I found 2 positive articles in Forbes (oxymoron intended) and two other sources.
I had a difficult time fathoming that Forbes has an honest assessment of the information.
Steve must have been sleeping off his holiday celebrating. . .
Seniors To See Improved Health Care Benefits In 2011
The next round of changes resulting from health care reform are set to go into effect on Saturday, January 1. This time, the chief beneficiaries will be the nation’s senior citizens – a group that has generally been opposed to the Patient Protection and Affordable Care Act, or, as it is better known, ‘Obamacare’.
Here are a few of the medical services that will now be available at no cost every twelve months (more often where appropriate.)
Annual physical exams
Bone mass measurement
Cardiovascular screenings*
Colorectal screening
Diabetes screening
Diabetes self-management training
Flu Shots
Glaucoma tests
Hepatitis Shots
Mammograms
HIV screening
Pap tests and pelvic exams
Prostrate screening*
Smoking Cessation
* In these instances, Medicare beneficiaries will receive tests at no cost but will be responsible for 20% of the cost for the office visit to the physician.
Currently, many seniors do not get an annual physical or deal with many of the issues covered by the list due to inability to pay. The failure to confront these issues often lead to serious illnesses going undiscovered – or discovered too late – resulting in longer and more expensive treatment and hospital stays – not to mention a severe decline in the quality of life.
Of course, with more seniors able to get that annual physical along with the other screening programs that will become available at no charge, there will need to be physicians available to them to provide these services.
In order to help insure that there are a sufficient number of doctors available, Medicare will begin paying higher sums to incentivize the physicians to remain in the Medicare program.
The next major change will greatly assist those who fall within what is known as the Medicare Part D doughnut hole. As the law stands today, Medicare participants are pretty much on their own after they have spent $2,840 per year on prescription drugs until such time as they reach $6,448 per year, the point at which the government steps back in to help.
The result of this gap has been millions of seniors not taking – or self-rationing- their prescribed medicines, causing even greater expense to the Medicare program as many fall ill when not taking their medications and end up in the hospital.
The PPACA granted a measure of relief in 2010 by providing a rebate of $250.00 those caught in the doughnut hole. However, beginning Saturday, affected Medicare beneficiaries will receive a 50% discount on all branded prescriptions during the gap in coverage, effectively cutting their out-of-pocket costs in half.
According to AARP, the change will assist some 3 million people.
To help pay for the improved benefits, the pharmaceutical industry will face a new tax. The levy will be $2.5 billion to be spread out among the drug companies based on their sales volume for the year. In this way, those who make the most will pay the most.
One of the lesser-discussed benefits about to kick in is the increase in payments to certified nurse midwives. These are the people who often provide senior women with basic medical services (Pap smears and other basic screenings) along with gynecological services to the 3 million younger women who receive Medicare due to disability. These practitioners are essential, particularly in rural areas where there is an extreme shortage of physicians to care for these people.
Currently, certified nurse midwives are paid 65% of what a physician is paid by Medicare when treating patients. Beginning tomorrow, certified midwives will receive 100% of the payment rate given to physicians for performing the same services. The result should be growth in the number of people choosing careers as midwives. This will provide a significant measure of relief in caring for senior women living in areas short on physicians.
The only bad news for seniors in the rules about to take effect is a change in benefits for those who still earn a healthy living. Medicare beneficiaries whose annual income is $85,000 or more -$170,000 for couples – will receive a smaller government subsidy from their Part D Medicare drug coverage.
- - - - - - - - - .
Missing and little publicized -
A PPACA provision that provides reproductive issues care for all women up to 300% of the poverty level.
All women, not just those on Medicaid.
Income limits raised for free birth control
Madison — A state program that provides free birth control to those from the ages of 15 to 44 will be available to more people after the federal government on Thursday approved raising income limits in the program.
Wisconsin is the first state to raise the income levels for the program, which was allowed under the federal health care reform law passed earlier this year, according to Wausau-based Family Planning Health Services.
The federal approval makes the program more widely available, but its future remains unclear because of skepticism from Republicans who will take over state government in January.
