Tomorrow celebrates the 45th anniversary of the enactment of Medicare*, a program that continues to bring peace of mind to seniors and people with disabilities by providing them with both health and economic security. The Affordable Care Act contains many provisions that strengthen the Medicare program. However, polling data released earlier this week by the National Council on Aging (NCOA) reveal that many seniors are still confused by the new law, including the provisions that directly relate to Medicare and senior health.
Please use Medicare’s anniversary as an opportunity to educate your community about the many ways people with Medicare benefit from the Affordable Care Act. To support your efforts, Families USA recently created two pieces that showcase how the law helps people with Medicare:
Helping People with Medicare discusses how people with Medicare stand to gain from the new health reform law. The new law will make Medicare more affordable by eliminating the “doughnut hole” over time, eliminating cost-sharing for preventive care, and providing more help for people with limited incomes. The new law will also make Medicare more financially secure—both now and in the future—by promoting quality and coordination of care, fixing the Medicare Advantage payment system, and strengthening Medicare’s finances while protecting benefits.
Medicare, Health Reform, and You is a PowerPoint presentation that helps dispel myths by outlining the ways in which the new law will improve Medicare. This is a useful public education tool when speaking with Medicare beneficiaries and can be used in conjunction with the piece above. The notes section includes a more in-depth discussion of each of the topics, which can be used to develop talking points for presentations.
The National Council on Aging also launched a new educational campaign to help seniors understand what is in the new law and how it will affect them. The campaign is called Straight Talk for Seniors on Health Reform, and the website provides fact sheets, tool kits, and other valuable resources. We encourage you to use these materials to support your public education efforts.
Millions of Americans rely on the Medicare system and millions more will come to rely on it in the future. It is imperative that seniors and people with disabilities are aware of what they stand to gain from the Affordable Care Act. Thanks for your continued hard work and dedication to optimize the new law for at-risk consumers.
Friday, July 30, 2010
Saturday, May 22, 2010
Health Reform for Seniors
SENIORS
Preventive Services: From annual checkups to cancer screenings, many preventive services will be free for those who receive Medicare. No co-pays or deductibles will be required. By fall of 2011, Medicare patients will have access to a comprehensive health risk assessment and a free personalized prevention plan to help them and their doctors continue to focus on wellness instead of just illness.
Prescription Drug Benefits: Currently, Medicare helps pay up to $2,830 a year for drugs. The coverage stops at that level until the bill for drugs reaches $6,440. This design leaves the recipient responsible for all drug costs between $2,830 and $6,440 annually, leaving a “doughnut hole” in the reimbursement scheme. The new law will close this gap for Medicare prescription drug plans by 2020 through a series of reforms, beginning in July 2010. This year, seniors who fall into the “doughnut hole” will receive a $250 rebate from the federal government. In 2011, they will receive a 50 percent discount on brand-name drugs. Also, seniors will receive a 7 percent discount on generic drugs, which will increase 7 percent every year thereafter. About 80,700 Massachusetts seniors will see their prescription drug coverage improve. .
Medicare Advantage: Beginning in 2012, the law reduces overpayments to Medicare Advantage insurance plans by $132 million over 10 years. This change could cause some insurers to reduce some of the benefits they offer – gym memberships, free eyeglasses and other perks. Others may choose to leave this market, which would require some seniors to have to switch coverage. There are about 198,000 Massachusetts residents enrolled in Medicare Advantage. If you are concerned about changes in your coverage, please call the numbers listed at the bottom of this fact sheet for assistance.
For more information:
BPHC Fact Sheet: Health Reform for Seniors
EARLY
Preventive Services: From annual checkups to cancer screenings, many preventive services will be free for those who receive Medicare. No co-pays or deductibles will be required. By fall of 2011, Medicare patients will have access to a comprehensive health risk assessment and a free personalized prevention plan to help them and their doctors continue to focus on wellness instead of just illness.
Prescription Drug Benefits: Currently, Medicare helps pay up to $2,830 a year for drugs. The coverage stops at that level until the bill for drugs reaches $6,440. This design leaves the recipient responsible for all drug costs between $2,830 and $6,440 annually, leaving a “doughnut hole” in the reimbursement scheme. The new law will close this gap for Medicare prescription drug plans by 2020 through a series of reforms, beginning in July 2010. This year, seniors who fall into the “doughnut hole” will receive a $250 rebate from the federal government. In 2011, they will receive a 50 percent discount on brand-name drugs. Also, seniors will receive a 7 percent discount on generic drugs, which will increase 7 percent every year thereafter. About 80,700 Massachusetts seniors will see their prescription drug coverage improve. .
Medicare Advantage: Beginning in 2012, the law reduces overpayments to Medicare Advantage insurance plans by $132 million over 10 years. This change could cause some insurers to reduce some of the benefits they offer – gym memberships, free eyeglasses and other perks. Others may choose to leave this market, which would require some seniors to have to switch coverage. There are about 198,000 Massachusetts residents enrolled in Medicare Advantage. If you are concerned about changes in your coverage, please call the numbers listed at the bottom of this fact sheet for assistance.
For more information:
BPHC Fact Sheet: Health Reform for Seniors
EARLY
Wednesday, May 5, 2010
$390 billion in savings from Medicare
The new health reform law wrings $390 billion in savings from Medicare over the next decade to help pay for health care reforms—but spending on the program will continue to rise.
How can the new legislation reduce Medicare costs and still spend millions more dollars on improvements like closing the gap in drug coverage and offering free preventive care? Here’s a quick lesson in Medicare math.
These are cuts in future increases, not cuts in services, experts explain.
Medicare spending has grown about 8 percent annually over 20 years, according to the Congressional Budget Office, an independent arm of Congress. The law could slow down the annual increase in spending to about 6 percent over the next 20 years, the CBO has reported.
For example, of the projected $390 billion in savings—the latest estimate from Congressional Research Service—$196 billion comes from smaller increases in payments to hospitals, nursing homes, home health workers and other medical providers. But physicians who work in primary care will be rewarded with a 10 percent bonus. Hospitals that prevent readmissions or hospital-acquired infections will be paid more than those that do not. The American Hospital Association and the American Medical Association were among the many health care organizations that backed the legislation, along with advocacy groups.
Medicare Advantage Another piece of the $390 billion savings, about $136 billion, comes from reductions in subsidies paid to private health insurance plans, called Medicare Advantage, that provide medical and drug coverage to about one of four people in Medicare. Currently, Medicare pays the private plans an average of 14 percent more to care for a member than it would cost if that person remained in traditional Medicare.
In 2012, the government will start lowering these overpayments to Medicare Advantage plans. Insurers contend they will be forced to cut benefits. But the law prohibits plans from reducing or eliminating essential guaranteed Medicare benefits. It also protects plan members by requiring that at least 85 cents of every dollar insurers receive is spent on benefits.
Guarantees The law also requires Medicare to spend more wisely. For example, a new independent Medicare advisory board is expected to save the program $16 billion over 10 years. Cracking down on fraud and waste will save an estimated $7 billion. Even bonus payments and innovations aimed at improving patient care are intended to produce a long-term payoff: People who get more effective treatment can recover more quickly from medical setbacks, and that saves Medicare money, too.
Finally, the law comes with a Medicare warranty in Section 3601: Nothing in the law can cut current Medicare benefits, and the Medicare savings it achieves “shall extend the solvency of the Medicare trust funds, reduce Medicare premiums and other cost-sharing for beneficiaries, and improve or expand guaranteed Medicare benefits and protect access to Medicare providers.”
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Other Insurance Situations
How can the new legislation reduce Medicare costs and still spend millions more dollars on improvements like closing the gap in drug coverage and offering free preventive care? Here’s a quick lesson in Medicare math.
These are cuts in future increases, not cuts in services, experts explain.
