Medicaid issues, not Medicare's, get fixes in Biden budget

[Yo_Mama_Been_Loggin]

WASHINGTON (AP) — Medicaid issues are turning up as winners in President Joe Biden’s social agenda framework even as divisions force Democrats to hit pause on far-reaching improvements to Medicare.

The budget blueprint Biden released Thursday would fulfill a campaign promise to help poor people locked out of Medicaid expansion across the South due to partisan battles, and it would provide low-income seniors and disabled people with more options to stay out of nursing homes by getting support in their own homes. It also calls for 12 months of Medicaid coverage after childbirth for low-income mothers, seen as a major step to address national shortcomings in maternal health that fall disproportionately on Black women.

But with Medicare, Democrats were unable to reach consensus on prescription drug price negotiations. Polls show broad bipartisan support for authorizing Medicare to negotiate lower prices, yet a handful of Democratic lawmakers—enough to block the bill—echo pharmaceutical industry arguments that it would dampen investment that drives innovation. Advocacy groups are voicing outrage over the omission, with AARP calling it “a monumental mistake.”

Not getting a deal on prescription drugs has consequences. Without expected savings from lower drug prices, Medicare dental coverage for seniors is on hold, as is vision coverage. The Biden framework does call for covering hearing aids, far less costly. Also on hold is a long-sought limit on out-of-pocket drug costs for Medicare recipients. Discussions are continuing around a more limited approach to drug price negotiations, according to a senior Democratic aide in the House, who spoke on condition of anonymity to describe a fluid situation.

https://apnews.com/article/joe-biden-business-seniors-medicaid-nursing-homes-da7a976587393d1522d74b602964132d

[Grasswire2]

1. Bad hearing won't kill ya.

Bad teeth can.

[canuckledragger]

4. Tell that to guy who got killed by a weasel.

[Grasswire2]

6. Haha.

Oh, Canada.

I've never seen a weasel. Have you? My father grew up on the Saskatchewan prairie. Are there weasels there?

[canuckledragger]

7. I'm pretty sure we do...

The guy in question here was deaf, standing on the train tracks and couldn't hear the weasel.

[Grasswire2]

11. did you grow up on the Saskatchewan prairie?

Egad. My uncles would make a joke like that.

[canuckledragger]

12. Nah, I grew up in southern Ontario for most of my life

I stole that joke from 'Heartbeeps', an old Andy Kaufman movie

[Grasswire2]

13. My grandmother was born in Owen Sound.

And my grandfather's family were some of the first non-indigenous residents of Long Point. It's said to be beautiful country.

[Bayard]

2. Seniors are the biggest voting bloc

"In the 2016 general election, 71% of Americans aged 65 and older turned out to vote."

Big mistake not to do more in this bill for them.

[Demsrule86]

16. States like Georgia where Medicaid was not expanded are literally killing their citizens....

so I disagree. And Medicare Advantage plans many that have no premiums have dental, vision and hearing aids...some have gyms as well. So there are plans for seniors...but a poor person in Georgia can't even see a doctor. And kids there are on waiting lists for CHIP.

[hamsterjill]

33. Thank you for that logic.

I was roasted on another thread for stating the same thing basically.

I'm happy for what some will be getting out of these bills WHEN they are finalized and we KNOW what's in them. But to leave seniors out (yes, I am one) is a BIG effin mistake. There were promises made and at least some of those promises should be fought for.

[hamsterjill]

3. Which age group is the biggest voting block?

Isn’t it seniors?

It’s sad that the well being of seniors is not giving more importance.

[GoodRaisin]

5. I was hoping the Medicaid fixes would include expanding

Obamacare to the people in Republican partisan states who didn’t have enough income to qualify for Obamacare. If I am reading this correctly, it will.

[PoliticAverse]

8. Yes, some states didn't expand Medicaid because they didn't want to pick up 10% of the tab...

This bill lets the federal government pay 100% of the cost instead of 90% in those states. Manchin had objected to the provision claiming it was unfair to the states which did expand and are having to pay 10% (and he does have a point).

[GoodRaisin]

10. He does.

But I'm very glad to see this getting addressed finally. I have known a number of people who have been impacted by this GOP partisan atrocity.

[PoliticAverse]

14. I do expect there to be lawsuits over this from states that are still having to pay 10%...

not sure what the outcome will be.

Remember part of the ACA was found to be unconstitutional - and that was also the part involving Medicaid (the court found that you couldn't penalize states for not expanding Medicaid as the ACA required them to do).

[Demsrule86]

19. No it was always political...and this bypasses the states...people can sign up on a national website

It literally costs states money when they do not implement the Medicaid expansion.

[PoliticAverse]

21. Under the ACA the Federal government picked up 100% of the cost of new adults added to the program..

but that was only for the first 3 years then the federal government's share gradually decreased each year until it was back to the usual 90%.

