Republican lawmakers cried foul Friday night over an Obama administration proposal to cut payment rates to private insurers who administer Medicare Advantage, a popular alternative to the government-run health program for seniors.
Although not a surprise, the proposed cut come after an intense lobbying effort by the insurance industry against slashing rates, citing the potential for higher costs to seniors, and GOP lawmakers this year are sure to use the cuts as further ammo against the Affordable Care Act and its Democratic supporters.
“The health law cut more than $300 billion from the popular Medicare Advantage program, potentially forcing hundreds of thousands of beneficiaries to find new health care plans, despite the president’s promise,” said Rep. Joe Pitts, Pennsylvania Republican and chairman of a House panel on health. “The cuts announced today will only exacerbate the effect this will have on the health care of millions of our nation’s seniors, leaving them with higher costs and fewer choices.”
About 15 million people, or slightly less than a third of all Medicare recipients, are enrolled Medicare Advantage plans, while the rest rely on the government’s fee-for-service model to reimburse doctors.
CMS officials insisted late Friday that the program is on the right course. It said Medicare Advantage premiums have fallen by 10 percent since the Affordable Care Act passed in 2010, while enrollment has increased to an all-time high 15 million enrollees.
“We believe that plans will continue their strong participation in the Medicare Advantage program in 2015 and beneficiaries will continue to have a wide array of high quality, high value, low cost options available to them while at the same time we are making certain that plans are providing value to Medicare and taxpayers,” said Jonathan Blum, CMS’s principal deputy administrator.
But top Republicans like House Majority Leader Eric Cantor of Virginia jumped all over Friday’s proposal, saying Democrats are taking another swipe at a popular program after Obamacare ushered in a first round of cuts.
“ObamaCare has already caused millions to lose the healthcare plans they liked, and now it is directly harming seniors who rely on the care they have through Medicare Advantage,” he said. “Our nation’s grandparents should not have to wake up tomorrow worried they no longer can access the care they want because of ObamaCare.”
The move is also a setback to trade groups who lobbied hard against the cuts in TV ads and through other means, arguing the cuts could destabilize rates.
“You know, we vote,” an elderly woman says in one frequently aired ad.
America’s Health Insurnace Plans has frequently warned the government not to slash Medicare Advantage payments and will likely redouble their efforts to combat Friday’s proposal.
“Another round of payment cuts would be devastating to the more than 15 million seniors and people with disabilities that have chosen to enroll in Medicare Advantage for the better benefits and higher quality coverage these plans provide,” AHIP President and CEO Karen Ignagni said.
(CNSNews.com) – President Barack Obama’s Treasury Department issued a new regulation today that for the second time directly violatesthe plain and unambiguous text of the Patient Protection and Affordable Care Act by allowing some businesses to avoid the law’s Dec. 31, 2013 deadline to provide health insurance coverage to their employees.
Initially, on July 2, 2013, the administration unilaterally delayed the deadline for the employer mandate until 2015. Now, the administration is unilaterally delaying it for some businesses until 2016.
n its official summary of PPACA, the Congressional Research Service said: “(Sec. 1513, as modified by section 10106) Imposes fines on large employers (employers with more than 50 full-time employees) who fail to offer their full-time employees the opportunity to enroll in minimum essential coverage or who have a waiting period for enrollment of more than 60 days.”
The text of the law itself describes an “applicable large employer” as follows: “The term ‘applicable large employer’ means, with respect to a calendar year, an employer who employed an average of at least 50 full-time employees on business days during the preceding calendar year.”
The final words in the section of PPACA mandating that employers with more than 50 full-time employees provide their employees with “minimum essential coverage” imposes a specific statutory deadline for doing so. It says: “EFFECTIVE DATE.—The amendments made by this section shall apply to months beginning after December 31, 2013.”
Last summer, the administration unilaterally moved this hard statutory deadline back one year to 2015 for all employers with more than 50 full-time employees. Now, without any action by Congress, the administration is moving it back again for some employers—despite the plain language of the law.
The Treasury Department has issued a fact sheet explaining how the Obama administration’s new declaration changes the meaning of the Patient Protection and Affordable Care Act.
“To ensure a gradual phase-in and assist the employers to whom the policy does apply, the final rules provide, for 2015, that: The employer responsibility provision will generally apply to larger firms with 100 or more full-time employees starting in 2015 and employers with 50 or more full-time employees starting in 2016.”
The fact sheet goes on to say:
“To avoid a payment for failing to offer health coverage, employers need to offer coverage to 70 percent of their full-time employees in 2015 and 95 percent in 2016 and beyond, helping employers that, for example, may offer coverage to employees with 35 or more hours, but not yet to that fraction of their employees who work 30 to 34 hours.”
