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Conference Call: How ObamaCare’s Medicaid Expansion Hurts Seniors

Jonathan Bechtle

Thank you for joining us on today’s call. I’m Jonathan Bechtle, the COO and General Counsel of the Foundation for Government Accountability.

FGA builds paths to a better life by equipping leaders with proven strategies to reform failed health and welfare programs in states all across the country. We do this by working with all of you to develop, promote, and help implement solutions in your state. If you’re interested in our Medicaid reform or our child welfare reform, I encourage you to take a look at our websites: and

Today we’re going to be talking about Medicaid expansion and it’s affect on senior citizens. FGA Senior Fellow, Josh Archambault, has taken a close look at the huge cuts to Medicare, and particularly Medicare Advantage, that fund ObamaCare’s massive Medicaid expansion for childless adults. Josh hails from Boston, where he has served as the Director of the Center for Healthcare Solutions at the Pioneer Institute. He’s been a Legislative Director in the Massachusetts State Senate, and a Senior Aide to former Governor Mitt Romney. Josh, welcome to the call.

Josh Archambault

Thanks, Jonathan, so much.

Jonathan Bechtle

Our format today is going to be pretty simple, like some of our previous calls. Josh is going to give us a brief overview of his findings, and what they mean for lawmakers, health care advocates, taxpayers, and most specifically patients and senior citizens. Then we will open up the call for questions and take as many as we can. We certainly want to respect everyone’s time, so we’ll keep this moving and wrap up early if we get through the questions. Anytime throughout the conversation that you want to ask Josh a question, you can press *6 to get into the question queue; that’s *6.

We will also be asking some pre-submitted questions that folks sent to us when they registered for this call. Josh, let’s start off by having you give a brief overview of what you’ve found, and the impact it will have.

Josh Archambault

Sure. Thanks, Jonathan. On this issue of Medicare reform, we’ve seen a lot of politicking on this. If you remember the presidential election in particular, there was a lot about the $716 billion cuts that were coming out of Medicare going forward. There hasn’t been an exploration of the connection between the Medicaid expansion under ObamaCare and some of these impacts actually in Medicare. As we started $716,000,000 in cuts over the next 10 years, it’s really important for folks to understand that this is a very timely topic.

Just last week, CMS set the reimbursement rates for Medicare Advantage, with a 2% cut going forward. These cuts were supposed to start pre-election, but the administration decided to put a legally questionable bonus program, costing over $8,000,000 into effect so that seniors wouldn’t feel the impact of those cuts early. The Government Accountability Office has called that program into question—it’s since gone away—and this will be the first year that the cuts will actually go into effect and start. The trade association for the health insurance company has put out a number of reports and articles, estimating that this year alone seniors’ out-of-pocket cost will go up at least $900, on average, due to these cuts, specifically in Medicare Advantage. We’ll go into a little bit more detail about what that actually means.

During the presidential election, there was a big discussion about whether this $716 billion in reduced payments would be used to shore up the trust fund for traditional Medicare, or whether it would be used to fund ObamaCare. Senator Jeff Sessions sent a letter to the Congressional Budget Office asking for some clarification about where this money would actually end up, and what they determined in a letter back to him was that, yes, in fact, the reduction in payments as well as the $1 trillion in new taxes in the law over the next 10 years will be used to finance the two main components of the law.

First, Medicaid expansion, and second, the subsidies in the exchanges. Today I wanted to spend a little more time talking about the expansion, and that financing link between the two programs. Before I move on though, I do want to give a little fiscal background here.

We’ve made about $37 trillion worth of promises to our seniors going forward, and our country sits around $17 trillion in debt. During this whole conversation about what state legislators at the state level they should make decisions about on Medicaid expansion or not. Please remember, that those have national fiscal impacts going forward.

