Posts filed under ‘Health Care’
Six Solutions for Medicare Solvency and Reducing the Deficit
As lawmakers debate the future of Medicare as part of broader efforts to address the federal deficit, proposals have emerged that would have severe repercussions for beneficiaries and their families.[1] Sound solutions that would protect Medicare coverage while reducing costs to taxpayers have not been seriously addressed. The six solutions we propose would accomplish both of these goals.
These solutions, unlike many current proposals, do not shift costs to beneficiaries or completely restructure the Medicare program. They promote choice and competition while shoring up the solvency of Medicare. Adopting these solutions would be a responsible step in reducing our deficit the right way.
1. Negotiate Drug Prices with Pharmaceutical Companies
The Medicare prescription drug law passed in 2003 prohibits the Secretary of Health and Human Services from negotiating prices with pharmaceutical companies. These companies gained 47 million customers when Medicare began covering prescription drugs, but they did not have to adjust their prices in return. Requiring the Secretary to negotiate drug prices for Medicare would save taxpayers billions of dollars – potentially over $200 billion over ten years.[2] Taxpayers currently pay nearly 70% more for drugs in the Medicare program than through the Veteran’s Administration, which has direct negotiating power.[3] Savings realized from reducing Medicare drug cuts could be used to improve benefits for beneficiaries and reduce the deficit.
2. Stop Paying Private Medicare Plans Anything More Than Traditional Medicare
According to the Medicare Payment Advisory Commission (MedPAC), Medicare pays, on average, 10% more for beneficiaries enrolled in private insurance (Medicare Advantage or MA plans) than for comparable beneficiaries enrolled in traditional Medicare.[4] Despite these extra payments, beneficiaries in private plans who are in poor health, or who have chronic conditions, often have more limitations on coverage than they would under traditional Medicare.[5]
A large portion of the overpayments made to private plans actually goes to insurers rather than to benefit Medicare beneficiaries.[6] Although the Affordable Care Act (ACA) changed the payment formula for Medicare Advantage plans, some plans will continue to be paid as much as 115% of the average traditional Medicare payment rate for their county when the new rates are fully implemented. MedPAC estimates that by 2017Medicare Advantage payment benchmarks will average 101% of traditional Medicare. ACA also provides additional payments for plans that receive high quality ratings, increasing the likelihood that some MA plans will continue to be paid more than under traditional Medicare. Reducing private MA payments to 100% of traditional Medicare, as MedPAC proposed before the enactment of ACA, will increase the solvency of the Medicare program and curb costs for taxpayers. Private plans simply should not receive higher pay than traditional Medicare.
3. Include a Drug Benefit in Traditional Medicare
Offering a drug benefit in traditional Medicare would give beneficiaries a choice they do not now have, encourage people to stay in traditional Medicare, and save money for taxpayers. It would also provide an alternative to unchecked private plans that leave many with unexpected high out-of-pocket costs. A drug benefit in traditional Medicare would protect beneficiaries against expensive and sometimes abusive marketing practices. Further, traditional Medicare’s lower administrative costs could free up money for quality care, would result in lower drug prices for beneficiaries, and save taxpayers over $20 billion a year.[7]
4. Extend Medicaid Drug Rebates to Medicare Beneficiaries Who Are Dually Eligible or Part D Low-Income Subsidy Participants
Dual eligibles (people eligible for both Medicare and Medicaid) comprise one-fourth of all Medicare drug users, and are among the most costly beneficiaries. Because Medicare, rather than Medicaid, covers most of their drugs and because Medicare cannot negotiate drug prices, their drugs are not eligible for the same rebates as they would be under the traditional Medicaid program. Extending these rebates for dually eligible people as well as for those who qualify for the Part D Low-Income Subsidy – the poorest Medicare beneficiaries - would save approximately $135 billion over ten years.[8]
5. Lower the Age of Medicare Eligibility
People between 55 and 65 who are not disabled are currently unable to enroll in Medicare. Lowering the age of eligibility to enroll this healthier population in the Medicare program would add revenue from people who will likely need less care and fewer services than older and disabled enrollees.
