Another Gov’t Report Finds Some Medicare Advantage Plans Hit Seniors With High Out-Of-Pocket Charges

By Igor Volsky on Jun 2, 2010 at 9:00 pm

During the health care reform debate, conservatives defended the overpayments to private insurers participating in the Medicare Advantage program by arguing that any effort to reduce the subsidy or place the private insurers on an equal footing with traditional Medicare would endanger the Medicare coverage for the 11 million seniors enrolled in the program. MA benefits vary and often include coverage for services not available in traditional Medicare, like eye and dental care, but not all Medicare Advantage is created equal. In fact, over the years, a steady stream of government reports has found that while some plans may present a model of efficiency, others rip off both taxpayers and seniors.

A number of government reports and independent estimates have found that the extra federal dollars don’t improve health outcomes, pad insurers’ bottom lines, raise costs for beneficiaries in the traditional Medicare program, and expose beneficiaries to serious financial risks.

Now, a new report from the Government Accountability Office (GAO) concludes that some MA plans used lower premiums to attract healthier enrollees, but then hit them “with high and unexpected out-of-pocket costs“:

- The average plan in the good health group charged about $100 more in cost sharing for a typical inpatient hospital stay (6 days) and about $150 more for a typical inpatient mental health stay (21 days) than the average plan in the poor health group.

- The average plan in the good health group charged about $500 more in cost sharing for a typical SNF stay (35 days) than the average plan in the poor health group.

- The average plan in the good health group charged over $300 more in cost sharing for a year of renal dialysis (156 sessions)32 than the average plan in the poor health group.

The monthly Part C Medicare Advantage premium was $24 for the plans in the good-health group, $37 for the plans in the average-health group, and $31 for plans in the poor-health group, while out of pocket spending for kidney dialysis, for instance, ran from $1,802 for those enrolled poor-health plans and $2,118 for enrollees in the good-health plan.

The report notes that the administration “had already begun to overhaul the Medicare Advantage program even before health reform became law… by holding Medicare Advantage plans accountable for meeting minimum cost-sharing requirements” and Democrats are pointing out that the new law would limit “the ability of plans to charge higher cost-sharing for services most likely to be used by sick enrollees — such as nursing home care, dialysis and chemotherapy.”

Democrats are using the report to rally support for reform among seniors, who have generally remained weary of the new law, but it’s unclear that yet another report about insurer abuses will change many hearts and minds. That will depend on how Medicare Advantage carriers will react to the cuts in the law and whether regulators can actually keep insurers from gaming the system.

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Economy

Contractor: BP Is Trying To Hide Dead Animals, Since The Ocean Will Eventually Wash Away The Evidence

By Amanda Terkel on Jun 2, 2010 at 8:05 pm

In recent weeks, reporters and photographers for major news organizations around the country have been speaking out about the attempts by BP to prevent them from getting a first-hand look at the Gulf Coast oil spill. A CBS News crew was threatened with arrest when it tried to photograph the spill, and a BP representative in Louisiana told a Mother Jones reporter that she couldn’t visit the Elmer’s Island Wildlife Refuge without a BP escort.

On Monday, journalists from the New York Daily News were also “escorted away from a public beach on Elmer’s Island bycops who said they were taking orders from BP.” However, they managed to get a covert tour of the Queen Bess barrier island from a BP contractor who is fed up with the oil company’s attempt to cover up the disaster:

“There is a lot of coverup for BP. They specifically informed us that they don’t want these pictures of the dead animals. They know the ocean will wipe away most of the evidence. It’s important to me that people know the truth about what’s going on here,” the contractor said.

“The things I’ve seen: They just aren’t right. All the life out here is just full of oil. I’m going to show you what BP never showed the President.” [...]

The grasses by the shore were littered with tarred marine life, some dead and others struggling under a thick coating of crude.

“When you see some of the things I’ve seen, it would make you sick,” the contractor said. “No living creature should endure that kind of suffering.”

“BP is going to say the deaths of these animals wasn’t oil-related,” the contractor added. “We know the truth. I hope these pictures get to the right people — to someone who can do something.”

