- Articles Highlight Medicare Advantage Concerns)
- Report: Affordable Care Act Narrowed Disparities in Health Care Access
- Register Now – Upcoming CMA Events
MA Limitations, Favoritism, and Quality & Access Issues – New York Times
A recent article in the New York Times highlights a number of concerns about the Medicare Advantage (MA) program, many of which have been raised by the Center for Medicare Advocacy. The concerns include the growing imbalance between MA and traditional Medicare, the limitations on consumer choice and ability to purchase Medigap plans, and efforts by the Centers for Medicare & Medicaid Services (CMS) to steer people towards enrollment in MA plans. “Medicare’s Private Option Is Gaining Popularity, and Critics” by Mark Miller, appeared in the Times online on Feb. 21, 2020, and in print on February 22.
Miller highlights limitations on consumer choice of coverage: “one of the least understood implications of selecting Advantage when you enroll in Medicare: The decision is effectively irrevocable.” Highlighting the difficulty of obtaining a Medigap plan in most states after a 6 month period when first signing up for Part B, the article notes that “After that time, you can be rejected or charged more, unless you live in one of four states […] that provide some level of guarantee to enroll at a later time with pre-existing condition protection.”
The article points out the growing imbalance between MA and traditional Medicare due to changes in law and policy, an issue the Center has repeatedly raised: “[t]he rise of Advantage has also been aided by changes in federal law and regulation in recent years. And under the Trump administration, critics say, Medicare’s administrators have been tipping the scales improperly in favor of Advantage.” This has occurred, in part, because “[l]egislation and regulatory changes in recent years have favored Advantage by permitting new supplemental benefits and more favorable enrollment rules.”
Miller notes that the privatization of Medicare has escaped scrutiny among policymakers, including those who are discussing using Medicare as a vehicle or model to expand health coverage:
The growth has occurred without much public policy debate about the effects of large-scale privatization on patient health, and on the costs to both the government and enrollees. As “Medicare for all” is debated in the 2020 presidential race, most voters perceive that these proposals are calling for a government alternative to commercial health insurance — yet the current Medicare program is shifting toward greater privatization, not less.
“When we talk about Medicare for all or public options,” said Tricia Neuman, director of the Medicare policy program at the Kaiser Family Foundation, “people may not realize that we already have a Medicare program that is coming to be dominated by some very large private insurance companies.”
The article also discusses how the federal agency administering the Medicare program is steering people towards MA enrollment rather than providing unbiased, objective information about coverage options. Stakeholders, including the Center for Medicare Advocacy, cited in the article, contend that CMS “has become a cheerleader for Advantage plans at the expense of original Medicare” and that there is “bias in educational and outreach materials on enrollment, and in public statements” by the agency. Miller notes that “communications from [CMS] during last fall’s Medicare enrollment period do appear to promote Advantage plans” as discussed in previous Alerts by the Center for Medicare Advocacy, including here and here.
Finally, the article highlights MA quality and access issues: “[t]he evidence is mixed” with respect to whether MA or traditional Medicare “produces better health outcomes.” Miller cites, among other things, a 2018 Office of Inspector General (OIG) report finding “‘widespread and persistent problems related to denials of care and payment in Medicare Advantage’ plans” as discussed in a previous Center Alert. Focusing on the plight of a Medicare beneficiary profiled for the article, Miller notes that “[s]erious illness is a common motive for leaving an Advantage plan, according to many Medicare advocates and counseling services.”
Growing Enrollment in and Growing Cost of MA – Axios
Similarly, a recent article by Bob Herman published by Axios highlights both the growing enrollment in, and cost of, the MA program. Herman notes that as of February 2020, “[r]oughly 24.4 million seniors and people with disabilities were enrolled in a Medicare Advantage plan […] a 9.4% jump from the same time in 2019 [… an enrollment growth rate that] is well above the 6.8% growth rate in 2019”.
The article explains “Why it matters: Medicare Advantage, which is run by private health insurers, continues to grow at high rates despite concerns over the program’s higher spending and evidence that insurers are making people appear sicker than they are.”
As addressed in a recent Center Alert, the article highlights this higher spending on MA:
The elephant in the room: The Congressional Budget Office raised new concerns about MA spending in its latest economic outlook.
- Net Medicare spending this year will be $22 billion higher than CBO originally projected, and “higher spending for Medicare Advantage accounts for most of that difference,” CBO said.
