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“Rick Scott Gets An Earful In Florida”: Talking To Regular People Who Don’t Have A Script To Follow Could End Your Career

There’s a reason so many politicians embrace carefully managed, pre-scripted events: they never know what actual people are going to say. The spontaneity may be refreshing for the rest of us, but for politicians and their aides, it’s frustrating when the public goes “off-message.”

Almost exactly two years ago, this happened to Mitt Romney’s presidential campaign in Pennsylvania, when aides arranged for the candidate to chat with a group of regular folks about the economy. One voter said, “None of us like to pay more taxes, but sometimes that’s necessary.” Another added, “It’s a necessary evil.” “Right, right,” a third person said as the group nodded.

The Republican presidential hopeful didn’t do too many unscripted events after that.

This week, Florida Gov. Rick Scott (R) ran into similar trouble. The Republican governor, facing a tough re-election fight, is heavily invested in condemning the Affordable Care Act, so he visited a South Florida senior center for a roundtable chat with retirees he assumed would agree with him.


The 20 seniors assembled for a roundtable with Scott at the Volen Center were largely content with their Medicare coverage and didn’t have negative stories to recount. And some praised Obamacare – a program that Scott frequently criticizes.

“I’m completely satisfied,” Harvey Eisen, 92, a West Boca resident, told Scott.

Eisen told the governor he wasn’t sure “if, as you say,” there are Obamacare-inspired cuts to Medicare. But even if there are, that would be OK. “I can’t expect that me as a senior citizen are going to get preferential treatment when other programs are also being cut.”

Ruthlyn Rubin, 66, of Boca Raton, told the governor that people who are too young for Medicare need the health coverage they get from Obamacare. If young people don’t have insurance, she said, everyone else ends up paying for their care when they get sick or injured and end up in the hospital.

Twisting the knife, Rubin added, “People were appalled at Social Security.  They were appalled at Medicare when it came out. I think these major changes take some people aback. But I think we have to be careful not to just rely on the fact that we’re seniors and have an entitlement to certain things…. We’re all just sitting here taking it for granted that because we have Medicare we don’t want to lose one part of it. That’s wrong to me. I think we have to spread it around. This is the United States of America. It’s not the United States of senior citizens.”

The underlying point of Scott’s visit was to try to complain about Medicare Advantage reforms and how awful recent “cuts” must be for seniors. But when the governor asked one elderly woman if she’d seen any changes, she said, “Not really.” Another member of the roundtable said he’s “very happy” with the current coverage. A third person said he’s had “no problems.” A fourth said she and her husband are “very pleased.”

When Scott asked if they’ve found doctors opting out of Medicare, most said, “No.”

It was at this point that the governor probably decided he no longer wants to talk to regular people who don’t have a script to follow.

For the record, as Scott probably knows, these so-called “cuts” to Medicare Advantage aren’t really cuts to beneficiaries. At issue are Medicare cost-savings embraced by the Obama administration through the Affordable Care Act. The so-called “cuts” are changes to the way in which the government reimburses insurance companies, which have been overpaid in the Medicare Advantage program.

What’s more, congressional Republicans – not exactly a moderate bunch – have already endorsed and voted for these “cuts.”

It’s likely the governor understands this, but hopes to fool voters. If yesterday was any indication, his efforts aren’t going well.


By: Steve Benen, The Maddow Blog, April 30, 2014

May 1, 2014 Posted by | Affordable Care Act, Obamacare, Rick Scott | , , , , , , , | 1 Comment

“More Stuff Made Up About Obamacare”: A Nasty Ideological And Racial Undertone To Bobby Jindal’s Latest Campaign

It’s been obvious from the beginning that a big part of the GOP strategy for demonizing Obamacare has been to convince existing beneficiaries of federal health programs that ACA coverage would come out of their hides. Thus the constant efforts to convince Medicare enrollees that ACA was financed by “Medicare cuts” (not at all true with the exception of the reductions in super-subsidies offered to the Bush-era conservative pet rock of Medicare Advantage policies offered through private insurers). There’s also a nasty ideological and even racial undertone to this campaign aimed at white middle-class retirees who view their Medicare benefits as earned (via both payroll tax contributions and a lifetime of work), as opposed to the “welfare” being offered to those people supported by Medicaid or Obamacare.

