Protecting Medicare and the Middle Class: Themes From The State of the Union
As described in his State of the Union address, the President’s blueprint for a lasting economy is both necessary and commendable. An essential part of that blueprint is ensuring all Americans have access to high-quality, affordable health care. As the President stated, we need to ensure that Medicare “remain[s] a guarantee of security” for older Americans and individuals with disabilities. When private insurance let older people down in the 1960s, Americans embraced the President’s theme of “shared responsibility” to care for our most vulnerable citizens by creating Medicare. While the economic security of the middle class has declined for decades, Medicare has dramatically enhanced the economic and health security of hundreds of millions of older Americans and people with disabilities.
And yet, the future of Medicare hangs in the balance as members of Congress discuss ways to privatize Medicare and diminish the security it provides for middle class families.
“We applaud the President’s commitment to continuing Medicare as a community program that families can rely on,” states Judith Stein, founder and executive director of the Center for Medicare Advocacy. “Medicare is an American success story. It has served American families and adapted with the times for more than four decades. It has provided a critical economic lifeline for families” she continued. “We can not afford to risk the security of the next generation by giving Medicare away to private insurance companies.”
The Center for Medicare Advocacy also echoes the President’s call to uphold the consumer protections and health coverage in the Affordable Care Act. “The Affordable Care Act greatly enhanced Medicare,” says David Lipschutz, policy attorney at the Center for Medicare Advocacy. “Since it was signed into law, millions of older and disabled Americans with Medicare have received more help in paying for their prescription drugs, putting money back into their pockets. Among other things, the Affordable Care Act has also added no-cost preventive benefits for people with Medicare and extended the solvency of the program.”
Medicare is a tried and true American value that provides high-quality, cost efficient health care for our grandparents, parents, neighbors and friends. “Pretending to protect Medicare by shifting costs from the federal government back to older people and their families would negate Medicare’s original purpose: to protect older people and their families from illness and financial ruin due to health care costs,” said Judith Stein. “We thank the President for defending Medicare’s guarantee of security and resisting calls for a private voucher system that would further endanger the middle class and destroy the national treasure we’ve known as Medicare.”
Perhaps Someone IS Listening
The NY Times editorial of 12/18/2011, “Working with Medicare,” picks up on some ideas the Center has been espousing for years:
- Negotiate drug prices for Medicare beneficiaries.
- Let the Affordable Care Act do its job.
- Be careful regarding private plans, premium support and too much cost-shifting to beneficiaries.
- The REAL solution to Medicare costs lies in addressing health care costs in general.
CMA in the New York Times: Don’t Privatize Medicare
http://www.nytimes.com/2011/12/10/opinion/medicare-and-private-health-insurance.html
Medicare “Reform” – Beware the Wolf in Sheep’s Clothing
This week, Rep. Paul Ryan (R-WI) and Sen. Ron Wyden (D-OR) outlined yet another effort to privatize Medicare; a twist on Rep. Ryan’s voucher plan from earlier this year.
The new proposal would supposedly “preserve” the traditional Medicare program, but force it to compete with private plans. Similar to the earlier Ryan voucher plan, which the Congressional Budget Office estimated would cost Medicare beneficiaries twice as much as traditional Medicare, this one is based on the flawed assumption that private plans will save Medicare money through competition and innovation. The belief that privatization will drive down costs is not based in fact.
On the contrary, private plans have not saved Medicare money, and often cost more than traditional Medicare. In fact, traditional Medicare — not private plans — has been the leader in innovations to keep health costs down and increase quality.
Under the latest Ryan privatization plan, beneficiaries would have a voucher to purchase a health plan (including traditional Medicare), and there would be a cap on the overall amount of Medicare spending per beneficiary. If a plan (including traditional Medicare) cost more than the voucher amount, then the beneficiary would have to pay the difference between the actual price and the voucher.
If traditional Medicare is forced to compete with private, for-profit plans, as Ryan proposes, private plans will work to minimize their spending, and woo the least costly beneficiaries. If beneficiaries that are more expensive to treat remain in traditional Medicare, it will be at a built-in competitive disadvantage, and might well become unsustainable.
The math is pretty simple. If beneficiaries pay more for health care, the federal government will save money. That’s where these federal savings come from. But this approach won’t do anything to reduce overall health care spending, which is the real problem. Instead, it will likely lead to reduction in benefits and increase cost-sharing for Medicare beneficiaries. Don’t be fooled into thinking this proposal protects and preserves Medicare – it eliminates a unified program.
Traditional Medicare has changed dramatically since its inception in 1965. It has been a cost-effective health care insurance model leading to innovation, access to care and economic security. But Medicare has been complicated and made more expensive by adding layers of private options. Further, as Medicare becomes more and more fragmented and traditional Medicare loses enrollment, it loses its bargaining power over health care costs and its ability to create innovations in the broader health system.