Your constituents, people in your state, and taxpayers don’t really care whether they’re paying state, local taxes, or federal taxes; they’re taxpayer and have to pay for those obligations regardless going forward. Briefly on the expansion issue. For those that haven’t been as engaged on this topic, and haven’t dug into the numbers as deeply, we need to remember that the Medicaid expansion is largely for childless, non-disabled adults. This is not for pregnant women or for children; it’s primarily for this new population.

The federal government has set up this enhanced reimbursement rate for them, in essence, to try to get states to go along paying a 100% of the cost, in many states, for the first three years, and then ratcheting down over the subsequent years. We’ve talked about on other phone calls previously, but I do want to mention here, that it is really important for folks to understand that this, in many ways, sets up a protected class in your state, if you decide to expand Medicaid. Because of the higher reimbursement rate for these childless, non-disabled adults, when it comes crunch time, when you have to balance your budget, it’s going to be much easier for you to cut money from the most vulnerable that are on the program that we traditionally think the safety net is for than it is for these other individuals because they come with more federal dollars. Make sure you and your constituents fully understand the impacts of Medicaid expansion.

Let’s return back to the impact on Medicare, in general—and seniors—of the Medicaid expansion. We will be releasing a paper shortly; it will be available on; looking at the some of the impacts on the Medicare program for seniors of these cuts. In particular, I wanted to spend just a minute or two looking at the Medicare Advantage program. For those that may not be as familiar, we have Part A which is traditional Medicare, and then we have Part B which is Medicare Advantage.

One of the real advantages of Medicare Advantage is that it is traditionally a comprehensive plan that offers many additional benefits to people. They don’t have to buy a supplemental policy as many seniors have to do. We’ll talk about some of those benefits going forward. One of the biggest concerns we have, about $308 billion in cuts that are coming out of Medicare Advantage due to ObamaCare’s reductions in payments in Medicare, is that it will reduce the number of access to doctors that seniors have. CMS’ own actuary has written that he believes 15% of hospitals and nursing homes will stop taking Medicare in the next 10 years due to this reduction in prices.

It reduces the amount of doctors that they have access to, it also reduces of number of hospital that they’re able to get access to. CMS actuary also has estimated that 40% of hospitals will become unprofitable by 2050 due to these cuts going forward. We’ve already seen a number of Medicare Advantage carriers or insurance companies reduce their network. One in particular, one of the largest, reduced by about 10 to 15% of their doctors. Perhaps you some of the headlines that were surrounded to that. One of the ways they’re trying to make up for these reductions in payments, they just have to cut hospitals out, cut doctors out. It should be concerning to you, and seniors that are on the program due to reduction in access to folks going forward.

There is also a big concern about the loss of access to health plans. Famously, the President did say that individuals could keep their health plan if they would like to, period, and we’ve seen a lot of controversy that happened on the individual market side, but it’s also going to be happening in the Medicare side. Due to these reductions in payments for Medicare Advantage, we’ve seen estimates from the Kaiser Family Foundation to a number of other organizations saying that about 5-to-7,000,000 individuals over the next six-to-seven years will not be on Medicare Advantage anymore.

Medicare Advantage has been very popular, about 30% or 15 million individuals are on that programs; it’s been growing over the last few years. There’s going to be a dip in that enrollment going forward, as people are forced off those programs as plans decide that it’s unprofitable for them to operate in certain areas, and decide to either close or to have individuals switch to other plans due to these reductions in payments going forward. Starting this year, that will translate somewhere around 250,000 individuals will lose those Medicare Advantage plans, will be forced to pick another plan.

In many cases, they will be going back to the traditional Medicare plans, and we’ll talk about some of the tradeoffs that are there, especially for low-income individuals going forward.

The final thing that I wanted to mention is that there will be a loss in benefits. As I said, one of the primary benefits of Medicare Advantage has been that it offers a lot of supplemental benefits to individuals that have signed up. I wanted to just spend a minute highlighting a few of those. Perhaps you’re aware that most Medicare Advantage plans offer drug benefit, where as if you’re on traditional Medicare, you usually have to buy an additional plan, a supplemental plan of some sort to be able to cover drug benefits.

