America Is On The Same Glide Path As The Fatal Germanwings Flight
The pilot was locked out of the cockpit. That phrase finally revealed the full horror of the crash of Germanwings flight 9525.
Co-pilot Andreas Lubitz waited for the pilot to leave the cockpit then locked the door to prevent his re-entry. After which Lubitz, for reasons unknown and perhaps unknowable, deliberately steered the jet into a harrowing 8-minute plunge, ending in an explosive 434 mph impact with a rocky mountainside. One hundred fifty men, women and children met an immediate, unthinkably violent death.
Lubitz, in his single-minded madness, couldn’t be stopped because anyone who could change the jet’s disastrous course was locked out.
It’s hard to imagine the growing feelings of fear and helplessness that the passengers felt as the unforgiving landscape rushed up to meet them. Hard, but not impossible.
America is in very deep trouble and we feel the descent in the pits of our stomachs. We hear the shake and rattle of structures stressed beyond their limits. We don’t know where we’re going anymore, but do know it isn’t good. And above all, we feel helpless because Barack Obama has locked us out.
He locked the American people out of his decision to seize the national healthcare system.
He locked us out when we wanted to know why the IRS was attacking conservatives.
He locked us out of having a say in his decision to tear up our immigration laws and to give over a trillion dollars in benefits to those who broke those laws.
Obama locked out those who advised against premature troop withdrawals. He locked out the intelligence agencies who issued warnings about the growing threat of ISIS.
He locked out anyone who could have interfered with his release of five Taliban terror chiefs in return for one U.S. Military deserter.
And, of course, Barack Obama has now locked out Congress, the American people, and our allies as he strikes a secret deal with Iran to determine the timeline (not prevention) of their acquisition of nuclear weapons.
Was Andreas Lubitz depressed, insane, or abysmally evil when he decided to lock that cockpit door and listen to no voices other than those in his head? Did he somehow believe himself to be doing the right thing? The voice recordings from the doomed aircraft reveal that as the jet began its rapid descent, the passengers were quiet. There was probably some nervous laughter, confusion, a bit of comforting chatter with seat mates, followed by a brief period in which anxiety had not yet metastasized into terror. It was only near the end of the 8-minute plunge that everyone finally understood what was really happening. Only near the end when they began to scream.
Like those passengers, a growing number of Americans feel a helpless dread as they come to the inescapable conclusion that our nation’s decline is an act of choice rather than of chance.
The choice of one man who is in full control of our 8-year plunge. I wonder when America will begin to scream.
The U.S. Treasury Department has rebuffed a request by House Ways and Means Chairman Rep. Paul Ryan, R- Wis., to explain $3 billion in payments that were made to health insurers even though Congress never authorized the spending through annual appropriations.
At issue are payments to insurers known as cost-sharing subsidies. These payments come about because President Obama’s healthcare law forces insurers to limit out-of-pocket costs for certain low income individuals by capping consumer expenses, such as deductibles and co-payments, in insurance policies. In exchange for capping these charges, insurers are supposed to receive compensation.
What’s tricky is that Congress never authorized any money to make such payments to insurers in its annual appropriations, but the Department of Health and Human Services, with the cooperation of the U.S. Treasury, made them anyway.
Health and Human Services spending on these cost-sharing payments is one of the issues named in House Speaker John Boehner’s lawsuit against the Obama administration’s executive actions on Obamacare.
In a Feb. 3 letter to Treasury Secretary Jack Lew, Ryan, along with House Energy and Commerce Committee Chair Rep. Fred Upton, R-Mich., asked for “a full explanation for, and all documents relating to” the administration’s decision to make the cost-sharing payments without congressional authorization.
In response, on Wednesday, the Treasury Department sent a letter to Ryan largely describing the program, without offering a detailed explanation of the decision to make the payments. The letter revealed that $2.997 billion in such payments had been made in 2014, but didn’t elaborate on where the money came from. Over the next decade, cost-sharing payments to insurers are projected by the Congressional Budget Office to cost taxpayers nearly $150 billion.
Instead of detailing the basis for making the payments without appropriations, Treasury officials cited the ongoing House GOP litigation, and referred Ryan to the Department of Justice.
