Posts filed under ‘Health Insurance’
Misconceptions and misinformation about the Affordable Care Act are still too many to innumerate. However, as advocates for Medicare beneficiaries and a strong Medicare program, we can tell you that the Affordable Care Act (ACA) is good for beneficiaries and good for the stability of a full and fair Medicare program. ACA has already added significantly to Medicare-covered preventive services – with no beneficiary cost-sharing, continues to reduce the cost of prescription drugs for people under Medicare Part D, is phasing out wasteful overpayments to private Medicare Advantage plans and added over a decade to Medicare’s long-term solvency.
Happy Anniversary, ACA. As my grandmother would say, “You should live and be well!”
The Ryan plan for 2013 is the same as the Ryan plan for 2012 and 2011: Privatize Medicare and repeal the Affordable Care Act. Once again the Ryan budget proposes to preserve Medicare in name only. It would change Medicare into a defined voucher system, sending beneficiaries into the marketplace to purchase indiivual insurance plans. These ideas were at the heart of the 2012 election. They are about changing the way government and Medicare work, not about saving Medicare or money. The proposals were rejected at the polls.
If Medicare and the deficit are really our concern, there are real savings possible that would not harm older and disabled people: Bring down the prices Medicare pays for drugs. Stop all overpayments to private Medicare Advantage plans. Add a prescription drug benefit to traditional Medicare. Lower the age of eligibility for Medicare. Let the Affordable Care Act work.
Mr. Ryan, move on! Join us in focusing on real solutions.
Medicare was in the spotlight in the Vice Presidential debate as the candidates outlined their respective plans for the program millions of American families rely on. Unfortunately, some pervasive myths were also highlighted regarding the impact of health care reform and the Ryan plan on Medicare and the 49 million Americans who count on it. [Check out the Center for Medicare Advocacy's Facebook and Twitter pages (Follow @CMAorg) for a full list of Medicare Myths and Facts from the debate.]
One of the myths that was repeated during the debate is the familiar claim that the Affordable Care Act cuts Medicare by $700 billion – the same claim that has been debunked time and again. In fact the $700 billion in savings are largely a result of rolling back unnecessary, wasteful overpayments to private Medicare insurance plans. Congressman Ryan’s budget plans have included these same $700 billion reductions; however, instead of ending overpayments to private insurance companies with the savings, Ryan’s plans would give private insurance companies an even larger share of Medicare expenditures.
The Ryan Plan to end Medicare would provide each individual with an annual allowance with which to purchase a health plan in the private market, would raise costs for current and future beneficiaries, and would repeal important Medicare benefit improvements, added by the Affordable Care Act (ACA). The ACA Medicare improvements include extending the solvency of the Medicare Trust fund, lowering prescription drug costs, adding new coverage for preventive services, and eliminating cost-sharing for most such services, such as mammograms and prostate screenings.
Mr. Ryan and other policy-makers often talk about waste, fraud, and abuse in Medicare. Yet too often these same policy-makers plan to extend private Medicare to restructure the entire Medicare program. They claim this will save money for Medicare, taxpayers, and beneficiaries. But a new study, once again, confirms just the opposite.
In a forthcoming issue of the International Journal of Health Services, researchers report that “Medicare has overpaid private insurers by $282.6 billion, or 24.4 percent of all MA payments, since 1985. In 2012 alone…MA plans are being overpaid by $34.1 billion, or 6.2 per¬cent of total Medicare spending”. This means nearly a quarter of all payments to private insurance companies in Medicare, subsidized with taxpayer dollars, have been unnecessary overpayments that have gone to profit margins and administrative costs, not health care services. Talk about waste!
The authors of the International Journal study conclude that the decades-long experiment with privatizing Medicare should end. Instead, policies should be developed to focus on the real issues of overall health costs and access to coverage. However, if the Ryan plan takes effect, the wastefully expensive private Medicare program will be expanded. Meanwhile, the cost-effective traditional Medicare program will be allowed to wither, and beneficiaries will become responsible for dramatic increases in out-of-pocket costs.
