I know that every campaign promise Barack Obama makes has an expiration date … but this is ridiculous. The confetti is barely off the floor at the Time Warner Cable Arena in Charlotte, North Carolina after Obama’s acceptance speech, and already we find out that he’s flip-flopped. Remember this part of the speech, in which he attacks the Paul Ryan plan to apply free-market reform and cost controls to Medicare?
Read the rest here.
If you enjoy the content at iBankCoin, please follow us on Twitter
The woodshedder mission: providing the misinformed with the information they need to stay that way.
No vouchers are involved – the beneficiaries are enrolled in healthcare plans, not sent out with a coupon to shop for insurance.
The federal government is not imposing the demonstration programs. States that don’t propose demonstration programs won’t have them. The list of states who have submitted proposals runs the full range of the political spectrum, suggesting a common interest rather than political partisanship or ideology.
The demonstration programs are an effort to provide better care at lower cost by integrating a fractured system of benefits and treatment.
The poor (and/or disabled) seniors involved all are so-called dual eligibles – people eligible for benefits from both Medicare and Medicaid. Dual eligibles represent a substantial fraction of the spending by both Medicaid and Medicare, so finding ways to deliver healthcare to that population with greater efficiency would have an important positive impact on state and federal budgets.
Because the two systems work in very different ways and have some very different coverages, dual-eligible patients suffer from a lack of coordination of their benefits and care. As a result, dual eligibles tend to show higher costs and poorer results than do patients of similar health who are covered by a single insurance or healthcare system.
HHS has approved demonstration programs by various states that will allow dual eligibles to enroll (either voluntarily or by not choosing to opt-out, depending on the state) in managed-care systems that integrate the coverage and treatment of the patients.
I’m sure that results will vary by state and program, and that there will be some unpleasant start-up and transition problems, but some of the programs might be able to replicate the success of a similar program in Arizona that already integrates care for dual eligibles. The results of that program (according to a study funded by a health insurer):
When compared to Medicare FFS dual eligibles across the country, and adjusted to match the risk of the FFS dual eligibles, the total Mercy Care population had:
— 43 percent fewer days spent in the hospital (per 1,000 months of beneficiary enrollment);
— 31 percent fewer discharges (per 1,000 months of beneficiary enrollment);
— 19 percent lower average length of stay;
— 21 percent lower readmission rate;
— 9 percent fewer ED visits (per 1,000 months of beneficiary enrollment); and
— 3 percent higher proportion of members accessing preventive/ambulatory health services.
http://healthaffairs.org/blog/2012/07/18/integrated-managed-care-model-for-dual-eligibles-reduces-readmissions/
So, there are no vouchers, broken promises, or nefarious efforts to take advantage of the poorest and sickest seniors. If you are worried about them, you should think about the impact of the Ryan plan that would turn Medicaid into block grants and shrink funding for the program by about 1/3 in real terms over the next 10 years.
Update: A couple of commenters object to my description of this as a “voucher” program — but that’s how Democrats describe Ryan’s plan, and that doesn’t have “vouchers,” either. It’s a premium-support plan in a federal exchange of insurance plans approved by Medicare for coverage. That’s what Medicare Advantage did too, and Obama raided it to pay for the Medicaid expansion in ObamaCare. This plan doesn’t even have the federal exchange that Ryan envisioned, but fifty different exchanges doling out federal dollars. Like I wrote, the plan and the experiment is worth trying, but it’s precisely the kind of push into private insurance that Obama swore the day earlier he’d never do … and he’s doing it with the poorest seniors with only an opt-out in some states rather than the opt-in that Ryan’s plan provided. I’ll put quote marks on “voucher” in the headline, but this mechanism only differs from Ryan’s in that the exchanges get managed by the states rather than Medicare.
If Obama supporters don’t like the term “vouchers” or want to gripe about its accuracy, look first to the beam in thine own eye.
http://hotair.com/archives/2012/09/08/surprise-hhs-pilot-program-to-send-2-million-poor-seniors-from-medicare-into-voucher-programs/