Medicare spending has grown about 8 percent annually over 20 years, according to the Congressional Budget Office, an independent arm of Congress. The law could slow down the annual increase in spending to about 6 percent over the next 20 years, the CBO has reported.
For example, of the projected $390 billion in savings—the latest estimate from Congressional Research Service—$196 billion comes from smaller increases in payments to hospitals, nursing homes, home health workers and other medical providers. But physicians who work in primary care will be rewarded with a 10 percent bonus. Hospitals that prevent readmissions or hospital-acquired infections will be paid more than those that do not. The American Hospital Association and the American Medical Association were among the many health care organizations that backed the legislation, along with advocacy groups.
Medicare Advantage Another piece of the $390 billion savings, about $136 billion, comes from reductions in subsidies paid to private health insurance plans, called Medicare Advantage, that provide medical and drug coverage to about one of four people in Medicare. Currently, Medicare pays the private plans an average of 14 percent more to care for a member than it would cost if that person remained in traditional Medicare.
In 2012, the government will start lowering these overpayments to Medicare Advantage plans. Insurers contend they will be forced to cut benefits. But the law prohibits plans from reducing or eliminating essential guaranteed Medicare benefits. It also protects plan members by requiring that at least 85 cents of every dollar insurers receive is spent on benefits.
Guarantees The law also requires Medicare to spend more wisely. For example, a new independent Medicare advisory board is expected to save the program $16 billion over 10 years. Cracking down on fraud and waste will save an estimated $7 billion. Even bonus payments and innovations aimed at improving patient care are intended to produce a long-term payoff: People who get more effective treatment can recover more quickly from medical setbacks, and that saves Medicare money, too.
Finally, the law comes with a Medicare warranty in Section 3601: Nothing in the law can cut current Medicare benefits, and the Medicare savings it achieves “shall extend the solvency of the Medicare trust funds, reduce Medicare premiums and other cost-sharing for beneficiaries, and improve or expand guaranteed Medicare benefits and protect access to Medicare providers.”
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Other Insurance Situations
Friday, April 16, 2010
Unnessary Hospial Re-Adimissions
A Serious problem we've been hearing about lately is that hospitals are discharging older patients without any followup or "transitional services.
One out of five Medicare beneficiaries is readmitted within 30 days of discharge and one out every three within 8-90 days--often because of poor communication between patients, care givers and health proveders.
We need a benefit in Medicare to help people safely transision to home or another setting to prevent costly and unecessary hospital readmissions.
One out of five Medicare beneficiaries is readmitted within 30 days of discharge and one out every three within 8-90 days--often because of poor communication between patients, care givers and health proveders.
We need a benefit in Medicare to help people safely transision to home or another setting to prevent costly and unecessary hospital readmissions.
Wednesday, March 31, 2010
Medicare in Helath ReformAct
_Gross cuts in projected payments to insurers, hospitals and other providers total $533 billion over 10 years, according to a preliminary analysis by the Kaiser Family Foundation. About $100 billion will be plowed back into Medicare, leaving a net cut of $428 billion. Medicare spending will continue to grow under the law, just not as fast. The reductions are smaller (about 6 percent) than Democratic President Bill Clinton and a Republican Congress came up with in 1997 (12 percent). Still, they're deep enough that some experts believe a future Congress will reconsider them.
_The law strengthens traditional Medicare, which covers about three-fourths of seniors, by improving preventive care and increasing payments to frontline primary care doctors and nurses serving as medical coordinators. But it gradually reduces generous government subsidies to private insurance plans, Medicare alternatives that have lately gained popularity. That could lead to an exodus from the private plans.
_The most significant new benefit — closing Medicare's prescription coverage gap — won't be fully phased in until 2020. That's a long time if you're old and frail. The coverage gap starts after the first $2,830 spent on medications in a year. Seniors then pay entirely out of their pocket until they have spent $4,550, when the government starts picking up 95 percent of the tab. After the rebate this year, seniors in the gap will get a 50 percent discount on brand name drugs in 2011, and a smaller break on generics. The discounts gradually ramp up until the "doughnut hole" is closed.
_One change has received little attention but could have major consequences. The law authorizes a variety of experiments to provide better care for seniors struggling with multiple chronic illnesses — about half the program's beneficiaries. Prominent voices in the medical community have been clamoring for the government to use Medicare as a laboratory for change. If the approach succeeds, fewer people may end up in the hospital for bad drug reactions and other common problems.
"It's going to be very important for Medicare beneficiaries to understand that on the whole, this is not the disaster some people have painted it to be," said health economist Marilyn Moon, who as a former Medicare trustee helped oversee program finances from 1995 through 2000. "It is a bit of a mixed bag, but I think on balance it is going to put the program in a better position, over a long period of time."
Her one major caveat: Many seniors in private insurance plans under Medicare Advantage will face higher premiums and reduced benefits as subsidies are scaled back over three to six years to bring the private plans' costs in line with those of traditional Medicare.
"Beneficiaries will notice that, and they're going to be unhappy because it's a takeaway," said Moon, who directs the health care program at the American Institutes for Research.
Government payments to the private plans — about 10 percent richer than per-person spending for traditional Medicare — have enabled them to offer comprehensive coverage for less. Seniors flocked to sign up, boosting enrollment to about one quarter of all Medicare beneficiaries.
The same cuts will benefit seniors in traditional Medicare, who have been paying higher monthly premiums to support the government's generosity. There's also a potential silver lining for private plans. The law allows them to earn bonus payments for high quality.
Such nuances got lost in an emotional debate that veered off into "death panels" and "pulling the plug on grandma." Nothing that drastic was ever in the bill. Still, Republicans accuse Obama of slashing Medicare, and polls show the message has stuck.
_The law strengthens traditional Medicare, which covers about three-fourths of seniors, by improving preventive care and increasing payments to frontline primary care doctors and nurses serving as medical coordinators. But it gradually reduces generous government subsidies to private insurance plans, Medicare alternatives that have lately gained popularity. That could lead to an exodus from the private plans.
_The most significant new benefit — closing Medicare's prescription coverage gap — won't be fully phased in until 2020. That's a long time if you're old and frail. The coverage gap starts after the first $2,830 spent on medications in a year. Seniors then pay entirely out of their pocket until they have spent $4,550, when the government starts picking up 95 percent of the tab. After the rebate this year, seniors in the gap will get a 50 percent discount on brand name drugs in 2011, and a smaller break on generics. The discounts gradually ramp up until the "doughnut hole" is closed.
_One change has received little attention but could have major consequences. The law authorizes a variety of experiments to provide better care for seniors struggling with multiple chronic illnesses — about half the program's beneficiaries. Prominent voices in the medical community have been clamoring for the government to use Medicare as a laboratory for change. If the approach succeeds, fewer people may end up in the hospital for bad drug reactions and other common problems.
"It's going to be very important for Medicare beneficiaries to understand that on the whole, this is not the disaster some people have painted it to be," said health economist Marilyn Moon, who as a former Medicare trustee helped oversee program finances from 1995 through 2000. "It is a bit of a mixed bag, but I think on balance it is going to put the program in a better position, over a long period of time."
Her one major caveat: Many seniors in private insurance plans under Medicare Advantage will face higher premiums and reduced benefits as subsidies are scaled back over three to six years to bring the private plans' costs in line with those of traditional Medicare.
"Beneficiaries will notice that, and they're going to be unhappy because it's a takeaway," said Moon, who directs the health care program at the American Institutes for Research.
Government payments to the private plans — about 10 percent richer than per-person spending for traditional Medicare — have enabled them to offer comprehensive coverage for less. Seniors flocked to sign up, boosting enrollment to about one quarter of all Medicare beneficiaries.
The same cuts will benefit seniors in traditional Medicare, who have been paying higher monthly premiums to support the government's generosity. There's also a potential silver lining for private plans. The law allows them to earn bonus payments for high quality.
