Obamacare Update
from the Obamacare Truth Squad
April 17, 2016
Tonight, I’ll bring you up to date on the Truth Squad’s activism projects, fill you in on some top Obamacare news, and finish up with a new way doctors are going to be paid under Medicare that is cause for concern.
When I saw that there are only 19 states remaining that have not expanded Medicaid, I got worried. Pressure is increasing on those states, and there doesn’t seem to be any coordinated effort to push back. So I looked for activists and found 5 who are fighting expansion in their own states. I started an informal group to share information and ideas at the state level, and to get legislation at the federal level to make it less attractive for states to expand. After talking to Congressional staffers this week, I see the best way to proceed on the federal level would be a law that reduces the federal match rate for expansion. Right now, it starts at 100 percent and goes down to 90 percent, while the match for the original, more needy Medicaid population is much lower, around 50 or 60 percent, depending on the state. My group will also throw a spotlight on the ways the administration is twisting arms and trying to get the remaining states to expand. The name of the group is MENTOR, which stands for ‘Medicaid Expansion Needless Total Overreach’ – referring to the facts that every bit of the money for expansion is borrowed, expansion pushes welfare into the middle class, and our opponents indulge in over the top rhetoric – ‘people are dying in the streets,’ don’t you know.
MENTOR has taken a lot of my time in the last few weeks, so there is no progress to report on the Truth Squad’s nullification project to bring back true catastrophic insurance. But I’ll be working on that again soon.
In Obamacare news this week, UnitedHealth will leave the Michigan exchange next year, it was announced yesterday. This followed several warnings this week from insurers that they might leave Obamacare exchanges next year if they don’t get big rate hikes. The administration’s comment in all this is bogus as usual – that big rate hikes aren’t so bad after subsidies. They really think we don’t remember the President promising everyone their premiums would go DOWN, $2,500 a year, not up. In other news, the GAO came out with its annual duplication and waste report this week. It found that billions could be saved on Medicaid by fixing faulty procedures. Here’s one example: CMS has no procedures for investigating contractors when they start turning in bigger bills without explanation. | The congressional exemption for Obamacare was back in the news this week, with an article talking about how crimes might have been committed when Congress told the D.C. Obamacare small business exchange that it is a small business. Making intentional false statements about congressional compensation is a 5-year felony, the article says. The article goes on to note that the D.C. exchange has stopped asking applicants how big their business is which, the authors say, is proof D.C. authorities know Congress wasn’t telling the truth on its application.
Turning now to the new payment system for doctors, it’s a 5-year plan for primary care physicians for their Medicare patients. The plan is called Comprehensive Primary Care Plus. The administration hopes to tie 50 percent of Medicare payments to so-called ‘alternative payment models’ by 2018. The basic idea, supposedly, is to pay doctors for quality, value, and patient outcomes, not procedures. My first concern is the incentive doctors will have to cut corners when getting global payments like this, instead of fees for actual services. With fee for service, there’s an incentive to do too many procedures. But with global payments, the incentive is to cut corners. So all this does is substitute one perverse incentive for another. Second, the payments are subsidies that will be removed if the doctor doesn’t adopt certain technology, and use data the way the government wants. It’s foreseeable the incentives will turn into actual penalties at some point. Third, I think it’s a real problem that the government will control the data, the information upon which doctors will base their medical decisions. Doctors will be implementing Washington’s policy choices and not even know it. The subsidies, the metrics, and the information control look to me like a plan by Washington to capture Medicare doctors and, eventually, all of medicine when the new payment system is rolled out to other government programs and beyond. It’s all meant to push things in the direction of single-payer and top-down control of all of healthcare, if you ask me.
Links
“UnitedHealth to exit Michigan Obamacare exchange”
http://www.detroitnews.com/story/business/2016/04/16/unitedhealth-exit-michigan-obamacare-exchange/83137432/
More flashing red lights from insurers about #Obamacare losses; setting the stage to jack up rates
http://thehill.com/policy/healthcare/276366-insurers-warn-losses-from-obamacare-are-unsustainable
Yo, HHS! You’re not getting away with this. 8% price hike is not what we were promised. #WheresMy2500
http://thehill.com/policy/healthcare/275983-new-hhs-report-pushes-back-on-talk-of-obamacare-price-spikes
First they said your premiums would go down $2,500. Now they say hikes not so bad after subsidy. #BaitAndSwitch
http://www.investors.com/politics/policy/virginia-insurers-seek-18-obamacare-premium-hike/
“Virginia Insurers Seek 18% ObamaCare Premium Hike”. O-admin: ‘only’ 4% after subsidy. #WheresMy2500
http://www.investors.com/politics/policy/virginia-insurers-seek-18-obamacare-premium-hike/
GAO finds that billions could be saved on Medicaid by remedying faulty procedures
http://gao.gov/assets/680/676473.pdf
GAO faults CMS for lack of procedures to investigate unexplained increases in contractor billing
http://gao.gov/assets/680/676473.pdf
New documents show criminal falsehoods in congressional Obamacare exemption application
http://thehill.com/blogs/congress-blog/healthcare/276286-on-obamacare-is-there-one-set-of-rules-for-congress-and
Follow-up:
http://www.forbes.com/sites/michaelcannon/2016/04/15/congress-is-getting-a-special-exemption-from-obamacare-and-no-its-not-legal/#73e9b7974eb0
Washington’s Plan to Capture Doctors – subsidize, push data and technology, remove incentives if don’t jump to tune
http://www.healthcareitnews.com/news/cms-reveals-comprehensive-primary-care-plus-risk-based-payment-model
New incentive payments for docs just cheese for mousetrap, real penalties for ‘doing it wrong’ foreseeable
http://www.healthcareitnews.com/news/cms-reveals-comprehensive-primary-care-plus-risk-based-payment-model
Washington to control information upon which doctors will base their medical decisions – this is NOT good.
http://www.healthcareitnews.com/news/cms-reveals-comprehensive-primary-care-plus-risk-based-payment-model