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From the category archives: Medicare

Congress Trades Bad Deal for Doctors for Bad Deal for Seniors in Medicare

The House has passed the so-called "doc fix" legislation replacing the flawed reimbursement formula Congress itself created years ago to cut pay to doctors in Medicare.  The formula has never worked and Congress has had to vote to replace it year after year.  We've supported the permanent replacement of this flawed formula and still do.  Unfortunately, the legislation that passed the House today merely trades one bad deal for another.  And this time it's seniors who take the hit. 

 “Contrary to claims by supporters, on both sides of the aisle, this ‘doc fix’ does not impact only ‘wealthy seniors’. Millions of beneficiaries who depend on a Medigap plan to help pay their health care bills – no matter their income -- will be hit with higher costs. Given that 46% of all Medigap policy holders had incomes of $30,000 or less, it’s clear this deal impacts far more than the wealthy, as the bill’s proponents have claimed.  What’s more, Medicare beneficiaries will be forced to contribute nearly $60 billion in premiums over the next decade to replace the SGR.

No doubt, we’ll hear today that this ‘compromise’ Medicare doc-fix plan must be a success because there are concessions from all sides.  Unfortunately, that political trope is just as flawed as the SGR itself because it ignores the financial reality facing Medicare beneficiaries just as the SGR ignored the reality facing doctors. Trading a bad deal for doctors for a bad deal for seniors is not a legislative victory and it is a surprising move from some in Congress who have previously vowed to protect Medicare from cuts and seniors from cost-shifting.

 It’s no surprise that anti-“entitlement” lobbyists on Capitol Hill and their allies in Congress are celebrating this deal for the benefit cuts they know will ‘grow like an avalanche over time’.  That avalanche will be headed straight for American retirees, current and future, as Congress continues to push Medicare down the slippery slope of means testing, raising costs for more and more seniors, including the middle-class.”...Max Richtman, NCPSSM President/CEO

See the GOP's Plans for Medicare - In One Picture

GOP Budget: Doubling-Down on Their Strategy to Destroy Medicare

Well, the GOP Budget Has Defined its Fiscal Priorities For America Alright...Middle-class Americans, Retirees, Children, People with Disabilities, and the Poor Foot the Bill So That Huge Corporations and the Wealthy Keep Tax Giveaways and Loopholes

Budget plans are about setting priorities and in a grander sense defining the nation’s values.  By the look of next year’s proposed GOP House Budget, that means conservatives in Washington intend to double-down on an economic vision in which our dwindling middle-class, America’s retirees, people with disabilities, the poor and their families continue to do the heavy-lifting so that the richest 1% can keep their tax breaks and loopholes. 

Here's our reaction from NCPSSM President/CEO, Max Richtman:

“Once again, the House GOP’s budget would privatize Medicare with a voucher plan, leaving seniors and the disabled – some of our most vulnerable Americans – hostage to the whims of private insurance companies.  Over time, this will end traditional Medicare and make it harder for seniors to choose their own doctor.  Vouchers will not keep up with the increasing cost of health insurance… that is why seniors will pay more.  Incredibly, the GOP budget also tries to have it both ways by counting the savings in Medicare since the passage of health care reform and then repealing the law that delivered those same savings. Seniors need to pay careful attention to this next fact: if the GOP isn’t stopped from repealing healthcare reform, Medicare beneficiaries would immediately lose billions in prescription drug savings, wellness visits and preventative services with no out-of-pocket costs, and years of solvency will be lost to the Medicare program. 

Social Security disability beneficiaries are also targeted by the GOP’s refusal to allow a routine and temporary reallocation of part of the 6.2 percent Social Security tax rate to the Disability Insurance Trust Fund.  Instead, Republicans in the House would allow a 20% benefit cut for millions of disabled Americans unless there are broader Social Security benefit cuts or tax increases improving the solvency of the combined trust funds.  This GOP budget also call for the creation of commission to study what Republicans claim are ‘structural deficiencies’ in Social Security, even though the program has never missed a payment and currently has $2.8 trillion in its trust fund. 

No doubt, Congressional conservatives feel emboldened by the 2014 elections; however, I suggest the message voters sent wasn’t the message the GOP is touting in this new budget.  The American people do not support gutting Social Security and Medicare and targeting the middle-class to pay for tax cuts and loopholes for corporations and the wealthy – which is the foundation the House GOP budget plan is built upon.” ... Max Richtman, NCPSSM President/CEO

 

 

 

 

Americans Push Back as Threat to Social Security & Medicare Grows

National Committee grassroots activists were on Capitol Hill today to deliver 2 million signatures to the Senate urging Congress to reject ongoing efforts to cut Social Security and Medicare benefits.  Senators Bernie Sanders (I-VT), and Sheldon Whitehouse (D-RI) received the petitions and vowed to continue leading the fight to protect these vital programs. 

 

 

 

 

The timing for today’s impressive show of grassroots action couldn’t have been better because according the The Hill newspaper, some in the Senate are looking at crafting yet another attack on middle-class benefits known as the so-called “Grand Bargain”. 

You’ll probably remember that this flawed fiscal plan was first offered by chairmen of the failed fiscal commission, Erskin Bowles and Alan Simpson, who had to issue their own report after they couldn’t get enough support by their own Commission.  They took their Bowles/Simpson report (BS for short) on the road, backed by the billion dollar Wall Street anti-“entitlement” lobby, hoping to sell the idea that cutting middle class earned benefits and raising middle class taxes while also lowering taxes (even more) for the richest Americans was the path to fiscal sanity.   No one was buying it then but that was before the GOP took control of the Senate.

Now, it appears corporatists of both parties in Senate hope to revive the BS “grand bargain”.

 “He (Senator Lindsay Graham (R-SC) said he was willing to close “loopholes” in the tax code if Democrats were willing to make concessions on entitlements. That’s the ideological problem for some Republicans, but not for me. I would generate some revenue by capping deductions in the tax code if Democrats help me make some small entitlement changes that buy it back…a mini Simpson-Bowles,’ he said.”

We’ve already seen this “let’s make a deal” gamesmanship many times before.  The problem is those “loopholes” Republicans are willing to close are the tax breaks that impact average Americans like the mortgage interest deduction and targeting retirement savings and health insurance.  They’re not interested in going after the trillions lost to corporations sending jobs overseas or gaming the system to avoid taxes entirely or lifting the payroll tax cap or instituting a financial transactions tax. 

You can see why this plan is truly a “grand bargain” for America’s billionaires, the Business Roundtable and their supporters in Congress.  It’s just a raw deal for everyone else.

 

 

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.

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