6. Let the Affordable Care Act Do Its Job
The Affordable Care Act includes many measures to control costs as well as models for reform that will increase the solvency of the Medicare program and lower the deficit while protecting Medicare’s guaranteed benefits. The Congressional Budget Office estimates that repealing or defunding ACA would add $230 billion to the deficit while ignoring the real issue of rising overall health care costs, which contribute heavily to the growing national debt. ACA includes strong measures to allow CMS to combat fraud, waste, and abuse that will bring down costs, as well as a variety of pilot and demonstration projects that aim to bring better care and quality to beneficiaries.[9] The bipartisan Bowles-Simpson Deficit Commission recommended that these projects be implemented as quickly as possible.[10] Allowing ACA to do its job will create a foundation on which to build by improving care and holding down costs for taxpayers.
Conclusion
“Protecting Medicare” by shifting costs from the federal government to beneficiaries and their families – whether through a voucher program or spending caps or other draconian measures – is a perversion of Medicare’s original intent: to protect older people and their families from illness and financial ruin due to health care costs. The Center for Medicare Advocacy’s Six Solutions promote the financial welfare of Medicare and the country, without doing so at the expense of older and disabled people.
[1]See previous Alerts from the Center, “Why Medicaid Matters to Medicare Beneficiaries and Their Families”, “What Happens to Current Nursing Home Residents if House Budget Resolution Becomes Law?”
[2]National Committee to Preserve Social Security and Medicare, available at http://www.ncpssm.org/pdf/price_negotiation_part_d.pdf
[3]Center for Economic and Policy Research, “Negotiating Prices with Drug Companies Could Save Medicare $30 Billion”, March 2007, available at http://www.cepr.net/index.php/press-releases/press-releases/negotiating-prices-with-drug-companies-could-save-medicare-30-billion.
[4]MedPAC, Report to the Congress, March 2011, Chapter 12 (March 2011), available at http://www.medpac.gov/documents/Mar11_EntireReport.pdf.
[5] Neuman P. Medicare Advantage: Key Issues and Implications for Beneficiaries. Testimony before the House Committee on the Budget, United States House of Representatives, June 28, 2007, available at http://www.allhealth.org/briefingmaterials/NeumanTestimony-830.pdf,
[6] Medicare Payment Advisory Commission. March 2009 Report to Congress, Chapter 3: The Medicare Advantage Program. P. 251-253, available at http://www.medpac.gov/chapters/Mar09_Ch03.pdf.
[7]Senator Dick Durbin, available at http://durbin.senate.gov/public/index.cfm/pressreleases?ID=555cc1e8-cc54-4ead-9d85-d5e6275b3789.
[8]Office of Management and Buget Congressional Budget Office, Living Within Our Means (September, 2011); Letter to Honorable Charles Rangel, available at http://www.cbo.gov/ftpdocs/104xx/doc10464/hr3200.pdf
[9]See previous Alert from the Center, “Combating Fraud, Waste, and Abuse in Health Care.”
[10]The National Commission on Fiscal Responsibility and Reform, “The Moment of Truth,” December 2010.
Medicare and Jobs: Not Mutually Exclusive!
The more people have health insurance, including Medicare, the more they stay healthy and are able to work. If health insurance is provided by Medicare or health care reform or any avenue outside the tired employer-based system, it reduces costs for employers and encourages hiring. Ask any employer.
Continuing to tie health insurance to employment only continues a system that COSTS jobs. It creates a disincentive for employers to hire. It creates an incentive for the new employment reality: Freelance, contract work, part-time, whatever you want to call the newly underemployed who do not have benefits and for whom employers do not pay into Medicare, Social Security, Unemployment, or Workers Comp. This is a big problem for everyone involved, including individual workers, their families, AND the solvency of important programs that Americans value and that have lifted generations out of poverty and provided fair access to health care.
Pay attention, people! We not only can have Medicare and jobs – we will have more jobs if we increase access to Medicare and health care. Don’t raid Medicare to pay for jobs. That will only reduce access to both.
New York Says No
New York voted for Medicare yesterday. In a traditionally Republican district, Democrat Kathy Hochul won a special election for an open Congressional seat. The major issue in the campaign was the budget recently passed by Republicans in the House of Representatives that eliminates Medicare as a defined benefit program. Candidate Hochul opposed this change, recognizing it for what it is - an end to Medicare. Voters agreed with her.
The New York vote reminds us that Americans value Medicare. They understand that the Republican Budget won’t save Medicare; it will replace it with individual vouchers toward the cost of purchasing private insurance.
