FAQ: Congress Passes A Bill To Fix Medicare’s Doctor Payments. What’s In It?

Well, our Congress has finally reached a decision on SOMETHING . . . .this time it's about how to stop the madness around the decreases to physician's payment schedules under what was known as the SGR or "sustainable growth rate" formula.  That's good news for physicians.  Maybe not such good news for some Medicare beneficiaries.

They are always looking for ways to pay for their changes to the system, and that is valid - it's WHAT they look at sometimes that puzzles me.  It is known that Insurance companies were caught increasing their risk scores (meaning that they over-inflated their numbers of high risk beneficiaries in their Medicare Advantage programs), so that they could receive more money to support those programs. 

Instead of reigning in that type of fraud, they decided to take away things like first dollar coverage for Medicare supplement plans C and F.  In other words, they are taking away more consumer choices, that have no impact on Medicare expenditures.  In 2012, this very issue was looked at to see if having first dollar coverage led to "overutilization" of medical care.  The National Association of Insurance Commissioners (NAIC) conducted its own study, concluding that it did not.  And, logic says that it cannot, since Medicare supplement plans can only pay AFTER Medicare pays.  So, if there is overutilization - it occurs at the Medicare payment level - not because someone has a first dollar Medicare supplement plan.

It's too bad we can't take away some of the wonderful choices around insurance that we provide to our legislators, while we tell them that we think that by taking away their choices, it will somehow "change their bad behavior".

There are other elements to the legislation that fixes the payments to physicians under Medicare.  You can read more here

Some Little Known Subsidy Cuts to "Safety-Net" Hospitals, May Leave Some Without Care . . . . .

As various subsidies to hospitals that provide care to the uninsured, especially those that do not qualify for Medicaid, are implemented - some could be left with nowhere to go for much needed medical care.

The Medicaid expansion under the Affordable Care Act would have provided coverage to many of these people.  But - since Supreme Court ruled that the states would have to be given the ability to "opt out" of the Medicaid expansion, many did.  That leaves a gaping hole in the body of people who would have been covered by the expansion.  Without the expansion, many of these individuals will not qualify for Medicaid - AND - they may not qualify for a federal subsidy to purchase health insurance through the new health insurance marketplaces.  An individual must have a Modified Adjusted Gross income of $11,490 to qualify for a subsidy.  If you make less, but do not qualify for Medicaid coverage, you will have no options other than to pay full price for a health insurance policy - which many cannot possibly afford.

Hospitals that previously might have cared for these patients because they were subsidized for doing so, will now have those subsidies cut and may need to begin to refuse care or turn people away.

The Wall Street Journal published a good article that explains the predicament very well.  Read more here . . . .

Obviously, some adjustments will need to be made to the health care law to compensate for these unexpected situations arising out of modifications in the law to date.  A lot of delivery of care and coverage issues were hoped to be solved with the Medicaid expansion.  Since that was limited significantly, large groups of people who had counted on it as a mechanism for health care coverage will be left behind once again and will remain uncovered, unless something is done to correct that.

There Will Be Fewer Medicare Advantage Plan Offerings for 2014

As we head into the Annual Enrollment period for Medicare eligible people, they will ultimately find that in some areas, some Medicare Advantage plans have withdrawn some plans they previously offered.  This article is a good synopsis of what's happening in this marketplace:

View the article here . . .

October will be a very busy month!

Repealing Obamacare - What are the consequences?

Bob Laszewski's review of what might happen if Romney were to win the presidency and make good on his promise to repeal or defund the Health Care Reform law (PPACA), is a concise analysis of some of the difficulties with either scenario and the unintended consequences.

Usually the Congress attempts to fix troublesome aspects of larger pieces of legislation, rather than this "all or nothing" stance that seems to prevail now.  "All or Nothing" is usually not a realistic scenario.

A lot of money has already been spent implementing this law, and more is on the table in both the public and private sectors.  Will all of that be for nothing?  Bob raises many issues and questions that need to be considered.  I could only hope that Mr. Romney might read Bob's blog post . . . .

Read Bob's Article here . . . .

The Ridiculous Cost of Health Care

This article by Brian Klepper through "Care and Cost" online, is very good summary about health care costs & potential ways to begin normalizing them.  He begins by describing his own personal experience with an outpatient procedure and how ridiculous the charges were for a diagnostic procedure. 

I have just gone through major surgery myself - the bills are beginning to roll in & even with good insurance (which I've never used, because I was always healthy), the costs and then the 'adjustments' to those costs are mind boggling.  I've only received the billing for the preliminary "outpatient" procedures that were simply to get a diagnosis and I'm sitting at about $3000 so far (that's MY expense after all insurance discounting & adjustments were made to the ridiculous, original charges).  I'm bracing myself for the in-patient hospital stay and the major surgery bill . . . .

Will the Bubble Burst?