But leave it to Bobby Jindal to come up with a line of attack that pits existing Medicaid beneficiaries against those who would qualify for coverage if, over his dead body, the ACA’s Medicaid expansion were to be enacted in Louisiana. TPM’s Dylan Scott has the story:

Engaged in all-out war with the liberal group over a pro-Obamacare billboard, Louisiana Gov. Bobby Jindal (R) has accused the organization — and liberals in general — of endorsing discrimination against the disabled through their support of the federal health care reform law and its Medicaid expansion.

“Liberal groups like won’t say one word about caring for individuals with disabilities, or how Obamacare prioritizes coverage of childless adults ahead of the most vulnerable,” Jindal wrote in an op-ed in the Shreveport Times last Thursday. “They just want to intimidate states into accepting Obamacare’s massive new spending programs.”

What does Bobby mean by “prioritizing” coverage of childless adults? Simply that expanded coverage comes with a higher federal match rate than is available for traditional Medicaid (not high enough, of course, to convince ideologically motivated Republicans, especially in the South, to execute an expansion that in many cases would represent a fiscal windfall for state governments while significantly reducing the ranks of the uninsured).

How, exactly, does that hurt people with disabilities, or others currently qualifying for Medicaid? The short answer is that it doesn’t, as Scott explains with some help from experts:

[T]here are a few huge problems with Jindal’s rationale, which effectively undermine the whole line of attack. First, some disabled people could actually qualify for health coverage under the Medicaid expansion, according to MaryBeth Musumeci, associate director of the Kaiser Commission on Medicaid and the Uninsured.

“People with disabilities can be within the new expansion group,” she said. “The ACA provides the opportunity for some people with disabilities to qualify for Medicaid who never qualified before. Their incomes, while still low, could have been above the very, very low limits states had set or they may not have been eligible at all if they fell into the category of single, childless adults. So it creates an expanded opportunity for people with disabilities to gain coverage.”

Second, Obamacare should have no policy bearing on the traditional Medicaid program. Federal funding for the traditionally eligible population remains exactly the same, and the states retain the same flexibility to manage their programs as existed prior to the law. The ACA brings a new population into the program, but there is no policy reason that it would lead to “discrimination” — as Jindal calls it — or any other detrimental effects for disabled people enrolled in the traditional program.

“I think that’s right,” Musumeci said when asked by TPM if the Obamacare’s Medicaid expansion should have no effect on traditional Medicaid. “What the Medicaid expansion essentially does is it creates a new eligibility category. Like any other time Congress has expanded eligibility of the program, it is adding statutory authority to cover this new group of people.”

“But it’s built into the same underlying Medicaid program. States still have all of the flexibility that they previously had in terms of how they structure their care delivery system, their benefits packages, and all of those things.”

It would be interesting to know how well people with disabilities, and other current Medicaid beneficiaries, would fare in Louisiana if the national Republican “reform” of Medicaid, a block grant that reduced federal funding over time, were to be enacted. Let’s hope we don’t find out. But in the meantime, the “prioritization” argument against the Medicaid expansion is just another effort to frighten one group of safety net beneficiaries they have a stake in excluding others. It’s exactly what we’ve come to expect from self-styled conservative Christian warriors like Bobby Jindal.


By: Ed Kilgore, Contributing Writer, Washington Monthly Politica Animal, March 20, 2014

March 22, 2014 Posted by | Affordable Care Act, Bobby Jindal, Obamacare | , , , , , , , | Leave a comment

“The Insurance Company Bailout That Republicans Love”: The GOP Has Found A Way To Be Even More Hypocritical Than Before

Remember when Republicans found insurance company bailouts outrageous? Good, because the Republicans don’t.

