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From the category archives: healthcare

When “Don’t Cut Medicare” Really Means “Protect Private Insurers’ Profits”

The annual lobbying extravaganza by the multi-billion dollar private insurance industry which sells Medicare Advantage plans to seniors, will enter a new phase tomorrow when the Centers for Medicare and Medicaid Services announces it’s 2016 rate schedule.  Lobbyists (America’s Health Insurance Plans alone spent nearly $5 million in just six months last year) have been in hyper-drive convincing Washington that trimming their billions of dollars in federal subsidies is the same as cutting seniors’ Medicare benefits.  It’s not.  But all that lobbying has paid off so far because not only have the proposed single-digit cuts been avoided; they’ve been replaced with rate increases:

“The Obama administration turned a proposed 1.9 percent cut to 2015 Medicare Advantage health plans into a .4 percent increase after heavy lobbying from insurers and the Hill. It was the second-straight year that the Medicare agency transformed a proposed rate cut into a raise.  Still, Medicare Advantage enrollment has grown every year since the ACA passed in 2010. In fact, enrollment has increased more than 9 percent each year since 2012, when the ACA’s cuts to the Medicare Advantage started to take effect.  The law is supposed to cut payments by $156 billion over 10 years because the program has historically reimbursed private insurers at a higher rate than the traditional Medicare program. Private plans are reimbursed at 106 percent of the traditional program, and Obamacare aims to close this gap.”  Washington Post

Except that gap will never be closed as long as the powerful insurance industry is allowed to pretend that a 1.9% cut in their federal overpayment is unreasonable to ask from  companies with financial reports like these: 

“Revenues at Humana for 2014 climbed 17.4% year over year to $48.5 billion. Meanwhile, reported premiums and services revenues increased 9.2% to $3.1 billion, primarily on the back of an increase in average group Medicare Advantage membership.” 

UnitedHealth Group’s full year 2014 revenues of $130.5 billion grew $8 billion or 7 percent year-over-year. UnitedHealthcare growth was led by strength in the public and senior sector.”

Let’s not forget that these giveaways to private insurers, covering just one-third of Medicare beneficiaries, are being paid for by taxpayers and the majority of seniors who don’t even participate in a private MA plan. The fact that these subsidies exist is terrible public policy.  The fact they continue to be protected by lawmakers is indefensible.  Especially when you consider the mounting evidence that the only advantage to Medicare Advantage plans is to the $884 billion dollar a year health insurance industry. 

Reports of Medicare Advantage fraud continue to surface.  Whistleblowers (including a former Bush administration official) have filed more than a half-dozen federal court cases detailing systemic over-billing by private Medicare Advantage insurance companies.

The Center for Public Integrity has investigated MA plans in depth.  It reports CMS officials acknowledge billions of dollars have been improperly paid to private MA plans due to a practice called “upcoding” in which insurers exaggerate how sick their patients are to increase their “risk score” and collect higher Medicare reimbursements. Some of CPI’s other findings include:

  • Risk score errors triggered nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013 — mostly overbillings, according to government estimates. 
  • Risk scores of Medicare Advantage patients rose sharply in plans in at least 1,000 counties nationwide between 2007 and 2011, boosting taxpayer costs by more than $36 billion over estimated costs for caring for patients in standard Medicare.
  • In more than 200 of these counties, the cost of some Medicare Advantage plans was at least 25 percent higher than the cost of providing standard Medicare coverage.
  • In 2012, CMS audits of six plans found that private insurers couldn’t justify payments for 40 percent or more of their patients. Those overpayments alone cost the Medicare program nearly $650 million in 2007.  That’s just for six plans for one year.
  • The Government Accountability Office reports Medicare Advantage plans collected $3 - $5 billion in “excess payments” over just two years (2010-2012) because of private insurers “upcoding.”
  • A new Government Accountability Office investigation is now underway continuing its look into MA “upcoding” fraud which, by some estimates, has provided an $70 billion dollars of improper payments to private insurance companies.

