Keep it simple today: Keep up to date about what is going on in the health insurance field and how it is likely to impact your experience. Knowledge must constantly be protected from becoming stale. How many times do we think we know about something only to find out that our knowledge is incomplete, out of date or perhaps even wrong. In the Health insurance experience, the temptation to ignore all things health insurance during the year is great. After all, it's boring and complex. But is your health boring? How 'bout your money?
In an effort to protect the knowledge we've gained, today we can examine a change in Federal Medicare legislation under the Medicare Improvements for Patients and Providers Act, HR6331.
First, let's remember the stakeholders: Health services providers (including physicians, their interest is primarily money), Government representatives (who are looking for support by people who vote for them and therefore tend to look at how many people support their actions and how little government involvement in the day to day responsibility for health insurance they can take), Health insurance companies who earn the most money when they can charge a lot in premium to deliver as little as possible in "coverage" and finally the consumer who wants the best medical care for the least cost.
Shortcuts: Legislation is dense and confusing. So how can we best assess health legislation. SHORT CUTS: A few tips include looking at comments by stakeholders, the government, the providers, the insurance companiest, in this case Speaker, Nancy Pelosi a Democrat supports the legislation.
What does it do? Why would it appeal to her? Well, it extends and IMPROVES low income assistance for Medicare beneficiaries. The bill also REDUCES costs out of pocket for mental health services. The bill also DELAYS Medicaid limits on payouts to pharmacies based on Average Manufacturer Price until September 2009. The bill adds rules for Medicare Advantage Plans. There are also several provisions regarding rural access to medical services. OK, so that covers popular ideas for government officials, spreading the NUMBER OF PEOPLE who will benefit (emphasis on rural people and expanding who is eligible for low income coverage) AND more rules for those charging the government, specifically Medicare Advantage Plans which are Medicare Plans through PRIVATE INSURERS. Government loves the idea of Medicare Advantage because it contracts out the business of insurance to insurance companies, but the lack of rules has had some ghastly consequences including overcharging the government, luring seniors in with "teaser" rates and then raising their costs, leaves providers of services unhappy as they experience the delays in insurance company payments.
In this case the giant Physician Lobbyist the American Medical Association declares VICTORY on its website. Why? Because physicians used every pressure in the book to protect their income derived from Medicare. For months we have read about how doctors will not take on new patients for Medicare unless their incomes are protected. Guess what, it worked. The legislation not only eliminates the 10% REDUCTION in physician fees originally provided for but includes INCREASES in payment including 1.1% right off the bat and an extra 2% as "FINANCIAL INCENTIVES" to use e prescribing technology.
You can probably guess where the insurance industry comes down on this legislation. AHIP, the largest health insurance industry lobbyist is AGAINST this legislation. Remember, Medicare Advantage Plans are horrible for consumers because they sold themselves as economic ways of having all your insurance needs met by one insurance company BUT the plans were not held to the minimal laws applied to standard Medicare plans. This legislation provides for phasing out Indirect Medical Education, a way that plans actually got double payments for IME. Hospitals will get payments but the insurance plans won't. Requiring that a sufficient number of providers, you know, people who actually accept the insurance exist. Private Fee For Service Plans lured people into participation who found an insufficient number of providers who accepted their insurance. The bill provides for "adequate access to providers." Further, there are new rules for marketing the plans AND the Medicare Advantage "slush" fund which was used to INCREASE payments to private plans is eliminated under the legislation. So what does AHIP say?
AHIP is full throttle in threaten mode: Seniors "will be shocked to learn they could face fewer choices, reduced benefits, and higher out of pocket costs." The budget savings are at the "expense" of the Seniors. AHIP attacks physicians who are getting their pay increase off the backs of seniors. Seniors are satisfied with Medicare Advantage plans.
As a final step in assessing this legislation, Barack Obama is against Medicare Advantage Plans because they represent "corporate welfare", subsidies to insurance companies for Medicare patients. Obama pointed out that the Medicare Advantage plans cost taxpayers more, can increase premiums paid by seniors and has left some without coverage in their geographic area.
Forming your own opinion: 1) Familiarize yourself with the viewpoints of the stakeholders. 2) Are consumer interests represented? To some extent yes though the legislation is heavy on the rural access provisions and if you don't live in those areas you might not support those expenditures. Further, physician payment protections in response to threats is unappetizing on many levels. Also, what if now that they got what they wanted, physicians use the same bullying tactic to demand more or refuse patients. Time will tell, my view is that physicians will keep demanding more and more, after all, threats worked!3) I still don't like Medicare Advantage Plans because they are not subject to sufficient rules. If the government wants to outsource the administration of a Medicare plan, they must be held to the same standards as traditional Medicare plans. 4) Costs for plans will rise for consumers so this may actually help fix the Medicare Advantage problem and perhaps consumers will vote with their dollars. 3)You might not be on Medicare. You might not want the government to spend another nickel on Medicare until there is a PLAN to make sure YOU will get your government benefits when you are older.
Plan on glancing at the AMA lobbyist website and the AHIP lobbyist website. These two sites help show how organized groups pressure government to the tune of billions. It will also help you understand the motivation behind the points of view put forth by certain industries.
Do you still think that Physicians are happy about the legislation because now they can go on "serving" the elderly?
Do you still think that health insurers are doing the best they can in an environment of spiraling medical costs?
