ObamaCare drastically reduces payments to MA plans; the cuts will total $150 billion over 10 years. This will force insurers to scale back the extra benefits they are able to provide seniors, or to withdraw their plans entirely from some markets. In some rural areas, these cuts may force all existing MA plans to pull out, leaving the beneficiaries with no options outside of the traditional program. An analysis of the MA cuts by Robert Book of the Heritage Foundationand ObamaCare Watch’s Jim Capretta has shown that, on average, MA enrollees will lose $3,714 worth of extra services by 2017 due to the MA reductions in ObamaCare. These reductions will also mean that 7.4 million beneficiaries who would have enrolled in MA in 2017 will be forced into less preferable options by the MA cuts. That’s a full 50% reduction in expected MA enrollment. The impact of the cuts will be even more dramatic in certain localities (as documented in the Book-Capretta analysis). This is one of the most concrete violations of the President’s pledge that “If you like your plan, you can keep your plan” in the entire law. Medicare Commission ObamaCare creates a new, unelected board -- the Independent Payment Advisory Board, or IPAB -- to cut Medicare even further. This board would be independent from Congress, and is empowered to make cuts that will automatically get implemented unless a veto-proof majority of Congress overturns them with subsequent legislation. The law prevents the IPAB from making any substantive reforms or improvements to Medicare; the only mechanism available to cut costs and hit budget targets is payment rate reductions for providers of services, cuts which only servie to drive even more hospitals and other providers of services to drop out of the program. Accountable Care Organizations One of many new ideas to cut costs is the creation of Accountable Care Organizations (ACO). These are effectively government-encouraged HMOs, except with hospitals and doctors, and not insurers, running them. The theory is that if hospitals and doctors get to share in the savings, they will find ways to manage care more efficiently for Medicare patients. The problem with ACOs, however, is that Medicare beneficiaries are going to be assigned to them involuntarily by the government. Thus, many seniors who today enjoy complete freedom of choice of physicians could find themselves in an ACO in which their physician has a financial incentive to steer them away from the specialists they have normally used for care. Pilot Programs ObamaCare authorizes scores of pilot programs from 2013 to 2016 which give the government the authority to experiment in Medicare with different payment models. Furthermore, ObamaCare establishes a Center for Medicare and Medicaid Innovation to sponsor additional research into new ways of paying for services. Proponents of ObamaCare have invested great hope in these pilots. But history indicates they are very unlikely to produce anything of tangible value. In the past, pilot programs have not worked to fundamentally change Medicare because program administrators have found it much easier to impose arbitrary cuts on all licensed providers than to pick and choose winners and losers based on disputable measures of quality and performance.
Posted on: Sun, 29 Sep 2013 18:12:04 +0000
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