Such nuances got lost in an emotional debate that veered off into "death panels" and "pulling the plug on grandma." Nothing that drastic was ever in the bill. Still, Republicans accuse Obama of slashing Medicare, and polls show the message has stuck.
Sunday, February 28, 2010
December 16, 2009, 9:25 am
Fewer Medicare Advantage Plans for Seniors
By MICHELLE ANDREWS
In the ongoing legislative tussle over how to trim the Medicare program to help pay for a health care overhaul, the Senate recently voted down an amendment by Senator Orrin G. Hatch, Republican of Utah, that would have blocked planned cuts to the subsidies that private insurers receive under the Medicare Advantage program. The extra money, 14 percent more per beneficiary on average than the government pays for seniors in traditional Medicare, has been targeted by the Democratic leadership and the White House as a giveaway to insurance companies that unfairly raises premiums for all Medicare beneficiaries.
Lawmakers who favor the private plans, however, say reducing the subsidies will result in painful cuts to the services seniors receive in the private plans, like vision and hearing screening and free gym memberships. Without the subsidies, they say, some private insurers may even pull out of the Medicare Advantage market.
But few lawmakers seem to realize that in some ways the horse has already left the barn: the Medicare Advantage program is shrinking already, thanks to new legal and regulatory changes. In 2010, there will be 18 percent fewer Medicare Advantage plans available to seniors than there were in 2009, according to an analysis by the Kaiser Family Foundation. Seven percent of the roughly 10 million beneficiaries who are enrolled in these plans will have to switch, according to the federal Centers for Medicare and Medicaid Services.
The biggest decline will be among Medicare Advantage private fee-for-service plans, whose numbers will decline by more than 40 percent when three insurers — Coventry, WellCare and Health Net — withdraw from the so-called P.F.F.S. market, according to Kaiser.
P.F.F.S. plans generally don’t have the defined provider networks associated with the better-established Medicare Advantage HMO and P.P.O. plans. The new plans have come under scrutiny for several reasons in recent years, including aggressive marketing tactics and the fact that some seniors have had difficulty finding providers who would accept their coverage.
These problems were an impetus for a 2008 law, the Medicare Improvements for Patients and Providers Act, that strengthened marketing protections for beneficiaries and required P.F.F.S. plans to have formal networks of providers in place starting in 2011. With the writing on the wall, some insurers decided to shut down their plans rather than invest resources in developing provider networks, experts say, and the shakeout may not be over.
“We’ll probably see lots of P.F.F.S. plans pull out in 2011,” said David Lipschutz, staff lawyer with California Health Advocates, a Medicare advocacy organization.
Other factors also are contributing to the reduced number of Medicare Advantage plans, including government efforts to eliminate plans that were very similar and to encourage
consolidation of those with fewer than 100 members.
Private Medicare health plans have been around since the 1970s as an alternative to traditional Medicare. They’re generally set up like managed care plans, with networks of providers and set co-payments for services, in contrast to traditional Medicare, in which patients see any participating provider and pay a percentage of the costs. Proponents thought that getting the private sector involved in Medicare would actually save the program money through increased efficiency and better coordination of care.
Over the past decade, Congress has encouraged participation in private sector plans by adding new types of plans and boosting the payments that plans received. Their efforts paid off: Just under a quarter of the 45 million people enrolled in Medicare today are in a private Medicare
Advantage plan.
The 2011 deadline for P.F.F.S. plans to develop provider networks is not the only pressure the plans face. In 2010, Medicare Advantage plan funding also was reduced by roughly 4 percent. Trade groups like America’s Health Insurance Plans warned that funding cuts would lead to reductions in the extra benefits that Medicare Advantage members typically receive. Other critics warned that the funding cutbacks would lead to a reduction in the number of Medicare Advantage plans that don’t charge a premium (apart from the regular Medicare Part B premium).
In 2010, there will indeed be fewer zero-premium plans. According to the Kaiser analysis, 43 percent of Medicare Advantage enrollees will be in plans without a premium next year, compared with 50 percent in 2009. And the 4 percent cut in plan payments is translating into $40 to $80 per member per month in reduced benefits or higher premiums, or a combination of the two, said John Gorman, chief executive of the Gorman Health Group, which provides consulting services to Medicare Advantage health plans.
So what happens if the subsidies are further reduced? Many experts note that even though some plans leave the market when their profit margins shrink, others have remained in the Medicare program for decades now. And although the number of plans has declined in 2010, enrollment has nearly doubled since 2004 and the number of plans has increased over that time, according to Tricia Neuman, director of the Medicare Policy Project at the Kaiser Family Foundation.
Further, though Medicare Advantage plans may drop some of the bells and whistles that they added when they were receiving bigger payments, the change may actually have an upside for beneficiaries. “The plans got fat and happy on these subsidies,” said Mr. Gorman. “What you’re seeing now is a renewed and urgent focus on medical cost management and care coordination.”
As for seniors, in 2010 the average Medicare beneficiary will still have a bewildering number of Medicare Advantage plans to choose from: 35 in urban areas and 24 in rural ones.
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White House Urges Repeal of Insurers’ Antitrust Exemption
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Feinstein to Propose Federal Supervision of Insurance Rates
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A Read-Aloud in the Senate — Or Not
15 Readers' CommentsPost a Comment »All CommentsHighlightsReaders' RecommendationsRepliesOldestNewest
1. Leah
California
December 16th, 2009
9:43 amFirst the government took our money. Now, it refuses to pay. This is why the government can't be trusted with health care.
If a private insurer behaved this way, they would lose customers overnight. The government doesn't have to worry about losing customers.
Recommend Recommended by 2 Readers 2. Justin
Bloomington, In
December 16th, 2009
11:56 amI was a Medicaid Caseworker in Indiana when these plans started. Indiana had 40 plans the first year. They made such a profit that the next year there were 60 companies to chose from. The elderly were hounded by H..... to pay high monthly premiums when the Seniors could find a good play to cover their drugs for free. Unfortunately Seniors, who have no one to help them, ended up paying monthly premiums and not being covered for their most expensive meds. These Seniors need advocates to help them find the right plan for them.
My opinion is that the Market is so crowded due to the huge payout for the Companies. The companies can also drop any Senior's prescription, with 90 days notice, if they decide that the meds are too expensive to cover.
Recommend Recommended by 2 Readers 3. leah
colorado
December 16th, 2009
11:56 amRight, #1, the government took our money, set up a system to provide basic coverage for all seniors, then made the mistake of paying private companies to administer services it was already administering itself more efficiently. Now we have seen the error of our ways and are appropriately turning away from subsidizing private profits with dollars from seniors' premiums and workers' paychecks.
Recommend Recommended by 3 Readers 4. Plutonium
New York
December 16th, 2009
11:56 amI don't know what Leah from California is talking about. Why on earth should I, a tax payer, pay to support private health insurance plans? I'd like to understand why private plans are permitted to offer services like vision and hearing screening and free gym memberships at my expenses in more ways than one!
The latter steams me considerably as I have had serious back problems including major surgery this past year and I am limited in the physical therapy services for which medicare pays. Clearly I need to be on a lifelong program to strengthen my back, but medicare pays 0 for it. Would I give up the right to choose my own doctors for gym membership? As a two time cancer survivor, I shout a resounding NO!
And I am fed up with the likes Joe Lieberman (supposedly a God-fearing man! Ha Ha) who have completely forgotten that the purpose of government is to help people accomplish together what none could accomplish alone.
This country has gone to hell in a handbasket and for me the only saving grace is that as I am 74 (and remember what it was like before Ronald Reagan) I won't be around to witness the next civil war. There will be one, mark my words!
Recommend Recommended by 4 Readers 5. shaman
usa
December 16th, 2009
11:56 amI am so angry at the politicans for screwing up what was already a screwed up system and finding ways to drive the costs up and reduce the options and quality. please stop these guys - kill both bills - and find some rational folks who will not be paid off by big pharma and insurance companies and start again. this is the most corrupt sick misbegotten hoax i think i've ever seen.