In a brief filed on Jan. 26, DOJ lawyers wrotethat the Boehner lawsuit was incorrect in saying that the payments required annual appropriation. “The cost sharing reduction payments are being made as part of a mandatory payment program that Congress has fully appropriated,” the brief read.
But this argument is undercut by the administration’s own previous budget request.
For fiscal year 2014, the Centers for Medicare and Medicaid Services (the division of Health and Human Services that implements the program), asked Congress for an annual appropriation of $4 billion to finance the cost-sharing payments that year and another $1.4 billion “advance appropriation” for the first quarter of fiscal year 2015, “to permit CMS to reimburse issuers …”
In making the request, CMS was in effect acknowledging that it needed congressional appropriations to make the payments. But when Congress rejected the request, the administration went ahead and made the payments anyway.
The argument that annual appropriations are required to make payments is also backed up by a report from the Congressional Research Service, which has differentiated between the tax credit subsidies that Obamacare provides to individuals to help them purchase insurance, and the cost-sharing payments to insurers.
In a July 2013 letter to then Sen. Tom Coburn, Congressional Research Service wrote that, “unlike the refundable tax credits, these [cost-sharing] payments to the health plans do not appear to be funded through a permanent appropriation. Instead, it appears from the President’s FY2014 budget that funds for these payments are intended to be made available through annual appropriations.”
Tax Shocker: Obamacare To Hit Subsidy Recipients With Huge Tax Bill
Anyone who receives Obamacare subsidies could be in for a rude awakening this tax season.
Four in ten low-income Obamacare participants will face sticker shock this April 15 when they discover they owe a great deal of money to the IRS because of a little-known “clawback” provision in the health-care law.
A family of four could owe the government as much as $11,200, according to a 2013 prediction by researchers at the University of California, Berkeley.
The idea that struggling, low-income Obamacare enrollees would have to repay the government for subsidies has been a dirty little secret that has always been part of the Affordable Care Act.
Although its existence has been known since 2010, neither Obamacare advocates nor the Internal Revenue Service have widely publicized it.
Authors of the groundbreaking UC study, written by supporters of the health-care law, warned the repayment feature could kill future support for Obamacare.
“Repayment requirements could lead to public dissatisfaction with the exchanges. And if there is much media attention to the need for repayments, some people could be dissuaded from participating in the exchanges,” they cautioned.
As tax time approaches, the word of forced repayment could fuel yet another round of public anger directed at Obamacare. This time, however, the anger could originate from Obamacare’s own beneficiaries.
Taxpayers should also be concerned, since estimates show the erroneous subsidy payments could cost the government up to $4.7 billion in 2014 alone.
And because the repayments are “capped,” the federal government will only be able to recover a small portion of the erroneously awarded subsidies.
Still, workers who receive income that’s 100 percent to 400 percent of the federal poverty line could face difficult repayments ranging from $600 to $2,500.
The California researchers admitted even a $2,500 repayment could be devastating to a couple.
“A repayment requirement of $2,500 could be a financial shock to a family of two earning $50,000 a year,” they stated.
Douglas Holtz-Eakin, the former director of the Congressional Budget Office, warned in an interview with TheDC that many Obamacare enrollees will be upset as April 15 approaches.
“There’s going to be a lot of dismay when they get to tax filing season,” he told TheDC in an interview.
Holtz-Eakin added it’s unlikely the government will recover or “recapture” all the wrongly-issued subsidies.
The administration “could simply say enforcing the recapture of too generous subsidies is too hard and effectively say, ‘we’re not going to get the money back.’ And the taxpayer loses,” he says.
The former CBO chief cited the federal government’s poor experience with a simpler, but comparable program called the Earned Income Tax Credit, under which as many as 25 percent of the filings were erroneous.
“This is a much more complicated system,” he said.
Obama Responds To ISIS Burning Pilot Alive By Promoting Obamacare!
President contrasts Obamacare to the death and destruction of ISIS
President Obama promoted Obamacare in his response to a video reportedly showing ISIS burning a captured Jordanian pilot to death.
After the Islamic State released a video Tuesday showing ISIS militants lighting pilot Moaz al-Kasasbeh on fire as he stood in a cage, Obama contrasted the death and destruction of ISIS with the “benefits” of Obamacare, which he claimed makes “people healthier” and “their lives better.”
