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Posts Tagged 'medicare privatization'

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House GOP Recklessly Pursues Privatization of Medicare in Budget Process

Congress is targeting the health and financial well-being of America’s seniors by making yet another attempt to privatize Medicare.   Yesterday the House Budget Committee passed the GOP’s FY 2018 budget resolution, which includes Speaker Paul Ryan’s “Medicare premium support” scheme – an innocuous name for turning time-tested senior health care coverage into “Coupon-Care.”  

The House budget blueprint slashes nearly $500 billion from Medicare over ten years and raises the eligibility age from 65 to 67 – along with gutting Medicaid and other social safety net programs for needy seniors.  

The Associated Press had a pithy summary of the painful cuts that the GOP proposes in its new budget:

“The plan, in theory at least, promises to balance the budget through unprecedented and unworkable cuts across the budget. It calls for turning this year's projected $700 billion or so deficit into a tiny $9 billion surplus by 2027. It would do so by slashing $5.4 trillion over the coming decade, including almost $500 billion from Medicare, $1.5 trillion from Medicaid and the Obama health law, along with enormous cuts to benefits such as federal employee pensions, food stamps, and tax credits for the working poor.” – Associated Press, 7/18/17

 National Committee President Max Richtman says that converting Medicare into a voucher program is an existential threat to the program itself. 

 “Over time, giving seniors vouchers to purchase health insurance would dramatically increase their out of pocket costs since the fixed amount of the voucher is unlikely to keep up with the rising costs of health care. And, as healthier seniors choose less costly private plans, the sicker and poorer seniors would remain in traditional Medicare, leading to untenable costs, diminished coverage, and an eventual demise of traditional Medicare, plain and simple.” – Max Richtman, NCPSSM President

Of course, raising the Medicare eligibility age from 65 to 67 as the House spending plan also proposes, is in itself a drastic benefit cut.

Undermining Medicare has been a long-held dream of fiscal conservatives. Their “premium support” proposal is a thinly veiled scheme to allow traditional Medicare to “wither on the vine,” as former House Speaker Newt Gingrich once put it.

Privatization is being sold as “improving customer choice,” but based on the way current Medicare Advantage plans work, private insurance will continue to offer fewer choices of doctors than traditional Medicare does.  If traditional Medicare is allowed to shrink and collapse, choice will disappear, too.

“Weakening Medicare is a politically perilous path for Republicans.  Recent polling indicates that large majorities of Americans across party lines prefer that Medicare be kept the way it is, not to mention that President Trump repeatedly promised to protect the program during the 2016 campaign.” – Max Richtman, NCPSSM President

Meanwhile, the National Committee strongly condemns other priorities of the House Republican budget resolution, as well.  The GOP budget resolution will mean: 

*Hundreds of billions in painful cuts to Medicaid, which seniors depend on for long-term care services and supports.

*Reaffirmation of a House rule that puts 11 million Social Security Disability Insurance (SSDI) beneficiaries at risk of a 7% benefit cut in 2028.

*Reductions to SSI (Supplemental Security Insurance), which provides cash assistance to low-income seniors and people with disabilities.

 *Caps on non-defense spending that will likely lead to devastating cuts to Older Americans Act programs and the Social Security Administration (SSA) operating budget.

 *Slashing of programs that benefit our nation’s veterans and deep cuts to spending on medical research (including cancer, diabetes, heart disease, and other conditions afflicting the elderly).

The savings from these devastating cuts will likely go to tax breaks for the wealthy.  Last year’s House Republican tax plan gave 99.6% of its benefits to the top one-percent of earners, with virtually nothing for middle and low income Americans.

 

 

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Social Security and Medicare are Financially Sound, Not “Going Bankrupt,” says Trustees Report

The 2017 OASDI Trustees Report confirms that the Social Security Trust fund is stable and healthy for now, but faces challenges in the future if corrective action is not taken.  The most important figures remain consistent with last year’s report:  The combined OASDI (Old-age, Survivor, and Disability Insurance) trust funds will remain fully solvent until 2034, after which Social Security can pay 77% of benefits if there are no changes to the program. The Trustees report there is now $2.847 trillion in the Social Security Trust Fund, which is $35.2 billion more than last year --- and that it will continue to grow by payroll contributions and interest on the Trust Fund's assets.  