Recommend Recommended by 4 Readers 6. Chicklet
Douglaston, NY
December 16th, 2009
11:56 amMedicare Advantage plans, which require the patient to pay extra for extra services not available in 'traditional' medicare are attractive to patients who need the services. Patients take direct responsibility for their care when they understand what is and is not covered and plan accordingly.
Once enrolled in a Medicare Advantage plan, most seniors are happy with the value of what they've purchased. Annual tinkering with the law that governs what benefits may be offered, what the fees are, etc. are too much for many insurers, who would rather leave the market than revamp their offerings every single year. Re-printing, publishing, filing for approval, sending mailings, every time the plans requirements change creates a problem, this money should be going to patient care.
It all fits in with the unstated goal, single payer with no consumer choice (well, maybe you can choose the fine or tax you'll pay if you disagree with what mother tells you to do) followed by taxes, bureaucracy and exploding costs. We all know the government has a terrible track record with the government programs they now administer, Medicaid, the VA, Medicare are not exactly paragons of value, and have next-to-no fraud and abuse safeguards.
I hope Senator Lieberman holds on to his principles and citizens continue to speak their minds, a 25 pound bill that moves 1/5 of the economy from private to government control, passed in a big hurry by a congress with no medical expertise is not a good idea to me.
Recommend Recommended by 4 Readers 7. mm
here
December 16th, 2009
2:11 pmIt's a clear example of the inefficiencies of add-on insurance to a single-payer market. A single person now has two entities to deal with - Medicare and add-on. If this were a free, competitive market, you could choose a single plan of your choice of coverage levels.
Those who moan about admin overhead, you now have it in two companies for a single person. Very inefficient.
A single policy through a single provider and the networks would already be in place, you would not have the problem of the add-on trying to negotiate for provider support.
Coverage is tied to budgets and politics - never a good thing. Reading through the article all one sees are regulation, policies, etc. getting in the way of care.
The need in the first place is because Medicare, due to budgets, politics and simply because it was a poor implementation in the first place, could not adapt their coverage to fit the needs of they people.
This article is a mini-case study for why single-payer is NOT a good idea and why tying health insurance to politics and budgets is NOT a good idea. Expand this to all of the US - we should all shudder at the thought, the cost, the quality.
Recommend Recommended by 2 Readers 8. Leah
California
December 16th, 2009
2:11 pmleah from Colorado - You are unhappy with the way the government managed your Medicare money. I am also unhappy but for different reasons.
We have a win-win situation here. How about we don't start yet another government entitlement program? You get to spend your money the way you want. I get to spend my money the way I want.
Recommend Recommended by 2 Readers 9. E. Nowak
Chicago, IL
December 16th, 2009
2:11 pm"The extra money, 14 percent more per beneficiary on average than the government pays for seniors in traditional Medicare, has been targeted by the Democratic leadership and the White House as a giveaway to insurance companies that unfairly raises premiums for all Medicare beneficiaries."
-------------------------------------------
How ironic. The health care bill the Democrats are trying to shove down our throats is one GIANT Medicare Advantage plan!
I agree with Howard Dean. Kill this bill and vote in liberal Democrats in the next election.
Better yet, start a third party that's devoted to campaign finance reform!
Recommend Recommended by 3 Readers 10. John Chik
OC, CA
December 16th, 2009
2:11 pmI have belonged to Kaiser Permanente (KP) senior advantage for several years and receive excellent coverage. KP is non-profit and has an excellent reputation for medical quality and cost control, 93% of every dollar goes directly to medical care with only 7% going to administration. If congress reduces Advantage payments by $1700 per year, my premiums will go up by $1700 per year. Just what a retired guy needs. Thank you Mr. O.
Recommend Recommended by 3 Readers 11. thomas
lima
December 16th, 2009
3:52 pmMost Soc.Sec.beneficiaries get by on very modest incomes.The Med.Advantage gym membership benefit gives them the means to focus on and follow healthy lifestyle practices at little or no cost to the beneficiary and for Medicare a modest cost that produces,in all probability significant reductions in Med.Advantage expenses.Need I say more?
Recommend Recommended by 3 Readers 12. mm
here
December 16th, 2009
3:52 pm"How ironic. The health care bill the Democrats are trying to shove down our throats is one GIANT Medicare Advantage plan!
I agree with Howard Dean. Kill this bill and vote in liberal Democrats in the next election."
No, the Single Payer you advocate is EXACTLY this scenario described above. You'd have a base set of coverages that would be insufficient. Folks would need to supplement that coverage with add-ons. The add-ons would not be effcient due to duplicity in adming and poor economies of scale. The original plan and any subsides would be fought over politcally and via budget every year. The original plan would not be flexible enough to adapt.
Again, this highlights exactly why many of us don't want ANYTHING to do with single payer. Or government control of healthcare.
Recommend Recommended by 2 Readers 13. mn
az
December 16th, 2009
5:47 pmMother in law was in regular Medicare, Mom has been in Advantage plans for many years - both over 80...clearly regular Medicare is much better so Mom just switched to regular Medicare for 2010. Advantage plan doctors were not cooperative about medication side-effects and she was not able to switch to another doctor easily (it took months), nursing home care relatively poor from Advantage vs better facility available via normal Medicare, and access to physical therapy took many appeals in Advantage plan but quality physical therapy care was easily provided in regular Medicare. These Advantage plans are not worth the extra money paid to them.
Recommend Recommended by 1 Readers 14. flamingcreature
nyc
December 16th, 2009
5:47 pmmedicare a was one of dubya's many parting gifts to private industry. it costs more than medicare. #10, you think you were only paying $1700 a year when in fact everyone, including yourself, was and is paying more in taxes to cover what medA enrollees are not paying up front, because the administration wanted to give as much money to private industry at taxpayer expense. it was never about helping you. it was - i repeat - a gift to private industry.
Recommend Recommended by 1 Readers 15. juanita
meriden,ct
December 17th, 2009
10:13 amMedicare Advantage plans are just another big giveaway to insurance companies.
Seniors were tricked into signing up for them without realizing that those plans had far more restrictions on them than regular Medicare. And as happened in the Northeast, when the insurance companies did not make enough profits on certain plans, they just dropped them mid-year and let the seniors scramble to get back on regular Medicare, or find another plan. There were a lot of panicked seniors because of that.
Why on earth should our taxpayer dollars go to insurance companies to manage a federal program, when it COSTS THE TAXPAYER MORE for funding Medicare Advantage plans than for funding regular Medicare? !!!!!
Recommend Recommended by 0 Readers
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February 25
(8)
Video: The Health Care Session in 4 MinutesHit rewind to see some of the top moments from President Obama's health care session at Blair House.
Where Things Stand Now
Check this space for the latest updates from Washington and beyond.
White House | Democrats and Republicans aired their differences over proposed health care legislation at a bipartisan health care summit hosted by President Obama on Feb. 25. In light of Republican opposition, Democrats weighing budget reconciliation.
Senate | Republican Scott Brown won Kennedy's Senate seat on Jan. 19. Passed health care legislation, 60 to 39, on Dec. 24.
Wary Centrists Posing Challenge in Health Care Vote
By SHERYL GAY STOLBERG and ROBERT PEAR
The future of President Obama’s overhaul rests largely with two blocs of swing Democrats: abortion opponents and fiscal conservatives.
Democrats to Press Health Bill With Simple Majority
By ROBERT PEAR
Seeing no prospect of bipartisan agreement on health care, Congressional Democrats said that they would make another effort to pass sweeping health care legislation on their own.
The Cost of Doing Nothing on Health Care
By REED ABELSON
In health care, there will be no status quo, with or without an overhaul. Prices will rise beyond reach. Then what happens?
