Can we really say we didn’t see the cuts to Medicare Part B coming? (These are described in the Houston Chronicle, our feature article below.) Last year the administration made the decision to cut $716 billion from Medicare over the next ten years. $156 billion of this is predicted to come from Medicare Advantage. If you are a Medicare Advantage policyholder, did this news somehow fail to appear in your “Annual Notice of Change” which arrived last October? If so–could this be because we were in the middle of a Presidential election and cuts to your Medicare Advantage Plan might not have helped someone’s re-election? Fortunately for me, I have always encouraged my clients to enroll in Medicare Supplement to fill in their gaps in Medicare if it was at all affordable.
Admin. – Kenton Henry

*OBAMACARE CUTS

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Feature Article:
Houston Chronicle Medicare Part B, life and death
By Michael Hazel | July 19, 2013 | Updated: July 21, 2013 7:04pm
Across Texas, seniors with serious medical conditions could soon lose access to the medical treatments they need.
Right now, in an effort to trim federal spending, lawmakers are considering cuts to Medicare Part B, the component of Medicare that covers cancer treatments and other medicines that are administered by physicians. Lawmakers must reject this proposal and work to balance the budget without restricting access to medical care.
Under Medicare Part B, health care providers purchase drugs that require administration by the provider and are later reimbursed by Medicare, after administering the treatments in their office, according to a preset formula.
For almost a decade, physicians have been reimbursed the average sales price (ASP) of each medicine plus an additional 6 percent. That extra 6 percent helps to cover costs related to the shipping, handling and storage of the drugs, in addition to health care providers’ other overhead and administrative costs.
The federal “sequester,” which took effect in April, has in effect reduced Medicare Part B’s payment formula for drugs from ASP, plus 6 percent, to ASP, plus 4 percent. Now, some lawmakers want to cut that reimbursement rate even further. Such reductions could mean big problems for Medicare patients.
Medicare patients in Texas are understandably worried. John Peterson, a patient at Texas Oncology who’s been battling leukemia for 12 years, is concerned about future treatments. “I have a lot of exotic drugs that we have Medicare pick up the cost … it’s been a life saver,” Peterson told News Channel 25 in Waco. He fears Part B reductions will make continuing treatments at his current cancer center impossible.
Such reservations are not unfounded. Further Medicare Part B cuts could very well force cancer clinics to start closing. According to the Community Oncology Alliance, approximately 240 oncology clinics have closed in the past four and a half years and another 400 are struggling financially.
“Without adequate reimbursement, providers will close their doors, forcing patients to either forgo treatment or be relocated to inpatient facilities, many outside their communities or region,” reports the National Patient Advocate Foundation.
Such closures are particularly problematic in states like Texas, because our state is home to so many rural residents. With fewer community clinics available, rural Texans will have to travel far distances to other centers or hospitals for treatment. For those suffering from life-threatening illnesses, unnecessary travel is exactly what they should be avoiding.
Treating patients in hospitals instead of doctors’ offices is also far more expensive. Milliman, a respected actuarial firm, found that a chemotherapy patient who receives treatment at a hospital costs Medicare about $600 more per month than a patient who is seen at a physician’s office.
For Texans like John Peterson, Medicare Part B is a matter of life and death. It’s unacceptable that politicians in Washington are considering further reductions to the program’s payments for Part B drugs.
Texas’ representatives should make certain that patients can continue to access the medical care they need.

Michael Hazel is the incoming president of Texas Nurse Practitioners.

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House Votes to Suspend Individual and Employer Mandate

07.18.2013

More symbolic than practical, was yesterday’s House Vote to suspend the employer and individual mandates. As the feature article reiterates, the chances of the Senate considering a vote, much less concurring, is very slim. In my opinion, the Senate will do nothing to lend credibility to the House or its votes and will only vote to perpetuate the political agenda of their own majority. In this case, they need do nothing relative to the employer mandate except sit back and accept the White House decision to suspend it. Theoretically, this will result in less fallout for them at the polls in 2014’s midterm elections. I anticipate the individual mandate will also be a non-issue as far as they are concerned. Their rational will be the undoubted influx of policyholders into health care compliant policies (effective January 1) will make it much more difficult to ultimately repeal the Affordable Care Act regardless any election results. I have to agree with that.

