Obama’s Medicare Malpractice


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Others, still clinging to Medicare Advantage, will not only have reduced levels of care but also possibly have different plans that don’t meet their needs as well, the study said.

The new health law chopped Medicare Advantage so deeply to offset some of the new non-Medicare entitlements in the legislation and to reduce the overall cost. But how on earth could a Democrat-structured, Obama-promised legislative mammoth become law when it so abused the Democrat-favored clientele?

Some background: As early as 1982, when Medicare had been in effect for only 17 years, program bureaucrats were frantically trying to hold down costs. The program’s design of fee-for-service (FFS) had serious shortcomings. Despite Medicare’s huge spending, most beneficiaries saw the coverage as so inadequate they would buy supplemental health protection at their own expense.

By 2006, the latest figure available, Medicare covered only 69 percent of the standard FFS beneficiaries’ health care costs, and 91.3 percent of Medicare beneficiaries had some kind of supplemental coverage, the new analysis said.

“Congress sought to address these shortcomings” by giving Medicare beneficiaries access to private-sector coverage options, the analysis explained, “allowing health maintenance organizations (HMOs) for a fixed fee…in exchange for accepting the full insurance risk for patients.” Eventually, other plans were permitted, with payments adjusted so private plans wouldn’t make more than a limited amount of money. In 1997, the program got a new name—Medicare+Choice. Then in 2003, Congress renamed it Medicare Advantage.

“Congress has maintained the approach in which all Medicare beneficiaries pay the same national premium regardless of the actual costs in their local areas. Thus, the system has evolved into a complex, opaque administered-pricing system that uses measured FFS costs in a county as a starting point for determining private- plan payment rates. It then applies different rules for different circumstances in each county.”

This approach to making payments to private plans, the new study said, in a pointed understatement, has “serious flaws”: Using measured FFS costs as a basis for MA payments “locks in massive and irrational regional variations in FFS spending…. FFS payments vary for many reasons unrelated to factors faced by MA programs….In many regions this gives an inappropriate “advantage” to FFS because FFS “pays below-cost rates for services by regulatory fiat”….Finally, using FFS as a reference point for MA payments “may actually penalize successful cost control by MA plans.”

“In time,” the authors suggest, “lower MA payments would lead to reduced MA benefits and enrollment, which could cause FFS spending to rise, reducing or eliminating the cost benefits of more efficient care.”

The CMS actuary projects that enrollment in MA plans by 2017, (when the cuts are fully phased in) will be about half of what it would have been under the law before ObamaCare—14.8 million.

“They either will be unable to enroll in MA plans or no longer find it attractive to do so,” the study authors wrote. Every patient “will experience a loss in the value.”

“Transferring beneficiaries from MA to FFS will also have the secondary effect of increasing Medicaid and Medicare Part D (prescription drug coverage) spending by almost $2.5 billion in 2017. This does not include higher out-of-pocket spending by patients for what will generally be lower levels of health care services. In other words, instead of reducing waste, the MA cuts will simply cut health care….”

The Government Accountability Office (GAO) called misleading a brochure Health and Human Services Secretary Kathleen Sebelius sent to all Americans last summer on Medicare saying ObamaCare improved Medicare Advantage. But the GAO indicated the MA change would “decrease enrollment and result in less generous benefit packages.” Apparently Sebelius had thought only the well-off could afford the extra cost of Medicare Advantage, not realizing so many low-income minorities owned MA and would “bear the brunt.” So, apparently this justified not telling the truth about it.

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  • DogWithoutSlippers

    Slowly, but surely, it is being read!

  • http://www.myspace.com/freddawes1776/ Fred Dawes

    The big third world one world rulers need this to be for all the worlds poor. Soon the system will not be able to pay real Americans the political and MONEY benefits to real Americans who have paid into this system which is now under the control of our enemies so what will our enemies DO? Our enemies will over massive race base system of medicare/ obamacare. The worlds people CAN Be used to take down the USA for one reason to make this nation into some BS Third world slave nation and remove any who fight for Freedom and the rule of law.

  • Lori

    Enough! Enough! Shout It On the Roof Tops!! Face It Folks This Country all Depend On some Kind Of Government Aide!!!! You Pay Into this and that! Who are you working For? Big Government And The Poor always get the Blame! from the Sick to Ones that eat out of Garbage cans! Well Got To say it Has always been this way! For The Sick and Needy! Health-Care Is Good In this Country Only If you have A prescript to It! Obama care will kill ! They will have The Blood on there hands! If they Kill People through the Health-Care System the Blood will be on Their Hands! Ezekiel 22 gives all warning of these actions watch out! If You Do not Warn! Blood is on your Hands!!!!Folks this is A WOA to all about about the Wrath Of God! It Trembles me! Oh God have Mercy.

  • nickelflipper

    My husband, who is 75 years old, has been seeing the same group of cardiologists here in Atlanta for 15 years. About 2 weeks ago, he received a letter from the group saying they would not be seeing medicare patients any longer. Sort of a "good bye and have a nice life" type of note. And The Won said we could keep our doctors if we wanted. I guess he lied.

  • Howard

    Nothing Inadvertent about it. They were robbing Peter to pay Paul and Seniors and the Disabled are now considered expendable. Getting the vote for millions of illegals and felons will guarantee that Democrats will eventually rule by tyranny.

  • 080

    Under Obamacare the codes by which docotors and patients are reimbursed is in the hands of the American College of Physicians. Anyone visiting a doctor's office who was covered under codes 992l1-25 are likely to find that they are covered by code 99397 which means that they will not be reimbursed. If you want to appeal just google Medicare code 992l5 and 99397. If anyone can understand the bureaucratic gobbledy gook it probably won't be the doctors and certainly not the patients.

  • Nick Shaw

    C'mon folks! It doesn't take a Harvard graduate or a new study to tell you that Obamacare is not going to work in either of it's forms. Yes, either form. The first being the ruse of having insurance companies look after it (this phase will be until 2014 or earlier). You cannot expect a for profit company to take on folks with pre-existing conditions, kids to the age of 26 and a whole slew of mandated benefits and regulations without premiums, using one of The One's phrases, skyrocketing. Then you blame the insurance companies for the "crisis" and implement government single payer, phase two. This is where your taxes "necessarily skyrocket" because you cannot insure 15-30 million more people without it costing a whole lot more. You know those premiums you pay now? You won't have to pay them shortly if this law is not repealed. No, think of it more like an addition and then some to your income tax bill. I don't think a lot of people have figured this out yet. Of course, the unions will cruise right through on our dime.

  • Kevin Wyman

    I am a disabled Paramedic who is on Medicare Advantage. Imagine my surprise the other day when I picked up my mail and was told I will now have the priviledge of paying the entire amount for my MA! Thanks Obama for putting the screws to the disabled! I have no problem with rooting out those who abuse the system. I saw them all the time as a Paramedic. However, an arbitrary cut does nothing to stop abuse, it only punished those of us who play by the rules and really need the help! I can't wait to vote in November!

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    "14.8 million seniors and disabled Americans[...] will be denied coverage for many services"
    Talk about numbers… that's a huge ooooopsss….

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