“We’re here to talk about how to make people healthier and make their lives better, and this organization appears only interested in death and destruction,” he said.
Obama was meeting with his supporters in response to House Republicans who are voting to repeal Obamacare and the president threatened to veto any attempt to repeal the health law.
But Obama has been more restrained in his response to ISIS, which is understandable considering the U.S. has been covertly funding the terror group alongside NATO ally Turkey as part of their proxy war against Syria.
“During investigations, Yousaf al Salafi [an ISIS commander] revealed that he was getting funding – routed through America – to run the organization in Pakistan and recruit young people to fight in Syria,” a source within Pakistani law enforcement told a local newspaper.
President Obama wants a $38 billion budget increase for the Defense Department, which includes $5.3 billion to equip “appropriately vetted elements of the Syrian opposition,” but back in September ISIS signed a truce with the remaining rebel groups and they are now working together against the Syrian government.
“We are collaborating with the Islamic State and the Nusra Front by attacking the Syrian Army’s gatherings in… Qalamoun,” Bassel Idriss, the commander of a “moderate” rebel brigade, told the Lebanese Daily Star.
And another “moderate” commander of the Free Syrian Army, Abu Khaled, also revealed they are collaborating with Islamic militants.
“Let’s face it: The Nusra Front is the biggest power present right now in Qalamoun and we as FSA would collaborate on any mission they launch as long as it coincides with our values,” he added.
Congress Looking Into Why IRS Has BIG MONEY Contract With Botched Healthcare.gov Company
Congress may conduct an investigation into the surprising report that the Internal Revenue Service awarded a $4.5 million IT contract to CGI Federal, the discredited designer of the botched Obamacare website, Healthcare.gov.
Rep. Chaffetz told TheDC he suspected the same mismanagement problems that plagued Obamacare exist at the IRS.
“I am concerned that this type of mismanagement will be repeated by the current administration under the new IRS contract,” he said.
Chaffetz, who succeeds outgoing chairman Rep. Darrell Issa, (R-CA) is expected to continue to aggressively pursue government wrongdoing and mismanagement in the administration. He chairs a committee that enjoys wide jurisdiction over many federal programs.
Grover Norquist, the president of the influential Americans for Tax Reform, a tax advocacy group, agreed there should be an investigation into the IRS contract awarded to CGI.
“This calls for serious investigation and people should be brought in under oath about how this could happen,” he told TheDC.
Norquist also said it seemed clear to him that the administration had learned little from the Obamacare debacle.
“This is proof that the administration learned nothing from the failure of the rollout of the Obamacare website,” he concluded. “It means nothing has changed.”
Dave Williams, president of the Taxpayers Protection Alliance, a Washington-based advocacy group told TheDC, “This is absolutely incredible. How does the federal government contract with the same firm that messed up the Obamacare site? It boggles the mind.”
Williams said the revelation breeds cynicism among citizen views of Washington. “All citizens are just dumbfounded when they see these kind of decisions coming out of Washington, D.C.”
Speaking at a November 2013 fundraising dinner for top Democratic donors shortly after the Obamacare website failed, President Obama publicly vowed to fix federal IT procurement.
“There are a whole range of things we’re going to need to do once we get this fixed, to talk about federal procurement when it comes to IT and how that’s organized,” Obama said then.
However, a 2014 Acquisition Policy Survey of IT executives issued Thursday by the Professional Services Council and the Grant Thornton consulting firm suggests that despite the rhetoric, the administration has done very little to reform IT government procurement.
The survey concluded, “A solid majority indicated that things have not improved overall or not improved sufficiently to ‘move the needle.’”
The IRS contract awarded to CGI was issued under a competitive bidding process.
Former IRS Commissioner Mark W. Everson, who served under President Bush’s administration, said based on the “professionalism” of the IRS procurement division, the tax agency was merely following federal guidelines.
“My experience with their procurement group at the IRS was positive. I think that is very different than what happened at HHS where the design of that website was abysmal,” he told TheDC.
Stan Soloway, the president of the Professional Services Council (which counts CGI as one of its members), also defended the IRS.
