Medicaid verse Medicare, and Obamacare closing access and hospitals!

Record 70.4 Million Enrolled in Medicaid in 2011: 1 Out of Every 5 Americans By Matt Cover November 9, 2012   (CNSNews.com) – A record 70.4 million people were enrolled in the Medicaid health care program for the poor in fiscal year 2011, according to government figures provided to CNSNews.com. That figure equals about 22 percent of the population, which means there was one person on Medicaid for every 5 Americans in 2011. The record number of Medicaid enrollees in 2011 – the earliest year for which figures are available – is a count of all persons enrolled in Medicaid for any part of that year, providing the fullest and most accurate count of the size of the entitlement program. (The federal fiscal year in 2011 ran from Oct. 1, 2010 to Sept. 30, 2011.) Figures provided to CNSNews.com by the Centers for Medicare and Medicaid Services (CMS), the agency that oversees the two health care entitlements, reveal an ever-expanding Medicaid program. From 2005 to 2011, total enrollees grew by more than 10 million people, going from 60.1 million in 2005 to 70.4 million in 2011. Medicaid is the joint federal-state health care program for the poor that allows states to extend coverage beyond those who are in poverty. Recently, the ObamaCare health reform law expanded Medicaid eligibility to those living on 133 percent of the federal poverty level. The poverty level annual income for a family of four is $23,000 – 133 percent of that, in terms of annual income for a family of four, would be $30,590. That expansion does not go into effect until 2014, however, and therefore does not affect the continued growth trend. Nor does it contribute to the record 70.4 million Americans enrolled in Medicaid.   According to CMS statistics, Medicaid has been growing rapidly since 2008, going from 62.8 million total enrollees to 70.4 million in 2011. Prior to 2008, Medicaid rolls had remained relatively stable, going from 60.1 million in 2005 to just 60.9 million in 2007. While Medicaid rolls would be expected to rise during a recession, as they did in 2008 and 2009, the last recession ended in June 2009 and Medicaid rolls have expanded faster than during the 2005-2008 period. Medicaid rolls have grown by 5.2 million Americans since 2009 – when the recession ended and the economy began to grow again slightly. Despite a period of modest gains in employment and economic growth, Medicaid rolls have grown to their record high of 70.4 million Americans.Medicare reimbursement is already low, and Obamacare will decrease this reimbursement rate by another 15% to 40%. The effect will be many physicians and health systems will limit their number of Medicare patients seen. Worse yet…health systems will be forced to drop Medicare patients! A second effect will be hospitals located in areas populated by a high percentages of Medicare patients then be forced to shut their doors (close)!   Then there is Medicaid! Just check out how badly Medicaid pays physicians and hospitals for services rendered:
How much each state pays doctors for Medicaid primary care services compared to Medicare rates.
State	Pct. of Medicare Rates
AL	70%
AK	125%
AZ	86%
AR	69%
CA	43%
CO	77%
CT	72%
DE	98%
DC	94%
FL	50%
GA	70%
HI	59%
ID	91%
IL	53%
IN	55%
IA	76%
KS	82%
KY	72%
LA	76%
ME	64%
MD	74%
MA	70%
MI	51%
MN	47%
MS	90%
MO	57%
MT	102%
NE	76%
NV	71%
NH	62%
NJ	50%
NM	85%
NY	51%
NC	86%
ND	141%
OH	60%
OK	95%
OR	74%
PA	56%
RI	33%
SC	79%
SD	76%
TX	62%
UT	66%
VT	83%
VA	75%
WA	72%
WV	71%
WI	61%
WY	104%
US Avg.	61%
Source: The Urban Institute, 2010 figures.

Making patients consumers shopping for good deals will lower the cost of medicine!

Best way to lower the cost of medicine: Let the patient become a consumer! Consumers are smart and shop for good deals. I like good deals!

Your health at stake

Obama, Romney & reform

By MICHAEL TANNER

Few election issues will have as much impact on our lives as what will happen to America’s health-care system. After all, health care represents a sixth of the US economy and employs more than 11.5 million workers. And to patients, it represents matters of life and death, involving some of the most important and personal decisions a person can make.

