BUCKNACKT'S SORDID TAWDRY BLOG
We should not be a journey to the grave with the intention of arriving safely in an attractive & well preserved body, but rather to skid in sideways, chocolate, bier or wein in hand, body thoroughly used up, totally worn out and screaming "WHOO-HOO, WHAT A RIDE!!!!!!"
NORTON META TAG
07 November 2014
As a result of Obamacare, "California seniors face benefit cuts of over $1,700." & "Over 214,000 doctors opt out of Obamacare exchanges." 28&30OKT14
verse of the day
You will know the truth, and the truth will make you free.
- John 8:32
voice of the day
You shall know the truth, and the truth shall make you odd.
-Flannery O'Connor
prayer of the day
Lord, may your truth make us both free and odd in a world that breeds bondage and demands conformity. Amen.
OBAMACARE. The very mention of the ACA / Affordable Care Act can set repiglicans and tea-baggers off on a foaming at the mouth, spit flying rampage. While that is all some of their supporters need to justify their voluntary ignorance and racist hatred, others need lies, deception and manipulation to make their voluntary ignorance and racist hatred more acceptable to themselves and those like them. Here are two examples of the continuing lies, manipulation, deception and fear started by greedy fascist pig koch brother's american action forum being spread on the internet by anonymous cowards and the blatantly fascist, racist and hateful karl rove's & ed (lost the VA Senate race) gillespie's american crossroads organization. From +PolitiFact .....
As a result of Obamacare, "California seniors face benefit cuts of over $1,700."
By Lauren Carroll on Friday, October 31st, 2014 at 9:30 a.m.
A recent American Crossroads ad attacks Rep. Ami Bera, D-Calif., for supporting Obamacare.
Even though Rep. Ami Bera, D-Calif., wasn’t in office when
Obamacare passed, a pro-Republican ad in California’s seventh
congressional district is using the law to attack him.
Bera is running against Republican Doug Ose for a second term, and
it’s a tight race. Less than six months into his first term, Bera voted against
repealing the Affordable Care Act, and American Crossroads, Karl Rove’s
conservative political action committee, used this fact to appeal to
California seniors in a recent ad.
"Bera voted to keep Obamacare, which cut $716 billion from Medicare,
slashing Medicare Advantage," the ad’s narrator says. "Now California
seniors face benefit cuts of over $1,700."
Many times, we’ve rated the claim that there are $716 billion in Medicare cuts as Half True. But we hadn’t heard claims about specific benefit cuts by state before, so we decided to check it out.
We found that the claim that California seniors will see $1,700 in
benefit cuts as a result of the Affordable Care Act is misleading. The
statistic comes from a report that ignores critical context and evidence
that the law has expanded Medicare’s benefits packages. Advantages
We should first note that the statistic comes from an April 2014 report by the American Action Forum,
and they have a stake in the election. The American Action Forum is an
arm of the American Action Network, which is a conservative political
nonprofit with financial ties to the Koch brothers. According to the Center for Responsive Politics, the group shares office space with American Crossroads -- the group that produced the very ad we’re checking.
Now to the claim. The ad makes it sound like all California
seniors will face cuts to this degree. However, the report only
addresses Medicare Advantage. About one-third of seniors use Medicare
Advantage, which is a private coverage option.
Medicare Advantage plans are required to provide at minimum the same
array of benefits as traditional Medicare. Many Advantage plans offer
extra benefits -- things like gym memberships, vision exams or generous
cost-sharing -- that have contributed to escalating program costs.
The creators of Medicare Advantage thought that letting seniors
choose plans from private insurance providers would be more
cost-effective than traditional Medicare. But Advantage has turned out
to be more expensive. Medicare paid insurers about 114 percent more for
Advantage plans than for traditional plans, as of 2009 before enactment of the federal health care law.
The law attempted to close that gap in part by gradually reducing how
much Medicare pays Advantage plan providers. It was estimated that its
changes would slow down spending
on Medicare by about $716 billion over 10 years, and Medicare Advantage
cost-saving measures accounted for about one-third of that. (Though the
Obama administration has reversed these cuts for the past two years -- facing pressure from insurance providers, Republicans and some Democrats, including Bera.)
Critics argue that the cuts will force insurance providers to reduce
the benefits they offer to Medicare Advantage enrollees. However,
Medicare Advantage plans are still required to offer, at minimum, the
same level of benefits as traditional plans. And Obamacare includes language protecting that set of guaranteed benefits from shrinking.
In fact, the law expanded Medicare’s required benefits to include
certain preventative services, annual visits, closing a gap in
prescription coverage and more.
Additionally, the law rewards Medicare Advantage providers
with financial bonuses to encourage quality and cost-efficiency.
Providers are required to use the bonuses to offer extra benefits,
attracting more enrollees. Nearly all Medicare Advantage plan providers received these bonuses in 2012, according to the Kaiser Family Foundation. A matter of speculation
It’s possible that Medicare Advantage providers could respond to
their pay cut by reducing benefits, but the only benefits they could cut
would be those extra benefits that go beyond Medicare plan
requirements.
