Tag: Medicare (United States)

Opinion: Paul Ryan leaves behind an unfixable mess

Opinion: Paul Ryan leaves behind an unfixable mess

Here’s his legacy: He spent his career, first as chair of the House Budget and Ways and Means committees, and later as speaker, devoted to cutting taxes so much it would force deep cuts in popular entitlement programs, mostly Social Security and health insurance, that actually dominate the non-defense part of the federal budget.
That’s bad enough, not least since the economy has been doing reasonably well before Congress and President Donald Trump administered the twin stimuli of a very large tax cut for corporations and the rich, followed weeks later by a $1.3 trillion spending bill that boosted federal spending, mostly to expand a defense budget that was already bigger than those of the next half-dozen nations with big military establishments put together.
But the real news was further down in the report — where CBO projected that the tax cuts and spending increases will only boost economic growth for about a year, after which things will stagnate.
Let’s put that $1 trillion deficit in perspective, especially since — unlike the trillion-dollar deficits in fiscal 2009 through 2013 — it’s happening when the economy is at full employment, rather than fighting off the worst recession since the 1930s.
And then, you have to take your pick of eliminating essentially all of Social Security, or all of Medicare and most of Medicaid (or vice versa).
Or you can whack all of the disability and SSI program, all of Medicaid, and all of domestic discretionary.
According to CBO, even with just the cake-and-candy policies Ryan and Trump have passed already will produce relative stagnation by 2020, with monthly job gains slowing to just 62,000 on average, though unemployment will still be low.
And it would get much worse if you really whacked the whole non-defense, non-entitlement parts of the federal government, plus most of Social Security, and then headed into a recession.
That’s the massive fraud Paul Ryan always was, even before Trump.
Fixing the budget damage he’s done is impossible if Republicans stay in control of Congress and cling to last year’s tax cut.

Social Security Has Paid Benefits To My Dead Husband For A Year
Social Security Disability

Social Security Has Paid Benefits To My Dead Husband For A Year

Getty Images/iStockphoto Ann Brenoff’s “On The Fly” is a weekly column about navigating growing older ― and a few other things.
For the past 12 months, your tax dollars have been going to pay Social Security benefits to a dead man.
No, I am not engaging in any sort of attempt to defraud the Social Security fund.
Quite the contrary, I reported his death to the Social Security Administration immediately after it occurred and have been reporting it repeatedly ever since.
None of my two dozen or so calls ― or the day I took off work to visit my local Social Security office and paid $13 to park ― has changed the fact that, as of this writing, the SSA continues to deposit a monthly payment into the checking account I shared with my dead husband.
In fact, they also continue to pay his Medicare premium out of his benefit payment.
To quote Philip Moeller, a journalist and co-author of Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security Benefits, “Among all of Social Security’s arcane rules, secrets, and claiming surprises, the greatest personal revelation to me has been that the agency often gives out confusing, inconsistent, and even flat-out wrong information.” Is there a #MeToo button for getting bad information from Social Security?
The Social Security Program Operating Manual System, the bible for agency workers, is virtually undecipherable to the untrained eye.
When it comes to understanding Social Security and Medicare, many people need to sit down with a human being.
An ongoing SSA survey finds that just 25 percent of people who call the agency’s toll-free number think they’ve received excellent service.

Donald Trump’s Nasty Budget

Donald Trump’s Nasty Budget

During his presidential campaign, Donald Trump told the “forgotten men and women of our country” that he would champion them.
As evidence that he was a different kind of Republican, he promised not to cut Medicare, Medicaid and other programs that benefit poor and middle-class families.
On Monday, President Trump proposed a budget that would slash spending on Medicare, Medicaid, food stamps, transportation and other essential government services, all while increasing the federal deficit.
Mr. Trump’s 2019 budget, combined with the tax cuts Republicans passed last year, would amount to one of the greatest transfers of wealth from the poor to the rich in generations.
The proposal would raise military spending by 14.1 percent while cutting funding for the State Department — the agency that has a mandate to resolve problems without going to war — by 26.9 percent.
Medicare and Medicaid, which benefit one-third of Americans, are targeted for cuts of hundreds of billions of dollars.
Over all, the administration wants to reduce the Department of Transportation’s budget by nearly a fifth.
The budget would also effectively cut the Highway Trust Fund by $122 billion over a decade.
The White House suggests that the federal government would put up only $200 billion, which would be enough to get state and local governments and the private sector to supply the rest of the money.
After all, Congress last week passed, and Mr. Trump signed, a two-year bipartisan budget that authorizes a significant increase in domestic, as well as military, spending.