“I have faith the Internal Revenue Service was well aware of the challenges of Healthcare.gov and took a very close look at their capabilities CGI,” Soloway said. “If anything, they would have been biased against making that judgment.”
However, A.R. Trey Hodgkins, a senior vice president of the Information Technology Industry Council says there are many barriers that prevent innovative IT companies from entering the government procurement process.
In a January 2014 blog, he wrote, “it is important to keep in mind that troubled IT program rollouts, like Healthcare.gov, are symptomatic of broader systemic failures in federal acquisition,” adding, “In order to encourage more competition in the federal public sector, we need to find ways to reduce barriers to entering and staying in the market.”
A spokesman for CGI would comment to TheDC that, “CGI has successfully supported the IRS for more than a decade, and continues to do so.”
H&R Block: ‘No One Can Understand’ New Obamacare Tax Code
H&R Block, the nation’s largest retail tax preparation company warns that the newly released Obamacare tax code, officially called the Affordable Care Act, is likely to confuse millions of taxpayers who try to tackle their tax returns for 2014.
“Now that the Affordable Care Act has made health care a tax issue, no one can understand it,” H&R Block flatly tells taxpayers in a video that resides on its dedicated Obamacare web site.
A former IRS Commissioner agrees, and cautions that the new tax requirements will be a “shock to the system,” especially afflicting low-income earners who have never itemized on their tax return.
The tax preparation giant — with 24 million tax clients worldwide — reports that the Obamacare tax rules now constitute “the biggest tax code change in the last 20 years.”
The company is so concerned, it has launched a high profile national televisionadvertising campaign directed solely at Obamacare enrollees. The ads were first broadcast the weekend of Jan. 10 during the NFL playoffs.
Illustrating H&R Block’s point is IRS Publication 5187, which attempts to explain to taxpayers how to comply with the new Obamacare tax requirements. That publication runs for a total of 21 single-spaced pages.
This year, for the first time, taxpayers will feel the full weight of the Obamacare tax rules, which were enacted in 2010. The new tax code regulations will apply to all Americans who file 2014 tax returns.
Some Obamacare users may discover that they need to repay the government for the subsidies they received to cover their health insurance premiums. A few will discover they were not entitled to insurance at all.
Other taxpayers also will find their refunds are smaller, due to penalties incurred because they didn’t enroll in a government-approved health plan.
Penalties for non-compliance with Obamacare have tripled since 2013, from $95 to an average of $301, according to an email to The Daily Caller from software giant Intuit which runs TurboTax, a competitor to H&R Block.
A large percentage of Obamacare enrollees are low-income earners who opted for the program because they qualified for government subsidies that would lower their monthly insurance payments.
H&R Block’s Tax Institute found in a national survey released last fall that nearly three out of four low-income earners were not aware of the need to file anything with the IRS because of their Obamacare insurance.
“Lower-income respondents (72%) are significantly less likely than other income brackets to be aware of the law,” the Institute reported.
Former IRS Commissioner Mark W. Everson, now vice chairman of Alliantgroup, warns the new Obamacare requirements will deliver a “shock to the system.”
“Low income filers are not used to itemizing and it will be a big challenge for them,” he noted in an interview with TheDC. “You’re introducing a whole new level of complexity.”
Grace Marie Turner, president of the non-profit Galen Institute and a critic of Obamacare, calls the new IRS filing requirements “a nightmare.”
“People don’t even know that they have to comply with this law through their tax filing,” she said in an interview with TheDC.
At the heart of the Obamacare tax rules are three new IRS health-related forms.
One is Form 1095, which will be sent to the estimated seven million Obamacare enrollees who received a federal subsidy.
Turner warned that many who will receive Form 1095 are likely to throw it out. “Many will think it’s junk mail.”
To prove they were entitled to subsidies, recipients will have to fill out a second document, Form 8962.
Mark Jaeger, a tax team leader at the software company Tax Act, which competes with H&R Block, says Obamacare recipients will be “most definitely” confused by Form 8962.
“If they’re trying to do it on their own doing, and do it by hand, that’s going to be pretty difficult for the user,” he told TheDC.
Turner agrees. “Millions of people who were used to doing a simple 1040 EZ form are going to be required, now, to fill out this complicated 8962 tax form.”
