Friday, March 22, 2013

Two Differences Between Obamacare and Medicare

Congressman Richard Neal of Mass. illustrates a difference between Obamacare and Medicare and wants to fix it:
Currently, Medicare waives cost-sharing for any colorectal cancer screening recommended by the U.S. Preventive Services Task Force. However, should the beneficiary have a precancerous polyp removed, the procedure is no longer considered a ``screening'' for Medicare purposes. The unintended consequence of this is that the beneficiary is obligated to pay the Medicare coinsurance. This is an unexpected and unwelcome ``sticker shock'' that does nothing to promote screening or improve patient care. The Administration announced in February 2013 that private insurers participating in state-based health insurance exchanges must remove all cost sharing for colon cancer screenings where a polyp was removed. We must have a similar policy in the Medicare program.
To translate this out of healthcare speak, and into English:

  • Under the law governing Medicare, a colonoscopy is reimbursed at 100%. However, a colonoscopy that finds a polyp, and removes a polyp, becomes a medical procedure, and the patient is liable for a co-payment.
  • Under Obamacare, a colonoscopy is reimbursed at 100%. HHS, in regulations, forbids insurance companies from imposing a copay when a polyp is found and removed. (Current practice of insurance companies, incidentally, has been to follow Medicare.)
Leaving aside the merits of the Congressman's proposed legislation for a second, let's take a look at what Mr. Neal also illustrates:
  • Changing Medicare's benefit package takes an Act of Congress;
  • Changing Obamacare's benefits package only takes a change in regulations

How you feel about this question is probably a good way to figure out the question -- Republican or Democrat?

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