This is just the fiscal side of what the privatization of Medicare has meant.  Now let’s consider what beneficiaries in Medicare Advantage plans have faced.  Unfortunately, that news is also disheartening.

  • The Center for Medicare Advocacy reports there is evidence that private insurers are “cherry picking” healthier seniors for their plans to keep costs down (and profits high.)  “A recently released CMS report confirms advocates’ fears by concluding that disenrollment by individuals from MA plans back to traditional Medicare ‘continues to occur disproportionately among high-cost beneficiaries, raising concerns about care experiences among sicker enrollees and increased costs to Medicare.’”
  • The Kaiser Family Foundation says that “Since 2012 average out-of-pocket spending limits have been on the rise, which could expose a subset of enrollees to higher costs – mainly those who have significant medical needs.” Again, that means older and sicker seniors.
  • These rising premiums are confirmed by the industry itself in a survey distributed to lawmakers.  Incredibly, the insurance lobby uses their premium hikes as justification for Congress to protect private insurers’ massive subsidies.   

“The sickest patients who need the most care have seen their maximum annual out-of-pocket costs increase by as much as $761 since 2012, according to the study, which was conducted by the actuarial firm Milliman for the Better Medicare Alliance advocacy group. The value of extra benefits that the health plans provide fell by a national average of $180.24 from 2012 to 2015.”  Congressional Quarterly

It’s hard to imagine how our political leaders can justify preserving federal over payments to private insurers in Medicare with a track record that looks like this. However, if early media reports are correct that’s exactly what’s likely to be announced tomorrow – federal subsidies to one of the wealthiest industries in America’s will be preserved while taxpayers and seniors in Medicare will continue to foot the bill.

What ACA Repeal Means for Seniors

House Republicans have voted more than 50 times to rollback or fully repeal the Affordable Care Act.  They did it again yesterday. While it feels like Bill Murray’s movie “Groundhog Day” it’s not even close to funny for the millions of Americans this repeal would hurt.  

 

Seniors have probably been the most demagogued group when it comes to what the ACA actually means to their health care. Remember those fake “death panels” you were assured were a part of health care reform?  They weren’t.  The ACA also didn’t “destroy Medicare” as promised by opponents.  Quite to the contrary, seniors in Medicare have benefitted from a number of important improvements since its passage.  This success is exactly why the conservatives in Washington remain desperate to repeal health care reform before evidence of the ACA’s success can no longer be buried in a mountain of their false claims and political hysteria.

 

Medicare beneficiaries will save, on average, $5,000 over the next ten years thanks to health care reform provisions. Here are just a few of the real-life benefits millions of seniors in Medicare would lose immediately if Republicans have their way and repeal the Affordable Care Act.  You can see even more in our NCPSSM brief.  

 

  • No out-of-pocket costs for preventive services like colorectal and mammogram screenings and annual wellness visits 
  • 50% discount for brand name drugs purchased while in the Part D donut hole, leading to the closure of the donut hole entirely 
  • $700 in covered drug costs for the average senior would be lost and the sickest seniors would face $3,600 in additional out-of-pocket costs
  • Reduction of billions in overpayments to private insurers in Medicare and a new requirement that 85% of every dollar is spent on healthcare rather than costs/profits 
  • $200 per year in premiums and $200 in out-of-pocket costs to be saved by seniors by the year 2018 
  • $350 million in fraud-fighting investment 
  • Medicare Trust Fund will lose years of solvency

 

Of course, seniors in Medicare aren’t the only ones this repeal would hurt.  Here’s a list of what losing the Affordable Care Act means for Americans of every age.

It’s (Past) Time to Reauthorize the Older Americans Act

Chances are if you, or anyone in your family, is 65 or older your life has been impacted by an Older Americans Act program.  From Meals on Wheels to senior centers, prevention of physical and financial abuse, computer training to legal assistance, OAA programs touch the lives of millions of seniors and their families.  This myriad of programs provides home and community-based services making it possible for older adults to remain independent, but they’ve continually faced flat or shrinking budgets at a time of growing needs.  Funding programs that allow seniors to age in place is cost-effective; however, Congress has not reauthorized these programs since 2010. 

