CMS has decided to raise rates for private Medicare Advantage (MA) plans. This is contrary to its earlier announcement that private Medicare reimbursement rates would be reduced to reflect slower per capita growth in Medicare and health care. Politicians from both parties and insurance companies called for this change and, unfortunately, CMS reversed course.
So, private Medicare will continue to cost more than it would cost to serve similar beneficiaries in traditional Medicare. While this may be good for insurance companies that offer MA plans, it is not good for Medicare, the vast majority of Medicare beneficiaries, or taxpayers.
Why should we spend more of our limited public funds on private Medicare when traditional Medicare costs less? Why should taxpayers ensure private profits to deliver public Medicare coverage? After all, the experiment in privatizing Medicare was originally intended to see if a private model would cost less, while providing the same or better coverage than traditional Medicare. That was not to be.
Private plans left the market when their reimbursements were capped at or below the per capita rate of public Medicare. CMS failed to learn from that experiment, and maintain the cost of traditional Medicare as the maximum taxpayers would pay for private plans. Instead, since the Medicare Act of 2003 we actually pay private plans more than traditional Medicare. This result is not good for the financial security of the Medicare program or for the federal budget deficit. It’s not good for the vast majority of beneficiaries who continue to choose the traditional Medicare program. It’s not even best for many MA enrollees, particularly those with long-term and chronic conditions, who often get less coverage than they would in traditional Medicare. And remember, by design MA plans have limited networks, so private MA enrollees have fewer choices in physicians and other health care providers than they’d have in traditional Medicare.
The Center for Medicare Advocacy continues to call for parity in payments between private Medicare plans and traditional Medicare. It’s the best deal for taxpayers, the Medicare program, and the vast majority of Medicare beneficiaries. Common sense should prevail.
On April 1st Representative Paul Ryan rolled out yet another “Path to Prosperity,” as he annually calls his budget. Unfortunately, the budget is a repeat of past year plans and is not a path to prosperity for most Americans – or for Medicare.
Once again, Rep. Ryan’s budget proposes a private approach to Medicare:
For future retirees, the budget supports an approach known as ‘premium support.’ Starting in 2024, seniors (those who first become eligible by turning 65 on or after January 1, 2024) would be given a choice of private plans competing alongside the traditional fee-for-service Medicare program.
Rep. Ryan has proposed “premium support” for future Medicare participants many times in the past. While his budget assures us that “this is not a voucher program,” it is, once again, a proposal to pay a certain amount towards private insurance for Medicare beneficiaries. Ironically, Mr. Ryan states such insurance plans “would be available in a newly created Medicare Exchange.” This is ironic because the proposal is remarkably similar to the Affordable Care Act marketplace that is so maligned by Mr. Ryan and his colleagues.
Rep. Ryan suggests that changing Medicare to premium support is needed because
the government has been … a clumsy, ineffective steward of value. Controlling costs in an open-ended fee-for-service system has proved impossible to do without limiting access or sacrificing quality.
In fact, over the last few years traditional Medicare per-capita cost growth has declined, leading the way to parallel reductions in the rise of overall healthcare costs.
The unnecessary costs for the government, taxpayers, and all Medicare beneficiaries that need controlling are the hundreds of billions of dollars in excess payments to private Medicare Advantage plans under Medicare Part C and private pharmaceutical companies under Medicare Part D. These unnecessary private industry payments are the real threat to Medicare’s future. If Mr. Ryan’s goal is really to save money and preserve a strong Medicare program, he would look to these cost overruns for savings. He certainly would not propose further privatizing Medicare.
However, the latest Path to Prosperity does again seek to privatize Medicare. At the same time it would reduce Medicare’s value to older people and people with disabilities by:
- Increasing the age of eligibility to 67.
- Charging more for Medigap coverage.
- Combining Parts A and B cost-sharing, thereby increasing costs for most beneficiaries.
- Increasing premiums for more beneficiaries.
Regrettably, the Ryan plan may provide a continued path to prosperity for private insurance and pharmaceutical companies, but it is a dead end for Medicare, older people and people with disabilities.