Medicare Advantage is part of that program, but they also offer a lot of other benefits that people aren’t as aware of. They often will cover preventative dental. Again, this is not universal in Medicare Advantage, and in the paper we detail how many plans, what percentage of plans, typically cover these sorts of benefits. Preventive dental, vision coverage, loss of hearing coverage.

They have out-of-pocket cost protections; this is one of the real advantages for people who are signing for Part B, is that they have a much more predictable out-of-pocket cost, a maximum, and that’s why, for individuals that are on traditional Medicare, they end up buying supplemental policies; for those that can afford it. If you’re lower income, it really has been a problem. It’s actually been one of the reasons why so many low-income people have signed up for Medicare Advantage, is that they have this out-of-pocket cost protection going forward. 41% of individuals signed up on Medicare Advantage actually make less than $20,000 every year.

There’s a number of other benefits I just wanted to list off, that I think is important to be aware of; chiropractic services. Medicare Advantage, a lot of them, will offer an additional travel benefit when you’re around the world, or whether you’re out of your service area for over six months. Things that traditional Medicare does not cover. Transportation benefits, getting to additional appointments. Some offer benefits along the line of gym memberships or wellness education.

And another big benefit for individuals, for seniors who are on these plans, is they typically are offered fixed co-pay, so they pay $15, $25 per visit, where on traditional Medicare they often are paying co-insurance, where it’s 20% of the cost of something. A lot of seniors have let survey folks know that one of the things they like is that they know when they go to the doctor; they know exactly how much their co-pay is going to be, instead of a little bit more unpredictable 20% cost that is under traditional Medicare.

Additional benefits that Medicare Advantage plan often will cover is additional days of hospital care, home visit coverage; sending folks that need a nurse or somebody else to come to their home to offer home-health visits. Traditional Medicare doesn’t cover quite as many as Medicare Advantage plans do.

Finally, I’ll close by talking about, again, that drug benefit. It is one of the primary reasons that seniors do like signing up for the program. They have some sort of drug needs. They now know it’s incorporated into their health care plan, and they’re not stuck with having to deal with buying a supplemental policy, making sure it covers the drugs that need. They just need to make sure they pick a good health insurance plan that does.

In conclusion, I want to say that the $716 billion in reductions of payment from Medicare do raise a number of issues about seniors’ access in the future to doctors, to hospitals, their choice of health plans going forward, and their loss of benefits. This has been a universal concern, bipartisan concern in DC. There’s been letters flying around Congress that people are signing on to, sending to the administration saying, “We really value the benefit of Medicare Advantage and the benefits that it gives to our constituents and we need to be very careful going forward, about the impact on these seniors and their access.”

I will say that I do anticipate in the future, there will have to be some sort of change to reimbursement rates because they get so low in the future, I simply think that either hospitals or doctors will stop accepting, and it’s going to look a lot of more Medicaid and some of the access issues that we have there, if something isn’t changed going forward.

These cuts are largely used to fund Medicaid expansion as well as the subsidies, but they do have a lasting impact on seniors that are trying to, navigate the system now.

Jonathan Bechtle

Great, Josh. Thank you for that thorough overview of the threats that Medicaid expansion and these cuts will pose to seniors and the programs that they’re in, and the promises that we’ve made to them.

Let’s change gears a little bit too some questions and answers. Remember that, for those of you on the call, if you’d like to ask a question of Josh, just press *6. That’s *6 to get into the question queue, and we will take those questions as they come in. As folks are thinking about that, Josh, let me start it off with a question for you.

You talk in your paper, and folks can look at that paper, as you mentioned on, you actually break out the cuts by state, the Medicare cuts by state. Could you tell us, maybe the top five or top 10 states that are going to have the most devastating impacts from this?

