“California is coming face to face with the reality of one of its biggest Obamacare successes: the explosion in Medi-Cal enrollment.
The numbers — 2.2 million enrollees since January — surprised health care experts and created unforeseen challenges for state officials. Altogether, there are now about 11 million Medi-Cal beneficiaries, constituting nearly 30 percent of the state’s population.
That has pushed the public insurance program into the spotlight, after nearly 50 years as a quiet mainstay of the state’s health care system, and it has raised concerns about California’s ability to meet the increased demand for health care.
Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down. Many are chronically ill and have gone without insurance or regular care for years, and some new enrollees have higher expectations than in the past.”
“Medicaid expansion continues to be a hot-button issue in the 38th District Virginia Senate race, as candidates try to define their positions on a subject that has divided the district — and the state — since the seat was vacated unexpectedly earlier this year.
The June resignation of former Sen. Phillip Puckett, D-Russell County, threw the balanced Senate into Republican control and affected the Senate vote on whether to expand Medicaid. When he resigned, Puckett said it was because of family reasons — his daughter sought to be a judge and the Senate makes the appointments — but others said it was to accept a job with the Virginia Tobacco Commission, which did not happen.
The resignation came just days before the General Assembly voted to pass the budget without Medicaid expansion. Expansion would extend Medicaid coverage to more people who make too much for Medicaid currently, but not enough to pay for coverage — some 400,000 Virginians.
Now, as three candidates vie for Puckett’s seat in the Aug. 19 special election, the Medicaid expansion issue is still on the table.
The stakes are high and the race is being closely watched across the state and beyond.
The candidates are Ben Chafin, R-Hansonville, currently a junior member of the House of Delegates; Mike Hymes, a Democrat from Tazewell who is on the county’s board of supervisors; and Rick Mullins, an independent candidate who is waging his first campaign.”
“The Affordable Care Act—also known as Obamacare—is “not an affordable product” for many people and it does not fix the underlying problems causing high health-care costs, Aetna Chairman and CEO Mark Bertolini told CNBC on Wednesday.
“If we’re going to fix health care, we’ve got to get at the delivery of care and the cost of care,” Bertolini said in a “Squawk Box” interview. “The ACA does none of that. The only person who’s really going to drive that is the consumer and the decisions they make.”
“Getting everybody insured should probably be our goal, but you have to have a more affordable system,” he added. “We have a 1950[-style] health care system in the Unites States.”
Aetna said Tuesday that its medical spending rose more than estimates in the second quarter, due in part to the higher costs of covering patients who bought insurance under Obamacare for the first time. But the third-largest U.S. health insurer also reported better-than-expected earnings and revenue in the second quarter and raised full-year guidance.”
“As the backlash over narrow physician networks continues to make headlines and lawmakers start the August recess, a new nationwide survey found 76 percent of likely voters support a bipartisan proposal to give Medicare patients better medication access and more choice of pharmacy.
Bait-and-switch. That’s the common refrain expressed by patients in recent articles about the narrow network trend, from Morning Consult to The New York Times to USA TODAY. Patients report either not knowing or being misinformed about restrictions on their access to the doctor of their choice. As a result some are racking up significant, unanticipated out-of-pocket costs. Now both regulators and insurance plans alike are reassessing the situation and contemplating adjustments for 2015.
It’s not just doctors, however. Patient access to medication and consultations on its proper use with the pharmacist they know and trust are also suffering. Particularly in Medicare drug plans, insurance middlemen are telling some patients to pay more – sometimes significantly more – or switch pharmacies, even if it means traveling 20 miles or more.
But perhaps unlike the physician narrow network conundrum, there is an easy, obvious solution to the narrow pharmacy network issue in Medicare drug plans: H.R. 4577, the Ensuring Seniors Access to Local Pharmacies Act.
The bipartisan proposal would give seniors in medically underserved areas more convenient access to medication at discounted or “preferred” copays at additional pharmacies that are willing to accept the plan’s terms and conditions. Currently, independent community pharmacies are usually locked out of these smaller or “preferred” networks. Moreover, when community pharmacists offer to accept the same terms and conditions they are still kept out. Independent pharmacies make up approximately half of all rural pharmacies, so their patients must pay this “rural tax” or travel great distances to reach a “preferred” pharmacy.
Three out of four likely voters (76 percent) support this proposal, according to a recent nationwide opinion survey conducted by Penn Schoen Berland, or PSB Research. Support runs across party lines as well as demographic ones, such as gender and age.”
“One of Medicare’s attempts to improve medical quality –by rewarding or penalizing hospitals — did not lead to improvements in the first nine months of the program, a study has found.
The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that. Hospitals were judged both on how they compare to others and how much they are improving.