Tomorrow, legislation to reauthorize OAA will be considered by the Senate Health, Education, Labor & Pensions (HELP) committee . We’ve urged the Senate to pass this reauthorization:

“S. 192 builds on the core programs of the Older Americans Act (OAA) – including congregate and home-delivered meals, help for family caregivers, transportation and senior center services - which enable older adults to remain as independent as possible. We support provisions in S. 192 that protect against elder abuse and strengthen long-term care ombudsman services, as well as programs such as fall prevention and chronic disease self-management that promote healthy living. OAA services help seniors avoid hospitalizations and nursing home care, and, as a result, save federal and state funds that otherwise would be spent on such care. In addition to reauthorizing OAA programs, increasing OAA funding is crucial to meet the growing needs of seniors and to compensate for the lack of adequate funding over past years, a funding shortfall that was aggravated by the sequester.” 

We’ve created a video to introduce Members of Congress to the real-life impact their decisions have on average American seniors. 

 

Fulfilling Eleanor's Hope for America

This was originally posted at The Huffington Post by NCPSSM President/CEO Max Richtman

America’s longest-serving First Lady and social activist, Eleanor Roosevelt, would have celebrated her birthday this week.  There have been so many momentous changes in our nation during the fifty-plus years since her death.  Even so, one can’t help but wonder if we have truly fulfilled Eleanor’s hope for America, particularly when it comes to equity for women.

In so many ways, women have come a long way; however, American women are still lagging behind their male peers in too many significant measures. Retirement security is one of those areas where women still face a future marked by inequality.  That’s why we at the National Committee to Preserve Social Security and Medicare have launched “Eleanor’s Hope,” a national initiative mobilizing women of all ages to advocate for income equality, retirement security and health protection. 

“It is better to light a candle than curse the darkness.”
-- Eleanor Roosevelt

The demographic reality facing most American women simply can’t be ignored.  Women live longer than men, on average, yet their lifetime earnings are generally lower.  They are more likely to work in part-time jobs that don’t qualify for a retirement plan or interrupt their careers to take care of family.  The gender wage gap continues, meaning women earn only 78 cents for every dollar paid to their male counterparts. Lower wages mean less is contributed to Social Security for their retirement.  The good news is more women are participating in pension and retirement savings plans than ever before.  The bad news is that the retirement savings gap persists.

According to the New School for Social Research, 75 percent of Americans nearing retirement have less than $30,000 in their retirement accounts. Almost half of middle-class workers will be poor or near poor in retirement and living on a $5-per-day food budget. The National Institute for Retirement Security reports four out of five working families have retirement savings less than one times their annual income and 45 percent do not have any retirement assets at all.  The economic downturn was especially difficult for elderly women.  The latest census reports that nearly 2.6 million elderly women are living in poverty and 733,000 of those live in extreme poverty.  For women who live longer on lower benefits, America’s retirement crisis is very real.  That’s why the financial protection Social Security provides is even more critical for the millions of women who depend on this vital program to keep them from poverty.

Not only do women live longer than men they are also more likely to suffer from three or more chronic conditions including arthritis, hypertension and osteoporosis, making Medicare especially vital for older women. The Kaiser Family Foundation estimated that out-of-pocket spending in 2009 for Medicare beneficiaries 65 and older was $4,844 for women compared to $4,230 for men.  As beneficiaries age, out-of-pocket spending consumes a larger share of their income.  At age 85, total out-of-pocket spending for women was estimated to be $7,555 compared to $5,835 for men.  Clearly, the inequity women face in the workplace continues to follow them even into retirement.

