Posts tagged ‘Medicare’
Rationing Medicare & Health Care?
The budget released on April 5th by the House of Representatives purports to benefit Main Street Americans.
Once again we’re hearing proposals to “reform” Medicare and to cut the federal deficit. These plans are not about reform or even dedicated to deficit reduction. They are about a long held desire to do away with Medicare, shifting costs to American families who are already struggling.
Newt Gingrich said in the 1990s that he might not be able to eliminate Medicare, but he could watch it wither on the vine. This time, the House of Representatives’ Republican budget actually does eliminate Medicare, replacing it with vouchers to purchase private insurance.
This proposal is reckless and extreme. As with Medicare Advantage and Medicare Part D, it will cost beneficiaries and taxpayers more than the traditional Medicare program. With a capped annual voucher to purchase insurance, Medicare beneficiaries will pay more out-of-pocket, get less coverage, and have less access to health care.
Sounds like rationing to us.
What’s The Benefit of De-Funding Health Care Reform?
The House of Representatives will vote today on an amendment to the 2011 Continuing Budget Resolution that would prevent all spending to implement the Affordable Care Act, the health reform law enacted almost one year ago. “This amendment is not in the interest of Medicare, the current fiscal crisis, or families,” says Judith Stein, executive director of the Center for Medicare Advocacy. “Defunding health care reform would endanger children who have pre-existing conditions, deprive uninsured young adults from coverage under their parents’ plans, limit Medicare coverage for preventive services, and end important consumer protections for Americans of all ages.” The amendment to defund health care reform would also eliminate tax credits to small business for providing health coverage to their employees, and would increase the deficit by over $200 billion over the next 10 years.
The Center for Medicare Advocacy has already seen how health reform has improved the lives of millions of people. For example:
• Our clients who are Medicare beneficiaries no longer have to pay cost-sharing for preventive services, and they are now eligible for an annual wellness visit.
• Those with high prescription drug costs will pay less out of pocket for their medicine when they enter the prescription drug donut hole or coverage gap.
• Fewer older people with both Medicare and Medicaid had to change their prescription drug plan in order to be in $0-premium Medicare drug plan.
• Four of our own Center staff members have young adult children who are now covered by the Center’s health plan; without the coverage they would be uninsured.
If the House votes to defund implementation of health reform, all of these people, and millions like them throughout the country, will lose the protections they have already received.
“This amendment is driven by ideology, not serious concern for the welfare of Americans, Medicare, small business, or the American economy,” continues Ms. Stein. We urge Congress not to move backwards by depriving Americans of increased access to fair, affordable health care. Implementation of the Affordable Care Act should be fully funded and should go forward so that, by 2014, all Americans have health insurance, regardless of their age, income, or health status.
Health Care Reform: A Family Value – Support it!
While some work to repeal Health Care Reform, others are already benefiting from its provisions.
People who have already benefited from health reform are at both ends of the age spectrum. Young and old, they reflect the family value of the law, particularly given these tough economic times when jobs are lost, unavailable, and employers are increasingly dropping benefits.
Here are some stories the Center for Medicare Advocacy has heard in just the last day:
1. A Connecticut State Health Insurance and Assistance Program (SHIP) counselor writes: “I know a lot of our seniors will benefit from the government slowly getting rid of the Donut Hole in prescription drug coverage.” This is echoed by many others including:
• An older Connecticut woman and her niece, from Delaware, both went into the Donut Hole in 2010 and both received $250 as a result of health care reform to help out.
• A gentleman from Florida reached the Donut Hole in both 2009 and 2010, and expects to do so again in 2011. He appreciated the $250 help in 2010 and, given his heart and other health problems, he will certainly benefit from health reform’s 50% discount on Brand name drugs in 2011.