Under the Republican plan, beginning in 2022, people who become eligible for Medicare would instead receive a voucher, worth about $8,000. No one knows what private plans would be available for purchase, what geographic regions would be included, or what health services and providers would be covered. We do know that Medicare guarantees certain coverages, and it has worked to bring quality health care to older and disabled people for 46 years. When Medicare was enacted in 1965, half of all Americans 65 or older had no insurance. Private insurance did not want to cover them. Now, because of Medicare, 95% of people 65+ are covered.
Yesterday, Joe Courtney, the Congressman who represents the district of the Center’s home office also said yes to Medicare and no to vouchers. ( VIDEO: Courtney decries GOP plan to end Medicare as we know it.)
Fortunately, when Kathy Hochul takes her seat in Congress to represent New York, Congressman Courtney will have another ally in efforts to preserve Medicare.
President Obama Supports Medicare
Thank you, President Obama, for proposals that strengthen Medicare. We are so pleased, and relieved, to have a leader in the White House who’s drawn a line, refusing to pretend the elimination of Medicare and Medicaid are necessary to protect America’s future. Instead, he’s called for real, shared responsibility and is continuing efforts to provide affordable health care for all.
The President’s framework for fiscal responsibility protects the integrity of Medicare and Medicaid by building upon the progress made in the Affordable Care Act to cut overall health care costs. His proposals strengthen both programs while achieving savings by addressing Medicare physician payment reforms; reducing overpayments; improving care for those who are eligible for both Medicare and Medicaid; and focusing on wasteful spending and cost growth.
The President was explicit about his vision for Medicare and Medicaid when he said:
…”let me be absolutely clear: I will preserve these health care programs as a promise we make to each other in this society. I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs. I will not tell families with children who have disabilities that they have to fend for themselves. We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations.”
The Center for Medicare Advocacy applauds the President for his work to preserve Medicare, Medicaid and the well-being of American families who are already struggling in today’s economy. We thank the President for recognizing that fiscal responsibility for the federal government does not mean eliminating programs like Medicare and Medicaid that work to provide access to health care for vulnerable populations. Nor does it mean saving federal dollars by shifting costs to states, families and taxpayers.
What a breath of fresh air!
Rationing Medicare & Health Care?
The budget released on April 5th by the House of Representatives purports to benefit Main Street Americans.
Once again we’re hearing proposals to “reform” Medicare and to cut the federal deficit. These plans are not about reform or even dedicated to deficit reduction. They are about a long held desire to do away with Medicare, shifting costs to American families who are already struggling.
Newt Gingrich said in the 1990s that he might not be able to eliminate Medicare, but he could watch it wither on the vine. This time, the House of Representatives’ Republican budget actually does eliminate Medicare, replacing it with vouchers to purchase private insurance.
This proposal is reckless and extreme. As with Medicare Advantage and Medicare Part D, it will cost beneficiaries and taxpayers more than the traditional Medicare program. With a capped annual voucher to purchase insurance, Medicare beneficiaries will pay more out-of-pocket, get less coverage, and have less access to health care.
Sounds like rationing to us.
Health Care Reform: A Family Value – Support it!
While some work to repeal Health Care Reform, others are already benefiting from its provisions.
People who have already benefited from health reform are at both ends of the age spectrum. Young and old, they reflect the family value of the law, particularly given these tough economic times when jobs are lost, unavailable, and employers are increasingly dropping benefits.
Here are some stories the Center for Medicare Advocacy has heard in just the last day:
1. A Connecticut State Health Insurance and Assistance Program (SHIP) counselor writes: “I know a lot of our seniors will benefit from the government slowly getting rid of the Donut Hole in prescription drug coverage.” This is echoed by many others including:
• An older Connecticut woman and her niece, from Delaware, both went into the Donut Hole in 2010 and both received $250 as a result of health care reform to help out.
• A gentleman from Florida reached the Donut Hole in both 2009 and 2010, and expects to do so again in 2011. He appreciated the $250 help in 2010 and, given his heart and other health problems, he will certainly benefit from health reform’s 50% discount on Brand name drugs in 2011.
