Advocates: Disabled take huge hit under GOP health reform

Advocates for the disabled say the House Republican plan to replace the Affordable Care Act seriously threatens some of the most vulnerable Americans.

The website DisabilityScoop reports that advocates say the bill threatens home- and community-based services and other supports that people with developmental disabilities rely upon.

Photo: Joshua Zader/Creative Commons

“The American Health Care Act shows callous and dangerous disregard for the well-being of people with disabilities and their families and erases decades of progress,” said Peter Berns, CEO of The Arc, an organization that service people with intellectual and physical disabilities.

The House passed the bill 217 to 213, allowing President Donald Trump and Republicans to do a victory lap that they had finally succeeded in destroying Obamacare. The measure though was roundly criticized by doctors, hospital and senior groups. It must still pass the U.S. Senate, which gave it a lukewarm response and promised to address its more draconian measures.

While the disabled take a hit, the most wealthiest Americans are big winners with the new legislation as it delivers a big tax cut the would redistribute billions of dollars to the upper tier.

 

How does it hurt the disabled? The many groups who represent them say the bill would institute a per capita cap for Medicaid. This means the federal government would offer a fixed amount of money for each beneficiary.

“These huge cuts and caps will likely put pressure on states to cut home- and community-based waiver services, especially those that are ‘optional,’ like personal care services and therapies,” said Kim Musheno, chair of the Consortium for Citizens with Disabilities, a coalition of disability advocacy groups.

Schools also would be affected by the Medicaid shift because they are currently able to seek reimbursement for a variety of services provided to disabled children to a tune of $4 billion annually. That means money to reimburse schools for speech and occupational therapy, specialized playground equipment, and even wheelchairs is now in jeopardy.

Advocates for the disabled say House Republicans would allow states to no longer consider schools as eligible Medicaid providers.

To read all of the story by DisabilityScoop click here.

 

GOP Health Bill Could Undermine Coverage Under Employer Plans

Under the GOP’s repeal of Obamacare, the most wealthy get a tax break, while the poor will have benefits rolled back under the Medicaid program, according to an analysis by the New York Times.

But what about those who get their health insurance through their employer? Not our problem, right? Think again.

The Wall Street Journal reports that many people who obtain health insurance through their employers could be at risk of losing protections that limit out-of-pocket costs of catastrophic illness. That’s about half of the country, folks.

“It’s huge,” Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services under President Barack Obama told the Wall Street Journal. “They’re creating a back door way to gut employer plans, too.”

Hardly noticed among the debate over pre-existing conditions, this change came in a last-minute amendment to the House Republican health-care bill that passed by four votes.

The House bill would allow large employers to choose the benefit requirements from any state including those that are allowed to lower their benchmarks under a new waiver, The Wall Street Journal reported.

By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation.

 

Health care analysts say the real question is, would employers do this?

“Many wouldn’t,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. “Many employers offer quality benefits to attract employees. But employers are always looking for ways to lower costs.”

Fifty-nine percent of covered employees who were in an employer plan had a lifetime limit on how much their insurance plans would cover before the ACA, Mr. Levitt said.

To read all of the Wall Street Journal story click here.

 

Study: Red states could lose big in Trump’s repeal of Obamacare

New President Donald Trump has made repealing the Affordable Care Act a top priority.

But a study out of Harvard finds that such a repeal could hurt some of his most ardent supporters in red states. The study focuses on Southern red states who have expanded Medicaid as part of Obamacare. Rolling this portion of the ACA back could have dire consequences for states like Arkansas, Kentucky and Louisiana.

States that have not expanded Medicaid for ideological reasons — such as Florida and Texas — may be less affected, the study from Harvard’s Department of Health Policy and Management. The survey of Texas found that Obamacare had a negative impact, for instance.

“The economics of rolling back Medicaid expansion strongly suggest that doing so would harm patients, hospitals, and state budgets,” stated an article in the New England Journal of Medicine published this week. 

Researchers Benjamin Sommers and Arnold M. Epstein have been doing telephone surveys for four years of low-income adults in Southern states to gauge the effectiveness of Obamacare.

“Our survey provides insight into the current views of many adults living in red states, and the verdict is clear: in states that have embraced coverage expansion despite their political leanings, the ACA’s Medicaid expansion has made a positive difference that is recognizable to the people whose lives have been most directly affected by it,” their article stated.

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Though 19 states declined to expand Medicaid under the ACA, 13 states won by Donald Trump in the 2016 presidential election have opted for expansion since 2014. West Virginia and Kentucky have experienced among the largest proportional increases in Medicaid enrollment in the country.

The researchers said that the question is not whether many Americans — even those in thoroughly red states — have benefited from the ACA, but whether that will be enough to save it.

Study: Red states could lose big in Trump’s repeal of Obamacare

New President Donald Trump has made repealing the Affordable Care Act a top priority.

But a study out of Harvard finds that such a repeal could hurt some of his most ardent supporters in red states. The study focuses on Southern red states who have expanded Medicaid as part of Obamacare. Rolling this portion of the ACA back could have dire consequences for states like Arkansas, Kentucky and Louisiana.

