<p>I understand the goal is to get millions more on Medicaid. But at the same time we continually hear that Medicaid is already beyond broke and that’s why a lot of the governors are reluctant to sign up their states. They don’t trust the Feds to actually come up with the money which does seem a valid concern. Medicare cuts and new taxes pay for some of it. But all of it? And essentially cutting old and sick to pay for new young and healthy does not sound very nice.</p>
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<p>The decision, however correct, had the effect of preventing millions of people from getting Medicaid. A court case about the exchange subsidies wouldn’t affect Medicaid, though, since the new Medicaid subscribers aren’t getting subsidies for health insurance premiums.</p>
<p>"“In these small handful of states, they’re aggressively targeting people they think might be eligible for Medicaid,” Salo said.</p>
<p>Salo pointed to people who the states already know are on food stamps receiving some other kind of state or locally funded health program.</p>
<p>“You know who they are, you know what their income is, you know they’re OK accepting government benefits. If you go after these guys, there should be no surprise that these people are being enrolled.”</p>
<p>Also, in some states, Medicaid coverage starts immediately, meaning there may be more of an incentive to enroll early because you get coverage sooner than on the private market where no matter when you enroll in the first two and a half months coverage still starts on January 1."</p>
<p>I think this is a great explanation about medicaid signups from razorsharp’s link.
Also, what is with all that data… :)</p>
<p>The headline was a little inflammatory. The body of the article… The numbers could be good.</p>
<p>I know this, CF. </p>
<p>But I really want the congress to have to follow the law. </p>
<p>As I said, this is the strangest set up and seems to me to have to do with insurance, not health care. I think that will change over time.</p>
<p>ETA. The nine are not preventing a Medicaid expansion. They are simply saying it is up to the states. This is where the voters come in. If they want the change in their state, they can make that happen.</p>
<p>Nevermind… I am trying hard not to get political. </p>
<p>Scratch that comment about blowing my mind.</p>
<p>The “cuts” to Medicare are cuts in the overpayments to Medicare Advantage. There is no reason we should have been paying MORE per person to cover the younger, healthier people on Medicare Advantage compared to the older, sicker people on traditional Medicare, but we were.</p>
<p>Another way ACA raises money from Medicare is fining hospitals that discharge too many sick people, only to have them readmitted on Medicare’s (our) dime. To avoid paying these fines, hospitals have to improve care for sick people. This is a good thing for everyone.</p>
<p>They just waste too much money and that helps no-one. Look at all the money wasted just on the silly website alone. Sure, they will fix it. But, it’s a not a good sign for cost controls.</p>
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<p>Through the legislative process? If you carefully (or not so carefully) consider that process, I believe you will come to the conclusion that the probability of that happening with the current congress is zero. If executive order could change it (but I don’t think it works that way), then sure.</p>
<p>Flossy, if you look at a link Tom provided up thread, Medicare manages to spend only 1.4 percent on managing costs and insurance and payments. </p>
<p>I think this has helped millions. And been very effective.</p>
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<p>Depends what happens in the midterms.</p>
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<p>A lot of us here have parents on Medicare. If my mother is hospitalized for pneumonia, and due to the extra care the hospital has instituted to reduce hospital-acquired MSRA infections that cause readmission she is not discharged and then readmitted, I’ll be happy. I don’t want my mom, or anyone else, to get MSRA in the hospital. Readmission is a BAD THING. Reducing readmissions helps sick people.</p>
<p>So, you misunderstood my post (which happens a lot on CC).</p>
<p>They waste too much money. Waste helps no-one. How can anyone disagree? The website is quite the example of waste. That’s all I’m sayin’. Really, that’s all.</p>
<p>So then why are you objecting to legislation (like the cuts to Medicare Advantage and the readmissions penalty) that cut waste?</p>
<p>Honestly, I don’t object to anything because it’s very hard to know what is and isn’t even true. And this whole thing is so complex with so many moving parts and unintended consequences and upcoming amendments and expected court challenges and big expensive unanticipated glitches and there really are some very valid concerns. You can keep your Dr. is a big one. And not everyone can just suck up a tripling of insurance rates even if they have income that says they can. And, income means very different things in very different parts of the country. And some people on here have Parent Plus Loans and houses that are worth less than their mortgages. So even though they make a decent amount of money they are still kinda broke. So yes, I occasionally have questions.</p>
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<p>Where did you get this flow information from? I saw a report that said there wasnt work on IRS servers. And another article on the Data Hub security said that no information was stored on at the Hub. Put those two things together and the income reconciliation (as well as VA status, Social security and other things they are verifying) would have to be done on servers on the back end of the healthcare.gov data vlan. </p>
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<p>This definitely isnt it. </p>
<p>First, off the concurrent sessions are ridiculously low compared to web commerce. The encryption premium (in terms of computation and bandwidth) just isnt that sever. Thirdly, this type of problem is easily handled by horizontal scaling. </p>
<p>You also have to consider that there are State sites pumping way more volume through the back end than hc.gov. If the encryption requirements are the bottleneck, why doesnt Kentucky and Washington experience them?</p>
<p>I think busdrivers concern is correct- security is the first thing that gets cut out in the rush to meet schedules and push out code fixes. And there really needs to be an round of Penetration Testing. That cant happen until the code base is finalized and the site stops crashing under load.</p>
<p>Everyone is concerned about waste. But I’m afraid that if we actually want to combat waste, we have to do the hard part and understand where the money is actually being spent, and where suspected waste is occurring. We can’t just throw up our hands and say it’s complicated. </p>
<p>Even if we say that 30% of the money spent on the exchanges was wasted, that still is not a significant cost in the scheme of things. For one thing, it’s going to be a one-time cost. I’m not defending high-cost, incompetent software; it needs to be fixed, and pronto. But if your greatest concern is waste, you should look elsewhere for the big bucks.</p>
<p>The sad fact is, one person’s “waste” is another person’s income. Most of the places in the US medical system where costs look particularly out of line have defenders to keep the dollars flowing. Outpatient surgical centers, medical device manufacturers, highly paid specialists, big pharma all have lobbyists.</p>
<p>I agree. The unanswered question is will it get better, worse, or just different. Time will tell.</p>
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<p>I seriously doubt that. </p>
<p>Remember Keynes said in General Theory that the government should pay people to dig holes in the ground and then fill them up. And Keynesians are everywhere in Washington.</p>
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<p>I recently learned more about Medicare than I wanted to know. My mom fell while visiting me and broke her pelvis. She was transported to the emergency room. Since a (stable) broken bone is not a good enough reason for admission to the hospital, the hospital had to come up with a reason to admit her. You have to be admitted (not in for observation) to the hospital and stay three nights in order to quality for rehab through medicare so they needed a reason, other than the break to keep her there. She is anemic and has low sodium and her blood pressure was unstable so they kept her for three nights and then she did almost 3 weeks of rehab. Medicare will only pay for 20 days of rehab. Her medigap insurance pays the rest. In order to get more Medicare rehab, she would have to be readmitted to the hospital. That is one of the reasons people are readmitted. Medicare was never meant to cover rehab but most people can’t afford $10k a month for a rehab facility so doctors figure out a way for Medicare to pay it. Hospitals also get a higher reimbursement for admissions than observation, so they like to find reasons to admit. </p>
<p>However, if they get audited, and Medicare is auditing more than they did in the past, and Medicare determines a hospital admitted someone on a bogus diagnosis, they lose every cent paid by Medicare for that patient. Some hospitals have had to repay millions.</p>
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<p>One person’s “waste” is another person’s benefit!</p>
<p>(Medicare Advantage is/was extremely popular with seniors.)</p>