[GoodRaisin]

23. Not familiar with the National Website (see edit). Is that part of this new bill?

Of course it was always political (and remains so with Republican states who still haven’t expanded Medicaid). That’s why we need to do this. It’s trying to fix a wrong. As far as the 100% vs 90% I was acknowledging that I understand Manchin’s argument. I don’t agree with it though. I would argue back that those states that still don’t get the funding, in fairness to those who went without coverage for so long, should be entitled to 100% funding for a while, considering they’ve been getting nothing for so many years at the detriment of their poor people who were cut out because of the partisan bullshit pulled by their Republican state governments.

Personally, if it were possible, I would like to see a law passed that makes whole the people who were cut out of the ACA by those governments. But that’s about as likely as unicorns so I am happy just to get this win.

(Edit my last post - I am aware of the national website, I had a brain fart on that comment. I forgot it was set up for states that didn’t create their own exchange). So I assume this bill just means those in these states won’t have to select a state insurance option.?)

[Demsrule86]

24. The ACA enhancement is designed to bypass states and offer a plan for those who do not qualify for

the ACA is a national plan which they can qualify for and has nothing to do with states. It bypasses the states. I think it may very well use the ACA website to sign folks up and all. The details are coming.

[PoliticAverse]

35. The more the Federal Government takes over in this regard the closer to single-payer we are. n/t

[Demsrule86]

17. Yes, the bill expands Medicaid by changing income levels so they can qualify for a medicaid

inspired ACA plan and there will be a national website...any doctors in say Florida who refuses to participate will lose Medicare as well...very clever. Florida has neither the ACA nor Medicaid reform in practice.

[PoliticAverse]

22. It's only clever if it doesn't result in a significant number of doctors abandoning Medicare.

The problem with Medicaid has been it pays doctors significantly less than Medicare does.

[Demsrule86]

25. Insurance companies pay less than Medicare. Doctors can't afford to abandon Medicare.

[PoliticAverse]

26. I don't think that is correct...

Private insurers paid nearly double Medicare rates for all hospital services (199% of Medicare rates, on average), ranging from 141% to 259% of Medicare rates across the reviewed studies.

The difference between private and Medicare rates was greater for outpatient than inpatient hospital services, which averaged 264% and 189% of Medicare rates overall, respectively.

For physician services, private insurance paid 143% of Medicare rates, on average, ranging from 118% to 179% of Medicare rates across studies.

From: https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/

[Demsrule86]

28. My husband had a 30,000 dollar bill for a minor surgery. The insurance company paid $3000.00

It depends on the insurance company of course but many insurance companies have private deals with doctors and hospitals.

[PoliticAverse]

31. I wonder what Medicare and Medicaid would have paid. Hospital bills are sketchy...

One man's ridiculous hospital bill sums up the problem with America's healthcare
https://www.revelist.com/viral/hospital-bill-outrageous/5597

It's like they throw in everything and see what they can get away with.

[Demsrule86]

30. I read that too...but from personal experience, in many areas doctors and hospitals do

not fare well with insurance. It depends on the state and the insurance company.

[Demsrule86]

32. Here is an interesting take on what is paid...

"...But insurance companies don't pay those listed charges. The listed charges are almost fiction. Instead, each insurer negotiates for lower prices with each hospital and doctor on every plan. The negotiated prices even can vary within an insurance company depending on which plan a patient has.

All of this means there are about as many price tags for that hypertension checkup as there are insurers and providers.

"For an individual consumer, I am completely sympathetic that it's very confusing," says Dr. Ezekiel Emanuel, who was an adviser to the president during the drafting of the health law and is now a health policy specialist at the University of Pennsylvania. "There are at least six different prices for a hospital day. And then there's the cost of actually delivering the service, which — for most of these things, even hospitals don't know what that is. So when you say, 'What's the price?' it's almost a meaningless question, because there [are] all these different prices."

The deals made by insurance companies are secret so there is no way to really know. But I did see it up close a couple of times.

[PoliticAverse]

34. Hospital billing resembles the asking prices at a yard sale...

One man's ridiculous hospital bill sums up the problem with America's healthcare
https://www.revelist.com/viral/hospital-bill-outrageous/5597

[Demsrule86]

29. why would they quit? These are doctors that would have to give up the entire ACA plan as well...

[BeckyDem]

9. Somehow they still sleep at night.

Shameful.

[Autumn]

15. It's a shame, a national disgrace that the Medicaid expansion for red states is all we can get.

[Demsrule86]

18. That is where we disagree...given the hateful nature of the GOP and our small majority, I consider

it a fucking miracle that we get this and other things in the bill...truly we are in great society territory here. You want more, help elect more Democrats.

[Autumn]

20. Then we fucking disagree. I've done my part to elect Democrat's so save your lecture.

This expansion in red states will not get any Dems elected there.

[Demsrule86]

27. Oh please, give me a break. We have a 5050 majority. I don't care what you have done

personally, we need more Democrats. More has to be done or there is a snowball's chance in hell, we get what we want...and if some who have threatened to pout and sit home, do so then we get way less...it is a no-win situation unless we elect more Democrats.

The reality is a 50 50 majority will never be enough to enact some of the policies we both agree on. I am willing to do it incrementally because I believe it will increase the appetite for such programs which will help us win elections as the ACA did. And eventually, we will get the progressive policies we both want and need.