kurtster wrote: 

Oh, sorry, I did not check the date on that "alert" posted on the nonprofit organization's website. It is from October 2010, so you are right,  it is dated. However, most of the points it makes are about what the act itself states, which has not changed.  And there are numerous other "alerts" pertaining to the ACA posted since then on the site, some as recent as a few days ago.  This organization, which, as the name indicates, advocates for Medicare recipients, stands behind the act.

You and others are making predictions on where this all will lead us.  You may be proven right.  You may be proven wrong.  We shall see. I do point out, however, that the predictions and opinions that you (and others) present are not facts.  In your exchanges with Romeotuna, you repeatedly stated that he was citing facts pertaining to the present whereas you were citing  what will happen in 2014.  However, what you say will happen in 2014 obviously is not a fact; it is a forecast.     

There has long been a tension between Medicare payment rates and the affect those rates will have on the availability of providers.  In the snippet you posted along with the post above, it talked about the most recent tensions dating to 2003.     

ACA is an attempt at reform. There are pitfalls, and we might fall into a crater. We might not.   
    

 hippiechick wrote: 

Is not one of the purposes of a society to strengthen and protect individual rights ?

 miamizsun wrote: 
You can't have it both ways. Either your health care is free, or you have to pay for it. If it's free, then someone must pay for it, and that would be the government. 

I really don't understand your statement, are we individuals, or are we society? 

 hippiechick wrote:
 
As long as it is voluntary and they are peaceful, do you have the right to deny them any treatment, service or help that they may seek in any area of their lives?

Regards

 miamizsun wrote: 
Are those people who are not willing to buy insurance willing to stay out the hospitals when they have an illness? These people cost taxpayers a lot of $$$ for their medical care. You can't have it both ways. 

Single payer is the answer to this.

This is the problem with LIbertarianism (did you see Gary Johnson on Colbert?): you all assume that everyone is responsible and concerned and will do the right thing. Society doesn't work that way, and if we live in a society, we must have some agreements as to what is good for the majority.

 

 hippiechick wrote:
 
is it moral and ethical?

no, it simply isn't

no one has the right to force you, as a peaceful person into coercion, esp politically motivated coercion, even if it is buying insurance from their insurance buddies

why even create a political rule, and then immediately create politically motivated exceptions? that's quite the contradiction

look, people should be able to associate peacefully and live life as they see fit, as long as there isn't anyone forced into their idea of what that should be, it has to be voluntary

if you believe in these principles, have at it, and i wish you well, may be that i'll join you some day

and if someone else doesn't see it your way, why would you want to force them to go along?

we both know that you shouldn't

peace

 kurtster wrote: 
I have not heard a good argument for why this is unconstitutional, but lots of good arguments of why it is. 

There are so many ways that this government operates in a manner that is unconstitutional, at least this one benefits people, not take away their rights. 

 hippiechick wrote: 
And ... ?

If its unconstitutional, it should never have been written and passed into law.  That is the fault of the authors (and one author is sitting on the SCOTUS and ruling on the law) and those who supported it and passed it.  Those who were led by a Constitutional scholar who knew exactly what he was doing.

Affordable Care Act Repeal Would Have Immediate Consequences

 steeler wrote: 

It all comes down to this.  One may have benefits, but without providers, they are meaningless.

And this is where we are ultimately headed.  The ACA does not address this issue.  The ACA is driving providers out of their professions.

This source is obviously dated and not current.

You got a lifetime warranty on those new windows, but the company just folded.  So much for that warranty.

Center for Medicare Advocacy, Inc. report:

Health care reform does not cut Medicare benefits. In fact, health care reform expands Medicare coverage, by eliminating cost-sharing for preventive services, adding a yearly wellness visit, limiting some cost-sharing in private Medicare plans, and closing the Part D "Donut Hole." It also improves the solvency of the Medicare program itself. Reform does, however, change some Medicare payment policies. Some misstated reports of these changes have resulted in exaggerating public fear of cuts to Medicare benefits. This Alert summarizes the changes in certain Medicare payments in order to clarify that the Medicare reforms do not reduce Medicare’s guaranteed benefits.

