Obamacare also called on Medicare to pay for one wellness exam each year for beneficiaries. (The exam is not a full-fledged physical; it’s basically a visit to assess someone’s health risks. Patients fill out a short health risk assessment, and the doctor may measure blood pressure and body mass or discuss strategies for improvement). The exam is free for seniors if their doctors have agreed to accept Medicare’s payment in full (most do). Doctors may do other tests and provide other services like vaccinations. Some may be covered under Medicare’s preventive benefits, but others may not be. The wellness exam has been underused. In 2012 only about 12 percent—about 3.1 million seniors and disabled people—enrolled in traditional Medicare (not Medicare Advantage plans) got their wellness visit.
THE MISSES
High-risk pools.
Obamacare intended these as a stopgap measure for sick people who needed insurance but have been shut out of the individual market because they had preexisting conditions, until the part of the law forbidding that takes effect. While several states had offered high-risk pools for years with little success, the health reform law pumped some $5 billion into such pools to encourage sick people to join. Advocates feared that wouldn’t be enough. Medicare’s chief actuary predicted in the spring of 2010 that 375,000 people would sign up by the end of that year. Instead enrollment has been disappointing. Sky-high premiums and deductibles have deterred a lot of would-be customers. Only 220,000 people are currently in them, and states are phasing them out in anticipation of the new exchanges.
Small business tax credit.
The idea here was to encourage small businesses to offer insurance to their workers by refunding a percentage of a firm’s health insurance expenses between 2010 and 2013. This has not been a spectacular success. The Government Accountability Office found that the credit was too small to persuade business owners to spend the time and money calculating the credit to cover their workers. It was estimated that between 1.4 and 4 million companies would be eligible for the credit. In mid 2012 the Government Accountability Office reported only 170,300 firms had claimed a credit in 2010. The White House said that in 2011, the number had jumped to about 360,00O, still way short of the estimates.
MIXED REVIEWS
Medicare Advantage plans.
The president came to office vowing to cut the government’s overpayments to Medicare Advantage plans, which are a private insurance alternative to receiving Medicare benefits, and which have been getting more money from Medicare for services than traditional government-run Medicare pays for the same benefits. And indeed the Affordable Care Act called for some $200 billion in cuts to these plans. For years the Medicare Payment Advisory Commission reported that the government was overpaying sellers of Medicare Advantage plans, and that those overpayments were shortening the life of the Medicare Hospital Trust Fund. But administration actions over the past few years have raised questions about how serious the president is about cutting overpayments.
First came a Medicare decision that restored money to Medicare Advantage plans. The rationale was to encourage better care. Plans that earned at least three stars on a five-star scale for improving care received a bonus. Three star or average plans could get a bonus payment of three percent of what the government normally paid them to provide benefits to seniors. Then this year, as CJR noted, Medicare Advantage plans were scheduled for a reimbursement cut of 2.3 percent as part of an annual review process. But a lobbying campaign by the industry aimed at the public and Beltway pols instead resulted in a 3.3 percent increase—worth billions to insurers.
The biggest mistake giving the states 100% reimbursement for Medicaid (for those below the poverty line) the first few years and then only 90% beginning in 2020.
That would have created a hardship for many state budgets.
When the Supreme Court ruled that states could elect NOT to fund the Medicaid expansion but they like, Republicans and other opponents did exactly what you’d expected they’d do. So far 21 states have decided not to participate and 6 are on the bubble.
Poor people below 100% of the poverty line are out of luck.
We should have passed Medicare for All rather than allowing insurance companies to make billions are middlemen. But failing that, Obama should have had the federal government cover 100% of the cost forever. Not doing that either was going to hurt some states OR as it turned out, allow opponents in some state to not cover the poor.
This is shameful (for both sides).
#1 Posted by William Du Bois, CJR on Tue 30 Jul 2013 at 03:32 PM
It should be noted that the Center for Advancing Health seems to funded by the usual pro-corporate suspects promoting the tired trope that individual choice [neoliberalism] will set us free:
"While advances in medical knowledge have been responsible for steady increases in the length and quality of life of Americans [unless you're black or poor], the potential of health care to improve individual and population health in the future rests increasingly in the hands of individuals. Whether we are sick or well, we will not benefit from the expertise of health professionals and the technologies they deploy unless we participate actively and knowledgably in our own care."
http://www.cfah.org/about/funders
Well, I guess we get these neoliberal solutions with Obamacare; we get fake choices, fake free markets, corporate welfare, and we are tricked into bickering amongst ourselves when the inevitable bad results hit. After the corporate terrorists come for health care the only targets left will be public education and Social Security/retirement benefits.
Why won't our corporate press discuss the obvious benefits of socialized health care and/or single payer health care and why oh why are we subjected to this propaganda about "individual choice?" Just try wading through the various policies and changes described in the two parts in this series! It's a mess (not necessarily the writer's doing) and the obfuscation hides the real agenda. . . austerity, privatization, and corporate welfare!
#2 Posted by Walter W., CJR on Tue 30 Jul 2013 at 04:59 PM
I live in Massahusetts.I have Medicare and a B/C B/S supplement. I recently found out why my doctor no longer give checkups, questions what other doctors suggested my primary physician do, but having her tell me it was up to me to make that decision. I was having a UTI that was not attended to properly, and after a bad episode, I was again on antibiotics. An article I read explained that doctors make more money if their patients can reduce the costs of treatments, and office visits should be kept to five minutes up to twenty minutes. What ever happened to PREVENTIVE MEDICINE? It seems the answer to medicare problems is a "do it yourself."
#3 Posted by Bunni Roberts, CJR on Wed 31 Jul 2013 at 08:18 PM