Posts tagged ‘Private Plans’

Ryan Retread: Ideology Trumps Medicare Protection and Deficit Reduction

The Ryan plan for 2013 is the same as the Ryan plan for 2012 and 2011: Privatize Medicare and repeal the Affordable Care Act. Once again the Ryan budget proposes to preserve Medicare in name only. It would change Medicare into a defined voucher system, sending beneficiaries into the marketplace to purchase indiivual insurance plans. These ideas were at the heart of the 2012 election. They are about changing the way government and Medicare work, not about saving Medicare or money. The proposals were rejected at the polls.

If Medicare and the deficit are really our concern, there are real savings possible that would not harm older and disabled people: Bring down the prices Medicare pays for drugs. Stop all overpayments to private Medicare Advantage plans. Add a prescription drug benefit to traditional Medicare. Lower the age of eligibility for Medicare. Let the Affordable Care Act work.

Mr. Ryan, move on! Join us in focusing on real solutions.

March 13, 2013 at 2:02 pm 1 comment

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 thatFrom 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.

February 13, 2013 at 4:20 pm Leave a comment

Medicare and … the Military?

I read David Brooks’ New York Times editorial yesterday with dismay. It seems Medicare is not only to blame for the federal deficit, but also for Sen. Hagel’s nomination and the end of America’s military might. I have been representing Medicare beneficiaries and studying Medicare since 1977. Even I was surprised by these positions.

The determination to slash Medicare seems never ending. One hardly knows where to begin responding. But we need to try, before it’s too late. Before the next deficit cutting activities get underway, we need to set the record straight.

The basic, public Medicare program was a cost-effective success. Medicare brought access to health care to older people who were refused private health insurance. It dramatically decreased poverty among older people. Unnecessary payments to private Medicare plans, unrestricted payments for prescription drugs and policies aimed at privatizing Medicare increased the program’s costs exponentially. These expensive provisions should be the targets for those whose true goal is to reduce the deficit. If the will exists, there is a way to reduce costs while preserving Medicare’s promise.
___________________________________________
Watch this short video from the Kaiser Family Foundation: http://www.kff.org/medicare/medicare-timeline2.cfm. It will remind you why Medicare matters.

January 9, 2013 at 9:29 pm Leave a comment

CMA in Action: Judith Stein Testifies in Congress on the Ryan Plan to End Medicare

This week, the Center for Medicare Advocacy’s founder and executive director, Judith Stein, was invited to speak before a House Policy and Steering Committee at a forum on Medicare to voice the concerns of beneficiaries and their families about the Ryan Medicare plan. Speaking alongside a health economist, a veteran medical provider, and a teacher whose family relies on Medicare and Medicaid for critical care, Ms. Stein spoke and answered questions from the Committee about the loss of coverage, higher costs, and limitations on choice that current and future beneficiaries would face under the Ryan plan. This Alert features excerpts from the testimony, as well as highlights from the subsequent Question and Answer portion of the forum.

___________________________

Leader Pelosi and members of the Committee, thank you for holding this important Forum and for honoring me with the opportunity to appear before you.

I am Judith Stein, founder and executive director of the Center for Medicare Advocacy, Inc.  Founded in 1986, the Center is a national, nonprofit, nonpartisan organization headquartered in Connecticut and Washington, DC, with offices around the country.    I have been representing Medicare beneficiaries since 1976.  My organization has represented tens of thousands of Medicare beneficiaries − more, I believe, than any other organization in the country.  I know the value of Medicare, and its challenges as well as anyone.

Medicare was enacted in 1965 because private insurance failed older people.  For over 47 years, Medicare has provided guaranteed benefits that have enhanced health security and financial stability when people need it most – when they are older or disabled and also sick or injured.  It has been so successful that this population is now almost uniformly insured − although only 50% of people 65 or older were insured when Medicare began.

I’ve seen Medicare coverage save lives and bring peace of mind to families. I also know how Medicare has changed since I began my work representing Medicare beneficiaries.  While coverage has been enhanced over the years, Medicare has also become ever more complex and difficult to navigate as private plan options have been introduced, swarmed in and out, and premiums have been income-based.  While we are regularly told that “one-size fits all” does not serve people well, this was simply not the case for the traditional Medicare program.  In fact, for decades the guaranteed, universal Medicare program fit most very well.

Today, the myriad Medicare choices, complex decision-making, and plan variations baffle many, often leading to inertia, and poor planning. Many people simply do not choose at all, and those who do, often stick with their initial choice, even as their plan offerings and their health needs change.[1] Further, most people want choice of doctors, hospitals, and other health care providers, not insurance plans.  Ironically, private Medicare plans reduce physician and health care provider choices far more than the traditional program.

