If Obamacare is canceled: Chaos for Medicare?by Denise Early on Jun. 01, 2012, under Health
If the Supreme Court rules the Affordable Care Act is unconstitutional, and the entire 2700 pages of rules, regulations, policies and programs must be stopped……..what happens then?
I was reading an insurance industry newsletter today that pointed out how a negative ruling will create chaos for Medicare, Medicare Advantage, and Part D.
Medicare Advantage should be especially hard hit because “bids” for 2013 plans must be submitted on Monday, June 4th, and these bids are based on payments, policies and rules that are part of the Affordable Care Act. If the rules of the game change at the end of June, when the Supreme Court ruling is expected, do the plans have to start all over again with their plan design and pricing?
How would Medicare Advantage plans make changes based on the new/old rules and get all this done in time for CMS (Centers for Medicare and Medicaid) to review and approve revised bids? The plans then prepare their marketing materials, all of which must be reviewed and approved by CMS. Materials must be printed and mailed to current plan members by the end of September. Four months of work would have to be crammed into the month of August if plans are required to adjust to a negative Supreme Court ruling on the Affordable Care Act.
If the entire law is canceled by the Supreme Court, what happens to the hundreds (thousands?) of rules and payment policies that have already begun? Health and Human Services Secretary Kathleen Sebelius wrote to Congress outlining potential consequences last year. At that time, she said the administration might have to suspend payments to Medicare Advantage plans.
Just a few of the Medicare-related rules that are part of the Affordable Care Act are:
*Reduced payments to Medicare Advantage plans – but offset by star rating bonus payments;
*50% discounts on brand drug costs for people in the Part D donut hole;
*Changes to the donut hole to make it smaller and less costly to seniors;
*10% increase in payment rates for primary care doctors;
*Reduced payment rates for certain specialists and tests;
*A long list of preventive services newly covered by Medicare, including an annual wellness exam.
Medicare’s payment system, the unseen but vital network that handles 100 million monthly claims, could freeze up if President Obama’s health care law is summarily overturned, the administration has quietly informed the courts.
Although Obama’s overhaul made significant cuts to providers and improved prescription and preventive benefits, Medicare was overlooked in Supreme Court arguments that focused on the law’s controversial requirement that individuals carry health insurance.
In Pima and Maricopa counties, 45% of Medicare beneficiaries are enrolled in Medicare Advantage plans. In Pinal County, 49% are enrolled in Medicare Advantage. This could be a very interesting and crazy time for Medicare Advantage in Arizona and around the country!