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Posts tagged ‘Medicare’

Obama Administration Drops Proposal to Limit Medicare Drugs.

The Obama administration has abandoned a proposed change in Medicare after the plan was criticized by Republicans and Democrats alike.

The plan would have given health insurance companies more freedom to limit the number of drugs covered by Medicare. Those against the proposal said it would restrict seniors’ access to drugs they need.

Under current Medicare law, the majority of drugs across six classes are covered. The proposed plan would have limited that list to three classes — drugs that treat cancer, HIV and seizures.

“We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years,” Medicare chief Marilyn Tavenner wrote to lawmakers Monday.

Senate Minority Leader Mitch McConnell of Kentucky responded by saying the Obama administration should not go forward with its proposed cut in Medicare Advantage, a program that helps seniors pay for select medical services — including prescription drugs, also known as Part D.

“We remain concerned about the impact of Obamacare’s looming cuts to Medicare Advantage, something that was not addressed in today’s announcement,” McConnell said in a statement. “Seniors need to know whether the president will stand by his word, and that they can keep the plans they have and like.”

As the administration tries to regulate the industry more under the Affordable Care Act, seniors’ access to drugs has become a hot-button issue. Several proposals have popped up, ranging from limiting certain drugs depending on where the patient lives to allowing all pharmacies to dispense medication, regardless of the patient’s plan or healthcare network.

“We plan to finalize proposals related to consumer protections, anti-fraud provisions that have bipartisan support and transparency after taking into consideration the comments received during the public comment period,” Tavenner wrote.

The Partnership for Part D Access, a coalition based in Washington that advocates for the right of seniors to continue to receive prescription drug coverage, was pleased with Monday’s decision to ax the proposal.

“We are thrilled that [the Centers for Medicare and Medicaid Services] has listened to the loud chorus of support for maintaining beneficiary access to the life-saving drugs provided under Medicare Part D,” said coalition member Chuck Ingoglia, senior vice president of the National Council for Behavioral Health.

“Although we need to remain vigilant on this issue, we commend today’s action by CMS, which will allow millions of seniors to continue to confidently rely upon Medicare to provide them the drugs they need.”

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© 2014 Newsmax. All rights reserved.
By Jason Devaney

Obamacare Pressures Insurers to Extend Doctor Choice.

The federal government is stepping up the pressure on healthcare insurance companies to provide a wider range of top-class hospitals and specialty doctors in their plans.

In an attempt to keep down the cost of coverage under Obamacare, federal officials have put forward proposals for stricter reviews of doctors and medical centers for plans being sold next year, according to The Wall Street Journal.

But the government proposals to extend doctor and hospital choice have already come under fire from America’s Health Insurance Plans, the industry’s largest insurance group.

A spokesman for the company told the Journal that plans with fewer healthcare providers are “one way health plans can help to preserve benefits and mitigate cost increases for consumers” under the new reform law.

Insurance companies say they can suppress costs to the patients in part by agreeing to reduced fees in exchange for a greater amount of business with fewer competitors.

The proposed shake-up has come after a series of complaints by consumers that their current plans do not offer the best doctors and leading academic hospitals because health networks leave them out of their coverage due to their higher fees.

Patients have complained that under President Barack Obama’s healthcare reform law they are forced to change doctors and hospitals, which means that they are not getting the best possible healthcare treatment.

According to the Journal, insurance companies have been dumping a long list of doctors and prestigious health network facilities from the private Medicare Advantage program due to their expensive billing.

Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said that the current guidelines for what doctors and hospitals are included in various plans are based on reviews by state health regulators and independent organizations.

But under the federal proposals for next year, insurance companies selling plans in the federal marketplace would have to submit a complete list of health providers to the Centers for Medicare and Medicaid Services before their plans are approved. There would also be new federal standards for the amount of providers in each plan.

The changes would mean the federal government getting even more involved in arranging patient healthcare, says Pollitz. “It’s a substantial change,” she said. “It’s much more specific, and it’s going to involve a lot more direct federal oversight.”

Under the proposals for next year, plans in the federal exchanges would include a greater number of “essential community providers,” which are hospitals and clinics used by lower-income people.

A spokesman for the Centers for Medicare and Medicaid Services said that it is “working to strengthen the network adequacy requirements that took effect for this year.”

