Trump's executive order has some stealth provisions that would blow up Medicare as we know it

[octoberlib]

Link to tweet

This provision would spike the cost of Medicare. Because premiums are linked to cost, premiums would skyrocket for seniors.

(b) The Secretary, in consultation with the Chairman of the Council of Economic Advisers, shall submit to the President, through the Assistants to the President for Domestic and Economic Policy, a report within 180 days from the date of this order that identifies approaches to modify Medicare FFS payments to more closely reflect the prices paid for services in MA and the commercial insurance market, to encourage more robust price competition, and otherwise to inject market pricing into Medicare FFS reimbursement.


This provision is a fancy way of saying Medicare privatization. This is Paul Ryan's old plan. Learn more here: https://americanprogress.org/issues/healthcare/reports/2011/12/16/10822/the-inherent-flaws-in-medicare-premium-support/


(b) The Secretary shall study and, within 180 days of the date of this order, recommend approaches to transition toward true market-based pricing in the FFS Medicare program. The Secretary shall submit the results of this study to the President through the Assistants to the President for Domestic and Economic Policy.

Note this stuff can probably be done under existing statutory authorities, if they decide to proceed. Scary stuff.

Link to tweet

If Democrats can't focus and weaponize this, god help us. We eviscerated Romney when he proposed Medicare privatization.

[Matthew28]

1. Evil

that is the only word for this.

[Newest Reality]

2. I am sure that,

everyone has noticed that, while we get the chaotic Spectacle from Trump, there have been a trickle of articles revealing how he and his MisAdminstration are eviscerating everything by way of policies and appointees.

If we didn't have the show as a BIG distraction, those revelations might get much higher priorities in the news and discussions here. I think it even reflects in the number of recs for threads here.

I know that the crimes are egregious and deplorable and impeachment is critically important, but there is a LOT of damage being done across the board.

[octoberlib]

7. Yep . I bet all those seniors at the Villages this

afternoon, slobbering all over Trump , have no idea what is in this.

[Newest Reality]

12. Sad!

A rude awakening, for sure.

Best to have extra defibrillators and oxygen on hand.

[Ahpook]

14. Were these wealthy people?

You know how that goes!

[octoberlib]

15. I googled it and it said that the cost of living in the Villages is 12% higher than the rest of

Florida. So, they probably wouldn't give a crap.

[Ahpook]

20. Makes since

That's why he went there.

I hope he got his rush from his cherry picked fans. I also hope the rubes that support this asshole wake the fuck up and figure this out. They have no business voting for or supporting this.

I know plenty of people that will live in a ditch if Medicare is deliberately broken.

On edit: You know what? It doesn't matter! These people might finally admit to their vote for Trump was a mistake. I can guarantee they will vote for an equally inept shithead in the future. They vote against their own interests constantly.

[Generic Other]

18. Reminder: Seniors have children

Families. If Medicare fails their parents, who do they expect to pick up the tab? We need to get the word out PRONTO on this issue. It is a bipartisan issue for most working Americans.

[SergeStorms]

30. I seem to recall....

that the least expensive home in "The Villages" was in the neighborhood of $300,000. That's not a neighborhood I'd be comfortable in.

[erronis]

48. Under the guise of pandemonium, evil lurks

I'm sure there are some very smart people concerned about these developments.

But since most of us get information from the most recent/sensationalist feeds (and that does include DU), we don't focus on those things that may be the most important.

Thanks for your post - I agree.

[Thekaspervote]

3. I don't buy it! If dotard could change Medicare with a wave of his sharpie

Last edited Thu Oct 3, 2019, 09:35 PM - Edit history (1)

The sick gop would have done it long before this!!

[bluestarone]

5. Well i'm sure it would be ILLEGAL but

Who's gonna stop him? No end to their EVILNESS!

[octoberlib]

6. Topher Spiro worked on the ACA for Obama.

He knows what he’s talking about. Ron Wyden also said this is Trump’s plan for 2020.

Link to tweet

?s=21

[shanti]

4. So is this why Ryan

is moving his family back to DC?