The family planning program, which also provides screening for sexually transmitted diseases, had been available to those making 200% above the federal poverty level. The changes approved Thursday raise eligibility to 300% of the federal poverty level, making it available to individuals who earn up to $32,490 a year.
The program is controversial because girls as young as 15 can get access to birth control without parental consent. Virtually anyone age 15 to 17 is eligible for the program because parental income is not taken into account when determining if children qualify for the program.
Initially available to females only, the program was expanded to include males last year. More than 54,000 people are enrolled.
Supporters say it has greatly reduced sexually transmitted diseases and saved millions of dollars by preventing births that would have been borne by Medicaid, the state-federal health care program for low-income people.
In an e-mail to supporters touting the federal approval of the expansion, Family Planning Health Services Executive Director Lon Newman wrote: "It is a great victory toward achieving universal access to reproductive health care."
Opponents have called for eliminating the program or raising the minimum age to 18. Scaling back the 7-year-old program appears possible with Republicans about to take over the governor's office and both houses of the Legislature.
"I certainly intend to pare it back as much as I can," said Sen. Glenn Grothman (R-West Bend), who will sit on the budget-writing Joint Finance Committee.
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(very long, however, very worthwhile)
Among the many narratives injected into the public debate over health care reform, I find the most disturbing to be the notion that our senior citizens will experience cuts in their Medicare benefits as a result of Obamacare.
Despite the ‘doom and gloom’ predictions you may have heard, the proposed savings in Medicare are designed to come from two sources; (a) a crackdown on Medicare fraud, estimated to currently cost the federal government as much as $60 billion per year and (b) a reduction in what is paid to the Medicare Advantage programs offered by private insurance companies.
As you may be under the impression that the legislation will cut payments to physicians by 21% and institute draconian cuts in payments to hospitals, let’s set the record straight on this at the outset so we can dispose of this bit of disinformation.
Physicians have faced a 21% cut in payment from Medicare long before Obama became president and, thus, long before health care reform was more than a gleam in the eye of its proponents.
The threatened cuts are the result of a formula (“SGI”) established during the Clinton years that was designed to control the rate of growth in Medicare payments to physicians. The problem is that nobody anticipated that the number would go down.
As a result of the decrease, and the understandable displeasure expressed by America’s doctors, Congress would end each year by deferring the cuts until they added up the 21% cut doctors now fear. Note that this number did not arise as a result of a stroke of the president’s pen as Obamacare detractors would have you believe. It was the constant deferral by Congress, dating back to 2002, that has permitted the number to reach this point.
The deferment is still the order of the day. While Congress has been afraid to permanently get rid of the threatened cut (they still figure in the total value of the cut in reaching their government healthcare expenditure numbers) and toss out the formula that failed to work as planned, the cut continues to be deferred. You can expect this to continue until Congress eventually gets rid of the entire mess as there are few Democrats or Republicans in Congress willing to do the damage that would be done by actually instituting these cuts.
It simply isn’t going to happen.
As for the hospitals, any cuts they will experience – estimated to be $155 billion over 10 years – are the direct result of negotiation and agreement between the Administration and the Hospital Associations. Nobody cut anything that the hospitals were not willing to accept as both reasonable and ‘doable’.
Lets move on to the real issues.
It is hard to imagine that anybody – with the exception of the bad guys who are profiting handsomely from Medicare scams- can object to efforts to curtail this expensive and popular criminal activity. So extensive is Medicare crime that, in the city of Miami, the cocaine capital of America, Medicare fraud has now replaced the drug trade as the number one criminal activity in the city.
And why not?
Medicare criminals rarely get gunned down in their pursuit of easy money. The most substantial inconvenience these bad guys experience is shutting down their offices when the feds get onto them. Of course, they simply open up a new one under a different name and continue the fraud.
I’m sure that the cynical among you are scoffing at the notion that the federal government will now, as a result of health care reform, have more success cracking down on Medicare crime than they’ve had in the past.
You may be right.
To date, the government’s record on getting Medicare crime under control has been nothing short of abysmal. As a result, we will just have to wait and see if the CMS and Justice Department can do a better job of this.
In the meantime, the success or failure of the effort to reduce Medicare fraud will have no impact on the benefits our seniors receive via Medicare. It is the cuts to the Medicare Advantage programs, enjoyed by 11 million plus senior citizens, which are at the heart of the controversy.