Some states, including Pennsylvania and Mississippi, are also mulling over legislation that will force the health insurance companies to make changes in their coverage to add top-class physicians and health facilities. And states like Washington and New Hampshire are planning to review their standards to help increase patient access to potentially better health providers.

California Insurance Commissioner Dave Jones said his agency is planning to upgrade its hospital and doctor choices to “make sure when people purchase health insurance, they have reasonable access to health-care providers.”

The American Medical Association is supporting the planned changes in federal and state exchanges, saying it planned “to implement proactive solutions we believe can enhance the public health and welfare by eliminating inadequate networks.

The AMA added that narrower provider networks could “endanger patients’ health if they cannot access timely, convenient, quality care.”

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© 2014 Newsmax. All rights reserved.
By Drew MacKenzie

Big Medicaid Changes in 2014 Under Obamacare.

Millions of Americans who consider themselves able-bodied and middle class will in 2014 find themselves covered by a remodeled Medicaid program that previously had the image of serving the poor and disabled.

People who live in the District of Columbia and the 25 states which have expanded Medicaid coverage under the Affordable Care Act will see Medicaid taking on a wider role in providing healthcare, The Washington Post reported.

From Wednesday, anyone in those places with an individual income of less than $15,856 a year, including childless adults, as well as families with earnings below $32,499 will be eligible for Medicaid coverage. Among those likely to seek Medicaid will be the unemployed, lower-paid workers, those just entering the job market and retirees who do not yet qualify for Medicare.

In states where Medicaid has not been expanded it will cover its usual catchment of children and those with very-low incomes as well as the elderly poor and handicapped.

The Supreme Court ruled in the summer of 2013 that the Obama administration could not compel states to expand their Medicaid services. The original plan was to use Medicaid expansion as part of a comprehensive Obamacare effort to provide all Americans with health coverage.

Starting in 2014, in all states, Medicaid will no longer factor personal savings — except for those in long-term care— in determining eligibility.

Medicaid presently covers more Americans than Medicare. Both programs were created by the Lyndon Johnson administration‘s Great Society legislation in 1965.

Matt Salo, who heads the National Association of Medicaid Directors, noted that “Medicaid — for all the good we think it does, and it does do a lot of good — does have a connotation,” of being a program for the very poor, the Post reported.

Opponents of the expansion say it will encourage dependency on the government. “It is very bad social welfare policy,” said Edmund Haislmaier, of the Heritage Foundation.

“You are taking people who are by and large young, healthy and perfectly capable productive members of society and encouraging them to become dependent on public assistance. This is the very last population you want to do that for.”

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© 2013 Newsmax. All rights reserved.


By Elliot Jager

If 2013 Was Hard on Obamacare, Just Wait for 2014: Lanhee Chen.

At his end-of-the-year news conference, President Barack Obama called the botched rollout of the Affordable Care Act his single biggest mistake of 2013. That’s putting it mildly. Supporters of Obamacare can’t wait to put this year behind them: From dropped insurance coverage for millions of Americans to the delay of the law’s employer mandate and the problems with, 2013 has been nothing short of a disaster.

There are two things that are important to recognize about Obamacare’s difficulties this year. First, people shouldn’t have been surprised that the law was so hard to implement and spawned so much bad press — in fact, it was designed so that the law’s more politically unpopular provisions would take effect only after the 2012 elections.

Second, as bad as 2013 has been for Obamacare, the year ahead doesn’t look much better. In fact, 2014 has the potential to be even worse — for the law, the Obama administration and congressional Democrats.

The drafters of Obamacare recognized that many elements of the law would be unpopular, while other provisions — allowing people up to the age of 25 to remain on their parents’ plans, ending co-payments for preventive care or closing the “doughnut hole” in Medicare prescription drug coverage — would be immensely popular with the voting public. These provisions all took effect shortly after the law was signed in 2010.

So, what was left for 2013 and beyond, after Obama had been re-elected president, were a series of provisions that Democrats knew would cause more political and policy trouble. Millions of Americans in the individual market being dropped from their existing plans is directly related to Obamacare’s essential health benefits requirement, which mandates coverage across 10 categories and goes into effect in 2014. And the one-year delay in the effective date of the employer mandate, which now starts in 2015, was an attempt to delay some of the law’s negative labor market effects — cuts in wages, hours and employment — until after the midterm elections in November 2014.