It further says:
“While the employer responsibility provisions will generally apply starting in 2015, they will not apply until 2016 to employers with at least 50 but fewer than 100 full-time employees if the employer provides an appropriate certification described in the rules.”
“Employers that are subject to the employer responsibility provisions in 2015 must offer coverage to at least 70 percent of full-time employees as one of the conditions for avoiding an assessable payment, rather than 95 percent which will begin in 2016.”
In sum, the law says that employers with “at least 50 full-time employees” must provide “minimum essential coverage” in the “months beginning after December 31, 2013” or pay a fine. The new declaration from the Obama administration’s Treasury Department says this part of the law no longer applies. It says employers with between 50 and 99 employees need not provide coverage until 2016 and larger employers need only provide coverage to 70 percent of their employees next year.
After 3-4-5 years of setting up the ObamaCare website, with the greatest minds money could buy from Belarus, I can only come to one conclusion. This was designed to fail on purpose. No other company in the history of the world has been so inept. The kids on the corner selling lemonade have a better business model. So might I say to all those in charge, I mean this from the bottom of my heart..
And I mean it.
HealthCare.gov can’t handle appeals of enrollment errors
Tens of thousands of people who discovered that HealthCare.gov made mistakes as they were signing up for a health plan are confronting a new roadblock: The government cannot yet fix the errors.
Roughly 22,000 Americans have filed appeals with the government to try to get mistakes corrected, according to internal government data obtained by The Washington Post. They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely.
For now, the appeals are sitting, untouched, inside a government computer. And an unknown number of consumers who are trying to get help through less formal means — by calling the health-care marketplace directly — are told that HealthCare.gov’s computer system is not yet allowing federal workers to go into enrollment records and change them, according to individuals inside and outside the government who are familiar with the situation.
“It is definitely frustrating and not fair,” said Addie Wilson, 27, who lives in Fairmont, W.Va., and earns $22,000 a year working with at-risk families. She said that she is paying $100 a month more than she should for her insurance and that her deductible is $4,000 too high.
When Wilson logged on to HealthCare.gov in late December, she needed coverage right away. Her old insurance was ending, and she was to have gallbladder surgery in January. But the Web site would not calculate the federal subsidy to which she knew she was entitled. Terrified to go without coverage, Wilson phoned a federal call center and took the advice she was given: Pay the full price now and appeal later.
Now she is stuck.
“I hope,” she said, “they really work on getting this fixed.”
The Obama administration has not made public the fact that the appeals system for the online marketplace is not working.
In recent weeks, legal advocates have been pressing administration officials, pointing out that rules for the online marketplace, created by the 2010 Affordable Care Act, guarantee due-process rights to timely hearings for Americans who think they have been improperly denied insurance or subsidies.
But at the moment, “there is no indication that infrastructure . . .necessary for conducting informal reviews and fair hearings has even been created, let alone become operational,” attorneys at the National Health Law Program said in a late-December letter to leaders of the Centers for Medicare and Medicaid Services (CMS), the agency that oversees HealthCare.gov. The attorneys, who have been trying to exert leverage quietly behind the scenes, did not provide the letter to The Post but confirmed that they had sent it.
A CMS spokesman, Aaron Albright, said, “We are working to fully implement the appeals system.”
Three knowledgeable individuals, speaking on the condition of anonymity about internal discussions, said it is unclear when the appeals process will become available. So far, it is not among the top priorities for completing parts of the federal insurance exchange’s computer system that still do not work. Those include an electronic payment system for insurers, the computerized exchange of enrollment information with state Medicaid programs, and the ability to adjust people’s coverage to accommodate new babies and other major changes in life circumstance.
The exchange is supposed to allow consumers who want to file appeals to do so by computer, phone or mail. But only mail is available. The roughly 22,000 people who have appealed to date have filled out a seven-page form and mailed it to a federal contractor’s office in Kentucky, where the forms are scanned and then transferred to a computer system at CMS. For now, that is where the process stops
The part of the computer system that would allow agency workers to read and handle appeals has not been built,
according to individuals familiar with the situation.
In the meantime, CMS is telling consumers with complaints about mistakes to return to the Web site and start over. “We are inviting those consumers back to HealthCare.gov, where they can reset and successfully finish their applications without needing to complete the appeals process,” said Albright, the agency spokesman. The rationale is that, since the computer system is working better now, it’s less likely to make mistakes.
Agency officials have no way of knowing how many people have taken that advice, according to two individuals familiar with the situation. The computer system containing the scanned appeals forms cannot yet communicate with HealthCare.gov’s enrollment database, so it is impossible to cross-check the information.
Across the country, a few specialists trained to help people enroll in the health plans point to examples in which withdrawing an application and starting over has solved the problem. But that is not a solution for everyone.
