ObamaCare must be repealed, and not in three phases. I pray the GOP can get this right
Senator Paul also opposes ObamaCare Lite
Can the GOP get it right? Again, I pray so
ObamaCare must be repealed, and not in three phases. I pray the GOP can get this right
Senator Paul also opposes ObamaCare Lite
Can the GOP get it right? Again, I pray so
By the time the VA got around to it, they’d been dead for years.
(CNN) Hundreds of thousands of veterans listed in the Department of Veterans Affairs enrollment system died before their applications for care were processed, according to a report issued Wednesday.
The VA’s inspector general found that out of about 800,000 records stalled in the agency’s system for managing health care enrollment, there were more than 307,000 records that belonged to veterans who had died months or years in the past.
In a response to the House Committee on Veterans Affairs’ request to investigate a whistleblower’s allegations of mismanagement at the VA’s Health Eligibility Center, the inspector general also found VA staffers incorrectly marked unprocessed applications and may have deleted 10,000 or more records in the last five years.
In one case, a veteran who applied for VA care in 1998 was placed in “pending” status for 14 years. Another veteran who passed away in 1988 was found to have an unprocessed record lingering in 2014, the investigation found.
Everybody knows if you don’t pay to repair your car, you limit its life.
The same is true with people. We need medical care to avoid becoming clunkers.
For a half-century, Medicare has enabled seniors to get that care. But now the Obama administration is pressuring hospitals to skimp.
Last week, the administration announced the largest-ever change in how Medicare pays for care. It’s called “bundled payments,” and it’s the latest trick to squeeze care from seniors.
Bundling will make it financially risky for hospitals in New York and many other areas of the country to do hip and knee replacements. These two procedures have transformed the experience of aging, allowing seniors to stay active.
But President Obama says too many seniors are getting these operations.
When the subject of hip replacements came up in a 2009 town-hall meeting, he said “maybe you’re better off not having the surgery but taking the pain killer.”
Science proves the president is wrong. Seniors with severe arthritis who opt for a knee replacement are 50 percent more likely to still be alive seven years later than seniors who don’t. Pain and immobility are killers.
Medicare is moving from paying doctors and hospitals for each item and service they provide to the new bundling system in January 2016.
It’s being rolled out in New York City, Newark, Buffalo, New Haven and New London, Conn., and many other regions, including Los Angeles. About 100,000 seniors will feel the pain, one quarter of the number expected to get hip and knee replacements each year.
Hospitals in these areas will have to settle for a flat fee for all the care a knee- or hip-replacement patient might need – including surgery, pain killers, hospital stays, rehabilitation and home care – regardless of how things go.
If there are complications, the hospital and doctors lose out. Hospitals will have to cut corners, and avoid the costliest patients altogether. So if you’ve been considering getting a hip or knee replacement, do it before January.
Ezekiel Emanuel, the president’s health-care adviser, applauds the impending change, promising that “savings are immediate and guaranteed.” What savings? Not for you.
Bundled payments will force cuts in care, not necessarily “savings.” The new system will set up a conflict of interest between patients and the very people they need to trust.
Whatever the patient gets will come off the hospital’s bottom line and out of the doctors’ own pockets at the end of the year.
Seniors are guinea pigs in this new scheme. The RAND Corp. says there are no studies to show the impact on patients.
Isn’t that what health care is supposed to be about? RAND says the scheme risks putting “pressure on physicians to spend less time with patients or on hospitals to decrease amenities.”
Health-care analysts at Lewin Group predict hospitals will scrimp by sending patients directly home with only a part-time health aide instead of to full-time rehabilitation at a skilled nursing facility.
Another risk is that hospitals will use low-cost implants instead of allowing surgeons to opt for newer prostheses that give patients more range of movement.
Bundling payments is one of several ploys to shortchange seniors. In October 2012, Medicare began awarding bonus points to the hospitals that spend the least per senior, despite evidence that spending less results in higher death rates.
Americans know Medicare is running out of money.
But it’s better to have an honest conversation about how to extend its solvency, including raising the eligibility age and enlisting competition among private insurers, than to have the hidden incentives to cut care the Obama administration is using.
Rationing is invisible. Patients won’t know about the care they should have gotten or how much less they could have suffered.
Bundled payments, like other perverse incentives buried in ObamaCare, destroy Medicare as we’ve known it.