Admin. – Kenton Henry

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FEATURED ARTICLE:

(REPRINTED FROM THE HOME PAGE OF NATIONAL ASSOCIATION OF HEALTH UNDERWRITERS)

House Votes To Delay ACA’s Employer, Individual Mandates.

As expected, the House voted Wednesday to delay two key aspects of the Affordable Care Act: its employer and individual mandates. Though symbolic, as the Senate is highly unlikely to even consider the bills, the votes were designed to capitalize on the negative attention currently surrounding the law. Some outlets, in addition to their reporting, draw distinction between the two mandates, noting that the White House is delaying the employer penalties while maintaining that the individual mandate is central to the law’s success.

The AP                          (7/18, Cassata) reports that on Wednesday, House Republicans voted “to delay core provisions of President Barack Obama’s health care law, emboldened by the administration’s concession that requiring companies to provide coverage for their workers next year may be too complicated.” The piece notes that “the House voted largely along party lines, 264-161, to delay by one year the so-called employer mandate,” and “it voted 251-174 to extend a similar grace period to virtually all Americans who will be required to obtain coverage beginning Jan. 1, the linchpin of the law.”

The New York Times

(7/18, Pear, Subscription Publication) reports that “the legislation has little prospect of approval in the Senate,” although the House debate allowed Republicans “to reiterate their opposition to the individual mandate,” and “gave them a rare opportunity to portray Mr. Obama as a friend of big business while presenting themselves as defenders of ordinary Americans.”

Politico

(7/18, Cunningham, Cheney) reports that “the point” of the votes “was to put Democrats on the spot, getting them to vote for the relief for employers but not individuals and families,” although “it didn’t exactly work as planned.”

The Hill

(7/18, Kasperowicz) “Floor Action” blog notes that both measures “won over dozens of Democrats.” The bill delaying the employer mandate, “a vote the GOP says authorizes Obama’s decision,” was approved by 35 Democrats. The bill delaying the individual mandate was approved by less, just 22 Democrats voted for it.

The Washington Post

(7/18, Johnson) reports that while “many Republicans see this as an effort to counteract a flawed law that is unraveling,” several “Democrats see it as grandstanding to please voters — and a complete waste of time.”

Illustrating this point, the Wall Street Journal

(7/18, Boles) “Washington Wire” blog quotes some statements made on the floor during debate of the bills. Minority Whip Steny Hoyer (D-MD) said, “This is about gotcha politics. Isn’t it a shame when millions of Americans have no health care…that we spend our time on this floor of gotcha politics.” Later, Rep. Candice Miller (R-OH) said, “The president is not the king, he is a president. He doesn’t have the authority to delay a law on his own. Congress would have to do that.”

The Los Angeles Times

(7/17, Memoli), in noting that this was the “38th attempt by congressional Republicans to repeal part or all of the law, according to Democrats who keep a tally,” White House Secretary Jay Carney quipped, “I’ve lost count; I think they have, too.”

Offering similar accounts of the votes are the Washington Times

(7/18, Howell), Bloomberg News  (7/18, Tiron), Reuters  (7/18, Lawder), CQ  (7/18, Khatami, Subscription Publication), the ABC News  (7/18, Parkinson) “The Note” blog, NBC News  (7/18, Dann), the CNN  (7/18, Walsh) “Political Ticker” blog, MSNBC  (7/18, Koenig-Muenster), US News & World Report  (7/18, Fox), the Daily Caller  (7/18, Levinson), Roll Call  (7/18, Dumain), the Washington Examiner  (7/18, Lengell), FOX News  (7/18), The Chattanoogan  (7/18), and the New Orleans Times-Picayune  (7/18, Alexander).

Outside of reporting on the votes to delay both mandates, several pieces account for the political machinations surrounding the actions Wednesday. Many of these, found mostly in the beltway publications, were published before the vote. For example, The Hill

(7/18, Baker) “Healthwatch” blog reports that the National Retail Federation “said Wednesday it would score as a ‘key vote’ a bill to delay the employer mandate in President Obama’s healthcare law.” As the article explains, “Retailers are among the harshest critics of the mandate, which requires large employers to offer affordable healthcare coverage to employees who work more than 30 hours per week.” The National Federation of Independent Business also planned to score the vote.

