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The coronavirus stimulus package Congress rushed out last week to help the nation’s hospitals and health care networks hands the industry billions of dollars in windfall subsidies and other spending that has little to do with defeating the COVID-19 pandemic.

The $2 trillion legislation, which President Donald Trump signed Friday, includes more than $100 billion in emergency funds to compensate hospitals and other health care providers for lost revenue and other costs associated with COVID-19. The measure also calls for spending up to $16 billion to replenish the nation’s depleted stockpile of medical gear, such as ventilators, medicines and personal protective equipment, or PPE.

But health care businesses will get billions of dollars in additional funding not directly related to the pandemic, in some cases because Congress agreed to reverse scheduled cuts in the rates paid by Medicaid and Medicare, which the federal government had tried for years to impose.

“Anything that could tangentially be related to the crisis lobbyists tried to get stuffed in this bill ― particularly health-care-related items,” said Steve Ellis, vice president of Taxpayers for Common Sense, a nonpartisan watchdog group. While the stimulus package is “not as big” a “Christmas tree” as some other bills, Ellis said, “I’m sure we’ll find a few baubles and gifts along the way.”

Hospitals have won widespread praise as their doctors and other medical staffs labor under perilous conditions, including shortages of protective gear. And, perhaps not surprisingly, the industry emerged as a big winner in the stimulus negotiations. Not only can hospitals draw on the $100 billion fund to stem their losses and cover other costs, but they will also see a boost in one stream of revenue as Congress overturned some planned rate cuts.

More than 3,000 hospitals that treat outsize numbers of Medicaid or uninsured patients, for instance, will share in an $8 billion windfall through the stimulus provision that reverses cuts in their Medicaid payments for 2020 and 2021.

Separately, hospitals will rake in at least $3 billion more because of a temporary suspension of a 2% cut in Medicare fees, according to the Federation of American Hospitals, which represents more than 1,000 for-profit hospitals and health systems. The infusion of cash also benefits doctors, nursing homes, home health companies and others.

“That’s welcome news during this time of crisis,” said Joanne Cunningham, executive director of the Partnership for Quality Home Healthcare.

Also tucked into the stimulus: a rollback of planned rate cuts to clinical laboratories and some medical equipment suppliers.

At this stage, it is unclear how much these measures will add to the COVID-19 tab ― or if far more stimulus would be required for the health care industry to rebound.

Take the 2% rate cut known as “the sequester.” The Office of Management and Budget expected it would save Medicare $16.2 billion in fiscal 2021. But the stimulus bill rescinds that rate cut from May 1 through the end of this year. As part of the legislation, Congress said it would, in effect, recoup the payments later by adding another year to the sequester. Whether lawmakers will follow through on that is anyone’s guess.

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), expects the sequester relief to translate to a “huge” financial boost for more than 15,000 medical practices his group represents.

“This would never have been done under any other circumstances,” Gilberg said. “The situation was recognized as dire.”

Dr. Patrice Harris, president of the American Medical Association, said the stimulus offers “needed financial relief to hard-hit workers, health systems and physician practices. At this critical moment, physician practices need significant financial support to sustain themselves and continue to meet the health care needs of all Americans during this time.”

Similarly, American Hospital Association CEO Rick Pollack called the legislation “an important first step forward. But, he added, “more will need to be done to deal with the unprecedented challenge of this virus.”

In a nod to clinical laboratories, which have helped bail out the federal government’s early failure to supply enough COVID-19 tests, the stimulus delayed planned rate cuts in 2021 likely to amount to tens of millions of dollars in revenue. Medicare officials have been at odds with the lab industry for years over rates for lab tests.

While other health care interests praised the bill, the laboratory trade association said it comes up short.

Just before the Senate passed the stimulus bill Wednesday, American Clinical Laboratory Association President Julie Khani slammed Congress for not designating funding to support labs. She said labs were in “an untenable situation, absorbing growing, uncompensated costs for testing specimens with no assurance that they will be appropriately or fairly reimbursed for all the tests they are performing.”

She added a not-so-veiled threat, saying: “If Congress fails to designate essential emergency funding for clinical laboratories to support our efforts, labs will be soon be forced to make difficult decisions about whether they can keep building the [testing] capacity our nation needs.”

