We agree it’s important to find a permanent solution to the physician payment formula (“Sustainable Growth Rate” or SGR), but the Bill passed by the House of Representatives today is not the answer. It isn’t balanced. It asks too much from beneficiaries without providing enough in return. It asks nothing from pharmaceutical or insurance companies. It continues the ever-increasing privatization of Medicare by increasing costs for beneficiaries for traditional Medicare and Medigap plans. It adds unnecessary costs for the Medicare program and taxpayers.
Of the portion of the SGR costs that will be off set, roughly half (approximately $35 billion of the total $70 billion over 10 years) would come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care, including:
• Adding deductibles to Medigap plans purchased by new Medicare beneficiaries starting in 2020;
• Further means-testing premiums for higher-income beneficiaries; and
• Overall increases in Part B premiums.
While the SGR package would make the low-income, Qualified Individual (QI), program permanent, which we strongly support, and would minimally increase and temporarily extend important funding for beneficiary education and outreach, it does not address other key issues that serve as barriers to care. For example, instead of repealing the annual outpatient therapy caps, the process to seek an exception to the cap is extended for another two years. Instead of addressing hospital Observation Status, the Bill further extends enforcement of the so-called “two-midnight” rule.
In short, Medicare beneficiaries would pay too much, with too little in return. Major drug and insurance industries pay nothing, and stand to gain a great deal. As the SGR debate moves to the Senate, we hope further balance and improvements for beneficiaries will be made.
2015 is a year of anniversaries important for all families: 50 years of Medicare. 50 years of Medicaid. 80 years of Social Security.
To honor the Medicare and Medicaid anniversaries, Senator Wyden introduced a Sense of the Senate Resolution today that should pass unanimously. It celebrates Medicare (and Medicaid) by resolving to protect a real Medicare program for future generations. Importantly, the Resolution states:
“… Resolved, That it is the sense of the Senate that—
(1) all efforts to improve Medicare and Medicaid must support and build upon President Johnson’s vision ‘‘to assure the availability of and accessibility to the best healthcare to all Americans, regardless of age or geography or economic status’’;
(2) Medicare’s guaranteed benefit is a lifeline to millions of Americans and must remain intact for this and future generations;
(3) Medicare should not be transformed into a voucher program, leaving seniors and people with disabilities vulnerable to higher out-of-pocket costs;”
Sen. Wyden’s three Medicare commitments deserve support from every lawmaker who really cares about Medicare and fair access to health coverage for all older and disabled people. That was Medicare’s promise in 1965. It’s up to us, and today’s lawmakers, to ensure it remains Medicare’s promise in 2015. We hope all members of Congress will start by committing to Sen. Wyden’s Medicare resolutions.
Since 1965, Medicare has opened doors to health care and increased economic security for hundreds of millions of older people, people with disabilities, and their families.
2015 will also usher in a new Congress. Many of its leaders and members will likely champion plans to further privatize Medicare. These proposals will likely surface despite increasing reports that Medicare costs and the federal deficit are declining, and that traditional Medicare costs less than private Medicare. Once again we will likely hear about plans to transform Medicare to “Premium Support” (a voucher towards the purchase of private insurance). We will probably read about proposals to increase the age of Medicare eligibility, decrease the value of Supplemental Medicare Insurance (Medigap), redesign Medicare to make it “simpler” (but less useful for most beneficiaries). We urge you to listen carefully for these and other such plans. And respond!
Since 1986, the Center for Medicare Advocacy has been on the front lines, advocating for people who depend on Medicare and for a comprehensive Medicare program for future generations. As we mark Medicare’s 50th anniversary, help us ensure its promise to advance access to healthcare. Help us explain what’s true and what’s not, where real savings exist, and when the true interests of beneficiaries are at stake. Help us ensure a real Medicare program lasts for another 50 years.
Be part of our Medicare Truth Squad. Ask us if you have questions. Spread the word – on Twitter, Facebook – in conversations! The future of a comprehensive Medicare program may depend on it.
”The private Medicare program has been a boon for insurers the past several years, offering sizable volumes and steady profit margins. … “ It will expand in the future as Baby Boomers join Medicare Advantage plans. (Modern Health Care 12/18/2014)
Why is this allowed to continue? How can we justify cutting Medicare coverage for older and disabled people while providing ever-increasing profit margins for private insurance companies?
Wake up people!
This is a scandal. Medicare Advantage plans continue to fail beneficiaries and cost taxpayers. Why don’t more people get it – or act to do something about it?
For more, see:
U.S. Finds Many Failures in Medicare Health Plans
“Federal audits found many coverage denials for medical services and prescription drugs are poorly…” @nytimes http://t.co/59LKyqkJSe
In “Fighting to Honor a Father’s Last Wish: To Die at Home” (the New York Times, September 25, 2014) author Nina Bernstein eloquently lays out the heartbreaking story of Joseph Andrey, whose last year of life was spent shuttling between inadequate care in every possible care setting. Often the services he received were provided in the most expensive available setting, regardless of the wishes of the family. Mr. Andrey finally died back in his home, but that final year of his life, quite likely the lowest quality-of-life year he ever endured, cost over a million dollars in Medicare, Medicaid and private funds.
It doesn’t have to be this way.
Unfortunately, too often it is. I have devoted over 30 years as a lawyer to Medicare advocacy, yet I could not help my uncle when his Medicare coverage was prematurely ended in the hospital and the nursing home. This resulted in his ending up at home with inadequate care, and he, too, experienced many of the dreadful occurrences that befell Mr. Andrey. A day after his death, and almost a year after his premature discharge, we won his Medicare appeal. Like too many others, he died after poor care and unfair denials from his private Medicare plan. Another victim of profits over people.
The Medicare trustees reported good news for Medicare today. The Trustees’ annual report finds the life of the Medicare Trust Fund has been extended another four years since their 2013 report, and an additional 13 years from their last projection before the Affordable Care Act passed. The annual report confirms that Medicare continues to provide cost-effective health insurance for more than 50 million older and disabled beneficiaries – and that the Affordable Care Act strengthened Medicare.
Medicare provides health insurance and access to needed care for most Americans age 65 or older and those with significant disabilities. The 2014 Trustees Report confirms that Medicare is working well and will be in fine shape for the foreseeable future. The Trustees conclude benefits are expected to be payable in full until 2030, four more years than they projected in May 2013.
“The Medicare Trustees’ favorable forecast is attributable to slowing health care costs, the recovering economy and the implementation of the Affordable Care Act. The Trustees Report answers skeptics and demonstrates that Medicare is healthy. It continues to be an efficient, cost-effective program that Americans can count on for future generations. It should be protected as one of our great success stories.” said Judith Stein, executive director of the Center for Medicare Advocacy.
The positive outlook for the Medicare Trust Fund is certainly good news. There are opportunities to further improve Medicare’s well-being without reducing benefits or cutting services. Congress could secure the program’s future even more by reducing wasteful overpayments to private Medicare Advantage plans, and by obtaining the best rates possible for prescription drugs.