States that have not expanded Medicaid for ideological reasons — such as Florida and Texas — may be less affected, the study from Harvard’s Department of Health Policy and Management. The survey of Texas found that Obamacare had a negative impact, for instance.

“The economics of rolling back Medicaid expansion strongly suggest that doing so would harm patients, hospitals, and state budgets,” stated an article in the New England Journal of Medicine published this week. 

Researchers Benjamin Sommers and Arnold M. Epstein have been doing telephone surveys for four years of low-income adults in Southern states to gauge the effectiveness of Obamacare.

“Our survey provides insight into the current views of many adults living in red states, and the verdict is clear: in states that have embraced coverage expansion despite their political leanings, the ACA’s Medicaid expansion has made a positive difference that is recognizable to the people whose lives have been most directly affected by it,” their article stated.

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Though 19 states declined to expand Medicaid under the ACA, 13 states won by Donald Trump in the 2016 presidential election have opted for expansion since 2014. West Virginia and Kentucky have experienced among the largest proportional increases in Medicaid enrollment in the country.

The researchers said that the question is not whether many Americans — even those in thoroughly red states — have benefited from the ACA, but whether that will be enough to save it.

Blocked! Feds could usurp Florida’s new abortion law

The federal government and Florida may be on a collision course over a new state law seeking to ban Medicaid funding for services at clinics that offer abortions, such as those run by Planned Parenthood, according to a News Service of Florida story.

The federal government has prohibited such bans on Medicaid funding when such laws have been put into place in other states, said Elizabeth Nash of the Guttmacher Institute, which researches abortion issues and supports abortion rights.

With the Capitol dome in the background, Mary Elizabeth Burke, of Washington, participates in a pro choice rally near the Supreme Court, Wednesday, Jan. 22, 2003. Opponents and supporters of abortion rights rallied at the nation's symbols of freedom Wednesday, energized on both sides by Republican hopes of curbing the procedure 30 years after the Supreme Court legalized it. (AP Photo/Susan Walsh) ORG XMIT: SAW101 ORG XMIT: MER0705021207182794

“You cannot exclude a provider from Medicaid because you don’t like the services they provide,” Nash said.

Florida has already been put on notice by the U.S. Centers for Medicare & Medicaid Services, the News Service reports.

The agency notified Gov. Rick Scott administration, “reminding them of the state’s obligation to ensure Medicaid beneficiaries continue to have access to services provided by any willing provider,” according to a CMS spokeswoman.

While only government-funded abortions can be obtained through extreme circumstances, women can obtain other medical services through Medicaid, the News Service reports. Indiana tried to do the same thing in 2011 and found it could not.

One of the sponsors – Rep. Colleen Burton of Lakeland – said they were aware that the state would have to apply to the federal government for a waiver.

“We knew that,” Burton said. “And we’ve said it in committees — I’ve said it on the floor of the House — that we are aware that this portion of the bill requires a waiver from the federal government.”

WASHINGTON, DC - JUNE 26: Pro-life activists gather outside the U.S. Supreme Court June 26, 2014 in Washington, DC. The court overturned today a Massachusetts law barring protests within 35 feet of abortion clinics. (Photo by Win McNamee/Getty Images)

Scott spokeswoman Jackie Schutz would not confirm that the administration was considering requesting  a waiver.

“The bill doesn’t take effect until July 1, and we’re working with our agencies on it, and looking at our options,” Schutz said.

Read the whole News Services story by clicking here.

Indicted Delray Beach doctor is focus of $4.8M whistleblower lawsuit

A newly unsealed whistleblower lawsuit alleges insurance giant Humana knew that a Delray Beach doctor for seven years bilked the government through fraudulent Medicare billing for $4.8 million, according to a report this week by the Center for Public Integrity that was published by NPR.

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A billing practice called a “risk score” is what a Delray Beach doctor used to perpetrate fraud, according to a whistleblower lawsuit.

The lawsuit claims that Humana  – which operates some of the nation’s largest private Medicare health plans –  did little to curb the practice even though it could harm patients.

The Center for Public Integrity is a nonpartisan, nonprofit investigative news organization.

The whistleblower suit was filed by South Florida physician Mario M. Baez and accuses Humana and his former business partner, Dr. Isaac K. Thompson, of Delray Beach, in engaging in a lucrative billing fraud scheme that lasted for years.

In Thompson’s case, Humana paid 80 percent of the money it received to the doctor and retained the rest. Prosecutors charged that fraudulent diagnoses submitted by Thompson between January 2006 and June 2013 generated overpayments of $4.8 million.

Thompson was indicted early last year on health care fraud charges and has indicated he would plead guilty.

The whistleblower suit was filed in October 2012 but remained under a federal court seal until Feb. 26.

Humana, which had no comment, is based out of  Louisville and covers more than 3 million elderly patients in its Medicare Advantage plans nationwide. At question in the whistleblower suit is a billing formula called a risk score that pays higher rates for sicker patients.

To read the whole story by the Center for Public Integrity click here.