Unfortunately, Congressman Paul Ryan proposes, and the House has twice passed, yet another effort to privatize and fragment Medicare – this time on a grand scale. The Ryan Plan would provide each beneficiary with a set annual allowance, or voucher, with which to purchase an insurance plan in the private market.  While we have not seen details about the Ryan voucher system, the outlines we have seen would increase costs to beneficiaries.  Regardless, of its details, the Ryan Plan would not impact the current deficit, since we are told it would not begin until 2022 at the earliest.  (The 2011 Ryan Plan called for the change to Medicare to commence in 2023.)

The certitude that competition in the private market will reduce Medicare costs is belied by past experience and numerous studies.  As former Medicare and Medicaid Administrator Bruce Vladeck has said, “private plans have not saved Medicare a nickel.”  When the private Medicare+Choice program was tried under Mr. Vladeck’s leadership, Medicare paid private plans 95% of what it cost to cover a similar beneficiary in traditional Medicare. The idea was to test the truth of the belief that private plans could provide health insurance more cost-effectively than traditional Medicare.  While dozens of private plans entered the Medicare market, they left in droves when it became clear they could not, in fact, compete with traditional Medicare.

In 2003, Congress authorized the Medicare Advantage program, which paid private plans approximately 14% more than the traditional Medicare per beneficiary cost.[2]  Not surprisingly, private plans reentered the market, but at a terrible cost to the Medicare program, all beneficiaries, and taxpayers.  The Congressional Budget Office estimated that these payments would amount to $150 billion over a ten-year period.

Further, if traditional Medicare is forced to compete with private insurance, private plans will work to minimize their spending and woo the healthier, least costly beneficiaries.  If older, more vulnerable, more expensive beneficiaries remain disproportionately in traditional Medicare it will not be sustainable and will wither on the vine.  This increased fragmentation of Medicare and Medicare’s 49 million customers will also reduce its bargaining power, thereby limiting its ability to help drive down health care costs.  Yet reducing health care costs is a key to reducing the federal deficit.

Certainly Medicare could be made more financially viable.  Reducing payments to private Medicare plans is one sure way to start this important effort.  However, the Ryan Plan does not propose this path.  Instead, its “Path to Prosperity” would increase the age of Medicare eligibility and provide individual, defined contribution vouchers to older people − gutting the community Medicare program that has ensured access to health coverage for generations. This approach would increase costs and reduce coverage for people with Medicare and their families.  Yet, according to the Kaiser Family Foundation, about half of people with Medicare live on incomes of $22,000 or less – just under 200% of the federal poverty level.  They simply can not afford the additional costs projected under the Ryan Plan, costs which are tantamount to imposing a health insurance tax on older and disabled Americans.

The Ryan Plan is based on the belief that private is better.  But Medicare controls health spending better than private insurance. Competition among private health insurance companies has not driven costs down either in the private Medicare Advantage program or for individual and employer-based policies for those under 65. As discussed above, Medicare has included private plans for decades, but they cost Medicare more than the same coverage under the traditional Medicare program.  Medicare administrative costs are a fraction of those for private insurance.[3]  And, over the next ten years, Medicare spending is expected to grow at rates of 3.1% compared to 5% for private insurance plans.[4] Thus, the traditional Medicare program, which the Ryan Plan would dismantle, shows greater promise for controlling costs than turning the program over to private insurance companies.

One last reality check: Mr. Ryan’s plan would affect current and near-term retirees, despite promises to the contrary. The Ryan Plan would immediately repeal health care reform, which greatly improves Medicare coverage for prescriptions and preventive care, saving people with Medicare a total of about $4 billion on drugs and increasing their access to preventive care. Repealing health care reform would retract these benefits.  It would also reinstate the wasteful overpayments to private Medicare Advantage plans that were rolled back by the Affordable Care Act.  Since all beneficiary premiums are set as a percentage of the costs of the entire Medicare program, these overpayments would translate into higher out-of-pocket costs for everyone with Medicare.

We recognize our responsibility to add constructively to the conversation.  It’s fair enough for those who favor the Ryan Plan to ask, “Well what would you do?”  Thus, the Center for Medicare Advocacy offers six key recommendations to keep Medicare solvent while it continues to provide fair, defined health coverage.  These recommendations, unlike the Ryan Plan, do not shift costs to beneficiaries, and do not unnecessarily restructure the Medicare program. They promote choice and competition while shoring up the solvency of the Medicare Program.