Starting over would not help Addie Wilson, for example, because she has already begun to pay for her new insurance and would have no way to get her money back. A few days before Christmas, Wilson was hospitalized with what turned out to be a gallbladder so infected that doctors inserted a drain so it would be safer by the time they operated — the first surgery of her life. She needed a health plan because her employer, the organization Home Base, was cutting off the Blue Cross-Blue Shield coverage she and her co-workers had, reasoning that they could find better choices on the new marketplace.
Given her salary, Wilson knew she was eligible for federal subsidies to help pay for her coverage. She was discharged from the hospital on Dec. 23, the insurance sign-up deadline; she did not yet know that CMS had quietly reset its computers to give people one more day to enroll. It had been weeks since the Obama administration had announced that the system was working smoothly, so she could not understand why the HealthCare.gov screen on her laptop, which should have calculated her subsidy, stubbornly refused to appear. She asked her boyfriend to try on his computer and her father to try on his. Nothing worked.
She called HealthCare.gov’s toll-free number, where, she said, a woman on the other end tried typing and then told her, “Well, it’s not working for me either.” The woman recommended that she choose a health plan at the too-high price and file an appeal. Since her Blue Cross coverage would end Dec. 31, she went back onto HealthCare.gov and picked a plan.
A failure to compute a subsidy is among a variety of mistakes the computer system has made. Another involves what some CMS and state Medicaid officials refer to as “loopers.” These are people who applied for coverage on HealthCare.gov and were told that their income was low enough to qualify for Medicaid. But when they went to their state Medicaid agency, they were told they were not eligible after all, and should get a private health plan through the marketplace. So they have “looped” back to the federal system, which is unable to fix the mistake.
The letter from the National Health Law Program describes families who are appealing for other reasons. In one instance, a North Carolina couple were told that they were eligible for subsidies to buy private policies and that their son was eligible for the Children’s Health Insurance Program, which is public insurance for children of working-class families. But the computer told them that their daughter was eligible for nothing — an obvious mistake. At the time of the letter, the family was uninsured while waiting for a decision on its appeal.
In Fairmont, Wilson is waiting, too. In early January, she contacted her new health plan about her missing subsidy and asked what to do. She was told to pay the full insurance premium — $215 a month. She did. The next day, Brandon Williams, an enrollment counselor at a local health clinic, helped her check HealthCare.gov again. This time, the computer worked properly and showed that, with the subsidy, her monthly premium should be just $106 and her yearly deductible $617, not $4,750.
Wilson and Williams called the online marketplace and, after three hours on the phone, got only a promise from a supervisor that Wilson would hear from CMS’s “advance resolution team” within five days. The call didn’t come.
Wilson’s scheduled outpatient surgery turned into an expensive, five-day hospital stay after her doctors discovered her gallbladder had gangrene. Home after the ordeal, and dreading the hospital bill and her big deductible, Wilson called Williams, and they tried to reach the advance resolution team. They couldn’t get through. When the call from the team finally came, she said, a knowledgeable-sounding man told her, “The system is not set up to go into someone’s account and correct a mistake.”
With Williams’s help, she has filed an appeal. And she is waiting — waiting to be healed enough to drive so she can go back to work, waiting for someone to decide that she deserves her money back.
“These little kinks should have been worked out prior to this thing being launched,” she said. “This is one more thing stressing me out.”
Happiness is always there within reach, no matter how long it lasts. Let’s enjoy life and don’t live a complicated life. Life is too short. Work as if it was your first day. Forgive as soon as possible. Love without boundaries. Laugh without control and never stop smiling. Please pray for those suffering from cancer. Keep this going .
After delivering a speech at an elementary school, the president lets the kids ask a few questions. One little boy, Joe raises his hand and asks, “How come you invaded Iraq without the support of the United Nations?”
Just as the president begins to answer, the recess bell rings and he says they’ll continue afterward. 25 minutes later the kids come back to class.
“Where were we?” says the president. “Oh, yes… do you kids have any questions?”
Another boy raises his hand and says, “I have three questions: First, why did you invade Iraq without support from the U.N.? Second, why did the recess bell go off 30 minutes early? And third, where is my buddy Joe?”
Trainee Blondes Detectives
A policeman was interrogating 3 blondes who were training to become detectives. To test their skills in recognizing a suspect, he shows the first blonde a picture for 5 seconds and then hides it. “This is your suspect, how would you recognize him?
The first blonde answers, “That’s easy, we’ll catch him fast because he only has one eye!” The policeman says, “Well…uh…that’s because the picture shows his side profile.”
Slightly flustered by this ridiculous response, he flashes the picture for 5 seconds at the second blonde and asks her, “This is your suspect, how would you recognize him?”