2. Another individual writes:
• “I have a sister who is 25 years old and was unable to find a job that would provide health care coverage due to the economy. She has very serious ear problems and required two major surgeries to replace her ear drum in both ears. If she was not able to be on our parents’ health insurance plan, she would not have been able to afford the surgeries and would have gone completely deaf. It is very difficult to be a young person out of college during these times. Even if you can find a job, it is very difficult to find a full time job with health benefits. I consider myself extremely lucky that I did find a job with benefits, but do know many who had no health insurance for some time. These young people need the cushion of being on their parents’ insurance until 26 when they can find a stable job with health benefits because in this economy, less and less employers are offering benefits to young people.”
The importance of health reform allowing young adults to obtain coverage on their parent’s health insurance plan is reiterated by another individual:
• “ I can personally speak for the kids 26 and under part of this. I have two kids under 26. One does not live at home. He is 22 and working at a job without health insurance. He would have no health insurance without being able to stay on my insurance. He was able to have an expensive blood test to find out if he has a potentially life threatening blood disorder because he had my health insurance to cover it.”
3. Four of the Center for Medicare Advocacy’s own employees have young adult children who have lost their jobs or are employed, but their employers do not provide health insurance. Again, these young people only have health insurance as a result of health care reform which allows them to be covered by the Center’s health insurance. At least one of these young adults has an on-going mix of mental health and medical problems that require on-going health care.
Health care reform is helping families struggling to deal with illnesses, age, unemployment, and underemployment. The law advances family values.
What is a Quality Medicare Advantage Health Plan?
It’s open enrollment season again, and Medicare beneficiaries and their families are barraged with mail, TV and radio commercials, and print ads describing the Medicare Advantage and prescription drug plan (PDP) options in their area. This year, Congress and Medicare would like people to consider the quality ratings of plans when making their choice for 2011. Beneficiaries can find quality information about plans on the Medicare Plan Finder tool. Plans are evaluated on a 5-star rating system that looks at medical care as well as customer relations, including complying with CMS rules about marketing and about appeals.
Quality ratings are so important that the new health reform law, the Affordable Care Act, awards quality bonuses, starting in 2012, to all Medicare Advantage plans if they score at least 4 out of 5 stars on the Medicare 5-star rating system. Quality ratings are so important that CMS, the Medicare agency, even moved up the starting date of and expanded eligibility for the quality bonus payments to Medicare Advantage plans. In fact, Medicare has created a demonstration project for 2011 that will give Medicare Advantage plans a bonus payment if they achieve 3 out of 5 stars on the star system.
But what does it mean to be rated “a high-quality Medicare Advantage Health Plan?”
Ask Arcadian Health Plans, a parent company that has been in existence since 1997, and that offers Medicare Advantage plans in 15 states. On November 17th Arcadian sent out press releases to many of the communities in which they offer Medicare Advantage plans to announce that they had been awarded the 2011 Senior Choice Gold Award by HealthMetrix Research “for excellent value among Medicare Advantage plans.” See, e.g., Southeast Community Care’s Medicare Advantage Part D Plan is Rated the #1 Value for Medicare Beneficiaries in the Roanoke Area, http://www.prnewswire.com/news-releases/southeast-community-cares-medicare-advantage-part-d-plan-is-rated-the-1-value-for-medicare-beneficiaries-in-the-roanoke-area-108768449.html; Texas’ Community Care’s Medicare Advantage Part D Plan Is Rated the #1 Value for Medicare Beneficiaries http://pr-usa.net/index.php?option=com_content&task=view&id=540001&Itemi.
Yet, two days later, on November 19th, CMS announced it was sanctioning Arcadian Health Plans and two other health plan sponsors and not allowing them to market or enroll new beneficiaries. Arcadian is being sanctioned for violations in marketing the plans they offer to beneficiaries. For example, Arcadian has given beneficiaries incorrect information about whether their doctor is in the plan network or whether their prescription is on the plan’s formulary. Arcadian plan agents may even have enrolled people into health plans who had not consented to, let alone known about, the enrollment. And, according to the letter CMS sent to the plan, CMS has been looking at Arcadian’s marketing activities since 2008.