Untethered from the overspending and complexities that have been foisted on Medicare by private plans and non-negotiable drug prices, it could once again be a model, for affordable health insurance. Traditional Medicare needs to be strengthened with fewer, not more private options.
CMA Responds to the NY Times: Don’t Privatize Medicare!
Dec. 4, 2011
The New York Times
620 Eighth Avenue
New York, NY 10018
To the Editor:
Your December 4, 2011 editorial (”What About Premium Support?” ) about changing Medicare into a voucher system wisely states many of the problems with public subsidies of private health insurance for Medicare beneficiaries. All such experiments have cost more and provided less value to those in need of coverage.
I have been an advocate for Medicare beneficiaries for almost 35 years. I’ve seen numerous forays into privatizing Medicare. Clinton-era plans, Medicare Plus Choice, Medicare Advantage: none of them have provided better coverage more cost-effectively than the traditional Medicare program.
I don’t recommend a private plan to my mother. That should be a good test for anyone championing premium support.
Additionally, ever-increasing private options have made Medicare too complex, especially given the very limited number of advocates available to help beneficiaries understand, choose and navigate the system.
Call it what you will, ”premium support” is the latest jingle for privatizing Medicare. It’s not a new or creative idea, and it will only add more costs and confusion. What we need is an objective look at what’s needed to encourage participation and cost efficiencies in traditional Medicare, not further adventures in privatization.
JUDITH STEIN
Executive Director
Center for Medicare Advocacy
No Deal is Better Than a Bad Deal
The Center for Medicare Advocacy is neither particularly surprised nor terribly disappointed that the Super Committee did not reach a budget cutting agreement. Many of the Medicare proposals the Committee was considering, such as increasing the age of eligibility and increasing cost-sharing for beneficiaries, would be harmful to the Medicare program and to older and disabled people while not decreasing overall health care costs.
There are ways to strengthen Medicare and reduce costs – such as requiring Medicare to negotiate drug prices, never paying private Medicare plans more than traditional Medicare, adding a drug benefit to the traditional program, lowering the age of Medicare eligibility, and letting the Affordable Care Act do its job. The Center for Medicare Advocacy has long advocated these ideas, and others like them, that would achieve real cost-savings without harming beneficiaries or ending Medicare altogether.
There is still time to secure the financial welfare of Medicare and the country, without doing so at the expense of older, disabled people and their families. There are solutions if those in authority will insist on spending only what is necessary to provide fair health coverage, and refuse spending one dime to change Medicare into a publicly-funded opportunity for private insurance and pharmaceutical companies.
With the end of the Super Committee, decision-makers have a new opportunity to carefully explore such solutions. If politicians find the will, there are ways to save Medicare, meet the needs of its beneficiaries and decrease costs.
Breaking Good News for Medicare Beneficiaries
Part B Cost-Sharing Lower Than Expected for 2012
Today the Obama Administration announced that Part B cost-sharing will be less than projected for all beneficiaries in 2012. The Part B deductible will decrease by $22 in 2012, from $162 per year in 2011 to $140 in 2012. Further, monthly Part B premiums will increase only slightly for those beneficiaries who have not had an increase in the last two years. Because there will be a cost-of-living increase for Social Security recipients in 2012, the Part B premium will increase, but only by $3.50 – from $96.40 in 2011 to $99.90 in 2012.[1] For those individuals who did have Part B premium increases in 2010 and 2011, the premium will actually decrease by $15.10 in 2012, from $115 to $99.90.
The Part B premium reductions are a result of slower Part B growth due in part to health care reform. The Affordable Care Act’s lower payment rates, reduced payments to private Medicare plans, and increased efforts to fight fraud and abuse are major factors contributing to this good news for Medicare, beneficiaries, and taxpayers. At the same time, health care reform has increased the value of Medicare – reducing beneficiary costs for prescription drugs, adding preventive care coverage, and eliminating cost-sharing for most preventive services.
In summary, between reduced Part B premiums and increased Social Security payments, the average Social Security recipient will have a net cost-of-living increase of $40 per month in 2012. Good news indeed.
_______________________________
[1] In 2010 and 2011, most beneficiaries were “held harmless” from the Part B premium increase because they did not have an increase in their Social Security.
Federal Judge Refuses To Dismiss Medicare Beneficiaries’ Challenge To The Medicare “Improvement Standard”
Plaintiffs have overcome a major hurdle in a lawsuit filed by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of Medicare beneficiaries with long-term and chronic conditions. In a comprehensive 35-page decision, Chief Judge Christina Reiss refused the federal government’s request to throw out a lawsuit that seeks to end use of an illegal Improvement Standard to deny Medicare coverage. The Improvement Standard is a “rule of thumb” that Medicare uses to deny or terminate coverage to beneficiaries whose conditions are not improving. Jimmo v. Sebelius, Civil No. 5:11-CV-17 (D. VT. 10/25/20011).
