Title: Medicare Gets a Health Checkup from CMA’s Judy Stein 
Guest: Judy Stein, Founder & Exec. Director, Center for Medicare Advocacy
Release Date:  4/5/24


Announcer:  It’s You Earned This, the Social Security and Medicare podcast, brought to you by the National Committee to Preserve Social Security and Medicare, and now your host, Walter Gottlieb.

WALTER: Good afternoon, Judy, how are you? 

JUDY:  I’m good, thank you. Thank you for having me. 

WALTER: Thank you for joining us from all the way up in Connecticut. 

JUDY:  My pleasure. 

WALTER:  I did wanna say that we have something in common. Our past president here at the National Committee to Preserve Social Security and Medicare, Barbara Kennelly, a fellow Connecticut- er, I think is how you say it. She is on your advisory board at Center for Medicare Advocacy. 

JUDY:  That’s correct. She’s a longtime esteemed member of the Connecticut population and a great advisor and colleague for the Center for Medicare Advocacy and was a long- standing member of the United States House of Representatives from Connecticut for many years. So we’re extremely fond and proud of Barbara. I’ll give her a shout out in case she is listening to this. 

WALTER: I couldn’t help but noticing — so you’re in Connecticut, Barbara’s in Connecticut, Congressman John Larson, who’s the hugest champion of Social Security in the Congress. Is there something in the water up there in Connecticut that turns people into advocates of Social Security and Medicare? 

JUDY:  Well, I think there, I don’t know if it’s in the water, but maybe it’s in the air. And that is a, I think a longstanding, fairly large community of people who want to push for social justice and a sense that social insurance, having folks as a whole joined together to help everybody, is still something we should push for and has been for a very long time in this state. 

WALTER:  And as are you and the Center for Medicare Advocacy. Can you tell us a little more about the Center for Medicare Advocacy and what your mission is? 

JUDY:  Oh, absolutely, my pleasure. So I founded the Center for Medicare Advocacy in 1986. We’re a private nonprofit law organization, which is kind of an unusual mix, a nonprofit law firm. We have a significant presence in Washington, DC and attorneys in Connecticut, California, Washington, Maryland. And we are organized. Our mission is to enhance and extend Medicare as a comprehensive benefit for all beneficiaries. 

WALTER: We admire very much what you do, especially since Medicare is in the name of our organization too, along with Social Security. I was wondering, Judy, have you had any personal interactions with the Medicare system, perhaps with elderly parents or other loved ones that informs your commitment to seniors’ health security? 

JUDY:  Well, yes, I’ve been dedicating my legal career to helping Medicare beneficiaries, so I’ve had experience with a lot of people’s stories. But let me speak for a moment about my mother and her brother, my mother and my uncle’s experience with Medicare, which I think is very illustrative.

WALTER:  Okay, great. 

JUDY:  So, when my mom was 89, and she’s still wonderfully alive and healthy at 97 now. 

WALTER:  Terrific. 

JUDY:  She had what turned out, blessedly, to be a benign tumor on her spine. She was in, and still is, what we call traditional Medicare, the public program, along with a Medicare supplement, Medigap coverage. And she was able to look into and find one of the best spinal surgeons in the country who happened to be at Yale New Haven Hospital in Connecticut. And from not being able to feel anything below her waist, she was, after the surgery, reclaimed her feeling. And she went to a good, known rehab nursing home facility near my home. This was possible, again, because she was in traditional Medicare… and she was able to afford this with her traditional Medicare and Medigap coverage. 

WALTER: We here at the National Committee, Judy, of course, strongly support traditional Medicare, but we’re having a lot of problems with Medicare Advantage, the private version of Medicare, which has now captured a majority of the market. But despite its name, Medicare Advantage has some serious disadvantages, especially for older and sicker seniors. I know you also have a personal story about Medicare Advantage. 

