HealthCare: Medicare, Medicaid, and Social Security

[phkrause]

Medicaid expansion is a compassion test many 2024 Republican presidential hopefuls fail

There is no excuse for leaving people vulnerable to illness, death and financial ruin. We should all care, even if it costs money.

https://www.usatoday.com/story/opinion/columnists/2023/02/20/medicaid-expansion-trump-desantis-haley-pence-2024/11281341002/?

[phkrause]

Millions who rely on Medicaid may be booted from program

WASHINGTON (AP) — If you get health care coverage through Medicaid, you might be at risk of losing that coverage over the next year.

https://apnews.com/article/access-to-health-care-48d1f565c800139bb397bb886436968f

[phkrause]

NC approves Medicaid expansion, reversing long opposition

RALEIGH, N.C. -- A Medicaid expansion deal in North Carolina received final legislative approval on Thursday, capping a decade of debate over whether the closely politically divided state should accept the federal government's coverage for hundreds of thousands of low-income adults.

https://abcnews.go.com/Business/wireStory/nc-approves-medicaid-expansion-reversing-long-opposition-98072417?

[phkrause]

Affordable Care Act at 13: forward not back

Thirteen years ago, the Affordable Care Act was signed into law. And about five years ago, my oncologist told me my stage 4 cancer was in remission. 

https://alaskabeacon.com/2023/03/22/affordable-care-act-at-13-forward-not-back/?

[phkrause]

Record 16.3 million seek health coverage through ‘Obamacare’

WASHINGTON (AP) — A record 16.3 million people sought health insurance through the Affordable Care Act this year, double the number covered when the marketplaces first launched nearly a decade ago, the Biden administration announced Wednesday.

https://apnews.com/article/biden-health-access-to-care-business-ca0fad2cc4af777044c1e61b5ec5372e

[phkrause]

In Mississippi, a Choice to Forgo Medicaid Funds Is Killing Hospitals

Mississippi is one of 10 states, all with Republican-led legislatures, that continue to reject federal funding to expand health insurance for the poor, intensifying financial pressure on hospitals.

https://www.banoyi.com/in-mississippi-a-choice-to-forgo-medicaid-funds-is-killing-hospitals-549080.html

[phkrause]

10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. But, when the continuous enrollment provision ends, millions of people could lose coverage that could reverse recent gains in coverage. As part of the Consolidated Appropriations Act, 2023, signed into law on December 29, 2022, Congress set an end of March 31, 2023 for the continuous enrollment provision, and phases down the enhanced federal Medicaid matching funds through December 2023. States that accept the enhanced federal funding can resume disenrollments beginning in April but must meet certain reporting and other requirements during the unwinding process.

https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/

Analysis of Recent National Trends in Medicaid and CHIP Enrollment

This data note looks at national and state-by-state Medicaid and CHIP enrollment data through November 2022. After declines in enrollment from 2017 through 2019, preliminary data for November 2022 show that total Medicaid/CHIP enrollment grew to 91.8 million, an increase of 20.6 million from enrollment in February 2020 (29.0%), right before the pandemic and when enrollment began to steadily increase (Figure 1).¹ Increases in enrollment may reflect changes in the economy, changes in policy (like recent adoption of the Medicaid expansion in the Affordable Care Act), and the temporary continuous enrollment provision created by the Families First Coronavirus Response Act (FFCRA). Under the continuous enrollment provision, states generally cannot disenroll Medicaid enrollees while the provision is still in effect and in exchange, states receive a temporary increase in the federal Medicaid match rate. The continuous enrollment provision has halted churning in Medicaid – the temporary loss of coverage in which enrollees disenroll and then re-enroll within a short period of time – in addition to preventing Medicaid coverage loss during the pandemic. As part of the Consolidated Appropriations Act, signed into law in December 2022, Congress set an end to the continuous enrollment provision on March 31, 2023, and will phase down the enhanced federal Medicaid matching funds through December 2023. States that accept the enhanced federal funding can resume disenrollments beginning in April 2023 but must meet certain reporting and other requirements during the unwinding process. KFF estimates that Medicaid/CHIP enrollment will peak at approximately 95 million enrollees in March 2023 before states resume disenrollments during the “unwinding” of the continuous enrollment provision.

https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/

Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for the Unwinding of the Pandemic-Era Continuous Enrollment Provision