At least 2.9 million Americans who signed up for Medicaid coverage as part of the health care overhaul have not had their applications processed, with some paperwork sitting in queues since last fall, according to a 50-state survey by CQ Roll Call.
Those delays – due to technological snags with enrollment websites, bureaucratic tangles at state Medicaid programs and a surge of applicants – betray Barack Obama’s promise to expand access to health care for some of the nation’s most vulnerable citizens.
As a result, some low-income people are being prevented from accessing benefits they are legally entitled to receive. Those who face delays may instead put off doctors appointments and lose access to their medicines, complicating their medical conditions and increasing the eventual cost to U.S. taxpayers.
Democratic lawmakers who have promoted the law’s historic coverage expansion are wary of acknowledging problems that hand opponents of the Affordable Care Act another rhetorical weapon, said Robert Blendon, a professor at Harvard University School of Public Health and Kennedy School of Government.
“Any problem plays against the Democrats,” Blendon said.
Meanwhile, Republicans usually eager to criticize the Obama administration or states for implementation problems risk looking hypocritical by showcasing the Medicaid waits. Many oppose expanding the program to people with incomes as high as 138 percent of the federal poverty line, as the law allows states to do, and are loath to demand more efficient enrollment to achieve that goal.
“It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.
Medicaid is a joint federal-state health program for the poor seen as a linchpin to expanding health coverage under the 2010 law (PL 111-148, PL 111-152).
Eligibility for the program is determined by federal and state guidelines, with the administration of the program left to the states. People enroll for Medicaid through federal or state websites or use other avenues, such as filing paper applications.
Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said the government tried to help states anticipate the workload from the coverage expansion through steps such as weekly data releases showing how many residents appeared to qualify for Medicaid. He said the agency is busy transferring remaining data to those states equipped to process the information.
“CMS is actively transferring accounts to all states that are ready to receive them,” Albright said in an email. “In the meantime, every state not receiving transfers can be enrolling people through alternative options CMS has made available.”
Variety of Problems
Forty-one states as of May 29 responded to requests from CQ Roll Call about the number of pending Medicaid applications, the number of individuals covered in the applications and processing times. The remainder, including Missouri and New Mexico, didn’t respond to CQ Roll Call’s emails and phone calls for enrollment data.
The problems are most acute in three states – California, Illinois and North Carolina – where almost 1.5 million Medicaid applicants remain in limbo. Though all three are experiencing high volumes of enrollment, problems vary from California’s balky electronic sign-up system to Illinois’ inability to predict a surge of applications.
The waits are linked in part to the troubled rollout of the federal insurance website healthcare.gov last fall. Alaska, Kansas, Maine and Michigan still are unable to receive applications their residents completed through the federal website. Others such as Georgia received applications submitted last fall in May.
“These people were encouraged to seek help, and they didn’t get it,” Blendon said.
Beyond the individuals, the delays have left doctors, hospitals and other health providers unsure whether they will be reimbursed for care they provide to people who appear eligible for Medicaid but haven’t received benefit cards.
“It’s a huge systemic issue right now,” said Rosenbaum.
The delays are caused by a mix of technical problems and a surge of applications, especially in states that cajoled their residents to sign up for newly expanded benefits. More than 900,000 Californians are waiting for their benefit cards or denial letters, say state officials. In Illinois, another 330,000 people are in limbo. In North Carolina, it’s 285,884, plus another 12,956 applications that may include more than one person.
Norman Williams, a spokesman for the California Medicaid system, said the situation is “not something we are satisfied with.”
He said people still waiting for coverage decisions could go to local hospitals that can expedite their enrollments and, in many cases, provide temporary benefit cards.
“It’s not an easy situation for them,” he said. “We certainly understand that. That’s why we have this sense of urgency to get this done and get them into coverage.”
Supporters of the law note that Medicaid benefits are retroactive. If an eligible person received care while waiting to be enrolled, the program would pay for services dating back 90 days before the person applied, although some states make applicants specifically request retroactive coverage. But people with applications in the queue may not be aware of that requirement and have no guarantee that states will agree they qualify for Medicaid.
States are supposed to process Medicaid applications within 45 days. Several reported that they are largely meeting those guidelines. Some, including Colorado, Iowa and New York, significantly sped up processing this year.
Others expect federal exemptions for “unusual circumstances.” In Virginia, which first got a trickle of applications from healthcare.gov in late February, 45 percent of applications are past the 45-day limit.