Mr. Ryan’s plan continues wasteful overpayments to private insurance companies at the expense of beneficiaries and taxpayers. It is not a plan to preserve Medicare, protect older and disabled people, or reduce health care costs.
Originally Published at Nieman Watchdog, in ASK THIS, June 14, 2012 (available at http://niemanwatchdog.org/index.cfm?fuseaction=ask_this.view&askthisid=00569), we offer reporters and editors a checklist for stories when the Supreme Court rules on the Affordable Care Act (ACA):
- What will happen to the Medicare Part D Donut Hole coverage, preventive benefit coverage improvements, Part D income-based premiums?
- Will young adults receiving coverage up to age 26 on their parents’ plans immediately lose their coverage? Will they be able to get coverage elsewhere?
- Will children with pre-existing conditions lose their coverage? If so, how will they get coverage in the future?
- What will happen in states that have started to implement the law, for example by setting up “exchanges”? Will some states try to proceed without ACA?
- What will happen to those who would have been covered by the Medicaid enhancements under the law?
- If so, what was struck down?
- What is left?
- Can the law still work without this requirement?
- Can the law be amended to make it work, without a minimum coverage mandate?
- What demographic groups will be most harmed?
- What will be the effect on costs to the federal government, states, and individuals?
Unless the entire law is upheld, people in need of health care will lose. Be ready to recognize what will be lost – and by whom.
We are happy to celebrate the second anniversary of health care reform. Since the Affordable Care Act (ACA) became law in 2010, significant progress has been made to enhance access to health care for all Americans. This progress touches the lives of millions of American families.—from every state, and every walk of life. We look forward to the law’s full implementation in 2014.
Health care reform has already improved and strengthened Medicare. It’s helping older and disabled Americans in many ways, including:
1. Adding Medicare preventive health care services, usually at no cost, including an annual wellness visit, many cancer screenings, vaccines, smoking cessation and dietary counseling. This means people with Medicare can work to maintain their health and can recognize problems early, when treatment is most effective.
2. Increasing Medicare coverage for prescription drugs for people with the highest medication costs, by providing more coverage during the “Donut Hole” coverage gap. These benefits will continue to improve every year through 2020, when the “Donut Hole” will end, ensuring continued cost savings for older and disabled people.
3. Insisting that private Medicare Advantage plans provide real value to those who enroll, including appropriate Medicare coverage and quality customer service. Beginning in 2014, the law will also require these plans to spend at least 85% of the premiums they collect on medical care, rather than on excessive administrative costs and increased profits. The law also saves Medicare and taxpayers millions of dollars by ending wasteful overpayments to these private insurance companies.
These are just a few of the ways ACA insists on fair value in return for taxpayer dollars, while improving health care for older and disabled people. And this is just the beginning. If the Affordable Care Act is allowed to proceed as designed, it will continue to enhance access to quality health care, increase efficiency, and reduce costs to Medicare and taxpayers.
Spread the word about the value of the Affordable Care Act and the need to see it through to full implementation. Health care reform is good for Medicare, good for families, and good for the country. Let it work!
How much does Mitt Romney really care about Medicare’s solvency? A lot. So much that he has decided not to enroll or use it at all - even though he’s turning 65.
What should we take from this? One thing for sure, Mitt Romney can afford a whole lot more financial risk than most Americans. Unless he has private insurance that will pay as the primary policy even after he’s Medicare eligible, Mr. Romney is accepting a huge liability if he intends to pay for his own heath care. Either way, he’s in a very different position than the vast majority of older and disabled Americans who MUST rely on Medicare to help pay for their health care and can not obtain insurance that will take its place.
Is Romney going to lead a battallion of well-to-do Americans out of Medicare? Leaving behind those who can not afford to pay either for their own care or for preciously rare primary insurance available to people eligible for Medicare. What a shame that would be.