In the third year of the COVID-19 public health emergency (PHE), Medicaid enrollment continued to increase albeit at a slower pace than in the first two years of the coronavirus pandemic. Since March 2020, states have provided continuous enrollment in Medicaid in exchange for enhanced federal funding. This continuous enrollment provision and enhanced federal funding were originally in place until the end of the COVID-19 public health emergency (PHE). In December 2022, the Consolidated Appropriations Act, 2023 (CAA) delinked the provision from the PHE and ends continuous enrollment on March 31, 2023. Beginning April 1, 2023, states may restart disenrollments after conducting a full review of eligibility. States that follow all federal Medicaid renewal requirements, take steps to update enrollee contact information, and attempt to reach enrollees via non-mail modes before terminating coverage for returned mail will qualify for ongoing enhanced federal funding that phases down until the end of 2023. States must also report to the federal government specific data needed to monitor the impact of the unwinding or risk financial penalties for not doing so.

https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-and-renewal-policies-as-states-prepare-for-the-unwinding-of-the-pandemic-era-continuous-enrollment-provision/

[phkrause]

Texas judge strikes down free HIV drugs, cancer screenings under Obamacare

A federal judge on Thursday struck down a key provision of the Affordable Care Act, jeopardizing free coverage of a wide range of preventive services including mammograms, colonoscopies and mental health screenings for nearly 168 million people on employer health insurance and on Obamacare’s individual market.

https://www.politico.com/news/2023/03/30/texas-judge-obamacare-00089641?

[phkrause]

Direct Contracting/REACH: A Backdoor Medicare Privatization Scheme

Medicare is rapidly becoming a privatized, heavily subsidized public health insurance program through the use of private insurers in the Medicare Advantage (MA) program. Estimates of excessive payments to MA plans now are in the range of more than $20 B annually, rising to almost $100 B annually in 2030 and costing a total of over $600 B over the next 9 years. People in traditional Medicare cost taxpayers much less. CMS just announced that it will not change its approach to risk scores and therefore expects MA revenue to increase 8.5% in 2023. This increased subsidy will no doubt accelerate the rate of growth of MA even further.

https://socialsecurityworks.org/direct-contracting-reach-a-backdoor-medicare-privatization-scheme/?

[phkrause]

Medicare, Social Security could fall short over next decade

WASHINGTON (AP) — The financial safety nets millions of older Americans rely on — and millions more young people are counting on — will run short of money to pay full benefits within the next decade, the annual Social Security and Medicare trustees report released Friday warns.

https://apnews.com/article/medicare-social-security-finances-shortfall-debt-biden-b1f45ba6dd6fdef18e741e308d8ecf12?

[phkrause]

Social Security trustees predict benefit cuts in 2033 without congressional action

WASHINGTON — Social Security will no longer be able to pay full benefits in 2033, a year earlier than previously expected, according to a report released Friday.

https://floridaphoenix.com/2023/04/01/social-security-trustees-predict-benefit-cuts-in-2033-without-congressional-action/?

[phkrause]

Millions will start losing Medicaid coverage as Covid safety net is dismantled

U.S. states on Saturday will start to kick as many as 15 million people off Medicaid insurance, as an emergency safety net put in place during the Covid-19 pandemic comes to a gradual end.

https://www.cnbc.com/2023/03/31/medicaid-millions-to-lose-coverage-as-covid-safety-net-dismantled.html?

[phkrause]

Entitlement, Spending Cap Plans Linked by GOP to Debt-Limit Deal

Social Security and Medicare eligibility changes, spending caps, and safety-net work requirements are among the top priorities for key House Republicans who want to use next year’s debt-limit deadline to extract concessions from Democrats.

https://about.bgov.com/news/entitlement-spending-cap-plans-linked-by-gop-to-debt-limit-deal/?

Rick Scott debates what’s in his ‘Rescue America’ plan with Fox host

“Senator, hang on, it’s not a Democratic talking point, it’s in the plan,” John Roberts said.

https://www.politico.com/news/2022/03/27/rick-scott-senate-agenda-roberts-00020694?

Rick Scott 'oversaw the largest Medicare fraud' in U.S. history, Florida Democratic Party says

First, Gov. Rick Scott scared the bejesus out of seniors with an online ad claiming that Medicare rate cuts would lead them to lose access to their doctors, hospitals and preventive care.

https://www.politifact.com/factchecks/2014/mar/03/florida-democratic-party/rick-scott-rick-scott-oversaw-largest-medicare-fra/?

