We are hearing so many things about health care reform that we need to remember what we know. We know that health care has been under siege by fraud for these few decades.....trillions of dollars lost to fraud may pale when you think of the tens of trillions stolen by financial fraud.....but when you consider the Medicare and Social Security Trusts......this amount of fraud is substantial. Remember, Reagan tripled the amount workers paid into payroll taxes back in the 1980s just so there would be plenty of money to cover the boomers.....AND THERE IS ENOUGH....ONLY IT HAS BEEN STOLEN.
The other thing I always remind people is that for decades workers have not only paid payroll taxes but also paid income taxes and it was the taxes people paid that funded all of the medical research of the last century. WE PAID FOR THE ADVANCES THAT THEY NOW ARE TRYING TO TAKE AWAY FOR MOST PEOPLE! MEANWHILE THE HEALTH CORPORATIONS THAT ARE FORMING HEALTH SYSTEMS WILL BE MAKING RECORD PROFITS ON THESE ADVANCES!
Shout out against cuts to health care and the need for entitlement reform! If your democratic incumbent is not shouting out about the need to recover fraud and not cut services and access.....THEY ARE THIRD WAY CORPORATE DEMOCRATS!!!
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Regarding AG Doug Gansler shouting out against a 25% increase in health insurance premiums:
I'd like to say that it is refreshing that Doug Gansler knows a crime when he sees it.....this is a first. It is indeed a crime to allow people to die from lack of access to health care in order to maximize health industry profits which is what private health systems do. Better for the Attorney General to shout out that in Maryland there are no laws that define health fraud adequately to prosecute and there is a cap on awards that make it impossible for the public to seek justice....that would be his job. Your Maryland Assembly incumbents are Third Way corporate democrats who work for wealth and profit.....neo-liberals.....at the expense of labor and justice. We just need to be rid of them and run and vote for labor and justice candidates to reverse what is an inhuman practice of allowing people to die to maximize profit. This policy is written and pushed by Johns Hopkins by the way. We do have a growing Health Care NOW- Maryland that is a universal care organization fighting against these profit-driven policies. Remember, Maryland Health Care for All is simply a Hopkins non-profit working to make sure universal care does not happen in Maryland so do not go there for activism!
Why is Doug shouting out against this 25% health insurance increase while doing nothing regarding billions of dollars in health fraud by doctors and health institutions in this state each year? It is an election headline that all Maryland media will provide with no questions asked. Gansler is a Wall Street team player so he will get the headline he needs for his campaign. This AG knows that these health insurance agencies just received a hike in 2011 and 2014 is just next year so there would likely have been no increase until after the implementation anyway. Think back to the BGE/Exelon merger when the same politicians told us the merger would not bring rate increases and then just months after the merger was complete they asked for a rate increase that almost doubled the current rate. This is the same thing.
Gansler seeks cap on health insurance rate increases Suggests no more than 5% until federal reform is fully implemented
By Andrea K. Walker, The Baltimore Sun 9:27 p.m. EDT, June 4, 2013
Maryland Attorney General Douglas Gansler urged state regulators Tuesday to cap the amount that insurers can raise premiums under the new health care law to no more than 5 percent until more is known about how the sweeping federal legislation will affect health costs.
The call comes as the Maryland Insurance Administration reviews requests by insurers to raise rates on those who will buy coverage from a statewide exchange, or open marketplace, established under the Affordable Care Act.
CareFirst BlueCross BlueShield, the region's largest insurer, is seeking an average rate increase of 25 percent for those who buy coverage individually. Some of its customers could see increases of 100 percent to 150 percent.
The issue reflects the continued uncertainty and challenges facing states as they implement the federal health care law, key provisions of which will go into effect in January.
No one knows how many people will sign up for health coverage or how much it will cost to implement the system. The Obama administration says costs will go down as more people enter the system.
Critics, including insurers across the country, are bracing for the higher cost of covering more and sicker people. Some say that the practice of denying coverage to people with pre-existing conditions helped to keep insurance costs down.
Under the Affordable Care Act, insurers may no longer refuse policies to those with pre-existing conditions.
Maryland, which is ahead of other states in implementing the provisions of the health care law, is experimenting with its own plan to lower costs. Officials are trying to persuade the federal government to adopt a plan that would tie hospital rates to the state's economy.
But the Centers for Medicare and Medicaid, the federal agency that administers the programs, won't decide on the state's proposal until later this year. In the meantime, state officials must make difficult decisions.
Gansler, a Democrat who is expected to seek his party's nomination for governor in 2014, wrote a "friend of the court" brief on behalf of several states that supported the Affordable Care Act. He argued that Congress had the right to mandate that Americans buy health insurance as a means of regulating the economy under the Commerce Clause of the U.S. Constitution.
The rate proposals that Gansler is contesting would not affect most people, who purchase insurance through job-based plans.
Gansler said it is unfair for insurers to request huge increases before the full impact of the health care law is known. He said rates should be capped and then re-examined six months after the law takes effect.
He contends that raising premiums will price people out of the market, defeating the purpose of the federal law, which is to make health insurance more affordable and expand the number who are covered.
"We don't know what is going to happen to health care costs, but the insurance companies are preying upon the idea that they will rise to jack up premium costs," Gansler said.
Under state law, Maryland Insurance Commissioner Therese M. Goldsmith has the sole power to review and approve insurance premiums. Gansler has no legal authority to set the rates, but he could sue to obtain a refund for consumers if it is found that they were gouged by unnecessarily high rates.
Goldsmith declined to be interviewed for this article. Her office released a statement saying that the rate requests are under review and that the commissioner will consider "all relevant factors" under the law.
"The law requires that the commissioner disapprove or modify a proposed premium rate if, based on statistical analysis and reasonable assumptions, the rate appears to be inadequate, unfairly discriminatory, or excessive in relation to benefits under the plan," the statement read.
Chet Burrell, the CEO of CareFirst, has said insurers need to implement a 25 percent premium increase because the cost of health care under the law is uncertain. He said the company's margins leave little room for mistakes.
"As a not-for-profit carrier, CareFirst operates essentially at cost and over the past five years has never produced an operating margin greater than 1 percent," the company said in a statement. "Premiums closely reflect actual cost. That is essentially what CareFirst has sought to achieve in its filings and nothing more."
CareFirst, which has 2.2 million customers in Maryland or 48 percent of the market, said the attorney general should let the rate approval process play out before criticizing it.
This is what our Maryland Attorney General should be hard at work doing. The only fraud collection that happens is when the Feds solve cases that send a small amount back to Maryland....average of a few million each year when we know that billions of dollars in fraud in Maryland occur each year!
Health Insurance fraud
Health insurance fraud is the purposeful act of deceiving, concealing, or misrepresenting the health care benefits being paid to an individual or group.
Health insurance fraud may be defined in the health insurance context as any behavior designed to solicit money to which a person or group is not entitled. Health Insurance Fraud perpetrators include insurance brokers, unscrupulous doctors, chiropractors, allied health professionals, medical institutions, and patients.
In response to the increased amount of health insurance fraud in the United States, Congress, through the Health Insurance Portability and Accountability Act of 1996 (HIPAA), has specifically established health care fraud as a federal criminal offense with punishment of up to ten years of prison in addition to significant financial penalties.
