November 29, 2016 – Despite statements during the campaign that he would protect Medicare, the President-Elect is indicating otherwise with his selections of Rep. Tom Price (R-GA) to head the Department of Health & Human Services, and health consultant Seema Verma to head the Centers for Medicare & Medicaid Services.
Price is an ardent foe of the Affordable Care Act, although it has extended the solvency of the Medicare Part A Trust Fund, closed gaps in prescription drug coverage, and expanded preventive benefits under Medicare.
Particularly threatening to Medicare and Medicare beneficiaries, says Center for Medicare Advocacy Executive Director, Judith Stein, “Rep. Price favors letting people opt-out of Medicare. Allowing beneficiaries – most likely the healthiest beneficiaries – to opt out of Medicare is an example of what Newt Gingrich in 1995 called letting the program ‘wither on the vine.’ The key to future solvency is a larger coverage pool, not a smaller one. That’s just how insurance works.”
In addition, Mr. Price’s proposals to rely on tax credits as incentives to purchase insurance ignore the fact that a huge number of families don’t make enough income for such credits to be worthwhile. Further, CMS nominee Verma favors Health Savings Accounts – another private option that would break up the Medicare community. “All of these proposals,” continued Ms. Stein, “will be sold to Medicare beneficiaries as ‘preserving’ and ‘protecting’ Medicare. In fact, they will end Medicare and turn it over to the private insurance industry.”
In 1995 Newt Gingrich predicted that privatization efforts would lead Medicare to wither on the vine. He said it was unwise to get rid of Medicare right away, but envisioned a time when it would no longer exist because beneficiaries would move to private insurance plans.
Well … that’s what’s happening. Not just by happenstance, but rather according to a determined, strategic plan. The plan has included the following:
- Government subsidies to private plans, renamed “Medicare Advantage,” ranging from 14% – 2% above traditional Medicare per-beneficiary costs;
- Additional benefits added to private Medicare Advantage, benefits that weren’t added, and aren’t allowed, in traditional Medicare;
- Part D prescription drug coverage wrapped into Medicare Advantage, but not into traditional Medicare;
- Increases in traditional Medicare Part B premiums, especially for the middle class;
- Limits on access to Medigap insurance to supplement traditional Medicare and on benefits for those who can obtain a Medigap policy.
It didn’t take a crystal ball. It took a vision, planning and persistence.
The Center for Medicare Advocacy also has vision, planning and persistence. We do all we can to keep Medicare focused on the needs of older and disabled people, not the insurance industry. We speak out with expertise and with the stories of real people.
With your support, we’ll keep insisting that Medicare is fully present for the families that rely on it – now and in the future. We’re ready to keep Medicare from withering on the vine.
- Earlier generations who had the vision to launch and support Medicare to help all American families.
- The Medicare program for its invaluable contribution to desegregating American hospitals.
- The Medicare program for helping to keep older Americans out of poverty.
- The Medicare program, for insuring people with disabilities, who, like older Americans, were left behind by private insurance.
- The Affordable Care Act for provisions that strengthen Medicare coverage, and cut wasteful overpayments to private insurance companies… oh, and for giving millions of uninsured Americans coverage they never had before.
- Medicare’s coverage of preventive services, which can limit the need for future, costlier care (and which were enhanced by the Affordable Care Act).
- The freedom, flexibility and choice offered by the traditional Medicare program.
- The guaranteed, defined benefits of the traditional Medicare program.
- Our partners and fellow advocates who help us open doors to health care for the 55 million people who rely on Medicare.
- You, our supporters, who believe in the promise of a real, robust Medicare program, now and for the future.
The title of Paul Krugman’s piece in today’s NY Times says it all. The Medicare Killers tells the truth about the Trump/Ryan plan to turn back the clock on Medicare and give it away to the private insurance industry. A good deal for insurance companies, but a very bad deal for the 60 million older and disabled people who access health care through Medicare. Importantly, as Krugman writes, this is not necessary. It’s just the latest ploy to privatize Medicare. Call it what it is.
Help the Center for Medicare Advocacy speak out against false claims and misinformation that could rob older people and people with disabilities of necessary health care – and diminish Medicare for generations to come. Spread the word. Tell the truth about Medicare.
Speaker Paul Ryan is already in the news saying that because of “Obamacare” Medicare is going broke (Fox News, 11/13/2016). As a consequence, he says, he intends to bring back his plan to privatize Medicare and change it into a voucher system. Under his plan, individuals would be given a set amount to help pay premiums for insurance on the open market. This tired idea is not necessary and not best for Medicare beneficiaries or taxpayers – all of whom would pay more and get less under the Ryan plan. It would “save” Medicare in name only.
