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Old 04-13-2010, 07:41 PM
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Exclamation Beneficiary Limbo

Beneficiary Limbo

posted at 8:34 pm on April 13, 2010 by J.E. Dyer
[ Healthcare ] printer-friendly

Those of us who are covered by TRICARE insurance – military retirees and military family members – are in a holding pattern this week, along with Medicare beneficiaries. The provisions of the 1997 Balanced Budget Act require a dramatic, 21.3% cut to physician reimbursements this year by both Medicare and TRICARE, whose policies generally proceed in lockstep (with changes implemented to TRICARE about a month after they are implemented for Medicare). The cut was originally to take effect on 1 March, but Congress postponed it to 1 April. Technically, the cut has taken effect for Medicare, but the program is waiting to process new claims to see if Congress will, in fact, override the automatic cuts as it has done in the past.

Jim Bunning and Tom Coburn have affected the progress of related legislation in the Senate, with their “holds” on it to require that Congress’ various routine authorizations – which include this on along with renewal of unemployment benefits – be paid for. So not only are we all in limbo – patients, doctors, hospitals – but we are being besieged with requests for us to contact our Congressional representatives and make our concerns known.

This development comes at a time when virtually all 50 of the states have made significant cuts to Medicaid reimbursements. A whole lot of people have lost their access to physicians who can’t afford to treat Medicaid patients any more. The cuts to Medicare and TRICARE will guarantee more such losses: as reimbursements drop across all government-subsidized programs, doctors will be able to carry fewer and fewer underpaying patients. (TRICARE is private insurance, but government-contracted and subsidized.) Maybe I’ll be one of the losers.

I’m not relating this to build up to an impassioned plea that there be no cuts to TRICARE. I’m not relating it to rant against Bunning and Coburn for their principled stand on pay-go. I’m not even relating it to score points against Obama. The situation we find ourselves in is the product of government programs and rules that were instituted long before he entered the Oval Office – and of an economic recession he didn’t create.

No, I’m relating it because it’s a perfect example of what we’ve been signed on to with Obamacare, for everyone in America. Government health-care subsidies become uncontrollable costs, always and everywhere. They are the big violators of balanced budget amendments.

They are the expenditures that have to be cut to balance budgets. And the more people who rely on them, the bigger the constituency for deficit spending.

The beneficiaries are very often people we just can’t demonize. Retired military who spent 20, 26, 30 years in uniform? Their families who make big sacrifices on a daily basis? The Amen corner for belittling this demographic is very, very small in America. The demographic itself is small; can we really not afford to provide this benefit to military retirees?

Seniors who worked hard for decades, building our nation and our economy, paying taxes, raising taxpayers for the future; our parents, our grandparents – who hates seniors? To even be eligible for Medicare as a senior, you have to have worked and paid taxes for at least 10 years, or been the spouse of someone who did. Medicare isn’t a “fog a mirror” entitlement liked Medicaid.

But who wants to make it even harder for the poor on Medicaid to find doctors either? I’m not seeing a lot of hands out there.

It’s informative to ponder how much we are already taxed and how comparatively few people are covered by the programs in question – and yet we can’t pay for them. There are about 9 million TRICARE enrollees (military retirees and the family members of active duty and retired).

There are about 44 million on Medicare (seniors and disabled). Medicaid patients are the largest group at 60 million, with their costs shared between federal and state funding.

Their status is also different from that of TRICARE and Medicare beneficiaries, because the latter two involve private insurance programs (most of the elderly on Medicare do purchase supplemental private insurance) whose premiums are paid by the beneficiaries. This means their payouts, while tied to government reimbursement tables, are still above the government program’s base figures. Medicaid is straight government payment for services. So it’s no surprise that, with states strapped for funds, it has taken the earliest and biggest cuts in the present recession.

Think about it. This is the future of your health care access as government assumes more and more control of it. It won’t be long before you’re the one waiting on Congress to yet again authorize deficit spending, for one more fiscal year, so that your family doctor doesn’t have to drop you from his patient list because she can’t afford to treat you anymore. And that’s if you’re lucky: you could just be waiting months, or even years, to be seen by a doctor whose schedule is controlled by government regulators anyway, and perhaps simply dying of what ails you before he gets to you.

Consider that the great majority of people on Medicare and TRICARE got to where they are the same way you did: by working to pay taxes to all levels of government between 4 and 5 months out of every year of their working lives. If they had been able to keep even one more month’s worth of their annual earnings for themselves, they could have put more aside for medical savings and insurance premiums, just as you could if you had that month’s earnings back. They’re almost all paying insurance premiums now anyway, but the subsidies that make the premiums affordable turn them into a constituency that has to worry about filibusters and senatorial “holds,” and annual Keep up the Deficit! votes that come down to the wire.

There’s supposed to be a vote tomorrow that will extend current Medicare reimbursement rates to 1 May. Another one-month extension so Congress can put off deciding whether this year is the one in which to go ahead and comply with the Balanced Budget Act of 1997. Millions of people’s near-term access to medical care depends on what Congress does about this. Just think: the day is approaching when you’ll be one of them.

Cross-posted at The Optimistic Conservative.

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