Posts filed under ‘Medicare’
Private Medicare Costs Too Much – THAT’S Why The Payments Should Be Cut
If Republicans and “conservative” Democrats really want to save money, help taxpayers, and serve Medicare beneficiaries, they will cut the wasteful subsidies to private Medicare plans. Private Medicare plans cost taxpayers about 14% more than would be needed to cover the same services in the traditional, public Medicare program. Private plans should be paid the same rate as original Medicare; we simply can’t afford otherwise. The subsidies to private “Medicare Advantage” plans cost taxpayers about $10 billion a year!
Congratulations America: Healthcare Reform is Moving Forward
The Center for Medicare Advocacy is grateful to those who courageously voted for the Affordable Health Care for America Act, H.R. 3962. This legislation goes a long way towards ensuring for all Americans the peace of mind that was brought to older people and their families with the passage of Medicare in 1965.
Medicare itself is based on the notion of a shared a public/private undertaking and of pooling resources for the common good. In Medicare’s case, the common good is that of older people, people with disabilities and their families. The Affordable Health Care for America Act advances the common good to all Americans by expanding access to health care to America’s uninsured and by implementing private market insurance reforms.
Among other things, the legislation passed by the House of Representatives will:
- Provide affordable health insurance options for those currently without coverage;
- Provide a Public Insurance option to provide competition with private insurance and keep costs down for individuals and taxpayers;
- Prevent insurance companies from denying coverage to those with pre-existing conditions;
- Prevent insurance companies from dropping the coverage of those who get sick;
- Prohibit insurance companies from having life-time limits on benefits;
- Ensure that insurance companies offer real value for premiums paid;
- Strengthen Medicare for the more than 44 million older people and people with disabilities who currently use the program and for future generations of beneficiaries;
- Improve Medicare’s payment to doctors and thus ensure that Medicare beneficiaries can continue, as they do now, to see the doctor of their choice or find a doctor if they need one;
- Require Medicare, as well as private insurance, to provide preventive benefits without application of cost-sharing;
- Promote care coordination in Medicare – especially for those with multiple chronic conditions – through various pilot projects;
- Improve access to Medicare-covered services for low-income beneficiaries by strengthening the programs that serve these individuals;
- Lower drug costs for Medicare beneficiaries by closing the Medicare Part D “Donut Hole” coverage gap
- Lower drug costs for Medicare beneficiaries by allowing the government to negotiate for lower drug prices with pharmaceutical companies;
- Provide benefits to help older people and people with disabilities live in their own homes and communities by establishing the Community Living Assistance Services and Supports (CLASS) program.
The Center for Medicare Advocacy applauds President Obama, Speaker Pelosi and all members of the House of Representatives who have worked so hard to bring this legislation to life. We urge the Senate to follow suit soon!
Kaiser Family Foundation Ad Audit: Message Sacrifices Truth About Health Bills And Medicare
AD TITLE: “Greatest Generation”
SPONSOR: The 60 Plus Association
SUMMARY: A conservative advocacy group uses testimony from sympathetic older Americans to warn that a health care overhaul would impair Medicare, the government health care program for the elderly. The ad says older Americans should be shielded from spending cuts because of their great sacrifices for the country. But it’s truth that’s sacrificed here: the ad exaggerates the impact of proposed Medicare cuts and ignores some improvements in Medicare benefits included in the main Democratic bills before Congress.
BACKGROUND: The 60 Plus Association, a nonprofit advocacy group that bills itself as a conservative counterweight to AARP, favors lower taxes and less government. The group says it is has purchased $2 million in airtime in eight states that are homes to key senators: Alaska, Arkansas, Connecticut, Louisiana, Maine, Nebraska, North Dakota and South Dakota. The ads come in 30-second and 60-second versions.
POLITICS: The ad is part of a broader effort to increase concerns among older Americans about pending health care legislation. The insurance industry’s main lobbying group, America’s Health Insurance Plans, made a similar argument in ads last month. Both AHIP and 60 Plus are upset about proposals to create government-run insurance that would compete with private companies in selling coverage to people under age 65. Since many surveys show substantial support for the public option, however, the opponents are focusing on something else: The bills’ potential impact on the popular Medicare program.
ACCURACY: The health bills would reduce Medicare spending, but it’s highly unlikely medical care for the elderly would suffer, many health analysts say. “This ad is clearly intended to frighten people with a great deal of misinformation,” says Judith Stein, executive director of the Center for Medicare Advocacy, a Connecticut-based nonprofit that helps people secure Medicare benefits.
Under the Senate Finance Committee bill, Medicare spending, on net, would be $379 billion less over a decade, or about 5 percent of program expenditures, than under current law. In both that bill and the House proposal, a big chunk of the cuts would involve Medicare Advantage plans that are run by private insurers and often provide additional benefits beyond what traditional fee-for-service Medicare offers. The Finance bill targets Medicare Advantage for $117 billion in cutbacks over a decade; the House bill, $170 billion, according to the Congressional Budget Office.