Klein knows the health care law inside and out, but more importantly he is fluent in the conservative alternatives. He discussed the way out of Obamacare in an interview with The Daily Caller.
Liberals hate it when people call Obamacare a government takeover of health care. Explain why they’re wrong.
Sure, Obamacare didn’t immediately turn the United States into a fully socialized system overnight, but it did put America on the pathway to such a system, which is also described in health policy circles as “single payer.”
Obamacare adds millions of people to the rolls of government-run Medicaid and then distributes government subsidies to individuals so they can buy government-designed insurance on government-run exchanges. And you don’t have to take it from me. Even liberal economist Paul Krugman wrote in The New York Times that Obamacare was a “Rube Goldberg device” that “relies on a combination of regulations and subsidies to rope, coddle, and nudge us into a rough approximation of a single-payer system.”
A standard Democratic talking point is that there have been 40-odd Republican votes for Obamacare repeal, the GOP hasn’t filled in the details on replace. How fair is that criticism?
The fairest way of putting it is the way Sally Pipes of the Pacific Research Institute put it to me in my book — the problem isn’t that Republicans haven’t had any plans to replace Obamacare, the problem is that they’ve had too many.
That is, individual members of Congress and outside policy experts have presented a number of ideas for overhauling the health care system, but due to differences (some technical, others more deeply philosophical) Republicans haven’t been able to rally around a single one. So, it’s been easier to just focus on their united opposition to Obamacare.
The main reason I wrote “Overcoming Obamacare” is that I don’t think that’s a sustainable position. I want to jump start the process of getting to an alternative, so I decided to take the often opaque jargon-filled health care debate that occurs within the confines of the Washington policy community and translate for a broader audience.
Introduce us to the major conservative schools of thought on what to do about Obamacare.
Having surveyed the landscape, spoken to dozens of influential policy experts as well as lawmakers such as Paul Ryan, Bobby Jindal, and Tom Price, I identified three different approaches.
The first approach, which I call the Reform School, comes from those who believe that full repeal of Obamacare is unlikely now that the law can claim millions of beneficiaries, but that Obamacare can still be reformed in a way that tilts the nation’s current trajectory toward a more market-oriented direction.
The second approach, the Replace School, comprises those who argue that Obamacare needs to be fully repealed, but that this can only be achieved if Republicans offer an alternative that helps make insurance broadly affordable and has an answer to Obamacare’s current beneficiaries.
Those who adopt the third approach, which I call the Restart School, believe that Obamacare needs to be completely scrapped (along with all of its taxes and spending) and that instead of engaging on the Left’s playing field by trying to compete with Democrats on coverage numbers, Republicans should work from a clean slate to bring down costs by fostering a free market.
How much is Republican disinterest in health care policy to blame for Obamacare in the first place?
A lot. After Hillarycare went down in flames in 1994, Republicans largely retreated on the health care issue. They never used their time in power to truly advance free market reforms, and to the extent they did anything on the issue, it was to expand government — as President Bush did with the Medicare prescription drug plan and Mitt Romney did as governor of Massachusetts.
While Republicans were ignoring the issue, Democrats were taking the time to retrench, learn from their mistakes, and set the stage for their next health care push whenever they retook power.
Speaking of Republicans responsible for Obamacare, how do you feel Mitt Romney (the subject of your last book) potentially running for president again will affect the GOP’s anti-Obamacare campaign?
It depends on how he does. In the primaries, savvy opponents could point to Romneycare as an example of precisely the wrong approach for Republicans to take on health care. In the general election, however — if Republicans were to make the mistake of re-nominating Romney – his candidacy would be a disaster for supporters of market-based health care solutions.
As we saw in 2012, because he is responsible for creating the plan that served as the model for Obamacare, he has no credibility in arguing against the mandate-and-subsidize approach. He failed utterly in 2012 – releasing some vague health reform ideas that he never talked about during the campaign. Another Romney nomination would cement Obamacare in place. Do you see single payer in our future, or does the failure to implement a Canadian-style system in Vermont show us it just can’t work here?
I don’t think that the Vermont experience tells us much about what could happen in the future. Remember, Democrats failed miserably trying to get a national health care plan passed in 1994, only to succeed 16 years later. As it is, a combination of Obamacare, Medicare and Medicaid merely growing on auto-pilot puts us on a course toward single payer. And if Republicans don’t advance an alternative when they have an opening, Democrats will wait for the right chance to build on Obamacare.