Today, the International Bird Rescue Research Center released new figures on the number of animals that have been reported to the Unified Area Command from the U.S. Fish and Wildlife Service in the affected region. The numbers include 779 dead birds, sea turtles, or mammals (not all showed visible oil signs), and another 108 that were “visibly oiled” but still alive.

A new CNN report shows some disgusting images of the oil on the shore of the Gulf Coast, and notes that some people — including children — are still unaware of the dangers of the oil and are swimming in the polluted water:

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Justice

Obama Directs Federal Agencies To Extend Benefits To Employees’ Same-Sex Partners

By Igor Volsky on Jun 2, 2010 at 7:50 pm

ObamaMemoLGBT In June of 2009, President Obama asked federal agencies to “conduct a thorough review of the benefits they provide and to identify any that could be extended to LGBT employees and their partners and families” within the scope of current law. Today, the administration released an additional memorandum directing agencies to “extend a host of benefits to their employees’ same-sex domestic partners as permitted by law.”

These benefits include:

credit union membership; access to fitness facilities; hardship transfers to maintain or improve the health of a domestic partner to the same extent provided to opposite-sex spouses; planning and counseling services (including briefings on employee pay and allowances, career counseling, retirement counseling, financial counseling, resource and referral services, planning sessions for permanent change of duty station, deployment support, parenting support groups, and elder care support groups); family assistance services (including adoption counseling, parenting counseling, childcare, elder care, financial planning, and home improvements); family and morale/wellness/recreation(MWR) events (including barbeques, golf outings, or awards ceremonies); access to medical treatment; access to lodging or allowances; joint consideration of transfers; and accidental death and dismemberment insurance.

Agencies that provide new benefits are also instructed to “provide them to the same-sex domestic partners of their employees and those same-sex domestic partners’ children” “to the extent permitted by law.” Agencies with greater flexibility over benefits must provide those extra benefits to their employees’ same-sex domestic partners and their children, in accordance with current law.

“For far too long, many of our Government’s hard-working, dedicated LGBT employees have been denied equal access to the basic rights and benefits their colleagues enjoy. This kind of systemic inequality undermines the health, well-being, and security not just of our Federal workforce, but also of their families and communities,” Obama writes in the memorandum. “Although legislative action is necessary to provide full equality to LGBT Federal employees, the agencies have identified a number of benefits that can be extended under existing law.”

To that end, Obama issued a separate statement renewing his call “for swift passage of an important piece of legislation pending in both Houses of Congress—the Domestic Partnership Benefits and Obligations Act.” “This legislation, championed by Senators Joe Lieberman and Susan Collins and Congresswoman Tammy Baldwin, would extend to the same-sex domestic partners of Federal employees the full range of benefits currently enjoyed by Federal employees’ opposite-sex spouses. I look forward to signing it into law,” Obama said. The bill has been reported out of committees in the House and Senate and “awaits consideration by the full body of both chambers.”

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Politics

Rep. Don Young says the Gulf oil gusher is ‘not an environmental disaster.’

By Matt Corley on Jun 2, 2010 at 7:10 pm

An oil-soaked dead dolphin found in Louisiana Last week, Obama administration officials admitted that the Deepwater Horizon blowout is the worst oil disaster in American history, exceeding the Exxon Valdez spill, as they estimated that the gusher had spewed between 15 and 40 million gallons of oil into the Gulf of Mexico. Around the same time, however, Rep. Don Young (R-AK) declared that the oil pumping into the Gulf is “not an environmental disaster”:

Young said: “This is not an environmental disaster, and I will say that again and again because it is a national phenomena. Oil has seeped into this ocean for centuries, will continue to do it. During World War II there was over 10 million barrels of oil spilt from ships, and no natural catastrophe. … We will lose some birds, we will lose some fixed sealife, but overall it will recover.”