Josh Archambault

Yes. The general rule is that the bigger the state you are, the more individuals you’ll have enrolled in Medicare and in Medicare Advantage and that will be felt from the greatest number, if you will. I do think it’s important to dive in, and it is listed in the paper, a state-by-state breakdown. We include a number of things, the Medicare cuts by states in the millions, then we also have the number of individuals that are projected to lose Medicare Advantage due to cuts, then we also have the average Medicare cut per beneficiary, and I think this might be of most interest to people on the call. It does highlight a number of states that will be disproportionally impacted by these cuts going forward, and they aren’t the big, huge states like California.

Just to run down the list from the highest average Medicare cut per beneficiary, just to give a handful of examples at the top. We have Louisiana with over $5,000 dollars per beneficiary, then DC, Texas, Hawaii, New York, New Mexico, Alaska, Massachusetts, California, Rhode Island, Oregon, and Virginia. That’s the top 11 or so, 11 or 12.

I highlight those just to say this really is a geographically diverse group of states. They are of varying population sizes, but the impact is as devastating in those states, whether they’re big or not, going forward. Those are probably the states that, if callers are from those states, they should be very active and aware, educating themselves about the impact in their own states.

Jonathan Bechtle

Thanks, Josh. As I mentioned before, if you want to see that list, you can go to and look at Josh’s paper, where he has all the states listed out. Josh, another follow-up question. This is from a little different angle, but some of the supporters of Medicaid expansion have said that fiscal conservatives should celebrate these Medicare cuts as the first step in a much needed Medicare overhaul. How would you respond to that?

Josh Archambault

I don’t think this is reform. It’s important to remember that these cuts are across the board, they’re not aimed at value or areas where there is additional fraud. This is a really painful way to get to some sort of reform.

Without a doubt, reform is still needed. I think there is bipartisan agreement that even with these cuts, there is true reform that is needed. This does hurts seniors. It also guts many of the market-oriented elements of Medicare that folks do enjoy, so it’s Medicare Advantage, giving folks choice between private health plans. That is hurt by these cuts. I wouldn’t say this is a good example of reform. That cliché saying of “cutting off your nose to spite the face,” this is exactly that.

For fiscal conservatives to argue that this is some sort of meaningful reform, I think is a little bit naïve. I think we need to start talking about an overhaul of the program. We have started to have that conversation in DC, thanks to Congressman Ryan, but I do think that we need to move farther along in that debate. This is certainly not the way to get there. It doesn’t help us have more competition and more choice; in fact, it does the opposite.

Jonathan Bechtle

Thanks, Josh. Just a reminder, you can press *6 if you want to ask Josh a question. Josh, let me ask you one of the questions we got ahead of time from our callers. The question is, has the Affordable Care Act, has it had any impact on the reimbursement percentage for a Medicare eligible person? For example, has it changed from the 20% reimbursement that a patient currently pays for Part B?

Josh Archambault

I think the short answer to this question is no. It doesn’t change the responsibility of individuals in what they have to pay. As I highlighted before, it really impacts the choice the individuals have. The one caveat I would give is if you’re an individual, if you’re a senior on Medicare Advantage and you fall into this five to seven million bucket of individuals that are forced off their plan, most of those individuals will go on to traditional Medicare as a result. If you’re lower income, as a good percentage of those on Medicare Advantage are, and can’t afford a supplemental coverage then, yes, it certainly impact your out-of-pocket costs going forward.

No, it doesn’t change. If you’re on the same plan going forward, it may increase your premium, but it would increase what your responsibility is to pay going forward.

Jonathan Bechtle

Josh, let’s broaden this discussion a little bit, because this whole conversation of Medicare is certainly very entangled, as you mention, with the Medicaid expansion. We know that some states have chosen to expand Medicaid, some states haven’t, which is changing the overall cost to taxpayers. Could you just update our listeners of the status of Medicaid expansion as many states are making decisions right now? What’s the trend? Are there more states expanding, are there less? What are we looking at?

