Medicare Funding
Medicare for All California AB 1400 – CalCare

Source KFF 

• Part A Hospital is financed primarily through a 2.9 percent tax on earnings paid by employers and employees (1.45 percent each) (accounting for 88 percent of Part A revenue). Higher-income taxpayers (more than $200,000/individual and $250,000/couple) pay a higher payroll tax on earnings (2.35 percent).
• Part B Doctor Visits is financed through general revenues (72 percent), beneficiary premiums (26 percent), and interest and other sources (2 percent). Beneficiaries with annual incomes over $85,000/individual or $170,000/couple pay a higher, income-related Part B premium reflecting a larger share of total Part B spending, ranging from 35 percent to 85 percent.
• Part D Rx is financed by general revenues (71 percent), beneficiary premiums (17 percent), and state payments for beneficiaries dually eligible for Medicare and Medicaid (12 percent). Higher-income enrollees pay a larger share of the cost of Part D coverage, as they do for Part B.
• The Medicare Advantage program (Part C) is not separately financed. Medicare Advantage plans, such as HMOs and PPOs, cover Part A, Part B, and (typically) Part D benefits. Beneficiaries enrolled in Medicare Advantage plans pay the Part B premium, and may pay an additional premium if required by their plan; about half of Medicare Advantage enrollees pay no additional premium. ^Kff *
• See the Medicare & You Manual for more background information. 

This might end with AHCA – Replace Obamacare

See also our section on the ratio of Part B & D premiums to actual costs of Medicare.  

 FAQs / Ask Us a Question

How the $$$ is spent 

Source KFF

Links & Resources

• wikipedia.org/Medicare
• very well health.com/is-medicare-going-to-run-out-of-money
• common wealth fund.org/options-extending-medicares-trust-fund
• fool.com/how-is-medicare-funded
• tax policy center.org/what-medicare-trust-fund-and-how-it-financed
• Kaiser Foundation facts on Medicare Spending & Financing
• medicare.gov/talk-to-someone
• house.gov/find-your-representative
• Despite rosier trust fund outlook, time running out to stabilize Medicare funding, researchers warn

FAQ’s

Questions

• Why do I have to pay so much for Medicare Part B Doctor Visits?
• I worked hard for over 40 years and paid taxes for it!

Gov. Gavin Newsom signed a unified healthcare financing bill, Senate Bill 770, into law on Oct. 7th. California has become the first state in the country to pass such a bill, paving the way towards greater healthcare equity and accessibility.

The bill requires the secretary of California Health and Human Services Agency (CalHHS) to consult with stakeholders and the federal government to pursue a waiver framework for a comprehensive package of medical, behavioral health, pharmaceutical, dental, and vision benefits. By Nov. 1st, 2025, the CalHHS secretary is required to provide the legislature and Newsom with a report of the finalized waiver framework. Read More State of Reform 

California SB 770

• CA Legislature Website
• Medicare for All would ‘fix’ what isn’t broken

California #AB1400 

Guaranteed Health Care for All

The California #Guaranteed Health Care for All Act, CalCare,

AB 1400 DIED January 31, 2022 ^{LA Times} *

We are very concerned that Medicare for All, National Health Insurance, CalCare, etc. would be like Medi Cal, not some great wonderful thing that pays for any doctor, any hospital anytime for any reason and no concern about Narrow Networks,  Medical Necessity  or MLR Medical Loss Ratio.

The California Guaranteed Health Care for All Act, CalCare, would provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.

CalCare would cover a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including the federal Children’s Health Insurance Program, Medi-Cal, &  Medicare program.

The Legislature finds and declares all of the following:

(1) PPACA Obamacare still leaves many Californians without coverage or with inadequate coverage.
(2) Californians, have experienced a rise in the cost of health care including rising premiums, deductibles, and copayments, as well as restricted provider networks and high out-of-network charges.
(4) Individuals often find that they are deprived of affordable care and choice because of decisions by health benefit plans

********Then why does Medi Cal mandate that you have an Insurance Company HMO?

Why does Medicare seem to encourage Insurance Medicare Advantage Plans?

guided by the plan’s economic needs rather than patients’ health care needs.

*****And you don’t think the Government has the same problems?

(6) Billions of dollars that could be spent on providing equal access to health care are wasted on administrative costs necessary in a multiplayer health care system. Resources and costs spent on administration would be dramatically reduced in a single-payer system, allowing health care professionals and hospitals to focus on patient care instead.

***How much Fraud do we have in Government Programs?

(7) It is the intent of the Legislature to establish a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state.