What lessons can Republicans take from the Democrats’ efforts to pass Obamacare?
Democrats could have given up on something as ambitious as Obamacare when the polling turned bad relatively early in the legislative process. But they persevered, despite the political risks. Yet they didn’t act in a total vacuum. From the perspective of liberals, the final bill represented a compromise from something closer to single-payer – but the liberals supported it anyway.
I think (and I’m arguing from the perspective of somebody wanting to advance conservatism) what Republicans can learn from this is that sometimes it’s worthwhile to risk political defeat to advance an agenda. But also, sometimes the base of your party has to be willing to settle for a field goal.
Wouldn’t real free-market reforms also fail the “If you like your doctor/health plan, you can keep your doctor/health plan” test?
Yes. Any major change to the health care system — whether it’s moving to Obamacare, or to a more market-based system from Obamacare – is going to cause some disruption. The plans I look at in my book try, in different ways, to limit that disruption – or at least make it more gradual. But it’s important to draw a distinction between a market-based reform that causes short-term disruption in the name of giving individuals more choices and control over their health care dollars and an Obamacare-style overhaul which dislocates people in the name of forcing them to purchase policies designed by the federal government.
What are the odds we will see an end to Obamacare?
The more people that buy “Overcoming Obamacare,” the better the odds it will be vanquished.
Liberal Harvard Faculty Upset By Rising Health Insurance Costs Due To Obamacare
Faculty at Harvard University are complaining that they will have to pay more for their health insurance under Obamacare, even though overall costs to faculty remain modest and employees of the Ivy League school tend to support President Obama.
Members of Harvard’s Faculty of Arts and Sciences voted in November against changes to their insurance policies which would require them to pay more for coverage due to Obamacare, The New York Times reports.
But the vote was too late to stop cost increases from taking effect this month, leading to an uproar among some faculty.
Richard Thomas, a classics professor, told The Times the changes are “deplorable, deeply regressive, a sign of the corporatization of the university.”
“This pay cut will be timed to come at precisely the moment when you are sick, stressed or facing the challenges of being a new parent,” said Mary Lewis, a professor of history, calling the cost increase the equivalent of a pay cut.
EDITOR’S NOTE: The Affordable Care Act (ACA, aka Obamacare) incentivized primary care physicians to accept new Medicaid patients by including a two-year provision that paid them Medicare rates rather than the previous, traditional woefully low Medicaid reimbursement rates.
Unfortunately for many Medicaid patients seeking access to primary care, that provision expires on Dec. 31, which will result in significant physician fee reductions in most states.
We’ve previously reportedon the challenges that Medicaid patients face in finding primary care physicians. Below, Kaiser Health News reports on the impact that the expiration of this ACA provision will have on both patients’ access to care and physicians’ ability to continue to care for and take on new Medicaid patients, and make ends meet.
Florida primary care physicians enjoyed a 50 percent raise in Medicaid reimbursement in 2013 and 2014, so will be hit hard by this cut. Fortunately, a very important alternative to private primary care as first-line professional resources for Medicaid recipients is community health centers like Brevard Health Alliance(BHA). The ACA provided $11 billion to expand community health centers like BHA that provide primary care to Medicaid patients.
—Dr. Jim Palermo, Editor-in-Chief
KAISER HEALTH NEWS — Andy Pasternak, a family doctor in Reno, Nev., has seen more than 100 new Medicaid patients this year after the state expanded the insurance program under the Affordable Care Act.
But he won’t be taking any new ones after Dec. 31. That’s when the law’s two-year pay raise for primary care doctors like him who see Medicaid patients expires, resulting in fee reductions of 43 percent on average across the country, according to the nonpartisan Urban Institute.
“I don’t want to do this,” Pasternak said about his refusal to see more Medicaid patients next year. But when the temporary pay raise goes away, he and other Nevada doctors will see their fees drop from $75 on average to less than $50 for routine office visits.
“We will lose money when they come to the office,” he said.