Uniting Democrats Is Challenge at Health Forum
By DAVID M. HERSZENHORN
The president did not seem to win over any Republicans, and seemed to end the day largely where he started, with little choice but to rally his Democrats to act on their own.
Parties Jousting With Dire Warnings
By ALESSANDRA STANLEY
Narrative choices designed to frighten were at the heart of the marathon health care summit meeting on Thursday.
Featured Posts
The Legislation
The Public Option
The public may have more appetite for the public option than many in Congress do.
Comparing Health Plans
Would Tort Reform Lower Costs?
The Abortion Question
The Problem With Prevention
Co-ops and Exchanges
Explaining the Exchange
Understanding the principle, and the politics, of the “insurance exchange.”
The Fine Print
What’s a Health Insurance Co-op?
Who Will Care for the Newly Insured?
Health Care Abroad
Taiwan
Taiwan implemented a Canadian-style single-payer system in less than a year.
Germany
Switzerland
France
Japan
Canada
Paying for Care
Insured, but Bankrupted Anyway
Medical bills are a major cause of personal bankruptcies in the United States, and proposed legislation isn’t likely to change that.
CaucusDebateEconomixBossNew Old Age A Tip on Slavery, Holocaust Talk
Comparisons to the Holocaust or slavery draw fire from left and right.
Blogging the Health Care Summit
President Obama, along with leading Democrats and Republicans, are meeting for a six-hour summit to try to hammer out some details of health care legislation.
Video: Health Summit Preview
A look at President Obama's style so far in negotiations.
Republican Senators: We'll Be There
The lineup is beginning to shape up for those who will attend Thursday's health care summit.
Congress Returns to Confront Jobs Bill
The Senate is expected to take up a scaled-back employment bill, but the Democratic majority needs a few Republicans to get on board.
Can Obama Bypass Republicans on Health?
The political risks of pushing through health care legislation without the G.O.P.
Did Obama Move Health Care Forward?
Will the president's words affect the political stalemate?
The G.O.P.'s Next Move on Health Care
What should the Republicans do now that they have the ability to change the game?
Medicare for 50-Somethings?
A Democratic plan to cover people 55 to 64 -- a group hard hit by layoffs.
Squeezing Money Out of Home Health Care
Does cutting Medicare spending on home health aides make good financial sense?
Once More, Health Care Cost Control
Many of Republicans' preferred ideas for controlling health care costs would have, at best, marginal influence, an economist writes.
What Is 'Affordable' Health Care?
President Obama needs to clarify the terms of the health care debate at his meeting with members of Congress, an economist writes.
If Colleges Worked Like Health Care
Just imagine what universities would be like if they sold education piecemeal the way the health care industry sells health care, an economist writes.
No Such Thing as 'Simple' Health Reform
Congress can do it "simply," or do it right, an economist writes.
What We're Reading...
Check-lists for finance, and other links from around the Web.
What Obama's New Health Care Plan Means for Small Businesses
What's unclear at the moment is whether this proposal reflects the views of Democratic leaders in Congress - that is, whether this is a bill the White House hopes can pass, or thinks can pass.
Your Business and Health Insurance Costs
How much have your business's health insurance rates gone up?
Entrepreneurs, Carefully Chosen, React to Obama's Speech
Even those who sat next to Michelle Obama have some questions.
Modernizing Government: An Entrepreneurial Perspective
President Obama calls business owners for tech support.
On Health Care, Readers Speak; The Agenda Responds
Please keep those cards and letters coming.
Home for Thanksgiving, and Managing Meds
A new brochure helps family members home for holiday visits talk to their parents about their multiple medications.
Easing Tensions in the Nursing Home
Conflicts between family members and nursing home staff may be familiar, but they are not inevitable, researchers say.
The Nursing Home as Battle Zone
Are conflicts with nursing home staff inevitable?
In Health Debate, the Oldest Voices Are Also the Faintest
The elderly are concerned about proposed changes to the health care system. But what of those patients who are most exposed to it?
When the Hospital Says 'So Long'
Tips on handling hospital discharges.
Multimedia
Comparing the House and the Senate Health Care Proposals
A look at how the proposals compare on some key issues.
A History of Health Care Reform
For almost a century, presidents and members of Congress have tried and failed to provide universal health benefits to Americans.
Impact of Health Care Measures
New new health care measures will affect certain types of households.
Uncovered: Coping With, and Without, Insurance
Covered by an inadequate plan, denied insurance or voluntarily without insurance – six men and women share their experiences.
Recommended Reads
Talking Points Memo
Not Budging: After Summit, Pelosi Says Health Care Is In Senate's CourtTime
On Health Care Who Goes First: House or Senate?The Wall Street Journal
Partisan Divides Continue to Cloud SummitThe Hastings Center
The (Unfortunate) Economic Logic of Technological ProgressCenter for American Progress
Interactive Map: Health Reform Will Lead to Job CreationHealth Affairs
Health Care Summit: The ConclusionReuters
California health insurers subpoenaed in rate probeFiveThirtyEight
A Few Final Thoughts on the Ublicpay OptionwayHealth Care Navigator
A list of topical resources selected by researchers and editors of The New York Times.
Draft Legislation
Senate Bill: Affordable Health Choices Act – Committee on Health, Education, Labor, and Pensions
Senate HELP Committee Press Release on the Affordable Health Choices Act – Senate HELP Commitee
Preliminary Analysis of the Provisions of Title I of the Bill – Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT)
House Bill: America’s Affordable Health Choices Act – Committee on Education and Labor
Summary of House Bill – Committee on Education and Labor
General Information
Health Funds Allocated by the American Recovery and Reinvestment Act – U.S. Dept of Health and Human Services
Budget (FY 2010) of the Dept of Health and Human Services – Office of Management and Budget
Fact Sheet: U.S. Health Care Spending – Centers for Medicare & Medicaid Services
U.S. Health Care Spending Highlights – Centers for Medicare & Medicaid Services
National Health Expenditures, 1960-2007 – Centers for Medicare & Medicaid Services
Advocacy Groups
The Stimulus Bill: What Does It Do for Health Care? – FamiliesUSA
Health Care Quality – National Coalition on Health Care
The Pillars of Health Care Reform – Conservatives for Patients’ Rights
Four Common Sense Reform Principles – Better Health Care Together
Health Care Reform Proposals – America’s Health Insurance Plans
The Fallacy of Health Care Reform as Economic Stimulus – The Heritage Foundation, Jan 16, 2009
Wrong on Health Care – Cato Institute (Michael Tanner), Feb 26, 2009
Three Roadblocks on the Road to Health Reform – American Enterprise Institute, Jan 8, 2009
Blogs
The Health Care Blog
Health Affairs
Health Care Policy and Marketplace Review
Health Beat
Video
Health Care Reform at Core of New Budget Plan – The NewsHour with Jim Lehrer, Feb 26, 2009
National Health Policy Conference – Academy Health, Feb 2, 2009
A Discussion about Healthcare with Ezekiel, Ari, and Rahm Emanuel – Charlie Rose, June 16, 2008
Other Coverage
The Market Can Fix the Healthcare Problem – U.S. News & World Report (Newt Gingrich), Jan 27, 2009
How Should Obama Reform Health Care? – The New Yorker, Jan 26, 2009
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Fewer Medicare Advantage Plans for Seniors
By MICHELLE ANDREWS
In the ongoing legislative tussle over how to trim the Medicare program to help pay for a health care overhaul, the Senate recently voted down an amendment by Senator Orrin G. Hatch, Republican of Utah, that would have blocked planned cuts to the subsidies that private insurers receive under the Medicare Advantage program. The extra money, 14 percent more per beneficiary on average than the government pays for seniors in traditional Medicare, has been targeted by the Democratic leadership and the White House as a giveaway to insurance companies that unfairly raises premiums for all Medicare beneficiaries.
Lawmakers who favor the private plans, however, say reducing the subsidies will result in painful cuts to the services seniors receive in the private plans, like vision and hearing screening and free gym memberships. Without the subsidies, they say, some private insurers may even pull out of the Medicare Advantage market.
