Refusals: Tale of 3 Gov’t Health Care Programs


April 22, 2015

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Refusals are common in government programs. The only question is who refuses and who gets refused. Find below three tales of refusals and who’s being impacted – for good or for bad.
First, many Americans REFUSED to enroll in Obamacare, forcing the Obama administration to drop its enrollment projections. And now Enroll America (EA), which got oodles and caboodles of dollars to enroll Americans in Obamacare, is cutting its staff in half. Politico reports a “precipitous drop in funding.” Perhaps with enrollment refusals widespread, donors are refusing to provide the dollars EA needs to fully continue the program. I’d like to think our “Refuse to Enroll” campaign helped people choose to refuse.
EA received a whopping $27 million from 30 donors in 2013 and $20 million from 80 donors in 2014. In 2013 they had net assets of $13.4 million. Net assets from 2014 have yet to be reported.
Second, a Medicare Advantage plan is REFUSING to pay for care. About 180,000 senior citizens in Pennsylvania may soon have their access to cancer care cut off. The Highmark health plan, a Medicare HMO, “won’t pay for cancer care,” says the UPMC hospital spokesman Paul Wood, so UPMC is terminating their contract with Highmark. Meanwhile, Highmark has sued UPMC saying the hospital overbilled for care by $300 million. Seniors that lose access to their cancer doctors must wait until October 15 to switch plans.
Medicare Advantage (MA) is the HMO version of Medicare. MA HMOs receive more dollars per recipient than are spent for the care of senior citizens in traditional, non-HMO Medicare -- some say 12% more; others say 9 – 13% more. But that doesn’t keep MA HMOs from being stingy. HMOs are in business to make a profit, not care for patients.
Third, state Medicaid directors want authority to REFUSE medications. While states can refuse to provide medications to Medicaid recipients, none do because a federal program, the Medicaid drug rebate program (MDRP) to reduce costs, requires participants to cover all FDA-approved drugs. All states participate, but they don’t have to, and may someday decide not to.
This “cover all drugs” MDRP requirement is expensive, and state Medicaid directors wrote Congress asking for flexibility to refuse to pay for certain prescriptions. Their angst comes after 11 million people have enrolled in the program through Obamacare’s expansion of Medicaid and after costly “new innovative ‘curative’ drugs” have arrived on the scene.
Such drugs include the $80,000 course of treatment with Sovaldi for hepatitis C. While expensive, the drug essentially cures patients, saving them and taxpayers from a lifetime of costly medications, liver transplants, anti-rejection drugs and possible death.
Medicaid directors also suggest Congress rethink drug research. They told Congress the “Development and Use of New Antimicrobial Drugs” section of the 21st Century Cures Initiative may “create an incentive for overutilization of new antimicrobial drugs. Would their suggestion limit everyone’s access to new medications?
For these reasons and more, Americans must REFUSE national health care, including Obamacare. We need a future of freedom, filled with personal health care choices and not massive government refusals.
Building a future where freedom thrives,
Twila Brase, RN, PHN
President and Co-founder
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