This reassuring report will not stop Social Security’s opponents from seeing the glass half-empty and claiming that the program is in dire financial trouble.  Expect to hear more false cries about Social Security (and Medicare) going “bankrupt” in the coming months. 

“Opponents of Social Security may once again try to use this report as an excuse to cut benefits, including raising the retirement age.  We must, instead, look to modest and manageable solutions that will keep Social Security solvent well into the future without punishing seniors and disabled Americans.” - Max Richtman, NCPSSM president and CEO

The National Committee endorses bills introduced by Senator Bernie Sanders (I-VT), Rep. John Larson (D-CT) and others, which keep the Social Security trust fund solvent while boosting benefits and cost-of-living adjustments (COLAs).  The bills achieve this mainly by phasing out the payroll tax income cap so that the wealthy pay their fair share into Social Security.

Forty percent of seniors (and 90% of unmarried seniors) rely on Social Security for all or most of their income.  The average monthly retirement benefit of $1,355 is barely enough to meet basic needs, and the Trustees’ latest projected cost-of-living increase of 2.2% will not keep pace with seniors’ true expenses. 

The news media touted the 2.2% bump for 2018 as “the largest in several years.” While it’s true that next year’s COLA is far superior to this year’s 0.3% increase, it is still woefully inadequate.  What the media don’t always explain is that a 2.2% increase translates into an extra $28 per month – hardly a fortune for seniors struggling to meet rising expenses on fixed incomes. A single co-pay for a prescription or a trip in a wheelchair van could easily gobble up $28, if not more.

Currently, Social Security cost of living increases are pegged to the Consumer Price Index for Wage Earners or CPI-W.  This index does not reflect seniors’ true expenses.  Older Americans pay a disproportionate share of their limited incomes for items like housing and medical care compared to younger wage earners.  The National Committee advocates the adoption of the Consumer Price Index for the Elderly (CPI-E), which tracks rising costs for the goods and services seniors actually spend their money on.  The leading categories are Housing, Transportation, Food and Medical Care.  As the National Committee’s Webster Phillips told CBS Radio News: 

“The consumer price index for the elderly (CPI-E), which is focused on the spending patterns of seniors, is a better measure of inflation as it affects older people’s consumption patterns.” – Webster Phillips, NCPSSM Senior Policy Analyst, 7/13/17

On Medicare, the Trustees report shows that the Part A Trust Fund will be able to pay full benefits until 2029, and 88% thereafter if nothing is done to bolster the system’s finances.  Depending on what the final version looks like, the Republican healthcare plan could reduce the solvency of Medicare by two years. The National Committee opposes the GOP health plan and rejects efforts to privatize Medicare – which Speaker Ryan and the House Republicans have promised to undertake during the budget resolution process for 2018.

Instead of privatization, the National Committee champions innovation and continuing efficiencies in the delivery of care, allowing Medicare to negotiate prescription drug prices, and restoring rebates the pharmaceutical companies used to pay the federal government for drugs prescribed to “dual eligibles” (those who qualify for both Medicare and Medicaid) – in order to keep Medicare in sound financial health.

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GOP Plans for Medicare? All Slash No Strengthen

The House Ways & Means Subcommittee on Health held a hearing entitled "Preserving and Strengthening Medicare."  Unfortunately, as the ranking member Rep. Jim McDermott (D-WA) made clear, this hearing actually had virtually nothing to do with preserving and strengthening Medicare:

“This is the first Health Subcommittee hearing of the year, and it could have been an opportunity to have a fresh, constructive conversation about Medicare. Unfortunately, this won’t be the case. It looks like we should expect more of the same from my Republican colleagues this morning – bad ideas repeated incessantly in the hope that the American people eventually fall for them.