The lab association, in a statement to Kaiser Health News, said labs have absorbed “staggering” Medicare reimbursement cuts of as much as 30% for many common tests in recent years.

In public securities filings this year, lab giants Quest Diagnostics Inc. and Laboratory Corp of America Holdings, known as LabCorp, reported they expected rate cuts in 2020 totaling more than $150 million. LabCorp said it supported the views of the lab association. Quest did not respond to a request for comment.

While labs processing COVID-19 tests missed out on direct funding, they could be eligible for some of the $100 billion allocated for hospitals and other providers to cover their losses, congressional aides said.

And the stimulus measure states that even in the event a lab is out-of-network, health plans are expected to pay the price it sets — as long as the lab publishes that price online — or negotiate with the lab.

Given that laws in some states ban surprise billing in particular, this provision seems to favor the labs, said Katie Keith, a Georgetown University law professor and health policy expert. “No one just lets the provider set the price,” she said.

The lab association disputes that, saying that many health plans are expected to pay them less than the $51.50 government recommended for a COVID-19 test.

Just how the $100 billion in health care funding will be distributed and how much oversight will occur is another unknown.

Health and Human Services Secretary Alex Azar has the authority to decide how long the emergency provisions remain in effect. Tracking all that money will be a challenge as well.

Ellis, the taxpayer advocate, noted that no government agency “is ready to handle the rush of extra funding.” He said that the stimulus grants extra resources to inspector general offices to monitor spending.

“There will be waste, there will be abuse,” he said. “It’s about exposing and rooting it out.”

The HHS Office of Inspector General expects to receive $4 million to support this oversight, according to spokesman Donald White.

Some groups aren’t waiting to compete over the $100 billion. The MGMA sent a letter March 27 to Azar and the Centers for Medicare & Medicaid Services chief Seema Verma asking for more direct help. Gilberg noted that some medical practices, such as doctors who perform colonoscopies, have not been able to continue their work.

“Doctors and physician practices are having a lot of trouble right now,” Gilberg said. “They are literally shut down, and they are having financial troubles. Their operations have come to a full halt.”

KHN correspondents Rachana Pradhan and Emmarie Huetteman contributed to this report.

Medical debt is a widespread problem in the US. One in five working-age Americans have trouble paying their medical bills, according to a 2016 Kaiser Family Foundation/New York Times survey

RIP Medical Debt was founded in 2014 by two former debt collections executives, Craig Antico and Jerry Ashton. 
During their decades in the debt-buying industry, Craig and Jerry had learned of thousands of Americans saddled with unpaid and un-payable medical debt and realized they were uniquely qualified to help these people in need.

They went on to create a unique way to forgive medical debt; they would use donations to buy large bundles of medical debt for a fraction of its price, like debt collectors do, and then forgive that debt with no tax consequences to donors or recipients. Reportedly the debt purchase price averages a penny on the dollar, so, wiping out $100 of medical debt would cost about $1 

RIP Medical Debt, is a New York based 501(C)(3) which is focused on helping people who are suffering the crippling medical costs
exacerbated by our broken health care system. The results have been spectacular  —  Nearly $1.4  billion in medical debts  have been eradicated so far, providing financial relief for over 650,000 individuals and families. The organization says it seeks to relieve medical debt for those most in need, meaning people who earn less than two times the federal poverty level, have debt that is 5% or more of their annual income or face insolvency, meaning their debts are greater than their assets. 

Click here to find out more about RIP Medical debt. There is also an  article in CNN about this topic.

One of the most frequent questions I get about Medicare is “Do I need to sign up for Medicare when I turn 65 if I have employer group coverage?” And the answer is:  It depends…. on the size of the employer group and some other factors:

-  Your cost for the coverage (including premium contribution and out of pocket expenses for deductibles, copays and your annual out of pocket maximum)

- If the employer plan benefits meet your needs (benefits, provider network)

- If your employer group is less than 20 employees, you should sign up for Medicare Part A and Part B when you are first eligible or face a lifetime late enrollment penalty. You have a 7-month Initial Enrollment Period:       

      - 3 months prior to your 65th birthday
      - your birthday month
      - 3 months after your birthday month

In this case, Medicare is the primary payer and your employer group coverage pays secondary based on the benefit plan.