Conclusion

“Protecting” Medicare by shifting costs from the federal government to beneficiaries and their families through the creation of a private Medicare voucher system is a perversion of Medicare’s purpose. Medicare was enacted to protect older, disabled people and their families from illness and financial ruin due to health care costs. The Center for Medicare Advocacy’s recommendations promote financial solvency without doing it at the expense of beneficiaries.

The Ryan Plan would enrich insurance companies while leaving beneficiaries with inadequate purchasing power in an increasingly expensive health care market.  It would end Medicare and begin a new private system that would be more expensive and more costly for older and disabled people. It would limit people’s choice of physicians and health care providers.  We welcome the opportunity to examine Medicare’s challenges and successes.  But for the 49 million American families who rely on Medicare now, and for all those who will someday, we look for a debate based in fact not preferences.  Simply stated, you can’t save Medicare by ending it.  The Ryan Plan will end Medicare.

___________________________

For a full transcript of the testimony, see: http://www.medicareadvocacy.org/2012/10/04/cma-in-action-judith-stein-testifies-in-congress-on-the-ryan-plan-to-end-medicare/.

For more information, contact executive director Judith Stein (jstein@medicareadvocacy.org) at (860) 456-7790.

To stay up to date on all the Medicare myths this election season, see our “Medicare Myths and Truths” chart at: http://www.medicareadvocacy.org/medicare-facts-fiction-quick-lessons-to-combat-medicare-spin/.


Highlights from the Question & Answer Session

Members of the Committee asked panelists to respond to questions and comments including:

Q: I see a train wreck, a continuing train wreck of seniors, on the highway of despair.  (Panelists were then asked to comment)

Ms. Stein: “The Kaiser Family Foundation tells us that about half of Medicare beneficiaries have an annual income of $22,000 a year or less.  I really do think it’s no wonder the country thinks Congress is out of touch with what’s really happening in this country… .  Medicare is in jeopardy and it’s for philosophical reasons, I believe.  [The Ryan Plan is] simply not the most cost-effective way to do what is being proposed and it will absolutely put us back to where we were in 1965.

It is a train wreck waiting to happen and we have to get people to hear that.  And, yes [Congressman Larson, in answer to your earlier question,] it is personal.  I’m a breast cancer survivor.  I know what it’s like to be perfectly healthy one day, and the next day to be maybe, maybe dying.  How can you plan for this?  And how can I plan to know that I can take care of my mother and maybe my children and grandchildren.  This is a personal matter.  [The Ryan Plan] is a train wreck.  It is not best for the people or the fiscal solvency of this country.  So why is it being proposed?  Because there’s a preference for privatization and fragmenting Medicare.  But privatizing this system will not help older people, their families, disabled people, or the deficit.  So on all points, I’m very worried about it.

Q: How does the Romney/Ryan plan limit people’s choices?

Ms. Stein: We need to look at what we actually know, because this is not something new.  Current private plans (Medicare Advantage) and private plans in the past have all had the impact of fragmenting the risk pool.  The widest network (and most effective risk pool) is traditional Medicare.  As soon as you enter into a private plan you will have a limited network with a limited choice of doctors and health care options.

Traditional Medicare, which, if we encouraged it for most of those with Medicare, has the best bargaining power of any health system in the country, and so it can bring down costs if we allow it (such as requiring negotiations on prescription drugs under Part D).  When you fragment Medicare as we have been doing since the 1990s, you reduce the risk pool and the buying power of Medicare and thereby reduce its impact on reducing health care costs – for everyone throughout the country, not just for Medicare beneficiaries.

One of the things we can do is look at this plan from past history.  We already know what happens.  We know that only 10% of beneficiaries in private plans make a change in their plans after they make their initial choice … it’s a mind-boggling set of options – it’s not just one or two choices.  Ideally, an individual should review their plan and potentially change it every year, but only 10% do this.

So what happens is that – even if you could predict what health choices you will need – and you don’t really know – most people don’t make a choice so we find that people call the Center because the choice they made is no longer effective … many people choose private plans when they are healthier and then when they are diagnosed with a disease or condition and want to see the best doctor or specialist for that disease, they find that they can not do so under their plan.  If they were in traditional Medicare they could still get the care they want and need.

We know from experience that private plan options in Medicare are not the best for any number of reasons, including costs and services for people.  They simply do not provide as many health care options or providers as traditional Medicare does.