Ex-HHS Secretary: How a Small Government Organization Treats Medicare Recipients ‘Like Guinea Pigs’

Ex-HHS Secretary: How a Small Government Organization Treats Medicare Recipients ‘Like Guinea Pigs’

However, as a close observer of the Administration’s health care policy and a former Secretary of the Health and Human Services Department (HHS), I’m increasingly concerned that its plans for the Center for Medicare and Medicaid Innovation (CMMI), an office created by Obamacare, lack necessary guardrails to ensure against future abuse by the Executive Branch.
This power is, purportedly, in service of an uncontroversial and even admirable goal: identifying through experimentation how the government can save taxpayer dollars and operate more efficiently.
For several reasons, however, Republicans have long viewed the office’s power with suspicion.
For example, in 2016 CMMI proposed an experiment that would have impacted care for cancer patients in 75% of the U.S.
Clearly, experimentation is a crucial part of discovering how the government can save taxpayers’ hard-earned money, and a well-designed program to study the impact of proposed reforms on isolated populations would benefit all of us.
But it is absolutely crucial that HHS start by working with Congress and other stakeholders to institute guardrails on CMMI to ensure it never conducts a study on the entire country, in addition to clearly defining CMMI’s authority to stay inside the executive branch’s constitutional authority to enforce — not write — the law.
Third, Congress should be afforded opportunities to review CMMI’s decisions and must remain the ultimate authority to approve or deny policy changes to Medicare and Medicaid.
A related issue is how congressional budgetary rules are being improperly promulgated to shield CMMI from reform legislation.
Under Obamacare, CMMI receives a mandatory funding allocation of $10 billion every ten years.
Instead, the Trump Administration could pave the way for broader legislative reforms in the future if it works to establish administrative safeguards to govern CMMI and clarifying, as part of a transparent collaboration with Congress and stakeholders, its operations.

Future drug cost estimates fuel Medicare set-aside hikes: NCCI

Future drug cost estimates fuel Medicare set-aside hikes: NCCI

Estimated future drug costs are the main reason that Centers for Medicare & Medicaid Services are requiring increases of Medicare set-aside amounts, according to a report from the National Council on Compensation Insurance released Monday.
According to the report, CMS usually requires larger percentage increases to Medicare set-asides when the submission amounts are smaller.
Boca Raton, Florida-based NCCI analyzed trends in the submission of Medicare set-asides to understand both the cost drivers and the medical care of workers injured on the job who are or are likely to become eligible for Medicare based on 11,500 Medicare set-asides submitted to CMS from September 2009 to December 2015.
The gap between approved and submitted Medicare set-asides was steady from 2013 to 2015 mainly due to the decrease between approved and submitted prescription drug amounts.
About 64% of claimants are eligible for Medicare because they have been on Social Security disability for at least two years and another 29% of claimants are eligible due to age.
Overall Medicare set-asides represent more than 40% of total submitted workers compensation settlement costs, NCCI said in the report.
“Understanding (Medicare set-asides) trends and the (CMS) review process can assist workers compensation carriers, employers, workers and other system stakeholders as they identify cost drivers,” said NCCI.

No, You Don’t Have To Give Your Doctor Your Social Security Number
Social Security Disability

No, You Don’t Have To Give Your Doctor Your Social Security Number

Illustration: Gabriela Landazuri Saltos/HuffPost Images: Getty Images While no cybercriminal worth his salt would turn down a chance to get his hands on your credit card information, there’s an even bigger prize: your Social Security number, which cybersecurity experts say is now the single most valuable piece of information in terms of being able to steal your identity.
So if our Social Security numbers are such hot property, why do doctors routinely ask for them?
In fact, not even the American Medical Association wants you to.
Given that Medicare/Medicaid covers roughly 35 percent of Americans, it may be that requesting the Social Security number from all patients is just more expedient for the doctor or hospital.
But it’s certainly not best for patients, who may be exposing themselves to identity theft.
The health care industry, with hospitals leading the way, reported that 113.2 million health care-related records were stolen in 2015 ― the most ever, according to the Department of Health and Human Services.
Alarmingly, about half of all health care organizations had little or no confidence that they could detect the loss or theft of patient data, and the majority lack the budget to secure their data, according to a 2016 annual study on health care data privacy and security by the Ponemon Institute, a security research and consulting organization.
But you can’t close your Social Security number.
And it gets worse: It’s an open secret that a person’s Medicare number includes their Social Security number.
Nunnikhoven suggests asking what other form of identification the doctor’s office would accept ― say, a driver’s license or a photo ID.

Trump’s Medicaid Work Requirement Will Backfire

Trump’s Medicaid Work Requirement Will Backfire

Image Just because President Trump and the Republican Congress were unable to pass health care legislation that would have unwound the coverage benefits of the Affordable Care Act doesn’t mean such attacks are behind us.
The administration’s new approach — one that no administration before it has taken — is to provide waivers to states that allow them to impose work requirements for Medicaid benefits.
Now the administration will be considering waivers that are likely to deprive thousands of low-income people of health care.
Some of these people will lose coverage because they can’t find jobs to fulfill the work requirements.
They would instead, she said, “let states kick people off coverage if they don’t comply with new requirements that have nothing to do with health insurance.” People losing coverage could suffer severe harm.
A study of Medicaid expansion in Kentucky and Arkansas found that it led to significant gains in access to care, financial security and health, with increases in the share of low-income adults going for checkups, getting regular care for chronic conditions and reporting that they are in excellent health.
Among adults on Medicaid who don’t work and could be subject to the work requirement, more than a third have a chronic health problem or disability, about half take care of their family or go to school, and just under 10 percent can’t find work.
By providing coverage for workers in jobs that are unlikely to provide such benefits, and by helping to stabilize the finances of people with illnesses, Medicaid has been found to help people stay employed or find work.
Medicaid is working, as are most able-bodied adults who are eligible for it.
The administration’s bid to cut the program under the guise of mobility-enhancing work requirements must be seen for what it is.