[octoberlib]

8. I didn't know they were. I imagine he's going to be a lobbyist.

[StarryNite]

9. Keep this kicked!

[patphil]

10. Wow! This will raise prices dramatically for many who can't afford health care insurance now.

In other words, it's gonna kill a whole bunch of people who will find health care is out of their financial reach.

Patrick Phillips

[pazzyanne]

25. K & R

[Captain Zero]

26. Now now, it's only going to kill them after they're bankrupt.

Nt

[Guilded Lilly]

11. Kick.

[Sherman A1]

13. Kick

[EveHammond13]

16. how does he expect to get this through the House

[SergeStorms]

31. He's going to do it by "executive order".

King Donald doesn't recognize Congress as a co-equal branch of the government. He wants to do this by his kingly decree. Whether he can remains to be seen.

[yaesu]

17. So, why are the House & Senate Dems still working with tRump and the fascists on anything

when they pull crap like this?

[B Stieg]

19. K&R

[spanone]

21. K&R...

[ancianita]

22. Countermanding law by executive order probably won't stand up in court.

[Thekaspervote]

33. Indeed it won't. Again, the gop has been trying to privatize Medicare for well over a decade

And haven’t succeeded. Not saying they won’t try, but it will not stand up in the courts

[secondwind]

23. K&R for visibility!!!!!!!!!!

[BadgerMom]

24. K & R

I’m both frightened as a cancer patient and enraged, again. This nightmare is certainly not good for anyone’s health.

[NRaleighLiberal]

27. manchurian candidate installed by vlad

[Hoyt]

28. Actually, this stuff is pretty common. There have been studies for changing reimbursement under

every administration, including Obama's. Heck, Clinton's admin approved big reimbursement cuts that were initiated under daddy bush.

The fact is, over 30% of Medicare beneficiaries choose Medicare Advantage over traditional Medicare because they save money on having to buy a supplemental policy and drug coverage. They also get some very limited dental coverage and vision coverage, that traditional Medicare beneficiaries don't get. The cost of saving what could amount to $150 - $250 a month in savings is that you have a restricted network of physicians and hospitals. Some people like that.

While I wouldn't trust trump to implement any worthwhile changes, there are some ideas in this executive order that could be quite beneficial to Medicare beneficiaries (although, they have been around for a long time and are hardly innovative).

For example, trump's executive order asks for a report on increasing the size of provider networks, one of the main criticisms of Medicare Advantage Plans by those who prefer the traditional Medicare. Depending on your view point, that could be a good thing, although I wouldn't trust trump's admin.

Although traditional Medicare has also attempted to improve use of telehealth services, it's nowhere near a effective as it could be. Telehealth will save money and make it easier for patients in rural areas, and elsewhere, get care.

"Enabling providers to spend more time with patients" is going to sound good to a lot of people, especially those who think Medicare-for-All will lead to big provider shortages, more rushed care, etc. An increase in reimbursement could also be viewed as something that might cause providers to spend more time with Medicare patients. From my experience, it's more likely that providers will just take any additional payments and still give you just a few minutes of their time.

Plus, paying Physician Assistants and Nurse Practitioners more than traditional Medicare could help in primary care shortages.

Speeding up coverage of new technologies will certainly be popular, at least in theory. Traditional Medicare is notoriously slow in adopting new technologies.

These studies and reports won't necessarily lead to changes, they often don't. Medicare coverage, etc., is seldom written into law, except for broad statements like the Secretary of HHS is empowered to determine coverage of new technologies, develop coverage determinations for other services, etc.

In any event, this executive order clearly shows how the GOP will fight Medicare-for-All.

Unfortunately, I believe they will win that fight -- at least in the next year -- by frightening people into believing one government plan for everyone is not acceptable. I believe that will handicap our candidates that push Medicare-for-All, even those who have pushed it in the primaries, then suddenly backtrack going into general election.

[Farmer-Rick]

34. First off show me where private insurance even Medicare dis-Advantage

Is cheaper on anything?

When my wife was on Medicare all those privatized programs were way more expensive. I can undetstand supplementals but those privatized offers are all outrageously overpriced.

Making Medicare premiums and co-pays match market prices will bankrupt most seniors. No doubt about it. The reason for Medicare in old age is because most middle class seniors can't afford the out of control prices we currently allow capitalist to extract from the sick and dying.