[1] For example, a recent study finds that less than 10% of people with Medicare Part D enroll in what would be the most cost-effective plan for them.  (National Bureau of Economic Research, “Plan Selection in Medicare Part D,” (June 2012).
[2] Medicare Payment Advisory Commission (MedPAC).  According to the Centers for Medicare & Medicaid Services, in 2012 Medicare Advantage plans are paid on average 7% more than similar beneficiary services would cost in traditional Medicare.
[3] Congressional Budget Office; Health Care Affairs, (9/20/2011).
[4] Kaiser Family Foundation analysis of Medicare Trustees Report 2012.

October 5, 2012 at 3:22 pm Leave a comment

Ryan Plan is Not About Helping Medicare or the Deficit

Here’s the truth follks: Rep. Ryan’s plan is about a governing philosophy, not about saving money, Medicare or reducing the deficit. If his plan was really about saving money, it would encourage movement back to traditional Medicare – which is less expensive than private plans. At the very least, his plan would equalize payments between traditional Medicare and private plans. But Mr. Ryan wants to repeal the Affordable Care Act’s payment reductions to private Medicare plans. Further, if Ryan’s private voucher system was really about deficit reduction, it would begin ASAP, not in 2022, as he proposes.

The Medicare “cuts” Mr. Ryan purports to be concerned about are almost entirely savings to Medicare’s expenses, which taxpayers and beneficiaries should welcome. They are largely from reducing wasteful overpayments to private plans and slowing increases for some providers, including hospitals, NOT from cuts in benefits. Neither taxpayers nor beneficiaries can afford to pay any more than is necessary to provide the same coverage available through traditional Medicare. Everyone should appreciate ACA’s efforts to hold down overall health care costs by looking to providers to create efficiencies in providing care.

The Affordable Care Act did not cut Medicare for beneficiaries; it added benefits (including an annual wellness visit, “Donut Hole” coverage for medicines, and no-cost preventive services). Thus, ACA represents a thoughtful approach to controlling health care costs, and reducing payments to private plans, while increasing Medicare coverage for valuable, cost-effective services. If his intent really was to save Medicare and money, Mr. Ryan would agree.

August 15, 2012 at 5:42 pm Leave a comment

Tell the Truth!

This week, Republican presidential candidates vie for their party’s nomination in Florida, where millions of residents rely on Medicare as a health and economic lifeline for themselves and their families. Unfortunately, some candidates are scaring seniors – making clearly incorrect and harmful statements about the effect of the Affordable Care Act on Medicare.
(See: http://www.washingtonpost.com/national/health-science/santorum-warns-florida-seniors-that-obama-health-care-law-will-force-doctors-to-leave-medicare/2012/01/23/gIQAzX4VLQ_story.html.)

As the Center for Medicare Advocacy has reported since the passage of the landmark legislation, Health Care Reform does NOT hurt Medicare benefits. In fact, it expands and improves benefits for all people with Medicare while saving our nation and taxpayers billions of dollars over the next decade.

Most recently, former Senator Santorum made significant misstatements about Medicare. Contrary to his statements, people with Medicare are NOT losing their doctors and are NOT facing rationing because of Health Care Reform. In fact, the Medicare payment board he mentions does not even exist yet. When it does begin, it will be charged with keeping overall Medicare costs down and will be specifically prohibited from reducing benefits.

Additionally, Mr. Santorum’s desire to “fix” Medicare by privatizing it and giving taxpayer money to insurance companies makes you wonder who he really wants to help. Privatizing Medicare and repealing health reform, which he also recommends, won’t help Florida’s older people or their families, but it would provide a windfall to the insurance industry. The traditional community Medicare program has helped generations of Americans at far less cost than private insurance. And health care reform has already enhanced Medicare, adding preventive benefits with no cost-sharing and reducing costs for prescription drugs.

If the Senator is truly concerned for the care of Florida’s people who rely on Medicare and the program’s integrity, he should get the facts straight and speak the truth about Medicare and health care reform. To start, he can visit the Center’s “Solutions for Strengthening Medicare” for common-sense ways to improve and expand the program while saving billions of dollars. www.medicareadvocacy.org.

January 23, 2012 at 10:04 pm Leave a comment

CMA in the New York Times: Don’t Privatize Medicare

http://www.nytimes.com/2011/12/10/opinion/medicare-and-private-health-insurance.html

December 18, 2011 at 3:37 am Leave a comment

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.

December 16, 2011 at 8:42 pm Leave a comment

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

December 12, 2011 at 8:09 pm Leave a comment

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.

April 6, 2011 at 4:24 pm Leave a comment

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