Trump Administration Says States May Impose Work Requirements for Medicaid

Trump Administration Says States May Impose Work Requirements for Medicaid

WASHINGTON — The Trump administration said Thursday that it would allow states to impose work requirements in Medicaid, a major policy shift in the health program for low-income people.
Federal officials said they would support state efforts to require able-bodied adults to engage in work or other “community engagement activities” as a condition of eligibility for Medicaid.
Ms. Verma said the Trump administration was responding to requests from Medicaid officials in 10 states that wanted to run demonstration projects testing requirements for work or other types of community engagement like training, education, job search, volunteer activities and caregiving.
The proposals, she said, came from Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.
Advocates for Medicaid beneficiaries said the new policy was likely to be challenged in court if people were denied coverage for failure to meet a state’s work requirement.
Federal law gives the secretary of health and human services broad authority to grant waivers for state demonstration projects that promote the goals of the Medicaid program.
In the past, federal officials said that work was not one of the purposes of Medicaid.
But Trump administration officials said Thursday that work requirements were consistent with the goals of Medicaid, because work and other community engagement activities could improve the health of Medicaid beneficiaries.
“Productive work and community engagement may improve health outcomes,” Brian Neale, the director of the federal Medicaid office, said Thursday in a letter to state Medicaid directors.
“For example, higher earnings are positively correlated with longer lifespan.” In addition, Mr. Neale said, researchers have found “strong evidence that unemployment is generally harmful to health,” while employment tends to improve “general mental health.” A 2013 Gallup poll found that unemployed Americans are more than twice as likely as those with full-time jobs to say they have or are being treated for depression, Mr. Neale said.

Trump administration allows states to make Medicaid recipients work

Trump administration allows states to make Medicaid recipients work

The Trump administration will allow states for the first time to impose work requirements on Medicaid recipients.
The Centers for Medicare & Medicaid Services released a guidance Thursday outlining what states need to do to mandate that certain Medicaid enrollees work to qualify for benefits.
The agency is expected to start approving state waivers promoting “community engagement activities” in coming weeks. “Medicaid needs to be more flexible so that states can best address the needs of this population.
States should take these issues — as well as recipients’ employability — into consideration and allow for modifications or exemptions, the agency said.
Many governors, including Republican ones, have defended the Medicaid program as being critical to addressing the substance abuse crisis.
States will be required to describe strategies to assist recipients in meeting the requirements and to link them to job training and support resources, including child care and transportation.
The agency is encouraging states to align their Medicaid work requirements with those mandated by other federal safety net programs.
Republicans have long wanted to add work requirements to the Medicaid program, which covers nearly 75 million low-income children, adults, elderly and disabled Americans.
South Dakota’s governor said in his State of the State address Tuesday that he would also look to require certain recipients to work.

Trump Officials, After Rejecting Obama Medicare Model, Adopt One Like It

Trump Officials, After Rejecting Obama Medicare Model, Adopt One Like It

WASHINGTON — In a notable back flip, the Trump administration has decided that maybe the Obama administration was right in its efforts to change the way doctors and hospitals are paid under Medicare.
Participation in the new project is voluntary.
Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services, said the new bundled payments were “an important step in the move away from fee-for-service and toward paying for value.” The Obama administration tried to accelerate that shift by testing new methods of payment under the supervision of an office created by the Affordable Care Act.
Medicare will make bundled payments for 32 types or “episodes” of care.
The lump sum payment will cover the services of doctors and hospitals, clinical laboratories, nursing homes, home health agencies and hospices, as well as reimbursement for some medical equipment like wheelchairs and certain drugs given to patients in doctors’ offices.
2 official at the Centers for Medicare and Medicaid Services under President Barack Obama, praised the new initiative as “a very good model.” In similar programs started in the Obama administration, “quality over all seems to be going up, and costs down,” said Dr. Conway, who is now the president of Blue Cross and Blue Shield of North Carolina.
As a member of the House, Mr. Price denounced bundled payment initiatives.
But Mr. Trump’s new nominee for health secretary, Alex M. Azar II, said Tuesday that mandatory participation might sometimes be needed.
In unveiling the pilot project, the Trump administration said doctors and hospitals must not restrict patients’ access to “medically necessary care” as a way to reduce Medicare spending.
The Trump administration said Medicare beneficiaries could not opt out if they were receiving services in an episode of care covered by the new bundled payment program.