Democrats Take Aim at Medicare Private Plans

By
Wednesday, August 12, 2009 at 6:00 am
Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) (WDCpix)

Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) (WDCpix)

The Democratic push to slash tens of billions of dollars for private insurers who cover Medicare patients has been met on Capitol Hill by something unusual: a relative silence, even from supporters of the program.

In past years, the Democrats’ proposals to cut subsidies to the popular but controversial Medicare Advantage program — which allows seniors to receive their Medicare benefits through private companies — have been greeted with howls of protest from both the insurance industry and conservative lawmakers, who argue that the private marketplace can offer efficiencies and benefits that traditional Medicare doesn’t. Yet this year, even as the Democrats hope to trim more than $100 billion from the MA program over a decade to help pay for their larger health reform effort, the focus of the critics’ attacks has been largely directed elsewhere.

Illustration by: Matt Mahurin

Illustration by: Matt Mahurin

Health care experts from across the political spectrum list a host of reasons why that’s been the case. First and foremost, much of the health reform debate so far has centered around the strategy of Democrat leaders to create a government-backed insurance option to compete with the private marketplace — a proposal that’s anathema to the industry and roughly every Republican on Capitol Hill. With that threat hanging over the insurers’ heads, experts say, the companies have largely focused their lobbying efforts on defeating the so-called public plan proposal.

“They’ve decided they don’t want to open a two-front war,” said Robert Berenson, senior fellow at the Urban Institute who headed Medicare’s payment and managed care division in the late stages of the Clinton administration.

Another reason, some health experts say, revolves around simple marketing and image creation. After contributing heavily to the defeat of President Bill Clinton’s health reform push 16 years ago, the insurance lobby has vowed to support the general goal of health reform this year. With that in mind, it doesn’t want to be seen fighting tooth and nail against every provision that affects it. Capitulating on some reforms, some experts contend, will lend the industry greater voice in defeating others.

Then there are the Republicans who are trying to kill the Democrats’ health reform plans at all costs. They’re banking on the simple theory that in-the-weeds debates about obscure Medicare policies like MA cuts don’t resonate with the public nearly so well as, say, the more provocative (though false) charges that the Democrats’ reforms would encourage abortion, promote euthanasia and establish “death panels.”

Under the Medicare Advantage program, created by a Republican-led Congress in 2003, the government buys private insurance coverage for Medicare patients in lieu of paying for health services directly. Supporters say MA plans have the advantage of delivering additional care to Medicare patients, including dental and eye services not covered under the traditional program. Those additional benefits, combined with a heavy dose of marketing, have made the program enormously popular. This year, a record-high 10.5 million seniors — or 23 percent of all Medicare beneficiaries — are enrolled in MA plans, according to a June report from the Medicare Payment Advisory Commission, or MedPAC, an independent panel that recommends Medicare reforms to Washington policymakers.

But the extra care doesn’t come cheap. Despite promises that private plans operating under MA could eventually save money, the cost to treat the average patient in the MA program is 14 percent higher than the cost to treat the average senior under traditional Medicare. A part of that additional cost, MedPAC noted, “consists of funds used for plan administration and profits and not direct health care services for beneficiaries.”

The argument that private plans are necessary to keep Medicare sustainable, Berenson said, “is belied by the fact that private plans always seem to require more money.”

“It’s hard to make the case,” Berenson added, “that these overpayments are justified.”

Kathleen Stoll, deputy director of Families USA, a health care consumer group, said the relatively tepid nature of this year’s MA debate is some indication that even the most adamant defenders of the program recognize that the 14-percent discrepancy is too large.

“There’s a sense of consensus that there’s an overpayment problem,” Stoll said.

MedPAC has long advocated for reforms in the way MA payments are structured. But MedPAC’s recommendations are non-binding, and defenders of the MA program on Capitol Hill have successfully thwarted most Democratic attempts to scale back the program in recent years to pay for other health care initiatives.

This year, the Democrats hope that will change. Under the House health reform bill, which has already passed through the Energy and Commerce, Ways and Means, and Education and Labor committees — the three panels with jurisdiction over the issue — MA payments would be scaled back over several years in an attempt to eliminate the 14 percent differential. The Congressional Budget Office estimates that the cuts will save taxpayers $156 billion over 10 years.

The White House has taken a different tack. As part of its 2010 budget proposal released in February, the Obama administration aimed to control MA costs by creating system that would require plans to bid competitively for regional contracts under MA. Those plans bidding higher than the regional average would nonetheless get paid only the regional average.

