Posts tagged ‘Medicare’
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.
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]
And we quote:
“Private insurers’ Medicare Advantage plans cost Medicare an extra $34.1 billion in 2012
Instead of being more efficient, private insurers have cost Medicare almost $300 billion more over the life of the program
A study published online today finds that the private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985, most of it over the past eight years. In 2012 alone, private insurers were overpaid $34.1 billion.
That’s wasted money that should have been spent on improving patient care, shoring up Medicare’s trust fund or reducing the federal deficit, the researchers say.
The findings appear in an article published in the International Journal of Health Services by Drs. Ida Hellander, Steffie Woolhandler and David Himmelstein titled “Medicare overpayments to private plans, 1985-2012: Shifting seniors to private plans has already cost Medicare US$282.6 billion.”
Hellander is policy director at Physicians for a National Health Program (PNHP), a nonprofit research and advocacy group. Woolhandler and Himmelstein are professors at the City University of New York School of Public Health, visiting professors at Harvard Medical School and co-founders of PNHP.”
We have to say, Forbes has it right! The co-pay for Medicare home health care proposed in the President’s budget is a big mistake. It will not save money, will harm people with chronic conditions, and will increase avoidable hospitalizations. It isn’t even a good tool for fighting fraud – if that is the goal.
Far from getting too much care, our experience is that thousands of people with multiple sclerosis, Parkinson’s disease, ALS, paralysis, and other long-term conditions, struggle to get the home care they DO need. A little bit of nursing and/or therapy, along with hands-on health aide services, often means the difference between staying home and requiring a hospital stay or nursing home placement. For most Medicare beneficiaries with chronic conditions, home health care is more humane, more effective and less expensive.
If fraud is the concern, fight it. Don’t add co-pays or other barriers for those who really do need home care and qualify for Medicare coverage.
As we said in today’s Politico Op Ed, it’s time to support Senator Rockefeller’s bill – and all serious efforts to reduce what Medicare pays for prescription drugs. High time. There are over 50 million people with Medicare. Why would we not insist on lowering drug prices for all of them? It would save Medicare $141 Billion over ten years. Wal-Mart knows the value of negotiating low prices for vast numbers of people, and is sure to do so. So should Medicare.
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.
According to a 2012 Congressional Budget Office report, aligning Medicare drug payments with what Medicaid pays just for low-income beneficiaries would save $137.4 Billion over ten years. (CBO Estimates for President’s Budget for 2013, 3/16/2012).
While the President suggested this reform in his State of the Union address, discounting what Medicare pays for drugs has thus far not been taken seriously by decision-makers.
Instead, we have repeatedly been told that Medicare cannot be sustained and that benefit cuts are necessary. Yet all these Medicare benefit cuts combined would only equal $35.4 Billion in savings over ten years:
1. Increasing income-related Part B premiums;
2. Increasing income-related Part D premiums;
3. Increasing Part B deductible for new enrollees;
4. Adding a Part B premium surcharge for first-dollar Medigap coverage;
5. Adding home health co-pays for new enrollees.
If all of these benefit cuts, that would hurt older and disabled people, save only 25% of the savings that would be achieved by requiring drug companies to give the same discounts to Medicare as it gives to Medicaid, why don’t we choose drug discounts? How can benefit cuts be preferable if the goals are to reduce the deficit and save Medicare for future generations?
Lower Medicare payments for prescription drugs. Choose People and Medicare over PRxOFITS!
The Center for Medicare Advocacy has represented Medicare beneficiaries since 1986. As one of the few advocacy organizations in the nation solely serving Medicare beneficiaries, we strongly oppose home health episodic payment caps or any other such defined payment limits. The counterpart to this notion, caps on outpatient therapy, has created significant barriers to necessary care for thousands of our clients with long-term and chronic conditions. We have no doubt that episode caps would be harmful to some of those in greatest need of home care. Thus, we are adamantly opposed to such limits in the home health context.
The Center has long opposed Medicare home health co-payments, and continues to do so. Like caps, co-payments will limit access to in-home care for those most in need of these services. However, we are increasingly concerned about proposals to introduce home health payment limits. There is no question that home health payment limits would be disproportionately harmful for people with conditions such as traumatic brain and spinal cord injuries, Alzheimer’s, Parkinson’s disease, MS, and other such illnesses and disabilities. Without the possibility for ongoing home health care, these individuals may well need costly nursing home or hospital care.
• Our client, Mrs. Berkowitz, who is 81 years old and receives skilled physical therapy and home health aide services for her Multiple Sclerosis and related health needs, will require a nursing home if payment caps are instituted for Medicare home health.
Payment caps contradict and undermine growing efforts to promote better care, at lower costs, by encouraging and investing in home and community-based services.
Payment caps would also undermine the settlement just arrived at with the U.S. Department of Health and Human Services in the national class action law suit, Jimmo vs. Sebelius. The Jimmo Settlement makes it clear that Medicare coverage is available for home health patients who need skilled nursing or therapy to maintain or slow deterioration of their conditions. Jimmo holds the promise of continuing care at home for people with long-term conditions who would otherwise often need more intense and expensive institutional care. Medicare home health payment caps, however, would create a barrier to this care and provide a disincentive to home health agencies to offer care to this particularly vulnerable population.