Health insurance fraud cost estimates
The FBI's Health Care Fraud Unit oversees investigations targeting individuals and/or organizations who are defrauding public and private health care systems. Areas investigated under Health Care Fraud include: billing for services not rendered, billing for a higher reimbursable service than performed (upcoding), performing unnecessary services, kickbacks, unbundling of tests and services to generate higher fees, durable medical equipment fraud, pharmaceutical drug diversion, outpatient surgery fraud, and Internet pharmacy sales.
The cost of health care fraud and abuse in both the public and private sectors, is estimated between 3 and 10 percent of total health care expenditures. Total health care spending to is estimated to exceed $3.3 trillion in 2012.
It is estimated that Health Care Fraud will cost the American Health Care system between $99 Billion and $330 Billion in the year 2012.
THIS ARTICLE SHOWS WHAT ARE CLOSER TO REAL NUMBERS....WE KNOW THAT 1/2 OF ENTITLEMENT SPENDING IS FRAUD SO THESE NUMBERS LOOK CLOSE TO THAT REALITY. You will see government figures that say that fraud is only tens of billions of dollars and THAT IS A LIE!!
Cost of Medical Fraud Could Pay for Health Care Reform —By James Ridgeway Mother Jones
| Wed Aug. 19, 2009 4:45 AM PDT According to reporting yesterday on NPR, the cost of medical fraud in the United States runs anywhere from $60 billion to $600 billion a year--in other words, it might actually exceed the price tag for health care reform. Instead of whining about the expense of reform measures, Republicans and Blue Dog Dems might think about saving us money by cracking down on fraudulent practices, which target both the government and private insurers.
Obama has recently announced a new DOJ/HHS task force to combat fraud, and some versions of the health care reform bill have a measly $100 million set aside for anti-fraud measures. It seems like far too little and too late--but apparently, it's more than has been done by past administrations, or by the oversight committees, the appropriations and legislative committees whose job it is to ride herd on taxpayer funds.
Here is a bit from the NPR report:
Medical fraud takes several forms. Most commonly, criminals get a list of patients’ names, then create fictitious doctors. They send bills to Medicare or Medicaid or health insurers for services supposedly rendered to these patients. By the time the payers figure out that the doctors they’re paying are fictitious and no service was ever rendered, the criminals have closed up shop and moved on.
Another popular form of health care fraud is the “rent-a-patient” scheme. Recruiters find people with health insurance willing to get care they don’t need, in exchange for cash or cosmetic surgery. Several years ago, insurers and the FBI said they had cracked a big case. People from 47 states were paid to come to California to receive unneeded care, including colonoscopies and surgery for sweaty palms. The doctors who performed the work reportedly charged insurers a total of $1 billion.
I suppose the libertarian Republicans would say it’s just a small price to pay for our free market system. And of course, if the government started taking a closer look at the crooks who illegally rip off the system, they might also have to deal with the crooks who rip off the system quite legally--the price-gouging insurance and pharmaceutical companies and their ilk.
Below you see an article from just one branch of medicine and how these cuts to Medicare will impact access and quality!
What WYPR and Maryland media is not telling you is that the Affordable Care Act is not about reducing the cost for the consumer, it is about increasing profit for the corporation by limiting access and pushing labor costs ever lower. The ACA is about consolidating the health care institutions into global health systems that will be as big, profit-driven, and unaccountable as Wall Street and will prey on the poor, elderly, and chronically ill not care for them. So, the intent is to end all social safety nets to nothing more than refugee-style public health checkups, make it impossible for the chronically ill and seniors to afford health insurance for quality care, and cheapening the service and research to develop new 'products'. Corporatizing health makes health procedures 'products' to patent and sell for the highest price you know! THIS IS WHAT JOHNS HOPKINS IS DOING FOR MARYLAND CITIZENS AND WHETHER O'MALLEY OR ANTHONY BROWN....OR GANSLER......THESE THIRD WAY CORPORATE DEMOCRATS ARE WORKING HARD TO SEE IT HAPPEN
Medicare Cuts Impact Access to Care
Released: 3/28/2013 12:00 PM EDT
Source Newsroom: American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) more news from this source By Kate Penz, AANEM Communications & Foundation Manager
Newswise — Physicians and patients alike are feeling the impact of Medicare reimbursement cuts that went into effect on January 1, 2013. With an additional 2% sequestration cut to roll out on April 1, it’s likely that physicians who treat Medicare patients will be faced with difficult decisions as operating margins continue to shrink.
The the 2% cuts may seem modest, but they come on the heels of much larger cuts to reimbursement for nerve conduction studies (NCSs) of 40-70% for Medicare beneficiaries. These cuts were announced November 1, 2012, and went into effect on January 1, 2013, allowing providers little time to prepare.
While all Medicare providers are feeling the squeeze, private practices are likely to experience the most impact. “These cuts may force private practice physicians to choose between seeing Medicare patients and keeping their practice open,” said Catherine French, AANEM senior analyst of medical economic affairs. French is concerned that the sequestration cuts will be adopted by private insurers, too. “It is possible that private insurers will follow suit and reduce reimbursement by 2% because most model their payment rates on Medicare.”
Cuts Threaten Access to Care
According to Kristi Snihurowych, MD, a spine interventionalist in Salt Lake City, UT, the cuts pose a serious risk to access to care. Snihurowych has decided to discontinue EMG and NCS testing, which previously made up an eighth of her total practice. “Given the cuts, it’s no longer feasible to perform these tests in-house. The problem is, I cannot find anyone to do them for me,” said Snihurowych. “It seems everyone has had to give them up, and not just for Medicare patients. Providers anticipate that other payers will soon follow suit, so many have stopped offering EMGs all together.”
Snihurowych suspects unnecessary and costly procedures will be among the cuts’ ripple effects. “I am seeing patients go to surgery without a definitive diagnosis of, for example, carpal tunnel syndrome because the surgeons cannot get confirmation by an EMG or NCS test.”
Utah-based physiatrist Faisel M. Zaman, MD, PC, agreed, “People will pay with their health. Of course there will be financial costs associated with unnecessary surgeries, but the biggest cost will be to the patients with scars and pain from procedures they didn’t need.”
Zaman is a spine specialist who has had several cases where an EMG has prevented patients from undergoing major surgery. In one case, a healthy and active 70-year-old male patient was referred by a vascular surgeon who thought the patient was experiencing symptoms of peripheral vascular disease. But the surgeon wanted to rule out spinal problems before he did a major bypass operation. Following EMG testing, the man was diagnosed with spinal stenosis.
“EMG was critical in this case,” said Zaman. “It turns out that he is a great candidate for nonvascular treatments that will improve his condition. Without the lower-extremity EMG, he would have undergone major surgery. It’s scary to think of the consequences to patients if the availability of EMG testing becomes more limited. Ultimately, it would hurt patients the most.”
Claire Wolfe, MD, AANEM past president, has similar concerns regarding access to care. Nearing retirement and working part-time, she is the only physician performing EDX studies for an office of 23 physicians, as well as some outside referrals. Before the cuts, two other physiatrists in her office performed EMGs.
“There will be greater uncertainty around diagnoses of upper and lower limb pain/numbness; neck surgeries rather than carpal tunnel releases and vice-versa; delayed diagnoses of motor unit diseases; and delayed recognition of folks with metabolic disorders like diabetes if patients don’t have access to an electrodiagnostic study that may catch peripheral neuropathy changes before the diagnosis of the underlying disorder is made,” Wolfe said.
