If you have "no place to go," come here!

At least Paul Ryan was going to wait a few years before killing Medicare. Barack Obama, on the other hand...

... is apparently going to start killing Medicare as we know it in 2013.

If you have Medicare now and are reasonably prosperous and healthy, you'll get to keep your benefits, your choice of doctor and hospital and pharmacy and so forth.

But if you have the audacity to become expensively sick and very, very poor, so sick and so poor as to require not only Medicare but Medicaid too to pay for your health care, you are in danger of essentially being pushed out of Medicare and shoved into Medicaid, whether you like it or not.

Beginning in 2013 states are going to be allowed to set up demonstration projects for their dual-eligibles (poor, sick people who are covered by both Medicare and Medicaid) whereby the federal government gives a chunk of Medicare money and a chunk of Medicaid money to the states and allow the states to use that money to choose and pay for managed-care private insurance plans.

No more traditional, fee-for-service, visit-any-doctor-in-the-country Medicare for you! Off to the ice floes, you useless eaters!

But back in Washington, [Obama's] Health and Human Services Department is launching a pilot program that would shift up to 2 million of the poorest and most-vulnerable seniors out of the federal Medicare program and into private health insurance plans overseen by the states.

The administration has accepted applications from 18 states to participate in the program, which would give states money to purchase managed-care plans for people who are either disabled or poor enough to qualify for both Medicare and Medicaid.

Obama’s 2010 health reform law allows experimentation in delivering health care at lower cost through demonstration projects. Many states would like permission to shift their entire population of so-called dual-eligible beneficiaries into the new plans. HHS has indicated that it will enroll about 2 million beneficiaries, out of about 7 million who qualify for full benefits from both government health programs.

California is already counting on more than $500 million in budget savings from its own program this year.

Potential cost savings are a big incentive for states. Patients who qualify for both federal health programs are a costly population and include many who need nursing-home care or other expensive services. About 40 percent of Medicaid’s costs go toward patients who are also eligible for Medicare. Advocates of the pilot program also say it could lead to better coordination of care for patients who often struggle to navigate the two different programs.

To get approval, states must guarantee that both Medicare and Medicaid would save money. They must also agree to accept a fixed payment to cover all care for each patient. While rules say the private plans must cover all standard Medicare benefits, they also waive many Medicare rules and leave insurer selection to the states.

Still, there is powerful opposition to the pilots among doctors, hospitals, nursing homes, patient groups, and key lawmakers, including Sen. Jay Rockefeller, D-W.Va., who wrote the provision in the health law that created the office in charge of the pilot program.

“I urge you to take immediate steps to halt this initiative as currently structured and to take the time necessary to develop a well-designed and thoroughly evaluated care coordination model for dual eligibles that meets the standards outlined in the law,” Rockefeller wrote in a letter to HHS.

The Medicare Payment Advisory Commission, a group of experts who advise Congress on Medicare policy, has also weighed in with an 11-page letter to HHS, warning that the speed and scope of the program raised questions about whether patients would receive the care they need.

The managed-care industry is gearing up for the expansion. Three large insurers have purchased companies that insure Medicaid beneficiaries. For years, states have been moving Medicaid patients into managed-care plans, with mixed results. But this pilot represents a new market: It is the first large program that would pool Medicare and Medicaid benefits in a single, state-administered plan.

One possible solution I would offer to you - this could save a lot of money - is just get rid of the sick people!

No votes yet


Submitted by jawbone on

supplemental insurance sales, they might not support it...or do they get a chunk of the mamaged care?

I love it." Dear grandchildren, I can no longer travel out of my managed care territory to visit you. If something happens out of territory, I won't be covered. I'm a prinsoner of my state's managed care plan!"'

And, as I've noted so often, just when our elderly --we ourselve-- will really, really NEED ice floes, they'll be gone as well. So, it's walking out into the deep water and hoping no one rescues you or jumping off a bridge or building? IF you can walk or get ot the right height of any building....

Hey, Barack, you got shares in Soylent Green?

Submitted by hipparchia on

Dear grandchildren, I can no longer travel out of my managed care territory to visit you.

given how mobile our society has been, this sure could affect a lot of grandparents. my parents have traditional medicare so when they travel to visit their grandkids, they're in good hands. for now.

as for aarp, i couldn't find anything current, but yeah, it was pointed out during the great health whatever reform debate that aarp was about as close to being an insurance company as you get without actually being a real insurance company. i can see the beginning of a pattern in the headlines though...

2006: Some question AARP's dual roles | The advocacy group may also benefit from the Medicare drug plan it endorsed.

2009: AARP dual role in health reform: Advocate and insurance business

2012: ___________________

letsgetitdone's picture
Submitted by letsgetitdone on

Do you know who the three insurers referred to above are?

Also, this all comes back to Medicare for All. We need to keep pushing for it and get the insurance companies and the States out of this mix.

