Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – Choose Medicare Act Offers a Step Forward; Health Care Sabotage Slides Back; More

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  1. Choose Medicare Act Introduced – Improving Medicare, Moving Toward Universal Coverage
  2. The Sabotage of Health Care Continues – Important News
  3. The Center for Medicare Advocacy and Florida Health Justice Project Sue to Obtain “Off-label” Part D Prescription Drug Coverage for Beneficiary

Choose Medicare Act Introduced – Improving Medicare, Moving Toward Universal Coverage

On April 18, 2018, Senators Chris Murphy (D-CT) and Jeff Merkley (D-OR) introduced the “Choose Medicare Act.”  The Act would create a new Medicare plan, “Medicare Part E,” which would allow virtually all Americans to choose the traditional Medicare program in addition to now-available private insurance options. Medicare Part E would be available on the Affordable Care Act exchange, as well as being an alternative to private coverage for employers to offer their employees. The Act would cover the same benefits as traditional Medicare, as well as additional benefits to meet the needs of the nonelderly.

The Act would help more people gain access to quality, affordable health coverage and would offer valuable options for employers and employees. Not only would the Act leverage the existing network and low administrative costs of the Medicare program, it would achieve additional savings by allowing Medicare to negotiate drug prices.  In addition, the Act would improve Medicare by introducing a long-overdue out-of-pocket cap in the traditional Medicare program.

The Choose Medicare Act is one of several pieces of legislation being discussed that build on the success of the Medicare program. The improvements it includes for Medicare and current Medicare beneficiaries, along with possible expansion, are of key import.  If Medicare is to be a model for, or method of, reaching coverage for all, it must first be strengthened and improved; the Choose Medicare Act is an important step forward.

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The Sabotage of Health Care Continues – Important News

Last week the United States Department of Health and Human Services issued the Notice of Benefit and Payment Parameters for 2019 final rule. This final rule is another assault on the Affordable Care Act (ACA) and its benefit and coverage protections. The Center for Medicare Advocacy, working with other advocacy partners, submitted comments and signed-on to letters opposing the rule when it was first proposed. We opposed “changes to the Essential Health Benefits (EHBs) standard which would lower the threshold of covered services and leave many consumers without access to the health care they need.” Unfortunately, the final rule, among other things, does just that.

The ACA requires insurers to cover Essential Health Benefits, which include ambulatory services, emergency services, hospitalization, maternity care, mental health and substance abuse, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services. The weakening of these essential benefits through regulation will lead to more and more plans that provide little or no coverage for people when they get sick or injured. In addition to undermining EHB’s, the final rule also negatively impacts network adequacy, rate review, navigators and the Medical Loss Ratio.  

As if this weren’t harmful enough, on Monday April 23, 2018 comments are due for the Short-Term, Limited-Duration Insurance Proposed Rule. Often referred to, accurately, as “junk plans” or “fake insurance,” these plans offer insurance in name only, and would leave consumers without any real coverage when they need care the most. As we’ve highlighted over the last few months, this would also leave consumers who remain in the individual market – including those who are older or have pre-existing conditions – with higher costs. We encourage advocates to submit comments on the proposed rule. These plans will do nothing but undermine benefits, erode ACA coverage protections and further inflate costs.

These attempts by the Administration to undermine the ACA and sabotage our health care system must end. The American people deserve access to quality, comprehensive health coverage that will be there when they need it most.

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The Center for Medicare Advocacy and Florida Health Justice Project Sue to Obtain “Off-label” Part D Prescription Drug Coverage for Beneficiary

On April 6, 2018 the Center for Medicare Advocacy and Florida Health Justice Project filed a lawsuit in U.S. District Court for the Southern District of Florida on behalf of a 49-year-old beneficiary seeking Medicare coverage for his “off-label” (non-FDA-approved) use of a critically needed medication (Dobson v. Azar, 4:18-cv-10038-JLK).  The beneficiary’s Medicare Part D plan denied coverage of the only medication that he and his doctor have found to control his debilitating symptoms. However, the denial was based on an overly restrictive interpretation of what counts as a “medically accepted indication” under the law. After exhausting Medicare’s appeal system, the beneficiary is now seeking help in federal court as his only hope to receive this critically important and medically necessary treatment.

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