Unfortunately, the impact of the cuts may be long-lasting. “These cuts will significantly impact Medicare beneficiary access to appropriate management of their disabling neurologic disorders, limit further the number of neurologists who are currently seeing Medicare patients, and discourage budding physicians from the field of neurology,” said Mohammed Zafar, MD, in response to an AANEM survey about the Medicare reimbursement cuts for EDX procedures.
Looking Forward
With the cuts to Medicare reimbursement, AANEM members are asking what can be done to protect their practices and to ensure access to care for patients into the future.
Get Involved in Policymaking
AANEM state liaison P. Caudill Miller, MD, actively encourages physicians who practice EMG to get involved in policymaking. Miller is a neurologist practicing at Neurology Consultants of Montgomery in Montgomery, AL. A longtime member of the AANEM, he has been involved in EMG quality control issues and has worked to improve insurance reimbursement.
“We have one year to prove the impact of the cuts on patient care,” said Miller at a recent meeting of AANEM member physicians in Birmingham, AL. “More than ever it’s important that fraud and abuse be reported.”
In fact, now is an ideal time to reach out to your local representative’s office, as the federal legislature is on break March 25 through April 5 and many representatives are in their home states.
Seek Certification and EDX Laboratory Accreditation
In December, AANEM representatives met with Jonathan Blum, deputy administrator and director at the Center for Medicare & Medicaid Services (CMS), who explained that the cuts resulted in part from the CMS’ concern over the substantial increase in use of NCS codes. AANEM President Peter Grant, MD, explained that we are working hard on abuse issues that affect increased use of NCS codes. The AANEM is working to provide input to CMS on how best to curb abuse, including recommending proper tests are performed by certified physicians in accredited laboratories.
“One way to combat abuse is to ensure EDX testing is performed by a board-certified neurologist or physiatrist, preferably by the American Board of Electrodiagnostic Medicine,” said Grant. “Also, it is important that EDX laboratories apply for the AANEM’s EDX Laboratory Accreditation Program. The program is meant to identify and acknowledge EDX laboratories for achieving and maintaining the highest level of quality.” There is precedent for CMS only paying for studies performed in accredited laboratories. For example, reimbursement for mammography is dependent on accreditation of the facility where the test was performed, and sleep medicine is held to a similar standard.
While it’s true that the cuts to EDX physicians are the reality facing many procedure-based fields, it is still important for AANEM members to become involved. Please see the “How you can help” section on this page for more information.
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Did you hear the US Health Secretary Sebelious tell us that Medicare will now last 2 years longer? They cut $1 trillion from the Medicare budget causing millions of seniors to not be able to afford to access health care and that is what is saving the Trust money. It's like spending less on groceries by starving your child and thinking that is a success. No wonder she couldn't look into the TV camera. These are evil people we have in office today and they need to go. We simply need to retake the democratic party from the neo-liberals who work for the 5% shareholders and bring it back to the 80% of labor and justice!!!
JOIN HEALTH CARE NOW - MARYLAND AND WORK FOR UNIVERSAL CARE!!!!
As this reporter knows the problem with Medicare and Medicaid ---AKA Entitlements---is that there has been massive fraud by doctors and health institutions these few decades that have emptied these Trusts. Doctors and watchdogs say that as much as 1/2 of all entitlement spending is stolen.....$200-400 billion each year. So, one would think that the priority in shoring up these programs would be to recover trillions of dollars in fraud first, then look at what adjustments need be made.
The second problem is that since Reagan's time payroll taxes have been sent to Treasury rather than the Trusts. Reagan raised the payroll tax considerably in the 1980s just so these Trusts would be healthy.....and they are except for the fact that they are raided over and over. So, we do not have a shortfall, we have thieves and a Justice Department that has simply suspended Rule of Law. Just think, with Entitlement spending at $600 billion and more each year, if you stopped the fraud of 1/2 of that.....that makes spending at $300 billion and you recover trillions of dollars to the Trust.....THESE TRUSTS HAVE PLENTY OF MONEY AND THERE IS NO NEED FOR CUTS IN COVERAGE AND QUALITY! This is needed for Social Security as well!
What we do have is a Third Way corporate democratic leadership....neo-liberals...who work for wealth and profit so they are pretending there need to be cuts and make no mention of theft. We need to give these neo-liberal the boot and run and vote for labor and justice in the next elections!!
U.S. Medicare outlook improves as healthcare costs ease
WASHINGTON | Fri May 31, 2013 3:04pm EDT Reuters
(Reuters) - Slower growth in U.S. healthcare costs improved the budget outlook for the Medicare program for the elderly from last year, but the fortunes of the Social Security pension program have not changed despite a better economy, trustees of the programs said on Friday.
The trustees repeated warnings to Congress to pass reforms that will enable the programs to meet all of their long-term obligations, but their report adds to recent evidence of an easing in U.S. budget pressures, and could help encourage a sense of complacency in Washington.
The main trust fund that supports the Medicare healthcare program will be depleted in 2026, two years later than forecast last year, the trustees said in their annual status report.
The trustees attributed the improvement to lower projected spending for most treatment categories, especially in skilled nursing homes, an assumption in keeping with recent signs of slower healthcare inflation.
They also said the implementation of key parts of President Barack Obama's healthcare reform law next year will reduce costs by more than previously projected.
The report said the Social Security fund for retirees will be depleted in 2033, the same as forecast last year. But a much more pressing need is the 2016 depletion date for the Social Security's trust fund that pays benefits to people with disabilities.
While this is also unchanged from last year's report, it means that Congress now only has three years to agree on new funding or reforms that would avoid reduced payments to beneficiaries.
Depletion of the Medicare and Social Security trust funds does not mean that all benefits would stop. At the current rate of payroll tax collections, Medicare would be able to pay about 87 percent of costs after 2026, declining to 71 percent by 2047. Social Security would be able to pay about three quarters of its benefits through 2087, according to the report.
REFORM ENTHUSIASM DIMS
The programs represent the two largest federal expenditures and account for about one-third of all U.S. fiscal outlays. The reports will feed into bitter arguments between Democrats and Republicans over how to reform the programs to keep them solvent and able to support the needs of the massive Baby Boom generation that is now starting to retire.
The healthcare improvements cited by the trustees in the report could dampen enthusiasm, particularly among Democrats, for any reforms to entitlement programs. The report comes on the heels of other signs showing a quick, if only temporary, reduction in the U.S. budget deficit.
"It reinforces a consensus in this city that the crisis isn't imminent," said Greg Valliere, chief political strategist at Potomac Research Croup, a firm that advises investors on Washington politics. "A mood of complacency is intensifying over entitlement reform. There's no sense of urgency."
U.S. Treasury Secretary Jack Lew said the report supports Democrats' approach of protecting the basic structure of Social Security and Medicare, while reducing healthcare costs and excessive drug subsidies and asking wealthier seniors to contribute more.
While the Obama administration wants to work on bipartisan reforms to strengthen the programs' financial footing, Lew said "changes to Social Security and that involve deep cuts in benefits or privatization will be unacceptable."