The Affordable Care Act> achieves savings in the Medicare program through a series of payment reforms, service delivery innovations, and increased efforts to reduce fraud, waste, and abuse. The actual projected reduction in Medicare spending is $428 billion over 10 years, after $105 billion in new Medicare spending is taken into consideration.> These projections actually extend the life of the Medicare trust fund by about a decade. It is important to stress that none of the payment reforms affect Medicare's guaranteed benefit packages. The law specifically states that the guaranteed benefits in Medicare Part A and Part B will not be reduced or eliminated as a result of changes to the Medicare program.>

Most Medicare Cuts Are to Private Insurance Plans

The greatest amount of savings in Medicare, about $130 billion over 10 years, will be achieved by reducing overpayments to private Medicare Advantage (MA) plans. These are the insurance plans that contract with the Centers for Medicare & Medicaid Services (CMS) under Medicare Part C to provide benefits to those who voluntarily enroll. MA plans must provide all of the guaranteed benefits under Part A and Part B; they may provide additional benefits with moneys they receive in excess of the cost of providing the guaranteed benefits.

Under the funding mechanism in effect before enactment of the Affordable Care Act, MA plans were paid, on average, 9 – 13% more than the traditional Medicare program to provide the same coverage. These extra payments resulted in Medicare Part B premiums being $3.35 higher per month for all beneficiaries in 2009, and resulted in the federal government (and taxpayers) spending $14 billion more than it would have had Medicare Advantage plan enrollees remained in the traditional Medicare program.>

The Affordable Care Act phases in changes to the MA overpayments, starting with a freeze in payments to MA plans for 2011. Payments will be based on national county benchmarks, with plans being paid a fixed percentage of traditional Medicare costs. As a result of this payment formula, plans in some lower-paid counties, generally rural and suburban areas, will continue to receive payments that exceed the traditional Medicare amount, while plans in higher paid counties, many of them large cities, may see substantial reductions.> Rebates (an amount plans receive if they bid less than the county benchmark) will also be reduced. The new payment structure also provides for an increase in payments by up to 5% for plans that receive four or more stars on the CMS star rating system.>

Medicare Advantage Options Remain Robust for 2011

Many people in the health care industry predicted that the change in MA payments would result in fewer MA plans contracting with CMS, higher premiums, and reduced benefit packages. CMS announced at the end of September 2010, however, that these predictions were not accurate. According to CMS, MA plan premiums for 2011 will be, on average, $1 less than in 2010, and most beneficiaries will have choices of Medicare Advantage plans. Many MA plans that chose to leave the Medicare market in 2011 did so as a result of changes made by the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA)> and NOT because of the Affordable Care Act.

Those who point to the cuts in the overpayments to MA plans as proof that Medicare benefits were reduced by health care reform legislation fail to acknowledge that the Affordable Care Act improves benefits offered by MA plans. For example, the new law sets limits on the amount of cost-sharing plans can charge for chemotherapy administration services, renal dialysis services, and skilled nursing care services.> Further, starting in 2014, 85% of MA plan revenues must go towards benefits, not profits, or plans may be subject to sanctions.>

Changes in Payments to Providers

Many of health care reform's payment reforms consist of changes in the methodology used to calculate payment updates for hospitals, skilled nursing facilities, home health agencies, and ambulance services, among others. Payment updates for these providers are based on an update to the "market basket" specific to the provider type that reflects the increased cost in doing business. In general terms, the Affordable Care Act reduces the annual market basket increase by a specific productivity adjustment that is phased in over a set statutory time frame.> Thus, the new law does not reduce payments from 2010 level, but only reduces the amount of payment increases.

Changes in Payments to Physicians

Payments to physicians are based on a formula, the sustainable growth rate or SGR, that was enacted as part of the Balanced Budget Act of 1997. Because application of the formula would have resulted in negative updates to physician payments, Congress has enacted delays to its implementation since 2003. The Affordable Care Act did not make any revisions to the physician payment formula. Unless Congress continues its practice of enacting a temporary "doc fix," or, more unlikely, reforms the method for calculating doctor reimbursement,> a reduction in payment to physicians will go into effect on December 1, 2010. The cuts remain a potential threat to access to doctors for Medicare beneficiaries.