"It's not automatic and won't affect every (Advantage) enrollee or
any of the (traditional Medicare) enrollees," said Dylan Roby, an expert
in health economics at the University of California Los Angeles Center
for Health Policy Research.
Insurance providers could also respond to lower payments by offering
the same benefits while operating more efficiently. They could cut
administrative costs, adjust cost-sharing plans, take in less profit or
drop out of the market altogether.
But, according to the Kaiser Family Foundation, the Department of Health and Human Services
and more, insurance providers’ response to the cuts has been less
dramatic than was expected when Obama signed the legislation in 2010. In
fact, Medicare Advantage enrollment is at an all-time high, and the
percentage of plans with four or more stars in the program’s five-star
rating system is increasing.
"When Congress debated the payment reductions in 2010, forecasters
and analysts also projected that reductions would drive insurers to
raise premiums, cut extra benefits and even pull out of the Medicare
Advantage market," Kaiser experts wrote in May. "Thus far, however, the
response by insurers to the (Affordable Care Act) cuts has been more
muted."
Health and Human Services reported in fall 2013
that "The average number of plan choices will remain about the same in
2014 and access to supplemental benefits remains stable. Since passage
of the Affordable Care Act, average MA premiums are down by 9.8
percent."
Experts also told us that they haven’t seen evidence of reduced Medicare Advantage cuts.
"The evidence is that plan participation has been stable, premiums
have been stable or even a little bit lower, and there are no overall
changes in the benefits provided," said Jack Hoadley, a research
professor at Georgetown University and a member of the nonpartisan Medicare Payment Advisory Commission.
"In my view, the claims in this advertisement are misleading,"
Hoadley added. "Seniors have not faced benefit cuts in Medicare
Advantage, even though the plans (and providers) have to manage with
somewhat lower payments."
So how did the American Action forum report come up with their estimated benefit cut figures?
The American Action Forum report breaks down the reduction in
Medicare payments to Advantage plan providers by state and county. It
says, compared to pre-Obamacare, Medicare Advantage benefits in
California are down $1,718 per beneficiary.
We asked several experts to take a look at the report, and they told
us that it is misleading because it assumes that Obamacare’s spending
reductions directly results in reduced benefits.
Yes, Obamacare reduces Medicare’s spending per Advantage beneficiary,
but this does not necessarily mean fewer benefits for seniors with
Advantage plans. Like we said before, there are multiple ways that an
insurance provider can deal with the spending cuts other than slimming
down its offerings.
"To immediately treat it as a cut to benefits is an exaggeration,"
said Judith Feder, a professor of health policy at Georgetown
University. Our ruling
American Crossroads said that as a result of Obamacare, "California seniors face benefit cuts of over $1,700."
First of all, this claim is misleading because it makes it seem like
all seniors will face these cuts, when the statistic actually refers to
Medicare Advantage enrollees -- only about one-third of seniors.
The statistic comes from a report that assumes all reductions in
Medicare Advantage spending results in fewer benefits for enrollees.
While insurance providers feel the cuts, there are multiple ways for
them to respond other than reducing benefits, such as trimming
administrative costs. We heard from multiple experts and researchers who
said Medicare Advantage benefits have remained stable.
The ad also leaves out the fact that the federal health care law
expanded Medicare’s minimum required benefits and established incentives
for Advantage plans to provide extra benefits.
It’s possible that some Medicare Advantage enrollees could see their
benefits shrink, but this ad blows that possibility out of proportion
and ignores important context. We rate this claim False.
By Steve Contorno on Thursday, November 6th, 2014 at 4:11 p.m.
A chain email
claims more than 200,000 doctors aren't accepting patients with coverage
bought on Affordable Care Act marketplaces.
Are doctors en masse refusing patients who gained health care coverage due to the Affordable Care Act?
That’s the claim in a chain email a reader asked us to check. "More,
truly scary Obamacare news," said the email, sent just before Halloween.
The accompanying story was from CNSnews.com, a site operated by the conservative Media Research Center.
"Over 214,000 Doctors Opt Out of Obamacare Exchanges," read a headline on CNSnews.com.
We found the source of the claim. It was coming from American Action
Forum, a self-described "center-right policy institute." The
organization put out an analysis on Oct. 27 titled: "Health Care
Providers are Opting-Out of Obamacare Exchange Plans."
How many? According to the post, "as many as 214,524 American
physicians will not be participating in any (Affordable Care Act)
exchange products." It went on to list some reasons "doctors are opting
out of the exchange plans."
That’s a lot of doctors. Have that many decided to turn away patients with insurance purchased on the marketplaces?
Let’s take a look. Can doctors opt out of Obamacare exchanges?