From the New York Times, January 8, 2014
“…This past year, I have achieved something big that I’ve not spoken of until now. Countless hours of physical therapy — and the talents of the medical community — have brought me new movement in my right arm. It’s fractional progress, and it took a long time, but my arm moves when I tell it to. Three years ago, I did not imagine my arm would move again. For so many days, it did not. I did exercise after exercise, day after day, until it did. I’m committed to my rehab and I’m committed to my country, and my resolution, standing with the vast majority of Americans who know we can and must be safer, is to cede no ground to those who would convince us the path is too steep, or we too weak. “
How can we not stay the course? We will continue to advocate for those who need a voice – for the long term.
Year after year congress has passed a short-term physician payment package instead of permanently fixing the unfair payment formula for doctors who treat Medicare patients.
Today, in Congress, there’s a real solution for this ongoing problem. Senator Rockefeller’s Medicare Drug Savings Act of 2013, which will allow Medicare to negotiate prescription drug prices for low-income beneficiaries, will save Medicare $140 billion over 10 years – almost the exact amount needed to permanently fix the physician payment formula and fairly pay doctors who treat Medicare patients.
Join us. Tell Congress you support finally fixing the formula by which Medicare pays physicians (it’s called “SGR”), but that the cost of doing so cannot be shouldered by older and disabled people.
In particular, Congress should not:
- Cap coverage for necessary care,
- Increase premiums, copays, and other costs for Medicare beneficiaries,
- Allow help for low-income people on Medicare to expire.
The timing couldn’t be more perfect. Senator Rockefeller’s Medicare Drug Savings Act is the solution. Congress can permanently fix the physician formula and pay for it by allowing Medicare to obtain the best possible price on prescription drugs for low-income individuals.
It’s a Win-Win Situation
- Remind them of your support for Senator Rockefeller’s bill, and
- Tell them to use the prescription drug savings to fairly pay physicians who treat Medicare beneficiaries!
In yesterday’s Wall Street Journal, Cong. Paul Ryan weighs in yet again on “entitlement” reform. Suddenly the debate in DC is changing from demolishing Health Care Reform to the traditional Republican targets: Medicare and Social Security.
Here are Mr. Ryan’s suggestions:
• “Reform Medigap plans to encourage efficiency and reduce costs.”
What does this mean? Whose costs would be reduced and where would we find the alleged efficiency? Since we’ve heard this refrain before we know the answer: This proposal would cost older and disabled beneficiaries more. It would require them to pay more for Medicare Part B if they want “first dollar” coverage from a Medigap plan. The efficiency mentioned is based on the assumption that people will forego this kind of Medigap coverage as a result of the increased cost and then forego unnecessary health care that they would obtain if they had full Medigap coverage.
This is suggestion is based on so many false premises it’s hard to know where to begin. Importantly, Medigap policies only make payment for health care that Medicare has already determined meets coverage criteria and is medically necessary and reasonable. Medigap insurance is there to cover some of the Medicare cost-sharing for this necessary care. Without the Medigap coverage the “efficiencies” and savings Mr. Ryan lists would come as a result of older and disabled people foregoing care that is by definition necessary and reasonable.
• Combine Medicare Parts A and B so the program is less confusing.
We are all for making Medicare less confusing. The Medicare Part C and D systems, added to Medicare in 2003, dramatically increased the complexity of the program and decreased the ability of people to understand and use Medicare. But Mr. Ryan does not suggest reducing reliance on the expensive and redundant Parts C and D. He suggests combining Parts A and B. Again, we have heard these proposals before. In the guise of adding simplicity, they increase costs to the older and disabled people who rely on Medicare. While reducing costs for inpatient hospital care, especially for longer stays, the proposals to combine Parts A and B increase beneficiary costs for those services that people need far more frequently: doctors’ care and other outpatient and community-based health services.
If negotiations are returning to the ceaseless discussions about so-called entitlement reform, (which always makes me wonder who’s entitled and what do we mean by reform), we should be serious. The standard should be what’s best for older and disabled beneficiaries and the budget – regardless of the interests of insurance and pharmaceutical industries.