On Friday, the Obama Administration announced proposed payment rates for Medicare Advantage plans, the private insurance option within Medicare. The federal government pays insurers a fixed fee for each senior they enroll. The program’s goal is to provide seniors with more options and, ideally, foster competition that will lead to better management of care both within the traditional program and for those who get private insruance instead. But, for a long time, experts have said the federal government is actually paying the insurers too much—in other words, more than it costs to provide the same coverage through traditional Medicare.

In the late 1990s, when the program was known as “Medicare+Choice,” the Clinton Administration attempted to rectify this by reducing insurer fees. But experts subsequently found the government was still paying the plans too much, so the Obama Administration and its allies included additional Medicare Advantage cuts in the Affordable Care Act—leaving discretion over the exact rates to the Department of Health and Human Services and its actuaries. On Friday, HHS revealed its calculations for next year’s rates, based in part on projections for how health care spending for the country as a whole is changing.

The payment formula is complicated and even now, with a weekend to digest the announcement, analysts aren’t entirely sure how insurers would react and what that would mean for seniors in the plans. (As Phil Galewitz of Kaiser Health News reports, many independent experts seem to think the effects would be pretty minimal.) But insurers, who say better benefits account for whatever extra funds they get, have warned that cuts of virtually any magnitude will force insurers to offer less generous benefits, charge higher premiums, or withdraw from the program altogether—as some of them did in the late 1990s, following those cuts the Clinton Administration implemented. The insurers are lobbying the administration to use its discretion to reduce the cuts or, ideally, eliminate them altogether. If you live in Washington and have seen those ubiquitous “Seniors are Watching” advertisements on billboards and buses, you have some idea of how strongly the insurers feel about this.

But insurers aren’t the only ones making a fuss. Republicans are too—and they have been for a while. As you may recall, Republicans pounced on the new Medicare Advantage cuts as proof that Obamacare was bad for seniors—in the 2010 midterms and then, again, in the 2012 presidential election. It was pure political gold, since seniors (particularly white seniors) were among those most skeptical of Obama and his health care law in the first place. Of course, House Republicans voted for the very same cuts when Paul Ryan’s budgets had them. But that didn’t stop Republicans from attacking the cuts then—and it’s not stopping them now. “ObamaCare has already caused millions to lose the healthcare plans they liked, and now it is directly harming seniors who rely on the care they have through Medicare Advantage,” Eric Cantor, the House Majority Leader, said on Friday. “Our nation’s grandparents should not have to wake up tomorrow worried they no longer can access the care they want because of Obamacare.”

With this latest salvo, however, Republicans have actually found a way to be more hypocritical than before. For the last few weeks, Republicans and their allies have been in high dudgeon about Obamacare’s so-called risk corridor program, in which the federal government will subsidize insurers that take heavy losses for the next three years. Republicans and their allies have decried risk corridors as a “taxpayer bailout” of the insurers. But the policy justification for risk corridors is straightforward and, even to some conservatives, incontrovertible: They will ease the transition to a newly regulated insurance market, so that it’s possible to provide universal coverage through a system of private plans. And unlike the additional Medicare Advantage payments, the risk corridor program might actually end up being a net boon to the taxpayers, since the government also shares in unexpected insurer gains. (The Congressional Budget Office has actually predicted as much, though, as with many such projections, there’s a lot of uncertainty there.)

Maybe Republicans think that’s insufficient reason to pay the Obamacare insurers money—fine. But then how can they simultaneously insist government keep paying higher fees to Medicare insurers, given the case for them is a lot more dubious?

Congressional Democrats haven’t exactly covered themselves in glory over this issue. New York Senator Charles Schumer was among the Democrats who signed a bipartisan letter to HHS, urging the administration not to harm beneficiaries with payment reductions, though the senators stopped short of calling for outright reversal of the cuts. But the current Republican position makes no sense whatsoever, unless the GOP’s real priorities are (a) opposing anything the Obama Administration supports (b) sucking money away from the traditional, government-run Medicare program (c) stopping programs and spending that benefits the non-elderly uninsured. Readers can decide for themselves which of those explanations make the most sense—or whether, perhaps, it’s all of the above.