- That higher spending was attributed to higher payment rates and the likelihood that more MA enrollees “will be coded as being in poorer health than the agency previously anticipated,” the CBO said.
- Federal watchdogs have warned about the coding practices of MA plans, and the industry has fought off regulators that want to audit their records more aggressively.
The Center for Medicare Advocacy calls on policymakers to address the growing imbalances in access, coverage and payment between Medicare Advantage and traditional Medicare. Without action, the traditional Medicare program – and the majority of beneficiaries who still choose it for their coverage – will be compromised.
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The Commonwealth Fund recently released a report, How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care. The Report found significant coverage gains nationwide as a result of the Affordable Care Act (ACA), with historic reductions in racial disparities in coverage and access.
Some key findings from the report:
- Coverage expansions from the Affordable Care Act (ACA) led to nationwide improvements in coverage and access to care.
- The ACA also led to historic reductions in racial disparities in coverage and access since 2014. This is true across most states, and especially those that have expanded Medicaid. However substantial gaps between people of color and whites remain across all regions and income levels.
- According to the U.S. Census Bureau’s American Community Survey, the U.S. working-age adult uninsured rate fell from 20.4 percent in 2013, just before the law’s main provisions took effect, to 12.4 percent in 2018.This improvement occurred between 2013 and 2016; since then, the rate has risen slightly.
- The uninsured rate for black adults dropped from 24.4 percent in 2013 to 14.4 percent in 2018.
- The rate for Hispanic adults decreased from 40.2 percent in 2013 to 24.9 percent in 2018.
Unfortunately, the report also noted that progress in coverage expansion for all three groups has slowed since 2016, and insurance coverage has slightly eroded for both black and white adults. According to the report:
“That can be linked in part to congressional inaction: there has been no federal legislation since 2010 to enhance or reinforce the ACA. At the same time, recent legislation and executive actions have negatively affected Americans’ coverage and access to care, including: the repeal of the individual mandate penalty for not having health insurance; substantial reductions in funding for outreach and enrollment assistance for people who may be eligible for marketplace or Medicaid coverage; and the loosening of restrictions on health plans that don’t comply with the ACA’s rules.”
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Whither Medicare – From Promise to Privatization
April 30, 2020, 8:30 AM – 3:30 PM
Kaiser Family Foundation,
1330 G St NW, Washington, DC 20005
Early-Bird Single Seat: $225 (Prior to 2/29/2020. $250 thereafter)
Against the increasing privatization of Medicare, voter focus on health care, and the ongoing talk about a Medicare for All, the 2020 Summit will focus on the promise, challenges to, and future of Medicare.
- What was the original vision and promise of Medicare?
- Is Medicare as a social insurance program a thing of the past?
- Will Medicare be allowed to “wither on the vine,” as Newt Gingrich suggested?
- Should Medicare be the model for universal coverage?
- How can Medicare be improved for all people who qualify now, and may qualify in the future?
The Center for Medicare Advocacy is honored to welcome Wendell Potter as this year’s Sen. Jay Rockefeller Lecturer.
Other confirmed speakers include: former Sen. Jay Rockefeller; former Sen. Chris Dodd; Ted Kennedy, Jr./strong>., Chair of the American Association of People with Disabilities; Tricia Neuman, Kaiser Family Foundation Senior Vice President; Clare Durrett, Associate Executive Director of Team Gleason; Judith Feder, Georgetown University professor of public policy and former dean of what is now Georgetown’s McCourt School of Public Policy; Peter Thomas, Principal, Powers, Pyles, Sutter & Verville, P.C; and health care journalists Susan Jaffe, Trudy Lieberman, and Mark Miller.
Register Today at: https://www.medicareadvocacy.org/summit/
Thursday, March 26, 2020 1:00 PM – 2:00 PM EST
Presented in collaboration with California Health Advocates Senior Medicare Patrol by Center for Medicare Advocacy Associate Director, attorney Kathleen Holt and Center Senior Policy Attorney Toby S. Edelman, this webinar will:
- Provide a brief overview of Medicare SNF and HHA Medicare coverage.
- Examine new Medicare payment systems for SNF (Patient Driven Payment Model or PDPM) and for HHA (Patient Driven Groupings Model or PDGM).
- Discuss the impact of PDPM and PDGM on access to Medicare covered services since implementation.
- Review practice tips and tools to access Medicare covered services.
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