The Centers for Medicare and Medicaid are adjusting requirements for the two programs as the Affordable Care Act becomes more ingrained in the nation’s health care system, Congressman James Lankford said at a recent gathering of the Edmond Area Chamber of Commerce.
“They are making a lot of decisions right now that are dealing with the smaller providers of health care,” Lankford said. “They’re pushing them out, and pushing them towards the hospitals.”
The Affordable Care Act is shifting the payment rate ratio of insurance for 20- to 30-year-olds from 6-1 to 3-1, Lankford said. More companies are shifting from providing insurance copays to increasing deductibles, he added.
Nonprofit health care navigators are being hired to go door-to-door, beginning this fall, to help people fill out 21-page eligibility forms for insurance exchange programs, Lankford said. The White House says these exchanges make insurance companies more competitive.
Oklahoma is one of 26 states to default to federally run insurance exchanges, according to The Washington Post. In November, Gov. Mary Fallin rejected $54 million in federal funding to set up an exchange.
Some aspects of the Affordable Care Act likely will be delayed, Lankford said, because agencies cannot keep up with the paperwork.
“When we approach October when everybody is supposed to know what’s going to happen — in January when its supposed to kick-in in full — we won’t know all the answers,” Lankford said.
Congressional members are also mandated to enlist in the health care exchanges with a few exemptions, he said. These exemptions include the committee staff members who helped write the Affordable Care Act.
Entitlement spending for Medicare and Medicaid has the potential of bankrupting the country, said Dr. James Kennedye, an emergency care physician.
“Medicaid and Medicare is up to 18 percent of GDP right now and is projected to hit over 20 percent in the next few years,” Kennedye said. He asked how to address the problem.
Much tinkering has taken place with the Medicare and Medicaid systems, Lankford said. Any more changes in Medicare and Medicaid would harm the systems for current beneficiaries, Lankford said.
“There’s a perception from that — that we will not do anything for current beneficiaries,” Lankford said. “I will assure you, with the Affordable Care Act, it’s not true.”
The 15-member Independent Family Advisory Board is set to begin in January, but nobody yet fully understands what the consequences of IFAB will be, he said. IFAB will recommend cost control measures for Medicare, Lankford said. IFAB’s decisions would remain in effect unless Congress removes them with a super majority vote, he added.
“They cannot change the premiums that people pay,” Lankford said. “But they can say, ‘This medicine or this device is too expensive. There’s something else that replaces that ….’”
Capping reimbursements is not the way to control health care costs, Lankford said. Earlier this month the White House reversed its plans to cut Medicare Advantage reimbursement rates by 2.2 percent and increased them by 3.3, according to The Washington Post.
Medicare Advantage should be accelerated to provide better cost options to seniors as companies compete for business, Lankford said.
Edmond resident Cheryl Medawattage, RN, director of business development at Sooner Hospice, said Monday that reimbursement cuts would change the ability of a hospice to serve patients without resources.
“For our patients here that have Advantage, it’s an invaluable asset for these patients who cannot afford care givers, cannot afford their medicine,” Medawattage said. “If you take away that Medicaid program, those patients are going to end up in the hospital. Guess who is going to be paying the bill? Either the public or Medicare. So I think it’s a very wise move not to cut it.”
Medawattage said she expects the Affordable Care Act will increase referrals to home health and hospice.
“The goal would be to keep them out of that hospital setting because the hospital is going to get penalized if that patient walks right back in after 30 days, because it’s all quality initiatives,” she said.
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