Posts tagged ‘Private Insurance’
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.
What a Shame
CMS has decided to raise rates for private Medicare Advantage (MA) plans. This is contrary to its earlier announcement that private Medicare reimbursement rates would be reduced to reflect slower per capita growth in Medicare and health care. Politicians from both parties and insurance companies called for this change and, unfortunately, CMS reversed course.
So, private Medicare will continue to cost more than it would cost to serve similar beneficiaries in traditional Medicare. While this may be good for insurance companies that offer MA plans, it is not good for Medicare, the vast majority of Medicare beneficiaries, or taxpayers.
Why should we spend more of our limited public funds on private Medicare when traditional Medicare costs less? Why should taxpayers ensure private profits to deliver public Medicare coverage? After all, the experiment in privatizing Medicare was originally intended to see if a private model would cost less, while providing the same or better coverage than traditional Medicare. That was not to be.
Private plans left the market when their reimbursements were capped at or below the per capita rate of public Medicare. CMS failed to learn from that experiment, and maintain the cost of traditional Medicare as the maximum taxpayers would pay for private plans. Instead, since the Medicare Act of 2003 we actually pay private plans more than traditional Medicare. This result is not good for the financial security of the Medicare program or for the federal budget deficit. It’s not good for the vast majority of beneficiaries who continue to choose the traditional Medicare program. It’s not even best for many MA enrollees, particularly those with long-term and chronic conditions, who often get less coverage than they would in traditional Medicare. And remember, by design MA plans have limited networks, so private MA enrollees have fewer choices in physicians and other health care providers than they’d have in traditional Medicare.
The Center for Medicare Advocacy continues to call for parity in payments between private Medicare plans and traditional Medicare. It’s the best deal for taxpayers, the Medicare program, and the vast majority of Medicare beneficiaries. Common sense should prevail.
Benefit Cuts or Drug Discounts?
According to a 2012 Congressional Budget Office report, aligning Medicare drug payments with what Medicaid pays just for low-income beneficiaries would save $137.4 Billion over ten years. (CBO Estimates for President’s Budget for 2013, 3/16/2012).
While the President suggested this reform in his State of the Union address, discounting what Medicare pays for drugs has thus far not been taken seriously by decision-makers.
Instead, we have repeatedly been told that Medicare cannot be sustained and that benefit cuts are necessary. Yet all these Medicare benefit cuts combined would only equal $35.4 Billion in savings over ten years:
1. Increasing income-related Part B premiums;
2. Increasing income-related Part D premiums;
3. Increasing Part B deductible for new enrollees;
4. Adding a Part B premium surcharge for first-dollar Medigap coverage;
5. Adding home health co-pays for new enrollees.
If all of these benefit cuts, that would hurt older and disabled people, save only 25% of the savings that would be achieved by requiring drug companies to give the same discounts to Medicare as it gives to Medicaid, why don’t we choose drug discounts? How can benefit cuts be preferable if the goals are to reduce the deficit and save Medicare for future generations?
Lower Medicare payments for prescription drugs. Choose People and Medicare over PRxOFITS!
New CBO Report Shows Medicare Leading the Way on Lowering Costs
Last week, the Congressional Budget Office released a new budget outlook with updated data on expected federal costs of programs including Medicare and Medicaid over the next ten years. According to the CBO, Medicare spending in 2012 grew by only 3% – the lowest rate of growth in over a decade,[1] and a rate much lower than that of the private market.[2] In fact, the Washington Post notes that “From the March 2010 baseline to the current baseline…[CBO] lowered estimates of federal spending for the two programs in 2020 by about $200 billion — by $126 billion for Medicare and by $78 billion for Medicaid, or by roughly 15 percent for each program”.[3]
The new baseline estimates indicate that Medicare is leading the way in controlling costs, and that Medicare has significantly contributed to lowering the nation’s deficit through innovative payment and delivery models as well as reductions in overpayments to private insurance plans under the Affordable Care Act.[4]
CBO’s outlook illustrates that Medicare is not the problem, but rather the solution that policymakers should look to for addressing the real issue of overall health care costs affecting payers system-wide. While many look to slash Medicare and Medicaid in the name of deficit reduction through proposals like raising Medicare’s eligibility age or fragmenting the program through further means-testing, the CBO estimates reveal that such proposals are not rooted in fiscal policy. As the Post points out, “…$200 billion out of [Medicare and Medicaid] is nothing to sneeze at; that’s about double the revenue the government would generate by raising the Medicare eligibility age from 65 to 67.”
The Center for Medicare Advocacy has long maintained that if policymakers are really concerned about strengthening Medicare and reducing the deficit, cutting benefits is the wrong approach – and new polling shows that over 60% of Americans agree.[5] In fact, 85% of Americans strongly favor one of the Center’s Solutions to reduce the deficit: Requiring drug companies to give the government a better deal on medications for people on Medicare. Whether Congress chooses instead to protect the windfall profits of pharmaceutical companies rather than protecting people living on less than $22,000 a year and rely on Medicare to maintain their health remains to be seen.
[1] Congressional Budget Office, The Budget and Economic Outlook: Fiscal Years 2013 to 2023, available at http://cbo.gov/publication/43907.
[2] http://www.healthcostinstitute.org/news-and-events/press-release-2011-health-care-cost-and-utilization-report
[3] Washington Post, Wonkblog: Three Ways CBO Expects Health Spending to Change. Available at http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/05/three-ways-cbo-expects-health-spending-to-change/
[4] Center for Medicare Advocacy, Medicare Facts and Fiction: Costs and Spending Edition, available at http://www.medicareadvocacy.org/2013/01/10/medicare-facts-and-fiction-costs-and-spending-edition/
[5] Kaiser Family Foundation and Harvard School of Public Health: The Public’s Health Care Agenda for the 113th Congress, available at http://www.kff.org/kaiserpolls/8405.cfm.
