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.