First, a little history to better understand what Medicare Advantage is, how it came to be and whether or not the program justifies the increased costs the American taxpayers have carried since 2003.
In the belief that Medicare could be more effectively administrated by the private sector and that beneficiaries should have the opportunity to purchase additional benefits in exchange for a higher premium payment, the “Medicare + Choice” program (Part C of Medicare) was created in the Balanced Budget Act of 1997.
The program experienced limited success until 2003 when The Medicare Prescription Drug, Improvement and Modernization Act dramatically increased the amount of subsidies paid by Medicare to the “Medicare+Choice” program in order to assist the health insurance companies to offer increased benefits to their members, including pharmaceutical coverage to assist seniors in avoiding the ‘gap’ in drug coverage called ‘the donut hole.’
The 2003 law additionally renamed the program ‘Medicare Advantage.’
Following the 2003 legislation, and largely in response to the pharmaceutical drug benefits made available in these programs, Medicare Advantage began to greatly expand its popularity.
But the popularity came at a significant cost to the taxpayers as the government subsidies provided to Medicare Advantage insurers added approximately 12 to 13 percent to the cost of Medicare benefits.
Under the conditions of the subsidy, an office visit, medical procedure, etc., that cost $100.00 for a beneficiary directly participating in Medicare, rose to $112.00 when the government reimbursed a Medicare Advantage program for the identical service or procedure.
The increased cost was not a secret. In 2003, the insurance companies asked Congress to provide them with this subsidy to give them time to get the program up and running.
The insurers told Congress that a few years of government assistance would enable them to craft a program that would deliver Medicare services – plus additional benefits – and do it more efficiently than the government.
The subsidy was included in the 2003 law with the proviso that the government payments would begin to phase out in 2010.
Not surprisingly, as 2010 rolled around, the health insurance lobby asked Congress to extend the subsidy. However, as a result of the new health care reform legislation, the answer to the lobbyists was a resounding “no” – forcing the Medicare Advantage programs to keep the deal they made back in 2003.
Importantly, and contrary to the misinformation out there, the health care reform legislation did not end the Medicare Advantage program. The impact of the legislation was to empower the CMS (the entity that oversees Medicare) to negotiate tougher deals with Medicare Advantage programs with respect to how much Medicare would reimburse them for their services to participants (more on how that is working out later.)
Let us assume for the moment that, as a result of receiving much lower payment rates from Medicare, some Medicare Advantage programs cease operating or diminish their benefits to the detriment of their customers. What, exactly, will these beneficiaries lose?
The typical Medicare Advantage program, which can either be a pay-per-service plan, PPO, or HMO (meaning that participants are obligated to stay in network rather than see any doctor or check into any hospital they wish as they can under Medicare), offers the following benefits over and above what one would receive by signing up for Medicare Parts A, B & D.
Free preventative care
Fill the Part D pharmaceutical benefit “donut hole”
Often contains dental and vision plans
Provides health club memberships
Let’s begin with free preventative care as, clearly, this is a meaningful benefit. Losing this benefit in a Medicare Advantage program would be a difficult challenge for our senior citizens who make the effort to stay healthy, right?
Wrong.
As of September 23, 2010, seniors are entitled – free of charge – to an annual physical along with free diagnostic tests such as mammograms and colonoscopies. No co-payments…no changes in deductibles…no increase in Part B premiums…no need for anything beyond your ‘run of the mill’ Medicare participation.
So, why would anyone want to pay an extra premium to a Medicare Advantage policy for this benefit? Equally important, why would American taxpayers want to subsidize these insurance programs for a benefit now available to Medicare beneficiaries at no cost whatsoever?
Still, one of the major reasons people opted for the Medical Advantage program was the pharmaceutical benefit – and with good reason. The gap in Part D drug coverage can present a senior with a serious problem when it comes to paying for badly needed medicines.
But that was pre-Obamacare.
Now, the donut hole will be gradually reduced until it is completely closed in 2020. In the meantime, the government is giving back money to seniors to help them through this issue until it is fully resolved. A check for $250.00 has already been issued to most Medicare qualified seniors (or soon will be) to assist with this problem. Beginning next year, seniors will get 50% off on prescription drugs during the gap with the full 100% of the cost of prescription drugs credited towards getting them through the gap period to where they once again regain full coverage.