Linking Payment to Quality Outcomes

In an earlier Alert> we reported, how the Affordable Care Act moves in the direction of linking payment to quality outcomes for entities that provide services to Medicare beneficiaries. Congress has placed emphasis on efforts to measure quality and to provide payment for only those services and procedures that meet certain quality of care standards. As stated above, Medicare Advantage plans may be entitled to bonus payments if they score highly on quality measures. In addition, hospitals will be given incentives to reduce hospital acquired conditions with respect to hospital discharges starting in 2015.

Payments also may be reduced to certain providers in the future if they do not provide high quality health care. For example, beginning in 2012, hospital payments may be reduced if a hospital is determined to have excessive readmissions for identified conditions or procedures that are high volume or high cost and for which the readmission rate is high. A readmission is defined as a return to the same or a different hospital for the same condition within a time frame to be specified by the Secretary of Health and Human Services (HHS).>

Independent Payment Advisory Board (IPAB)

The Independent Payment Advisory Board (IPAB) is a new quasi-governmental body which will take over from Congress the function of establishing Medicare payment policies. Policy makers anticipate that the IPAB, which is to commence operations in 2014, will be able to achieve another $15.5 billion in savings to the Medicare program from 2014-2019.

The 15-member Board will be appointed by the president and confirmed by Congress; members will serve full-time. The IPAB will be advised by a 10-member consumer advisory council. The Affordable Care Act includes strict parameters for IPAB activity. It must submit proposals to Congress to reduce Medicare spending if statutorily-defined parameters are met. These proposals will go into effect if Congress does not act.

Importantly, the law prohibits the IPAB from changing eligibility or benefits, reducing the Part D low-income subsidy, or rationing care.>

Conclusion

The Affordable Care Act slows the growth in future Medicare spending by reducing overpayments to private Medicare Advantage plans, by restructuring up-dates in payments to many providers, and by tying payments to improved quality of care. Health care reform does not reduce Medicare benefits.

---

 romeotuma wrote: 

You keep dealing in the now and taking the words of this administration at their face value.  I have learned to not believe the words of this administration, only its actual deeds which are far different than its words.  Going through the timeline on the first link, we already have one part that has been found unworkable and admitted by HHS Sec. Sibelius.  There will no doubt be many others.  The Cost panel is just beginning to write the regulations and we have no idea what their recomnedations are going to be, especially in the light of the coming finacial collapse due to the debt.  It is a fact that money is being removed from Medicare to pay for parts of the ACA.  Obama's pledge of removing billions and billions of fraud from Medicare have already fallen far short of his words.  There is very little in writing except what is going to be cut from Medicare.

There are grand promises made, but the rules for these promises have yet to be written.  I've heard the promises to close Gitmo within the first year.  Immigration and border reform within the first year.  Unemployment would not go above 8%.  Shovel ready.  I will not raise taxes on anyone making less than $250K.  Afghanistan was the right and just war.  The SCOTUS has no right to strike down a law passed by Congress.  Yada, yada.  This man is not believable nor trust worthy.  I do not want an unaccountable board without oversight writing rules that can not be reviewed on matters of medicine, which is what the ACA has put in place.  There are no guarentees, yet it is being assumed that nothing can go wrong, because Obama has said so.

Not good enough for me.  Actions always speak louder than words.  The actions and record of this POTUS are not something to be proud of.  Proof is he is ignoring his record and in particular the ACA as an accomplishment to be proud of.  Instead this Constitutional scholar has created a Constitutional crisis over the ACA.

 romeotuma wrote: 
You are not citing government sources, while I am.  Page 46 covers Mental Health which I cited below, earlier.  I prefer the government sources.  There is also a Part B deductable for these mental health visits that applies beyond what has already been mentioned, but not by you or your source.  Under Medicare Advantage the Part B deductable is not a factor and again I have a $20 co-pay, not a 40% of Medicare approved rates plus a potential 15% surcharge depending upon provider after the initial visit you cited above.  Medicare Advantage is better than plain Medicare and it is being gutted by the Affordable Care Act. 

