Posted on 06/30/2012 5:49:24 PM PDT by upchuck
JEFFERSON CITY, Mo. (AP) -- Republicans in at least four states want to abandon an expansion of Medicaid in President Barack Obama's health care overhaul, and more than a dozen other states are considering it in the wake of the Supreme Court decision removing the threat of federal penalties.
...
The states considering whether to withdraw from the expansion include presidential battlegrounds Florida, Ohio, Pennsylvania and Colorado.
"One thing is clear, state legislatures will play a big role in the future of Obamacare," said Republican state Rep. Todd Richardson of Missouri.
For elected officials, the high court decision presented a stark choice: agree to accept an ambitious expansion of Medicaid or leave behind a vast pile of federal money that could provide health care to millions of poor constituents.
The law signed by Obama in 2010 was projected to provide coverage to more than 30 million Americans, reducing by more than half the number of uninsured people. Of those, about 17 million were supposed to be added to Medicaid, the joint federal and state health care program for the poor. The rest were to be covered by a strengthened and subsidized private insurance market.
The federal government agreed to pay the full tab for the Medicaid expansion when it begins in 2014. But after three years, states must pay a gradually increasing share that tops out at 10 percent of the cost. That may not sound like much, but it translates to a commitment of billions of dollars at a time when many local officials are still anxious about the slow economic recovery.
(Excerpt) Read more at hosted.ap.org ...
Fox just reported the number of states not participating has grown to ten.
It's probably viewed differently by different doctors, hospitals and medical equipment and supply businesses, and pharmaceutical companies. But there have been many stories about inadequate reimbursements for various services provided by doctors and hospitals.
Google: doctors refuse Medicare Medicaid patients
Oh, they will be covered, Obama promised, remember? Either the private insurers will have to take what Obama offers or put them on Medicare.
AP: Always Propaganda
“Republicans in at least four states want to abandon ...the poor.”
(Yep, that’s how J-school teaches them to subliminally manipulate stories...)
What you say is consistent with what I’ve read also and we’ve had similar publicity regarding hospital classifications in our area. What I said stands: Hospitals can not refuse to admit these categories of patients when in medical need. They don’t, of course, have to provide room and board and medical care permanently.
I can tell you that under Tricare in the US, at least, doctors and hospitals do refuse to “participate” and will not accept the low reimbursements. Those that do accept Tricare on a case by case basis are cautious about what cases they accept. A friend of mine from the Philippines is currently in Arizona getting chemo for his colon cancer, and will later have surgery. He spent a lot of time trying to find a doctor that would accept Tricare. The Mayo institute will not accept Tricare.
Here is an example of the Tricare reimbursement/payment for him in Arizona, (each area of the US has different payment rates based on prevailing rates and are tied to the Medicare rates);
Example——I have a PET/CT scan tomorrow and the cost is
$4,230————TRICARE will be paying $1,034——and the provider will just accept that.
I had a mobile chemo pump installed in a main artery, it was going to cost about $3k in the PI————here the bill was over $5k-——but tricare paid $1,700—————again without any moaning from the provider.
The last example is pertinent for us in the Philippines. Tricare will reimburse us the $1,700 but since this is a cash and carry society, (and almost no providers will “participate” on a Tricare claim, and can’t be forced to), we must absorb the extra $1,300 that Tricare won’t pay, but we must pay to the provider before we can have the medical care.
We have been fighting this for a long, long time. And I know, many on FR will say that we should just go back to the US. The problem with that is the US Embassy/State Department will not allow most of our wives and children to immigrate to the US because are income is too low, (most of us live on our military pension and have no other income).
Add to that that the OBAMA admin wants us to pay higher deductibles and co-pays and is threatening to veto the DOD budget bill because Congress did not approve those fee increases in the bill.
Under obumacare, $303 million is alotted to hire new IRS goons to harass Americans.
I’m kinda curious about how many of these tough guys would last a minute in the ring with a girl scout.
These new gestapo freaks will be living in our neighborhoods. Time to apply the Founder’s remedies to Tory traitors.
The expansion of Medicaid was planned to accommodate the illegal immigrants. After the states were forced to expand their coverage and took the federal money, they would change the rules administratively and require the states to include the illegals. That was the plan which would break the states and make them totally dependent on the feds. A previous example of this kind of activity was when the feds offered one time payments for the states to expand their unemployment payments to include people who would not ordinarily qualify (such as college students, part-time/intermittent employees, etc.). If the states changed their laws and accepted the money, they couldn’t change them back later .... they owned you.
Yes indeed. Prop C. Which the depraved pols promptly ignored.
Many doctors will not accept new Medicaid or Medicare patients. They limit the number of these to a set amount which they consider as a loss and charity work. If you have a good payment history or previous relationship with the doctor, then they may keep you after you acquire Medicare. Many doctors are going cash only where you pay and then file with your insurance to get reimbursed. Some doctors are charging an annual fee to the patient just to get accepted as a patient.
I was surprised to learn that TriCare has so many problems and shortcomings. From what I’ve heard, it seems like the VA is a better funded medicare program, but of course that doesn’t cover any family members. I’m not entirely clear on what is provided by on base medical facilities, or TriCare, and what there is families of retired career servicemen and women.
In a lot of ways Tricare has 3 or 4 different programs, (depending on how you view them).