An argument can be made that since the donut hole in pharmaceutical coverage for seniors is not completely filled until 2020, Medicare Advantage is still of considerable importance to our seniors. However, given the steps already being taken to reduce the pain, there is ample reason to question the allure of the extra premium paid for a Medicare Advantage program as something much less than that premium would, in all likelihood, more than cover the coverage gap if you simply put the premium payment in the bank and used it when – and if – you hit the gap period.
Strike two against Medicare Advantage. Two of the key benefits seniors pay extra for in these programs are now offered – or soon to be offered – as a basic benefit of Medicare Parts A, B and D.
As for the dental and vision, these are important benefits that seniors might wish to purchase. And they can. If the value of these services is worth it, a senior can still buy a Medicare Advantage program that offers this to them.
But, you ask, won’t it now cost them more? Hang in there just a bit longer for the answer.
As for the health clubs – sorry, but I don’t feel good about subsidizing these memberships with my tax dollars. Like so many younger Americans, seniors are likely to sign up and then never use the place after the first few weeks. A daily walk outdoors or through the shopping mall coupled with a couple of $10 home barbells will produce the same results at no charge (other than the one-time $20 charge for the barbells) to our seniors or the taxpayers.
So, by doing away with the subsidies, the taxpayers save billions – money that will be used to reduce the annual costs to the government and extend the life of the Medicare program. Medicare Advantage participants may lose their health club memberships, and possibly, their vision and dental, all of which they will still have the opportunity to buy if they are willing to pay an additional premium.
These savings, folks, are the savings contemplated in Obamacare – nothing less and nothing more.
Now, the big, surprise finish.
Many legislators and policy experts have assumed that the health care reform legislation would result in a dramatic rise in Medicare Advantage premium charges. In 2009, the rates went up 15% as the insurance companies offering Medicare Advantage programs sought to teach Congress a lesson by providing a glimpse of what could be expected should health care reform become law. As a result, upon passage, the expectation was these rates would continue to dramatically increase.
After all, without the billions in government subsidies, Medicare Advantage programs would have to dramatically raise the premium costs to their customers if they were to stay in business.
At least, that’s what they told us would have to happen.
Yet, somehow, it was announced this week that the 11.3 million beneficiaries who participate in Medicare Advantage programs will experience a premium rate drop of 1% this year.
How can this be possible? Certainly, the health insurance companies would never be less than completely honest with us … would they?
Medicare officials said the reform law gave them a stronger stance in negotiations with participating insurers, which they used initially to reject about 300 plans. Donald Berwick, head of the CMS, said, “These plans unfairly proposed to increase out-of-pocket expenses for beneficiaries while increasing their own profit margins,” adding,
“We said, ‘No, you have to do better.‘”
Via Newoxy
And they did. But how?
According to John Gorman of the independent consulting firm, Gorman Health Group,
Officials gave insurers “a beat-down” during negotiations. This was night-and-day different from the Bush years. Insurers succumbed to the government’s demands and stayed in the Medicare market because they have become much more dependent on Medicare business.
Via Newsoxy
So it seems that the business is still profitable after all, even without the 12% government subsidy.
Go figure.
The end result?
Seniors who are no longer interested in Medicare Advantage programs, now that they can receive free physicals and diagnostic tests by signing up directly with Medicare, and are getting much better benefits towards filling the pharmaceutical donut hole, will now save the cost of the added premium charges they have been paying for these extra benefits. Meanwhile, the American taxpayer saves billions upon billions in the subsidies we’ve been paying to these Medicare Advantage programs to feather their profits.
Further, seniors who would like to continue in Medicare Advantage programs for full pharmaceutical protection until this is fully resolved in 2020, along with dental and vision coverage and, yes, continued health club membership, can – at least for this year and likely well into the future – do so paying one percent less than what they were paying last year.
Not so bad after all.
I do realize this information blows a hole in the whole “Obamacare is screwing our seniors” narrative. I also realize that many will want to lash out because they cannot accept that what they’ve been told is wildly inaccurate.