Senator Bernard Sanders, a liberal Independent from Vermont, said the report shows that Social Security "is not going broke" and argued against Obama's proposal to limit future cost-of-living increases by applying a less-generous measure of inflation.
Sanders in a statement said the report showed the wealthy should pay more into the pension program. "We must lift the cap on Social Security payroll taxes and make the wealthy contribute the same percentage of their income as other workers," he said. "Today, someone making $10 million a year contributes the same amount of money as someone making $113,700. That is absurd."
Republicans in the House of Representatives, meanwhile, have proposed massive long-term changes to Medicare that would effectively convert the popular fee-for-service program into a voucher-like system that provides a subsidy to seniors to buy private health insurance.
"Today's report is yet another reminder that Medicare and Social Security are in great danger," said a spokesman for House Budget Committee Chairman Paul Ryan of Wisconsin, the leading Republican fiscal voice. "We need to protect and strengthen these critical programs."
Republicans also want to repeal Obama's healthcare reforms. But the report said the "modest improvement" in the Medicare finance outlook came from lower projected spending for most service categories "that reflect recent data suggesting that certain provisions of the Affordable Care Act will reduce growth in these costs by more than previously projected."
(Reporting by Margaret Chadbourn and David Lawder; Editing by Vicki Allen and Tim Ahmann)
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THE HEALTH LAW DIDN'T BLUNT COSTS......$1 TRILLION IN CUTS TO MEDICARE IN THESE FEW YEARS HAVE CUT COSTS.....AND ACCESS TO CARE FOR SENIORS!!!!
THESE PEOPLE ARE ANIMALS!
Medicare’s Deterioration Slows as Health Law Blunts Costs By Alex Wayne & Anna Edney - May 31, 2013 3:46 PM ET Bloomberg Financial
The $574 billion Medicare health system, the second-largest U.S. social services program, will exhaust its main financial trust fund in 2026, two years later than predicted as the Affordable Care Act helps control costs.
Assets for the Part A trust that pays for hospital visits, nursing care and related services for Medicare’s 51 million elderly and disabled beneficiaries, fell $23.8 billion in 2012, according to a report today from the program’s trustees. That compares with a net drop in assets of $27.7 billion for 2011.
The decrease was the smallest since 2009 as debt-reduction legislation enacted two years ago included payment cuts that begin taking effect this year. The data should be useful in the debate between President Barack Obama and Republicans over the best approach to improving Medicare’s long-term footing.
“This is meaningful, but two years, I don’t think anyone should get too excited,” said Marilyn Moon, a senior vice president at the American Institutes for Research in Washington. “There is no reason to believe things have gotten worse, things have gotten a little better and we will get some breathing room over time to decide what to do with Medicare.”
Republicans have considered raising the Medicare eligibility age and switching to a system in which beneficiaries get subsidies to buy private insurance, instead of the government paying for their care. Obama has sought to mostly keep the current structure and instead find ways to boost efficiency of the program and reduce excess costs, partly through provisions in the 2010 health-care law he helped create.
ACA Effect “With the health-care law, our goal was to put Medicare on more stable footing,” Health and Human Services Secretary Kathleen Sebelius said at a news conference. “The past few years have borne out that promise.”
Medicare will be bankrupt in 13 years and the report shouldn’t provide comfort, Senator Orrin Hatch, a Republican from Utah, said in a statement.
“Slower economic growth means that fewer Americans are purchasing health care,” said Hatch, the top-ranking Republican on the Senate committee that oversees Medicare. “As our economy improves, there will be a greater deterioration in the health of the Medicare program for our seniors.”
Hatch has suggested allowing private health plans to compete for Medicare beneficiaries as a way to reduce costs along with raising the program’s eligibility age.
Funding Warning Moon said the improvement in Medicare resulted from a combination of “the economy, the fact that the new people on the Medicare rolls are swelling it but they are healthier because they are younger, and some of the reforms are starting to kick in.”
While the data today showed improvement, the program’s financial condition was still enough to trigger the eighth consecutive “Medicare funding warning.” That designation by the trustees requires Obama to propose new funding or cuts in benefits, a mandate that he and his presidential predecessor have ignored.
“To date, lawmakers have never allowed the assets of the Medicare HI trust fund to become depleted,” the trustees said, referring to the Part A hospital insurance fund.
If Congress weren’t to prevent insolvency, steep cuts in payments to hospitals would result.
Private Plans In a report released alongside the Medicare data today, the projection for the 2033 exhaustion of the U.S. Social Security trust funds, used to make retirement and disability payments, was left unchanged.
Medicare’s total spending rose about 4.6 percent to $574 billion in 2012, from $549 billion in 2011, the report shows.
The program has three parts -- A, B and D -- that cover hospital in-patient stays, outpatient services and prescription drugs. Part C is the Medicare Advantage program, in which private insurers including UnitedHealth Group Inc. (UNH) and Humana Inc. (HUM) contract to provide those services in place of the government.
Parts B, C and D, whose trusts are collectively referred to as SMI, are adequately financed for now, the trustees said.
Medicare’s trustees include Lew, Sebelius, the Labor Department secretary, Social Security commissioner and two members of the public. The board annually reports on the program’s financial condition.
“It doesn’t look like the trail we are on quite gets to the cliff as fast as we might have thought, but it doesn’t mean we can afford to coast and say things have slowed down and everything is OK,” said Stuart Guterman, a vice president at the Commonwealth Fund, a New York-based nonprofit group that advocates for better health care.
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This is actually a good thing as we need to look at these doctor's bills in order to stop what we know is massive entitlement fraud...
Federal judge lifts ban on public access to Medicare data
Fri May 31, 2013 8:01pm EDT
n">(Reuters) - A federal judge lifted a 33-year-old injunction barring public access to a confidential database of Medicare insurance claims, a decision that could lead to greater scrutiny of how physicians treat patients and charge for their services.
Judge Marcia Morales Howard ruled Friday in favor of a motion by Dow Jones, publisher of the Wall Street Journal, that the U.S. District Court for the Middle District of Florida lift an injunction imposed in 1979.
The American Medical Association had fought lifting the ban, arguing that disclosure of the information would violate physicians' right to privacy. Doctors had successfully made the same argument in 1979, when a judge ruled the release of such information would violate the 1974 Privacy Act.
The AMA suggested Friday that it might appeal the decision. In a statement, AMA President-elect Ardis Dee Hoven said the doctors lobby was "considering its options on how best to continue to defend the personal privacy interests of all physicians."
Officials at the Centers for Medicare and Medicaid Services couldn't be reached for comment. A Dow Jones spokeswoman declined to comment.
Dow Jones went to court in January 2011, attempting to overturn the injunction after a series of stories in the Journal found tens of millions of dollars in fraud and other abuse by doctors and other Medicare providers. Medicare is funded by U.S. taxpayers.
The Journal's work, however, was restricted by limitations placed on the data released by the U.S. Department of Health and Human Services, which rendered anonymous all information pertaining to individual Medicare providers. That meant reporters weren't allowed to name individual doctors who the Journal identified solely through using the data.
In her ruling, Judge Howard said that because judicial rulings in the years since the injunction have restricted the Privacy Act's reach, the ban was based "upon a legal principle that can no longer be sustained."