Romney: Raise retirement age for Social Security and Medicare

Mitt Romney says the U.S. must raise the retirement age one month every year to become economically sustainable. He said 65 and 67 is too young to retire because Americans live longer than they used to.

https://www.pressherald.com/2012/02/25/romney-raise-retirement-age/?

The TRUST Act is a plot to gut Social Security behind closed doors

Eight years ago, Mitt Romney ran for president on a promise to cut Social Security, Medicare and Medicaid. He even picked Medicare’s worst enemy, Paul Ryan, to be his running mate. Fortunately, he lost.

https://thehill.com/blogs/congress-blog/politics/478929-the-trust-act-is-a-plot-to-gut-social-security-behind-closed/?

Ron DeSantis once expressed support for privatizing Social Security and Medicare giving his rivals an opening

(CNN)Florida Gov. Ron DeSantis expressed support for privatizing Medicare and Social Security during his first campaign for Congress in 2012, giving political rivals who have pledged to protect the programs an opening to attack him ahead of DeSantis' expected run for president in 2024.

https://www.cnn.com/2023/02/09/politics/kfile-ron-desantis-privatize-social-security-medicare/index.html?

Nikki Haley says she wants to raise Social Security’s full retirement age — what you need to know about the FRA now

Presidential candidate Nikki Haley proposed raising the full retirement age for future Social Security beneficiaries during a town hall meeting in Iowa — a controversial suggestion, given its potential impact on benefits. 

https://www.marketwatch.com/story/nikki-haley-wants-to-raise-social-securitys-full-retirement-age-what-you-need-to-know-about-the-fra-now-70f36ad?

Mike Pence calls for privatizing Social Security: They "keep saying the quiet part out loud"

"They want to cut ... Social Security and take away our young people's futures," says Rep. Pramila Jayapal

https://www.salon.com/2023/02/06/mike-pence-calls-for-privatizing-social-security-they-keep-saying-the-quiet-part-out-loud_partner/?

Trump’s Plan To Defund Social Security

Permanently terminating the employee payroll tax along the lines President Trump has proposed would empty Social Security’s trust fund by 2026 or earlier.

https://www.americanprogress.org/article/trumps-plan-defund-social-security/?

[phkrause]

Most oppose Social Security, Medicare cuts: AP-NORC poll

WASHINGTON (AP) — Most U.S. adults are opposed to proposals that would cut into Medicare or Social Security benefits, and a majority support raising taxes on the nation’s highest earners to keep Medicare running as is.

https://apnews.com/article/social-security-medicare-cuts-ap-poll-biden-9e7395e8efeab68063d741beac6ef24b

[phkrause]

Kicked off Medicaid: Millions at risk as states trim rolls

WASHINGTON (AP) — Days out from a surgery and with a young son undergoing chemotherapy, Kyle McHenry was scrambling to figure out if his Florida family will still be covered by Medicaid come Monday.

https://apnews.com/article/medicaid-enrollees-removed-review-health-insurance-pandemic-bffc3c67ab2767e4e3cea8250683ea7a?

[phkrause]

What GOP’s plan for Medicaid work requirements would mean

WASHINGTON (AP) — More than a half million of the poorest Americans could be left without health insurance under legislation passed by House Republicans that would require people to work in exchange for health care coverage through Medicaid.

https://apnews.com/article/medicaid-work-requirements-republicans-debt-bill-7f34418be9157a73f031b892baaa595d

[bonnie1962]

Terrible isn't it? Requiring able bodied people without dependents in the home to work, How heartless can anyone be.  As long as the middle and upper class are required to work to fund Medicaid it seems only just and right that the millions on Medicaid be exempt from helping to fund their "free medical care"

[phkrause]

Jayapal, Dingell, Sanders Introduce Medicare for All Act of 2023

WASHINGTON – U.S. Representatives Pramila Jayapal (WA-07), Debbie Dingell (MI-06) and U.S. Senator Bernie Sanders (I-VT) are today introducing the Medicare for All Act of 2023. The House legislation is cosponsored by more than half of the Democratic Caucus and 13 powerful committee ranking members.

https://jayapal.house.gov/2023/05/17/jayapal-dingell-sanders-introduce-medicare-for-all-with-record-number-of-house-cosponsors/

[phkrause]

The $20 Billion Scam At The Heart Of Medicare Advantage

The health insurance behemoth Humana enjoyed a banner 2022. The Louisville, Ky.-based insurer made $2.8 billion in profits last year, while paying out $448 million in dividends to shareholders and more than $17 million in compensation to its CEO.

https://www.levernews.com/the-20-billion-scam-at-the-heart-of-medicare-advantage/

[phkrause]

'Enormous Policy Failure': States Throw Hundreds of Thousands—Including Many Children—Off Medicaid

"We knew this was coming," wrote one policy expert. "But we still treat these burdens like they're unavoidable natural disasters."

https://www.commondreams.org/news/states-hundreds-of-thousands-medicaid?

