Still Playing Politics With Medicare

I wrote recently about the threat of a 23 percent drop in Medicare reimbursement to physicians, which was scheduled to go into effect December 1. Well, Congress managed to kick the can down the road one more month, to January 1.

As I explained in the last post, this drop has nothing whatsoever to do with health care reform, or “Obamacare.” The cut is the result of a law passed back in 1997. This law would have cut Medicare payments to physicians several times over the past few years. However, every year since 2003, Congress has voted to defer the cut one more year.

Until this year, that is. This year, some politicians blocked all attempts to defer or revoke the cuts. That way, they can blame the cut on “Obamacare,” even though the cut in reimbursement is from other legislation passed more than a dozen years ago.

Well, the games-playing is not done. The cuts are still looming, now scheduled to go into effect January 1. And Senate Republicans say they will hold Medicare reimbursements hostage so that some parts of health care reform can be de-funded.

Sarah Klif reports for The Politico that Senate Republicans plan to demand that money for the “doc fix,” or keeping reimbursement rates from falling, must come out of the money appropriated for health care reform; specifically, $15 billion for public health funding.

What is public health? According to the Public Health Institute, public health is the science and practice of protecting a community’s health by controlling the spread of disease, improving sanitation, and eliminating environmental health hazards. For example, programs to provide vaccinations for school children are funded through public health programs.

Public health grants also provide funds for asbestos abatement in schools and other public buildings. As buildings with asbestos insulation and other materials age, asbestos fibers are released into the air. This creates a terrible risk that people in the building will develop the deadly lung cancer mesothelioma and other life-threatening diseases. Abatement is expensive, and the costs can overwhelm local budgets.

Note that the $15 billion would not permanently increase physician reimbursements, but just postpone the cut one more year. But if the cut isn’t stopped, many physicians are likely to drop Medicare patients.

The argument for robbing the public health budget to pay for a one-year “doc fix” for Medicare reimbursement is that otherwise the cost would increase the federal budget deficit. However, these same politicians have just negotiated a deal to extend tax cuts for the very wealthy that will add more than $700 billion to the deficit, according to Ezra Klein.

This entry was posted on Tuesday, December 7th, 2010 at 10:41 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Medicare Advantage Fee For Service About to Expire

A recent — and mostly inaccurate — news story sent some seniors into a panic. Last month Harvard Pilgrim Health Care announced it would drop Medicare Advantage at the end of this year. Immediately, many “pundits” blamed the new health care reform law, and newspaper headlines screamed that Medicare Advantage was being killed by “Obamacare.”

Medicare Advantage plans are administered by private insurance companies, but Medicare pays the private insurer a set amount per person covered. The new health care reform law is cutting this subsidy. And now it seemed the private companies were starting to drop Medicare Advantage!

But the fact is that Harvard Pilgrim’s decision had nothing to do with the new health care reform law. Instead, the company had a problem with another piece of legislation, the Medicare Improvements for Patients and Providers Act (MIPPA), which passed in 2008 over President Bush’s veto.

MIPPA provides that after the end of 2010, Medicare will no longer subsidize private fee for service (PFFS) plans, but only HMO plans. Harvard Pilgrim CEO Eric Schultz told Maggie Mahar of the Century Foundation that the MIPPA would have forced the company to radically restructure its First Seniority Freedom Plan to become an HMO, and company executives decided it would be better for their bottom line to just drop the plan altogether.

When MIPPA was passed in 20o8, almost 2 million Americans were in Medicare Advantage fee-for-service plans. So why is it ending? The problem with these plans was that they do not control cost as well as HMOs. The MIPPA is expected to save taxpayers several billion dollars over the next few years.

But it’s no wonder many seniors are nervous about what might happen to their Medicare policies. It’s a sad fact that as we age, nearly all of us will suffer increasing problems with our health. Some ailments — heart disease, arthritis — are common, and some are rare, such as mesothelioma cancer, which is rarely diagnosed before the patient is 50. Private insurance companies don’t want seniors as customers — unless taxpayers are supplying the profits.

In recent years Congress has passed many bills that will impact Medicare in complex ways, but between sloppy journalism and politicians trying to demagogue issues to scare people into voting for them, most of us aren’t getting the facts. Right now, anyone who is still covered by a Medicare Advantage free-for-service policy needs to find out what will happen to that policy.

This entry was posted on Monday, October 11th, 2010 at 8:50 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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