When the suit was filed, the Journal's editor-in-chief at the time, Robert Thomson, said: "The Medicare system is funded by taxpayers, and yet taxpayers are blocked from seeing how their money is spent. It is in the interest of law-abiding practitioners that those who are gaming the system are exposed."
Dow Jones is a unit of News Corp.
The other thing I always remind people is that for decades workers have not only paid payroll taxes but also paid income taxes and it was the taxes people paid that funded all of the medical research of the last century. WE PAID FOR THE ADVANCES THAT THEY NOW ARE TRYING TO TAKE AWAY FOR MOST PEOPLE! MEANWHILE THE HEALTH CORPORATIONS THAT ARE FORMING HEALTH SYSTEMS WILL BE MAKING RECORD PROFITS ON THESE ADVANCES!
Shout out against cuts to health care and the need for entitlement reform! If your democratic incumbent is not shouting out about the need to recover fraud and not cut services and access.....THEY ARE THIRD WAY CORPORATE DEMOCRATS!!!
LOCALLY:
Regarding AG Doug Gansler shouting out against a 25% increase in health insurance premiums:
I'd like to say that it is refreshing that Doug Gansler knows a crime when he sees it.....this is a first. It is indeed a crime to allow people to die from lack of access to health care in order to maximize health industry profits which is what private health systems do. Better for the Attorney General to shout out that in Maryland there are no laws that define health fraud adequately to prosecute and there is a cap on awards that make it impossible for the public to seek justice....that would be his job. Your Maryland Assembly incumbents are Third Way corporate democrats who work for wealth and profit.....neo-liberals.....at the expense of labor and justice. We just need to be rid of them and run and vote for labor and justice candidates to reverse what is an inhuman practice of allowing people to die to maximize profit. This policy is written and pushed by Johns Hopkins by the way. We do have a growing Health Care NOW- Maryland that is a universal care organization fighting against these profit-driven policies. Remember, Maryland Health Care for All is simply a Hopkins non-profit working to make sure universal care does not happen in Maryland so do not go there for activism!
Why is Doug shouting out against this 25% health insurance increase while doing nothing regarding billions of dollars in health fraud by doctors and health institutions in this state each year? It is an election headline that all Maryland media will provide with no questions asked. Gansler is a Wall Street team player so he will get the headline he needs for his campaign. This AG knows that these health insurance agencies just received a hike in 2011 and 2014 is just next year so there would likely have been no increase until after the implementation anyway. Think back to the BGE/Exelon merger when the same politicians told us the merger would not bring rate increases and then just months after the merger was complete they asked for a rate increase that almost doubled the current rate. This is the same thing.
Gansler seeks cap on health insurance rate increases Suggests no more than 5% until federal reform is fully implemented
By Andrea K. Walker, The Baltimore Sun 9:27 p.m. EDT, June 4, 2013
Maryland Attorney General Douglas Gansler urged state regulators Tuesday to cap the amount that insurers can raise premiums under the new health care law to no more than 5 percent until more is known about how the sweeping federal legislation will affect health costs.
The call comes as the Maryland Insurance Administration reviews requests by insurers to raise rates on those who will buy coverage from a statewide exchange, or open marketplace, established under the Affordable Care Act.
CareFirst BlueCross BlueShield, the region's largest insurer, is seeking an average rate increase of 25 percent for those who buy coverage individually. Some of its customers could see increases of 100 percent to 150 percent.
The issue reflects the continued uncertainty and challenges facing states as they implement the federal health care law, key provisions of which will go into effect in January.
No one knows how many people will sign up for health coverage or how much it will cost to implement the system. The Obama administration says costs will go down as more people enter the system.
Critics, including insurers across the country, are bracing for the higher cost of covering more and sicker people. Some say that the practice of denying coverage to people with pre-existing conditions helped to keep insurance costs down.
Under the Affordable Care Act, insurers may no longer refuse policies to those with pre-existing conditions.
Maryland, which is ahead of other states in implementing the provisions of the health care law, is experimenting with its own plan to lower costs. Officials are trying to persuade the federal government to adopt a plan that would tie hospital rates to the state's economy.
But the Centers for Medicare and Medicaid, the federal agency that administers the programs, won't decide on the state's proposal until later this year. In the meantime, state officials must make difficult decisions.
Gansler, a Democrat who is expected to seek his party's nomination for governor in 2014, wrote a "friend of the court" brief on behalf of several states that supported the Affordable Care Act. He argued that Congress had the right to mandate that Americans buy health insurance as a means of regulating the economy under the Commerce Clause of the U.S. Constitution.
The rate proposals that Gansler is contesting would not affect most people, who purchase insurance through job-based plans.
Gansler said it is unfair for insurers to request huge increases before the full impact of the health care law is known. He said rates should be capped and then re-examined six months after the law takes effect.
He contends that raising premiums will price people out of the market, defeating the purpose of the federal law, which is to make health insurance more affordable and expand the number who are covered.
"We don't know what is going to happen to health care costs, but the insurance companies are preying upon the idea that they will rise to jack up premium costs," Gansler said.
Under state law, Maryland Insurance Commissioner Therese M. Goldsmith has the sole power to review and approve insurance premiums. Gansler has no legal authority to set the rates, but he could sue to obtain a refund for consumers if it is found that they were gouged by unnecessarily high rates.
Goldsmith declined to be interviewed for this article. Her office released a statement saying that the rate requests are under review and that the commissioner will consider "all relevant factors" under the law.
"The law requires that the commissioner disapprove or modify a proposed premium rate if, based on statistical analysis and reasonable assumptions, the rate appears to be inadequate, unfairly discriminatory, or excessive in relation to benefits under the plan," the statement read.
Chet Burrell, the CEO of CareFirst, has said insurers need to implement a 25 percent premium increase because the cost of health care under the law is uncertain. He said the company's margins leave little room for mistakes.
"As a not-for-profit carrier, CareFirst operates essentially at cost and over the past five years has never produced an operating margin greater than 1 percent," the company said in a statement. "Premiums closely reflect actual cost. That is essentially what CareFirst has sought to achieve in its filings and nothing more."
CareFirst, which has 2.2 million customers in Maryland or 48 percent of the market, said the attorney general should let the rate approval process play out before criticizing it.
This is what our Maryland Attorney General should be hard at work doing. The only fraud collection that happens is when the Feds solve cases that send a small amount back to Maryland....average of a few million each year when we know that billions of dollars in fraud in Maryland occur each year!
Health Insurance fraud
Health insurance fraud is the purposeful act of deceiving, concealing, or misrepresenting the health care benefits being paid to an individual or group.
Health insurance fraud may be defined in the health insurance context as any behavior designed to solicit money to which a person or group is not entitled. Health Insurance Fraud perpetrators include insurance brokers, unscrupulous doctors, chiropractors, allied health professionals, medical institutions, and patients.
In response to the increased amount of health insurance fraud in the United States, Congress, through the Health Insurance Portability and Accountability Act of 1996 (HIPAA), has specifically established health care fraud as a federal criminal offense with punishment of up to ten years of prison in addition to significant financial penalties.
Health insurance fraud cost estimates
The FBI's Health Care Fraud Unit oversees investigations targeting individuals and/or organizations who are defrauding public and private health care systems. Areas investigated under Health Care Fraud include: billing for services not rendered, billing for a higher reimbursable service than performed (upcoding), performing unnecessary services, kickbacks, unbundling of tests and services to generate higher fees, durable medical equipment fraud, pharmaceutical drug diversion, outpatient surgery fraud, and Internet pharmacy sales.
