Seniors lose insurance and doctors under Obamacare

Evan Gahr Investigative Journalist
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Retired chemist Edward Schokowitz was incredulous when he received a letter from Horizon Blue Cross Blue Shield of New Jersey early last month saying his Medicare Advantage Plan, which had no premium, would be eliminated next year.

“They took all the senior citizens and threw us out of the plan. They now want to give us the same plan for $153 [per month],” he told the Daily Caller. “The President said you can’t be kicked out of your plan. He lies.”

Schokowitz is one of many Medicare beneficiaries now learning that — like Americans who buy insurance on the individual market — they are losing their insurance, and in some cases their doctors, under Obamacare.

Private insurance companies that cover patients with government funds under the Medicare Advantage program have quietly started to dump doctors and patients because of Obamacare budget cuts.

Schkowitz, 75, who lives in a senior citizen complex near Atlantic City, would also pay more for prescription drugs under the new plan. The co-pay for a three-month supply of one of his medications increases next year from $7.50 to $54.00.

Thousands of New Jersey residents are suffering the same fate . Currently, 74,000 Garden State residents are enrolled in Blue Cross Blue Shield Medicare Advantage. Nearly half have zero-premium plans.

But in 2014, New  Jersey Horizon Blue Cross Blue Shield is eliminating all zero-premium plans with prescription drug coverage and all but two of its other plans with monthly fees.

New Jersey Horizon Blue Cross Blue Shield spokesman Tom Vincz tells the Daily Caller that “due to rising health care costs and cuts to Medicare Advantage we had to make these product changes.”

The company is asking elected officials to avoid further cuts to the program, “We’ve been lobbying Congress to help insure that Medicare Advantage is appropriately funded to avoid further increases in premiums and changes in the product,” Vincz told TheDC. “We are hoping to make this a one time experience.”

Federal payments to Medicare Advantage HMOs will decrease seven to eight percent in 2014, according to one prominent health care industry analyst.

Overall, the Affordable Care Act slashes Medicare Advantage funding by $156 billion in ten years, a reduction that Democrats and many journalists long insisted would not harm patients. Republicans, however, have continually warned of dire consequences.

Now, insurance companies, feeling squeezed, are nixing doctor contracts and patient plans to save money. Medicare Advantage plans are being dropped all over the country.

Nearly 4,000 UnitedHealthCare Medical Advantage members in Hawaii will have their plan terminated next year, according to the Honololu Star-Advertiser.

UnitedHealthCare Medical Advantage is also eliminating two plans in Broward County, Florida.

In Portland, Oregon, Providence and Humana are nixing their PPO plans, which allow patients to see any Medicare doctor. HMO plans, on the other hand, give patients access to only doctors in the network.

UnitedHeatlhCare is also dropping two of the plans it offers Western Pennsylvania residents.

Avalere Health, a consulting group, said in a little-noticed report this September that patient access to Medicare Advantage Plans will decline next year because of the Obamacare cuts.

Relying on data provided by the Center for Medicare and Medicaid Services (CMS), Alvalere concluded, “A majority of the counties across the country will see a decrease in the number of MA plans available from 2013 to 2014.

“Approximately 80 percent of counties in the South and Midwest will see a reduction in MA plan options, while slightly more than half of the counties in the Northeast and West will have fewer plan options.”

Avalere said the total number of plans will decrease by 5.3 percent. Before Obamacare the number of plans was increasing.

Medicare Advantage patients accustomed to seeing any Medicare doctor they wish are going to be particularly hard-hit under further Obamacare budget cuts.

Avalere chief executive officer Dan Mendelson tells the Daily Caller, “There are going to be fewer PPOs in the program. That product is difficult to maintain.”

Even when insurance companies continue to offer the same Medicare Advantage plans some are increasing prices.

Plan pricing varies by locality, right down to the zip code.

The Aetna Medicare Advantage Standard HMO plan for West Philadelphia residents in the 19104 zip code now costs $39 per month. In 2014, the premium increases to $75.50. Another plan will increase from $140 to $172.

As prices increase for some Medicare Advantage patients their access to doctors withers.

Medicare Advantage HMOs last month started to inform doctors nationwide that their contracts will not be renewed.

Noted Obamacare critic Betsy McCaughey tells the Daily Caller that the cancellation of contracts decreases costs for Medicare Advantage HMOs by reducing doctor utilization. Fewer doctors available will make it harder for patients to get appointments.

“This is happening all over the country,” McCaughey said.

Lazlo Weiss, a Brooklyn ophthalmologist, learned early last month that his Medicare Advantage contract with Empire Blue Cross Blue Shield is being canceled. “You have patients that you have a relationship with some over many years and you know their problems and they know you and then all of a sudden they are no longer your patients,” he told the Daily Caller. “I hope something can be done before there is more harm to these people.”

New York State Medical Society president Sam Unterricht said that United Health Care Medical Advantage is canceling the contracts of 2,100 New York providers. Emblem Health is also axing doctors but Unterrich has no exact figures.

“We think [Congress] should investigate to see if anything can be done,” Unterrich said. “This affects a lot of patients and physicians adversely.”

Unterricht says the New York State Medical Society has written the entire New York Congressional delegation asking for help. The office of Democratic Sen. Charles Schumer of New York told Unterricht’s  staff members that they will look into the matter.

