- A First Step in an Important National Discussion: Congressional Committee Holds Hearing on “Medicare for All”
- Medicare Coverage for Genetic Tests: Know the Facts
Repeated efforts to repeal and undermine the Affordable Care Act (ACA) have led to growing public awareness of the importance of access to health coverage and accompanying patient protections. Recognition of the important role of the ACA and Medicare, and growing support for Medicaid, have combined to shape public support for expanding health coverage, instead of retracting it.
In recognition of such growing support, on Tuesday, April 30th, the House Rules Committee held a hearing to discuss H.R. 1384, Reps. Pramila Jayapal and Debbie Dingell’s Medicare for All bill. Although the focus of the hearing was not on the current Medicare program, the combined testimony and subsequent discussion gave rise to a powerful indictment of our current health care system, and began an important conversation in Congress about how to fix it.
Ady Barkan, a health care advocate living with ALS who gave particularly compelling testimony at the hearing, noted that “[o]n the day we are born and on the day we die, and on so many days in between, all of us need medical care. And yet in this country, the wealthiest in the history of human civilization, we do not have an effective or fair or rational system for delivering that care.”
Our mission at the Center for Medicare Advocacy is to advance access to comprehensive Medicare coverage and quality health care for older people and people with disabilities. We strongly believe in universal health care – everyone should have access to quality, affordable coverage and care. We also recognize that there are different ways to achieve that goal.
The Jayapal/Dingell Medicare for All bill would create a new program for everyone that would provide much broader coverage than the current Medicare program, with limited or no cost-sharing for individuals. Further, the Medicare for America Act, reintroduced on May 1st by Reps. Rosa DeLauro and Jan Schakowsky, would, among other things, significantly expand current Medicare coverage, cap out-of-pocket spending, and strengthen patient protections – while retaining employer-based insurance. Such expansion of coverage, and reduction or elimination of out-of-pocket expenses, would be considerable improvements over what we have now.
Although the Center strongly supports achieving universal coverage, our primary focus, and the weight of our efforts, is on identifying flaws in and improving the current Medicare program. As an advocacy organization that provides assistance for Medicare beneficiaries, and develops policy initiatives based upon the experiences of real people, our emphasis is on improving Medicare now.
As Dr. Dean Baker from the Center for Economic and Policy Research testified during the House Rules Committee hearing, there are ways to “fix Medicare” – including adding an out-of-pocket limit for beneficiaries in traditional Medicare, incorporating the Part D drug benefit into the core Medicare program, rather than having stand-along prescription drug plans, and stopping overpayments to private Medicare Advantage plans.
These recommendations align with the Center’s recommendations to improve Medicare, contained in the Medicare Platform we issued in December 2018, reproduced below.
Shifting to universal coverage won’t happen overnight. However, there are enhancements to Medicare for all those who are currently eligible that could be realized soon, and that would make it a better vehicle for universal coverage. As Congress debates how best to expand quality health insurance coverage, we urge policymakers to improve Medicare now.
Medicare Platform: Core Considerations for Today & Tomorrow
The Center for Medicare Advocacy works for a comprehensive Medicare program and quality health coverage and care for all people. To accomplish these goals for current and future beneficiaries in the changing health care environment, we seek to:
- Improve Medicare for current and future beneficiaries.
- Support the development of the best method possible to increase access to quality health coverage and care for the most people.
Medicare Platform to Improve Medicare for all beneficiaries, now and in the future:
1. Consumer Protections and Quality Coverage for All Medicare Beneficiaries (Including Parity Between Traditional Medicare and Medicare Advantage)
- Cap out-of-pocket costs in traditional Medicare
- Require Medigap plans to be available to all individuals in traditional Medicare, regardless of pre-existing conditions and age (“Guarantee Issue” and “Community Rating”)
- Ensure all benefits in Medicare Advantage are also available in traditional Medicare
- For example, include all MA “supplemental benefits,” waiver of 3-day prior hospital stay requirement for SNF coverage, coverage for home health aides, coordinated care
- Simplify enrollment in traditional Medicare, Part D and Medigap, and ease transitions from other insurances to Medicare
- Improve consumer protections in Medicare Advantage
- Standardize benefit packages,
- Strengthen network adequacy requirements
- Strengthen plan oversight
- Strengthen marketing protections
- Ensure parity between mental health and physical health coverage
- Ensure the Medicare appeals system is cost-effective, accessible and fair
2. Reduce Ongoing Barriers to Care
- Eliminate the harm of hospital “Observation Status”
- Home Health – Ensure access to coverage is actually available for all beneficiaries who meet coverage criteria, ensure access to legally authorized home health aides, resolve conflicts between payment models and coverage laws
- Jimmo Implementation – Ensure beneficiaries with longer-term, chronic, and/or debilitating conditions have full access to skilled nursing, therapy and related care needed to maintain their conditions or slow decline
3. Improve Traditional Medicare
- Add oral health, audiology, vision coverage
- Restructure Medicare to make it comprehensive, simpler and affordable
- Increase Low-Income Protections in the Medicare Savings Program (at least on par with ACA subsidies)
Long-term Care – Add coverage over time. For now, make incremental improvements (For example, repeal homebound requirement for home health coverage, repeal requirement that individual need skilled care and be homebound to qualify for home health aide coverage, repeal requirement that DME generally be needed in the home)
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Medicare typically covers genetic tests only when a beneficiary has signs or symptoms that can be further clarified by diagnostic testing. Medicare also covers some genetic tests that assess an individual’s ability to metabolize certain drugs. The only screening test Medicare will cover (once every three years) is to determine if a beneficiary has colorectal cancer. That test is appropriate when a beneficiary has no symptoms of colorectal cancer and only an average risk of developing it. Federal Regulation 42 CFR § 410.32(a) requires genetic tests to be ordered by a physician who is treating the beneficiary.
The Center for Medicare Advocacy (the Center) has heard of beneficiaries who have been approached outside of their doctor’s offices by individuals and companies seeking, inappropriately, to assure them that Medicare will pay for DNA kits and screening tests. Beneficiaries should always seek the advice and orders of their treating physician on Medicare-coverage related issues. A detailed article on Medicare coverage and oversight of genetic testing, authored by a long-time colleague of the Center, Mike Klug, can be found at https://www.smpresource.org/Handler.ashx?Item_ID=E3BA48E4-57F1-458B-B3D1-7F22FD13FF58
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