Josh Archambault

The current state of play at the moment is we have 16 states that are firm non-expansion states at the moment. We have about eight that are leaning against expansion going forward, we have 24 that are implementing some sort of expansion, and two that are kind of headed in that direction of expanding. I think what’s been interesting in this conversation is that in a number of states, we’ve seen legislators really step up to the plate and have creative conversations about what sort of role the state government should play in getting coverage for this expansion population. I just highlight a handful of those.

I think Florida, Utah, Virginia come to mind as legislators who realize the strings that are attached with the Medicaid expansion. They realize that protected class they would be setting up if they went along with the federal government, they realize some of the other unintended consequences that we’ve talked about on previous calls, and FGA’s research in the past has really highlighted. As a result, these individuals, the legislators, are really trying to think outside the box in saying, “How do we use state-only money to be able to really target and tailor a reform to our own state?”

It is not an Arkansas-type model in which, as an update, is in serious question about whether it will end up passing going forward, and I think legislators in other states that are considering the Arkansas model should take that to heart, that even in Arkansas what they’re all looking for inspiration, there has been a real battle to even get it passed, get the money appropriated for it to go forward. It may eventually happen, but they’ve taken repeated votes where individuals have taken a stand and said, “Look, this is not what we were originally promised.”

I do think there is a mixed trend, but I’m heartened by some of the creative thinking by legislators in a handful of these states, trying to think of truly state-specific reforms that aren’t Medicaid, ObamaCare’s Medicaid expansion by another name.

Jonathan Bechtle

We still have time for a few question, if folks would like to ask a Josh a question just press *6. Josh, let’s bring this back around to our original topic, with the Medicaid expansion battles and fights, how does this Medicare impact and the cuts that we’ve discussed today, how does that impact the conversation about Medicaid expansion? Does it change anything? Does it change how legislators and policymakers should be looking at the Medicaid expansion conversation?

Josh Archambault

I think it should, from a few different angles. The first one is, if you don’t expand Medicaid, you’re not throwing a lot of individuals into a system in which there is already this severe pressure on the Medicare side; not only from an access perspective of saying Medicare individuals are going to be seeing these reductions in cuts. More and more doctors, as CMS’ own actuary has said, will not probably take or see new Medicare patients, you’re not confounding that issue. If you don’t expand Medicaid, it doesn’t mean the Medicare cuts automatically go away. They’re going to happen, they’re scheduled to happen, and they’re part of the law.

I do think that there’s opportunity for state legislators and others at the state level to do a few different things. This truly is an education initiative, not only to your own constituents, but I think it’s also to your federal officials, whether that’s through a resolution, passed through the state legislature, or whether it’s reaching out to your congressional representative and saying, “Look, by us not expanding Medicaid, it leaves the federal government some additional options so that they can fulfill the promises that we’ve made to our seniors here going forward, before throwing on all these childless, able-bodied adults into a system in which we already have these massive issues.

I also think it should intensify calls for reform of Medicare. This is a very good opportunity for individuals to renew that call and say, “Not only from a financial stand point, but also from a quality of care standpoint to the most vulnerable, for those seniors that we’ve committed to providing some sort of access, basic access to health care, that we need to make sure that they aren’t harmed in this process of us trying to expand Medicaid.” We’ve seen that over and over again, that people have tried to make a compassion case for why they need to expand Medicaid. In fact, those unintended consequences end up hurting those most vulnerable, often low-income seniors that are on Medicare that will be most directly impacted by these cuts.

The final thing that I would say is, I anticipate, in light of an election coming forward, we’re going to see a lot of discussion about and attacks on individuals that have stepped forward saying they want to reform Medicare. There’s been these back-and-forths about vouchers, about throwing granny off the cliff, and I think this is a great opportunity for people to educate the general public that ObamaCare cuts Medicare, it already has, it’s scheduled to do it, and to talk about what the impacts will be, and the true impetus for reform going forward will be to offer those individuals better quality care, more choice through competition, instead of gutting the market-oriented pieces of Medicare that ObamaCare goes after.