In Ohio, UnitedHealthCare Medicare Advantage it is cutting doctors loose because of Obamacare.

UnitedHealthCare spokesman Kevin Shermach told the Springfield News Sun that the company is “dealing with the financial pressures created by severe cutbacks in Medicare Advantage funding.”

Shermach did not respond to repeated requests for comment.

It is unclear how many doctors are being axed. But Ohio State Medical society official Todd Baker told the Daily Caller it is happening across all specialties.

SAS Surgery and Vein Specialists, a four physician practice in Springfield, Ohio, just had its UnitedHealthCare Medicare Advantage contract canceled, leaving more than 400 of its patients in the lurch. Some had been under the care of their doctors for decades.

Becky Browning, the office manager for the practice, tells TheDC, “Patients have expressed concern and fear about losing the doctor they are comfortable with. The senior citizens don’t understand why this is happening.”

UnitedHealthcare Medical Advantage has also terminated the contracts of doctors in Connecticut, Florida and New Jersey. Exact numbers could not be determined for those stats.

But Rhode Island Medical Society spokesman Steve DeToy says UnitedHealthCare informed him that the group is cutting 20 percent of its Medicare Advantage doctors.

DeToy told the Daily Caller that dermatologists, rheumatologists and endocronologists who remain in the program are worried they will not be able to handle anymore patients.

“This is creating tremendous havoc,” he said.

Democrats and many journalists have long insisted that Obamacare cuts to Medicare would not harm patients and dismissed Republican objects as partisan grandstanding.

The Affordable Care Act cuts $717 billion from Medicare–$156 from Medicare Advantage–over ten years.  Obamacare supporters claimed the government pays more to insure seniors under Medicre Advantage than it does under traditional Medicre so the cuts were justified.

The Romney presidential campaign last year repeatedly attacked Obama for taking the axe to Medicare. But journalists sided with Obama.

Last year, Time magazine staff writer Kate Pickert said the Romney campaign assertions were patently false. Her October 12, 2012 “Fact Check” post for the magazine’s Swampland blog said the notion “that the Affordable Care Act struck a dangerous blow to Medicare that will change the program in fundamental ways is untrue.”

Pickert insisted that the Medicare Advantage cuts were a prudent cost-saving measure.

Mitt Romney also charged during the campaign that Obama was “destroying the Medicare Advantage program.”

Traditional Medicare covers 80 percent of the fees for any doctor that accepts Medicare. Patients buy “Medigap” insurance to cover the rest. They must also obtain separate prescription drug coverage.

Medicare Advantage HMO plans cover 100 percent of the cost for in-network providers only and generally include drug coverage. Medicare Advantage PPOs allow patients to visit any doctor who accepts Medicare but they pay out of pocket and then get partially reimbursed.

Zero-premium plans sound free but they are not. The government deducts $104.90 from the monthly social security payments to everyone enrolled in both Medicare Advantage and traditional Medicare

28% of all Medicare beneficiaries receive coverage through Medicare Advantage.

One of them is the mother of Florida Republican Sen. Marco Rubio.

In August Rubio, who frequently expresses concern that his mother will suffer under Obamacare, said that “the chances are that soon seniors will open up the mail to the bad news that your Medicare Advantage…has been changed in negative ways because of Obamacare.”

Time magazine’s Pickert last month  likened Rubio and other Republican critics of the Medicare cuts to chicken littles.

“Back in 2009 and 2010, one of the harshest criticisms of President Obama’s health care law was that it would hurt seniors,” she opined on October 14.  “Four years later, with the ACA in place, it appears that worries about the future of Medicare Advantage have not come to fruition — at least not yet.

“But Republicans have not given up. Some still say the program is in jeopardy thanks to Obamacare.”

But warnings about Obamacare’s threat to seniors were not just coming from politicians.

According to Forbes magazine, Citi health industry analyst Carl McDonald told clients on February 18 that he expected 7 to 8 percent cuts to the Medicare Advntage program in 2014.

He said the funding reductions would be “enormously disruptive to Medicare Advantage, likely forcing a number of smaller plans out of business and creating disarray for many seniors.”

MIT professor Jonathan Gruber, architecht of the Massachuseets health insurance law that was the model for Obamacare, told the Daily Caller that seniors who stand to lose their doctors and Medicare Advantage plans must be sacrificed for the greater good.

“It is a tiny effect compared to the benefits of this law.  There is small fraction of Americans who might need to change doctors or plans because of the law.”

Medicare Advantage covers 14.4 million people.

Asked if Obama had betrayed seniors with his famous promise to Americans that they could keep their doctor and health plan Gruber insisted that, “He was not really talking about seniors.” But in fact, the president’s promise, in dozens of televised speeches was all-inclusive and unqualified. (Related: Obama denies ‘you can keep it’ videotaped promises)

Pressed further, Gruber, who is normally quite expansive with journalists, said, “I have to go” and hung up the phone. (Related: Media skip disclosure of paid Obamacare shill)

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said another aspect of the Affordable Care Act has also sparked changes to doctor networks and Medicare Advantage policies. The new health insurance tax is “extremely disruptive” to the industry, forcing companies to find new ways to cut costs, he contended.

Evan Gahr, a former press critic for the late New York Post editorial page editor Eric Breindel, has written for almost every major conservative publication, plus the Washington Post and Philadelphia Inquirer. Twitter:@EvanGahr