The truth is Obamacare is good for Medicare and Medicare beneficiaries. It added about 10 years to the solvency of the Medicare trust fund, preventive benefits with no co-pays, and reduced prescription drug prices for beneficiaries. Surely Mr. Ryan knows this.
The truth matters. Pass it on.
For more information see the Washington Post article that gives Ryan’s statement “4 Pinnochios,” their fact-checker’s worst rating for accuracy.
It’s no surprise that the election has left many of us worried and disoriented. But we’ll regroup.
We may not understand where we’ve landed, but we’ll acclimate and march forward – with hope.
We hope the new administration will realize how today’s families are balancing – often barely – all the responsibilities they face at home and work. We hope they’ll think about the sick kids, older and disabled people who need health care and what it’s like for them and their caregivers when they can’t afford it, or can’t navigate our health insurance maze. We hope the administration will consider their needs, before the profits of insurance and pharmaceutical companies.
We hope they’ll remember why Medicare was enacted and how best to ensure it helps today’s beneficiaries as well as coming generations. We needed Medicare because private insurance failed to cover 50% of older people. We hope they won’t turn back history by giving Medicare away to that private insurance world, a world that didn’t, and doesn’t, want to insure people who most need health care.
We hope they will keep traditional Medicare strong and not waste precious public dollars on private Medicare Advantage, a voucher system, and prescription drug company profits.
We hope they’ll make sure Medicare covers quality health care that doctors order and patients need. We hope they won’t let the Medicare claim system save money intended for health care by denying coverage and access to care. We hope they’ll let their Contractors know that homebound people with Medicare who need home health care are supposed to get it. Paralyzed people who need physical therapy to maintain what function they have are supposed to get therapy. Grandparents who need to get hospital care overnight are supposed to be admitted as inpatients.
We hope the deal made with generations of workers to preserve a real Medicare program will be honored.
We’re ready to be as collaborative as we can be, and as strong as we must be, to advocate for people in need.
We’ll keep hoping and working to ensure access to quality health care, income security and justice.
We’ll gather the energy to insist on fairness for everyone. Our heads may be spinning, but we will continue to advance our Mission.
It’s never been more important. And it’s the best cure for these unsettled times.
We move forward with determination, and hope.
This summer, the New York Times article “New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage”* told the story of one of many people who contact the Center for Medicare Advocacy for help with hospital “outpatient” Observation Status. These patients stayed in the hospital for multiple days receiving skilled care, but were coded for billing purposes as “outpatients,” often with disastrous financial consequences for the individual.
Ms. Cannon was a patient in a hospital outside Philadelphia where she was said to be an “outpatient” on Observation Status for six and a half days. After discharge from the hospital, Ms. Cannon spent nearly five months in a nursing home for rehabilitation and skilled nursing care at a cost of over $40,000. Unfortunately, the hospital insisted that Ms. Cannon had never been formally admitted as an inpatient, despite being treated inside the hospital. This distinction has far reaching implications under federal rules; in short, Medicare would not pay for her nursing home stay. She was responsible for the entire cost.
The Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare are fighting to fix this. Sign the petition urging Medicare to stop the misuse of “Observation Status” today.
The Center hears stories like Ms. Cannon’s every week. “Outpatient” Observation Status hurts Medicare beneficiaries and reduces trust in the Medicare program and between patients and their physicians. We know that, but we need to make sure the Medicare agency knows it too. For example:
- So-called “outpatient” Observation Status is not about the location or care a patient actually receives. It’s a billing code used by hospitals to protect from overzealous auditors.
- Medicare beneficiaries in “outpatient” Observation Status cannot get any Medicare coverage for post-hospital nursing home stays, resulting in huge, unexpected expenses that beneficiaries think Medicare will cover. Too often, people go without this care because they can’t afford it.
- Medicare beneficiaries in “outpatient” Observation Status do not have a right to hospital discharge planning, so must figure out next steps on their own.
- Medicare beneficiaries in “outpatient” Observation Status usually must pay for prescription drugs in the hospital – another surprise cost.
- Medicare beneficiaries in “outpatient” Observation Status cannot appeal after-the-fact to try to change their status from hospital outpatient to inpatient.
“Observation Status” may seem like just a matter of paperwork, but for Medicare beneficiaries it can ruin lives – and it can happen to anyone.
Judith Stein, J.D.
Center for Medicare Advocacy, Inc.
Max Richtman, J.D.
National Committee to Preserve Social Security and Medicare