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  • Ralph Weber Talks MediCrats with FreedomWorks – Part 3 January 26, 2015
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  • Medical Debt Still a Problem for Those With Health Insurance January 23, 2015
    by Adrienne Snavely Medical debt can affect anyone of any age in any state in any income bracket. Medical debts account for more than half of debt collections on credit reports. One in three Americans struggle to pay medical bills, …
  • Q&A with Direct Pay Physicians January 22, 2015
    Direct pay physicians answer colleagues’ questions about third-party-free medical practice. From January 9, 2015, New Orleans AAPS workshop.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 2 January 21, 2015
    The pitfalls of Obamacare are that it makes healthcare affordable to the employee, yet unaffordable to dependents. Some plans cover children, but not spouses. This means less options for families. The independent physicians are being bought out by hospitals and …
  • Cash and out-of-network: good for medicine as free agency is for sports January 21, 2015
    Andrew Schlafly, J.D., General Counsel, AAPS, opens the 21st Thrive, Not Just Survive workshop held Jan. 9, 2015 in New Orleans, LA.
  • Opting Out of Medicare January 20, 2015
    Lawrence Huntoon, MD, PhD, presents via Skype at the AAPS 21st Thrive Not Just Survive Workshop on Third Party Free Practice, January 9, 2015
  • Say Goodbye to 3rd Party Medical Payments January 19, 2015
    Obamacare is increasing costs, restricting access to care, and putting Medicrats in charge. Out of this adversity comes innovative physicians who are changing the world of medical care. Doctors know what is best for their patients, so they must be …
  • My Direct Pay Practice January 19, 2015
    Brenda Arnett, MD http://arnettmd.com, talks about why and how she launched a third-party-free internal medicine practice. From January 9, 2015.
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    Dr. Josh Umbehr, founder of http://atlas.md speaks at AAPS XXI Thrive Not Just Survive Workshop, January 9, 2015 in New Orleans, LA.
  • Epiphany Health, Affordable, high-quality direct primary care January 17, 2015
    Lee Gross, MD, Founder, Epiphany Health http://www.epiphanyhealth.net & President, Docs 4 Patient Care Foundation http://www.d4pcfoundation.org addresses the AAPS Thrive Not Just Survive XXI conference, January 9, 2015, in New Orleans, Louisiana.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 1 January 16, 2015
    Wayne Brough of FreedomWorks interviews MediBid’s CEO, Ralph Weber, about Obamacare and Weber’s book MediCrats. Weber has found innovative ways to bring the free market to healthcare. MediCrats, by definition, are medical bureaucrats who add administrative burdens and increase costs. …
  • Third Party Free Specialty Practice January 16, 2015
    Gerard J. Gianoli, M.D., F.A.C.S. of The Ear and Balance Institute, Covington, Louisiana, http://EarAndBalance.net speaks at the AAPS Thrive, Not Just Survive workshop held January 9, 2015 in New Orleans.
  • Stop the Interstate Licensing Compact January 15, 2015
    Dr. Ken Christman explains how the FSMB’s proposed compact is a backdoor for MOC and MOL. January 9, 2015, New Orleans, LA.
  • Update on AAPS Legal Initiatives in War on Doctors and Patients January 15, 2015
    Andrew Schlafly wraps up Thrive XXI with a look at ongoing and future AAPS legal initiatives to protect patients and their physicians.
  • The Answer to American Medicine is NOT Coming from DC January 15, 2015
    … it is coming from physicians who are kicking ObamaCare and insurance OUT and working directly with their patients, explains AAPS Executive Director, Jane M. Orient, MD. From AAPS Thrive, Not Just Survive XXI, Jan. 9, 2015, New Orleans, LA.
  • The End of the 10-Minute Doctor’s Appointment January 14, 2015
    The patient-physician relationship should be balanced, not one-sided with physicians skimping on visit time and not allowing patients to ask enough questions or explain their symptoms well. Eighteen seconds is the average time a patient is allowed to talk before …
  • The Physicians Declaration of Independence in 2015 January 14, 2015
    We need a critical mass of truly independent doctors and core who will pass along the art of medicine to the next generation, explains AAPS President Richard Amerling, MD on January 9, 2015 at talk to colleagues in New Orleans, …
  • Physicians & Patients: Take Your Power Back January 14, 2015
    Dr. Elaina George explains that it is crucial for patients and physicians to work together outside of ObamaCare and insurance-dominated system. She discusses alternatives to ObamaCare such as health care sharing programs like Liberty HealthShare: http://LibertyOnCall.com
  • Self-Funded Awareness & The Movie “Dune” January 7, 2015
    by G. Keith Smith, MD “The sleeper has awakened.” Anyone who has seen the movie “Dune” knows the scene where Paul Atreides proclaims his new awareness. Having recently attended the annual meeting of the Self-Insurance Institute of America I was …
  • Perils of Obamacare Reenrollment January 5, 2015
    Obama has come up with the 95% solution to make reenrollment figures look good: A senior federal official told CNBC that an estimated 95 percent of HealthCare.gov enrollees—some 5.1 million people—will be signed up for the 2015 plan year and …

