The Hill: CBO: GOP Bill Revising Health Law Ratio Will Add To Deficit A Republican bill altering the healthcare law’s medical loss ratio (MLR) will add about $1 billion to the budget deficit over the next decade, the Congressional Budget Office (CBO) said Thursday. The Obama administration frequently touts the MLR as a policy that helps consumers. It mandates that insurers spend no less than about 80 percent of their premium dollars on medical care rather than administrative costs or profits. The difference insurance companies must send back to policyholders, producing more than $1 billion in consumer rebates this year. Rep. Mike Rogers’s bill (H.R. 1206) would exclude insurance brokers’ fee from counting as administrative costs under the ratio. Agents say the MLR in its current state threatens their business by incentivizing insurers not to work with them (Viebeck, 11/8).
Video: American Sign Language (ASL) – Medicare Basics
Important: We have the wrong Medicare program
Second, Canadian hospitals receive prospectively determined global operating budgets, removing incentives to provide unnecessary care while simplifying billing and administration. However, unlike accountable care organization payment schemes in the United States, capital costs are not folded into the global budgets but distributed separately through an explicit health-planning process. Canadian hospitals cannot use operating surpluses to fund new buildings or equipment but must request separate capital appropriations. Hence, they cannot expand by overproviding lucrative services, gaming the payment system through upcoding, avoiding unprofitable patients, or cost shifting.
Democrats’ Plan to Reform Drug Benefit is Snake Oil
The result? Medicare Part D has brought down drug costs for millions of seniors and has done so at a much lower price to taxpayers than originally predicted. In fact, it has cost around 43 percent less than first thought possible. Better yet, with a satisfaction rate of 88 percent, seniors in Louisiana and throughout the country have reported being overwhelmingly pleased with the program.
AHA sues Medicare over audit program aimed at trimming improper payments
Politico Pro: Hospitals Take Aim At Audit System Flaws The lawsuit hospitals filed against HHS on Thursday unloads years of pent-up frustration over what hospital officials perceive as an unfair policy of second-guessing doctors that has cost the industry hundreds of millions of dollars. But it’s also pushback against a program meant to save the government billions in improper Medicare billing. The American Hospital Association and four hospitals sued HHS to stop the agency from not paying claims when auditors determine that inpatient hospital care for a patient should have been provided in an outpatient setting, which is typically cheaper. The lawsuit seeks to overturn the policy and reimburse hospitals that have been denied payment (Norman, 11/1).
President, GOP Leaders Begin Talks To Avoid Medicare Payment Cuts
In a conference call with House Speaker John Boehner (R-Ohio) and other top lawmakers, Obama urged them to set aside partisan differences to develop a solution for the sequester. Following the conference call, Boehner said Republicans are willing to accept a budget deal that would raise federal revenues as long as the administration does not “continue to duck the matter of entitlements” (
Daily Kos: Medicare’s ‘death spiral’ under Romney/Ryan voucher plan confirmed in new study
Another study finds that the voucher system Mitt Romney and Paul Ryan envision for Medicare will cause the program’s demise. TPM’s Sahil Kapur reports on the study from Health Services Research, which used the model of the existing optional Medicare Advantage, the current subsidized Medicare alternative. The study’s conclusion: healthy seniors tend to gravitate to private plans and sicker seniors gravitate to traditional Medicare. That’s because private insurers craft their plans to attract lower-cost patients and leave sicker, more expensive ones for traditional Medicare—a process known as favorable selection. […] “I think what that means for premium support is that fee-for-service Medicare would gradually be a dumping ground for the sickest people and the premiums would go higher and higher if they want to stay in their plan,” said Austin Frakt, a health economist at Boston University. “And that’s a huge concern for some people.” That’s, in microcosm, a huge part of the problem the private insurance system has seen, except seniors have the option of Medicare that has to accept them, and sicker people who aren’t eligible for Medicaid are pretty much out of luck when it comes to finding affordable insurance. But in the case of Medicare, adding in private competition that markets to and selects the healthiest individuals means that traditional Medicare eventually becomes too expensive to sustain. That would lead to what Frakt calls the “classic adverse selection death spiral,” and the end of Medicare.
In Swing States, Obama Leads on Handling of Medicare
Mr. Romney and Mr. Ryan have called for curbing the growing costs of Medicare by making major changes to the program. Their plan would change Medicare for people who are now under 55 so that when they are eligible for coverage they would no longer receive a government-guaranteed, fee-for-service health plan but rather a fixed amount of money each year that they would use to purchase private health insurance or buy into a version of the existing Medicare program. But they have not provided enough details of their plan to assess how much it might increase out-of-pocket costs for future beneficiaries. Mr. Obama has pledged to preserve Medicare in its current form, but has spoken less about its rising costs.
Your Health: Medicare open enrollment under way
A: All Medicare enrollees should have gotten notice by now that the Medicare open enrollment season has begun. Medicare beneficiaries have through Dec. 7 to decide whether they want to stay with their current plan — whether it’s a Medicare Advantage managed-care plan or original Medicare — or switch coverage to something else.
Proposed Settlement May Extend Coverage to More Medicare Home Health Patients
If finalized, this change in policy is likely to be welcomed by home health agencies. Over a period of many years, agencies have been stymied in their efforts to provide services to patients like the plaintiffs and similar patients across the country. The historic lack of coverage for services to such patients has caused home health agencies to confront difficult legal, economic, and ethical dilemmas. Even if agencies could afford to continue to provide substantial free services to such patients, it appeared that the provision of free services violated applicable prohibitions of the Office of Inspector General (OIG) of HHS regarding the provision of free services to patients that exceed $10.00 at a time or $50.00 in the aggregate during a calendar year. Agencies would welcome relief from difficult dilemmas and an opportunity to provide care to as many patients as possible.
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