JustCare

Tag: Policy

  • Five concerning policy outcomes of Medicare Advantage program

    Five concerning policy outcomes of Medicare Advantage program

    We frequently think about aspects of Medicare and MA in isolation from their effects on our healthcare system. But when we step back, we see the following Medicare Advantage policy outcomes that we would never choose to accomplish on a stand-alone basis.

    1. Medicare Advantage program incentivizes insurer competition around attracting healthy people and avoiding people with costly conditions—with networks that avoid top specialists and specialty hospitals, with coverage protocols that delay and deny care inappropriately—increasing costs for providers and patients in the system and maximizing profits for insurers.
    2. Medicare Advantage program is effectively unaccountable, operating largely on trust, with no real-time oversight or meaningful enforcement, which prevents people from knowing which MA plans will provide high value care if they have cancer or heart disease and which to avoid, forcing them to gamble when they choose an MA plan and leading more than 10,000 people to die needlessly each year when they choose the wrong MA plan.
    3. Medicare Advantage program misleads people, particularly those with low incomes, into believing that they will get the same benefits as people in traditional Medicare with an out-of-pocket cap, when insurers can game Medicare coverage requirements so as not to deliver the same benefits. In fact, mounting evidence indicates insurers too often inappropriately deny critical care and provider payments, threatening the health and financial security of the most vulnerable enrollees with complex conditions.
    4. Medicare Advantage program uses a payment system that insurers can game to achieve 23 percent more per enrollee than the government spends on enrollees in traditional Medicare, driving up Medicare spending and Medicare premiums by $260 billion in the 10 years ending in 2033, and threatening the Medicare program. And, while MA offers a valuable out-of-pocket cap to people with low incomes and “extra” benefits, unlike TM, when they get sick, they are often faced with financial and administrative barriers to care wealthier people in TM do not face, which aggravate health inequities.
    5. Medicare Advantage program is financially unsustainable over the middle to long term and, left to its own devices, likely will lead to the withering away of traditional Medicare, the end of Medicare negotiated rates as providers acquire more leverage over insurers, greater financial and administrative barriers to care and much higher costs for enrollees with costly conditions.

    Here’s what MA policy should be designed to do:

    • MA policy should incentivize MA plans to compete to deliver high value care to the people with complex and costly conditions.
    • MA policy should bar bad actors from participating in the program; at the very least, it should identify the bad actors so that people can avoid enrolling in them.
    • MA policy should ensure that MA enrollees get the same benefits as people in Traditional Medicare and that providers are paid appropriately for the care they deliver.
    • MA policy should ensure that insurer administrative costs and profits total no more than 15 percent more than insurers spend on care.
    • MA policy should not allow the MA program to cost any more per enrollee than Traditional Medicare.

    Here’s more from Just Care:

  • Senate Republicans propose to slash billions from Medicare

    Senate Republicans propose to slash billions from Medicare

    Congressional Republicans are moving full speed ahead to gut Medicare, with no interest in honoring Trump’s repeated campaign promise not to touch Medicare. Senate Republicans now propose to slash billions of dollars from Medicare. Vox reports that the plan is to cut $450 billion from Medicare over 10 years. Can it pass?

    Vox reports that if the Senate Budget committee adopts this proposal, it is still not likely to pass because it would need support from eight Democrats. But, if Trump were willing to sign off on these cuts—and there’s good reason to believe he would be—according to the Center on Budget and Policy Priorities, the Senate could pass this proposal through the budget reconciliation process, which would mean that it would not need Democratic support.

    Sen. Bernie Sanders, who sits on the Senate Budget Committee, called out Republicans for proposing cuts that undermine President Trump’s campaign promise and drive up costs for older and disabled Americans with modest incomes, while also proposing tax cuts that help the most wealthy Americans.

    Senator Cole and his colleagues want cuts in Medicare, Social Security and Medicaid to pay for tax cuts for the wealthy and additional defense spending.

    Not surprisingly, the U.S. Republican-controlled House also wants massive Medicare cuts. On October 5, the House passed a cut to Medicare of almost $500 billion in its fiscal 2018 budget resolution. In addition, the House voted to raise the Medicare eligibility age from 65 to 67. And, it voted to turn Medicare into a voucher program. Moreover, it voted to slash Medicaid by more than $1 trillion.

    If you want Congress to keep its hands off Medicare, please sign this petition.

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  • When will Congress address health care costs?

    When will Congress address health care costs?

    While the majority of Americans have health insurance through Medicare, Medicaid or private insurance, even with this coverage, an increasing proportion of them are struggling to afford their health care. A new Kaiser Health tracking poll reveals the many challenges people with health insurance face paying for care and the increasing worries they have over their long-term ability to get the care they need. Given the pace with which health care premiums, deductibles and other out-of-pocket costs are growing, when will Congress address health care costs?