Experts fear other doctors will respond the same way as Pasternak, making it harder for millions of poor Americans to find doctors. The pay raise was intended to entice more physicians to treat patients as the program expanded in many states. In the last year, Medicaid enrollment grew by almost 10 million and now covers more than 68 million people nationwide.
The challenge is to convince physicians not just to continue accepting such patients but to take on more without getting paid what they’re used to, said Dr. J. Mario Molina, CEO of Molina Healthcare, one of the nation’s largest Medicaid insurers.
Charles Duarte, CEO of a large community health center in Reno where some patients already wait two months or more for appointments, foresees increased demand for services at his Community Health Alliance clinics, which are paid more generously by Medicaid and were not eligible for the enhanced pay.
“We will see more patients and longer wait times,” he predicted.
STATE IMPACT DIFFERS
Despite the concerns, most states say they’ve seen no evidence the increase has resulted in greater doctor participation — mostly because it was temporary. The bonus boosted pay rates for primary care doctors who saw Medicaid patients to the same level as they are paid by Medicare.
Because Medicaid reimbursement rates for doctors vary by state, however, the pay bump varied from no change in Alaska, Montana and North Dakota, to a 50 percent raise or more in California, New York, New Jersey, Michigan, Florida and Rhode Island, according to the Urban Institute.
Only a handful of states have acted to continue the Medicaid pay boost using their own funds, including Maryland, Alabama, Colorado, Iowa and Mississippi. Connecticut will continue the raise, but not for primary care services done in hospitals.
Nevada and several other states are still considering extending it.
The American Academy of Family Physicians has lobbied Congress to extend the higher pay rate, but has been hampered by lack of data showing the higher fees spurred more doctors to join, said Robert Wergin, president of the academy and a physician in Milford, Neb.
Wergin said he participated in Medicaid before the health law and won’t be deterred from accepting new patients in the rural town in which he practices after the pay raise expires.
Nonetheless, “I believe access as a result of the cuts will be an issue,” he said.
Low reimbursement rates are not the only reason doctors’ avoid Medicaid. High patient no-show rates also make private physicians reluctant about participating, Duarte said.
Kaveh Safavi, global managing director of Accenture Health, said physicians have always gone in and out of the Medicaid program as a business decision. Others participate because they feel a social obligation, especially if they practice in an area where patients don’t have other health care options.
“There are a lot of dynamics at play … though historically, things have not changed [doctors’ participation] as much as when states make payment changes,” he said.
RHODE ISLAND FACES BIGGEST CUTS
The Urban Institute study found that Rhode Island doctors will face the biggest pay drop next year — 67 percent. Even so, the Rhode Island Medical Society expressed doubt that the change will cause disruption. It notes that some large insurers require doctors in the state who want to treat privately insured patients to see their Medicaid members, too.
“Every little bit helps, but I don’t see this as a deal breaker,” said Steven DeToy, director of governmental public affairs for the society.
Officials with Neighborhood Health Plan of Rhode Island, one of two Medicaid health plans in the state, said they’re not worried about the end of the pay raise.
“We had wide availability of doctors before the pay raise and don’t expect much change when it ends,” said spokesman Tom Boucher.
The pay raise went to doctors working for private managed care plans, as well as those in private practice.
Stephen Zuckerman, senior fellow at the Urban Institute, said the states that will use their own funds to continue the fee increase were typically paying higher-than-average Medicaid rates already. But the most populous states — among them, New York, California and Illinois — are not doing that.
“It’s an open question of whether more doctors will quit Medicaid or stop seeing new Medicaid patients,” Zuckerman said. “But these cuts cannot help.”
Measuring Medicaid enrollees’ access to care is not simple.
But a December report by the Health and Human Services’ Office of Inspector General found that about half of Medicaid doctors listed as participating in managed-care plans don’t have availability or don’t contract with the health plan at all.
Other experts note that the pay raise was just one way the health law tried to ensure that newly covered Americans would have a place to get care. Funding to community health centers was also boosted by $11 billion from 2011 to 2015 to help them expand.
“The Medicaid pay boost was never meant to be a silver bullet,” said Leonardo Cuello, director of health policy at the National Health Law Program, an advocacy group for low-income Americans.
Still, the provider fee cuts have him worried. “It won’t sink the ship but … I’m concerned it will contribute to access problems.”