See, http://op.bna.com/hl.nsf/id/bbrk-8bcule/$File/Arcadian%20Sanctions%20Letter.pdf.
If CMS is going to suggest that beneficiaries consider enrolling in particular, “highly-rated,” Medicare Advantage plans or PDPs because of the quality of coverage and services they provide, and if these plans are going to get extra bonus payments, we need to be clear about what a high quality plan is – and is not!
Perhaps Arcadian’s press releases are another example of marketing violations that should be investigated by CMS.
Our NY Times Letter to the Editor – Improvement Standard Impacts Coverage and Care
The Center for Medicare Advocacy reiterates last week’s New York Times story: the Medicare Improvement Standard is an unjust danger to people in need of care!
http://www.nytimes.com/2010/11/08/opinion/l08medicare.html?_r=1&emc=tnt&tntemail0=y
Pants on Fire!
HEALTH CARE REFORM DOES NOT CUT MEDICARE BENEFITS
Health care reform does not cut Medicare benefits. In fact, health care reform expands Medicare coverage, by eliminating cost-sharing for preventive services, adding a yearly wellness visit, limiting some cost-sharing in private Medicare plans, and closing the Part D “Donut Hole.” It also improves the solvency of the Medicare program itself.
Health care reform changes some wasteful Medicare payment policies. Some misstated reports of these changes have resulted in exaggerating public fear of cuts to Medicare benefits.
The Affordable Care Act, aka health care reform, achieves savings in the Medicare program through a series of payment reforms, service delivery innovations, and increased efforts to reduce fraud, waste, and abuse. The actual projected reduction in Medicare spending is $428 billion over 10 years, after $105 billion in new Medicare spending is taken into consideration. These projections actually extend the life of the Medicare trust fund by about a decade. None of the payment reforms affect Medicare’s guaranteed benefit packages. Indeed, the law specifically states that the guaranteed benefits in Medicare Part A and Part B will not be reduced or eliminated as a result of changes to the Medicare program.
Health Care Reform Rolls Back The Privatization of Medicare.
Most of the new law’s Medicare “cuts” are actually reductions in subsidies to private Medicare plans, which were begun in 2003 during the Bush Administration. These overpayments to private insurance companies, (known as “Medicare Advnatage” plans) will account for about $130 billion in Medicare savings over 10 years. Medicare Advantage plans are offered by private insurance companies that contract with the government to provide Medicare for people who choose to enroll in a private plan. By law these plans must provide all of the guaranteed benefits under Part A and Part B.
Under the funding mechanism in effect before enactment of the Affordable Care Act, Medicare Advantage plans were paid, on average, about 13% more than the traditional Medicare program to provide the same coverage. These extra payments resulted in Medicare Part B premiums being $3.35 higher per month for all beneficiaries in 2009, and resulted in the federal government (and taxpayers) spending $14 billion more than would have been necessary, if Medicare Advantage enrollees had remained in the traditional Medicare program.
The Affordable Care Act will end these wasteful overpayments by phasing in reductions in Medicare Advantage payments, starting with a payment freeze in 2011. Medicare Advantage payments will be based on national county benchmarks, with plans being paid a fixed percentage of traditional Medicare costs. As a result of this payment formula, plans in some lower-paid counties, generally rural and suburban areas, will continue to receive payments that exceed the traditional Medicare amount, while plans in higher paid counties, many of them large cities, may see substantial reductions. Rebates (an amount plans receive if they bid less than the county benchmark) will also be reduced. The new payment structure also provides for an increase in payments by up to 5% for plans that receive four or more stars for high quality on the CMS star rating system.
Health care reform cuts wasteful payments put in place to encourage private Medicare. Health care reform increases benefits for all people with Medicare, decreases Medicare costs for beneficiaries and taxpayers, and extends the life of the Medicare program.