The core proposal that my Republican colleagues have offered – to end Medicare as we know it – will have devastating effects on seniors. It will shift costs onto beneficiaries, create more losers than winners, and lead to a death spiral in traditional Medicare.

We all know this.”

NCPSSM President/CEO, Max Richtman, submitted testimony to the Committee and reacted to the day’s proceedings:

“Unfortunately, today’s Congressional hearing on ‘Preserving and Strengthening Medicare’ offered no new ideas and was instead an Orwellian political exercise in which politicians say preserve when they actually mean privatize, and strengthen when they mean slash. 

Republicans in the House envision a future in which millions of seniors will lose their guaranteed Medicare benefits in favor of a privatized CouponCare system in which they receive a government coupon to try and buy private insurance. Millions of seniors in Medicaid will lose their benefits due to block-granting to states without providing the resources to pay for it.  The repeal of the Affordable Care Act will leave tens of millions without insurance and strip benefits from seniors in Medicare.  

The Republican leadership has offered no plans to improve benefits in Medicare or make reforms to reign in the skyrocketing price of drugs and healthcare costs system wide.  Instead, the GOP vision for seniors in Medicare is they must just do more with less. Stagnant wages are grinding away at the middle class’s ability to save for retirement.  Many employers have significantly scaled back or eliminated the traditional retirement benefits offered to their employees.  As a result, current and future retirees simply cannot afford proposals to cut benefits, raise the eligibility age or privatize the program.”...Max Richtman, NCPSSM President/CEO

While the House Ways and Means Health Subcommittee promoted destroying traditional Medicare in favor of a fully privatized system during today’s Congressional hearing, their GOP colleagues are moving a budget through Congress that would make that plan reality.

The House budget would cut Social Security and Medicare by $463 billion over 10 years, while cutting Medicaid and other health programs by $1.028 trillion, not including the Affordable Care Act.  The GOP budget protects the wealthiest Americans and big corporations from any tax increases while imposing massive spending cuts on average Americans and their families.

Max Richtman’s full testimony as submitted to the House Ways and Means Health Subcommittee is here.  

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A Tale of Two Medicares

CMS has announced it will raise rates for insurance companies offering privatized Medicare Advantage, rather than trimming back the billions of federal overpayments as required in the Affordable Care Act.  Wall Street and the insurance industry loved the news that taxpayers will continue to overpay Medicare Advantage plans:

“WellCare Health Plans Inc. jumped as much as 12 percent on Monday after the government proposed raising payments next year for private insurers that provide Medicare coverage.Shares in Humana rose 2.6 percent. Centene Corp. and Molina Healthcare Inc. also rose Monday following the CMS’s proposals, adding 4.2 percent and 6.2 percent respectively.”

The health insurance industry’s massive advertising and lobbying campaign to keep their government subsidies has become an annual ritual here in Washington – one that’s more predictable than the timing of the cherry blossoms. To head off any chance that CMS might reduce the massive federal overpayments, as required by the Affordable Care Act, the multi-billion dollar insurance industry floods the airways and hallways of Congress with threats to cut seniors’ MA benefits unless their overpayments are protected.  Clearly, that lobbying works. 

For the second year in a row, CMS has proposed a rate increase. This year’s 1.35%  rate hike, when combined with other industry requested changes, will lead to a 3.55% increase in revenue for America’s health insurance industry.  Last year, CMS initially proposed a .95% rate cut which was reversed after AHIP’s lobbying blitz turned it into a 1.25% increase.  In 2015, Medicare paid $8 billion more to provide coverage for seniors in Medicare Advantage than for traditional Medicare. That will now continue.

The Washington Post’s analysis last year, still fits today:

“Alas, since its origins in the early ’80s, MA has proven no more immune to perverse incentives and system-gaming than any of the government’s other health programs.

First, insurers cherry-picked healthier customers, who are less costly, and hence more profitable, to treat. Congress responded with new payment formulas to reward companies for accepting relatively sick customers. But this led to rampant “upcoding,” whereby MA plans find and report as many illnesses per enrollee as they can plausibly document.

