News In Healthcare

Rep­re­sen­ta­tive Jerry Weller (Il.) spon­sored an amend­ment to the 2008 Labor, Health, and Human Ser­vices, and Edu­ca­tion Appro­pri­a­tions Bill (H.R. 3403) which, with the approval of almost 270 mem­bers of Con­gress, pro­hibits CMS from reduc­ing Medicare pay­ments to hospitals.   The cuts were CMS’ way of recoup­ing funds it believes it will over­pay to hos­pi­tals in the future.  In his blog, Rep­re­sen­ta­tive Weller thanked his col­leagues for vot­ing for the amendment.

The Min­neapo­lis Star Tri­bune recently reported that more physi­cians are going to start turn­ing away new patients cov­ered by Medicare.  Why?  The physi­cians say they can’t afford to treat Medicare patients espe­cially with the expected reim­burse­ment cuts in 2008.  Accord­ing to the Amer­i­can Med­ical Asso­ci­a­tion, the reim­burse­ment prob­lem is tied to the for­mula used to cal­cu­late pay­ments.  It is tied to the gross national prod­uct so when the econ­omy slumps, so does the reim­burse­ment to the physi­cians.  The prob­lem is that the cost of health care doesn’t fol­low suit.

On May 7, 2007, we wrote about a report that some sales peo­ple for Medicare Advan­tage plans were engag­ing in wrong­ful and decep­tive prac­tices in order to get indi­vid­u­als enrolled.  Well, now Con­gress is look­ing into the mat­ter.  A hear­ing was held today by the Sen­ate Spe­cial Com­mit­tee on Aging to get to the bot­tom of the issue.  We will report back as to the out­come of the hearing.

Well, read the Senator’s entry on The Hill’s Con­gress Blog and you will find out.   Yes­ter­day, Sen­a­tor Bernie Sanders of Ver­mont com­mented on all of the recent action regard­ing pre­sprip­tion drugs and the power of the phar­ma­ceu­ti­cal indus­try lobby.   In a nut­shell, Sen­a­tor Sanders’ view is “What this debate on pre­scrip­tion drugs is really about is not safety.  It is about the power of the phar­ma­ceu­ti­cal indus­try, which in this city of enor­mously pow­er­ful spe­cial inter­ests stands alone as the most impor­tant, and in my view the greed­i­est lobby in the entire United States of America.” 

Accord­ing to some con­sumer advo­cates, as well as state and fed­eral offi­cials, some insur­ance com­pa­nies are using ques­tion­able tact­cis to get seniors enrolled in Medicare Advan­tage plans.  Accord­ing to a report in the New York Times, the Medicare Advan­tage plans are typ­i­cally pri­vate “fee-for-service” plans and actu­ally cost the fed­eral gov­ern­ment far more than the tra­di­tional Medicare pro­gram.  The “unscrupu­lous sales­peo­ple” are per­suad­ing Medicare recip­i­ents to move to the pri­vate plans because they bet­ter coor­di­nate care or they offer more ser­vices.  Accord­ing to fed­eral offi­cials, Medicare Advan­tage plans typ­i­cally do not coor­di­nate care and may cost the indi­vid­ual, as well as Medicare, more money.  The arti­cle details sto­ries of vic­itms of these mar­ket­ing tac­tics from all over the coun­try — an insur­ance agent forg­ing the sig­na­ture of a woman to get her enrolled, sud­den respon­si­bil­ity for co-payments of over $1,000 every three weeks, and sign­ing up deceased individuals.

That’s the mes­sage being deliv­ered by Sen­a­tors Norm Cole­man (R-Minn) and Carl Levin (D-Mich).  This week, the two Sen­a­tors are expected to intro­duce leg­is­la­tion which would require Medicare to with­old pay­ments to physi­cians who owe fed­eral taxes.  The arti­cle on TwinCities.com explains that the bill would also autho­rize the recov­ery of non­tax debt, such as unpaid stu­dent loans and child support.

At the hear­ing on the 2007 Report of the Board of Trustees of the Medicare Trust Fund, Chair­man Pete Stark opened by say­ing, “Despite the gloom and doom fore­casts and rhetoric from some of my col­leagues, this year’s Trustees report shows that Medicare remains sol­vent and sus­tain­able.”  In regards to the 45% fund­ing warn­ing that was reached for the sec­ond year in a row, Stark said that fig­ure “is lit­tle more than an arbi­trary, hid­den hatchet designed to elim­i­nate Medicare’s enti­tle­ment and con­tinue the march toward pri­va­ti­za­tion .…”   So last week we reported that Medicare will be obso­lete by 2019.  Today we report that Medicare is just fine.  Who and what are we to believe?

Rep­re­sen­ta­tive Pete Stark, Chair­man of the House Ways and Means Health Sub­com­mit­tee, announed that a hear­ing will be held on May 5, 2007 to dis­cuss finan­cial assis­tance pro­grams for low-income Medicare ben­e­fi­cia­ries.    The focus of the dis­cus­sion will be on the cur­rent state of the Part D Low Income Sub­sidy, the Medicare Sav­ings Pro­grams, and oppor­tu­ni­ties to increase enroll­ment and expand eli­gi­bil­ity in these programs.

Last week Pres­i­dent Bush par­tic­i­pated in a meet­ing regard­ing Medicare Part D.  Dur­ing the meet­ing, Pres­i­dent Bush declared the Medicare Part D reforms “a great suc­cess.”  He wants to take the prin­ci­ples that worked in that reform and apply them to the over­haul that is nec­es­sary for Medicare and Social Secu­rity.  Those prin­ci­ples are com­pe­ti­tion in the mar­ket­place and trust­ing peo­ple to make deci­sions in their lives.    Kind of sounds like a pre­cur­sor to a plan for high deductibles and health sav­ings accounts in the Medicare arena, doesn’t it? 

Can it be?  Sen­a­tor Edward M. Kennedy and Rep­re­sen­ta­tive John Din­gell intro­duced leg­is­la­tion on April 25 that is aimed at extend­ing Medicare to all Amer­i­cans, from birth to the end of life.  Under the pro­posed plan, any­one with a social secu­rity num­ber is eli­gi­ble to par­tic­i­pate in the plan unless they choose one of the pri­vate options.  The plan will be financed by a com­bi­na­tion of pay­roll taxes and gen­eral rev­enues that will sub­sti­tute for pri­vate pay­ments.  This will be one to watch!