2. Another individual writes:
• “I have a sister who is 25 years old and was unable to find a job that would provide health care coverage due to the economy. She has very serious ear problems and required two major surgeries to replace her ear drum in both ears. If she was not able to be on our parents’ health insurance plan, she would not have been able to afford the surgeries and would have gone completely deaf. It is very difficult to be a young person out of college during these times. Even if you can find a job, it is very difficult to find a full time job with health benefits. I consider myself extremely lucky that I did find a job with benefits, but do know many who had no health insurance for some time. These young people need the cushion of being on their parents’ insurance until 26 when they can find a stable job with health benefits because in this economy, less and less employers are offering benefits to young people.”
The importance of health reform allowing young adults to obtain coverage on their parent’s health insurance plan is reiterated by another individual:
• “ I can personally speak for the kids 26 and under part of this. I have two kids under 26. One does not live at home. He is 22 and working at a job without health insurance. He would have no health insurance without being able to stay on my insurance. He was able to have an expensive blood test to find out if he has a potentially life threatening blood disorder because he had my health insurance to cover it.”
3. Four of the Center for Medicare Advocacy’s own employees have young adult children who have lost their jobs or are employed, but their employers do not provide health insurance. Again, these young people only have health insurance as a result of health care reform which allows them to be covered by the Center’s health insurance. At least one of these young adults has an on-going mix of mental health and medical problems that require on-going health care.
Health care reform is helping families struggling to deal with illnesses, age, unemployment, and underemployment. The law advances family values.
Center for Medicare Advocacy Co-Sponsors Tele-Town Hall With President Obama & Sec’y Sebelius
THE WHITE HOUSE
Office of the Press Secretary
_______________________________________________________________________________________________
FOR IMMEDIATE RELEASE
June 3, 2010
President Obama to Join Seniors for Tele-Town Hall Meeting on Affordable Care Act
WASHINGTON—On Tuesday morning, June 8, President Barack Obama will participate in a national tele-town hall meeting at the Holiday Park Multipurpose Senior Center in Wheaton, Maryland with senior citizens to discuss the Affordable Care Act and efforts to combat senior scams and fraud in advance of the first mailing of the $250 “donut hole” rebate checks. In addition to attendees at the Senior Center, seniors across the country will be able to participate in the town hall meeting by phone. The President will be joined at the town hall meeting by HHS Secretary Kathleen Sebelius and representatives of the following organizations:
AARP
AFL-CIO
AFSCME Retirees
Alliance for Retired Americans
American Association of Homes and Services for the Aging
American Federation of Teachers Program on Retirement and Retirees
American Postal Workers Union Retirees Department
Center for Medicare Advocacy, Inc.
Communications Workers of American Retiree Division
International Union of Painters & Allied Trades – IUPAT
National Academy of Elder Law Attorneys
National Association of Area Agencies on Aging
National Association of State Units on Aging
National Association of Nutrition and Aging Services Programs
National Association of State Long Term Care Ombudsman Programs
The National Caucus and Center on Black Aged
National Committee to Preserve Social Security and Medicare
National Council on Aging
NCCNHR – The National Consumer Voice for Quality Long-Term Care
National Gay and Lesbian Task Force
OWL- The Voice of Midlife and Older Women
SEIU
Service and Advocacy for GLBT Elders
Workers United
These organizations – which together represent over 40 million seniors across the country — will be organizing satellite town hall meetings across the country to dial in and participate in the President’s event, which will be broadcast live on C-SPAN. A detailed list of meeting locations will be released in the coming days.
Politics Trump Health Care for People with Pre-Existing Conditions
The new health reform law encourages states to create or expand existing state high-risk pools as one of the first steps towards insurance market reform and increasing access to health care for people who would not otherwise be able to obtain health insurance. State high risk pools can provide insurance, for example, for people who are receiving Social Security disability benefits but who are in the 24-month waiting period for Medicare.
Citing objections to a “federal takeover” of health care, Georgia’s Insurance Commissioner, John Oxendine, has announced that Georgia will not establish a high-risk pool for its residents with pre-existing conditions. The irony is that the health reform law also provides for the establishment of a federal high risk pool for uninsured people with pre-existing conditions that live in states that don’t have their own risk pool. So, by deciding that Georgia won’t establish its own program, Commissioner Oxendine is guaranteeing a “federal takeover” of health care – Georgia residents who can’t otherwise get insurance will only have the option of insurance through a federal, not state, program.
VG/DC