Yet it has often seemed like an afterthought in the campaign. Health-care reform is the signature accomplishment of President Obama’s first term, but barely rates a mention in most of his speeches. Mitt Romney generally includes a ritual promise to repeal ObamaCare, but almost never discusses what he’d replace it with. In fact, both candidates have serious problems with the issue. The ObamaCare law remains extremely unpopular with voters — who oppose it 52-42 in the most recent Rasmussen poll, for example. And Romney labors under the weight of his own Massachusetts health-care plan, so very like ObamaCare. At the least, it makes any Romney discussion of the issue too painfully complex for campaign sound bites.
Still, you can see some clear differences in how the two would approach the issue.

If Obama is re-elected, ObamaCare will be fully implemented. The changes so far have been relatively popular — for instance, letting children stay on their parents’ policies until age 26, or beginning to close the “doughnut hole” for Medicare prescription-drug costs. These reforms have hidden costs, but mostly just that: hidden.

But Jan. 1 will bring a host of new ObamaCare taxes on medical devices, insurance plans and prescription drugs, as well as on investment incomes for higher earners. In 2014, the individual and employer mandates kick in. The Congressional Budget Office suggests that as many as 6 million Americans will get hit with the mandate’s penalty or tax. And many businesses may choose to drop coverage for their workers, dumping them into the new government-run insurance exchanges.

Romney’s promise to repeal ObamaCare will be hard to fulfill unless Republicans also win control of the Senate on Nov. 6. If not, expect years of political skirmishing, with Republicans trying to pick off the law’s most unpopular provisions one at a time.

But a President Romney would have a great deal of power over how much — or how little — money is spent to implement the law. For example, he’s highly unlikely to spend $303 million to hire 4,500 new IRS agents to police the mandate.

What would Romney replace ObamaCare with? His centerpiece is likely to be giving people a tax break for buying insurance on their own, rather than through their employer. That simple step for equality would make health insurance personal and portable, controlled by the individual rather than government or an employer.

Romney believes that letting workers take charge of their own health policies would make them more involved shoppers, demanding better quality and a lower price, and ultimately driving down the cost of insurance. At the same time, he hopes that by making insurance more affordable, he’d expand the number of people who buy it.

We can also expect a President Romney to push for legislation enabling consumers to purchase health insurance across state lines — breaking up the cartels that allow just two insurers, GHI and Empire Blue Cross, to control half of the New York state market.

He’d also deal with the issue of preexisting conditions by guaranteeing eligibility to people who maintain continuous coverage, while helping to finance high-risk pools for others.

The differences are also stark on Medicare. Both Obama and Romney understand that the now-projected level of Medicare spending is unsustainable. The program ran a $300 billion shortfall last year, and faces total future shortfalls of $42.8 trillion to $88.9 trillion, depending on which estimate you believe.

Obama aims to reduce this spending from the top down. Starting in 2017, the 15 unelected bureaucrats of the Independent Payment Advisory Board would have the authority to order reductions in payments to doctors, hospitals and nursing homes. Only a vote of both the House and Senate can overturn IPAB’s package of cuts — and Congress must accept or reject it in total.

The president insists these are only cuts to providers, but reducing reimbursements will most likely lead to more physicians refusing to see Medicare patients, and possibly some hospitals closing.

On the other hand, Romney aims to reduce costs from the bottom up by empowering Medicare beneficiaries. He’d leave Medicare unchanged for current recipients, even repealing $716 billion in cuts over the next 10 years that are part of ObamaCare. But he’d give younger workers a choice between continuing in the current Medicare program and enrolling in a new “premium support” model.

Under the second option, insurers would bid for the right to participate under Medicare. Plans would have to include certain minimum benefits and accept all applicants, regardless of age or health. Retirees would get a government payment equal to the cost of the second-least-expensive plan in their area. If seniors chose a lower-cost plan, they could keep the difference. But if they choose a more expensive plan, they’ll have to pay the extra beyond what the government pays.

The hope is that, as with Romney’s proposal for health insurance generally, the combination of competition and consumer cost-sharing would help hold down costs — for consumers and taxpayers.