Premiums for part B started under W in 2007. Don't go blaming that on Dems. Yes, every president plays with reimbursement rates to hospitals and doctors. But only RepubliCONS increase the cost to our grandmothers and grandfathers.

[Hoyt]

35. It's obvious you don't understand how Medicare works, nor understand Medicare Advantage.

A lot of people on DU have it, and over 30% of Medicare beneficiaries voluntarily take it, mainly because they get the supplemental aspects and drug coverage, usually for zero additional premium or a lot less than than if you buy a supplement and drug coverage and elect traditional Medicare.

Part B was started by Johnson, a Democrat, not bush in 2007. If you want facts, up until Part D, in 2005, prescription drugs were not covered at all by Medicare. I know, for one reason because I paid for my mother's prescriptions.

The Executive Order is involved with reimbursement rates to providers, and the shortage of primary care physicians. No doubt trump can, and will, screw it up, but you are misreading it -- assuming you even read it. But, at least get your facts straight before posting.

[Farmer-Rick]

36. It's obvious you are ignorant about Medicare

Premiums for part B started under W. Look it up. Before that there was NO COST.

Medicare advantage is a scam and that IS obvious. No privatized plan can give you something for the lower price that the government, with absolutely NO profit motive, can give you. You can claim otherwise but a claim is not evidence.

It was a bit cheaper originally to get people into it and then they started their price creep. Once the corporate insurance billionaire CEOs have you, they hope to keep you and suck up all the Medicare funding so we have no choice but to pay for their overpriced crappy insurance.

Did you even bother to read what I posted? Yeah, I wrote about reimbursement rates and presidents... But Only RepubliCONS (Is this the part you don't like?) like to charge our grandmothers more for the same insurance.

[Hoyt]

37. Medicare charged a monthly premium for Part B in 1970, and every year since.

If you don’t know basics, it’s hard to discuss things with you.

Bush signed Part D, which provides some coverage for prescription drugs.

Good luck.

[Farmer-Rick]

38. I stand corrected on the premium issue. See I admit when I make a mistake.

You are right. I meant to say the large increase in premiums but somehow got it in my head that we didn't pay that monthly fee until 2017. I stand corrected.

But privitazation being cheaper is still untrue.

[Hoyt]

40. OK. Medicare Advantage is cheaper compared to buying a supplement and drug coverage from

a monthly premium standpoint. That is especially true if the beneficiary is in reasonably good health.

If you have conditions that require a lot of visits or expensive drugs, then you have to weight whether MA or traditional Medicare and supplements are the better route. A lot of beneficiaries choose the MA route. Any effort to improve MA, doesn’t bother me.

With all that said, I would have Kaiser MA if they were in my area. They are not, so I have traditional Medicare and pay extra for a supplement and drug plan.

[Farmer-Rick]

44. Medicare Advantage is privitization.

It is stealth privitization and costs more.

You can not have a private, for profit organization that commonly pays their CEOs multimillions, take over a government task and claim they can do it cheaper. Think about it. It is NOT logical on it's face. And in practise it always costs more whenever you contract out a government function.

RepubliCONS would like you to believe privitization is cheaper because it allows the filthy rich to gobble up infrastructure, that is essential for the community, pennies on the dime, and then charge outrageous fees that they legally bribe our politicians with.

Privitazation always costs more and Medicare Advantage, stealth privitization put in as a poison pill by RepubliCONS, is no different.

[Hoyt]

45. Fine, don't take it. You have a choice. By the way, even your traditional Medicare is privatized.

Private insurance companies pay Medicare claims, promulgate rules, develop coverage policies, answer beneficiary questions, handle appeals, conduct fraud and abuse investigations, etc. I guess you are going to drop out of Medicare altogether.

[Farmer-Rick]

49. Yeah you have a point. I think we should make it all

Government run.

I mean it would still provide jobs and circulate money. Why did we ever go into contracting out? Was it just to get rid of unions like Raygun did with the air traffic controllers?

I use to do contracting out studies for the Navy. Only when you estimated a marked lower wage, lower worker pay or reduced benefits did any of the studies come out cheaper than the government run function. But they privatized anyway. Our tax dollars at work or lining the pockets of RepubliCON contractor friends.