Jonathan Bechtle

I think that’s a great point, Josh, talking more about these promises that we’ve made in the past that we need to keep first. One other question that was submitted, wanted to make sure we got in is about Medicaid estate recovery. This issue has come up in terms of ObamaCare regarding whether your house or the parts of your estate can be taken. Josh, can you tell us more about that and how it relates to the Affordable Care Act?

Josh Archambault

Sure. There’s been a little bit of misinformation about this on the internet, if you will, or through e-mail chains. ObamaCare doesn’t set up the estate recovery plan, where an individual goes into long-term care, they own some assets, and when they die the state can go after some of those assets to recover. This actually has been around since almost the beginning of the Medicare program. In 1993, there was a federal law that required states to go after payments for nursing homes for individuals that had long-term care or home or community-based care, individuals over 55.

That was a big change. Before, it was more optional for states whether they wanted to go after individuals; it became mandatory in 1993. Just so people don’t think that’s the only requirement, other states have gone much farther, that they can go after individuals for a number of different costs related to those being on Medicare. There are 27 states that have some sort of statute that they can go after … For instance, in North Dakota, you can go after assets of your surviving spouse, or in California you can be a little more aggressive for reimbursements for medical costs, not just for long-term care costs going forward.

There has been misinformation that it doesn’t come from ObamaCare; I actually do think this is a relevant issue to this discussion because so many more individuals will be eligible for Medicaid, if you’re expanding Medicaid, but also even if you don’t expand Medicaid. One of the provisions in ObamaCare changes the way they calculate eligibility for Medicaid. It largely eliminates asset-tests so more seniors and others will qualify for Medicaid than previously. Those individuals who maybe have a home, who weren’t previously eligible in a number of these states will now become eligible based on the new way that they calculate. They will be added into that system, potentially going forward.

CMS is aware of this and they’re so concerned that they’ve written a letter to all the states, I believe it was last week, saying, “We are looking at ways to get rid of this, and we don’t encourage you to go after people’s assets due to this.” I’m not sure they have the authority to tell states what they can do, and states can continue to go after people’s assets if they want to recover them going forward. There is another side to this coin, which is if you’re fiscally conservative; you don’t want individuals to be gaming a system to make themselves look poor to be able to access Medicaid for long-term services and others, so there is a sense that we don’t want people to get in the system.

The catch here, and the real concern is, going forward, this is once again another way that ObamaCare unintentionally will end up hurting the lowest and most needy, is they won’t be able to afford to hire a lawyer to help them start the rules, which wealthier people probably will do, and often do now, when figuring out ways to hide assets, or to pass assets or money down to people earlier so they look poor, so that the can get on Medicaid more quickly for long-term care. I do think that we need to be really aware of the unintended consequences going forward, that states will continue to play an active role in determining whether they’re going to go after estates or not, and that individual, seniors or not, are aware of these changes that are coming under ObamaCare.

Jonathan Bechtle

Thanks, Josh. We have question from one of our callers. If you’ll go ahead, ask your question.


Hi there. My name is Joshua. Thank you, Josh, for the overview so far. I have a question about the stat you mentioned with 15% of hospitals and doctors over the next 10 years who will stop seeing Medicare patients. Based on whatever kind of survey question that is, are the doctors planning to retire or switch careers, or switch to more private medical practice like concierge medicine?

Josh Archambault

CMS’ actuary, this is his assessment based on what the average reimbursement rate is for individuals. It was not around the country, and whether individuals are in or out. In the paper, we have a reference to the actuary’s report. I would commend that to your reading so you can get a much better sense of his methodology. This is just his assessment saying given the average payment for Medicare around the country, and how many doctors currently take it; this is what I think the projection will be for doctors accepting them going forward.