The cost of health care fraud and abuse in both the public and private sectors, is estimated between 3 and 10 percent of total health care expenditures. Total health care spending to is estimated to exceed $3.3 trillion in 2012.
It is estimated that Health Care Fraud will cost the American Health Care system between $99 Billion and $330 Billion in the year 2012.
THIS ARTICLE SHOWS WHAT ARE CLOSER TO REAL NUMBERS....WE KNOW THAT 1/2 OF ENTITLEMENT SPENDING IS FRAUD SO THESE NUMBERS LOOK CLOSE TO THAT REALITY. You will see government figures that say that fraud is only tens of billions of dollars and THAT IS A LIE!!
Cost of Medical Fraud Could Pay for Health Care Reform —By James Ridgeway Mother Jones
| Wed Aug. 19, 2009 4:45 AM PDT According to reporting yesterday on NPR, the cost of medical fraud in the United States runs anywhere from $60 billion to $600 billion a year--in other words, it might actually exceed the price tag for health care reform. Instead of whining about the expense of reform measures, Republicans and Blue Dog Dems might think about saving us money by cracking down on fraudulent practices, which target both the government and private insurers.
Obama has recently announced a new DOJ/HHS task force to combat fraud, and some versions of the health care reform bill have a measly $100 million set aside for anti-fraud measures. It seems like far too little and too late--but apparently, it's more than has been done by past administrations, or by the oversight committees, the appropriations and legislative committees whose job it is to ride herd on taxpayer funds.
Here is a bit from the NPR report:
Medical fraud takes several forms. Most commonly, criminals get a list of patients’ names, then create fictitious doctors. They send bills to Medicare or Medicaid or health insurers for services supposedly rendered to these patients. By the time the payers figure out that the doctors they’re paying are fictitious and no service was ever rendered, the criminals have closed up shop and moved on.
Another popular form of health care fraud is the “rent-a-patient” scheme. Recruiters find people with health insurance willing to get care they don’t need, in exchange for cash or cosmetic surgery. Several years ago, insurers and the FBI said they had cracked a big case. People from 47 states were paid to come to California to receive unneeded care, including colonoscopies and surgery for sweaty palms. The doctors who performed the work reportedly charged insurers a total of $1 billion.
I suppose the libertarian Republicans would say it’s just a small price to pay for our free market system. And of course, if the government started taking a closer look at the crooks who illegally rip off the system, they might also have to deal with the crooks who rip off the system quite legally--the price-gouging insurance and pharmaceutical companies and their ilk.
Below you see an article from just one branch of medicine and how these cuts to Medicare will impact access and quality!
What WYPR and Maryland media is not telling you is that the Affordable Care Act is not about reducing the cost for the consumer, it is about increasing profit for the corporation by limiting access and pushing labor costs ever lower. The ACA is about consolidating the health care institutions into global health systems that will be as big, profit-driven, and unaccountable as Wall Street and will prey on the poor, elderly, and chronically ill not care for them. So, the intent is to end all social safety nets to nothing more than refugee-style public health checkups, make it impossible for the chronically ill and seniors to afford health insurance for quality care, and cheapening the service and research to develop new 'products'. Corporatizing health makes health procedures 'products' to patent and sell for the highest price you know! THIS IS WHAT JOHNS HOPKINS IS DOING FOR MARYLAND CITIZENS AND WHETHER O'MALLEY OR ANTHONY BROWN....OR GANSLER......THESE THIRD WAY CORPORATE DEMOCRATS ARE WORKING HARD TO SEE IT HAPPEN
Medicare Cuts Impact Access to Care
Released: 3/28/2013 12:00 PM EDT
Source Newsroom: American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) more news from this source By Kate Penz, AANEM Communications & Foundation Manager
Newswise — Physicians and patients alike are feeling the impact of Medicare reimbursement cuts that went into effect on January 1, 2013. With an additional 2% sequestration cut to roll out on April 1, it’s likely that physicians who treat Medicare patients will be faced with difficult decisions as operating margins continue to shrink.
The the 2% cuts may seem modest, but they come on the heels of much larger cuts to reimbursement for nerve conduction studies (NCSs) of 40-70% for Medicare beneficiaries. These cuts were announced November 1, 2012, and went into effect on January 1, 2013, allowing providers little time to prepare.
While all Medicare providers are feeling the squeeze, private practices are likely to experience the most impact. “These cuts may force private practice physicians to choose between seeing Medicare patients and keeping their practice open,” said Catherine French, AANEM senior analyst of medical economic affairs. French is concerned that the sequestration cuts will be adopted by private insurers, too. “It is possible that private insurers will follow suit and reduce reimbursement by 2% because most model their payment rates on Medicare.”
Cuts Threaten Access to Care
According to Kristi Snihurowych, MD, a spine interventionalist in Salt Lake City, UT, the cuts pose a serious risk to access to care. Snihurowych has decided to discontinue EMG and NCS testing, which previously made up an eighth of her total practice. “Given the cuts, it’s no longer feasible to perform these tests in-house. The problem is, I cannot find anyone to do them for me,” said Snihurowych. “It seems everyone has had to give them up, and not just for Medicare patients. Providers anticipate that other payers will soon follow suit, so many have stopped offering EMGs all together.”
Snihurowych suspects unnecessary and costly procedures will be among the cuts’ ripple effects. “I am seeing patients go to surgery without a definitive diagnosis of, for example, carpal tunnel syndrome because the surgeons cannot get confirmation by an EMG or NCS test.”
Utah-based physiatrist Faisel M. Zaman, MD, PC, agreed, “People will pay with their health. Of course there will be financial costs associated with unnecessary surgeries, but the biggest cost will be to the patients with scars and pain from procedures they didn’t need.”
Zaman is a spine specialist who has had several cases where an EMG has prevented patients from undergoing major surgery. In one case, a healthy and active 70-year-old male patient was referred by a vascular surgeon who thought the patient was experiencing symptoms of peripheral vascular disease. But the surgeon wanted to rule out spinal problems before he did a major bypass operation. Following EMG testing, the man was diagnosed with spinal stenosis.
“EMG was critical in this case,” said Zaman. “It turns out that he is a great candidate for nonvascular treatments that will improve his condition. Without the lower-extremity EMG, he would have undergone major surgery. It’s scary to think of the consequences to patients if the availability of EMG testing becomes more limited. Ultimately, it would hurt patients the most.”
Claire Wolfe, MD, AANEM past president, has similar concerns regarding access to care. Nearing retirement and working part-time, she is the only physician performing EDX studies for an office of 23 physicians, as well as some outside referrals. Before the cuts, two other physiatrists in her office performed EMGs.
“There will be greater uncertainty around diagnoses of upper and lower limb pain/numbness; neck surgeries rather than carpal tunnel releases and vice-versa; delayed diagnoses of motor unit diseases; and delayed recognition of folks with metabolic disorders like diabetes if patients don’t have access to an electrodiagnostic study that may catch peripheral neuropathy changes before the diagnosis of the underlying disorder is made,” Wolfe said.