Last fall, {2014} the Department of Health and Human Services released a comprehensive analysis showing that MA costs grew faster than they would have under fee-for-service between 2004 and 2013 — and that only upcoding, not patient demographics or other neutral factors, could explain this.”

Family physician and Senior Health Policy Fellow for Physicians for a National Health Program, Dr. Don McCanne says:

“Ensuring success of the MA plans is part of the plot to eventually privatize Medicare - converting it into a premium support system (vouchers) for a market of private plans that will displace the traditional Medicare program. The value of the voucher equivalents will erode with time, shifting ever more of the costs to the Medicare beneficiaries. It will be disastrous.

They (private MA plans) have been profitable only because they have continued to be successful in enrolling healthier, less costly patients while at the same time receiving overpayments from the government.”

So how did we get here?

Medicare Advantage was created by the Bush Administration to privatize Medicare. Prior to the ACA, the federal government paid MA plans up to 14 percent more than traditional Medicare for identical services, costing taxpayers about $1,000 extra per beneficiary.  MA plans attract younger and healthier customers by offering benefits not included under traditional Medicare, such as gym memberships.  That competitive and financial advantage has paid off, as MA enrollment continues to grow.  Seniors in private Medicare say they like their plans, as do people enrolled in traditional Medicare. 

The real irony in this debate is that while traditional Medicare has been repeatedly targeted in Congress for cuts, $8 billion in overpayments to the insurance industry remain protected. Congressional conservatives claim America can’t afford Medicare yet many of these same politicians defend sending billions of Medicare dollars straight to the insurance industry, in spite of growing concerns that insurers are gaming the system:

  • Independent analysis by the National Bureau of Economic Research shows private plans are “upcoding” or manipulating patient diagnoses in order to game payment systems and generating billions of dollars annually.  
  • Risk scores have risen 9 percent faster in Medicare Advantage, on average, than in traditional Medicare for comparable beneficiaries, MedPAC estimates.  This leads to excessive payments to Medicare Advantage plans. 
  • Last year, CMS took 35 enforcement actions against MA and Part D sponsors for a range of issues, including limited provider access and charges for higher than allowed out-of-pocket costs. Among the enforcement actions last year were 25 fines in the six figures. This year, CMS has fined $1 million to Aetna for Part D directories that erroneously listed 7,000 pharmacies as being in-network. 
  • GAO investigators found Medicare officials rarely enforce rules for private insurance plans intended to make sure beneficiaries will be able to see a doctor when they need care. In Connecticut, UnitedHealthcare, the nation’s largest health insurance company, dropped more than a thousand of health care providers and doctors leaving patients desperately scrambling for care. 
  • Brown University study shows that once medical care becomes costly for seniors in Medicare Advantage and the coverage no longer meets their needs for acute care, beneficiaries are leaving private MA plans to return to traditional Medicare. 

As we wrote here last year,

“Private Medicare Advantage plans continue to see growth as they promise gym-memberships, limited optometric coverage or zero premium plans.  However, as predicted by many healthcare experts and indicated in the Brown study, seniors find that once they actually need help with more costly care, MA plans aren’t providing the coverage they need. 

Ultimately, this means that younger and healthier seniors are being lured into private insurers’ plans only to have to switch to traditional Medicare once they need coverage for more serious health issues (and isn’t that why we have health insurance in the first place – to cover when we get sick, not when we’re healthy?).  Meanwhile, private insurance companies continue to reap the benefits of annual federal subsidies to provide this limited coverage for healthier seniors – which are tax dollars that could have been used in traditional Medicare to serve all beneficiaries.”

Modern Healthcare reports Medicare Advantage has been a boon for health insurers, which views taxpayer-funded insurance as a ripe business opportunity.  Meanwhile, the GOP Congress is preparing another round of cuts to traditional Medicare in their upcoming 2017 Budget plan

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