[phkrause]

Half a million people in less than a dozen states have lost Medicaid coverage since April

The rate of disenrollment is highest in Florida

https://floridaphoenix.com/2023/06/01/half-a-million-people-in-less-than-a-dozen-states-have-lost-medicaid-coverage-since-april/?

[phkrause]

More than 725K pushed off Medicaid rolls by redeterminations

More than 725,000 Medicaid recipients have been pushed off the safety net program's rolls as of last week, based on data from 14 states that are unwinding a pandemic-era policy that assured continuous coverage, according to a KFF tracker.

https://www.axios.com/2023/06/12/pushed-off-medicaid-rolls-kff?

[phkrause]

Health care: Appropriations staffers to watch

The appropriations process is getting under way, and the House and Senate are on a collision course. House Republicans are eying deeper cuts, going back to FY22 levels, while the Senate wants to stick to the debt limit agreement that was just made. We thought this would be a good time to look at some of the major players behind these decisions as the process gets going.

Read the full story

[phkrause]

More than 1 million people are dropped from Medicaid as states start a post-pandemic purge of rolls

More than 1 million people have been dropped from Medicaid in the past couple months as some states moved swiftly to halt health care coverage following the end of the coronavirus pandemic.

https://apnews.com/article/medicaid-eligibility-states-coronavirus-pandemic-46484af651466539d6874c1a97397b50?

[phkrause]

Health insurers have spent nearly $141 billion buying back their own shares since 2007 while premiums and deductibles have skyrocketed

In 2007, executives of America’s biggest insurance companies were well on their way to transforming health insurance policies in ways that would make them and their companies’ shareholders vastly richer–while pushing millions of insured families deep into debt. 

https://wendellpotter.substack.com/p/health-insurers-have-spent-over-141

100 million adults have health-care debt — and 12% of them owe $10,000 or more

For many adults, health-care debt is part of their balance sheet — it just may show up differently than expected, new research suggests.

https://www.cnbc.com/2022/06/22/100-million-adults-have-health-care-debt-and-some-owe-10000-or-more.html

Functionally Uninsured: The Fiction Of Healthcare Coverage

The shortcomings of insurance plan design in the U.S. have led to a new category of uninsured patients—those who are functionally uninsured. This population is burdened with deductibles so high they cannot afford to seek and pay for medical care that isn’t covered prior to meeting their deductible and out-of-pocket maximum. While maintaining health insurance is more critical than ever, the risk transfer has placed a greater burden on the insured individual. This has produced an affordability crisis even with coverage through an insurance product.

https://www.forbes.com/sites/forbesbusinessdevelopmentcouncil/2022/07/27/functionally-uninsured-the-fiction-of-healthcare-coverage/?

The System Makes Patients Sick And CEOs Rich

By Wendell Potter

(AP Photo/Matt Rourke)

Big health insurance companies have been on a spending spree buying back shares of their own stock, a gimmick — illegal until a few years ago — that has made a few insurance company CEOs incredibly rich at a time when 100 million Americans are saddled with medical debt.

Share repurchases benefit top executives and other shareholders at the expense of the insurers’ customers — especially health plan enrollees with such high out-of-pocket requirements they’re getting buried under a mountain of medical debt. As Forbes reported last July, those out-of-pocket requirements have reached such heights that millions of Americans are now “functionally uninsured.”

Now that the seven investor-owned health insurers have disclosed how much money their top executives made last year (as the SEC requires publicly traded companies to do), we can see just how important that gimmick has become to the people who are ultimately responsible for whether we get the care our doctors say we need, how much we have to send them every month in premiums, and how much we have to shell out in copays and deductibles before they’ll start paying our medical bills.

As Bob Herman, a journalist at healthcare news outlet STAT, reports, the CEOs of those companies were paid a record $335 million last year, 18 percent more than the previous record set in 2021. Had it not been for their companies’ share buybacks, they wouldn’t have banked nearly that much money.