Active duty personnel are not really under Tricare. They are required to use base hospitals and clinics, (or in case of U.S Navy when deployed, the ship’s medical facilities). The only time that is not true is when the active duty personnel are stationed somewhere that is not close to a military medical facility, such as recruiting duty or on leave or transiting through an area where there is no military medical facilities.
In the above exceptions the active duty personnel are covered under Tricare Remote. This is a program where they are assigned to a private provider, or network, and coordinate their care through the contractor that Tricare contracted with for that purpose. In the US the contractors are split into several regions and they coordinate the medical care. Overseas, International SOS, (ISOS), is the contractor for all outside the continental US, (OCONUS), active duty medical care.
Active duty family members, (ADFM), are covered under Tricare. If they are residing within the area of a medical hospital, they normally will use the hospital staff and facilities for their care, but that will be coordinated with Tricare Prime which is basically a Preferred Provider Organization, (PPO), which is set-up and run by the regional contractor. The ADFM will be assigned to a Primary Physician who will then coordinate with the contractor and other Prime specialist for referral medical care. Prime has an annual premium which must be paid and there are minimum co-pays for some services.
All ADFM’s OCONUS must be on Tricare Prime and those in remote areas are on Tricare Prime Remote. Tricare Prime OCONUS requires the premium be paid but the co-pays are waived. Also, under the newest Tricare Prime OCONUS, all Tricare Prime is to be a cashless system. The foreign Prime providers are under contract with ISOS and the providers submit the full bill to ISOS through their sub-contractor Wisconsin Physician Services, (WPS, the claims processing contractor).
For AFDM’s that do not want to be on Tricare Prime, (stateside), they can use any Tricare certified provider under Tricare Standard. Tricare Standard requires a $150, (individual), or $300, (family), deductible annually and then they are required to pay 20% of the Tricare allowable amount, (called a Champus maximum allowable charges, CMAC). Many ADFM’s chose this option because they can use doctors that they like rather than the Prime assigned doctor.
Retirees in the US near a military hospital can use Tricare Prime if there are openings in the available slots, (I.E. if there are not enough ADFM’s signing up for the Prime).
Otherwise, retirees in the US are on Tricare Standard and pay the same deductibles as the ADFM’s but pay 25% of the CMAC for their medical care.
Finally, we get to the retirees OCONUS. No retirees OCONUS are allowed to be in Tricare Prime OCONUS. They must be on Tricare Standard. Most OCONUS areas, (Europe mostly), the providers will participate on claims, (but that is not an absolute), and will bill Tricare directly. The problem arises there when WPS pays less than billed due to WPS’s determination of non-medically necessary care or, because of the differences in medical terminology OCONUS and the US, WPS determines that the procedure is not the procedure billed. Then, after losing certain amounts of payments, the providers refuse to participate and require payment up front.
In the US if a provider accepts a Tricare patient they can not bill the patient for the difference of what they normally charge and what Tricare’s CMAC will pay, (balance billing). OCONUS, that law does not apply except for the contract that ISOS has with Prime providers. Thus OCONUS the patient may be required to pay the bill in full and files a claim with WPS for reimbursement. If the bill is from a country other than the Philippines and Panama, WPS pays the billed ammount, (except as I indicated above). But for the Philippines and Panama, Tricare has developed a CMAC for us. The Philippine CMAC is .52% of the average US CMAC. Panama’s is .60% of the average US CMAC.
Unfortunately, since they were established in 2008, there has been no increases in the CMAC other than the Medicare adjustment for US inflation, (annually, 1-3%), but the inflation in the Philippines has been 8-15%, (or more), for medical care annually. Along with that, there has been no adjustment for the fluctuation in the money exchange rate. When the exchange rate was 52 Pesos to a $ when the study was done for this CMAC, (2005), and is now 42 Pesos to a $, there is a loss of purchasing power, but no adjustment in the CMAC to reflect the true inflation and exchange rate.
The bottom line is, what was somewhat close to the actual cost of medical care in the Philippines, (based on the CMAC), now leaves the retirees paying more than the 25% co-pay mandated by law.
When the CMAC was announce, but before it went into effect, we were able to convince Tricare that ancillary cost, (x-rays, laboratory test, etc.), were higher here than in the US because most of the equipment comes from the US and/or Europe and the maintenance, training and repair parts also come from the US and/or Europe. We forced Tricare to do an independent study of the ancillary issue and got them to agree that those should be paid at the full Tricare Puerto Rico CMAC.
We also won on the issue of prescription medicines because most are also from the US or Europe, so they are paid mostly at billed charges.
I know I was long on this explanation, and may have a few minor points wrong, but I hope it gives a better idea of what Tricare is.
We live under numerous other rules that US retirees do not live under, but I will leave those issue for another day unless someone request a rundown on them.
“Any hospital in the United States that refused to admit a Medicaid or Medicaid patient in medical need (including non-emergency) would find its license suspended immediately. “
However, private docs are NOT required to accept them as far as I know. The jerks that wanted this should have been careful what they wished for.
That does tell me a great deal about Tricare I didn’t know. Actually, I’d never heard of it until the late ‘90s when I became reacquainted with an old high school classmate who is the widow and a career servicemen. She’d mention it occasionally, and for the first time maybe, it seems Tricare is a political issue being discussed in the news since Obama seems to want to make some changes, or cuts to the program.
Truthfully, that sounds a bit high for the PI. Have medical prices gone up so much since I left in '05?
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