamaCare Finally Cause American Seniors to Turn Against Government Health Care? | John Goodman’s Health Policy Blog | NCPA.org.


Obama Breaks ‘Keep Your Doctor’ Promise With Seniors – Investors.com

November 26, 2013

In fact, both the Centers for Medicare and Medicaid Services and the Congressional Budget Office projected in 2010 that millions would be pushed off Medicare Advantage entirely and back into traditional Medicare over ObamaCare\’s first 10 years.

Recognizing the political risk of deep cuts to a popular program in an election year, the administration created a dubious $8.3 billion \”quality improvement\” demonstration project, with the bulk of the money given to Medicare Advantage plans in 2012.

Not only did this project dwarf any previous federal demonstration project, it was so poorly designed that it was unlikely to \”produce meaningful results,\” according to a Government Accountability Office audit.

But the funds masked nearly all of ObamaCare\’s scheduled Medicare Advantage cuts for 2012, and much of cuts for this year.

In addition to plan cancellations, seniors are starting to feel the impact of these ObamaCare spending cuts via higher costs.

via Obama Breaks ‘Keep Your Doctor’ Promise With Seniors – Investors.com.


Will Obamacare Finally Cause American Seniors to Turn Against Government Health Care? | The Beacon

November 26, 2013

Although most Americans are now aware of the disastrous rollout of Obamacare health-insurance exchanges for privately insured people, they may not yet have noticed that Obamacare is inflicting pain on Medicare beneficiaries, too.

On November 16, the Wall Street Journal reported that UnitedHealth Group has dropped thousands of doctors in at least ten states from its Medicare Advantage networks. This is a consequence of the federal government’s cutting payments to Medicare Advantage plans — by $156 billion over ten years — to fund Obamacare. Earlier this month, Evan Gahr of the Daily Caller wrote an article describing how plans nationwide are shrinking and citing a report by consultants at Avalere, which projected reduction in Medicare Advantage plans, especially in rural areas.

via Will Obamacare Finally Cause American Seniors to Turn Against Government Health Care? | The Beacon.


The Daily Caller » Seniors lose insurance and doctors under Obamacare » Print

November 9, 2013

MIT professor Jonathan Gruber, architecht of the Massachuseets health insurance law that was the model for Obamacare, told the Daily Caller that seniors who stand to lose their doctors and Medicare Advantage plans must be sacrificed for the greater good.“It is a tiny effect compared to the benefits of this law.  There is small fraction of Americans who might need to change doctors or plans because of the law.”Medicare Advantage covers 14.4 million people.Asked if Obama had betrayed seniors with his famous promise to Americans that they could keep their doctor and health plan Gruber insisted that, “He was not really talking about seniors.” But in fact, the president’s promise, in dozens of televised speeches was all-inclusive and unqualified.

via The Daily Caller » Seniors lose insurance and doctors under Obamacare » Print.


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