[Hoyt]

50. The big difference is that private companies have the start up money.

Government nowadays do not want to come up the money needed to buy computers, hire competent staff, by software, etc. And I think government agencies like being insulated from direct blame when problems arise.

I used to work for a state Medicaid agency 40+ years ago. They tried to handle claims processing in-house but never had the money for state of the art hard- and software, or staffing. They got 3 years behind paying claims, and all the doctors and other providers were dropping out.

They finally farmed it out to Ross Perot’s company. I’m sure it cost more, but they got the backlog cleaned up and current. I don’t think that would have happened using in-house assets and staff, mainly because you couldn’t count on the funding needed upfront. Plus, each new governor would have different funding priorities. While there were still issues, the government employees saved their ass by blaming it on the private claims adjudication company.

The government set specs and coverage requirements, fees, etc., and monitored performance and compliance with state and federal requirements. So they were just handling the processing of several billion dollars of provider claims, which is much more complicated than it should be.

Sometimes, it’s better to go with someone who specializes in a particular field.

[forthemiddle]

47. What will happen to Premiums, or taxes when MFA comes to be?

I hardly think your argument for expensive coverage will stand up when the true costs of Medicare for All become known.
And no, there is no way the rich will pay for it all, or that it will be free with no premiums, deductibles, or copays.

[58Sunliner]

52. Do you have numbers? And who said it would be free?

"your argument for expensive coverage"? I have Medicare and it's not free but I sure pay less than I did with regular insurance.

[forthemiddle]

55. But right now

Medicare doesn’t cover any Obstetrics, no Pediatrics, no dental no vision.
That doesn’t include the nursing home care, or the no premium, no copay, no deductible that Bernie is talking about.
Where will all that come from?

[DeminPennswoods]

42. When there is no SSA COLA, part B premiums don't rise for

Medicare eligible seniors whose income is at or below $85,000 (single) or $170,000(married) don't see an increase in Part B.

Link: https://www.ssa.gov/pubs/EN-05-10536.pdf

The program cost increases are spread over that segment of seniors who make more than those figures and who do see an increase in their part B premiums. I know this because it effected my parents.

[octoberlib]

39. You pay a lot more out of pocket on medical

Last edited Fri Oct 4, 2019, 05:03 AM - Edit history (1)

procedures with Advantage . It almost bankrupted my mom’s friend. Not a solution for those living off of SS. My mom had two friends who were on Advantage and they both hated it.

Spiro worked for Obama , is a healthcare policy expert and knows what he’s talking about here as to the effects of privatization.

Also , because of Trump ,junk insurance is flooding the ACA. I imagine that’s what’s in store for Medicare if Trump gets his way.

[Hoyt]

41. I'd like to see the specifics on paying more under MA for

procedures. I’d be surprised.

30+% of beneficiaries choosing MA says it appeals to a lot, and I’m OK with genuine attempts to make it better.

[octoberlib]

43. That will not occur under Trump and Mulvaney.

I don’t know the specifics I only know that my mom pays zero for hospitalization and was shocked at what her friend owed.Of course my mom would probably be shocked at $500. Does the donut hole still affect seniors under Advantage? That’s something that needs to go.

[Hoyt]

46. I think the donut hole does apply under most Medicare Advantage Plans, certainly the ones that save

you a bit on monthly premiums compared to a supplement.

I agree the donut hole needs to go, although there is some special coverage for low income people even in the donut hole. While Part D sucks, I remember before 2005 when there was no coverage at all for prescription drugs outside a hospital. That really sucked. Way too many seniors were forgoing meds, cutting them in thirds, etc.

[sakabatou]

29. Cruelty is a feature

[McCamy Taylor]

32. HCA has probably given Trump a huge contribution

Executive decisions/pardons and appointments are his only way to make money now that he is a sitting duck.

[Bernardo de La Paz]

51. For profit hospitals got to tRump. . . . nt

[stuffmatters]

54. I'd take a look at the religous/faith based hospitals especially

[Mr.Bill]

53. If Medicare can be destroyed by executive order,

I don't understand why another republican president didn't do it a long time ago.