Now that 2013 is drawing to a close, we see why Obamacare’s drafters did what they did. Obama’s approval ratings are at or near all-time lows, but that matters little to a White House that already won four more years. And while Republicans in Washington and in state capitals across the U.S. have successfully directed the public’s attention toward Obamacare’s woes, their failure to win the White House or a Senate majority in 2012 means that outright repeal of the law remains a pipe dream for now.

Unfortunately for Obamacare’s supporters, the story doesn’t end there. Nor do the political ramifications for Democrats. It may be that 2014 is an even rougher year for the ACA than 2013 was, and I think that will be the crucial reason Republicans regain control of the Senate in the midterm elections. Here’s why.

First, some of Obamacare’s least popular provisions go into effect in 2014. This includes a new $60 billion tax on health insurers, which will be levied relative to premiums collected and directly passed on to consumers. And, of course, Obamacare’s requirement that individuals secure health insurance coverage (or pay a tax penalty) kicks in during the coming year as well.

Second, millions of Americans who buy their coverage on the individual market or get it through small employers will be shocked by just how much their premiums go up in 2014. The young and healthy will be especially susceptible to this rate shock, and this in turn will further drive them away from purchasing coverage in future years. Given skyrocketing premiums, the economic incentives for many of these “young invincibles” are aligned against buying coverage in the coming years. But these are also the people that the ACA most needs to be enrolled through its health insurance exchanges to offset the comparatively higher risk and costs associated with insuring the sick and old. These dynamics may lead to even higher premiums in the coming years.

Third, not only will millions of Americans on the individual and small group markets who like their plans be unable to keep them in 2014, but many will experience what it’s like to be unable to continue seeing the doctors they know and trust. As health insurers face pressure to keep costs down while providing the richer package of benefits that Obamacare mandates, many are limiting their networks of doctors and other health-care providers. A cancer survivor’s opinion article in the Wall Street Journal illustrated the horrible situation that Obamacare will place some Americans in: Being forced to choose between doctors that have been critical to their care or, in some cases, not having access to any of their existing health- care providers.

Finally, Obamacare’s Medicare cuts will continue to hurt senior citizens. For the 14 million people enrolled in the Medicare Advantage program, the ACA’s $200 billion in cuts over the next 10 years will accelerate in 2014 and have tangible impacts on beneficiaries. Insurers predict that seniors in Medicare Advantage plans will see higher premiums, increased cost-sharing for primary and specialist visits, and limits on the doctors they can see. Although the ACA is not solely responsible for the headwinds the Medicare Advantage program faces, it will (and should) shoulder most of the blame.

While President Obama might hope he can put all of Obamacare’s woes behind him when the clock strikes midnight on New Year’s Eve, the reality is that the worst is only just beginning. Democrats in Congress and around the country will be the ones forced to deal with the collateral damage created by the president’s misguided effort to remake the American health care system.

Lanhee Chen is a Bloomberg View columnist and a research fellow at the Hoover Institution at Stanford University. He was the policy director of Mitt Romney’s 2012 presidential campaign.

© Copyright 2013 Bloomberg News. All rights reserved.

Medicare Paying out Billions for Improper Hospice Care.

Over the past decade, the number of people discharged alive from hospice care has soared, partly because hospice firms are enrolling patients who are not actually dying, a Washington Post investigation has found.

These patients, whose care is paid for largely by Medicare, are more profitable since they require fewer visits and remain enrolled for longer, according to the Post.

Editor’s NoteObamaCare Is Here. Are You Prepared?

The Post’s analysis focused on hospice industry records in California, which showed that the proportion of patients released alive from hospice care rose roughly 50 percent between 2002 and 2012, while the average length of stay jumped substantially as well.

Profit per patient quintupled over that time, reaching $1,975, the records showed. Medicare reportedly pays about $150 a day per Hospice patient for routine care, whether or not the Hospice company sends out a nurse or health care worker.

According to MedPACthe Medicare watchdog created to advise Congress, that financial incentive could be costing billions of dollars a year. In 2011, MedPAC found that nearly 60 percent of Medicare’s expenditure of $13.8 billion on hospice services went to patients who received care for longer than six months.

MedPAC has recommended reforming hospice payments in order to eliminate the incentive for improper care, according to the Post. But so far, no reform steps have been taken.

