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Zaimoni [userpic]
That sweet lemony smell of 1990 Medicare rates

Now that the U.S. Congress actually is double-minded about controlling the deficit, those rates proposed as a price inflation inflation fix in 1990 suddenly don't look as bad. (The preaching of Ben Bernanke and Alan Greenspan is taking hold -- "Want to make the U.S. a Grecian disaster?". This isn't a fair comparison.) Claims are now being processed with a ~21% payout slash.

Too bad the anemic jobs bill isn't that viable without the Medicare rate fix:

House Democratic leaders were furious at the Senate’s scaled-down doc-fix legislation, in part because it was offset largely by a pension provision unpopular among labor unions. The second problem: Removing that must-pass provision from the extenders proposal has robbed some of the urgency from the underlying bill.

Some health experts and advocates worry the strategy could threaten the other provisions of the extenders bill, including tens of billions of dollars in funding for state Medicaid programs.


The Senate on Friday passed the doc fix by unanimous consent after Sens. Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa), the leaders on the Finance Committee, hammered out a last-minute deal to offset the $6.5 billion cost. The proposal would delay a 21 percent cut to Medicare doctors, which took effect this month, until the end of November.

Although House leaders had separated their 19-month doc fix from the larger extenders bill to appease Blue Dog Democrats, they effectively sent the two proposals to the Senate as a package. Senate Democratic leaders, however, haven’t been able to convince even a single Republican to support the extenders bill, forcing separate consideration of the doc-fix measure.

Sens. Ben Nelson (D-Neb.) and Joe Lieberman (I-Conn.) also opposed the bill during a test vote last week.

The Senate was expected to resume consideration of the extenders bill this week, but Democratic leaders might have to delay a vote because they don’t have the support to pass it.


The Senate’s Medicaid funding, estimated to cost roughly $24 billion, is popular with children’s healthcare advocates because it would also prevent states from scaling back eligibility and benefits. House leaders dropped the funding from their tax extenders bill because of budget concerns, but pressure is building for lower-chamber leaders to reconsider that omission.

Governors from both parties have been lobbying for weeks for the additional funding, warning of layoffs and benefit cuts if it doesn’t arrive. Last week, a long list of freshman Democrats wrote to Pelosi and House Majority Leader Steny Hoyer (D-Md.) urging approval of the Medicaid funding.


Healthcare groups are also urging Congress to extend a program providing insurance premium subsidies to unemployed workers. New enrollment in the COBRA subsidy program — which covers 65 percent of premium costs for unemployed workers — expired June 1, leaving an estimated 144,000 families ineligible each month, according to the National Employment Law Project, an advocacy group.

Sens. Bob Casey Jr. (D-Pa.) and Sherrod Brown (D-Ohio) have offered an amendment to the extenders bill that would extend eligibility through November. The Congressional Budget Office, however, recently estimated the cost of the provision at $4.1 billion — much higher than the sponsors anticipated. That price tag threatens to sink the amendment.
Also, remember that Medicare and Medicaid are (currently) the only parastatal health insurance plans where acceptance isn't mandated by law. Thus:
But even as the Beltway wrangling winds on,increasing numbers of physicians are paring Medicare patients from their rosters. As the Baby Boom generation nears eligibility for the federal health insurance program ’ nearly 40 million seniors will have enrolled in Medicare by 2015 and 57.5 million by 2020, compared to 41.4 million in 2008 ’ the American Academy of Family Physicians says 13% of doctors did not participate in Medicare last year, up 8% from 2008 and 6% from 2004. The American Osteopathic Assn. says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients.

And if the 21% cut becomes permanent, the AOA estimated that those numbers would double. The American Medical Assn. cited a survey of 9,000 members that found that 17% restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.


I think the partisan gridlock is going to mean we don't get any sort of plan to reduce the deficit, just arbitrary failures to extend certain tax breaks or spending items. And maybe a few gimmicky but incomplete and temporary spending freezes.