If your employer group is more than 20 employees, and has medical and prescription drug coverage that is at least as good as Medicare, you may not need to sign up for Medicare Part B right away. However, you should review the benefits and cost of your employer plan compared to the benefits and cost of Medicare plus a Supplement or Medicare Advantage plan. In many cases, people save money by enrolling with Medicare.

There are several options for Medicare Advantage and Medicare Supplement plans available, and the key is determining which one will offer you the best coverage based on your healthcare needs, your lifestyle and your budget.

Medicare agents must be licensed in the state they sell products and must complete an annual certification and insurance company specific product training each year to assure they are qualified to help beneficiaries in making good choices. 

If you need assistance with your Medicare decisions, please contact me at 206-569-5415 or by email at suderloy@gmail.com. I am a licensed and certified health insurance agent in WA State and represent multiple health insurance companies. I can help you with your decision and enrollment for the plan that best meets your needs.

December 15th is the deadline to enroll or make changes to your health insurance for individuals and families. If you need assistance understanding the current options available to you or help in completing your enrollment application, call Suder Group Health Insurance Consultants at (206)569-5415. 

There will not be an extension this year as we have done in the past in WA, so now is the time to act and make sure you have coverage!

The Annual Enrollment Period, which is the time for making changes to Medicare coverage, ends on December 7th. If you have not reviewed your current plan to assure it is meeting your needs, now is the time to do it!  SuderGroup Health Insurance consultants are available to help you define your needs and find the plan that will work the best for you in 2019. Call Loy Suderman at 206-569-5415 to get the help you need.

If you missed open enrollment for Individuals and Families for a January 1 coverage start date, you still have time to get coverage in place for February 1st. Washington State has extended open enrollment to January 15th for those who missed the December 15th deadline. January 15th is the absolute deadline unless you qualify for a Special Enrollment Period. If you need help and advice, contact an expert - Call Loy at 206-569-5415 or email Loy@Sudergroup.com. Get the help you need!

New to Medicare?

Medicare can be confusing for many people – for instance, often people do not realize that Original Medicare does not cover all of their medical expenses - there are out of pocket costs that can really add up with deductibles, copays and coinsurance. There are a variety of plans available to help protect you from these costs, including Medicare Supplement (Medigap) or Medicare Advantage plans. And, you need to purchase Part D prescription drug coverage to avoid paying a penalty later on.

If you are approaching your 65th birthday, it is very likely you have been receiving information from a variety of health insurance companies about their plans – understanding the differences can be a challenge, there are so many options to choose from and there is no one size fits all.

As an independent health insurance agent, I represent several Medicare plans and I can help you understand your options so you can find the coverage that is right for you. You are not charged a fee to work with an independent agent; I earn commissions from the insurance companies and my goal is to help you find the plan that best meets your needs.

Before I or any agent can work with you, you must have your Medicare card that indicates the effective date of your Hospital (Part A) and Medical (Part B) enrollment. There are three ways you can enroll:

• By Phone: Call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778).
• In Person: Take proof of your age and W-2 forms for the past two years to any Social Security office. Your local phone directory will list the office location nearest you.
• Online: Apply online at www.ssa.gov.

If you have questions, or if I can be of assistance to you, please call me at (206)569-5415 or send me an email to loy@sudergroup.com. I’m happy to select the plan that will meet your unique needs.

For those of you on Medicare, now is the time to review your current coverage and the new plan options to make sure you enroll in the best plan for you. A variety of new benefits have been added to Medicare Advantage plans such as hearing aids, travel to doctor appointments, meals after a hospital discharge, naturopathy/acupuncture and more; not all plans have added the same features. There are also some changes in premium and per service copays, depending on the plan you are on and the specific benefit. 

When reviewing your current coverage or selecting a new plan, there are several factors to consider, such as provider network, pharmacy coverage (is your specific medication included in the plan formulary), out of pocket costs and limitations, premium and the service area, just to name a few. 

I am a licensed agent, certified with several health plans representing multiple Medicare Advantage, Medicare Supplement and Part D Prescription Drug Plans in Washington and I can help you find the plan that best fits your unique needs.

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