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OpEdNews Op Eds    H2'ed 2/10/14

Obamacare: The Final Payment

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Some states use private insurers to manage health care for their Medicaid population through Medicaid Managed Care Plans, and the Obamacare expansion of Medicaid is a huge money-maker for these private insurers as well as a huge cost booster for U.S. health care. For giants UnitedHealthcare and WellPoint, as well as for smaller publicly-traded companies such as Molina Healthcare, a Fortune 500, multi-state health care organization, an expanded customer base brings revenue growth. Medicaid Managed Care Plans are hoping to enroll the majority of the expanded Medicaid population.

"This is several hundreds of billions of dollars of new market opportunity for these plans over the next couple of years," says Jason Gurda, managing director of healthcare with investment bank Leerink Swann in New York."

Many states are choosing to move all or portions of their Medicaid populations to managed care plans. Thirty-five are expected to make changes to their managed care programs in 2014, up from 28 in 2013 and 20 in 2012. States jumping on the privatized-Medicaid bandwagon will mean more profit for corporations and less money allocated to patient care.

A Managed Care Plan is a system of health insurance which includes a network of contracted providers that are paid a fixed amount to provide health benefits to a defined population. Needless to say, this model relies on restriction and denial of care putting Medicaid patients at risk.

A Medicaid Managed Care Plan adds more charges subject to estate recovery for those who are tossed into Medicaid. The Medicaid Manual says that when an individual age 55 and older is enrolled either voluntarily or mandatorily in a managed care plan, the state must seek recovery from the individual's estate for the premium payments. If the state plan recovers for all Medicaid services, the state must recover from the individual's estate the total capitation rate for the period the beneficiary was enrolled in the managed care plan. If the state plan recovers for only some services covered under the state plan, the state must recover from the individual's estate that portion of the capitation payment that is attributable to the recoverable services, based on the most appropriate actuarial analysis determined by the state.

The manual also states that when the individual enrolls or is enrolled in the managed care plan, the state must provide a separate notice to the individual that explains that the premium payments made to the managed care plan are included either in whole or in part in the claim against the estate.

States that use private insurers to manage their Medicaid population will most likely have capitation payments but might not have reinsurance or fee-for-service programs which can also be recovered from an estate. Therefore, it is prudent to find out what your state has and who is affected. Here are the fees that can be recovered from estates:

Capitation Payments -- a fixed monthly fee paid by the state to the Medicaid Managed Care Plan for each month you are enrolled in one of these plans, regardless of whether or not you use any medical services. If you do seek care, capitation payments can exceed the actual costs of services provided during the month.

According to the Massachusetts EOHHS Privacy Office: The estimated average capitation payment for October 1, 2013 through December 31, 2013 was $449.59 per month -- an average annual total of $5,395.08. In other words, a person from age 55 through, let's say, 62, accumulates $43,160.64 on his or her tally against assets including the home. There goes a chunk of your estate even if you didn't use any medical care.

Reinsurance Payments -- An amount reimbursed to program contractors for certain contract service costs incurred by a Medicaid patient that are beyond a contractual dollar threshold. These payments are in addition to the monthly capitation payment.

Fee-for-Service Payments -- A direct payment of some or all of a Medicaid member's medical bills not covered by other available insurance.

According to the Massachusetts Office of Medicaid, with certain exceptions, persons who are eligible for the Obamacare Medicaid expansion (age 21 to 64) must enroll in one of the state's Medicaid Managed Care Plans.

The hard sell is on for states to privatize Medicaid, and many who are forced into Medicaid by Obamacare will also be forced into managed care plans as is the case in Massachusetts. This represents yet another noose around the necks of low-income and poor people since the three payments described above are recoverable from estates.

Once the limited estates of poor and low-income Americans have been taken to reimburse Medicaid, the U.S. will be left with a permanently poorer and more desperate population and will be faced with higher Medicaid costs as there will no longer be any private property to confiscate.

Pursuant to the Deficit Reduction Act of 2005 (DRA) and clarified in the Tax Relief and Health Care Act of 2006, states were given greater authority to impose and increase premium and cost-sharing charges on certain Medicaid enrollees, but despite these charges their estates are still subject to recovery. Under Obamacare, the government has a right to recover reimbursement from estates of those with lower incomes who are enrolled in Medicaid. Yet, individuals with higher incomes who qualify for a subsidized plan are also paying premiums subsidized by the government but are not subject to estate recovery.

Is it fair to impose estate recovery on Medicaid enrollees but not on other subsidy recipients? Is it fair if recovery adheres to the basic requirements in federal statute, but, thereafter, is based on state policy which differs from state to state and, thus, is not applied equally across the nation to all Medicaid enrollees at age 55 and up? Is targeting a specific age group fair? Or legal?

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Dr. Roberts was Assistant Secretary of the US Treasury for Economic Policy in the Reagan Administration. He was associate editor and columnist with the Wall Street Journal, columnist for Business Week and the Scripps Howard News Service. He is a contributing editor to Gerald Celente's Trends Journal. He has had numerous university appointments. His books, The Failure of Laissez Faire Capitalism and Economic Dissolution of the West is available (more...)
 

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