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Medicare Has Already Been Privatized. And That’s Not Good News.
As Drew Altman of Kaiser Family Foundation wrote in the Wall Street Journal (4/15/2016):
“To some degree many changes long sought by conservatives are already happening incrementally: More than half of Medicaid beneficiaries are in private managed-care plans. Almost one-third of Medicare beneficiaries are enrolled in private Medicare Advantage Plans this year, rather than the traditional program, and the share is projected to grow to more than 40% by 2026. The same is true of private health insurance. Conservatives complain about the ACA, but their preferred vision of health insurance–with high deductibles and lots of “skin in the game” plans–is dominating in the marketplace. The trend is reinforced by many of the policies being sold in the ACA’s insurance marketplaces.”
Proposed Budget Seeks to Reduce Dramatic Rise in Part B Costs: Advocates Remain Concerned About Underlying Causes
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Medicare is 50!
The 50th anniversary of Medicare has given us an opportunity to reflect on all it has accomplished to advance the health and well-being of families throughout the country. It also reminds us what could have been better – and what could still be improved.
We are thankful for the vision and fortitude of President Johnson and policy-makers in 1964 who insisted on a national program and refused its funding to segregated hospitals. We thank the 1972 Congress that added people with disabilities to those who receive Medicare coverage. We are grateful to those who expanded home health coverage in 1980 and added hospice coverage in 1982. We honor the years between 1965 and 1990 when Americans were willing to pay slightly more in payroll taxes to expand benefits. We recognize recent improvements to Medicare included in the Affordable Care Act – adding value to Part D drug coverage, new and no-cost preventive benefits to Part B, and years to the solvency of the Part A Trust Fund.
We remember the short-lived Medicare Catastrophic Coverage Act, which greatly added to coverage for nursing home care, added a respite benefit, and Part B drug coverage – and we regret its repeal. We are grateful for the 2006 addition of drug coverage, but regret it is only available through private plans. We appreciate all the support for Medicare and its anniversary, but regret the ever-increasing fragmenting and privatizing of the program. We are grateful for all Medicare has done to expand access to health care for older and disabled people, but fear it is becoming more oriented towards providers, insurance and pharmaceutical industries, and less focused on the needs and financial abilities of Medicare beneficiaries.
We celebrate Medicare with a renewed commitment to enhancing the well-being of older people, people with disabilities and their families. We call on those in power to honor Medicare by:
• Including a prescription drug benefit in Part B;
• Insisting on the best price for all Medicare-covered medications;
• Committing to parity between private Medicare Advantage and traditional Medicare payments;
• Adding dental, hearing aide, and vision coverage;
• Developing a long-term services and support benefit; and
• Ensuring access to a fair and accurate appeals system.
Medicare has been an incredible success. It’s our turn to ensure it continues, in more than name only, and opens doors to health care and economic security for future generations.
Supreme!
The Supreme Court moved the arc towards justice and fair access to health care a bit closer with its decision in King v. Burwell (6/25/2015). The 6-3 decision, written by Chief Justice Roberts, sends a clear message that the Affordable Care Act is the law of the land.
As Justice Roberts stated, the intent of the Affordable Care Act is to build up, not diminish health insurance market places. Further, basic legal process calls for statutory provisions to be read to meet the overall intent of the law. This is not legal over-reach; it’s a standard taught in first-year law school. In King v. Burwell this long-accepted legal analysis results in the Court’s conclusion that subsidies to help people pay for health insurance are available in all Affordable Care Act markets, whether they are established by the individual state or federal government.
The Supreme Court followed basic legal analysis to support a basic human right – access to health care.
Now it’s our turn to make it happen.
Hold The Applause
We agree it’s important to find a permanent solution to the physician payment formula (“Sustainable Growth Rate” or SGR), but the Bill passed by the House of Representatives today is not the answer. It isn’t balanced. It asks too much from beneficiaries without providing enough in return. It asks nothing from pharmaceutical or insurance companies. It continues the ever-increasing privatization of Medicare by increasing costs for beneficiaries for traditional Medicare and Medigap plans. It adds unnecessary costs for the Medicare program and taxpayers.
Of the portion of the SGR costs that will be off set, roughly half (approximately $35 billion of the total $70 billion over 10 years) would come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care, including:
• Adding deductibles to Medigap plans purchased by new Medicare beneficiaries starting in 2020;
• Further means-testing premiums for higher-income beneficiaries; and
• Overall increases in Part B premiums.
While the SGR package would make the low-income, Qualified Individual (QI), program permanent, which we strongly support, and would minimally increase and temporarily extend important funding for beneficiary education and outreach, it does not address other key issues that serve as barriers to care. For example, instead of repealing the annual outpatient therapy caps, the process to seek an exception to the cap is extended for another two years. Instead of addressing hospital Observation Status, the Bill further extends enforcement of the so-called “two-midnight” rule.