    • Today, more than four in ten people (43 percent) say they face difficulties affording their health insurance deductibles and one in three say they struggle to afford their premiums and other out-of-pocket costs.
    • Almost three in ten people (29 percent) report trouble paying their health care bills with more than 70 percent of them saying that these bills force them to reduce their spending on food, clothing and other basic needs.
    • About one in four people report delaying care (27 percent) or skipping care they were told to get (23 percent) because of the cost. More than one in five people (21 percent) report not filling a prescription.
    • About half of people worry about being able to afford needed care.

    Two out of three Americans want Congress to take action to lower the amount they pay for health care, seeing it as their number priority. Relatedly, their second priority is reducing the cost of prescription drugs.

    If you support Congressional action to rein in prescription drug prices, please sign this petition.

    Here’s more from Just Care:

  • Sanders bill would allow drug importation, lower costs

    Sanders bill would allow drug importation, lower costs

    The way to ensure prescription drugs are affordable in the U.S. is for the government to establish fair prices for these drugs, just as virtually all other nations do. In the meantime, Senator Bernie Sanders, along with co-sponsors Senators Cory Booker and Bob Casey, have introduced a bill in Congress that would allow people in the U.S. to take advantage of the low drug prices other advanced nations have negotiated. It would allow drug importation from these countries by individuals, pharmacies and wholesale distributors, lowering people’s drug costs.

    Sanders’ bill, the Affordable and Safe Prescription Drug Importation Act, would direct the Secretary of Health and Human Services to develop regulations that allowed importation of safe and effective drugs from Canada within 180 days of the law’s enactment. And, two years later, the law would permit importation of safe and effective drugs from many advanced nations.

    The law uses free trade between the U.S. and other countries to drive down the cost of drugs here. Failing to allow people in the U.S. to import lower cost prescription drugs disadvantages us economically. We spend more than $300 billion a year on prescription drugs, with the federal government (taxpayers) picking up $100 billion of the cost. Making drug importation by wholesalers, pharmacies and individuals legal would save us tens of billions of dollars annually.

    In 2014, Americans spent an average of $1,114 per person on prescription drugs. Canadians spent about 70 percent of what we spent per person, $772. Danes spent $325 on average. That said, millions of Americans already take advantage of lower prescription drug prices abroad through online pharmacies.

    Today, the drug industry is among the most highly profitable industries. The five most profitable pharmaceutical companies took in more than $50 billion in profits in 2015. High drug prices benefit drug company executives and shareholders and hurt working people. The lack of competition in the prescription drug marketplace for many medically necessary drugs is jeopardizing the health and well-being of millions of Americans.

    Congressmen Elijah Cummings and Lloyd Doggett introduced companion legislation in the House of Representatives.

    If you support making drug prices in the U.S. affordable, please sign this petition.

    Here’s more from Just Care:

  • Up to 4 million will be uninsured if Medicare eligibility age raised to 67

    Up to 4 million will be uninsured if Medicare eligibility age raised to 67

    In a recent report published by the National Committee to Preserve Social Security and Medicare Foundation based on research by the Actuarial Research Corporation, we demonstrate that Speaker Paul Ryan’s proposal to raise the age of Medicare eligibility from 65 to 67 would harm the health of 65- and 66-year old adults as well as the financial health of the institutions that care for them.

    If Congress raises the Medicare eligibility age to 67, between two and four million people 65 and 66 years old would be left uninsured, depending on whether or not the ACA is repealed. Currently, Medicare covers almost everyone 65 and over, with only 1.1 percent of people over 65 uninsured. But if the eligibility age for Medicare increases by two years, even if the ACA is not repealed, the percentage of uninsured would increase seventeen-fold to 18.7 percent or 1.9 million people 65 and 66. If the ACA is repealed, the percentage of uninsured would increase to 37 percent or 3.8 million people, more than one in three people 65 and 66.

    These uninsured older Americans will be hard-pressed to get needed care, particularly if the ACA is repealed. To the extent they have chronic conditions, insurers may no longer agree to cover them and, even if coverage is available, it is unlikely to be affordable for most people; if it’s affordable, it is likely to cover only limited benefits, with annual and lifetime caps. They will, therefore, end up using emergency services at far greater cost to our health care system and the institutions that provide them care.

    Doctors and hospitals in particular will find themselves covering the cost of care for most of these newly uninsured Americans (without reimbursement), putting these health care providers at financial risk. To the extent they raise their rates to absorb these costs, insurance premiums will rise further, escalating health care costs for insured Americans.