Mr. Romney should enroll and rely on Medicare coverage like most Americans do when they turn 65. As a would-be national leader he should experience firsthand what works and what doesn’t, what coverage is and should be available. He should be part of the Medicare community and help it stay viable for all those who look to this national treasure to help pay for health care.
If Mr. Romney really cares about Medicare he should vote for it with his feet.
This week, Republican presidential candidates vie for their party’s nomination in Florida, where millions of residents rely on Medicare as a health and economic lifeline for themselves and their families. Unfortunately, some candidates are scaring seniors – making clearly incorrect and harmful statements about the effect of the Affordable Care Act on Medicare.
As the Center for Medicare Advocacy has reported since the passage of the landmark legislation, Health Care Reform does NOT hurt Medicare benefits. In fact, it expands and improves benefits for all people with Medicare while saving our nation and taxpayers billions of dollars over the next decade.
Most recently, former Senator Santorum made significant misstatements about Medicare. Contrary to his statements, people with Medicare are NOT losing their doctors and are NOT facing rationing because of Health Care Reform. In fact, the Medicare payment board he mentions does not even exist yet. When it does begin, it will be charged with keeping overall Medicare costs down and will be specifically prohibited from reducing benefits.
Additionally, Mr. Santorum’s desire to “fix” Medicare by privatizing it and giving taxpayer money to insurance companies makes you wonder who he really wants to help. Privatizing Medicare and repealing health reform, which he also recommends, won’t help Florida’s older people or their families, but it would provide a windfall to the insurance industry. The traditional community Medicare program has helped generations of Americans at far less cost than private insurance. And health care reform has already enhanced Medicare, adding preventive benefits with no cost-sharing and reducing costs for prescription drugs.
If the Senator is truly concerned for the care of Florida’s people who rely on Medicare and the program’s integrity, he should get the facts straight and speak the truth about Medicare and health care reform. To start, he can visit the Center’s “Solutions for Strengthening Medicare” for common-sense ways to improve and expand the program while saving billions of dollars. www.medicareadvocacy.org.
Instead of raising the age of eligibility for Medicare, why don’t we just use Part D as a model and create a new Eligibility Donut Hole?
People ages 65 – 69 can keep their eligibility. But, between ages 70 and 85: Into the new Donut Hole. Eligibility for Medicare would end during this time – after all it’s these older people that start getting sick, so it’s the perfect time to stop paying for their health care. The new Donut Hole would save the government a ton of money!
Those who do make it through the Eligibility Donut Hole without Medicare, would once again become eligible at age 86. At that point most people only need “comfort measures” and their conditions usually won’t improve, so Medicare wouldn’t pay for their care anyway!
If the goal is to save money, a new Medicare Eligibiity Donut Hole is the way to go.
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. 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. Taxpayers currently pay nearly 70% more for drugs in the Medicare program than through the Veteran’s Administration, which has direct negotiating power. 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. 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.
A large portion of the overpayments made to private plans actually goes to insurers rather than to benefit Medicare beneficiaries. 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.
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.
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. The bipartisan Bowles-Simpson Deficit Commission recommended that these projects be implemented as quickly as possible. Allowing ACA to do its job will create a foundation on which to build by improving care and holding down costs for taxpayers.
“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.
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?”
National Committee to Preserve Social Security and Medicare, available at http://www.ncpssm.org/pdf/price_negotiation_part_d.pdf
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.
MedPAC, Report to the Congress, March 2011, Chapter 12 (March 2011), available at http://www.medpac.gov/documents/Mar11_EntireReport.pdf.
 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,
 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.
Senator Dick Durbin, available at http://durbin.senate.gov/public/index.cfm/pressreleases?ID=555cc1e8-cc54-4ead-9d85-d5e6275b3789.
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
See previous Alert from the Center, “Combating Fraud, Waste, and Abuse in Health Care.”
The National Commission on Fiscal Responsibility and Reform, “The Moment of Truth,” December 2010.