Congress is eyeing Medicare Advantage plans largely because they spend an average of about 14 percent more on their members than traditional Medicare spends on its beneficiaries. If the cuts are enacted, the number of Medicare Advantage plans might decline. In addition, those that survive might pare back some of the extra benefits they offer, such as low or zero monthly premiums, dental care and free gym memberships. But no one would be denied basic Medicare benefits.
On the other hand, not all the proposed reductions would be painless – especially for the providers who would bear the brunt of other Medicare cuts. Overall, though, the cuts would be substantially less than the reductions approved by Congress in 1997 to balance the federal budget deficit, according to Tricia Neuman, a Medicare expert at the Kaiser Family Foundation. (KHN is a part of the foundation.) Congress ended up restoring some of that money a few years later. Lawmakers were worried some of the reductions, including those for skilled nursing facilities, were too severe. “It’s hard to anticipate changes in the health care system,” Neuman says. “Ongoing tweaks may be necessary.”
The ad’s warning about the rationing of “potentially life-saving drugs” lacks support. The 60 Plus Association tries to back up this claim by citing a few news stories about patients in England and Canada denied drugs by government insurers. But far from restricting access to drugs, “ironically, there are enhancements to the Medicare drug benefits” in the health overhaul bills, says Paul Ginsburg, president of the Center for Studying Health System Change, a Washington research group.
The bills being debated would eliminate co-payments for preventive services. In addition, the House bill would provide a 50 percent discount on brand-name drugs purchased when beneficiaries hit the coverage gap known as the “doughnut hole,” and it would gradually eliminate the gap. The Senate Finance bill would not close the doughnut hole, but it would provide the discount, which was negotiated with the Obama administration and the pharmaceutical lobby earlier this year. The House bill also would require Medicare to cover immunosuppressive drugs for as long as kidney transplant recipients need them, rather than for the current 36 months.
Overall the ad’s argument is built on a logical inconsistency: It raises the specter of “government-run health care” to increase concerns among both young and old. But at the same time it extols Medicare – which is government-run health care for people 65 and older.
Source: Kaiser Health News, Jordan Rau, KHN Staff Writer
Say It Ain’t So, Joe
We hear that Senator Lieberman is prepared to join Republicans to filibuster against health care reform if it includes a public option. We can’t understand our Senator’s position.
The Center for Medicare Advocacy is a Connecticut-based organization with over 30 Connecticut employees. We have worked for decades to advance fair access to health coverage and care for residents of Connecticut. We have seen the painful ramifications when Medicare private plans came and went from Connecticut – leaving tremendous financial and emotional costs in their wake. In one case, a Medicare beneficiary died at a forum about a private Medicare plan that was leaving Connecticut! We were there.
As Senate Majority Leader Harry Reid said when he announced Monday that the bill he will bring to the Senate floor will include a public option, “I’ve concluded … that the best way to move forward is to include a public option with the opt-out provision for states. .. The public option, with an opt-out, is the one that’s fair.” ( Read more here.)
The public option is necessary to provide fair access to quality health coverage at a price taxpayers can afford. We know that from Medicare. We know that in Connecticut. We urge our Senator to rethink his position.
Dear Senator Dodd
We have avoided adding to the myriad requests we know you must be getting now that you are helping to develop a final Senate health care reform bill. But, it’s quickly becoming now or never, so we write about two of our main concerns:
- The Center for Medicare Advocacy is concerned about the Medicare Commission that the White House seems to envision and that the Finance Committee passed. While we understand the value of a payment commission from some points of view, we, and others who represent Medicare beneficiaries, are terribly concerned about provisions that would essentially empower an unelected Commission to cap Medicare funding. There is no justification for such unilateral Medicare cost-containment. (Except regarding private Medicare Advantage. We have been stating, and will continue to explain, that cuts to the outlandish, wasteful Medicare Advantage subsidies are completely justified.) A Commission empowered to cap overall Medicare funding threatens the future of the traditional Medicare program and is dangerous to older and disabled people. This is sadly ironic since such a Commission could essentially create the very kind of privatized, capped Medicare program that Newt Gingrich envisioned when he said that, “while we may not be able to kill Medicare, we can make it wither on the vine”.
- As you know, the Center for Medicare Advocacy is highly supportive of a real public option in health care reform. We are grateful for your active support for this key component of true reform. We know all too well how private Medicare Part D and Medicare Advantage plans have often abused the system, profited the insurance industry, and endangered the financial well-being of traditional Medicare. To replicate this system by having a private – only – health care reform system is simply to repeat history and to once again give away taxpayer dollars to big industry.
Thank you for all you are doing to bring health care access to all and reason to the health care system. Please let us know if we can help.
Fiscally Conservative? Support A Public Option!
In the Senate Finance Committee, Arkansas Senator Blanche Lincoln voted against including a public option in health care reform. She explains that her opposition to a public option rests with her knowledge that Arkansas voters are “fiscally responsible”. We hope she will yet realize that anyone whose real concern is fiscal responsibility will support a public plan option.
