NEWS: Washington Post: Doctors Cut from Medicare Advantage Networks Struggle with What to Tell Patients

January 27, 2014

The State of Obamacare: Medicare Advantage Cuts Force More #BrokenPromises

Patients, Most Vulnerable Americans Losing Access to Doctors as Health Law’s Cuts Take Effect

As President Obama prepares to deliver his State of the Union address Tuesday, the state of the health law is an unsettling one for those seniors and disabled Americans who rely upon Medicare Advantage for care. The president’s signature health care law raids more than $300 billion from the Medicare Advantage program in order to fund the new entitlement, a policy that Energy and Commerce Committee leaders warned at a hearing in December would lead to the next wave of broken promises. Sadly, seniors and disabled Americans who rely on Medicare Advantage are now losing access to their trusted and familiar doctors because of these cuts. The Washington Post reports, “Thousands of primary-care doctors and specialists across the country have been terminated from privately run Medicare Advantage plans.” This is leaving our nation’s most vulnerable in search of access to health care in newly limited networks.

January 25, 2014

Doctors Cut from Medicare Advantage Networks Struggle with What to Tell Patients
 

Thousands of primary-care doctors and specialists across the country have been terminated from privately run Medicare Advantage plans, sparking a battle between doctors who say patient care is being threatened and insurers that insist they have to reduce costs and streamline their operations.

Medical associations, which describe the dismissals as the largest in the program’s history, say the cuts are forcing some patients to leave their doctors in mid-treatment and creating gaps in the types of medical specialists covered in some areas. They’re taking their protests to court, and having some success.

In December, a federal judge in Connecticut issued an injunction that temporarily prohibits an insurer from dismissing doctors in Fairfield and Hartford counties, and an appeals court in Texas has upheld a similar court order. Another lawsuit is pending in New York, and doctors groups in several other states are threatening legal action.

The American Medical Association, the nation’s premier doctors organization — along with 39 state affiliates and 42 patient and medical specialty groups — has called on the Obama administration to intervene and put pressure on insurers to reverse the terminations.

Insurers say they must shrink their physician networks because they face billions of dollars in government-payment cuts over the next decade — reductions that are being used partly to fund insurance coverage for millions of people under the federal Affordable Care Act. They also say the smaller networks will allow them to curb premium increases and to remain nimble as they prepare for an influx of patients under the law.

Medicare Advantage, an alternative to traditional Medicare, covers 13 million beneficiaries, or 27 percent of the people in the federal health-care program for the elderly. Besides providing the standard benefits, the thousands of Medicare Advantage plans often offer extra perks such as free eyeglasses and adhesive bandages. They can do that because, for years, the government has paid the plans more, per patient, than it spends on regular Medicare.

That has been a sore point for Democrats, who used the health-care law to cut payments to Medicare Advantage by $156 billion over the next decade. …

Read the complete story online here.

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