It is you who are delusional on this, not me.  I have the facts.  I have studied this very hard.  I am beyond preventive care.  I am well connected in the medical field and this knowledge has helped me make smart and informed decisions.  Do not be fooled.  Medicare is being destroyed by Obama.  That is a fact.

 romeotuma wrote: 

Yes I know the makeup of the SCOTUS.  Learned it back when Roberts was confirmed.

On the psych care, reading now from the 2012 Medicare Book.  "Generally, for outpatient treatment of your condition (such as counseling and psychotherapy), you pay 40% of the Medicare - approved amount."   At $150/ hour, that's what $60 ?  Under Medicare Advantage, I get 12 visits per year with a $20 per co-pay and with more provider choices.  Medicare Advantage is so much better and it is being destroyed.  This is just one example.

 romeotuma wrote: 
I'm on Medicare.  The Affordable Care Act, (not Obamacare) is screwing Medicare.  It makes things worse for those on Medicare not better.

I remember a time when I was criticized for calling the Affordable Care Act Obamacare by Democrats.  Now the Democrats run from calling it what it is because it does not make things more affordable.  Afffordable Care, sounds so ...  ... so phony, doesn't it ?

 romeotuma wrote: 

That is now.  I am talking about then.  When the freaking plan kicks in full force.

Then is less than 2 years away.

 romeotuma wrote: 
What part of coverage cuts in Medicare Advantage don't you see ?  I'm not making that up.

The Independent Payment Advisory Board, a collection of unelected HHS bureaucrats deciding the medical fate of Americans.  The same fault Obama laid at the feat of the SCOTUS, a collection of unelected people deciding the medical fate of Americans.

What part of taking away $50 B from Medicare Advantage is going to make it stronger and better ?

 romeotuma wrote: 
You cite the now, I cite the future.

Effective by January 1, 2014

Pay for new spending, in part, through spending and coverage cuts in Medicare Advantage, slowing the growth of Medicare provider payments (in part through the creation of a new Independent Payment Advisory Board), reducing Medicare and Medicaid drug reimbursement rate, cutting other Medicare and Medicaid spending
That is taking away from Medicare and giving it to another entity.  Money that was paid directly into Medicare and is being highjacked to pay for the Affordable Care Act.  Bullshit.  One example of the gutting or robbing of Medicare to the tune of $500 Billion overall. 

This cut alone costs Medicare $ 50 Billion by the .govs own admission.

The Affordable Care Act levels the playing field by gradually eliminating Medicare Advantage payments to insurance companies in excess of Medicare's costs. These changes will achieve an estimated $50 billion in savings over the next five years.

 romeotuma wrote: 

The Affordable Care Act (lets not forget the lie about affordable) eliminates Medicare Advantage plans which are the only supplemental plans availabe to those under 65 and participating due to disability.  That's a real big deal.  Florida got to keep theirs, because of the vote bribe.  Citizens are not treated equally.  Let's not forget the Louisiana Purchase for a vote and Nelson in Nebraska. 

I will be with bare bones Medicare.  Due to the law, I cannot purchase supplemental insurance even if I wanted to.  Tell me how it gets better again ?  My costs go up because Medicare is only an 80 / 20 plan without supplemental insurance.  The list of Medicare providers keeps shrinking, resulting in defacto rationing.

 hippiechick wrote: 
You wouldn't say that if you were on Medicare.  it has ripped the heart out of Medicare, elimating Advantage plans, except in Florida where he had to give up a bribe for a vote in the Senate.  He stole 500 Billion from Medicare to help fund your Obama care which you or no one else has paid into yet.  Affordable Care Act.  Affordable my ass.  He is a Liar.

Obama is bitching about the unelected SCOTUS while we have unelected HHS bureaucrats deciding the medical future of all Americans.  What arrogance, what denial of reality.