No matter how much one might want to believe that the private market is always a more cost-effective model than a public program … it just ain’t so. Medicare proves the point.
- When Medicare private plans were paid 95% of what it costs to provide the same coverage in the public program, they left the program in droves. They couldn’t make enough profit. (“Medicare+Choice,” enacted in 1997.)
- Under the “Medicare Advantage” program, passed in 2003, private Medicare plans are paid about 14% more than the same coverage would cost in the traditional public Medicare program. And, not surprisingly, private insurance plans have flocked back into the system. The insurance industry is making a windfall from this system – at the expense of all Medicare beneficiaries, including the vast majority of beneficiaries who still choose “regular Medicare.” Taxpayers overpay too.
- The private Medicare plan program is bleeding the Medicare trust fund, reducing Medicare’s solvency by about 8 years.
If the Congress passes a requirement that all Americans have health insurance, but does not provide for a public option, we will have been taken to the cleaners yet again. Private insurance will gain tens of millions of new customers and we taxpayers will all pay a much higher bill than is necessary. Medicare’s experience proves this.
Come on, Senator Lincoln, be fiscally responsible – support a public option in health care reform!
Medicare Private Insurance Companies Are At It Again
Late last week Humana, one of the largest private insurance companies offering Medicare Advantage and prescription drug plans under Medicare, sent a letter to the Medicare beneficiaries enrolled in their HMOs and other Medicare Advantage plans. The outside envelope warned that the letter contained important information about their Medicare benefits. The letter itself said that Congress was considering cuts to Medicare in its health care reform legislation, these cuts would result in reduced benefits for Humana plan enrollees, and enrollees should contact their members of Congress to protest the cuts.
This is not the first time that private Medicare plans have written their enrollees with misinformation about alleged Medicare cuts. The Center for Medicare Advocacy and a number of other beneficiary organizations have been concerned for years about these kinds of mailings by private Medicare plans. We recently asked CMS to modify its guidance to private Medicare plans in order to specifically identify these communications as marketing materials, which are subject to CMS oversight and review. We said in our comments:
We are very concerned about plan sponsors soliciting their enrollees to join “grassroots” efforts to influence Medicare policy via member newsletters and other means. …We believe there should be a prohibition on plan sponsors soliciting members’ participation in political activities, particularly those that benefit the plan sponsor, and urge CMS to analyze whether such activity already violates current law.
CMS did not amend its guidance to plans per our suggestion, but it did take swift action against Humana. CMS sent a letter to Humana yesterday telling the organization to stop sending misleading and confusing communications, and that it believed such communications are potentially contrary to federal regulations and guidance. CMS further advised that the agency takes this matter very seriously and could pursue compliance and enforcement actions. CMS also sent a comparable memo to all private insurance companies telling them not to send similar communications.
We thank CMS for acting so swiftly to curb misleading and confusing communications to people in their Medicare plans. While we are pleased that the government is exercising its oversight and enforcement authority, we see this incident as another example of how reliance on private insurance companies can generate confusion and fear for Medicare beneficiaries. This happens because the interests of private Medicare plans are not always in accord with the interests of Medicare beneficiaries.
How Will We Know If Good Enough is Good Enough?
We now have four health care reform bills and a proposal from the Senate Finance Committeee, the last of the Congressional committees with jurisdiction over this topic. None of the bills are perfect and the Senate Finance Committee’s proposal, lacking both a public option and any Republican support, is the most disappointing. Still, as Paul Krugman writes in today’s New York Times, several countries, including Switzerland and the Netherlands, manage to provide health insurance for all largely through the private market.
So, how will we know if we should support what emerges as the final health care reform bill? Here are six key standards to determine whether the final bill is good enough to support – let us know if you have others:
- Will the bill make quality health care coverage available to all, especially to the uninsured, underinsured, and those who will fall into these categories in the future?
- Will the bill provide real competition in the market place, with or without, a true public plan, so that reform will be reasonably affordable?
- Will the bill provide adequate help for people of low and moderate incomes to purchase good quality health coverage ?
- Will the bill preserve and fairly enhance the Medicare program for future generations?
- Will the new coverage be adequately comprenhensive, understandable and easy to use?
- Will the new law provide a fair, accessible appeal system for people to contest denials?
I am often told not to let the perfect be the enemy of the good. We will not get “the perfect” health care plan. We may not even get “the good”. But – will we get “the good enough”? Too soon to tell.
They All Clapped
Okay, maybe not everybody, but most members of Congress, Democrats and Republicans, applauded last night when President Obama pledged to safeguard Medicare, calling it a “sacred trust” with older Americans.
What the President didn’t say, and what too many people forget, or try to, is that Medicare IS a public health insurance program. It was created and is broadly implemented by the federal government; claims are administered by private insurance companies. For everyone who applauds Medicare – and most people do – support a public option so we can pass the sacred trust of health care security on to younger generations!
CMA Health Policy Blog 