But few lawmakers seem to realize that in some ways the horse has already left the barn: the Medicare Advantage program is shrinking already, thanks to new legal and regulatory changes. In 2010, there will be 18 percent fewer Medicare Advantage plans available to seniors than there were in 2009, according to an analysis by the Kaiser Family Foundation. Seven percent of the roughly 10 million beneficiaries who are enrolled in these plans will have to switch, according to the federal Centers for Medicare and Medicaid Services.
The biggest decline will be among Medicare Advantage private fee-for-service plans, whose numbers will decline by more than 40 percent when three insurers — Coventry, WellCare and Health Net — withdraw from the so-called P.F.F.S. market, according to Kaiser.
P.F.F.S. plans generally don’t have the defined provider networks associated with the better-established Medicare Advantage HMO and P.P.O. plans. The new plans have come under scrutiny for several reasons in recent years, including aggressive marketing tactics and the fact that some seniors have had difficulty finding providers who would accept their coverage.
These problems were an impetus for a 2008 law, the Medicare Improvements for Patients and Providers Act, that strengthened marketing protections for beneficiaries and required P.F.F.S. plans to have formal networks of providers in place starting in 2011. With the writing on the wall, some insurers decided to shut down their plans rather than invest resources in developing provider networks, experts say, and the shakeout may not be over.
“We’ll probably see lots of P.F.F.S. plans pull out in 2011,” said David Lipschutz, staff lawyer with California Health Advocates, a Medicare advocacy organization.
Other factors also are contributing to the reduced number of Medicare Advantage plans, including government efforts to eliminate plans that were very similar and to encourage
consolidation of those with fewer than 100 members.
Private Medicare health plans have been around since the 1970s as an alternative to traditional Medicare. They’re generally set up like managed care plans, with networks of providers and set co-payments for services, in contrast to traditional Medicare, in which patients see any participating provider and pay a percentage of the costs. Proponents thought that getting the private sector involved in Medicare would actually save the program money through increased efficiency and better coordination of care.
Over the past decade, Congress has encouraged participation in private sector plans by adding new types of plans and boosting the payments that plans received. Their efforts paid off: Just under a quarter of the 45 million people enrolled in Medicare today are in a private Medicare
Advantage plan.
The 2011 deadline for P.F.F.S. plans to develop provider networks is not the only pressure the plans face. In 2010, Medicare Advantage plan funding also was reduced by roughly 4 percent. Trade groups like America’s Health Insurance Plans warned that funding cuts would lead to reductions in the extra benefits that Medicare Advantage members typically receive. Other critics warned that the funding cutbacks would lead to a reduction in the number of Medicare Advantage plans that don’t charge a premium (apart from the regular Medicare Part B premium).
In 2010, there will indeed be fewer zero-premium plans. According to the Kaiser analysis, 43 percent of Medicare Advantage enrollees will be in plans without a premium next year, compared with 50 percent in 2009. And the 4 percent cut in plan payments is translating into $40 to $80 per member per month in reduced benefits or higher premiums, or a combination of the two, said John Gorman, chief executive of the Gorman Health Group, which provides consulting services to Medicare Advantage health plans.
So what happens if the subsidies are further reduced? Many experts note that even though some plans leave the market when their profit margins shrink, others have remained in the Medicare program for decades now. And although the number of plans has declined in 2010, enrollment has nearly doubled since 2004 and the number of plans has increased over that time, according to Tricia Neuman, director of the Medicare Policy Project at the Kaiser Family Foundation.
Further, though Medicare Advantage plans may drop some of the bells and whistles that they added when they were receiving bigger payments, the change may actually have an upside for beneficiaries. “The plans got fat and happy on these subsidies,” said Mr. Gorman. “What you’re seeing now is a renewed and urgent focus on medical cost management and care coordination.”
As for seniors, in 2010 the average Medicare beneficiary will still have a bewildering number of Medicare Advantage plans to choose from: 35 in urban areas and 24 in rural ones.
Deaths Rising for Lack of Insurance, Study Finds
Anthem Executive Blames Premium Increases on Rising Medical Costs
White House Urges Repeal of Insurers’ Antitrust Exemption
Anti-Abortion Group Opposes Increased Oversight of Premiums
Feinstein to Propose Federal Supervision of Insurance Rates
--------------------------------------------------------------------------------
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Lieberman vs. the ‘Public Option’ Patriarch Next post
A Read-Aloud in the Senate — Or Not
15 Readers' CommentsPost a Comment »All CommentsHighlightsReaders' RecommendationsRepliesOldestNewest
1. Leah
California
December 16th, 2009
9:43 amFirst the government took our money. Now, it refuses to pay. This is why the government can't be trusted with health care.
If a private insurer behaved this way, they would lose customers overnight. The government doesn't have to worry about losing customers.
Recommend Recommended by 2 Readers 2. Justin
Bloomington, In
December 16th, 2009
11:56 amI was a Medicaid Caseworker in Indiana when these plans started. Indiana had 40 plans the first year. They made such a profit that the next year there were 60 companies to chose from. The elderly were hounded by H..... to pay high monthly premiums when the Seniors could find a good play to cover their drugs for free. Unfortunately Seniors, who have no one to help them, ended up paying monthly premiums and not being covered for their most expensive meds. These Seniors need advocates to help them find the right plan for them.
My opinion is that the Market is so crowded due to the huge payout for the Companies. The companies can also drop any Senior's prescription, with 90 days notice, if they decide that the meds are too expensive to cover.
Recommend Recommended by 2 Readers 3. leah
colorado
December 16th, 2009
11:56 amRight, #1, the government took our money, set up a system to provide basic coverage for all seniors, then made the mistake of paying private companies to administer services it was already administering itself more efficiently. Now we have seen the error of our ways and are appropriately turning away from subsidizing private profits with dollars from seniors' premiums and workers' paychecks.
Recommend Recommended by 3 Readers 4. Plutonium
New York
December 16th, 2009
11:56 amI don't know what Leah from California is talking about. Why on earth should I, a tax payer, pay to support private health insurance plans? I'd like to understand why private plans are permitted to offer services like vision and hearing screening and free gym memberships at my expenses in more ways than one!
The latter steams me considerably as I have had serious back problems including major surgery this past year and I am limited in the physical therapy services for which medicare pays. Clearly I need to be on a lifelong program to strengthen my back, but medicare pays 0 for it. Would I give up the right to choose my own doctors for gym membership? As a two time cancer survivor, I shout a resounding NO!
And I am fed up with the likes Joe Lieberman (supposedly a God-fearing man! Ha Ha) who have completely forgotten that the purpose of government is to help people accomplish together what none could accomplish alone.
This country has gone to hell in a handbasket and for me the only saving grace is that as I am 74 (and remember what it was like before Ronald Reagan) I won't be around to witness the next civil war. There will be one, mark my words!
Recommend Recommended by 4 Readers 5. shaman
usa
December 16th, 2009
11:56 amI am so angry at the politicans for screwing up what was already a screwed up system and finding ways to drive the costs up and reduce the options and quality. please stop these guys - kill both bills - and find some rational folks who will not be paid off by big pharma and insurance companies and start again. this is the most corrupt sick misbegotten hoax i think i've ever seen.
Recommend Recommended by 4 Readers 6. Chicklet
Douglaston, NY
December 16th, 2009
11:56 amMedicare Advantage plans, which require the patient to pay extra for extra services not available in 'traditional' medicare are attractive to patients who need the services. Patients take direct responsibility for their care when they understand what is and is not covered and plan accordingly.
Once enrolled in a Medicare Advantage plan, most seniors are happy with the value of what they've purchased. Annual tinkering with the law that governs what benefits may be offered, what the fees are, etc. are too much for many insurers, who would rather leave the market than revamp their offerings every single year. Re-printing, publishing, filing for approval, sending mailings, every time the plans requirements change creates a problem, this money should be going to patient care.