Last month, Gulf Coast marine scientists told The Wonk Room’s Brad Johnson that the ecological impact of the accident will be “devastating” because “oil’s bad for everything.” The massive amount of oil threatens several endangered species, coral reefs, and the fragile ecosystem of Louisiana’s coastline. The exact impact of the oil is more uncertain than in other spills because “for the most part, researchers have studied the aftermath of surface spills. The Deepwater Horizon blowout occurred at 5,000 feet, dispensing crude oil from seafloor to surface.” “This is uncharted territory in terms of assessing the effects of a spill from a deep well like this,” Judy McDowell, a scientist at the Woods Hole Oceanographic Institution in Massachusetts told the Christian Science Monitor.

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Climate Progress

Lubchenco Concedes ‘Circumstantial Evidence’ Means Oil Plumes Are ‘Quite Possible’

By Brad Johnson on Jun 2, 2010 at 6:57 pm

The foreign oil giant BP has come under withering fire for questioning the existence of vast undersea oil plumes from the Deepwater Horizon disaster. BP’s skepticism is nearly matched by the federal government’s top ocean official, Dr. Jane Lubchenco, the ocean scientist in charge of the National Oceanic and Atmospheric Administration (NOAA), raising more questions about the wisdom of the unnecessary federal collaboration with this environmental criminal.

In a teleconference with reporters, Lubchenco said that numerous teams of ocean scientists have found only “anomalies” that might or might not be oil which might or might not be from the BP disaster. She said that only chemical analysis to fingerprint water samples as being contaminated with the Deepwater Horizon’s oil should be considered confirmation of the plumes. Questioned by the Wonk Room, Lubchenco dismissed the findings of the University of Georgia research vessel Walton Smith team — who took physical samples of water contaminated with oil — as “circumstantial evidence.” After further questioning by Huffington Post’s Dan Froomkin, she then conceded:

It is quite possible there is oil under the surface. I think there is reason to believe that may be the case.

Although it is certainly true that chemical analysis of water samples will be definitive, the evidence for these “possible” oil plumes is far stronger than “circumstantial,” as today’s ABC News report about the Walton Smith mission shows:

Lubchenco’s expressed doubt of the existence of oil plumes is consistent with NOAA’s approach to other scientific questions about this environmental calamity. Like BP, she has dismissed the oil entrained in the loop current as a “very small amount of light sheen” which is “likely to be very, very diluted.” Like BP, Lubchenco claimed the 210,000-gallon-a-day guess for flow rate — which was questioned by independent scientists the day it came out on April 28 — was the “best estimate” for an entire month. Eventually NOAA admitted the actual flow rate was at least 240 to 500 percent greater.

Below is a timeline of the scientific research about these undersea plumes: Read more

Yglesias

Endgame

By ThinkProgress on Jun 2, 2010 at 6:30 pm

By Matt Zeitlin

From Oakland to Sacktown/The Bay Area and back down/Cali is where they put they mack down

- A scene from the upcoming film The Elements of Style.

- I like Rajon Rondo as much as the next guy, but, contra Bill Simmons, just because you’re arguably the best player on what might be the best team doesn’t make you the best at your position.

- Manohla Dargis on Sex and the City 2: it’s about as bad as the first one!

- Not everything Kenneth Rogoff and Carmen Reinhardt say is true because they said it.

- Let’s treat all credit cards the same.

- French judge says that Turkish aid group that launched Freedom Flotilla was tied to Al Qaeda in late 1990s.

- Crime is down in Arizona, but Charles Grassley says we need the immigration law so that “murderers can’t come into Arizona.”

Well guys, this is my last Endgame and also my last post as a guestblogger here. I’m pretty sure Matt will be back in D.C. and in full blogging form tomorrow and my services will no longer be necessary. Thanks so much to Matt for letting me do this, it’s been fun. Thanks, especially, to the commenters, who kept up their usual torrid pace even in Matt’s absence. Satyam, Ali, Matt, Dara, Ryan and Jamelle were all fantastic. One could hardly ask for a better group to blog with. If you want more of my blogging, check this out. Oh yeah, Lakers in seven.

2pac – California Love.

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Politics

GOP congressman breaks with Rand Paul on birthright citizenship.