Many states that relied on healthcare.gov to handle applications as well as states that built their own websites are wrestling with backlogs.
In the 36 states whose residents signed up through healthcare.gov, at least 1.4 million people faced delays because the website was unable for months to transmit the information to states. Once it did, states complained they weren’t receiving all of the applications and that data was incomplete or riddled with errors.
The logjams were so bad that officials asked applicants to re-apply directly through the states, where workers often sorted the information by hand. That created duplicate applications for as many as half of prospective Medicaid enrollees in Idaho and Louisiana. Other states disagreed with federal eligibility decisions: Indiana approved only 5 percent of the healthcare.gov applications, Texas approved 17 percent and North Carolina approved 19 percent.
States that ran their own websites, including California and Illinois, also experienced troubles. The new California computer system has technical glitches, including difficulty sending information to counties that help process applications. Because California had a massive campaign urging people to enroll, workers were swamped.
“It’s a very big deal because millions of people are waiting for health care, and these people can’t afford health care,” said Rosenbaum.
Cynthia Carmona, the director of government and external affairs at the Community Clinic Association of Los Angeles County, said that the group has “been having a hard time getting good answers from the state.” She said that some people who applied in October still haven’t heard whether they are enrolled.
“We’re disappointed,” Carmona said. “We’re trying to give them room to fix the issue but this can’t go on forever. We need resolution.”
Smitty at The Other McCain lays it our very well
Barack Obama will take many things; your life, your liberty, your pursuit of happiness: but he will never take responsibility. That’s on you:
Julie, her husband, and four children were covered by a medical plan they liked, and had been promised they could keep by President Obama. But like so many others in this country, her family’s private health care policy was cancelled because of the Affordable Care Act. So my sister and her family struggled through the expensive and incompetently designed Obamacare website to find a new policy. Unfortunately, while they waited for their new Obama-approved healthcare plan to finally kick in, my little sister fell ill. She couldn’t keep down solid food. She should have gone to a doctor. But she toughed it out, as many people do, until her new coverage would kick in on February 2. She and her husband didn’t have a lot of money, so she didn’t want to incur what she thought were avoidable medical expenses.
But she didn’t make it. It turns out that, unbeknownst to her, she wasn’t suffering from an upset stomach or food poisoning, but a badly blocked gall bladder that had become highly infected. Her body went into septic shock just two days before her Obamacare policy would have kicked in.
Just remember, it is for the “common good” Individuals? They only matter as long as they bow to, and aid, the Collective. When they fail, they are, well expendable.
Adding to a devastating CBO report of how Obamacare could damage the economy, a Duke University survey of top companies found that 44 percent are considering reducing health benefits to current employees due to Obamacare, confirming the fears of millions of American workers.
In its December survey of chief financial officers around the country, Duke also found that nearly half are “reluctant to hire full-time employers because of the Affordable Care Act.”
And 40 percent are considering shifting to part-time workers and others will hire fewer workers of fire some to avoid the costs of the program.
What’s more, they said in the study, “One in five firms indicates they are likely to hire fewer employees, and another one in 10 may lay off current employees in response to the law.”
Without the law, the CFOs told Duke that they would hire more full-time workers.
The survey adds to the Congressional Budget Office’s study in raising new questions about the economic impact of Obamacare. Both give Republicans ammunition to continue their efforts to repeal the program that has upset how millions of Americans get health insurance. The survey was initially released in December and re-released Wednesday to provide context to the CBO report.
Duke University’s Fuqua School of Business Professor Campbell R. Harvey said that the school’s survey shows that the economic hit the CBO warned of will be worse.
“Our survey shows that the situation is much more serious because employers tell us that they will choose not to hire and may lay people off,” he said. “I doubt the advocates of this legislation anticipated the negative impact on employment. The impact on the real economy is astonishing. Nearly one-third of firms may either terminate employees or hire fewer people in the future as a direct result of ACA.”
His colleague John Graham said in a statement promoting the survey, “An unintended consequence of the Affordable Care Act will be a reduction in full-time employment growth in the United States. Companies plan to increase full-time employment by 1.4 percent in 2014, a rate of growth which is down from last quarter and unlikely to put a dent in the unemployment rate, assuming that the labor force participation rate remains constant. CFOs indicate that full-time employment growth would be stronger in the absence of the ACA.”
See the full survey here.