 “The battle for the individual rights of women is one of long standing and none of us

should countenance anything which undermines it.” – Eleanor Roosevelt

There are ways to address these inequities if we can find the political will.  Our “Eleanor’s Hope” campaign will lead grassroots advocacy and education efforts in our communities and on Capitol Hill to build momentum in Congress to address these critical retirement issues.  Our goal is to raise awareness, recruit and train new activists and bolster Congressional leaders who are making a difference on women’s health and retirement security issues.  We’ll advocate for legislation that addresses the inequities threatening millions of retired women.  Some of our proposals for Social Security and Medicare include:

  • Providing Social Security credits for caregivers
  • Improving Social Security survivor benefits
  • Equalizing Social Security’s rules for disabled widows
  • Strengthening the Social Security Cost of Living Allowance
  • Boosting the basic Social Security benefit of all current and future beneficiaries
  • Building on preventive care provisions in the Affordable Care Act and expanding coordination of care for beneficiaries with multiple chronic conditions.
  • Generating greater savings on the cost of prescription drugs by increasing manufacturer discounts, allowing Medicare to receive the same drug rebates as Medicaid for dual-eligibles, and promoting lower drug costs by providing for faster development of generic drugs. 

If this sounds ambitious, it’s because it is.  However, just under 77 million baby boomers are retiring and more than half of them are women.  Too many will face retirement inequity and insecurity.  As we honor Eleanor Roosevelt’s legacy this week and into the future, we must continue the work necessary to fulfill Eleanor’s hope for America.

“The future is literally in our hands to mold as we like. We cannot wait

until tomorrow. Tomorrow is now.” – Eleanor Roosevelt

Why a Medicare Flat Line is Good News for Seniors

While a flat line in the medical world is usually bad news...when it comes to health care costs in Medicare, this flat line is a good thing.  We reported earlier on the latest Congressional Budget Office forecast for Medicare and why that news is being ignored by Washington’s well-financed anti-entitlement lobby and the fiscal hawks they support in Congress. 

Today, the New York Times provides even more good news for Medicare and bad news for anti-Social Security and Medicare scolds:

“Medicare spending isn’t just lower than experts predicted a few years ago. On a per-person basis, Medicare spending is actually falling.

If the pattern continues, as the Congressional Budget Office forecasts, it will be a rarity in the Medicare program’s history. Spending per Medicare patient has almost always grown more rapidly than the economy as a whole, often by a wide margin.”

 

For years now, Wall Street funded fiscal hawk groups have been promising fiscal Armageddon unless Congress immediately cut benefits to middle-class seniors and their families. Contrary to that billionaire-financed bluster, the truth is there are clearly ways to see savings in Medicare through lower health care costs, not just by slashing benefits:

“The recent pattern reflects two main factors. One is that the baby boom generation is entering the program. In the long term, that’s a problem for Medicare’s finances because the number of people it must care for is going to surge. But in the short term, it skews the group enrolled in Medicare toward a younger, healthier population.

The second factor is more surprising and consequential. Over the last few years, Medicare patients have been using fewer expensive medical services, particularly hospital care and prescription drugs. The budget office is increasingly persuaded that such a pattern is going to last for a while.”

And there are even more proposals that could be enacted which don’t single out seniors for benefits cuts.  How about allowing Medicare to negotiate for lower drug costs like the VA does for veterans?  Or fully allow the proposed reductions in billions of dollars in federal overpayments to MA private insurance companies to be enacted, as proposed by the Affordable Care Act?  This CBO report clearly proves there are ways to manage costs beyond the benefit-cutting or privatization schemes preferred by Congress’ self-proclaimed deficit hawks:

Joan McCarter at Daily Kos sums it up best this way:

“Here's what's particularly significant in this: "Reductions made in the last four years alone are responsible for 10-year savings of more than $715 billion, which dwarfs nearly every deficit-reduction measure currently under discussion." Take that, Paul Ryan.

Here's the thing. Medicare is going to be facing issues when the baby boom cohort gets older and sicker. But this trend in shrinking costs gives policymakers time to look at reforms that do not require benefit cuts, that don't require pain for Medicare patients. That means there's no reason for another Paul Ryan budget that slashes the safety net or for another catfood commission calling for raising the Medicare eligibility age or more cost-sharing by patients. Take note, Democrats, and stop with the deficit fetish already.”

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