Obamacare Opens the Door to Cuts in Medicare Payment and Access

October 7th, 2016

As I said last week there are many unknown, shadow organizations that can have an enormous effect on your healthcare.  These emails will bring these organizations into the open, one by one.

The first shadow organization I’ll discuss is the Centers for Medicare & Medicaid Innovation (CMMI) which was created and funded by the Affordable Care Act (Obamacare).  Its purpose is to develop “innovative payment and service delivery models to reduce program expenditures”.  I’ve talked before about this organization, they are the group that is rolling out a demonstration project that will have dire effects on your ability to stay on medications that work well for you and will burden doctors with severe payment cuts.  As we look behind the curtain of this demonstration project we will find differences that reveal the insidious intervention of politics into the workings of CMMI.  We will find that the President’s influence steered this organization away from its defined duty and used it for political purposes.

Obamacare, in its creation of CMMI, allowed the suspension of regulations that normally oversaw healthcare payment and access changes.  This allowed demonstration projects the freedom to explore approaches that were unfettered by laborious regulations.  This was a good thing, until the loophole was exploited by unscrupulous politicians . . . and exploited it was.  It is my belief that the President, in his search for some quick reaction to drug prices and in his concern with his legacy, turned to this unregulated government organization to roll out healthcare payment and access changes that didn’t have to pass either a judicial or congressional review.

There are five areas where this politicized demonstration project revealed the finger prints of the President.  This “demonstration project” –

  1. Ignored their own guidance and had little if any stakeholder input.On previous projects stakeholders were consulted from the beginning.The unified outcry from stakeholders in opposition is evidence of how they were blindsided by this demonstration project.
  2. Mandated that doctors participate.In many earlier demonstration projects, more doctors than could be accommodated applied to participate.It should raise a red flag when you have to force doctors to sign on.
  3. Was rolled out nationwide, covering approximately 70% of all doctors in the first year.A demonstration or test is done with a small number of participants and is closely watched and evaluated before it is rolled out nationwide.That’s how previous projects were done.
  4. Had few, very broadly defined, evaluation criteria . . . another red flag.When you are not interested in really finding the best answer but only in forcing a change on patients then you don’t care about evaluation criteria or quality assessment.
  5. Has a very short timeline with full implementation in two years.Many passed projects lasted three years or longer with an evaluation process after they were completed and, with input from stakeholders, the timing and method of implementing the changes were developed.70% forced participation in the first year with full roll-out by year two has the markings of an edict rather than a true search for a better solution.

This President has said that he was tired of waiting for Congress and would take matters into his own hands.  I think the political use of CMMI is proof that, in this case, he was true to his word.

RetireSafe is working to stop this hurtful “demonstration project”.  The Senate has already had a hearing and many in Congress are upset about it.  We will continue our efforts.

Look for our email next Friday when we talk about MedPAC.



Thair Phillips – President