Submitted by weldon on

Don't know specifically about the other two, but I'm sure Unitedhealth is among them. They're not really buying other companies so much as they're buying patients. About 9 million people are in that lucrative medi-medi group.

Submitted by lambert on

Given that Liz Fowler, a WellPoint VP, crafted the ACA while on secondment to Max Baucus's office.

Submitted by hipparchia on

Mr. Bertolini is the chief executive of Aetna, which on Monday agreed to acquire Coventry Health Care, a huge provider of Medicare and Medicaid programs. His $5.7 billion bet makes a lot of sense if you believe that the Affordable Care Act — otherwise known as Obamacare — will not be repealed.


Aetna is not the only company to make a bet on the White House.WellPoint agreed to acquire Amerigroup for $5 billion in July, just a little over a week after the Supreme Court’s decision to uphold the Affordable Care Act. Before that, Cigna paid $3.8 billion for HealthSpring in another bet on the expansion of Medicaid and Medicare.

Submitted by lambert on

It's also a medical experiment without informed consent -- as morally vile as it's possible to be, short of turning my skin into a lampshade after the experiment is done.

letsgetitdone's picture
Submitted by letsgetitdone on

at most Seniors because there's a very good chance we'll need both programs before death takes us!

Submitted by hipparchia on

morally vile is right on the money, but wait, it gets worse...

i didn't do this before i wrote the top post, but i went and followed one of the links in the pnhp article just now and found that not only are almost all the medicaid managed-care plans in the california experiment rated one "star" (with 5 stars being the best rating) but of the corresponding medicare managed-care plans offered by each company, 7 of them are rated anywhere from 2.5 to 4 stars [see table on pg 3].


ever since reagan was president, i've been resigned to the possibility that someone would get around to destroying medicare and social security before i could get any benefit from them, but i've always thought my parents were probably safe. now it's looking like maybe not. they're in reasonably good physical, mental and financial health for now, but they're not rich and if something really bad were to happen, there's no way i could help them out of anything like this.

reslez's picture
Submitted by reslez on

Health insurers don't want to cover disabled/sick people, they're too expensive. So they're going to do this because the federal government wants to "save money", and a couple grinning skulls in the private health insurance industry think they can turn a profit by denying care to people who need it (because that's the only way it's possible to profit) while tossing their 30% administration fee on top.

[T]here is powerful opposition to the pilots among doctors, hospitals, nursing homes, patient groups, and key lawmakers

I'm glad Obama and the insurers want this, because apparently they're the only ones.

This election is Obama's mandate to reduce American life expectancy. Gives a new twist to "vote or die".

Submitted by hipparchia on

it sure does, doesn't it?

This election is Obama's mandate to reduce American life expectancy.

or at least a mandate to keep reducing the life expectancy of the 99%:

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

twig's picture
Submitted by twig on

to living in a one-star hellhole nursing home for some of us.

A friend was looking for a nursing home recently, and decided to find out which ones were not involved in lawsuits over patient issues. In greater LA, which has dozens (hundreds, maybe) of homes, she found only one with no current lawsuit.

Of course, that doesn't necessarily mean it's a good one and some of the lawsuits may have been frivolous. But my dad died from dehydration/kidney failure in a "good" nursing home. I don't even want to think about what the causes of death might be in a one-star home.

Submitted by hipparchia on

i asked my parents, only half-jokingly, if they want me to go out and try to find them a cyanide pill if they're ever in a situation like that. they said yes [not jokingly].

Submitted by lambert on

Isn't that a huge number for a 2% cut? What's the logic?

And ha ha, all those people going into health care because "that's where the jobs are." Oh well...

Submitted by hipparchia on

The model reflects how reductions in Medicare payment for healthcare services will lead to direct job losses in the healthcare sector; reduced purchases by healthcare entities of goods and services from other businesses, which in turn will lay off workers; and reduced household purchases by workers who lose their jobs.

so, (1) fewer healthcare workers, like nurses, (2) fewer workers in healthcare drug and device manufacturing etc, and (3) fewer workers in the wider economy, since jobless people spend less money on food, clothing, housing, etc.

sounds like a good example of looking at the "ripple effect" and how spending cuts in one sector of the economy spread out to kill off influence the rest of us.

link to the full report [PDF]

Submitted by lambert on

... in the comment.

I wonder if we have similar orders of magnitude in other industrial sectors, eg auto or aircraft, and if a 2% decrease in the past has been shown to have similar effects.

I'm pushing on this because, after all, if I were any entity having my budget cut, this is exactly the sort of argument I'd make -- true or not! (I'm sure the defense crowd in VA has produced similar studies for the same reasons).

twig's picture
Submitted by twig on

that I link to in that comment, there's a PDF with a discussion of the methodology and how they arrived at those figures.

They keep saying that the cuts won't affect patient care, only what Medicare pays hospitals, etc. That makes no sense to me. If thousands of health-care workers are being laid off, of course that will affect patient care. How could it not??