But I also know that Americans of all political persuasions have no desire to unnecessarily frighten or mislead our senior citizens.
So, here’s the deal.
If you have some facts (backed up with citations) that reveal some other cut in Medicare that will harm our seniors, I invite you to provide this information in the comments section below. Not only will the readers learn from any information you might have, so will I.
But if your plan is to simply rant because this puts a giant crack in the importance of your believing that the health care reform program is out to get you, please don’t.
While you are clearly entitled to whatever ideology works for you, let’s do our senior citizens a favor and give them the facts.
I think we owe them that much.
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Much more here in a great summary like this goodie -
Non-profit Blue Cross insurers are required to maintain a loss ratio of 85% or higher to take advantage of IRS tax benefits. . All Blues .
And these gotchas - (Do you guys think this is another reason a small influential group want a repeal?)
Earned income of individuals above $200,000 annually or couples above $250,000 annually will be subject to Medicaid Payroll withholding of 3.8%.
Investment income of individuals above $200,000 annually or couples above $250,000 annually will be subject to Medicaid Payroll withholding of 3.8%. (Do you guys think this is another reason a small group want a repeal?)
These two nice provisions quietly increase the top tax brackets by 2 points to 38.8% total.
These folks now pay only 1.8% on top of their 35% (36.8%).
(Do you guys think these 3 items are additional reasons a small influential group want a repeal?)
(Thanks to Eugene Barufkin for finding and providing these articles for our resource library.)
The next We Energies rate hike must be opposed.
This action is needed now.
We Energies is asking for yet another rate raise, the 4th in less than 30 months*.
During this time Social Security has had only one (1) COLA increase, and will not have a COLA increase 2011.
i.e. Only one COLA increase in three (3) years.
However, electric rates have risen three times in WI, and there is another pending.*
Add this to vehicle gas, heating fuel, rent and food cost increases since 2008, and Wisconsin Seniors need help.
A constructive proposal to reduce rates -
Close some of the old small coal fired plants with at least three results.
- Reduce personal and maintenance overhead costs.
- Increase efficiency.
- Reduce pollution.
And - A 15% utility rate discount for seniors.
Where is the outcry by our candidates and the Democrat Party?***
This should be an issue for this years election cycle.
Furthermore there is an unknown in 2011 -
"The actual impact on customers isn’t yet known because the utility will be continuing to send bill credits to customers in 2010 from the 2007 sale of the Point Beach nuclear plant.
Bills can be expected to go up again in 2011 when those credits are no longer available."**
The same is true for most of WI's smaller utilities ex -
- 5/2009 Rate watch: Green Bay utility seeks hike
- 12/2009 Rate watch: 3.5% hike approved for Madison electric utility
However, at the same time there have been approvals for 'discounting commercial' rates.
AND Further More -
"Manufacturers say they shouldn't be penalized with higher rates when We Energies' power sales fall."
And, behold the great all mighty profits and to hell to those struggling -
"The utility's (WE) parent company is still forecasting record earnings in 2010.
Wisconsin Energy has said profit will rise by at least 15% this year . . . . . . ."
Summarizing - The constructive proposal -
Close some of the old small coal fired plants with at least three results*.
- Reduce personal and maintenance overhead costs.
- Increase efficiency.
- Reduce pollution.
Interesting information that one would think would be a factor to 'reduce rates' - Wisconsin is "awash in electricity*" and "slow sales due to the recession"**.
* . . . . . ."Michigan's attorney general's office and a PSC administrative law judge argued that We Energies has far too much power supply to meet demand and called on the Michigan PSC to reduce the utility's request.
* . . . .(Oak Creek was)"Conceived when the state was teetering on the brink of blackouts in the late 1990s, the plant is coming online at a time when the economy has sapped demand for its power. But the utility says the project - by far the biggest construction effort of any type in state history - will lessen Wisconsin's reliance on imported energy while boosting the company's profit and allowing it to clean up its fleet of older coal plants."
. . . . . "Although environmentalists agreed to drop lawsuits challenging the plant, they still regret that it was built, particularly because the utility's forecasts for rising power demand haven't been borne out."