Meanwhile, four of the 10 biggest for-profit hospice companies in the country, including AseraCare and Vitas, have reportedly been sued by whistleblowers for allegedly taking in patients who did not need hospice care.

And in May, the Justice Department joined in, filing suit against Vitas, the country’s biggest hospice provider, alleging false Medicare billings.

“The Medicare hospice benefit is intended to provide patients nearing the end of life with pain management and other palliative care to make them as comfortable as possible,” said Stuart F. Delery, acting assistant attorney general for the Justice Department’s Civil Division.

“Too often, however, we hear reports of companies that abuse this critical service by using aggressive marketing tactics to push patients into services they don’t need in order to get higher reimbursements from the government.”

AseraCare and Vitas have reportedly denied all of the allegations made in the cases.

Editor’s Note: Weird Trick Adds $1,000 to Your Social Security Checks 

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© 2013 Newsmax. All rights reserved.
By Lisa Barron

Obamacare Tweaked Yet Again: Sign-up Extended to Christmas Eve.

Americans are being given an extra day to sign up for the Affordable Care Act, with the Obama administration quietly extending the deadline to 11:59 p.m. on Christmas EveThe Washington Post reports.

Government officials and outside IT contractors working on the online marketplace’s computer system made a software change” that automatically gives people the extra day, sources told the newspaper.

The rule change is the latest of the many tweaks that have been made to the healthcare law, which has been plagued by numerous issues, from a botched website launch to the reality that many will have to drop their doctors, despite the president’s promise.

The latest tweak comes weeks after administration officials announced that the website’s glitches had mostly been fixed.

The Post said the unannounced extension is “intended as a buffer in case the website has trouble if a last-minute surge of insurance-seekers proved more than the computer system could handle.”

Sources told the newspaper that the one-day extension is automatic and cannot be overridden by insurers who might object.

Officials at the Centers for Medicare and Medicaid Services, the federal agency overseeing the health exchange, had no immediate comment.

One insurance industry official told The Post: “Making yet another last-minute change to the rules by shortening an already-tight time period in which to process enrollments makes it even harder to ensure people who have selected a plan are able to have their coverage begin in January.”

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© 2013 Newsmax. All rights reserved.
By Newsmax Wires

US Admits Dropping Ball on 15,000 Obamacare Enrollees.

The government admitted Saturday it failed to send data to health insurers for about 15,000 people who enrolled in Obamacare through early December.

The error was corrected this week, before it could jeopardize their coverage, the Centers for Medicare and Medicaid Services said in a report that noted error rates for such data transmissions to insurers, a process known as an “834 transaction” are now close to zero.

While the government announced Dec. 1 that it fixed many of the bugs and errors that had frustrated consumers using its insurance-enrollment system, garbled back-end communications with carriers have taken longer to sort out.

The data transmissions are critical to complete the enrollment of millions of people seeking coverage under the 2010 Patient Protection and Affordable Care Act that was the signature domestic achievement of President Barack Obama’s first term.

“Our priority is working to make sure that every 834 form — past and present — is accurate, and that consumers are able to successfully enroll in the coverage of their choice,” Julie Bataille, a spokeswoman for the U.S. Centers for Medicare and Medicaid Services, said in a blog post today.

The 834 form, which provides insurers information including new customers’ names, addresses, gender and Social Security numbers, is generated at the end of the sign-up process after a health plan is selected. The data transmission failed as much as 15 percent of the time in the middle of October, according to today’s report. The enrollment system and its website,, at that time were plagued with errors, and federal technicians had only just begun a repair effort.

By Dec. 5, the rate of failed transmissions had fallen to less than 1 percent, according to the report. About 137,000 people had selected a health plan using the federal system by the end of November, according to the government.

The federal system serves 36 states, including Texas and Florida. About 365,000 people have enrolled nationwide, including in states such as California, New York, Kentucky, and Washington that run their own systems and have reported fewer technical problems.

Last week, Bataille’s agency shared all of its enrollment data with about 300 insurers participating in the federal system. That process, separate from the 834 transmissions, allows the plans to double-check their enrollment information against the government’s records.

“We are double and triple-checking all enrollment data across systems,” Bataille said in her post.

Americans who want coverage that begins Jan.1 have to sign up by Dec. 23. Bataille said the government will conduct another round of data reconciliation with insurers after that deadline.

© Copyright 2013 Bloomberg News. All rights reserved.

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