The program is one of several payment initiatives instituted by the health law. Others include penalties for hospitals that have high rates of Medicare patients readmitted within 30 days and penalties that will go into effect this fall for hospitals with high rates of patient injuries or infections.”
“Did you hear the great news? According to the latest Medicare Trustees report, “Medicare isn’t going bankrupt,” and Vox has a chart to prove it! Not only that, “slow health cost growth has improved Medicare’s financial outlook, extending the program’s trust fund to last until 2030.” That’s four years longer than last year’s forecast!
It all sounds great until you hear what Vox unaccountably elected not to tell its readers. All those rosy Medicare predictions are based on a scenario that no one with any common sense should believe.” As PolitiFact.com pithily puts it: “There are good reasons to question whether things will pan out that way.” Indeed, you don’t exactly have to be a mind-reader to see that the Medicare actuaries also don’t believe this scenario which is precisely why they again (as they have done routinely in 2011, 2012, and 2013) released an alternative fiscal scenario that is far more likely to transpire.
Medicare Part A Actually Will Grow 2-1/2 Times As Fast As Vox Says
When Vox says the trust fund will last another four years, that’s a reference to the Part A Hospital Trust Fund. Under the so-called “projected baseline” used in the Trustees’ report, the trust fund will indeed last until 2030. But that baseline portends cuts in hospital payment rates so drastic that Obamacare-mandated reductions in payments to hospitals so drastic that:
•Hospital payments for both Medicare and Medicaid will be 38% lower than the amounts paid by private health insurers by the year 2030 (Figure 1).
•Eventually, payment reductions to hospitals will mean they are paid 59 percent less by Medicare and Medicaid than by private health insurers!””
“A high-level report recommending sweeping changes in how the government distributes $15 billion annually to subsidize the training of doctors has brought out the sharp scalpels of those who would be most immediately affected.
The reaction also raises questions about the sensitive politics involved in redistributing a large pot of money that now goes disproportionately to teaching hospitals in the Northeast U.S. All of the changes recommended would have to be made by Congress.
Released Tuesday, the report for the Institute of Medicine called for more accountability for the funds, two-thirds of which are provided by Medicare. It also called for an end to providing the money directly to the teaching hospitals and to dramatically alter the way the funds are paid.
The funding in question is for graduate medical education (GME), the post-medical school training of interns and residents required before doctors can be licensed to practice in any state.”
“Medicare’s true cost is the biggest problem in Washington and the one most ignored.
The long-awaited 2014 Medicare Trustees report is out, and the “spinning “ is well underway. But the media is not yet reporting another big finding – this one by the Medicare Actuary and revealed on the same day: Taxpayers face a Medicare unfunded liability ranging from $28 trillion to $35 trillion, depending on the most realistic assumptions about the future. In other words, Washington politicians have promised seniors that over the next 75 years (the so-called long-term “actuarial window”) they will receive tens of trillions of dollars of Medicare benefits that are not paid for. It is Washington’s biggest, most expensive and most difficult federal entitlement problem. And it is one most politicians—with a few noble exceptions—continue to ignore.”
“Medicare spending growth will be slow again in 2014 relative to historical standards, and some of the usual suspects are now crediting the Affordable Care Act — Obamacare — for the good news. For instance, a recent post at Vox suggests that the slowdown in Medicare spending can be attributed, in part, to the ACA’s provision penalizing hospitals for excessive readmissions of previously treated patients.
This is nonsense.
At the time of the ACA’s enactment in March 2010, the Congressional Budget Office estimated that the readmission provision would reduce Medicare spending by $0.3 billion in 2014, and only $7.1 billion over a decade. That’s about one tenth of 1 percent of total Medicare spending over that time period. There has been no information from any source since 2010 suggesting that the savings from the readmission provision has escalated into a major cost-cutting reform. In the context of overall Medicare spending, the readmissions provision is simply inconsequential.
The same can be said for the other supposed “delivery system” reforms driven through Medicare and contained in the ACA, such as Accountable Care Organizations and efforts to promote more “bundled” payments to providers of services. These reforms were all assessed by the CBO at the time of enactment and found to be insignificant items in budgetary terms. Moreover, the early experience with these changes indicates they are unlikely to dramatically alter the way health care is delivered to Medicare patients.”
“”Responding to inquiries from federal officials, the California health department has released a plan it says will dramatically slash its backlog of Medi-Cal applications within six weeks.
For months, the state has labored under the largest such pile-up in the country, with 900,000 pending cases reported in May—the combined result of unexpectedly high application numbers and bug-ridden computer systems.
In a letter to the Centers for Medicare & Medicaid Services on Monday, the California Department of Health Care Services said that it had reduced its application backlog to 600,000 by the start of this month. State officials also outlined a plan for technology fixes and administrative workarounds that they project will nearly halve that figure by the end of August—with most of those applications being processed within the allowed 45-day window. The letter was made public Tuesday.”