Anyone who truly wants to simplify Medicare and reduce costs, both worthy goals, should bring these suggestions to the table:
Combine Parts B and D. Do away with the expensive costs associated with running a Medicare prescription drug program only through private plans – or at least give people the choice of getting drug coverage through Part B, in the traditional Medicare program.
• Prohibit Medicare from paying any more for the medications it covers than Medicaid pays. The Congressional Budget Office reports this would save at least $140 billion over ten years.
• Reduce the dependence on private Medicare Part C plans.
These private plans are more expensive to taxpayers and provide less value for beneficiaries.
Case in point: Out of the blue, Connecticut residents learned today that one of the largest Medicare Advantage plans, United Healthcare, is dropping 2250 physicians from its network. This means a lot fewer providers will be available for thousands of older and disabled people – as a result of one non-appealable decision made in the best interest of private profit, not Medicare beneficiaries. Medicare Part C adds complexity and costs and should be scaled back accordingly. Beneficiaries should be encouraged to stay in traditional Medicare, which includes all physicians who participate in the program nationwide and is less expensive for taxpayers.
If Mr. Ryan and his colleagues really want to save money and reform Medicare and Social Security, while maintaining their core missions, it can be done. Let’s talk seriously – if there’s the will, there’s a way.
And we quote: Mark McClellan, CMS Administrator in the G. W. Bush Administration:
“If the exchanges’ tech problems are resolved by November, no one will even remember what happened this week,” McClellan said, comparing the Affordable Care Act rollout to when the Medicare Part D prescription drug benefit took effect.
“Millions of seniors in different programs were enrolled into new [private] drug plans, and the computer system fumbled the handoff for tens of thousands of people who really urgently needed their prescriptions,” he said. “By comparison, the frustration of not being able to shop online in the first days of the Obamacare exchanges is small potatoes.”
[From Politico 10/4/2013]
Senator Ted Cruz’s long speech on the Senate floor against “Obamacare” (the Affordable Care Act)might have been a remarkable spectacle and certainly led to a lot of press coverage. But many of his statements do real harm. Declarations like “you don’t want an IRS agent deciding if your mom lives or dies,” lead to people calling our office in fear that they will lose their health insurance. (For the record, people on Medicare will stay on Medicare.) The relentless efforts by Senator Cruz and others to turn people against Obamacare, to the point of telling them not to sign up for health insurance they may desperately need, brought to mind a contrast with the implementation of Medicare Part D, the prescription drug benefit that was passed under President George W. Bush.
In 2006 people were starting to enroll in Medicare Part D. It was not the drug benefit that many of us in the Medicare advocacy world wanted. It was administered by numerous private insurance companies rather than being a straightforward, public Medicare benefit. Its structure was difficult to explain, with a big “donut hole” that left many vulnerable people with high out of pocket costs. It prohibited Medicare from negotiating lower drug prices from manufacturers. We voiced these complaints and advocated for a different kind of drug coverage. But Part D was the drug benefit we got. It was the law, and we knew people on Medicare who were in desperate need of prescription drug coverage, even if that coverage was imperfect. Many of us had clients who split pills, skipped doses, or had to choose between medicine and food.
So we went to trainings, gave talks at senior centers, helped people choose plans, and helped resolve problems that prevented some from getting their medications smoothly. Once Part D got started – and it was a rocky start – we even filed lawsuits to make sure that people were actually getting the Part D benefits they were supposed to get, improving the existing program. We did not try to prevent Part D’s implementation, “defund” it, spread falsehoods about it, or try to make it fail.. We tried to make sure people could make the best possible use of Part D, because people needed their medications. We did and still do advocate for changes to Part D (like closing the donut hole, finally being accomplished by Obamacare!). Today there are millions of people who need health insurance and cannot get it. Obamacare will help them get that insurance. (Luckily, there are also people working hard to enroll the uninsured.) This new program may not be perfect, but obstructing its implementation, scaring away people who truly need insurance coverage, placing political gain over the urgent medical needs of real people – those tactics should be out of bounds.