"They overestimated the growth in demand at the time they proposed it. That's what we said at the time, and it certainly turned out to be true," said Katie Nekola, energy program director at Clean Wisconsin. "And now people are paying for an enormous power plant that isn't needed." . . . . . .
and -
"The Citizens' Utility Board says the company should cut costs by mothballing some power plants. Opening new coal-fired plants in Oak Creek when sales have plummeted means the utility is generating too much power, the group says." 9/9/2009
** We Energies blames decline in sales amid recession, asks for 7% electric rate increase.
Summary - Just may be, the effort to conserve energy is working and WI will always, and more so in the future need less fuel powered energy production per person. One good point of the recession is people are cutting back. Also Wisconsinites seem to be doing what we are asked to do, conserve energy & go green. So why penalize us and why is WE Energies asking for permission to raise rates to make up a loss of revenue, not profits, at the time we need less fuel produced energy? The choice of plants to shut down may be easy as choosing ones that must have expensive upgrading first. example -
Report: State has two plants in top 50 in mercury pollution in the US.
Hypocrisy seems to have no boundaries -
Read numerous contradictions in the same reportª -
"Wisconsin Energy Corp . . . . . reported its 2009 profit from continuing operations totaled $377 million, or $3.20 a share, a 5% increase over 2008."ª
"The higher profit came despite a sales decline that was linked to the recession.
Sales fell 7% in 2009, . . . . . ."ª
. . . . . . "The company said cost-cutting moves helped reduce operating costs and increase profit."ª
"In a tough economy, we cut costs, improved productivity and posted solid financial results," said Gale Klappa, chairman and chief executive.ª
. . . . . . . ."Wisconsin Energy has forecast that profit will rise by another 15.6% this year (2010), . . . ."
"That reflects the $85.8 million price increase approved recently by state regulators for the company's electricity customers but is mainly linked to profit from the new Oak Creek power plants."ª
notable is the statement re residential customers, thus seniors . . . . "Electric rates are rising in part because of power plant construction, and monthly bills for We Energies residential customers rose 7% in January from December." . . . . . .ª
"The addition of new coal plants (Oak Creek) at a time when demand for power is down has led the state Public Service Commission to begin an inquiry into whether some of the older, least-efficient coal plants in the state should be retired or mothballed. That review is expected to begin this year.". . .ª
. . How long should we wait?
How many pot holes will be dug in the road to delay this no brainer exercise?
. . . . ."The company said retail sales of electricity dropped 8.1% last year, including a 10% drop in use by commercial and industrial customers because of "the dramatic slowdown in the economy."
Electricity use by residential customers fell 8.1%."ª and is this expense necessary?
"The other project, projected to cost $960 million, is work to install pollution scrubbers at the four coal-fired boilers built in the 1950s and 1960s at the Oak Creek site. . . . . . ."ª
. . . . ."We Energies says the impact of the economy on demand for power couldn't have been foreseen, and that demand for power will return as the economy recovers."ª
"Plus, utility spokesman Brian Manthey said, customers will benefit because We Energies will be able to sell power from the plant in the Midwest regional wholesale energy market, known as MISO, reducing reliance on older power plants across the Midwest."ª
"Because the plant will be one of the most efficient plants in the MISO footprint, it will be selling into MISO on a pretty consistent basis, to the point where it will be replacing less-efficient, older-generation, most likely higher-emission units," he said." . . . . . ª
Well lets reduce rates now, how much more evidence does WI PSC need?
What additional information/evidence does the PSC need besides the information in their files?
A suggested formula -
Gross amount power that can be produced in 1 day (gPw), less the greatest 1 day demand (D), subtracted down by one old plant (p1 - p2 - p3 etc) at a time,
until the answer equals 'D'.
I bet about one days work.
[gPw - D = p1 - p2 - p3 etc = 'D']
ps Wisconsin is also doing very well of using alternative fuel sources -
*** Wisconsin needs an organized "Wisconsin Seniors Democrats" Auxiliary -
- Senior Dems have time during the day to advocate.
- Many experienced Senior Dems have management & advocacy experience and would like an opportunity to execute.
- There are not enough party elected positions to accommodate many Dems who have experience and are available.
- At least 30 states have organized Senior Democrats.