While a few other media outlets reported on the CEOs’ 2022 compensation, STAT’s reporting calculates the pay packages to reflect how much the executives gained on their long-held stock (primarily by cashing in on stock options they’ve been awarded in recent years).

An analysis of how much the companies have used our premiums and tax dollars to buy back shares of their own stock showed that they spent a combined $141 billion on share repurchases between 2007 and 2022.

Keep in mind that that is $141 billion that otherwise could have been used to reduce our premiums and deductibles — and keep an untold number of American families out of bankruptcy and away from GoFundMe campaigns — but was instead used to increase the wealth of their shareholders and top executives.

A strong case can be made that the biggest beneficiaries of the stock buybacks are the companies’ CEOs. That’s because the value of the shares of stock they hold increases every time their companies repurchase shares.

It works like this: When a company buys back shares, it reduces the number of shares outstanding, and that has the effect of inflating the value of each share of stock.

I benefited from this gimmick myself when I was at Cigna because a portion of my compensation was paid — in one way or another — in stock.

What I was paid in stock, however, was a tiny fraction of what my CEO was paid. As I told reporters when I was Cigna’s chief spokesman, about 90 percent of the CEO’s compensation was “at risk,” meaning that most of what he was paid was based on how well the company met shareholders’ financial expectations, specifically whether and how much the company increased the value of each share of stock (earnings per share, or EPS).

Not much has changed in how CEOs are compensated since I left Cigna in 2008. As STAT’s Herman reported last year when he compiled insurance company CEOs’ compensation figures for 2021, roughly 87 percent of their pay came from exercised and vested stock.

When that much of your pay is “at risk,” you can be certain the CEOs’ top priority is to do whatever it takes to boost earnings per share. Their net worth depends on it. Every time Cigna announced quarterly earnings, my net worth would go up or down based largely on how shareholders reacted to the EPS number — a number that could be artificially inflated upward by share buybacks during the quarter. But the swings in my net worth were negligible compared to my CEO’s. (Cigna’s current CEO, by the way, took the top spot among health insurance executives in 2021 with a $91 million haul. In 2022, he landed in second place with $37.1 million in total compensation.)

The money insurers’ CEOs make these days is especially alarming when you consider that they are getting more and more of it from us as taxpayers. The three smallest of the seven big for-profit insurers — Centene, Humana, and Molina — now get 80 to 90 percent or more of their revenue from taxpayers through the Medicare Advantage plans they operate and the state Medicaid programs they manage.

And what should be especially alarming is that the CEO of the smallest of the taxpayer-dependent companies — Molina — was paid the most last year — by far.

Of the $335 million the seven CEOs were paid last year, more than half of it, $181 million, went to Molina’s CEO, Joseph Zubretsky. As STAT’s Herman reported, “More than 80% of Molina’s revenues come from Medicaid, the state and federal insurance program that covers low-income people.”

Zubretsky’s compensation package, Herman noted, “is one of the largest ever among health insurance executives.”

The total is even more eye-popping when you look at how Molina's CEO pay has jumped over the past 10 years — from $9.5 million in 2012 to $180.8 million last year.

Molina hired Zubretsky in November 2017 after posting a significant quarterly loss. His hiring was announced at the same time the company said it planned to lay off 1,500 employees, exit some of the markets it served, and jack up premiums on the ACA marketplace plans by 55 percent.

To be fair, all seven of the companies are far bigger than they were 10 years ago. But that growth has been fueled largely by mergers and acquisitions, not by organic growth of their health plan membership.

As Herman wrote:

“The paydays reflect not only the higher stock prices but also the companies’ relentless pursuits to get bigger. Most of the companies have continued to invest in other areas outside of health insurance — things like medical groups, technology, home health, and pharmacy benefits. And on the insurance side, every company has gone all-in on government-funded programs they previously viewed as unattractive: Medicare Advantage and Medicaid. Even the individual exchanges created by the Affordable Care Act — which for a time were viewed as untouchable and led to a spate of insurer exits — are now highly sought-after.”

Keep all of this in mind the next time you go to the pharmacy counter and are told that even with insurance you’ll have to pay a king’s ransom for your meds because your insurer — through its pharmacy benefit manager (PBM) — has once again jacked up your out-of-pocket requirement. Or the next time you notice how much has been deducted from your paycheck for your health insurance — and Uncle Sam.