At an AARP-sponsored health reform forum last month, Obama promoted his proposal. “We’ll eliminate billions in unwarranted subsidies to insurance companies in the Medicare Advantage program — giveaways that boost insurance company profits but don’t make you any healthier,” he said.

Many health policy observers expect that the Senate Finance Committee, which is expected to unveil its much-anticipated health reform bill next month, will come up with an MA strategy akin to the White House proposal.

Sen. Charles Grassley (Iowa), the highest ranking Republican on the Finance panel, has long-expressed concerns about MA cuts, arguing that such reductions would threaten rural patients who, without the plan subsidies, might not have access to the same range of health care services. Grassley’s concerns haven’t disappeared, but the powerful Iowan has also been open to the administration’s blueprint.

“I’m all for competitive bidding if it doesn’t cut services for rural America,” Grassley said in March, in response to the White House budget plans.

Joel White, executive director at the Coalition for Affordable Health Coverage, pointed to one reason why the Democrats will likely choose a compromise like the competitive bidding model over a strategy that simply chops the MA overpayments down to the size of Medicare rates. “[I]f the majority attacks MA too hard,” White wrote in an email, “it weakens their argument for the public option as they would be eliminating the ‘private’ choice in Medicare.”

The competitive bidding approach, he added, would also allow the insurance companies a good deal of freedom to determine their own fate under the reforms.

“They figure it could be a lot worse,” said White, a former senior aide to then-Ways and Means Chairman Bill Thomas (R-Calif.), who helped write the 2003 law that created the MA program. “Heck it could be eliminated.”

Not that the insurance industry is pleased with the proposals to slash MA. Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the industry’s mouthpiece in Washington, warned that the cuts being proposed by the Democrats would have “a devastating effect on the seniors in the program.” Premiums could go up; benefits could be reduced; and the Democrats’ vows to allow people to keep their current coverage would not be met if the cuts are realized, Zirkelbach said.

Still, AHIP remains outwardly supportive of health reform — including changes to the MA program, he added.

If the Democrats are successful in their efforts to rein in MA, it could mark a set-back to the decades-old Republican push to privatize Medicare. In October 1995, for example, then-House Speaker Newt Gingrich (R-Ga.) took the podium at a Blue Cross/Blue Shield conference in Washington and promoted a health reform strategy he knew would be music to his audience. Labeling Medicare “a centralized command bureaucracy,” Gingrich proposed to shift the popular program from “a government monopoly plan” to “a free-market plan.”

Gradually.

“Now we don’t get rid of it in round one because we don’t think that that’s politically smart,” he said. “But we believe it’s going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.”

Comments

123 Comments

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70cooper
Comment posted August 12, 2009 @ 1:55 pm

I have a health advantage plan and like it. If it is cut out I will not take Medicare I will not have any insurance period. The goverment should have the same plans we the public have. The same with their retirement plans.


Donald Bryce
Comment posted August 12, 2009 @ 7:45 pm

The Medicare Advantage program is only an “advantage” for big insurance companies rather than Medicare recipients. It seems to me to be not only unwise but also insane to use tens of billions of taxpayer dollars, collected to provide health care for the elderly, to fill the profit coffers of these companies. All of us Medicare recipients do without additional benefits in order to enrich greedy insurance companies. We must eliminate Medicare Advantage. A national health care plan that offers a public option to everyone is the only sensible answer.


robellen
Comment posted August 13, 2009 @ 2:07 am

Any competitive bidding is bad. The bidding for Durable Medical Equipment will slash choice for seniors in the companies they can deal with and will put price over quality in the services they need. Add to this the thousands of people who will be put out of work when companies do not get the Medicare bid, and we have a disaster in the making. It's nothing but privatization of Medicare and it stinks.


captainsteve
Comment posted August 13, 2009 @ 3:04 am

Don’t believe obummer’s lie that there will not be death panels. Why do I know? There already are death panels in Oregon’s universal care system! They have had real people be refused treatment on account of cost. Those same people were however offered suicide drugs.

Nothing obama says has meaning because he can't be trusted.

Watch this video. You’ll see obama lie like a dog in his very own words.

http://www.breitbart.tv/naked-emperor-news-obam…

People need to wake up and see this lying fraud for who he is, an America hating, Saudi King bowing, dictator loving, former cocaine addict, racist Kenyan usurper dirt-bag Chicago thug!


HSR0601
Comment posted August 13, 2009 @ 7:00 pm

Misinformation & Correction :

1. Rationing & A long Line :

With the help of upcoming IT system, the concern of a long waiting list probably doesn't matter. And now that docs are liable for patient's outcome, no intervention in the final decision is allowed other than 'recommendations' for best practices.