By: Jonathan Cohn, The New Republic, Fenbruary 24, 2014

February 25, 2014 Posted by | Affordable Care Act, Medicare, Republicans | , , , , , , | Leave a comment

“Let’s Not Forget Medicare Advantage”: Selective Outrage Over Federal Health Care Costs

Knowing I’ve been both a critic of insurance company practices and a supporter of efforts to reform the industry, a FOX news producer reached out last week to get my take on accusations by conservatives that Obamacare will actually result in a bailout of big insurance companies.

Under the headline, “Bailing Out Health Insurers and Helping Obamacare,” The Weekly Standard on Monday urged Republicans to insist that future debt ceiling increases contain a no-bailout provision. The magazine also cited Sen. Marco Rubio’s, R-Fla., bill to repeal a provision of the Affordable Care Act designed to limit potential initial losses of insurers selling policies on the new health insurance exchanges.

I reminded the FOX producer that Republicans have been supporting — and vigorously defending — a much more expensive transfer of taxpayer dollars to private insurers than the one Obamacare foes are now concerned about.

Here’s the issue:

Lawmakers who drafted the Affordable Care Act knew that insurers would be reluctant to participate in the new health insurance exchanges — also called marketplaces — if the government didn’t create a temporary program to protect them against what’s known in the insurance world as adverse selection.

Insurers were concerned, for good reason, that the first people to sign up for coverage through the exchanges would be folks previously shut out of the insurance market — people who were older and sicker than the population at large. Those people couldn’t afford to buy coverage previously because insurers were able to charge them far more than younger, healthier people.

In many cases, insurers refused to sell coverage at any price to prospective customers with preexisting conditions. That’s a big reason why the number of uninsured Americans had reached nearly 50 million when Congress passed the reform law.

So it wasn’t the least bit surprising that the first few million who have signed up for coverage since the exchanges opened on Oct. 1 skew older than many expected. People who have been denied coverage for years are far more motivated to get insurance — and fast — than anyone else. There is not the same pent up demand among the young and healthy.

In anticipation of this, drafters of the reform law established a $25 billion risk fund to insulate insurers from big losses during the first three years. Although the risk fund has always been in the law, conservative pundits apparently just became aware of it.

Yes, $25 billion is a lot of money, but it is pocket change compared to the enormous amount of taxpayer dollars that have been flowing to private insurance companies for nearly three decades to keep them in the Medicare Advantage program, which has had the unwavering support of Republicans.

Republicans have long supported efforts to privatize Medicare, and the Medicare Advantage program is one of the ways they’ve tried to do it. Medicare Advantage is billed as a private alternative to traditional Medicare. When Americans reach 65, they can enroll in traditional Medicare or in a private plan operated by an insurer. If they opt for a private plan, the federal government still picks up the tab and transfers money to the private insurer every month.

As the U.S. Government Accountability Office explains it, the Centers for Medicare and Medicaid Services (CMS) adjusts the monthly payments it sends to private insurers to account for each beneficiary’s health status. As part of this risk adjustment process, CMS assigns each Medicare Advantage beneficiary a risk score — “a relative measure of expected health care costs,” as the GAO puts it.

We’re talking a lot of money here. In 2012 alone, the GAO calculated that the federal government spent about $135 billion on the Medicare Advantage program. The problem for taxpayers is that, according to the GAO, the government has been more than generous over the years to private insurers, having paid them way more than it should have because of shortcomings in how the risk scores are developed.

Interestingly, but not surprisingly, there was no mention of that, or any reference at all to the Medicare Advantage program, the biggest champion of which are Republicans, in The Weekly Standard’s “bail-out” story last week. If they are sincere in their alarm that Obamacare might reward private insurers with an extra $25 billion between now and the end of 2016, they should be apoplectic about the ongoing bailout known as the Medicare Advantage program.