By Ian Millhiser on Jun 2, 2010 at 6:15 pm

mack Last week, Kentucky GOP Senate candidate Rand Paul proved that he has never actually read the Constitution by endorsing a plan to strip children born in the U.S. to undocumented parents of their citizenship. Today, Rep. Connie Mack (R-FL) hit back at Paul’s “disrespect[]” for the nation’s founding document:

“Late last week, Dr. Rand Paul, a candidate for the U.S. Senate in Kentucky, said, ‘We’re the only country I know that allows people to come in illegally, have a baby, and then that baby becomes a citizen … And I think that should stop also. . . .’”

“As we all know, the Fourteenth Amendment of the U.S. Constitution explicitly states, ‘All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States …’

“The Constitution was created to limit government, protect liberty and safeguard individual rights. Ignoring the plain meaning and written word of the Fourteenth Amendment – and indeed, the entire Constitution – disrespects the Constitution itself and discredits the candidate.”

For the record, Paul isn’t just wrong about the Constitution, he is also wrong to claim that “we’re the only country” that embraces birthright citizenship. In reality, both of the United States’ neighbors — Canada and Mexico — automatically grant citizenship to children born within their borders, as do many other nations.

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Economy

Bair Takes On Treasury And Fed By Backing Collins’ Capital Requirements Amendment

By Pat Garofalo on Jun 2, 2010 at 6:15 pm

Federal Reserve Chairman Ben Bernanke and FDIC Chairman Sheila Bair

During the financial regulatory reform debate, an amendment from Sen. Susan Collins (R-ME) was adopted without much fanfare. The amendment mandates that big banks with riskier profiles need to hold more capital against losses and that bank holding companies (like Goldman Sachs, Morgan Stanley, and Bank of America) be subject to the same capital requirements as banks. It generated so little controversy that it was approved via a unanimous consent request.

However, since then, the Treasury Department and the Federal Reserve have been working behind-the-scenes to kill the amendment.

As Kevin Drum wrote, “we can set reasonable floors [for capital], and when both Treasury and the banks are fighting those floors tooth and nail it doesn’t bode well for how seriously they take this stuff.” Federal Deposit Insurance Corp. Chairman Sheila Bair, however, seems to take this stuff very seriously, as she has penned a letter in strong support of the Collins amendment. Bair argued that the amendment will prevent financial conglomerates from treating their federally insured depository arms as a backstop in an emergency, which leaves the FDIC on the hook if the firm goes bust:

The thrust of U.S. law and regulation governing holding companies is to ensure that risks undertaken by the parent company and the nonbank subsidiaries do not compromise the safety and soundness of insured banks…As we saw during the crisis, the source of strength doctrine was turned on its head as insured banks often had to come to the aid of their holding companies — holding companies that in too many cases also required substantial federal support…[T]he Collins amendment would constrain the Federal Reserve’s discretion to lower capital requirements below levels that would be implied by the source of strength function expected of holding companies.

While not eliminating regulatory discretion, the amendment does ensure that there’s a floor for capital requirements below which regulators can’t go. It also more closely correlates capital requirements with risk profile, and ensures that financial firms that aren’t traditional banks (but want to act like banks) get regulated like banks. These are all good things. As Mike Konczal wrote, “ultimately, here’s the big question: is the way we measured leverage and the amount of capital we asked banks to hold in 2007, one year before the massive crisis that has devastated our real economy, good enough? Or do we need to get serious about increasing it?”

As Tim Fernholz noted, the Collins amendment “speaks to the broader concern that we want banks taking less risk in general and focusing less on trading and more on lending.” As financial reform moves into conference committee, those shaping the bill should be taking Bair’s advice by giving the Collins amendment serious consideration.

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Yglesias

The Very Difficult Task of Making Gulf Residents Whole Again

By ThinkProgress on Jun 2, 2010 at 6:05 pm

By Satyam Khanna

hayward2 Long after the press attention on the BP oil leak fades, devastated Gulf residents and businesses will be embroiled in years of litigation against BP. The WSJ reports today that the court battles “are likely to mimic the legal cases stemming from the Exxon Valdez spill, litigation that took about twenty years to be resolved” [italics mine].