Health care reform is good for Medicare. Pass it on!
The New York Times Features CMA’s Judith Stein in Its Coverage of Looming Medicare Enrollment Period
Judith Stein, right, executive director of the Center for Medicare Advocacy, with Jocelyne Watrous, a beneficiary consultant. Many private insurers this year are consolidating their Medicare offerings and discontinuing some plans.
From The New York Times:
Medicare enrollment season is approaching, and many experts say they believe it promises to be a turbulent one — “a perfect storm,” said Paul Gada of Allsup, a provider of Medicare plan selection services.
Why? In some areas, there will be dozens, even hundreds, of coverage options. The choices must be reviewed not just by current enrollees and a crush of baby boomers newly eligible for the government-run insurance program, but also by millions of people helping older beneficiaries.
All of them must navigate a system that is changing rapidly, in part because of requirements imposed by the new health care law. “It’s a complicated year for Medicare beneficiaries,” said Judith Stein, executive director of the Center for Medicare Advocacy, a nonprofit group that helps Medicare beneficiaries.
To help simplify the process, you’ll first need a quick rundown of exactly what Medicare entails.
Read the full article, here.
Wake Up, America!
In a column in the Washington Post on August 24th, Republican National Committee Chair Michael Steele purported to be worried about the damage health care reform will do to Medicare.
Really? Talk about raiding Medicare: Can you say “Medicare Advantage”? The last Administration privatized Medicare in 2003 with the Medicare Advantage system that lured private insurance into the program by paying huge subsidies of more than 14% on top of what the traditional, public Medicare program is paid for the same services.
Can you say “Part D”? The last Administration created the incomprehensible Part D prescription drug program that made Medicare drug coverage available ONLY through private plans and actually wrote into law a PROHIBITION against Medicare negotiating prices with drug companies. Talk about a boondoggle for Big Pharma!
The Bush Administration created a windfall for private insurance and pharmaceutical companies – all at the expense of the cost-effective public Medicare program, seniors, and taxpayers.
Come on, America, Wake Up! Don’t buy into using health care reform to create another welfare program for private insurance and pharmaceutical companies. Haven’t we given them enough by giving them Medicare?
Medicare, We Hardly Know Ya
44 years ago Medicare was enacted into law. All of today’s dire warnings about a public health option – socialism and government barring the doctor’s door – were made in opposition to Medicare. Despite such opposition from “conservative,” leaders, including Senator Bob Dole, Medicare passed.
Before Medicare, 50% of everyone 65 or older had NO health insurance. Now, as a result of Medicare, almost all older people are insured. Medicare, which is national, government-run health insurance, succeeded in insuring older people where private insurance failed. And, until the Bush Administration privatized Medicare with the extraordinarily subsidized private “Medicare Advantage” and Part D plans, Medicare was remarkably cost-effective too. It’s private Medicare, not the traditional, public program, that’s bleeding taxpayers of billions of dollars.
Medicare has been a success, fiscally and morally. It took on the job of insuring health coverage and care to people that private insurance had abandoned. Since 2003, on the other hand, private Medicare plans have cost us all tens of billions of dollars that went to support the private insurance industry, not to providing health care. In addition, private Medicare plans have too often engaged in marketing abuses and restrictive coverage practices.
As Paul Krugman recognizes in today’s New York Times, people with Medicare love it. They do not want government to fool around with the traditional program. Ironically, these are sometimes the same people who worry that a public health care option will cause long waits for health care and government invasions into their private medical decisions. They, and their family members, (which accounts for pretty much all of us), forget that the traditional Medicare program is a public health insurance option.
Hello, America, meet Medicare: Our 44 year-old public health insurance option that provides care to all its enrollees, anywhere in the country, and that has provided health and economic security for millions of older people, people with disabilities, and their families.
Happy anniversary, Medicare. Thank you for showing us what a true public insurance program can offer.
CMA Health Policy Blog 