by Barbara B. Kennelly, NCPSSM President/CEO

Imagine starting a business with a guaranteed 12 percent to 50 percent federal subsidy not available to your competition. The cost of that subsidy is then passed on to your competitor's customers. And finally, let's add restrictions to your competitors that don't apply to your new business. Sounds like a sweetheart deal, right? It is. It's called Medicare Advantage, the privatized Medicare plan created by the insurance industry, passed by Congress in the Medicare Modernization Act of 2003 and now enrolling millions of seniors nationwide.

Private insurers offering Medicare Advantage plans will collect $75 billion this year alone and $1.31 trillion over the next decade, according to the Congressional Budget Office. That's federal funding which could have gone to Medicare but is now going to the insurance industry instead. These private plans are paid $1,000 more a year for each beneficiary than the government pays for seniors enrolled in traditional Medicare. The independent Medicare Payment Advisory Commission estimates that every Medicare beneficiary is paying $24 more per year for their Part B premiums just to subsidize these private plans. So, even though 81 percent of Medicare's beneficiaries have chosen to remain in traditional Medicare, they are now paying extra premiums to cover the 19 percent who've chosen the private plans. These billions of dollars in overpayments have also cut two years from Medicare's solvency.

Insurers and privatization supporters in Washington defend Medicare Advantage plans claiming better service at a lower cost. The overpayment price tag certainly casts doubt on the cost argument. And, as we saw with the Part D prescription drug benefit, there are mixed results with the quality of service. MedPAC reports that in the case of private fee-for-service plans, only half of the excess payments to insurers are being used for extra benefits to seniors. The other half goes directly to insurance companies' bottom lines. And even though private plans are required to cover everything Medicare covers, they often impose higher cost-sharing requirements than traditional Medicare for benefits such as hospitalization, home health care and skilled nursing care. This means more out-of-pocket costs for seniors, many of whom don't even realize it until faced with a serious health crisis.

Congress is now reconsidering the future of these massive subsidies. Not surprisingly, the insurance industry lobby is geared up and launching its full assault to protect the spoils it won with the passage of MMA 2003. The industry's political case was slowed somewhat with recent news reports that seniors from coast to coast have been defrauded by Medicare Advantage salesmen luring them out of traditional Medicare into private plans their own doctors wouldn't accept or the seniors couldn't afford.

A recent survey of state insurance agencies found 39 of 43 states had received complaints about Medicare Advantage misrepresentations. While the industry claims the complaints are from "a few bad eggs" it promises to crack down on; in fact, the marketing abuses are inevitable in a system designed to reward enrollment numbers. And in an effort to persuade Democrats in Congress, the insurance lobby now claims low-income and minority seniors will suffer if these overpayments are stopped. Conveniently, their data ignore the large number of these beneficiaries currently receiving Medicaid.

A recent analysis by the economists at the Center on Budget and Policy Priorities found that low-income and minority beneficiaries are far more likely to receive coverage through Medicaid than Medicare Advantage plans. In fact, only 14 percent of Asian Americans, 13 percent of African Americans, and 25 percent of Hispanics are enrolled in private plans. The lifeline for Medicare Advantage is the insurance lobby and the billions of dollars it has convinced Congress to pump into industry coffers at the expense of seniors. Insurers have threatened to cut their Medicare Advantage plans if Congress halts the flow of excess payments. However, if Medicare continues to fund large subsidies to private plans, the program will face even more pressure to cut benefits and increase out-of-pocket costs for beneficiaries. Traditional Medicare will be eroded while private plans continue to collect billions in subsidies and beneficiaries pay more of the high costs of healthcare.

Advantage ... insurers.

It's time to stop disadvantaging Medicare. End these costly subsidies to insurance companies and put that money to work for all of the 43 million Americans enrolled in Medicare not just the few enrolled in private plans.

This OpEd can also be seen in the July 10th Hartfort Courant.