Posts filed under ‘Reform’

Medicare Platform: Core Considerations for Today & Tomorrow

The Center for Medicare Advocacy works for a comprehensive Medicare program and quality health coverage and care for all people. To accomplish these goals for current and future beneficiaries in the changing health care environment, we seek to:

  • Improve Medicare for current and future beneficiaries.
  • Support the development of the best method possible to increase access to quality health coverage and care for the most people.

Medicare Platform to Improve Medicare for all beneficiaries, now and in the future:

1. Consumer Protections and Quality Coverage for All Medicare Beneficiaries (Including Parity Between Traditional Medicare and Medicare Advantage)

  • Cap out-of-pocket costs in traditional Medicare
  • Require Medigap plans to be available to all individuals in traditional Medicare, regardless of pre-existing conditions and age (“Guarantee Issue” and “Community Rating”)
  • Ensure all benefits in Medicare Advantage are also available in traditional Medicare
    • For example, include all MA “supplemental benefits,” waiver of 3-day prior hospital stay requirement for SNF coverage, coverage for home health aides, coordinated care
  • Simplify enrollment in traditional Medicare, Part D and Medigap, and ease transitions from other insurances to Medicare
  • Improve consumer protections in Medicare Advantage
    • Standardize benefit packages,
    • Strengthen network adequacy requirements
    • Strengthen plan oversight
    • Strengthen marketing protections
  • Ensure parity between mental health and physical health coverage
  • Ensure the Medicare appeals system is cost-effective, accessible and fair

2. Reduce Ongoing Barriers to Care

  • Eliminate the harm of hospital “Observation Status”
  • Home Health – Ensure access to coverage is actually available for all beneficiaries who meet coverage criteria, ensure access to legally authorized home health aides, resolve conflicts between payment models and coverage laws
  • Jimmo Implementation – Ensure beneficiaries with longer-term, chronic, and/or debilitating conditions have full access to skilled nursing, therapy and related care needed to maintain their conditions or slow decline

3. Improve Traditional Medicare

  • Add oral health, audiology, vision coverage
  • Restructure Medicare to make it comprehensive, simpler and affordable
  • Increase Low-Income Protections in the Medicare Savings Program (at least on par with ACA subsidies)
  • Long-term Care – Add coverage over time. For now, make incremental improvements (For example, repeal homebound requirement for home health coverage, repeal requirement that individual need skilled care and be homebound to qualify for home health aide coverage, repeal requirement that DME generally be needed in the home)

1/2019

January 30, 2019 at 3:11 pm Leave a comment

Time to Renew, Not Repeal or Retreat!

Last week, an older adult wrote the Center for Medicare Advocacy:

“I will be on the streets at 66 years old without Medicare and Medicaid.  It’s as simple as that.  My money has all gone raising 3 granddaughters after their mother died.  There are millions of stories like mine everywhere.  We must help the least of us that had bad luck or are sick etc.” J.D., Medicare Beneficiary, Michigan

This week, on its first day, Congress passed a Resolution that begins the process to repeal the Affordable Care Act (ACA). Repealing ACA threatens access to health coverage and Medicaid for 20 million people. It would also reduce Medicare prescription drug coverage, reduce Medicare preventive benefits, and decrease the long-term solvency of the Medicare program.

ACA, Medicare and Medicaid are intertwined. Repealing the Affordable Care Act would also harm Medicare and Medicaid. It would harm the people, like Mrs. D, who raised her own family and is now raising her grandchildren.

Policy-makers need to know how their decisions impact real people. If you know someone who has benefited from the Affordable Care Act, Medicare and/or Medicaid –  Tell Your Story!

January 4, 2017 at 11:26 pm Leave a comment

The Rush to Destroy Medicare as We Know It

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.”

 

November 29, 2016 at 5:44 pm Leave a comment

Medicare Is Withering on the Vine

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:

  1. Government subsidies to private plans, renamed “Medicare Advantage,” ranging from 14% –  2% above traditional Medicare per-beneficiary costs;
  2. Additional benefits added to private Medicare Advantage, benefits that weren’t added, and aren’t allowed, in  traditional Medicare;
  3. Part D prescription drug coverage wrapped into Medicare Advantage, but not into traditional Medicare;
  4. Increases in traditional Medicare Part B premiums, especially for the middle class;
  5. 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.

Will you help?

November 28, 2016 at 4:48 pm Leave a comment

Telling It Like It Is: The Ryan Plan Would Kill Medicare

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.

November 18, 2016 at 4:35 pm Leave a comment

As We’ve Been Saying!

Finally, the Center’s long-time concerns about costly misuse of public Medicare funds may be gaining attention. For years we’ve been pointing to Medicare overpayments for prescription drugs and to private Medicare Advantage plans. These huge expenditures help pharmaceutical and insurance industries, not older and disabled people. If these costs were reigned in, billions of dollars would be freed to cover necessary health care and sustain the Medicare program. This week these matters received some much needed publicity:

Prescription Drug Pricing

An excellent and well-timed (given #Epi-gate) article appeared in this week’s Journal of the American Medical Association discussing the reason drug costs are so high in the U.S. According to the article, the major cause is the “granting of government-protected monopolies to drug manufacturers, combined with restriction of price negotiation at a level not observed in other industrialized nations.” Thus, state the authors, “providing greater opportunities for meaningful price negotiation by governmental payers” is one of the conclusions. A “possible solution” is described as “Price negotiation: Enable Medicare to negotiate drug prices for individual Part D plans and to exclude coverage for expensive products that add limited clinical benefit; experiment with value-based drug pricing and rational prescribing reimbursement models for Medicare.” For more information, see http://jama.jamanetwork.com/article.aspx?articleid=2545691#.V8OQC8OH7Hg.twitter

Medicare Advantage Overpayments

NPR recently published an article from the Center for Public Integrity entitled “Medicare Advantage Audits Reveal Pervasive Overcharges” (August 29, 2016) by Fred Schulte. The article reports on recently-released federal audits of 37 Medicare Advantage (MA) plans relating to overpayments made in 2007. According to the author, these “audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression.”
As discussed in previous Alerts, including one in May 2016 entitled “Government Auditor Finds Billions in Improper Payments to Medicare Advantage Plans Coupled with Inadequate Oversight by Federal Regulator,” MA “upcoding” – when an MA plan reports an enrollee as being more sick than they actually are in order to obtain a higher risk-adjusted payment from the Medicare program – remains a problem that policymakers must address, particularly as they weigh policy proposals that would shift additional costs on to Medicare beneficiaries.

August 31, 2016 at 9:45 pm Leave a comment

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.

July 30, 2015 at 2:21 pm Leave a comment

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We provide effective, innovative opportunities to impact federal Medicare and health care policies and legislation in order to advance fair access to Medicare and quality health care.

Judith A. Stein, Executive Director

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