(b)

(1)  universal health coverage for every Californian, funded by broad-based revenue.
(2) any federal funds would be paid by the federal government to the State of California
(4) Those programs would be replaced and merged into CalCare, which will operate as a true single-payer program.

(g) It is the further intent of the Legislature to address the high cost of prescription drugs and ensure they are affordable for patients.

FAQs / Ask Us a Question

Read the ACTUAL Bill and not just summaries….

California AB 1400
Actual Bill

• ACA Assembly Constitutional  Amendment #11 – allowing taxation
• LA Times 1.7.2022
  • No debate on skyrocketing cost of California single-payer bill? So much for good government LA Times 1.24.2022
  • Column: California Democrats are trying again for universal healthcare. It’s a debate well worth having
• CA Health Line 1.6.2022
• CAHIP, NAFIA & IIABCAL Opposition Letter 1.17.2022
• a $400 billion dollar price tag per year and no guarantee of better healthcare
• minimum funding shortfall of over $150 billion per year.
• benefit structure determined by what government feels it can afford, not on what the consumer may want or need..
• it does not guarantee access to medical care
• consumers who are denied coverage for a surgery, procedure or prescription by a carrier can turn to their health insurance agent for help appeals – IMR Independent Medical Review  AB 1400 eliminates hundreds of thousands of jobs in California.
• Gosh, how many agents are helping people with Medi Cal for no compensation what so ever!!!
• The consumer is left undefended in the hands of a government-run single-payer bureaucracy.
  • Coalition Statement AB 1400
  • New Taxes Summary
  • Infographic
• Los Angeles Times Opinion June 6, 2021 – Public Option First
  • Federal S 1129 Bernie Sanders introduced April 2019

One reason why nothing happened in 2021

The California legislature operates on a series of deadlines that are outlined in the Constitution and in Legislative Rules. There are deadlines to introduce bills, amend bills and have bills heard (i.e. voted on in a hearing) in a policy committee. The deadline for any bill with a fiscal component to be heard in a policy committee is next week, April 30th. On matters of health insurance and healthcare, virtually every bill has a fiscal component, so it must receive a majority of votes to pass out of policy committee (most often the Health Committee) or it is dead for the year. AB 1400 was held in the Assembly Rules Committee, and accordingly will not be heard in a policy committee in time to meet the legislative deadline necessary to advance  ^{CAHU email dated 4.23.2021}

Links & Resources

• 80% Medical Loss Ratio (MLR) – Actuarial Value
  • CA Insurance Rate Regulation
    • Premium increases? Why are they always going up?
      • Financial Impact of Health Care Reform on Premiums
•  FAQs / Ask Us a Question
• Lack of universal health care cost 300,000 American lives in pandemic, study shows
  • US universal health care could have saved more than 200k lives in 2020
  • Comparison of status quo with universal health care suggests 330,000 in US died needlessly during pandemic
• Lowering Medicare age to 60 would increase coverage — but also spending

Did Health Care Reform – #ObamaCare
make any Changes to Medicare?

• Medicare Advantage
  REDUCTIONS IN PAYMENTS AND OTHER  REQUIREMENTS –
• The federal government pays more for beneficiaries enrolled in Medicare Advantage plans than for beneficiaries in fee-for-service Medicare. [My understanding was that these plans were created to SAVE $$$]  That additional funding provides enrollees with additional benefits, such as reduced cost sharing and coverage of items not covered by traditional Medicare, which are seen as necessary to attract enrollees to these managed care plans. However, all Medicare beneficiaries, not just those enrolled in Medicare Advantage plans, have ended up footing the bill for these extra payments.
• The new law freezes the extra Medicare payments to Medicare Advantage plans in 2011 and begins to reduce the payments to plans in 2012. It also requires Medicare Advantage plans to pay at least 85 percent of the premium dollars they collect for medical claims. However, it also makes it possible for Medicare Advantage plans to receive higher payments if they demonstrate that they are providing high-quality care to enrollees. ^{Health Affairs.org}
• Federal reimbursement rates for insurance carriers administering Medicare Advantage products to performance, as measured by the Stars rating system. Bonus payments are attached to stars ratings, and bonus revenue will be awarded, gradually increasing with maximum bonus opportunity in 2014 Wikipedia 5 Star Rating System
•  FAQs / Ask Us a Question
•  
• Medicare Part B premiums include a fee of  over $43.20 more each year to subsidize Medicare Advantage plans ^N4A.org
• I don’t have a citation, but I believe Medicare has more preventative care as Health Care Reform requires it for most everything else.
• Quality Control – Medicare oversight of MAPD – Medicare Advantage Plans – Chinese Community Plan – censured insuremekevin.com
• [CMS] “is establishing a policy to allow enrollees to switch plans when they are affected by significant mid-year provider network terminations initiated by their Medicare Advantage Organization without cause,”
•  
• The CMS now will require plans to give 90 days’ advance notice of “any significant changes to their provider networks in order to ensure help compliance with provider access requirements.”
• Health plans, particularly UnitedHealth Group, had responded to expectations for lower rates by terminating providers from their networks—much to the surprise of doctors in Connecticut, Florida, Indiana, New Jersey, New York and Rhode Island in particular.
• In October, plans said the terminations were being made in anticipation of rate cuts.
• modernhealthcare.com/
• Medicare Advantage Cuts 2.28.2014
• additional cuts could raise beneficiaries’ Medicare Advantage premiums by between $420 and $900 per year
• californiahealthline.org
•  
• ahip coverage.com
• modern healthcare.com
• wikipedia.org – Health Risk Assessment
• AHIP info    See our Introduction to Medicare Page
• Kaiser Foundation comparison  for 2017 bills