I think he’s realistic. I think the reason he believes that 40% of hospitals will be unprofitable by 2015 is the reimbursement rates. If you see some of the charts that are included in his reports, and he’s done a number of them, it shows that some of the doctors, way out in the future, would be accepting 25 cents on the dollar. I think most of us realize whether you’re a doctor or not, that that’s unsustainable, and that most doctors would seriously reconsider; these are 50, 60 year projections. That’s why I made the assessment that I truly believe that Congress is going to have to go back in and try to change some of these things in the future because they simply aren’t sustainable. Seniors will be so devastated by access to hospitals, nobody will want to participate.

I think that’s why it’s all the more important to start these conversations now, because the cuts are starting this year, and they will be getting worse and worse going forward as they reduce payment levels, and as more individuals are forced on traditional Medicare going forward.

Jonathan Bechtle

Great question. If anyone else has a final question, you can still press *6 to jump into the queue. Josh, I have one final question for you, from a little bit different angle. We have seen support from AARP, the Association of Retired Persons for Medicaid expansion in many states. Based on our conversation today, that seems a little counter intuitive. Can you react to why they might be supporting this?

Josh Archambault

Yeah. From what I’ve seen from AARP, their rationale is we support Medicaid expansion because some of those individuals, some of those childless, non-disabled adults, would be over the age of 50 but under the age of 65. That’s been their kind of public response. I think this is one of those examples where when you dig a little bit deeper, and you start to follow the money trail, you start to get a better sense of why AARP has been so aggressive on pushing for Medicaid expansion.

AARP supports and sells a Medicare Gap Policy for traditional Medicare, and ends up benefitting very handsomely as more individuals are pushed off Medicare Advantage, and pushed on to traditional Medicare, as more individuals will purchase those policies.

They do have a financial interest in having more people on Medicare Advantage. I think for them it is one of the ways that Medicaid expansion is one of the ways that that $716 billion is used. They’re using this mechanism as a backdoor way for them to get additional people on traditional Medicare, then perhaps to buy their Medicare Gap Policy. It should be noted, AARP makes more money from selling that product then they do from dues from their members. They have a large financial interest in those changes going forward.

Jonathan Bechtle

Makes a lot of sense. Thank you, Josh. I think we’re about out of time. Do you have any final thoughts that you wanted to share?

Josh Archambault

Yeah. We can empathize that it’s really, really important that people understand that ObamaCare does impact Medicare going forward. Medicare individuals didn’t have to sign up on the exchanges, we didn’t see a rash of cancellations in 2013 or the beginning of 2014, but over the next couple of years, there will be dramatic changes in the program that individuals will start to become aware of. I do think that given independent analysis by CMS’ own actuary about the impact on our system in general, and the additional burden that would happen into the system from an access perspective if states do decide expand Medicaid, that these individuals are very aware of the connection, and how, at a 30,000 foot level, there’s connections between these two programs, both from how we interact with the health care system but also from a financial standpoint.

As states continue to debate Medicaid expansion, if you’re in one of those states, that you make sure that seniors see that connection, that those cuts coming out of Medicare are being used to finance Medicaid expansion, if your state decides to move in that direction.

Jonathan Bechtle

Thank you, Josh. Thank you for joining us today. Thank you for all the folks on the phone for joining us. We are going to have another phone call next Friday, March 7, at 12:00 Eastern. This one will be titled, “Does Medicaid Expansion Really Help Employers?” We’ll feature FGA Director of Research, Jonathon Ingram. We’ll be sending out e-mails about that, but if you’d like to register in advance for the call, you can e-mail us at We’ll also have a transcript of today’s call posted on our website,, along with the Josh’s study and additional research and resources on this issue.

Early next week, we will send out a follow-up e-mail with links to all of those things as well. Thanks. We’ll talk to you again soon. Have a wonderful day.

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