In short, Medicare beneficiaries would pay too much, with too little in return. Major drug and insurance industries pay nothing, and stand to gain a great deal. As the SGR debate moves to the Senate, we hope further balance and improvements for beneficiaries will be made.
50 Years Ago Pres. Johnson Proposed the Medicare Program
2015 is a year of anniversaries important for all families: 50 years of Medicare. 50 years of Medicaid. 80 years of Social Security.
To honor the Medicare and Medicaid anniversaries, Senator Wyden introduced a Sense of the Senate Resolution today that should pass unanimously. It celebrates Medicare (and Medicaid) by resolving to protect a real Medicare program for future generations. Importantly, the Resolution states:
“… Resolved, That it is the sense of the Senate that—
(1) all efforts to improve Medicare and Medicaid must support and build upon President Johnson’s vision ‘‘to assure the availability of and accessibility to the best healthcare to all Americans, regardless of age or geography or economic status’’;
(2) Medicare’s guaranteed benefit is a lifeline to millions of Americans and must remain intact for this and future generations;
(3) Medicare should not be transformed into a voucher program, leaving seniors and people with disabilities vulnerable to higher out-of-pocket costs;”
Sen. Wyden’s three Medicare commitments deserve support from every lawmaker who really cares about Medicare and fair access to health coverage for all older and disabled people. That was Medicare’s promise in 1965. It’s up to us, and today’s lawmakers, to ensure it remains Medicare’s promise in 2015. We hope all members of Congress will start by committing to Sen. Wyden’s Medicare resolutions.
2015 Marks the 50th Anniversary of Medicare – Help Ensure its Future
Since 1965, Medicare has opened doors to health care and increased economic security for hundreds of millions of older people, people with disabilities, and their families.
2015 will also usher in a new Congress. Many of its leaders and members will likely champion plans to further privatize Medicare. These proposals will likely surface despite increasing reports that Medicare costs and the federal deficit are declining, and that traditional Medicare costs less than private Medicare. Once again we will likely hear about plans to transform Medicare to “Premium Support” (a voucher towards the purchase of private insurance). We will probably read about proposals to increase the age of Medicare eligibility, decrease the value of Supplemental Medicare Insurance (Medigap), redesign Medicare to make it “simpler” (but less useful for most beneficiaries). We urge you to listen carefully for these and other such plans. And respond!
Since 1986, the Center for Medicare Advocacy has been on the front lines, advocating for people who depend on Medicare and for a comprehensive Medicare program for future generations. As we mark Medicare’s 50th anniversary, help us ensure its promise to advance access to healthcare. Help us explain what’s true and what’s not, where real savings exist, and when the true interests of beneficiaries are at stake. Help us ensure a real Medicare program lasts for another 50 years.
Be part of our Medicare Truth Squad. Ask us if you have questions. Spread the word – on Twitter, Facebook – in conversations! The future of a comprehensive Medicare program may depend on it.
Medicare Public Funds: Increasing Profits for Private Insurance Cos.
”The private Medicare program has been a boon for insurers the past several years, offering sizable volumes and steady profit margins. … “ It will expand in the future as Baby Boomers join Medicare Advantage plans. (Modern Health Care 12/18/2014)
Why is this allowed to continue? How can we justify cutting Medicare coverage for older and disabled people while providing ever-increasing profit margins for private insurance companies?
Wake up people!
NY Times Reports Unfair Medicare Advantage Coverage Denials
This is a scandal. Medicare Advantage plans continue to fail beneficiaries and cost taxpayers. Why don’t more people get it – or act to do something about it?
For more, see:
U.S. Finds Many Failures in Medicare Health Plans
“Federal audits found many coverage denials for medical services and prescription drugs are poorly…” @nytimes http://t.co/59LKyqkJSe
Profits Over People
In “Fighting to Honor a Father’s Last Wish: To Die at Home” (the New York Times, September 25, 2014) author Nina Bernstein eloquently lays out the heartbreaking story of Joseph Andrey, whose last year of life was spent shuttling between inadequate care in every possible care setting. Often the services he received were provided in the most expensive available setting, regardless of the wishes of the family. Mr. Andrey finally died back in his home, but that final year of his life, quite likely the lowest quality-of-life year he ever endured, cost over a million dollars in Medicare, Medicaid and private funds.
It doesn’t have to be this way.
Unfortunately, too often it is. I have devoted over 30 years as a lawyer to Medicare advocacy, yet I could not help my uncle when his Medicare coverage was prematurely ended in the hospital and the nursing home. This resulted in his ending up at home with inadequate care, and he, too, experienced many of the dreadful occurrences that befell Mr. Andrey. A day after his death, and almost a year after his premature discharge, we won his Medicare appeal. Like too many others, he died after poor care and unfair denials from his private Medicare plan. Another victim of profits over people.
CMA Health Policy Blog 