"The rebates that will go to four-star and higher plans are to be used to provide additional benefits, such as lowering beneficiary premiums or reducing co-pays for doctor visits. Lower-income seniors are, arguably, more in need of those benefits. But not all plans are available in all counties. The report notes that four-star plans are offered in less than 14% of the counties where at least 25% of residents are below the federal poverty level. Thus, poorer Medicare beneficiaries are less likely to have access to the plans that receive the rebates and have better benefits."

"The health reform law changes that: It raises Medicaid rates for primary care to match those of Medicare for 2013 and 2014. That, the Obama administration hopes, will lure doctors to accept Medicaid patients — and also prevent some costly emergency room visits down the line. But there’s a problem: The payment boost runs out at the end of 2014. While the federal government estimates that it will spend $11 billion raising provider rates for 2013 and 2014, no additional federal funds are appropriated beyond that. There’s already some thinking, among the health-care provider community, that a fierce lobbying battle could play out as doctors look to turn a short-term pay boost into a permanent one."