What is the #Additional Medicare Tax and Who Pays It?

Some taxpayers may be required to pay an Additional Medicare Tax if their income exceeds certain limits. Here are some things that you should know about this tax:

• Tax Rate.  The Additional Medicare Tax rate is 0.9 percent.
• Income Subject to Tax.  The tax applies to the amount of certain income that is more than a threshold amount. The types of income include your Medicare wages, self-employment income and railroad retirement (RRTA) compensation. See the instructions for Form 8959, Additional Medicare Tax, for more on these rules.
• Threshold Amount.  You base your threshold amount on your filing status. If you are married and file a joint return, you must combine your spouse’s wages, compensation or self-employment income with yours. Use the combined total to determine if your income exceeds your threshold. The threshold amounts are:

• Withholding/Estimated Tax. Employers must withhold this tax from your wages or compensation when they pay you more than $200,000 in a calendar year. If you are self-employed
  • Schedule C – Self-Employment Income – Hobby? Office in home?
• you should include this tax when you figure your estimated tax liability.
• Underpayment of Estimated Tax.  If you had too little tax withheld, or did not pay enough estimated tax, you may owe an estimated tax penalty. For more on this, see Publication 505, Tax Withholding and Estimated Tax.

If you owe this tax, file Form 8959, with your tax return. You also report any Additional Medicare Tax withheld by your employer on Form 8959. Visit IRS.gov for more on this topic. You can also get forms and publications on IRS.gov/forms anytime.

Each and every taxpayer set of fundamental rights they should be aware of when dealing with the IRS.  These are your Taxpayer Bill of Rights. Explore your rights and our obligations to protect them on IRS.gov.

Additional IRS Resources:

• Questions and Answers for the Additional Medicare Tax
• Democrats Aim To Shore Up Medicare By Raising Taxes On Some High Earners  

Medi Cal Network #Limitations 

See the next “module” below for the  plans and doctors you have to choose from on Medi-Cal.  Do you really want Medi Cal expanded to everyone?

Take a look at Our  Medi Cal webpages, let alone the ones we took down as we are not paid a PLUMB NICKEL to help people with Medi Cal.  How’s that for funding?  Look how many FAQ’s we get as Medi Cal doesn’t have the staff or time to help people!  Do Medi Cal, Insurance Company, Salaried Personnel have the background, caring or time to answer questions.  Here’s 17 reasons to use Steve Shorr Insurance.

• Medi-Cal 
  • Contact Info – Complex Questions – Reference Materials Medi-Cal
  • Eligibility Criteria for Medi-Cal – MAGI Income
    • Aged and Disabled Federal Poverty Level Program
      • Share of Cost – Medically Needy – What is it?
      • SSI – Supplemental Security Benefits – Automatic Medi Cal – SSDI
        • DAC Disabled Adult Child – Keep Medi Cal – Retirement
          • Disabled Adult Children – over 26 – stay on parents insurance
    • Transitions from Medi-Cal to get Covered CA
  • Full Scope Medi-Cal – Benefits & Coverages – no index
    • Dual Coverage? Medi Cal, Employer Group, Individual, Cal Medi Connect & Medicare
      • dual coverage faq
• Narrow Lists? Fewer MD’s than before? Mirrored Plans?
• Medi Cal Pages on Archive.org as we were getting too many requests for Medi Cal uncompensated help

• • Medi Cal Redetermination? Renewals? Verification MC 216
    • Bank Statement Review
    • Don’t want Medi-Cal for the kids – redetermination form?
    • MC 216 Income & Expense Definitions
    • MC 262 Long-Term Care Medi-Cal Renewal