Details aside, their approach to health-care reform reflects the candidates’ general governing philosophy. Obama supports an activist government, managing the system from the top down. Romney favors a more market-oriented approach, with individual consumers having more choice, but also more responsibility.

Regardless of who wins Nov. 6, our health-care system is going to look very different in the future.

Michael Tanner is a Cato Institute senior fellow.

Canadian Physicians take another pay cut - Patients suffer! Obamcare would be worse than the Canadian system for Patients and Physicians alike

If Obamacare is not repealed, one may only have to look to Ontario, Canada to see the future of healthcare in America. In the Canadian province, the government unilaterally imposed over $300 million in fee cuts to try to close a $15 billion deficit, which has led to physicians fighting with the government -- and their own medical association -- over payouts, fees, hours, and what exactly constitutes a proper and appropriate salary for physicians and specialists.

By Tony Lee  H/T Brietbart 10/23/12

It is pure chaos where government randomly picks winners and losers.

As the National Post reports, Ontario’s doctors are taking the province to court to fight the $340-million in proposed fee cuts, and some doctors are considering setting up an outside collective bargaining organization to negotiate with the province, claiming that the current group (Ontario Medical Association) that represents them is selling them out to government negotiators. The Ontario government unilaterally imposed these cuts, picking winners and losers

The Ontario government, according to the report, commissioned studies from outside experts and have determined "certain physicians earn too much relative to others, partly because technological changes have made some procedures — like cataract operations — easier and faster to perform."

Meanwhile, Ontario specialists "targeted for fee cuts, however, counter that their income has risen chiefly because they received additional funding to shorten wait lists — meaning they are working harder and longer hours for the extra pay."

David Jacobs, a Toronto radiologist, feels the medical association is sacrificing specialists like radiologists and ophthalmologists.

“We feel that the government’s belligerence and bullying is being rewarded,” he told the Post. “It’s like asking someone with a knife sticking out of their chest if they wouldn’t mind donating blood.”

Many of the speciality groups have publicly expressed their dismay at the government and the medical association, while others have been afraid to comment because they fear the government or the association will retaliate against them.

Radiologists:

“We have not received a clear answer as to why the OMA is sacrificing the interests of a minority of its membership,” the Ontario Association of Radiolgoists says in a toughly worded position paper. “The OMA is not delivering on its duty of fair and equitable representation of radiologists and other similarly affected physicians.”

Cardiologists:
The cardiologists’ association is reserving judgment as fee talks with the Health Ministry play out, said Dr. Bill Hughes, the group’s president.
“If, two or three weeks from now, it appears a few [specialty] sections are really being run roughshod over, then I think you’ll hear voices about (OMA) representation,” said Dr. Hughes.

 Ophthalmologists:

Dr. Nav Nijhawan, chair of the opthalmology section of the association, also hard hit by the cuts, declined to comment.

Not to be outdone, the medical association has launched a constitutional challenge against the Ontario government regarding the unilateral nature of the cuts. With all this infighting, patients end up being the biggest losers, and this chaos awaits Americans if Obamacare is not repealed.

U.S Physician Shortfall will be 33,000 in 2015, and it gets worse from there as more Americans enter the Medicare System!

The Obamacare Primary care physician shortage just got worse. Estimates are pointing to a 50% increase in the predicted shortage fall. That's gonna be a big problem!

 

(Reuters) - The U.S. healthcare reform law will worsen a shortage of physicians as millions of newly insured patients seek care, the Association of American Medical Colleges said on Thursday.

The group's Center for Workforce Studies released new estimates that showed shortages would be 50 percent worse in 2015 than forecast.

"While previous projections showed a baseline shortage of 39,600 doctors in 2015, current estimates bring that number closer to 63,000, with a worsening of shortages through 2025," the group said in a statement.

"The United States already was struggling with a critical physician shortage and the problem will only be exacerbated as 32 million Americans acquire health care coverage, and an additional 36 million people enter Medicare."

Medicare is the federal health insurance plan for people over the age of 65, and census projections show that group growing as the giant baby boomer generation born from 1946 to 1964 hits retirement age.

The U.S. healthcare reform plan signed into law by President Barack Obama in March is designed to provide insurance to 32 million Americans who now lack it.