It all fits in with the unstated goal, single payer with no consumer choice (well, maybe you can choose the fine or tax you'll pay if you disagree with what mother tells you to do) followed by taxes, bureaucracy and exploding costs. We all know the government has a terrible track record with the government programs they now administer, Medicaid, the VA, Medicare are not exactly paragons of value, and have next-to-no fraud and abuse safeguards.
I hope Senator Lieberman holds on to his principles and citizens continue to speak their minds, a 25 pound bill that moves 1/5 of the economy from private to government control, passed in a big hurry by a congress with no medical expertise is not a good idea to me.
Recommend Recommended by 4 Readers 7. mm
here
December 16th, 2009
2:11 pmIt's a clear example of the inefficiencies of add-on insurance to a single-payer market. A single person now has two entities to deal with - Medicare and add-on. If this were a free, competitive market, you could choose a single plan of your choice of coverage levels.
Those who moan about admin overhead, you now have it in two companies for a single person. Very inefficient.
A single policy through a single provider and the networks would already be in place, you would not have the problem of the add-on trying to negotiate for provider support.
Coverage is tied to budgets and politics - never a good thing. Reading through the article all one sees are regulation, policies, etc. getting in the way of care.
The need in the first place is because Medicare, due to budgets, politics and simply because it was a poor implementation in the first place, could not adapt their coverage to fit the needs of they people.
This article is a mini-case study for why single-payer is NOT a good idea and why tying health insurance to politics and budgets is NOT a good idea. Expand this to all of the US - we should all shudder at the thought, the cost, the quality.
Recommend Recommended by 2 Readers 8. Leah
California
December 16th, 2009
2:11 pmleah from Colorado - You are unhappy with the way the government managed your Medicare money. I am also unhappy but for different reasons.
We have a win-win situation here. How about we don't start yet another government entitlement program? You get to spend your money the way you want. I get to spend my money the way I want.
Recommend Recommended by 2 Readers 9. E. Nowak
Chicago, IL
December 16th, 2009
2:11 pm"The extra money, 14 percent more per beneficiary on average than the government pays for seniors in traditional Medicare, has been targeted by the Democratic leadership and the White House as a giveaway to insurance companies that unfairly raises premiums for all Medicare beneficiaries."
-------------------------------------------
How ironic. The health care bill the Democrats are trying to shove down our throats is one GIANT Medicare Advantage plan!
I agree with Howard Dean. Kill this bill and vote in liberal Democrats in the next election.
Better yet, start a third party that's devoted to campaign finance reform!
Recommend Recommended by 3 Readers 10. John Chik
OC, CA
December 16th, 2009
2:11 pmI have belonged to Kaiser Permanente (KP) senior advantage for several years and receive excellent coverage. KP is non-profit and has an excellent reputation for medical quality and cost control, 93% of every dollar goes directly to medical care with only 7% going to administration. If congress reduces Advantage payments by $1700 per year, my premiums will go up by $1700 per year. Just what a retired guy needs. Thank you Mr. O.
Recommend Recommended by 3 Readers 11. thomas
lima
December 16th, 2009
3:52 pmMost Soc.Sec.beneficiaries get by on very modest incomes.The Med.Advantage gym membership benefit gives them the means to focus on and follow healthy lifestyle practices at little or no cost to the beneficiary and for Medicare a modest cost that produces,in all probability significant reductions in Med.Advantage expenses.Need I say more?
Recommend Recommended by 3 Readers 12. mm
here
December 16th, 2009
3:52 pm"How ironic. The health care bill the Democrats are trying to shove down our throats is one GIANT Medicare Advantage plan!
I agree with Howard Dean. Kill this bill and vote in liberal Democrats in the next election."
No, the Single Payer you advocate is EXACTLY this scenario described above. You'd have a base set of coverages that would be insufficient. Folks would need to supplement that coverage with add-ons. The add-ons would not be effcient due to duplicity in adming and poor economies of scale. The original plan and any subsides would be fought over politcally and via budget every year. The original plan would not be flexible enough to adapt.
Again, this highlights exactly why many of us don't want ANYTHING to do with single payer. Or government control of healthcare.
Recommend Recommended by 2 Readers 13. mn
az
December 16th, 2009
5:47 pmMother in law was in regular Medicare, Mom has been in Advantage plans for many years - both over 80...clearly regular Medicare is much better so Mom just switched to regular Medicare for 2010. Advantage plan doctors were not cooperative about medication side-effects and she was not able to switch to another doctor easily (it took months), nursing home care relatively poor from Advantage vs better facility available via normal Medicare, and access to physical therapy took many appeals in Advantage plan but quality physical therapy care was easily provided in regular Medicare. These Advantage plans are not worth the extra money paid to them.
Recommend Recommended by 1 Readers 14. flamingcreature
nyc
December 16th, 2009
5:47 pmmedicare a was one of dubya's many parting gifts to private industry. it costs more than medicare. #10, you think you were only paying $1700 a year when in fact everyone, including yourself, was and is paying more in taxes to cover what medA enrollees are not paying up front, because the administration wanted to give as much money to private industry at taxpayer expense. it was never about helping you. it was - i repeat - a gift to private industry.
Recommend Recommended by 1 Readers 15. juanita
meriden,ct
December 17th, 2009
10:13 amMedicare Advantage plans are just another big giveaway to insurance companies.
Seniors were tricked into signing up for them without realizing that those plans had far more restrictions on them than regular Medicare. And as happened in the Northeast, when the insurance companies did not make enough profits on certain plans, they just dropped them mid-year and let the seniors scramble to get back on regular Medicare, or find another plan. There were a lot of panicked seniors because of that.
Why on earth should our taxpayer dollars go to insurance companies to manage a federal program, when it COSTS THE TAXPAYER MORE for funding Medicare Advantage plans than for funding regular Medicare? !!!!!
Recommend Recommended by 0 Readers
Pelosi Faces Two HurdlesCompromise health care legislation faces a tough road in the House.
February 26
(11)
New Developments in the Health Care DebateProminent economists call for Congress to overhaul health care, and other news related to the health care debate from Times bloggers.
February 26
(54)
Deaths Rising for Lack of Insurance, Study FindsIn the absence of comprehensive health care legislation, a lack of insurance will contribute to 275,000 deaths over the next decade, an advocacy group warned on Thursday.
February 26
(15)
The Morning AfterThe Times ponders Thursday's health care forum.
February 25
(8)
Video: The Health Care Session in 4 MinutesHit rewind to see some of the top moments from President Obama's health care session at Blair House.
Where Things Stand Now
Check this space for the latest updates from Washington and beyond.
White House | Democrats and Republicans aired their differences over proposed health care legislation at a bipartisan health care summit hosted by President Obama on Feb. 25. In light of Republican opposition, Democrats weighing budget reconciliation.
Senate | Republican Scott Brown won Kennedy's Senate seat on Jan. 19. Passed health care legislation, 60 to 39, on Dec. 24.
Wary Centrists Posing Challenge in Health Care Vote
By SHERYL GAY STOLBERG and ROBERT PEAR
The future of President Obama’s overhaul rests largely with two blocs of swing Democrats: abortion opponents and fiscal conservatives.
Democrats to Press Health Bill With Simple Majority
By ROBERT PEAR
Seeing no prospect of bipartisan agreement on health care, Congressional Democrats said that they would make another effort to pass sweeping health care legislation on their own.
The Cost of Doing Nothing on Health Care
By REED ABELSON
In health care, there will be no status quo, with or without an overhaul. Prices will rise beyond reach. Then what happens?
Uniting Democrats Is Challenge at Health Forum
By DAVID M. HERSZENHORN
The president did not seem to win over any Republicans, and seemed to end the day largely where he started, with little choice but to rally his Democrats to act on their own.