JUDY: My mother’s brother, who at the time was 92, had a need for hip surgery. He had the hip surgery. That went all right, but he needed to go to a nursing home after the fact. The plan he was in, like all Medicare Advantage plans, has what’s known as a network of providers, and that is that you can only go, usually, to the providers and facilities within the plan. That was not the nursing home that he and my cousins, his children, would have chosen, but it was what was available. 

He went there and he did okay, but within a very short time, he was informed that the plan would no longer cover his nursing home stay, and that he couldn’t afford to stay there without Medicare coverage.  And that night, he fell — and he remained on the floor for about 12 hours until my cousin visited him in the morning, and he was pretty miserable. He passed away within a couple of months after that time. And two weeks after he passed away, I won the Medicare administrative law judge hearing saying that Medicare should have covered the nursing home stay for a longer period of time. 

Now, those are two stories, one family. I’m not saying it’s exactly what would happen to everybody, but there is more choice in traditional Medicare, more options to choose your geographic area and the facility and provider of your choice.

WALTER: We’re sorry to hear about your uncle. That’s a very sad story, and then to get the news that you won the appeal, but it was too late because he passed away, that’s really frustrating to hear. 

I am interested to know what you think of the Biden administration’s efforts to level the playing field a little bit, to make Medicare Advantage more transparent, to make those ads a little less disingenuous, to try to keep Medicare Advantage from overbilling the government. Are you happy with those efforts and is there anything else we can do? 

JUDY:  We’re buoyed by the fact that this administration has been much more active than in the recent past at being an ombudsman for Medicare beneficiaries, for keeping a close eye on Medicare Advantage private insurance plans, how they’re marketed, how people are approached to encourage to purchase and join a Medicare Advantage plan, (and) beginning to look at the overpayments to Medicare Advantage. The plans are paid about 22% more than the traditional Medicare program is paid for the same equivalent beneficiary. 

WALTER: We are banging the drum very loudly for all those things that you just mentioned. We also have been lobbying for traditional Medicare to be expanded to include hearing, dental and vision coverage. And we almost got hearing coverage in the Build Back Better bill until it died in the Senate. Is it important from where you sit that dental, vision and hearing coverage be added to traditional Medicare? 

JUDY:  Absolutely, and kudos to the National Committee, with which we are really proud to partner with, (for) doing things that we can’t do. We thought for a while we might get all three: oral health, vision, and audiology. It’s incredibly important. And some have said, you know, the body includes the head and all the orifices therein: one’s eyes, one’s mouth and one’s ears. And and there’s increasing studies and reports that show the incredible impact (of) the lack of hearing support and lack of oral health. 

We also support those critical coverages in traditional Medicare, and that’s part of the level playing field that the National Committee and the Center for Medicare Advocacy are pushing for. 

I’d also add that it’s extremely important to add an out-of-pocket cap to traditional Medicare, which exists, though it’s rather high in Medicare Advantage. But an out-of-pocket cap at a reasonable rate would be extremely important for Medicare beneficiaries in the traditional program, as well as better access to those Medigap Medicare supplement insurance benefits. 

WALTER:  And, of course, the results of the 2024 election may help determine how realistic it is to affect those changes, Judy. And on that subject… the House Republican Study Committee just came out with a 2025 budget blueprint that essentially reverses the progress of the Inflation Reduction Act, which is doing so much to lower drug prices for seniors, and it would basically turn Medicare into a voucher program, which we oppose, oppose, oppose! I’m just wondering — those policies that the House Republican Study Committee suggests amount to at least a trillion dollars in cuts to Medicare. What is Center for Medicare Advocacy’s response to that? 

JUDY:  Well, it feels like we’re back to the future. We spent so much time pushing back against a premium support program for Medicare when Paul Ryan was Speaker of the House. So that’s history. It’s like, it’s nothing new under the sun. 

It’s a recommendation (for) essentially what we call a voucher program, where instead of guaranteeing certain benefits to Medicare beneficiaries that they could count on, they would get a certain, know that they had a certain amount to spend on their health needs, health coverage… It’s a false promise and hollow… and we oppose it. 

