JustCare

Tag: AARP

  • Can you trust AARP when it comes to choosing a Medicare Advantage plan or health clinic?

    Can you trust AARP when it comes to choosing a Medicare Advantage plan or health clinic?

    Back in the 90’s, when I was launching the Medicare Rights Center, AARP partnered with United Healthcare to offer standardized Medicare supplemental insurance policies for people in traditional Medicare. Since then, AARP has partnered with UnitedHealthcare to support its private Medicare Advantage plans. Now, Fred Shultz reports for Kaiser Health News, that AARP is now partnering with Oak Street Health, which operates health clinics in more than 20 states. Can you trust AARP when it comes to choosing a Medicare Advantage plan or using a health clinic?

    Make no mistake. AARP, a non-profit trade association for older adults, is partnering with health insurers and health clinics in order to generate hundreds of millions of dollars in income. If AARP had meaningful data to assess and choose partners offering high quality products and services, its partnerships could add value for its members. But, no one has that ability because the data is not available.

    AARP’s partnerships with UnitedHealthcare and Oak Street are all about the money, pure and simple. And, therefore you cannot trust the AARP name when it comes to deciding whether you should join a Medicare Advantage plan operated by UnitedHealthcare or visit a health clinic operated by Oak Street. AARP is generating $1 billion a year from these partnerships. Talk about conflicts of interest.

    As it turns out, Oak Street is under investigation by the Justice Department for possible violation of the False Claims Act because of its marketing practices. Naturally, Oak Street denies any wrongdoing, and it claims it offers “value-based care.” I say, “no data, no value.”

    Oak Street is one of the 99 “direct contracting entities” that the Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare, has contracted with as part of an experiment intended to reduce Medicare spending and improve quality of care for people in traditional Medicare. But, the experiment injects for-profit middlemen into traditional Medicare that show no evidence of delivering value as I and many others have argued.

    As health economist Marilyn Moon explains, these partnerships put AARP in a compromising position. These partnerships are very different from AARP partnering with a travel company to help its members get travel discounts. The partnerships could keep AARP from advocating to promote the needs of their members.

    For example, because of its partnership with Oak Street,  AARP does not appear to have spoken out against the privatization of traditional Medicare through direct contracting entities, renamed REACH. REACH is a government experiment in which Oak Street and other private equity and insurer entities are paid to “manage” care for people in traditional Medicare.

    AARP claims that its partnerships do not affect its advocacy on behalf of its members. Even if that were true, the appearance of a conflict in and of itself is troubling.

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  • Organizing older adults to defend our health care

    Organizing older adults to defend our health care

    A recent paper by Community Catalyst’s Leena Sharma, Carol Regan and Katherine Villers published in the Journal of Aging and Social Policy, looks at the history and future of advocacy by older adults to defend our health care. It finds that we need a more organized and politically powerful base of older adults to defend our health care.

    Older adults are known to vote, which helps enormously. But, the authors say that we cannot take for granted their support for health care. To best organize and empower older adults to defend health care, we need to appreciate that they are a very racially and ethnically diverse group. While they strongly support Medicare, Medicaid does not get the same degree of support.

    The authors suggest that it is harder to generate support for Medicaid. Older adults are divided along income lines on health care issues. Moreover, Medicaid covers people of all ages, and there are long-held stigmas associated with it. This is concerning, especially as the Affordable Care Act and Medicaid are under serious attack. Older adults with low incomes and from minority groups are at particular risk.

    The three biggest organizations that work with older adults are the AARP, the ARA (Alliance for Retired Americans) and the National Committee to Preserve Social Security and Medicare (NCPSSM). The AARP and ARA have a local presence in the vast majority of states, but the NCPSSM has no local presence and focuses on lobbying Congress, in part by activating older adults through direct mail. Working America also organizes around health care issues at the local level.

    State level organizations that engage and activate older adults are few and far between. Medicare Rights Center, a national consumer organization, does some organizing work in New York. The Massachusetts Senior Action Council and the New York Statewide Senior Action Council organize older adults in their respective states and work closely with low and moderate income older adults. Organizations such as the Pennsylvania Health Access Network and Take Action Minnesota focus on organizing people across generations, particularly people with low and moderate incomes, to fight for better long-term care in Medicaid.

    Faith-based organizations also help to organize older adults around health care. PICO, for example, which represents more than 1100 congregations from 40 denominations, does grassroots organizing on a range of issues, including health care.