Unfortunately, the impact of the cuts may be long-lasting. “These cuts will significantly impact Medicare beneficiary access to appropriate management of their disabling neurologic disorders, limit further the number of neurologists who are currently seeing Medicare patients, and discourage budding physicians from the field of neurology,” said Mohammed Zafar, MD, in response to an AANEM survey about the Medicare reimbursement cuts for EDX procedures.
Looking Forward
With the cuts to Medicare reimbursement, AANEM members are asking what can be done to protect their practices and to ensure access to care for patients into the future.
Get Involved in Policymaking
AANEM state liaison P. Caudill Miller, MD, actively encourages physicians who practice EMG to get involved in policymaking. Miller is a neurologist practicing at Neurology Consultants of Montgomery in Montgomery, AL. A longtime member of the AANEM, he has been involved in EMG quality control issues and has worked to improve insurance reimbursement.
“We have one year to prove the impact of the cuts on patient care,” said Miller at a recent meeting of AANEM member physicians in Birmingham, AL. “More than ever it’s important that fraud and abuse be reported.”
In fact, now is an ideal time to reach out to your local representative’s office, as the federal legislature is on break March 25 through April 5 and many representatives are in their home states.
Seek Certification and EDX Laboratory Accreditation
In December, AANEM representatives met with Jonathan Blum, deputy administrator and director at the Center for Medicare & Medicaid Services (CMS), who explained that the cuts resulted in part from the CMS’ concern over the substantial increase in use of NCS codes. AANEM President Peter Grant, MD, explained that we are working hard on abuse issues that affect increased use of NCS codes. The AANEM is working to provide input to CMS on how best to curb abuse, including recommending proper tests are performed by certified physicians in accredited laboratories.
“One way to combat abuse is to ensure EDX testing is performed by a board-certified neurologist or physiatrist, preferably by the American Board of Electrodiagnostic Medicine,” said Grant. “Also, it is important that EDX laboratories apply for the AANEM’s EDX Laboratory Accreditation Program. The program is meant to identify and acknowledge EDX laboratories for achieving and maintaining the highest level of quality.” There is precedent for CMS only paying for studies performed in accredited laboratories. For example, reimbursement for mammography is dependent on accreditation of the facility where the test was performed, and sleep medicine is held to a similar standard.
While it’s true that the cuts to EDX physicians are the reality facing many procedure-based fields, it is still important for AANEM members to become involved. Please see the “How you can help” section on this page for more information.
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Did you hear the US Health Secretary Sebelious tell us that Medicare will now last 2 years longer? They cut $1 trillion from the Medicare budget causing millions of seniors to not be able to afford to access health care and that is what is saving the Trust money. It's like spending less on groceries by starving your child and thinking that is a success. No wonder she couldn't look into the TV camera. These are evil people we have in office today and they need to go. We simply need to retake the democratic party from the neo-liberals who work for the 5% shareholders and bring it back to the 80% of labor and justice!!!
JOIN HEALTH CARE NOW - MARYLAND AND WORK FOR UNIVERSAL CARE!!!!
As this reporter knows the problem with Medicare and Medicaid ---AKA Entitlements---is that there has been massive fraud by doctors and health institutions these few decades that have emptied these Trusts. Doctors and watchdogs say that as much as 1/2 of all entitlement spending is stolen.....$200-400 billion each year. So, one would think that the priority in shoring up these programs would be to recover trillions of dollars in fraud first, then look at what adjustments need be made.
The second problem is that since Reagan's time payroll taxes have been sent to Treasury rather than the Trusts. Reagan raised the payroll tax considerably in the 1980s just so these Trusts would be healthy.....and they are except for the fact that they are raided over and over. So, we do not have a shortfall, we have thieves and a Justice Department that has simply suspended Rule of Law. Just think, with Entitlement spending at $600 billion and more each year, if you stopped the fraud of 1/2 of that.....that makes spending at $300 billion and you recover trillions of dollars to the Trust.....THESE TRUSTS HAVE PLENTY OF MONEY AND THERE IS NO NEED FOR CUTS IN COVERAGE AND QUALITY! This is needed for Social Security as well!
What we do have is a Third Way corporate democratic leadership....neo-liberals...who work for wealth and profit so they are pretending there need to be cuts and make no mention of theft. We need to give these neo-liberal the boot and run and vote for labor and justice in the next elections!!
U.S. Medicare outlook improves as healthcare costs ease
WASHINGTON | Fri May 31, 2013 3:04pm EDT Reuters
(Reuters) - Slower growth in U.S. healthcare costs improved the budget outlook for the Medicare program for the elderly from last year, but the fortunes of the Social Security pension program have not changed despite a better economy, trustees of the programs said on Friday.
The trustees repeated warnings to Congress to pass reforms that will enable the programs to meet all of their long-term obligations, but their report adds to recent evidence of an easing in U.S. budget pressures, and could help encourage a sense of complacency in Washington.
The main trust fund that supports the Medicare healthcare program will be depleted in 2026, two years later than forecast last year, the trustees said in their annual status report.
The trustees attributed the improvement to lower projected spending for most treatment categories, especially in skilled nursing homes, an assumption in keeping with recent signs of slower healthcare inflation.
They also said the implementation of key parts of President Barack Obama's healthcare reform law next year will reduce costs by more than previously projected.
The report said the Social Security fund for retirees will be depleted in 2033, the same as forecast last year. But a much more pressing need is the 2016 depletion date for the Social Security's trust fund that pays benefits to people with disabilities.
While this is also unchanged from last year's report, it means that Congress now only has three years to agree on new funding or reforms that would avoid reduced payments to beneficiaries.
Depletion of the Medicare and Social Security trust funds does not mean that all benefits would stop. At the current rate of payroll tax collections, Medicare would be able to pay about 87 percent of costs after 2026, declining to 71 percent by 2047. Social Security would be able to pay about three quarters of its benefits through 2087, according to the report.
REFORM ENTHUSIASM DIMS
The programs represent the two largest federal expenditures and account for about one-third of all U.S. fiscal outlays. The reports will feed into bitter arguments between Democrats and Republicans over how to reform the programs to keep them solvent and able to support the needs of the massive Baby Boom generation that is now starting to retire.
The healthcare improvements cited by the trustees in the report could dampen enthusiasm, particularly among Democrats, for any reforms to entitlement programs. The report comes on the heels of other signs showing a quick, if only temporary, reduction in the U.S. budget deficit.
"It reinforces a consensus in this city that the crisis isn't imminent," said Greg Valliere, chief political strategist at Potomac Research Croup, a firm that advises investors on Washington politics. "A mood of complacency is intensifying over entitlement reform. There's no sense of urgency."
U.S. Treasury Secretary Jack Lew said the report supports Democrats' approach of protecting the basic structure of Social Security and Medicare, while reducing healthcare costs and excessive drug subsidies and asking wealthier seniors to contribute more.
While the Obama administration wants to work on bipartisan reforms to strengthen the programs' financial footing, Lew said "changes to Social Security and that involve deep cuts in benefits or privatization will be unacceptable."
Senator Bernard Sanders, a liberal Independent from Vermont, said the report shows that Social Security "is not going broke" and argued against Obama's proposal to limit future cost-of-living increases by applying a less-generous measure of inflation.