Parties Jousting With Dire Warnings
By ALESSANDRA STANLEY
Narrative choices designed to frighten were at the heart of the marathon health care summit meeting on Thursday.
Featured Posts
The Legislation
The Public Option
The public may have more appetite for the public option than many in Congress do.
Comparing Health Plans
Would Tort Reform Lower Costs?
The Abortion Question
The Problem With Prevention
Co-ops and Exchanges
Explaining the Exchange
Understanding the principle, and the politics, of the “insurance exchange.”
The Fine Print
What’s a Health Insurance Co-op?
Who Will Care for the Newly Insured?
Health Care Abroad
Taiwan
Taiwan implemented a Canadian-style single-payer system in less than a year.
Germany
Switzerland
France
Japan
Canada
Paying for Care
Insured, but Bankrupted Anyway
Medical bills are a major cause of personal bankruptcies in the United States, and proposed legislation isn’t likely to change that.
CaucusDebateEconomixBossNew Old Age A Tip on Slavery, Holocaust Talk
Comparisons to the Holocaust or slavery draw fire from left and right.
Blogging the Health Care Summit
President Obama, along with leading Democrats and Republicans, are meeting for a six-hour summit to try to hammer out some details of health care legislation.
Video: Health Summit Preview
A look at President Obama's style so far in negotiations.
Republican Senators: We'll Be There
The lineup is beginning to shape up for those who will attend Thursday's health care summit.
Congress Returns to Confront Jobs Bill
The Senate is expected to take up a scaled-back employment bill, but the Democratic majority needs a few Republicans to get on board.
Can Obama Bypass Republicans on Health?
The political risks of pushing through health care legislation without the G.O.P.
Did Obama Move Health Care Forward?
Will the president's words affect the political stalemate?
The G.O.P.'s Next Move on Health Care
What should the Republicans do now that they have the ability to change the game?
Medicare for 50-Somethings?
A Democratic plan to cover people 55 to 64 -- a group hard hit by layoffs.
Squeezing Money Out of Home Health Care
Does cutting Medicare spending on home health aides make good financial sense?
Once More, Health Care Cost Control
Many of Republicans' preferred ideas for controlling health care costs would have, at best, marginal influence, an economist writes.
What Is 'Affordable' Health Care?
President Obama needs to clarify the terms of the health care debate at his meeting with members of Congress, an economist writes.
If Colleges Worked Like Health Care
Just imagine what universities would be like if they sold education piecemeal the way the health care industry sells health care, an economist writes.
No Such Thing as 'Simple' Health Reform
Congress can do it "simply," or do it right, an economist writes.
What We're Reading...
Check-lists for finance, and other links from around the Web.
What Obama's New Health Care Plan Means for Small Businesses
What's unclear at the moment is whether this proposal reflects the views of Democratic leaders in Congress - that is, whether this is a bill the White House hopes can pass, or thinks can pass.
Your Business and Health Insurance Costs
How much have your business's health insurance rates gone up?
Entrepreneurs, Carefully Chosen, React to Obama's Speech
Even those who sat next to Michelle Obama have some questions.
Modernizing Government: An Entrepreneurial Perspective
President Obama calls business owners for tech support.
On Health Care, Readers Speak; The Agenda Responds
Please keep those cards and letters coming.
Home for Thanksgiving, and Managing Meds
A new brochure helps family members home for holiday visits talk to their parents about their multiple medications.
Easing Tensions in the Nursing Home
Conflicts between family members and nursing home staff may be familiar, but they are not inevitable, researchers say.
The Nursing Home as Battle Zone
Are conflicts with nursing home staff inevitable?
In Health Debate, the Oldest Voices Are Also the Faintest
The elderly are concerned about proposed changes to the health care system. But what of those patients who are most exposed to it?
When the Hospital Says 'So Long'
Tips on handling hospital discharges.
Multimedia
Comparing the House and the Senate Health Care Proposals
A look at how the proposals compare on some key issues.
A History of Health Care Reform
For almost a century, presidents and members of Congress have tried and failed to provide universal health benefits to Americans.
Impact of Health Care Measures
New new health care measures will affect certain types of households.
Uncovered: Coping With, and Without, Insurance
Covered by an inadequate plan, denied insurance or voluntarily without insurance – six men and women share their experiences.
Recommended Reads
Talking Points Memo
Not Budging: After Summit, Pelosi Says Health Care Is In Senate's CourtTime
On Health Care Who Goes First: House or Senate?The Wall Street Journal
Partisan Divides Continue to Cloud SummitThe Hastings Center
The (Unfortunate) Economic Logic of Technological ProgressCenter for American Progress
Interactive Map: Health Reform Will Lead to Job CreationHealth Affairs
Health Care Summit: The ConclusionReuters
California health insurers subpoenaed in rate probeFiveThirtyEight
A Few Final Thoughts on the Ublicpay OptionwayHealth Care Navigator
A list of topical resources selected by researchers and editors of The New York Times.
Draft Legislation
Senate Bill: Affordable Health Choices Act – Committee on Health, Education, Labor, and Pensions
Senate HELP Committee Press Release on the Affordable Health Choices Act – Senate HELP Commitee
Preliminary Analysis of the Provisions of Title I of the Bill – Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT)
House Bill: America’s Affordable Health Choices Act – Committee on Education and Labor
Summary of House Bill – Committee on Education and Labor
General Information
Health Funds Allocated by the American Recovery and Reinvestment Act – U.S. Dept of Health and Human Services
Budget (FY 2010) of the Dept of Health and Human Services – Office of Management and Budget
Fact Sheet: U.S. Health Care Spending – Centers for Medicare & Medicaid Services
U.S. Health Care Spending Highlights – Centers for Medicare & Medicaid Services
National Health Expenditures, 1960-2007 – Centers for Medicare & Medicaid Services
Advocacy Groups
The Stimulus Bill: What Does It Do for Health Care? – FamiliesUSA
Health Care Quality – National Coalition on Health Care
The Pillars of Health Care Reform – Conservatives for Patients’ Rights
Four Common Sense Reform Principles – Better Health Care Together
Health Care Reform Proposals – America’s Health Insurance Plans
The Fallacy of Health Care Reform as Economic Stimulus – The Heritage Foundation, Jan 16, 2009
Wrong on Health Care – Cato Institute (Michael Tanner), Feb 26, 2009
Three Roadblocks on the Road to Health Reform – American Enterprise Institute, Jan 8, 2009
Blogs
The Health Care Blog
Health Affairs
Health Care Policy and Marketplace Review
Health Beat
Video
Health Care Reform at Core of New Budget Plan – The NewsHour with Jim Lehrer, Feb 26, 2009
National Health Policy Conference – Academy Health, Feb 2, 2009
A Discussion about Healthcare with Ezekiel, Ari, and Rahm Emanuel – Charlie Rose, June 16, 2008
Other Coverage
The Market Can Fix the Healthcare Problem – U.S. News & World Report (Newt Gingrich), Jan 27, 2009
How Should Obama Reform Health Care? – The New Yorker, Jan 26, 2009
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Monday, February 22, 2010
Medicare and the Elderly
President Obama hopes to finance a health care overhaul in part by squeezing hundreds of billions of dollars in savings from Medicare through a crackdown on fraud and waste. An oft-cited example: Medicare Advantage, run by private insurers reimbursed by Medicare, costs the government 14 percent more per enrollee than traditional Medicare.
Republicans claim that Democrats will ultimately be forced to reduce Medicare benefits to seniors in order to finance health care for more citizens. Are the elderly being asked to shoulder the burden for universal coverage? Should Medicare, or something like it, be available to an even greater number of Americans?
Republicans claim that Democrats will ultimately be forced to reduce Medicare benefits to seniors in order to finance health care for more citizens. Are the elderly being asked to shoulder the burden for universal coverage? Should Medicare, or something like it, be available to an even greater number of Americans?
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