For the plaintiffs, a repeat of Exxon isn’t a good thing. Take a look at this piece from 1996, written by a lawyer involved in the litigation, about how very savvy Exxon lawyers narrowed cases, sought friendly judges, got the cases dismissed, tied up the litigation in the appeals process for years, and avoided paying full compensation to residents. It’s very long, but informative. Some highlights:

— “However…after it became clear that Judge Holland was more sympathetic to Exxon’s positions than Judge Shortell, Exxon concocted a number of legal theories designed to remove cases from state court to federal court.”

– Maritime preemption of state law “became the law of the case, and led to a number of rulings just before trial dismissing the claims of the following groups of plaintiffs: processors, cannery workers, tenderers, area businesses, and municipalities. Judge Holland also dismissed the claims of “unoiled” property owners for devaluation of their property, and the Alaska Natives’ claims for injury to their subsistence culture.”

– For discovery, “the parties, at Exxon’s request, were ultimately ordered by the court to follow a ‘protocol’ [that] was enormously time-consuming. The end result was that plaintiffs were only able to challenge 3,000 of the 12,000 documents on Exxon’s privilege log.”

–”Yet, Exxon had successfully shaped and limited the case before trial, and the trial was conducted according to rules favoring Exxon. Most evidence that Exxon found objectionable or “prejudicial” was excluded from the trial, and the jury instructions ultimately delivered were, at least in plaintiffs’ view, tilted in Exxon’s favor.”

The paper concludes, “Exxon has the time and resources to fight every battle, and its grand strategy may yet turn defeat into victory. But even now, only one thing is certain: more than seven years after the spill, and more than two years after the trial began, there is still no end in sight.”

Given Exxon’s successful lawyering, I don’t doubt that BP will mimic some of those strategies. In fact, the WSJ reports that BP is seeking to have the cases tried in “oil-friendly Texas.” Regardless, BP’s strategy, as we see in politics, will likely be “delay and obstruct.” The oil leak itself may be the first sad story of many.

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Justice

One More Hurdle To DADT Repeal: GOP Threatens To Delay Defense Bill Over Abortion Provision

By Igor Volsky on Jun 2, 2010 at 5:30 pm

Republican senators, who initially threatened to filibuster the Defense Authorization bill over an amendment that would begin the process of repealing the Don’t Ask, Don’t Tell law, have now decided to protest the measure “over a provision offered by Sen. Roland Burris (D-IL) that would allow servicewomen to receive abortion care in military hospitals if they pay for the procedure themselves, CQ Today reports.”

The amendment “repealed the prohibition in the use of private funds to pay for abortion care in military hospitals but maintains restrictions on the use of federal money for abortion services at military hospitals except in case of rape, incest or life endangerment.” Last month, the Senate Armed Services Committee voted 16-10 to approve the Burris amendment,” but some Republicans are now seeking to control how service members appropriate their own private funds:

Some GOP senators have tied the abortion provision with legislation that would allow gays and lesbians to openly serve in the military, calling the measures examples of “social engineering” and vowing to filibuster when the bill is brought to the floor, CQ Today reports. In a May 28 floor speech, Sen. Roger Wicker (R-Miss.) said the abortion provision would allow military medical facilities “to be used for abortions performed late term, abortions performed for purposes of sex selection, abortions performed for any reason, abortions at will.” The amendment is “another piece of social engineering, another vast and serious and consequential departure from long-standing Department of Defense policy,” Wicker said, adding, “I guarantee you this will be challenged on the floor for the House and Senate with separate amendments.”

Republicans may be eager to re-litigate the abortion debate ahead of the midterm elections, but the measure places one more hurdle to passing the Defense Authorization measure before the August recess. Senate Majority Leader Harry Reid (D-NV) has not scheduled a date for bringing the measure to the Senate floor and President Obama has already issued a veto threat against the version of the bill passed by the House last Friday, which includes funding for a second engine for the F-35 fighter that both the Pentagon and the White House have said is a big waste of money.

Any attempt to filibuster the measure, however, will likely fail given the pro-choice voting record of the two Republicans senators from Maine.

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