With regard to the other plan about, the other budget component:  In the Republican Study Committee, they want to roll back the hard-fought effort to get negotiations for drug prices under Medicare. 

This is a boon to Medicare beneficiaries and to our economy, and it will each year add new drugs to be negotiated under the Medicare program. We think this is long overdue (and) of tremendous value, both with regard to access to necessary medications and to the well-being of the Medicare program. 

WALTER:  And we don’t want to see Republicans or anyone else roll back the progress of the Inflation Reduction Act. I do want to move on real quick to the Medicare Part A Trust Fund. The Medicare Part A Trust Fund, the hospital fund, is projected to become depleted in 2028. President Biden has proposed using the net investment tax on the wealthy to help shore up the program’s finances. What solutions does your organization favor to keep Medicare financially sound into the future? 

JUDY: I have been at this for decades, and we’ve been told that the Medicare Trust Fund is going to be insolvent into the future year after year after year. So let’s assume this is true. Insolvent doesn’t mean bankrupt. It would mean that they would have to stop, start cutting back on coverages, which often happens as it is. So that’s not good news. What can be done about it? A lot. 

Stop those overpayments to the Medicare Advantage plans. There’s absolutely no reason that they should be paid more per enrollee than in the traditional program. In fact, that was started because it was expected that private plans would cost 95 cents on the dollar to what it costs in traditional Medicare. So roll back those costs. Make sure that prescription drugs do continue to be negotiated, because those are very high costs to the Medicare program. 

And, also, it should be looked at, it hasn’t for years and years, that the payroll tax and the taxes on people making more money, much more money, should be covered, added to what’s paid towards the Medicare program. There are ways to increase the revenue that comes to Medicare without cutting benefits that are not seriously looked at and haven’t been for way too long. 

WALTER: Thank you, Judy. And finally… CMA is holding its annual National Voices of Medicare Summit, of which we are a sponsor by the way, on April 24th at the Kaiser Family Foundation Barbara Jordan Conference Center right here in Washington, D. C. And I believe for the first time the summit is free to attend, if I’m not wrong about that. Tell us what makes this year’s summit special. What are you excited about? 

JUDY: The summit is a fantastic opportunity to hear about Medicare from one of the few entities that just looks at it from the Medicare beneficiaries’ point of view. It’s the voices of the Medicare beneficiaries. And we will have people who are both beneficiaries themselves; (a) caretaker from SEIU. We will have Cathy Hurwit give the Rockefeller Lecture. She’s a long-time policy star in health care and Chief of Staff for Representative Jan Schakowsky. We will have panels with showing all… the theme is… all the various pathways to change. 

And it’s going to be a wonderful day which highlights all various ways in which you can access advocacy, provide advocacy. Yes, it is free. We thank you, the National Committee to Preserve Social Security and Medicare, and others for sponsoring this event, which allows us to be as inclusive as possible. It’s live streamed as well as in person at the Barbara Jordan Conference Center on April 24th. 

WALTER:  That sounds like a lot of great content at the summit, Judy. Tell us how people can participate in the summit. Where do they go for more information? 

JUDY: All you have to do is go to our website, medicareadvocacy.org, which I recommend in any event. And on the homepage, you’ll find more access to more information about the summit, as well as how to register. You’ll get a link to register — and we really hope people will join us in person or live stream. Join us and you will be welcome and there’s no cost. 

WALTER: That is all wonderful. Thanks for going through all that with us and we will be there! And we’ll hope to see you there as you make your way down from the great state of Connecticut. Judy, you are obviously one of our most passionate advocates for Medicare and built a whole organization around your commitment to preserving Medicare and making sure that it serves beneficiaries fully and for that, we are so grateful. Thank you for taking the time to come on the podcast. 

JUDY: Thank you so much for inviting me and for all the work you all do at the National Committee. It takes a village. Thank you so much. 

WALTER: I think I’ve heard that somewhere. All right. Well, thank you very much, Judy, and take care.