In the government-run, single-payer Medicare program, enrollees choose their own doctors, receive care in a timely manner. Similarly, the public option can be viewed as extension of medicare, exactly speaking, an upgraded version of it.

2. Saving & low Quality :

Most part of savings is made up of weeding out such wastes as so called “doughnut hole” , the unnecessary subsidies for insurers, the duplicate tests and unproven sham level of treatments, abuse, exorbitant costs by the tragic ER visits and so forth. As president Obama noted, the analogy of insulation, weatherization would be appropriate.

With that in mind nearly two-thirds of the cost of reform will come from reallocating money, overall, the financial architecture is looking good.

And let me stress : If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to prescribe the best medicine available earlier in the process, let alone skimming the wasteful, unnecessary, and risk-carrying procedures.

3. Take-over ;

The runaway premium similar to the peak fuel price last year and left so many folks in despair insists on staying the course with the attitude 'unchanged', clearly this trend could bankrupt individual, business, and government. Now the government subsequently is tasked with these two main assignments, first, to address premium inflation, second, to expand coverage to all in urgent need.

In order to cover all and not to add to the deficit, the public option can not set the same rates of private market, rather, it needs to have BALANCING function to keep it in check in terms of INFLATION, too. Unfortunately, this 'unavoidable' direction is aggressively being accused by the runaway premium, citing government 'take-over' .

Under the circumstances the energy bill to determine human future and the other major issues are presently piled up, who wants to waste time making enemies ?, which also does not benefit the forthcoming election.

with the heartbreaking tears in mind (Nearly 11 Million Cancer Patients Without Health Insurance), private market also needs changes and should join together to complete this reform , as promised, otherwise, the runaway premium only has itself to blame while new firms are filling the void with competitive deals.
And It can be said that fair competition starts with a fair, sustainable market value.

However, Job-based coverage (indirect payment) and a limitation code over transfer, mandate code, and ample capital, reduced ER costs, IT base to streamline the administrative processes and trim costs might be favorable to the private market. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.

4. Tax rise :

In the context the current health care wastes an estimated one-third – or about $700 billion – on unnecessary procedures, unnecessary visits to the doctor, overpriced pharmaceuticals, bloated insurance companies, and the most inefficient paper billing systems imaginable, health care reformers have often cited the system at Mayo Clinic as a model.

In modernized society, the business lacking IT system is unthinkable just like pre-electricity period, nevertheless, the last thing to expect is happening now in the sector requiring the most accuracy in respect to dealing with human lives. Apparently the errors by no e-medical records have spawned the crushing lawsuits, and these costs have led to the unnecessary tests, treatments, even further, more profits so far.

Thankfully, the pay for 'outcome' pack modeled after the system at Mayo Clinic is most likely to expedite the introduction of IT system, and the combined system is capable of shifting volume into quality in Medicare & Medicaid, thereby offsetting the 239 billions of estimated deficit, which is generated by $245 billions, the 10-year cost of adjusting Medicare reimbursement rates so physicians don’t face big annual pay cuts.

Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve' care, supposedly even a quarter of it might be enough to meet the goal of revenue-neutral. Moreover, in case this innovative idea applies to the public option, presumably it can lower the overall expense sharply, too.

Please be 'sure' to visit http://www.nytimes.com/2009/08/13/opinion/13gaw… for credible evidence !

And in respect to preventative program, surprisingly enough, the system today is designed around treating patients once they become sick, following 'spillover' and 'levee breach' , as too high level of preventable chronic disease accounts for it. By contrast, all of the excellent health systems seem to have one feature in common, an expansive, systematic preventative program demanding immense investments.

Some say the effect of preventative program is below zero compared with investments, or takes a long time even beyond next decade window, but if this program in the exemplary systems is disorganized, the odds are high that they will also face the same pressing need for reform in a few years. Like common sense, fire needs to prevent in advance or foil in early phase, and it would be the most cost-saving measure, in my mind.

Just like marriage, economy also undergoes up and down, however, economic downturn is not reflected in the employment-based system. The rising mental stress & 'keep eating habit' , which are the epicenter of a number of different diseases, might be traced to this insecure system and exorbitant premiums.
Once the health care reform provides the general public with peace of mind, the rising mental stress, obesity caused by the the deep-seated apprehension and exorbitant premiums may bend the curve surprisingly.
And reducing the tragic ER visits can lessen costs for the already insured, what's more, the balancing function of public option could mitigate fast-rising premiums.

