If a person without health insurance shows up at a hospital with a serious illness, should he get medical treatment he cannot pay for out of his own pocket?

This question was posed to Representative Ron Paul during the CNN/Tea Party debate on Monday. Representative Paul said the hospital and government should not pay for that person’s care, and when Wolf Blitzer asked if the person should be left to die,  the audience applauded and hooted their approval.

I’ve written about this issue and my mixed emotions when it comes to people who go without health insurance, get sick, and stick hospitals, and ultimately taxpayers, with their bills. (Arizona-ends-medical-expense-deduction-program)

What do you think?

Republicans want to repeal the 2010 Affordable Care Act which impacts a broad range of medical and health  insurance issues.  Many of the reforms are actually quite popular with the public.  Here are some changes that will affect Medicare beneficiaries in 2011.

Medicare will increase payments for primary care services by 10 percent. This increase applies to all fees for services provided by primary care physicians as well as nurses, nurse practitioners, and physician assistants.

Preventive health services, such as vaccinations and cancer screenings, will be covered for people on Original Medicare at no cost to the patient. Also, Medicare beneficiaries can now get a free annual “wellness exam” from their doctors.  Note:  People enrolled in Medicare Advantage plans have had these preventive and wellness benefits for many years. Medicare seems to have learned from the Medicare Advantage model which encourage seniors to get preventive screenings.

The Part D doughnut hole is being changed in 2011. Anyone who falls into the doughnut hole in 2011 will receive a 50% discount on their brand drugs while they are in the gap.  Generics will be discounted by 8%.  So a person whose brand drug costs are $500 per month would pay $250 instead.  This should provide serious relief to people who take expensive brand drugs.

Medicare Advantage plan payments from Medicare will be frozen at 2010 levels, so 2011 Advantage plans have not seen major changes to benefits. Actual reductions in what Medicare pays Advantage plans will begin in 2012, so we’ll have to wait and see what the plans will look like next year.

In the meantime, the Advantage plans will be working hard to upgrade their customer service so they qualify for bonus payments Medicare will offer to plans that get three or more stars on the Medicare.gov rating system.  People enrolled in Medicare Advantage plans can expect more attention from their plan this year, which might be a good thing.

Good news for Medicare Advantage plans in Arizona!   In what Kaiser Health News called a “surprising move”, the Obama administration “will extend special bonus payments meant to reward top-performing Medicare Advantage plans to those that score only average ratings”.

With most Advantage plans in Arizona rated as average (3 stars), our plans will get additional money even as Medicare reduces payments to the insurance companies that run the plans.

Part of the health care reform law requires Medicare to reduce payments to all Medicare Advantage plans by about 15% over three years starting in 2012. At the same time, the law provides for bonus payments to Advantage plans that are highly rated, or earning 4 or 5 stars based on a range of quality measures.

In Arizona, only Cigna in Maricopa County gets 4 stars or more.  In Tucson, the major Advantage plans (Secure Horizons, Health Net and Humana) get 3 stars.

I have written previously that the three-star ratings of Advantage plans in southern Arizona would not bode well for the 45% of Medicare beneficiaries in Pima County who are enrolled in these plans. With payment cuts to Medicare Advantage looming, would all plans have to start charging premiums in 2012?  Would co-pays for doctor visits and hospital stays be increased? Would free gym memberships be dropped?

The Kaiser Health News article says the move to reward 3 star-rated Advantage plans is a way to prevent areas like southern Arizona from having a market shock in 2012 where Advantage plans drop out of the market and large numbers of seniors are forced to change plans or return to Medicare.  This happened in the late-90′s when payments to private Medicare plans were cut drastically from one year to the next and companies like Blue Cross Blue Shield dropped out of the the Medicare HMO business.

So, while Medicare is going to cut payments to Medicare Advantage plans, the plans are being encouraged to improve their ratings so they will get bonus payments.  One of my clients, who is enrolled with Humana, said she was surprised to get a phone call from Humana asking her why she hadn’t gotten her annual physical.  The Humana representative encouraged her to use the preventive screening benefits provided in her Medicare Advantage plan. This is a sign that Humana is trying to improve its rating.

The summary rating gives an overall score on the health plan’s quality and performance on 33 different topics in 5 categories:

• Staying healthy: screenings, tests, and vaccines. Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
• Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
• Ratings of health plan responsiveness and care. Includes ratings of member satisfaction with the plan.
• Health plan member complaints, appeals, and choosing to leave the health plan. Includes how often members have made complaints against the plan and how often members choose to leave the plan.
• Health plan telephone customer service. Includes how well the plan handles calls from members.