Similarly, The Hill

(7/18, Viebeck) “Healthwatch” blog reports that the U.S. Chamber of Commerce “is threatening to punish lawmakers in the 2014 midterm elections if they oppose a vote today to delay ObamaCare’s employer mandate.”

Other reports include those in The Hill

(7/18, Kasperowicz) “Floor Action” blog, another found in The Hill  (7/18, Kasperowicz) “Floor Action” blog, The Hill  (7/18, Viebeck) “Healthwatch” blog, the Washington Times  (7/18, Howell), the Washington Times  (7/18, Howell) “Inside Politics” blog, CQ  (7/18, Attias, Subscription Publication), the Puget Sound (WA) Business Journal  (7/18, Bauman, Subscription Publication), the Sacramento (CA) Business Journal  (7/18, Robertson, Subscription Publication), Forbes  (7/18, Japsen), and the Atlantic  (7/18, Lazarus).

Commentary Considers Implications Of House Votes. Many outlets carry opinion pieces reacting to the House votes to delay both the employer and individual mandates of the Affordable Care Act. The commentary is mostly favorable toward the ACA, criticizing Republicans for continuing to push for repeal of the law, rather than work to improve it. A handful take the opportunity, however, to blast the law.

Senate Finance Committee Chairman Max Baucus (D-MT) commends the Obama Administration for delaying the employer mandate in a piece for Politico

(7/18), arguing that it “shows the administration is listening to the business community and working to address its concerns, as well as the concerns of Congress.” He criticizes Republicans for not being similarly accommodating, instead remaining “engaged in a quixotic bid to repeal the ACA and take away its many benefits for America’s families and businesses.” Baucus concludes, “Wouldn’t it be better if both parties worked together to improve the law?”

In his Washington Post

(7/18) column, Dana Milbank writes that “Congress has voted to repeal all or part of Obamacare” 67 times, while “Wednesday’s 66th and 67th attempts went much like the previous 65, except for a mid-debate recess so that lawmakers could have their official photograph taken on the House floor.” Milbank notes that “the overkill isn’t irrational,” as “research shows that people resist regulations more vigorously if they think the requirements will eventually be repealed. … And so Republicans continue to tee up the repeal votes — far more than anybody realized.”

Jamelle Bouie, a staff writer and blogger at The American Prospect, writes in the Washington Post

(7/18) “Plum Line” blog that because the votes took place on the same day that New York announced its premiums were plummeting by up to 50 percent thanks to the law, “It’s Republicans who are caught in a bind.” He concludes, “Soon, they’ll either have to accommodate the law in order to satisfy their constituents, or continue their quest for repeal, and in the process, further harm their political standing.”

Similarly, Jon Healey, in his Los Angeles Times

(7/18) column, writes that the New York news should have stopped Republicans “in their tracks.” And what’s more, “the fact that it didn’t shows that Republican lawmakers are so determined to undermine the law, they don’t care what might happen to their constituents.”

Chris Stirewalt, in his “Power Play” column for FOX News

(7/18), argues that the vote to repeal part of the Affordable Care Act, “again,” means “quite a lot.” He writes that in delaying the employer mandate, the President has “armed” Republicans with a talking point “about unequal treatment for consumers while big businesses benefit.”

Research Shows ACA Could Encourage People To Leave Work Force.

In continuing coverage, Fox Business

(7/18, Brooks) reports on a new study which found that “nearly a million employees could drop out of the work force when new, cheaper health care options are officially offered to U.S. residents.” The research, conducted by economists from Northwestern, Columbia University and the University of Chicago, found that “between 500,000 and 900,000 Americans may choose to stop working because they are no longer dependent on their employers for health insurance.”

Ross Douthat, in his New York Times

(7/18) “Evaluations” blog, discusses the study, concluding that he is somewhat “untroubled” by its findings because “many of the people dropping out of the workforce would be near-retirees or people dealing with severe family health issues, rather than the kind of able-bodied workers whose declining workforce participation we should actually be worried about.”

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