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America’s Seniors Need Health Care Reform
By NCPSSM | November 5, 2009
The House expects to vote on health care reform this weekend. It’s hard to exaggerate how important this vote is for the future of Medicare, its long-term viability and the millions of American seniors who depend on it.
If you, or a loved one, are covered under Medicare and have been sitting on the sidelines of this health reform debate, scratching your head and hoping to make some sense of all the frightening and misleading political rhetoric—it’s not too late to take a stand, make a difference in this debate and voice your support for health care reform that improves efficiency and care for millions of Medicare beneficiaries while also providing savings for system-wide health care reform efforts.
Health Care Reform Stregthens Medicare
The House Health Care Reform bill, the Affordable Health Care for America Act , provides the most beneficial reforms for seniors since Medicare’s creation .
There are more than 550 sections dealing with Medicare reforms included in this legislation. The vast majority of these have been ignored by opponents of healthcare reform because together they make historic improvements to the Medicare program. See for yourself by linking to the legislation directly and reviewing the sections highlighted below. This list offers just a glimpse of the benefits in this legislation for seniors in Medicare:
Closes the Part D doughnut hole
Div B Title I-Subtitle E – Elimination of coverage gap –Sec. 1181.
- The House health care reform legislation eliminates the Part D donut hole, beginning with a $500 reduction in 2010, and completing phase-out by 2019. Pays for the elimination of the gap with funds raised by requiring drug manufacturers to provide Medicaid rebates for drugs used by full dual eligibles.
- 3.4 million Medicare beneficiaries fall into the coverage gap each year, and in 2009, none of the stand alone Part D prescription drug plans (PDPs) offered full coverage through the doughnut hole
- National Committee analysis shows the House reform legislation also prevents the doughnut hole from doubling during the phase-out period.
Allows government negotiation of drug prices in Part D
Div B-Title I Subtitle E – Negotiation of lower covered Part D drug prices on behalf of Medicare beneficiaries- Sec. 1186.
- Part D price negotiation is a win-win proposition for Medicare and seniors because it shifts the focus back to providing the best prices to government and its beneficiaries rather than boosting industry profits. The National Committee policy staff detailed $24 billion in savings possible if Medicare was allowed to negotiate drug costs. Our report also shows that seniors in Medicare are currently paying up to twice as much for drugs as veterans who receive their coverage from the VA, which does allow negotiation for the lowest costs . That negotiation savings would be more than enough to close the Part D coverage gap known as the “doughnut hole” and address other deficiencies in the Part D plan.
Eliminates Billions of Dollars of Wasteful Subsidies to Private Insurers
Div B-Title I Subtitle D – Medicare Advantage Reforms-PART 1 Sec. 1161
- The only threat to cut Medicare benefits comes from private insurers — not Congress –not the President. Cutting billions in subsidies to private insurers is NOT the same as benefits cuts. $11 billion dollars in subsidies will go to Medicare Advantage insurers in 2009 alone. Reducing these overpayments to private insurance plans, so that they are paid what it costs to treat beneficiaries in traditional Medicare, would strengthen the solvency of the Medicare program and reduce the rate of increase in Part B premiums for all Medicare beneficiaries.
Here’s just a few more important health care reforms for seniors in the House bill:
Sec 110. Prohibition against post-retirement reductions of retiree health benefits by group health plans. Prohibits employers from reducing retiree health benefits below what was offered to retirees at the time of their retirement unless reductions are also made to active workers’ health benefits. Effective as of date of enactment
Sec. 111. Reinsurance program for retirees. Establishes a temporary reinsurance program to provide reimbursement to participating employment-based plans for part of the cost of providing health benefits to retirees (age 55-64) and their families.
Sec. 240. Dissemination of advance care planning information. Provides that health insurers in the Exchange present enrollees with information about resources available for advanced care planning which is voluntary to the individual.
Sec. 1114. Expanding Physician Assistants’ Role in Medicare. Allows physician assistants to order skilled nursing facility care and lists them as an eligible provider for hospice care.
Sec. 1123. Payments for efficient areas. Provides incentive payments in the Medicare program to physicians practicing in areas that are identified as being the most cost-efficient areas of the country.
Sec. 1151. Reducing potentially preventable hospital readmissions.
Sec. 1185. No mid-year formulary changes permitted. Prevents Part D plans from making any formulary change that increase cost-sharing or otherwise reduce coverage once the plan marketing period begins.
Sec. 1188. Free generic refill in Part D allowed.
The Status Quo is NOT an option
“Don’t Touch Medicare” is a good slogan but a fatal strategy for the program.
- Benefits cuts are not included in the House health care reform legislation but that’s exactly what beneficiaries will ultimately face if we do nothing. The status quo isn’t sustainable and failure to pass health care reform is not an option for seniors who rely on Medicare. Without reform, neither seniors nor the government will be able to afford the program and Medicare will be targeted with unprecedented benefit cuts, higher premiums, and growing out-of-pocket costs.
- If health care costs continue to grow unchecked the Congressional Budget Office (CBO) predicts, total spending on health care would rise from 16 percent of the Gross Domestic Product (GDP) in 2007 to 49 percent in 2082. Federal spending on Medicare and Medicaid would rise from 4 percent of GDP in 19 percent in 2082. Benefits cuts are NOT proposed in the House reform legislation; however, without health care reform, it is inevitable that Medicare and Medicaid will face deep cuts and benefit cuts for seniors will be on the table then. Arbitrarily cutting Medicare without addressing system wide health care reform is not a hypothetical financial exercise. It would have real impacts on real people, most of whom have nowhere else to go for coverage and limited options for increasing their resources.
- The Medicare Hospital Insurance Trust Fund, which pays for Medicare Part A, is projected to be exhausted by 2017. Without reform, seniors will bear an increasing burden of higher out-of-pocket costs—costs which already consume about one-quarter of the average senior’s Social Security benefit. Without reform, that amount will continue to grow far beyond the average beneficiaries ability to keep up. The Part D doughnut hole alone is projected to double with in the next decade.
Consider this: Health care reform’s most vocal opponents in Congress have also been philosophically opposed to the existence of social safety net programs like Medicare in the first place. Given the current health care crisis in America, health care opponents’ strategy of “Don’t Touch Medicare” will ultimately achieve the same goal proposed by Medicare’s opponents back in the 1990’s to let Medicare “whither on the vine”.
Sorting the Fact from Fiction
For more than a year, we have tried to offer seniors a comprehensive and honest assessment of the ongoing and constantly evolving health care reform debate. Seniors need to know the truth about this historic debate. Our “Truth Squad” campaign is the latest in our efforts to provide the facts about health care reform. Here is the latest video in the Truth Squad series:
Health care reform is vital for America’s seniors—Now’s the time for seniors to share that message with Congress. Our Legislative Action Center helps connect you directly to your member of Congress.
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