I guess If the cost of the reform is an issue Americans take seriously, then all of the 'free' nations in the world should withdraw the existing public policy. Instead, it might be the 'will' of reform to end disgrace. Here is the hope, while the runaway premium wound up in the collapse of middle class ranging ' from finance to mental health' , alongside the peak fuel price and fast-growing mortgage rate, this time, clearly, the positive impacts involving massive job creation, promising stem cell research, several times more economic effects of 'from bed to work' , in return, will help realize health care reform

Thank You For Reading !


julimac
Comment posted August 14, 2009 @ 3:49 am

They're very aware and very actively opposing changes to MA. I got a robocall two days ago from the Coalition for Medicare Advantage, an arm of Coalition for Medicare Choises, that gave the distinct impression that the changes would cut benefits to seniors. They ask you to piush a button on your phone to join 881,000 other seniors in protest.


SteveL
Comment posted August 14, 2009 @ 7:24 pm

You are confused.

The Oregon situation, in which a public plan for those who could not otherwise afford insurance does not cover some drugs, shows the need for reform, and the serious problems with the status quo. Reform along the lines that Democrats have proposed would offer this woman something. You offer her nothing.


SteveL
Comment posted August 14, 2009 @ 7:27 pm

Mike-

MA was not created in 2003, but in 1997.

You are thinking of Medicare part D.


Omaar
Comment posted August 16, 2009 @ 3:51 am

Republican Credo: Fear,Hate,Dread,Doom & Gloom.

The So Called [Republicans]

Actually Dixie Crats

In 8 Years as President, Did Reagan get Rid of Government Run, Single Payer Health Care called…

[Medi-Care]

Ans: No

Did Republican Presidents, Richard Nixon 7 Years, Gerald Ford, 1Yr. Or George H.W.Bush 4 Years Or his son, George W.Bush Jr. 8 Years, Get Rid of Medi-Care, Medi-Caid, Indian Health Services, VA:Hospitals, CHIP: Covering Poor American Children…

Ans: No

Did they get Rid of the IRS [No]

Or the Federal Reserve [No]

Did they start the Flat Tax [No]

What do you know, Majority of the USA has been Under Control of Republicans, the Presidency, Congress and Senate and what have they Accomplished ?

Not a Thing

Bush Extended Medi-Care Part D [Fact]

Medi-Care:A Government Run Single Payer Plan and Rural Republicans Think,Medi-Care & Medi-Caid are Not Government Controlled [Jeesh]


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mikelillis
Comment posted August 17, 2009 @ 10:12 pm

Thanks for the comment, Steve. Actually, Medicare Advantage as it's now administered was created in 2003, alongside the arrival of Part D. MA replaced a similar program called Medicare+Choice, which was created under the Balanced Budget Act of 1997.


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pantleg
Comment posted August 28, 2009 @ 11:06 pm

I was suckered into a advantage program. Humana never explained the program. In fact they misrepresented it. I came from a supplement and thought it covered what medical did not cover.
They actually covered less than Medicare . Under Medicare I Could go to any doctor; under Humana I had to go in the network Or paid a high price. Under Medicare I had no co pays ; In Humana I always had co pays; under Medicare they always paid 80%; under Humana Advantage they paid 70%. To have Advantage; Medicare covered any illness ; Advantage had exclusions. I had to pay and extra $50.00 above my Medicare To have Advantage. The only thing Advantage did above Medicare Was two teeth cleaning and examination and they paid for my gym.
I was also covered by the VA. Human’s idea of fair was that they Get the money and VA does the work. My advise stay away from This so called advantage program.


patmcgrowen
Comment posted September 2, 2009 @ 1:36 am

You actually listen to those things. I immediately hang up on anything that is not a person. Most of the time it's just a scam anyway. I can't wait for the FCC to forbid those things.


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Comment posted April 12, 2010 @ 4:36 am

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susanhowes
Comment posted April 27, 2010 @ 5:31 pm

So are the Advantage companies responding to the new healthcare bill by finding ways to deny coverage that would normally be approved by Medicare?

I am just learning about this medicare “advantage” plan now that my mother is recovering from a second fall. She has Network, a Medicare Advatage program. She had 100 days approved for skilled nursing care to rehab from a fall. She went home after about 70 days but fell again within a week. We got her into another facility for needed additional therapy and found that her plan denied coverage even though she did meet medicare requirements for additional skilled nursing care and physical therapy. We appealed the decision with Network, were turned down, and then appealed with Maximus – yet another layer of for-profit insurance. They are only going to pay for 4 days even though she was initially approved for another ~30 days.


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