“The Improvement Standard is the most unfair and harmful reason for Medicare denials,” stated Judith Stein, executive director of the Center for Medicare Advocacy. “It has a particularly devastating effect on patients with chronic conditions such as Multiple Sclerosis, Alzheimer’s disease, ALS, Parkinson’s disease, and paralysis.”
The lawsuit, which was filed in January of this year, was brought on behalf of a nationwide class of Medicare beneficiaries by six individual beneficiaries and seven national organizations representing people with chronic conditions.
In asking the court to dismiss the case, the government raised several arguments to contend that the court lacked jurisdiction over the plaintiffs’ claims. The government also argued that the plaintiffs failed to state a claim, namely, that there was no proof that the government was even applying such a policy as the Improvement Standard. Judge Reiss rejected that contention. She did agree, however, that the court lacked jurisdiction over one beneficiary plaintiff and one organizational plaintiff, but the case will go forward with the remaining eleven plaintiffs.
“Judge Reiss understands the core issue plaintiffs in this case seek to address,” stated Michael Benvenuto, attorney for plaintiffs from Vermont Legal Aid. “They are not seeking individual claim reviews; they are challenging a broad secret policy.”
“This is a great first step for these plaintiffs and for Medicare beneficiaries in general,” remarked Gill Deford, the lead attorney for the plaintiffs. “The Improvement Standard has been used for over 30 years to deprive hundreds of thousands of Medicare beneficiaries of coverage they desperately needed. This decision starts the process of ending that illegal policy.”
Medigap – Fact & Fiction
Nearly one in five Medicare beneficiaries rely on Medicare Supplemental insurance policies (Medigap) to fill in the gaps of some of their Medicare coverage. As noted by the Kaiser Family Foundation, “Medigap policies help shield beneficiaries from sudden, relatively high out-of-pocket costs due to an unpredictable medical event, and also allow beneficiaries to more accurately budget their health care expenses, which is important to a population living on a fixed income” (Kaiser Family Foundation, “Medigap Reform: Setting the Context” Sept. 2011; http://www.kff.org/medicare/8235.cfm).
Unfortunately, among the proposals raised to achieve savings for Medicare as part of ongoing debt and deficit reduction talks, some policy-makers have suggested changing the way Medigap policies are structured. Under the assumption that charging beneficiaries more upfront will deter them from using unnecessary medical care, these proposals seek to increase Medigap deductibles and other cost-sharing. Such proposals are found in the Simpson-Bowles Debt Reduction Commission proposal, the President’s Plan for Economic Growth and Deficit Reduction, and have been echoed in the media. (See, e.g., a recent Washington Post editorial “Mind the Medigap” October 1, 2011.)
MYTH: Eliminating First-Dollar Medigap Coverage Will Lead To Beneficiaries Choosing Only Necessary, “Higher Value” Health Care Services
Many of the proposals to reform Medigap coverage aim to achieve Medicare savings by creating “financial incentives for newly eligible beneficiaries to seek high-value health care services.” (See, for example, the President’s Plan for Economic Growth.) However, as discussed in our recent CMA Alert, many so-called cost-saving measures are based on the misguided assumption that greater out-of-pocket expenses will lead to more reasonable decisions about obtaining various types of unnecessary or “low-value” medical care. (See CMA Alert at: http://www.medicareadvocacy.org/2011/09/the-presidents-plan-for-economic-growth-and-deficit-reduction-a-first-look-at-the-impact-on-medicare/.)
On the contrary, these proposals would at best fail to steer people toward high-value services and, at worst, would charge people more for obtaining needed health care, or deter them from seeking care altogether.
FACT: As Cost-Sharing Goes Up, Utilization of Services – Both Necessary and Unnecessary – Goes Down.
Raising cost-sharing for beneficiaries will discourage utilization of health care, including necessary services. The National Association of Insurance Commissioners (NAIC), the organization of state insurance regulators who oversee Medigap plans, recently warned of just such dire consequences:
It is important to note that the proposed changes will impact cost-sharing coverage for “medically necessary” services. By contract, Medigap policies only pay cost-sharing for items and services that Medicare itself has already determined to be medically necessary. The NAIC is concerned that the effects of this proposal will result in many seniors foregoing needed medical care because they cannot afford the care resulting in more costs to the Medicare program later on. Additionally, the proposal will simply shift more costs onto seniors (who by and large are not wealthy) and not address the underlying cause of increased medical costs. (Emphasis added.)
National Association of Insurance Commissioners, Letter to the Joint Committee on Deficit Reduction (September 21, 2011), http://www.naic.org/documents/committees_ex_grlc_
110921_letter_murray_hensarling_medigap_first_dollar.pdf.)
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