Heritage’s Stuart Butler, director of the Center for Policy Innovation, wrote at the JAMA Forum yesterday on the Obama Administration’s push for states to participate in the expansion of Medicaid. Here’s an excerpt from Butler’s piece:
Even after the Supreme Court struck down a requirement of the Affordable Care Act (ACA) that required states to expand Medicaid coverage to low-income individuals,* states still seemed to have a juicy carrot to do so. That’s because 100% of the extra cost for states will be met by Uncle Sam for the first 3 years, starting in 2014. And although the federal share of costs for these newly covered individuals will gradually decrease thereafter to 90%, that is still a much bigger share than for “regular” Medicaid.
Not surprisingly, the Obama Administration is pressing states to see this as a deal that no sensible governor and state legislature can refuse and to think that doing so would harm the state and its clinicians and health care facilities. And even some Republican governors, such as Rick Scott of Florida, say there is no sense in leaving federal money on the table. Still, others are balking, such as Louisiana’s Bobby Jindal. Are they lacking common sense?
There seems to be much confusion surrounding the recent drama of Medicare Advantage’s (MA) 2014 payment rate. Here’s what happened:
In February, the Centers for Medicare and Medicaid Services (CMS) released its advance notice of estimates of the national per capita Medicare Advantage (MA) growth percentage, which is a key factor in determining the MA payment rate for 2014. The notice revealed that MA payment rates were set to decrease by 2.2 percent. The CMS had until April 1 to finalize the rate.
This 2.2 percent reduction would have been on top of the MA reductions included in Obamacare ($156 billion over 10 years) and Obamacare’s new annual fee on health insurers, often referred to as the “premium tax” (costing $101.7 billion over 10 years), which will also hit MA plans.
Last Friday afternoon, the Centers for Medicare and Medicaid Services (CMS) issued a short frequently asked questions (FAQ) document that should remove any remaining belief that the federal government will give state lawmakers flexibility on the Obamacare Medicaid expansion. The message is clear: The only thing a state that agrees to the Medicaid expansion will get is a bigger Medicaid program.
The CMS reiterated the position it took in an earlier FAQ that the Obama Administration considers the expansion to be an “all or nothing” proposition for states.
Yet another doctor has decided to quit practicing medicine due to Obamacare’s onerous burdens.
“I am in my mid-70s and have both the capacity and willingness to care for patients for another decade. But I am retiring,” Dr. John Curry of Fairfax, VA, wrote to one of his patients, columnist Cal Thomas, in an explanation of how the Affordable Care Act (ACA), more commonly known as Obamacare, is leading him to retire early.
“I cannot stand it anymore. More than half of my time in the office is spent filling out forms, writing letters, responding to inquiries, and attending to ‘urgent’ matters that did not exist 10 years ago. And every year my income is less,” he wrote. “At this point I would rather be paid nothing and have the freedom to decide what is right for my patients.”
“ACA is only another straw, but for this tired camel, it will break my back,” wrote Curry.
Would you ever read a 906-page law? You’d be hard pressed to find anyone who would—but actor Jake McClain is, and he’s taking it to another level. On Friday, McClain began tweeting through every single word of the 906-page Obamacare law, which he opposes.
McClain is using tweetpower to send an effective message.
“Folks … this will probably take a long time to do, but I decided I will read every page, word by word, of Obamacare, and tweet every word,” he tweeted last week.
Today marks three years since Obamacare was signed into law, and taxpayers probably aren’t celebrating.
Over the last three years, the Congressional Budget Office (CBO) has revised its cost estimates for Obamacare’s new entitlements—the Medicaid expansion and exchange subsidies—many times, and they have more than doubled since 2010.
The first estimate in 2010 pegged the gross cost at $898 billion from 2010 to 2019. But this projection was deceptive, because it included only six years of spending on these provisions, since they don’t begin until 2014.
However, CBO’s latest estimate in February 2013 provides a more accurate cost projection, finally encompassing 10 years of full spending. The 11-year estimate places spending on these provisions at $1.85 trillion from 2013 to 2023.
Obamacare created the ERRP to provide employers and other health plan sponsors funding for insuring early retirees between the ages 55 and 65 and their dependents. Eligible plan sponsors would receive partial federal reimbursement for health benefit claims beginning in June 2010 until 2014, serving as a bridge program until Obamacare’s government-run exchanges are up and running.
As Heritage research pointed out in 2011, “Based on a report from the Obama Administration, the program appears to be mostly a bailout for public-sector and union health benefit programs for early retirees.” Indeed, that Administration report shows that of the approved ERRP sponsors, government plans accounted for 47 percent of total plans and union plans accounted for 10 percent.
It’s Obamacare’s third anniversary. Though many key parts of Obamacare—including some of its tax hikes and mandates—don’t go into effect until next year, Americans are feeling many of its changes already.
Please share these impacts to mark three years of this bureaucratic nightmare.
Learn more: Obamacare’s 18 New Tax Hikes
Accountable Care Organizations (ACOs)—a concept that a group of doctors and hospitals will work collectively to manage the care and costs of Medicare patients—were expected to transform the delivery of health care. Yet again, much like the rest of Obamacare, these promises appear to be falling short of expectations.
In writing for Heritage, founding member of the Galen Institute John Hoff explains:
ACOs, as described, are a strange hybrid of fee-for-service and managed care, subject to ongoing control by CMS [Centers for Medicare and Medicaid Services]. Like other hybrids, they are not likely to breed naturally. ACOs are a keystone of the PPACA [Patient Protection and Affordable Care Act], but they are unlikely to improve health care and reduce its costs. ACOs are further demonstration, if any is needed, that the PPACA is ill-conceived. CMS-directed change will not bring meaningful reform, but impede it.
Thus far, the experience of the first group of ACOs, the 32 “Pioneers” (as the government calls them), has been shaky, and some have suggested they might even drop out of the program.
When the same Congressmen who voted for Obamacare vote to repeal a provision of it, it’s obvious that provision must be totally unworkable on every level. And that’s what happened to the Community Living Assistance Services and Support (CLASS) Act.
Formally repealed in January’s fiscal cliff deal, CLASS was Obamacare’s attempt at creating a new long-term care entitlement that was once referred to by Senator Kent Conrad (D–ND) as “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of.” CLASS was one of Obamacare’s most overt failures.
CLASS was supposed to begin in 2011 as a voluntary, government-run long-term care program that was supposed to be fully funded by beneficiaries’ premiums and require no federal tax dollars. Like most government entitlements, this deal sounded too good to be true—and it was.
This concept was so flawed that even the Obama Administration recognized that implementation had to be stopped. A letter to Congress in 2011 from a CLASS administrator warned of extreme adverse selection in the program, stating that “if healthy purchasers are not attracted to the CLASS benefit package, then premiums will increase, which will make it even more unattractive to purchasers who could also obtain policies in the private market. This imbalance in the beneficiary pool would cause the program to quickly collapse.”
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