By: Wendell Potter, The Center for Public Integrity, January 20, 2014

January 21, 2014 Posted by | Affordable Care Act, Conservatives, Health Care Costs | , , , , , , | 6 Comments

“Obamacare’s Secret Success”: Health Reform Is Starting To Look Like A Bigger Success Than Even Its Most Ardent Advocates Expected

The law establishing Obamacare was officially titled the Patient Protection and Affordable Care Act. And the “affordable” bit wasn’t just about subsidizing premiums. It was also supposed to be about “bending the curve” — slowing the seemingly inexorable rise in health costs.

Much of the Beltway establishment scoffed at the promise of cost savings. The prevalent attitude in Washington is that reform isn’t real unless the little people suffer; serious savings are supposed to come from things like raising the Medicare age (which the Congressional Budget Office recently concluded would, in fact, hardly save any money) and throwing millions of Americans off Medicaid. True, a 2011 letter signed by hundreds of health and labor economists pointed out that “the Affordable Care Act contains essentially every cost-containment provision policy analysts have considered effective in reducing the rate of medical spending.” But such expert views were largely ignored.

So, how’s it going? The health exchanges are off to a famously rocky start, but many, though by no means all, of the cost-control measures have already kicked in. Has the curve been bent?

The answer, amazingly, is yes. In fact, the slowdown in health costs has been dramatic.

O.K., the obligatory caveats. First of all, we don’t know how long the good news will last. Health costs in the United States slowed dramatically in the 1990s (although not this dramatically), probably thanks to the rise of health maintenance organizations, but cost growth picked up again after 2000. Second, we don’t know for sure how much of the good news is because of the Affordable Care Act.

Still, the facts are striking. Since 2010, when the act was passed, real health spending per capita — that is, total spending adjusted for overall inflation and population growth — has risen less than a third as rapidly as its long-term average. Real spending per Medicare recipient hasn’t risen at all; real spending per Medicaid beneficiary has actually fallen slightly.

What could account for this good news? One obvious answer is the still-depressed economy, which might be causing people to forgo expensive medical care. But this explanation turns out to be problematic in multiple ways. For one thing, the economy had stabilized by 2010, even if the recovery was fairly weak, yet health costs continued to slow. For another, it’s hard to see why a weak economy would have more effect in reducing the prices of health services than it has on overall inflation. Finally, Medicare spending shouldn’t be affected by the weak economy, yet it has slowed even more dramatically than private spending.

A better story focuses on what appears to be a decline in some kinds of medical innovation — in particular, an absence of expensive new blockbuster drugs, even as existing drugs go off-patent and can be replaced with cheaper generic brands. This is a real phenomenon; it is, in fact, the main reason the Medicare drug program has ended up costing less than originally projected. But since drugs are only about 10 percent of health spending, it can only explain so much.

So what aspects of Obamacare might be causing health costs to slow? One clear answer is the act’s reduction in Medicare “overpayments” — mainly a reduction in the subsidies to private insurers offering Medicare Advantage Plans, but also cuts in some provider payments. A less certain but likely source of savings involves changes in the way Medicare pays for services. The program now penalizes hospitals if many of their patients end up being readmitted soon after being released — an indicator of poor care — and readmission rates have, in fact, fallen substantially. Medicare is also encouraging a shift from fee-for-service, in which doctors and hospitals get paid by the procedure, to “accountable care,” in which health organizations get rewarded for overall success in improving care while controlling costs.

Furthermore, there’s evidence that Medicare savings “spill over” to the rest of the health care system — that when Medicare manages to slow cost growth, private insurance gets cheaper, too.

And the biggest savings may be yet to come. The Independent Payment Advisory Board, a panel with the power to impose cost-saving measures (subject to Congressional overrides) if Medicare spending grows above target, hasn’t yet been established, in part because of the near-certainty that any appointments to the board would be filibustered by Republicans yelling about “death panels.” Now that the filibuster has been reformed, the board can come into being.

The news on health costs is, in short, remarkably good. You won’t hear much about this good news until and unless the Obamacare website gets fixed. But under the surface, health reform is starting to look like a bigger success than even its most ardent advocates expected.


By: Paul Krugman, Op-Ed Columnist, The New York Times, November 28, 2013

November 29, 2013 Posted by | Affordable Care Act, Health Care Costs | , , , , , , , | Leave a comment

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