The AAMC projected a shortage of 33,100 physicians in specialties such as cardiology, oncology and emergency medicine in 2015.

It calls for Congress to increase funding to train new doctors. "The number of medical school students continues to increase, adding 7,000 graduates every year over the next decade," the AAMC said.

It said at least 15 percent more were needed.

Other groups, such as the nonprofit

Obamacare seeks to decrease Physician salaries 10% to 15%! Obamacare seeks to drop Medicare reimbursements 29%!

The take-away here is that the AMA backed ObamaCare, and now the Physicians will have their salaries cut by 10% to 15%. Worse yet the Obama administration is seeking to drop Medicare reimbursements by 29%! Gets worse...Medicaid will drop reimbursements to only 2/3rds of Medicare payments.

 

 

H/T American Thinker

 

September 30, 2011

The Coming Obama Administration War on Doctors

By Scott Kirwin

A recent study in the journal "Health Affairs" compared physicians in the United States with those in Europe, Australia, and Canada and concluded that higher physician fees, including those by primary care physicians (PCPs), were the main reason for escalating health care costs in the U.S. In short, the authors of the study Miriam Laugesen, an associate professor at Columbia University, and Sherry Glied, appointed in June 2010 by the Obama administration to the position of assistant health secretary for planning and evaluation, believe doctors are overpaid.

Glied tried distancing the Obama administration from the study in a statement after the study was announced, saying that the study did not reflect the administration's views. Laugesen has targeted physicians in the past. In her 2009 paper "Siren Song," she compared Congress to Ulysses as being unable to resist the siren song of physicians' groups. Glied's work has been no less controversial, penning a study that found "substantial racial/ethnic disparities in satisfaction with care," implying physicians were racists.

I presented the study findings to the CEO of a non-profit hospital. He believes that this study is the first shot by the Obama administration in a war against physicians to cut health care costs by cutting Medicare payments. There is currently a bill in Congress recommending a 29% decrease in Medicare physician fees, and he believes that the Obama administration will use this study to negotiate a "compromise" cut of 10%-15%. Since private insurance increasingly uses the Relative Value Unit (RVU) method to determine their own reimbursement schedules, this would have the effect of cutting payments not just for Medicare but to private insurance payers as well.

It is ironic that doctors would find themselves targeted by the Obama administration. The American Medical Association endorsed ObamaCare, much to the dismay of a large portion of its members. Although the Association tried to walk back its support two years later, the AMA finds itself in the sights of the administration that got what it needed from the group, and Republicans who view the organization as providing the cover the bill needed at the critical time when it could have been killed. Suddenly doctors find themselves with few friends on either side of the aisle.

Laugesen and Glied's study design suffers from errors of omission and faulty assumptions although it was extensively cited by the press. First, it didn't mention the cost of malpractice insurance, which averages $12,500 per year for primary care physicians but is tiny in countries with national health systems that do not award large payouts. Second, it called the cost of medical school in the U.S. "negligible." Medical school abroad is often free, but American doctors graduate $180,000 in debt that will cost each $400,000 in taxable income to pay off over 15 years after the loan is capitalized and taxes are included. Next the study compared Medicare payments with private insurance payments, but it didn't consider Medicaid, which pays on average a third less than Medicare for the same treatment.

What is the average pay for a primary care physician in 2011? Statistics vary. It should be no surprise that health care personnel placement firms report higher salaries since placement firms encourage lucrative starting salaries so that they can get a bigger cut after they place a doctor. But this overstates salaries since most doctors earn these starting salaries for a fixed time and are then placed on productivity -- whereby their salaries fluctuate depending on the number of patients they see and the procedures they perform in a quarter as translated into RVU's. The Bureau of Labor Statistics reports a median income for family and general practitioners in 2011 of $163,510.

If salaries are the main driver of escalating costs shouldn't they escalate? A 2006 study by the Center for Studying Health System Change reported that in 1995 the average salary for a primary care physician was $135,036. By 2003 that figure had risen to $146,405, but adjusting for inflation by using 1995 dollars, the 2003 salary was $121,262, a 10.1% decrease in just 8 years. Translated into 1995 dollars, the BLS 2011 median income of $163,510 becomes $110,299. Primary care physician salaries have actually declined over the past 16 years. Even Laugesen and Glied's fantastic average of $186,582 is the equivalent of just $125,862 in 1995 dollars, below the 1995 average of $135,036 reported in the 2006 study.