The second blonde giggles, flips her hair and says, “Ha! He’d be too easy to catch because he only has one ear!” The policeman angrily responds, “What’s the matter with you two?!? Of course only one eye and one ear are SHOWING because it’s a picture of his side profile!! Is that the best answer you can come up with?
Extremely frustrated at this point, he shows the picture to the third blonde and in a very testy voice asks, “This is your suspect, how would you recognize him?” He quickly adds”… think hard before giving me a stupid answer.”
The blonde looks at the picture intently for a moment and says, “Hmmmm…the suspect wears contact lenses.” The policeman is surprised and speechless because he really doesn’t know himself if the suspect wears contacts or not. “Well, that’s an interesting answer…wait here for a few minutes while I check his file and I’ll get back to you on that.”
He leaves the room and goes to his office, checks the suspect’s file in his computer, and comes back with a beaming smile on his face.
“Wow! I can’t believe it…it’s TRUE! The suspect does
in fact wear contact lenses. Good work! How were you able to make such an astute observation? “That’s easy,” the blonde replied. “He can’t wear regular glasses because he only has one eye and one ear.
~Steve~ H/T https://dailyjokes.co
Life is sexually transmitted.
Good health is merely the slowest possible rate at which one can die.
Men have two emotions: Hungry and Horny. They can’t tell them apart. If you see a gleam in his eyes, make him a sandwich.
Give a person a fish and you feed them for a day. Teach a person to use the Internet and they won’t bother you for weeks, months, maybe years.
Health nuts are going to feel stupid someday, lying in the hospitals, dying of nothing.
All of us could take a lesson from the weather. It pays no attention to criticism.
In the 60’s, people took acid to make the world weird. Now the world is weird and people take Prozac to make it normal.
And The Number 1 Thought
Life is like a jar of Jalapeno peppers–what you do today, might burn your ass tomorrow. – – – and as someone recently said to me: “Don’t worry about old age–it doesn’t last that long
AFP Photo / Justin Sullivan
The 11 largest drug companies have made $711 billion in profits in just a decade, largely due to overcharging Medicare, which does not seek out competitive prices and uses taxpayer funds to support Big Pharma.
Since Medicare is prohibited from purchasing drugs based on their cost, its prescription drug program has been making large payouts to drug companies that have overcharged the program for years, according to an analysis by Health Care for America Now (HCAN).
“There is nothing wrong with a company making profits – that’s what their supposed to do. But the drug industry’s profits are excessive as a result of overcharging American consumers and taxpayers,” writes Ethan Rome, executive director of HCAN, for the Huffington Post. “We pay significantly more than any other country for the exact same drugs.”
Rome notes that per capita drug spending in the US is 40 percent higher than in Canada, 75 percent greater than in Japan, and nearly 300 percent greater than Denmark.
The 11 largest global prescription drug companies have skyrocketed since the Medicare Part D prescription drug program was launched in 2006. The government health program enables seniors and the disabled to buy taxpayer-subsidized coverage for many of the most widely disseminated medicines. But Medicare is prohibited from negotiating prices with pharmaceutical companies or seeking out more cost-effective drugs, thereby costing seniors, the disabled and American taxpayers billions of dollars more than some argue the drugs are worth.
Some lawmakers have recently urged Congress to consider changing the law, for the sake of cutting unnecessarily high costs. Wisconsin Democratic State Senator Jon Erpenbach told Wisconsin Public Radio that his state could save $1.2 billion over ten years if Congress were to allow Medicare to partake in prescription drug negotiations.
“I understand that pharmaceutical companies are for-profit companies,” he told the station last week. “I understand there’s a lot of research and development that goes into the products that they produce. All of that being said, it shouldn’t cost us more to get that kind of pharmaceuticals we need to have.”
But according to the HCAN analysis, Big Pharma spends very little on research and development. Even though pharmaceuticals cite research as a costly part of its operations, the money spent on this is exaggerated, Rome claims. Drug companies spend 19 times more on marketing than on research and development – another reason why the industry reaps so much in profits each year, he adds.
US President Barack Obama has long promised to repeal the prohibition on Medicare negotiations with drug companies, but has so far failed to do so. The Veterans Administration currently negotiates drug prices, and manufacturers argue that letting Medicare take over the negotiations would make no difference to the industry. Supporters of drug manufacturers also continue to emphasize the high costs of research and development.
But the Congressional Budget Office found that if Medicare were to receive the same bulk-purchasing discounts on prescription drugs that state Medicaid programs receive, the federal government would cut its spending by $137 billion over 10 years.
“Our politicians give all kinds of tax breaks and subsidies to big corporations that don’t need them: Big Oil. Wall Street. Companies that ship our jobs overseas,” Rome writes. “Every gift to a special interest, including allowing Big Pharma to overcharge Medicare, is an expenditure of scarce tax dollars. That’s called wasteful spending.”