The Affordable Care Act requires essentially everyone to have
insurance. To make it easier for people to buy insurance, the government
created federal and state insurance marketplaces, sometimes called
exchanges. The biggest one is HealthCare.gov, but some states elected to operate their own as well.
These marketplace policies are private plans sold by insurance
companies. In some states, just one or two companies are providing
plans; in others, it’s many. Consumers typically have dozens of choices
ranging from bronze policies, which pay 60 percent of health costs on
average, to platinum, which pay 90 percent of costs. (For comparison, a typical employer-based plan covers about 80 percent of costs.)
Can doctors choose not to participate in the networks of policies
purchased on exchanges? Sure. While some states require doctors to
accept any plan for an insurance provider they do business with, in most
cases insurance companies are constantly negotiating with physiciansand hospitals to determine which policy networks they will participate in, experts and industry officials told us.
Some doctors might decide they don’t want to be in the network of
plans purchased on federal or state marketplaces. In other instances,
insurance providers might choose not to include certain doctors or
health groups in policies they created for the marketplaces.
It’s a two-way street, and marketplace policies are just the latest
twist to a contracting process that has always existed between doctors
and insurance companies. 200,000 doctors?
We asked American Action Forum to explain their analysis to us. The
organization based its findings on an April survey from the Medical
Group Management Association, a trade organization for physician groups.
"The survey found that 23.5 percent of doctors said they would not
participate in (Affordable Care Act) exchange plans," said Marisol
Garibay, spokeswoman for American Action Forum.
That percentage was multiplied by the total number of professional
active physicians, which Kaiser Family Foundation estimates is 893,851.
That equals 210,054 doctors, close to the American Action Forum number.
Garibay called it an "upper bound" estimate.
But when we looked at the survey ourselves, we found this to be a pretty dubious figure.
Here’s the rub, from the research: "The survey includes responses
from more than 700 medical groups in which more than 40,000 physicians
practice nationwide."
While there’s a lot of interesting information gleaned from this
survey, the results cannot be extrapolated to represent all the doctors
in the country. Why not? Because the Medical Group Management
Association only represents doctors who are part of medical groups. This
does not include physicians who run independent practices, for example,
and there’s no reason that a poll of 700 medical groups is
representative of all 900,000 physicians in the country.
"That’s a significant difference," said Anders Gilberg, a senior vice
president of government affairs for Medical Group Management
Association. "I wouldn’t generally suggest using it as a proxy for all
physicians."
Let’s put that aside for a second and dig further. The survey found
that as of April, 76.5 percent of respondents were accepting health
insurance sold on a state or federal marketplace.
Of those not participating in marketplace policies, 42 percent said
it was because insurance companies in their area didn’t ask them to
participate in the networks of plans sold on marketplaces.
Meaning, even if this limited survey could be extrapolated to
represent all doctors, not all of them are "opting out" of Obamacare.
Many — almost half — weren’t asked to participate in ACA marketplace
policies.
Why weren’t they asked? One reason is that the insurance companies
want to limit which doctors will serve their customers by creating
narrow networks.Narrow networks are a way for insurance providers to keep costs lower for insurers.
How? If you create a narrow network, it guarantees a doctor will get a
bigger share of your patients, and a doctor would be willing to accept
lower reimbursement rates in exchange for more business.
Narrow networks are also more common on the exchanges because
consumers can pick the plan with the doctors that fit their needs, said
Paul Ginsburg, a professor of the practice of health policy and
management at University of Southern California.
"Employer plans tend to have a broad network because they’re trying
to satisfy everyone (at the company)," Ginsburg said. "On an exchange,
you don’t have to satisfy everyone with one policy, you can offer many,
so you can have narrower plans."
There are plenty of broad plans on the exchanges, they just tend to
be more expensive. According to a May survey of individuals likely to
use the marketplace, 54 percent said they would accept more limited
networks to get a cheaper sticker price. As it is, 85 percent of plans
bought on federal and state marketplaces were the less expensive bronze
or silver plans, according to the Department of Health and Human
Services.
To be sure, it appears some doctors want nothing to do with these cheaper marketplace plans or the customers who buy them.
Among other things, doctors worry that many of the plans on the
marketplace, particularly bronze and silver plans, have high
deductibles. Some patients won’t be able to meet their obligations for
cost-sharing, potentially forcing physicians to eat those costs or shake
down customers.
These are legitimate concerns, and there is reason to believe that
some doctors are choosing not to contract with marketplace insurance
plans. But there is no evidence to suggest the number is anywhere near
214,000. Our ruling
A chain email claimed that more than 214,000 American doctors are
"opting-out of Obamacare exchange plans." That is based on a survey of a
select group of doctors and even the makers of the survey said it can’t
be extrapolated for the entire country. Further, of the doctors
responding to the survey, 42 percent said they weren’t participating in
marketplace plans because they were never asked to, not because they
were "opting out."
The estimate is the result of a flawed methodology and a misreading of survey data. We rate the claim False.