    The authors recommend that to better organize older adults to defend our health care, we need to appreciate their differences and develop an intergenerational and inclusive strategy and infrastructure. Organizing at the community level is critical, with a national infrastructure coordinating efforts. The authors further suggest that in addition to support for Social Security, Medicare and Medicaid, the organizing efforts should be around age-friendly communities and public services, antipoverty initiatives, support for caregivers and the care workforce.

    For the organizing to succeed, the effort will need a bold inclusive vision, strong local and national leadership, significant coalition-building and financial support.

    If you support Medicare for all, please let Congress know. Sign this petition.

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  • Congress may end tax deduction for medical expenses

    Congress may end tax deduction for medical expenses

    The House Republicans are proposing a tax bill that would end the tax deduction for medical expenses. This tax deduction benefits people whose medical spending represents more than ten percent of their adjusted gross income. Given high health care costs, almost nine million middle and low-income people benefit from the deduction; according to AARP, most of them are over 65.

    Sarah Kliff explains for Vox that out-of-pocket costs for health care services and prescription drugs, including deductibles,  as well as the cost of a joining a weight-loss club, are tax-deductible medical expenses as defined by the IRS. And, people who work for themselves can usually include the cost of their health insurance premiums as a tax-deductible medical expense if their total medical spending is more than 10 percent of their adjusted gross income.

    Unlike some tax deductions, many working families benefit from the medical expense deduction. Three percent of Americans with annual incomes under $20,000 take the medical expense deduction as compared to one percent of people earning $1 million or more. To put these numbers in context, in 2014, just over 60 million people, earned under $20,000 a year. About 130,000 Americans earned over $1 million in 2014.

    AARP is lobbying against the elimination of this tax deduction because it benefits millions of older people with high health care costs, including people needing long-term care. People with incomes under $20,000 who use the medical expense deduction claim an average of $9,136 in medical expenses.

    Bloomberg News reports that the Senate tax proposal keeps the tax deduction for medical expenses. The Senate Finance Committee will begin considering the tax proposal next week; it is not clear whether the medical expense deduction will ultimately stay or go.

    Whatever the future of the medical expense tax deduction, given the GOP control over both houses of Congress and the GOP desire to lower tax rates for the wealthy, the data suggest that the tax bill will drive up taxes for many middle and working class families.

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  • PhRMA fights states on drug pricing

    PhRMA fights states on drug pricing

    Drug prices are rising at crazy rates; in 2015, almost one in three brand-name drugs saw a price increase of 20 percent. In response, more than a dozen states are considering legislation that would call the drug companies to account. Of course, PhRMA is fighting states on drug pricing.

    On June 3, 2016, Vermont’s governor signed into a drug transparency law intended to make drug companies justify huge drug price increases. And, since then, the California Assembly’s Health Committee approved a similar drug price transparency bill, which its Senate has passed, intended to make drug companies justify huge drug price increases. That said, Stat reports that the bill has recently been gutted. 

    Now, a ballot initiative in California, Proposition 61, is designed to reduce the cost of drugs for state agencies. This would not only take a toll on drug company profits, it would set the stage for other states to pass similar initiatives. Not surprisingly, PhRMA has already put $70 million into fighting this initiative.

    Proposition 61 would keep California agencies like MediCal, (California’s Medicaid), which covers poor children, from paying any more for a drug than the lowest price paid by the Veterans’ Administration (V.A.). Ohio has a similar initiative, but PhRMA may successfully keep it from being voted on by bringing a lawsuit challenging it.

    California state agencies today spend $4 billion a year on drugs. If Proposition 61 passes, the state could  could save hundreds of millions of dollars. But, some argue that it would be hard to implement.

    Most drug prices, including discounts and rebates, are not transparent. So, it could be hard to know exactly what the V.A. is paying.  That said, the CBO reported ten years ago that the V.A. pays about 42 percent of the retail prices and Medicaid pays about 52 percent.

    California AARP supports Proposition 61 as does the California Nurses Association. But, according to the New York Times, some advocates oppose it for fear that it will lead drug companies to drive up prices at the V.A. and for others even further. It’s not clear whether some or all of these advocates take money from the drug companies and are therefore conflicted.

    As important as it is for states to be taking action on drug pricing, state action is not likely to succeed at reining in drug prices as much as needed. The pharmaceutical industry is too powerful. But, state activity keeps a spotlight on the pharmaceutical industry and that in turn keeps pressure on Congress to act. How long that will take, however, is anyone’s guess.

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