Obama's Rationing Plan Revealed in Lawsuit

Commentary from Twila Brase, President CCHF


February 27, 2013

A federal lawsuit has revealed one of Obama's rationing plans. The Administration says states can cut Medicaid payments to doctors and other providers to hold down costs. 

This is a breathtaking statement. President Obama's signature law, Obamacare, adds 16 million people to Medicaid. It offers states the "opportunity" to expand Medicaid at no cost for the first two years, and then offers to pay 90% of the cost in perpetuity of all individuals eligible under the expansion -- until they decide not to and the states are stuck with the bill. The law also increases payment to primary care doctors for two years to encourage them to accept more Medicaid patients. 
Perhaps the president was never planning to pay the full cost of Obamacare. 
The administration's position, set forth in federal appeals court documents in California, was revealed Monday. As The New York Times reports," In a brief filed with the United States Court of Appeals for the Ninth Circuit, in San Francisco, federal officials defended a decision by California to cut Medicaid payments to many providers by 10 percent."
"There is no general mandate under Medicaid to reimburse providers for all or substantially all of their costs," the administration claims. Again, breathtaking. AARP and other supporters of Obamacare are not happy. They no doubt feel betrayed. New Medicaid recipients should be even more unhappy. Obama's only promise is coverage, not care.
The administration's explanation for their position is revealing. Kathleen Sebelius, secretary of health and human services, had approved California's Medicaid cuts because she determined that recipients would still have "adequate access" to a wide range of services. 
Sebelius is the czar of all czars. Under Obamacare, the Secretary has sole authority to decide what medical services are and are not "adequate" in health plans. She's also in charge of implementing any payment restrictions the Independent Payment Advisory Board ("death panel") recommends. Alternatively, according to the Cato Institute's excellent report, she can act as the sole voting member of IPAB if the President doesn't appoint anyone else to the 15-member board. And she can implement and enforce her fiat decisions without Congressional approval.
Coverage is not care. Never has been. Never will be. President Obama promised to expand coverage. Clearly, care is not part of the package. If medical treatment is not paid for, it will eventually go away. Rationing can be overt or covert.
Already, one-third of physicians refuse to accept new Medicaid patients. There is also a "silent exodus" of physicians taking place nationwide, decreasing access for all Americans. In California, where the lawsuit is taking place, Dr. Paul R. Phinney, president of the California Medical Association, told the Times, "Two-thirds of doctors in California cannot afford to participate in Medicaid because the rates are so low."
What is Obama's game plan? Does he plan to force America's doctors to work for free or at a loss? I don't think so. At least not overtly. I think he plans to force them out of private practice and into employment with hospital and health systems -- Obamacare's ACO's. Then he would force the healthcare systems to take Medicaid patients at a huge loss. Don't forget how he's manhandled banks and car manufacturers. 
The administration's position makes no sense — unless President Obama cares little about the underprivileged Americans he's about to trap in Medicaid. Physicians are already facing a nearly 30% cut in Medicare payments. January's "fiscal cliff" deal delayed the cut for only one year. Medicare Advantage is facing a 2.3 percent cut over and above the $200 billion cuts imposed by Obamacare. We've got this president for four more years. Why wouldn't the president just keep on cutting payments to doctors and hospitals?
To protect all patients, Obamacare must be repealed. In the meantime, I offer last week's "5C" solution for your consideration—and some ideas for a Medicare "escape plan," which 77 million babyboomers may need.
In freedom,
Twila Brase RN, PHN
President, CCHF
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