“Two of the central promises of President Barack Obama’s health care overhaul law are unlikely to be fulfilled, Medicare’s independent economic expert told Congress on Wednesday.
The landmark legislation probably won’t hold costs down, and it won’t let everybody keep their current health insurance if they like it, Chief Actuary Richard Foster told the House Budget Committee.”

“In a Jan. 7 letter to President Obama, more than 30 current and former GOP governors urged the White House to remove ‘excessive constraints placed on us by healthcare-related federal mandates.’ The letter says that ObamaCare and spending mandates from the stimulus bill passed in 2009 ‘prevent states from managing their Medicaid programs for their unique Medicaid populations.'”

“Beginning in 2014, most U.S. residents will be required to have health insurance coverage. However, provisions of the new Affordable Care Act (ACA) will limit the choice of health plans offered. Health insurance that does not cover preventive care, plans with deductibles above the statutory limit and plans that cap benefits at predetermined levels will ultimately disappear.”

“Roughly half of the anticipated gains in insurance coverage from the Patient Protection and Affordable Care Act (PPACA) are achieved through a massive expansion of Medicaid, the joint federal–state health insurance program for the poor. The Medicaid program, with its soaring price tag and dubious level of care for recipients, is in serious need of reform, not expansion. Increasing enrollment in this program by a third is a major flaw of the new health care law.”

“Once ObamaCare becomes fully effective in 2014, the cost of newly eligible Medicaid enrollees will be almost fully covered by the federal government through 2019, with federal financial support expected to be extended thereafter. But ObamaCare provides states with zero additional federal financial support for new enrollees among those eligible for Medicaid under the old laws. That makes increased state Medicaid costs from higher enrollments by ‘old-eligibles’ virtually certain as they enroll into Medicaid to comply with the mandate to purchase health insurance. This study estimates and compares potential increases in Medicaid costs from ObamaCare for the five most populous states: California, Florida, Illinois, New York, and Texas.”

“The current Medicaid program is arguably the worst health insurance plan in the country. It has expanded massively beyond the original intent in 1965 and is now one of the two or three largest budget items for nearly every state. In spite
of massive annual increases in spending, Medicaid chronically experiences budgetbreaking costs. Expanding Medicaid, as the new health care reform law requires,
will only compound these problems.”

“The ACA essentially imposes price ceilings on Medicare payments to providers. These price controls will lead to fewer health care options and lower quality of care for the Medicare population. In contrast, the Rivlin/Ryan approach would affect both the demand and supply side of the health care market – patients would shop and providers would respond. Provision for low-income beneficiaries in the form of health spending accounts could be structured to keep pace with the new system. The more realistic cost savings resulting from the Rivlin/Ryan proposal could be accomplished without the unintended consequences of price ceilings.”

Prohibit federal payments to states for Medicaid services related to health care acquired conditions.

Create a new Medicaid state plan option to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least one serious and persistent mental health condition to designate a provider as a health home. Provide states taking up the option with 90% FMAP for two years for health home related services including care management, care coordination and health promotion.

Create the State Balancing Incentive Program in Medicaid to provide enhanced federal matching payments to increase non-institutionally based long-term care services.