Medicaid is a tax on the estates of the poor

by Jane Orient, MD

snakebiteMost people think they’re exempt from the estate tax (often called the “death tax”) because they don’t have $2 million. A lot of people with low incomes do have some assets, however, and if they have used any Medicaid benefits, their heirs may be in for a shock.

Depending on state law, the state may have the right to everything, up to the cost of Medicaid benefits received — house, car, bank accounts, tools, annuities, piano, furniture, everything — and not just 50 percent of it.

This situation is not exactly new. The Omnibus Reconciliation Act of 1993 requires states to pursue Medicaid asset recovery from persons who receive benefits at age 55 or older. At first, this applied mainly to nursing home benefits, but at state option, it could now include any items or services provided under Medicaid.

There are some limits on what the state can take, as in the case of hardship or to protect surviving spouses, but the law is extremely complex. “The only certainty is controversy,” writes lawyer David L. McGuffey, a member of a Georgia law firm specializing in estate law, in a 77-page document.

“Estate recovery tends to reach individuals of very modest means and has a chilling effect on low-income people seeking benefits to which they are entitled,” he notes. To enroll in Medicaid, people have had to sign a disclosure form explaining this requirement, and some decide to forgo the benefit.

A plaintiff who represented himself described estate recovery as “nothing more than a vast, unlawful conspiracy to deprive the plaintiff, an American who is black, of his property, his dignity and his constitutional rights, simply because they could.” (Drake v. Miller)

A potential for greatly expanded use of estate recovery was created in Obamacare, as pointed out in an anonymously authored, well-documented article distributed by economist Paul Craig Roberts. Obamacare increases the number of people eligible for Medicaid by dropping the asset test for enrollment (Page 162 of Obamacare).

It is not clear how disclosure can work if people are automatically enrolled — for example, if they appear to be eligible when they sign up for another program, such as food stamps. In addition, people who apply for mandated insurance through an exchange will have to enroll in Medicaid, if eligible, or pay the penalty — a “tax,” as determined by the U.S. Supreme Court — for being uninsured.

In Arizona, where all Medicaid beneficiaries are enrolled in a managed-care plan, their estates could be repaying “benefits” even if the enrollee never actually received any goods or services. Information provided by the Arizona Health Care Cost Containment System (Arizona’s Medicaid program) explains that the program makes a monthly capitation payment of around $3,340 to “program contractors,” who arrange for services, if any. It warns, in bold print: “It is important to be aware that capitation payments can exceed the actual costs of services provided during the month.”

For comparison, the privately paid cost for my father’s private room, decent meals, and kind and competent 24-hour care in a comfortable group home was around $2,500 per month. Many people would probably pay less for services they need and choose than their estates would be charged for merely being a “covered life” in a program contractor’s inventory.

Federal and state governments are desperate for revenue. Pollyanna herself would find it hard to believe that estate recovery will diminish rather than increase.

Medicaid, supposed to be a program to help the poor, has become a cash cow for multibillion-dollar, managed-care companies, who milk federal and state taxpayers. Expanding Medicaid to persons with modest assets will enable estate recovery to become a cash cow for states to milk the poor and the middle class.

Dr. Jane M. Orient practices internal medicine in Tucson, Ariz., and is executive director of the Association of American Physicians and Surgeons.

Source: http://www.washingtontimes.com/news/2013/mar/11/medicaid-as-a-tax-on-the-estates-of-the-poor/



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