Sanders in a statement said the report showed the wealthy should pay more into the pension program. "We must lift the cap on Social Security payroll taxes and make the wealthy contribute the same percentage of their income as other workers," he said. "Today, someone making $10 million a year contributes the same amount of money as someone making $113,700. That is absurd."
Republicans in the House of Representatives, meanwhile, have proposed massive long-term changes to Medicare that would effectively convert the popular fee-for-service program into a voucher-like system that provides a subsidy to seniors to buy private health insurance.
"Today's report is yet another reminder that Medicare and Social Security are in great danger," said a spokesman for House Budget Committee Chairman Paul Ryan of Wisconsin, the leading Republican fiscal voice. "We need to protect and strengthen these critical programs."
Republicans also want to repeal Obama's healthcare reforms. But the report said the "modest improvement" in the Medicare finance outlook came from lower projected spending for most service categories "that reflect recent data suggesting that certain provisions of the Affordable Care Act will reduce growth in these costs by more than previously projected."
(Reporting by Margaret Chadbourn and David Lawder; Editing by Vicki Allen and Tim Ahmann)
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THE HEALTH LAW DIDN'T BLUNT COSTS......$1 TRILLION IN CUTS TO MEDICARE IN THESE FEW YEARS HAVE CUT COSTS.....AND ACCESS TO CARE FOR SENIORS!!!!
THESE PEOPLE ARE ANIMALS!
Medicare’s Deterioration Slows as Health Law Blunts Costs By Alex Wayne & Anna Edney - May 31, 2013 3:46 PM ET Bloomberg Financial
The $574 billion Medicare health system, the second-largest U.S. social services program, will exhaust its main financial trust fund in 2026, two years later than predicted as the Affordable Care Act helps control costs.
Assets for the Part A trust that pays for hospital visits, nursing care and related services for Medicare’s 51 million elderly and disabled beneficiaries, fell $23.8 billion in 2012, according to a report today from the program’s trustees. That compares with a net drop in assets of $27.7 billion for 2011.
The decrease was the smallest since 2009 as debt-reduction legislation enacted two years ago included payment cuts that begin taking effect this year. The data should be useful in the debate between President Barack Obama and Republicans over the best approach to improving Medicare’s long-term footing.
“This is meaningful, but two years, I don’t think anyone should get too excited,” said Marilyn Moon, a senior vice president at the American Institutes for Research in Washington. “There is no reason to believe things have gotten worse, things have gotten a little better and we will get some breathing room over time to decide what to do with Medicare.”
Republicans have considered raising the Medicare eligibility age and switching to a system in which beneficiaries get subsidies to buy private insurance, instead of the government paying for their care. Obama has sought to mostly keep the current structure and instead find ways to boost efficiency of the program and reduce excess costs, partly through provisions in the 2010 health-care law he helped create.
ACA Effect “With the health-care law, our goal was to put Medicare on more stable footing,” Health and Human Services Secretary Kathleen Sebelius said at a news conference. “The past few years have borne out that promise.”
Medicare will be bankrupt in 13 years and the report shouldn’t provide comfort, Senator Orrin Hatch, a Republican from Utah, said in a statement.
“Slower economic growth means that fewer Americans are purchasing health care,” said Hatch, the top-ranking Republican on the Senate committee that oversees Medicare. “As our economy improves, there will be a greater deterioration in the health of the Medicare program for our seniors.”
Hatch has suggested allowing private health plans to compete for Medicare beneficiaries as a way to reduce costs along with raising the program’s eligibility age.
Funding Warning Moon said the improvement in Medicare resulted from a combination of “the economy, the fact that the new people on the Medicare rolls are swelling it but they are healthier because they are younger, and some of the reforms are starting to kick in.”
While the data today showed improvement, the program’s financial condition was still enough to trigger the eighth consecutive “Medicare funding warning.” That designation by the trustees requires Obama to propose new funding or cuts in benefits, a mandate that he and his presidential predecessor have ignored.
“To date, lawmakers have never allowed the assets of the Medicare HI trust fund to become depleted,” the trustees said, referring to the Part A hospital insurance fund.
If Congress weren’t to prevent insolvency, steep cuts in payments to hospitals would result.
Private Plans In a report released alongside the Medicare data today, the projection for the 2033 exhaustion of the U.S. Social Security trust funds, used to make retirement and disability payments, was left unchanged.
Medicare’s total spending rose about 4.6 percent to $574 billion in 2012, from $549 billion in 2011, the report shows.
The program has three parts -- A, B and D -- that cover hospital in-patient stays, outpatient services and prescription drugs. Part C is the Medicare Advantage program, in which private insurers including UnitedHealth Group Inc. (UNH) and Humana Inc. (HUM) contract to provide those services in place of the government.
Parts B, C and D, whose trusts are collectively referred to as SMI, are adequately financed for now, the trustees said.
Medicare’s trustees include Lew, Sebelius, the Labor Department secretary, Social Security commissioner and two members of the public. The board annually reports on the program’s financial condition.
“It doesn’t look like the trail we are on quite gets to the cliff as fast as we might have thought, but it doesn’t mean we can afford to coast and say things have slowed down and everything is OK,” said Stuart Guterman, a vice president at the Commonwealth Fund, a New York-based nonprofit group that advocates for better health care.
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This is actually a good thing as we need to look at these doctor's bills in order to stop what we know is massive entitlement fraud...
Federal judge lifts ban on public access to Medicare data
- By Maurice Tamman
Fri May 31, 2013 8:01pm EDT
n">(Reuters) - A federal judge lifted a 33-year-old injunction barring public access to a confidential database of Medicare insurance claims, a decision that could lead to greater scrutiny of how physicians treat patients and charge for their services.
Judge Marcia Morales Howard ruled Friday in favor of a motion by Dow Jones, publisher of the Wall Street Journal, that the U.S. District Court for the Middle District of Florida lift an injunction imposed in 1979.
The American Medical Association had fought lifting the ban, arguing that disclosure of the information would violate physicians' right to privacy. Doctors had successfully made the same argument in 1979, when a judge ruled the release of such information would violate the 1974 Privacy Act.
The AMA suggested Friday that it might appeal the decision. In a statement, AMA President-elect Ardis Dee Hoven said the doctors lobby was "considering its options on how best to continue to defend the personal privacy interests of all physicians."
Officials at the Centers for Medicare and Medicaid Services couldn't be reached for comment. A Dow Jones spokeswoman declined to comment.
Dow Jones went to court in January 2011, attempting to overturn the injunction after a series of stories in the Journal found tens of millions of dollars in fraud and other abuse by doctors and other Medicare providers. Medicare is funded by U.S. taxpayers.
The Journal's work, however, was restricted by limitations placed on the data released by the U.S. Department of Health and Human Services, which rendered anonymous all information pertaining to individual Medicare providers. That meant reporters weren't allowed to name individual doctors who the Journal identified solely through using the data.
In her ruling, Judge Howard said that because judicial rulings in the years since the injunction have restricted the Privacy Act's reach, the ban was based "upon a legal principle that can no longer be sustained."
When the suit was filed, the Journal's editor-in-chief at the time, Robert Thomson, said: "The Medicare system is funded by taxpayers, and yet taxpayers are blocked from seeing how their money is spent. It is in the interest of law-abiding practitioners that those who are gaming the system are exposed."
Dow Jones is a unit of News Corp.
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