Save Medicare From Private Vouchers
Once again, Rep. Paul Ryan has reiterated his plan and commitment to “save” Medicare through priatization. (http://washingtonexaminer.com/opinion/op-eds/2012/05/medicare-two-paths-two-futures/568246) If only the logic of his plan was as clear as his determination to change Medicare into a set of capped vouchers. If passed, the popular community Medicare program would be replaced. Instead, individuals eligible for Medicare would get an annual alloawance to shop for their own insurance coverage.
Yet again, the Ryan plan would eliminate Medicare, not save it.
No Medicare For Mitt
How much does Mitt Romney really care about Medicare’s solvency? A lot. So much that he has decided not to enroll or use it at all – even though he’s turning 65.
What should we take from this? One thing for sure, Mitt Romney can afford a whole lot more financial risk than most Americans. Unless he has private insurance that will pay as the primary policy even after he’s Medicare eligible, Mr. Romney is accepting a huge liability if he intends to pay for his own heath care. Either way, he’s in a very different position than the vast majority of older and disabled Americans who MUST rely on Medicare to help pay for their health care and can not obtain insurance that will take its place.
Is Romney going to lead a battallion of well-to-do Americans out of Medicare? Leaving behind those who can not afford to pay either for their own care or for preciously rare primary insurance available to people eligible for Medicare. What a shame that would be.
Mr. Romney should enroll and rely on Medicare coverage like most Americans do when they turn 65. As a would-be national leader he should experience firsthand what works and what doesn’t, what coverage is and should be available. He should be part of the Medicare community and help it stay viable for all those who look to this national treasure to help pay for health care.
If Mr. Romney really cares about Medicare he should vote for it with his feet.
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.”
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.
Health Care Reform: Standing Up To Insurance Companies and Standing Up For People
OPINION – Wall Street Journal, SEPTEMBER 28, 2010
Health Insurers Finally Get Some Oversight
By KATHLEEN SEBELIUS, Secretary of Health and Human Services
In the last two weeks, my department has been accused of “thuggery” (this editorial page) and “Soviet tyranny” (Newt Gingrich). What prompted these accusations? The fact that we told health-insurance companies that, as required by law, we will review large premium increases and identify those that are unreasonable.
There’s a long history of special interests using similar attacks to oppose change. In the mid-1960s, for example, some claimed Medicare would put our country on the path to socialism.
But what is really objectionable about these comments is not who they’re attacking, but what they’re defending. These critics seem to believe that any oversight of the insurance industry is too much, and that consumers would be better off in a system where they have few rights or protections.
Over the past decade, Americans have seen what happens when insurance companies have free rein. The cost of health insurance has more than doubled, while millions of hard-working Americans lost their coverage or drained their savings to keep up with premiums. Employers, big and small, have struggled mightily to absorb these cost increases and have been losing the fight.
As insurance commissioner and governor of Kansas, I saw firsthand how these rate hikes burdened people. I spoke with families who watched their insurance go up 20%, 30%, even 40% a year without explanation. I met with small business owners who had stopped offering health insurance to their employees because they couldn’t afford the annual double-digit premium increases.
A woman who wrote to me recently summed up the frustration that many feel. “As a self-employed, hard-working person,” she wrote, “I have no good options for health coverage.”
Yet even as our insurance markets have failed Americans time and time again, special interests successfully blocked reform. That’s changing with enactment of the new health insurance law. Under the Affordable Care Act, 46 states have already received grants to beef up their premium-review and oversight capabilities. And additional funding is on the way.
The law also gives clear instructions to the new state-based health insurance marketplaces called exchanges that will be created in 2014. As the exchanges decide what plans to include, they must incorporate recommendations from states about whether particular health insurance issuers should be excluded based on a pattern of excessive or unjustified premium increases.
We are already seeing this new level of accountability pay off. Last week, North Carolina’s largest insurer announced a “one-time refund that will return $155.8 million to more than 215,000 individual Blue Cross Blue Shield customers as a result of the Affordable Care Act.” This rebate will put an average of $720 back into the pockets of each of those policyholders. In addition, thanks to diligent work by North Carolina’s insurance commissioner, they’ll see their premiums rise by less than 6% in 2011, thesmallest rate increase in four years.
A day after Blue Cross Blue Shield’s announcement, seniors with private Medicare plans got some news that most Americans haven’t heard in years: Their premiums will actually go down 1% next year, even as many of them enjoy better benefits.
The Affordable Care Act is bringing some basic fairness to our health insurance market. So when I learned that a handful of insurers around the country are blaming their significant rate increases on the new law, even though the facts show that the impact of the law on premiums is small, just 1% to 2% declining over time‹I let them know that we’d be closely reviewing their rate hikes.
It’s understandable that some insurance companies and their allies don’t welcome this change. They’ve made large profits from the status quo. And it’s not surprising, though still disappointing, that House Republicans have recently pledged to repeal the Affordable Care Act and get rid of these new consumer protections.
If critics really want to go back to the days when insurance companies ran wild with no accountability, they should have the courage to say so openly instead of hiding behind distracting attacks. In the meantime, we’re going to keep standing up for American families and small business owners who deserve a system that works for them.
Ms. Sebelius is the U.S. secretary of Health and Human Services. http://online.wsj.com/article/SB10001424052748704082104575515851336184716.ht
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