According to the Department of Health and Human Services, in 1995 the per capita national health expenditure was about $3,950. In 2009 the per capita expenditure was $8,086 -- $5,744 in 1995 dollars. Health care costs are soaring -- that's a rise in 16 years of 69% beyond inflation, but Laugesen and Glied's conclusion is wrong. How can primary care physicians be the main drivers of higher U.S. spending on health care when their earnings have fallen over the past 16 years, not risen?

Medicine is a business, but for some reason doctors are penalized when they begin to treat it like one. As the CEO of the non-profit hospital states, "[r]elating the income to the costs born by physicians is a silly comparison. ... That isn't ever done for the lawyers, is it?"

Doctors aren't to blame for the health care system mess, but they will soon find themselves held responsible by an administration that got what it needed from them two years ago and now finds them expendable.

Obamacare...Physicians earn less, and will pay more income and investmant taxes...Obamacare is a no win for Physicians!

This tax will hit physicians in their paychecks...why...because Physicians work hard, earn good Money, and Obamacare is targeting physicians on the salary side (salaries will be lower), and the tax side (Physician paychecks will be taxed at higher rates). No win situation for Physicians in America.

 Top Five Worst Obamacare Taxes Coming in 2013

Of the twenty new or higher taxes in Obamacare, below are the five worst that will be foisted upon Americans for the first time on January 1, 2013.

Of the twenty new or higher taxes in Obamacare, below are the five worst that will be foisted upon Americans for the first time on January 1, 2013:

1)

The Obamacare Medical Device Tax – a $20 billion tax increase: Medical device manufacturers employ 409,000 people in 12,000 plants across the country. Obamacare imposes a new 2.3 percent excise tax on gross sales – even if the company does not earn a profit in a given year. In addition to killing small business jobs and impacting research and development budgets, this will increase the cost of your health care – making everything from pacemakers to prosthetics more expensive.

2)

The Obamacare “Special Needs Kids Tax” – a $13 billion tax increase: The 30-35 million Americans who use a Flexible Spending Account (FSA) at work to pay for their family’s basic medical needs will face a new government cap of $2,500 (currently the accounts are unlimited under federal law, though employers are allowed to set a cap).

There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are several million families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. This Obamacare tax provision will limit the options available to these families.

3)

The Obamacare Surtax on Investment Income – a $123 billion tax increase: This is a new, 3.8 percentage point surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income:

	Capital Gains	Dividends	Other*
2012	15%	15%	35%
2013+ (current law)	23.8%	43.4%	43.4%

The table above also incorporates the scheduled hike in the capital gains rate from 15 to 20 percent, and the scheduled hike in dividends rate from 15 to 39.6 percent.

4)

The Obamacare “Haircut” for Medical Itemized Deductions – a $15.2 billion tax increase: Currently, those Americans facing high medical expenses are allowed a deduction to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). This tax increase imposes a threshold of 10 percent of AGI. By limiting this deduction, Obamacare widens the net of taxable income for the sickest Americans. This tax provision will most harm near retirees and those with modest incomes but high medical bills.

5)

The Obamacare Medicare Payroll Tax Hike -- an $86.8 billion tax increase: The Medicare payroll tax is currently 2.9 percent on all wages and self-employment profits. Under this tax hike, wages and profits exceeding $200,000 ($250,000 in the case of married couples) will face a 3.8 percent rate instead. This is a direct marginal income tax hike on small business owners, who are liable for self-employment tax in most cases. The table below compares current law vs. the Obamacare Medicare Payroll Tax Hike:

	First $200,000 ($250,000 Married) Employer/Employee	All Remaining Wages Employer/Employee
Current Law	1.45%/1.45% 2.9% self-employed	1.45%/1.45% 2.9% self-employed
Obamacare Tax Hike	1.45%/1.45% 2.9% self-employed	1.45%/2.35% 3.8% self-employed