    Medicare is far better than commercial insurance at guaranteeing coverage, containing costs, and giving people with costly conditions access to the care they need. We should be expanding Medicare to everyone in the U.S., not driving up health care costs and the number of uninsured by raising the eligibility age.

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  • CBO projects premiums could double after ACA repeal

    CBO projects premiums could double after ACA repeal

    A new report from the Congressional Budget Office (CBO) projects that premiums could double by 2026 for people buying coverage in the individual market after key parts of the Affordable Care Act are repealed. Moreover, 18 million people could lose their health insurance within a year. The New York Times reports that these CBO findings could lead the Republican leadership to delay dismantling of the ACA until they have a replacement plan.

    Without a replacement plan for the ACA, the CBO estimates that 32 million will lose health insurance in the next nine years. These 32 million are in addition to the 26 million who are uninsured today. By 2026, we would more than double the number of uninsured in the U.S. from 26 million today to 59 million.

    Republicans plan to eliminate funding for Medicaid expansion, which means 19 million people with Medicaid would lose insurance. Republicans also plan to end subsidies that have helped people with moderate incomes afford their insurance, leaving another 23 million without coverage. The CBO believes that employer-based coverage will increase some.

    Republicans also plan to do away with the insurance mandate and penalty imposed on people who do not have health insurance. As a result, many insurers will leave the state health insurance exchanges. Insurers depend upon healthy people to join their health plans to keep premiums down.

    Without the insurance mandate, many of the young and healthy will not sign up. Without these healthy people in the exchanges, the CBO projects that premiums will rise by as much as 25 percent in the non-group market during the first full year after a replacement plan goes into effect. And premiums will be about 50 percent higher once the premium subsidies are no more.

    Here’s more from Just Care:

  • 150 million people at risk of losing good affordable coverage

    150 million people at risk of losing good affordable coverage

    JoAnn Volk of the Georgetown University Center on Health Insurance Reform writes for Health Affairs about the consequences for people with employer coverage of the Republicans’ plan to repeal the Affordable Care Act.  We know that if the ACA is repealed, 22.5 million people are at risk of losing their health insurance because they will no longer be eligible for Medicaid or will lose subsidies to help afford coverage in the individual market or have preexisting conditions. In addition 150 million people who get their health insurance through their jobs are at risk of losing good affordable coverage and being underinsured.

    Here’s what tens of millions of Americans will be facing if the ACA is repealed and replaced with a health insurance plan lacking strong consumer protections:

    • Health plans with only limited benefits, leaving people underinsured: The ACA ensures that large employer plans cover essential benefits and not simply a minimal set of benefits that would leave people needing costly care without adequate coverage. If the ACA is repealed, we will return to a state where health insurers sell tens of millions of Americans less coverage than they may need.
    • Health plans requiring people to pay up for preventive care: The ACA ensures that the cost of preventive services does not interfere with people getting these services; it has required that vaccines, annual check-ups and other key screenings to detect health issues before they develop are covered in full. If the ACA is repealed insurers can once again make people meet hefty deductibles and/or pay a large portion of the cost of preventive care.
    • Long delays in coverage for people with pre-existing conditions: The ACA prevents employers from making people wait to get coverage for their pre-existing conditions. Until the ACA was implemented, employers were able to make people with pre-existing conditions wait as long as a year. Only people who had the option of buying COBRA from a prior job and were able to afford the high cost of that insurance were able to avoid the wait if they had a pre-existing condition.
    • No dependent health care coverage for young adults up to age 26: The ACA ensures coverage to young adults through their parents’ job coverage until they are 26. As a result, many more young adults have health coverage today then ever before. (This is one provision of the ACA that the Republican leadership says it will keep in a replacement plan.)
    • Unlimited annual out-of-pocket costs for reasonable and necessary care: The ACA ensures a limit on how much money health insurers can require people to pay for their care in a given year. This provision in turn helps people with costly conditions afford the cost of their care without going bankrupt. Without it, people who need a lot of care may be forced to go without it or pushed into poverty paying for it.
    • Yearly and lifetime dollar limits on health plan coverage of reasonable and necessary care. The ACA prevents employers from limiting the amount of coverage they provide based on the cost of people’s care in a year or in their lifetimes. Caps on benefits are prohibited, ensuring that people with costly and complex conditions will always have coverage. If the ACA is repealed, people with costly conditions could lose their health care coverage mid-year or, worse still, for the rest of their lives.
    • No right to challenge denials of coverage or payment: The ACA ensures that workers who are in employer health plans that are self-funded (60 percent of workers) can question decisions by their health plans to deny them coverage or not pay for their care through an inexpensive independent review process.

    Here’s more from Just Care:

  • Republican New Year’s Resolution: Dismantle Medicare

    Republican New Year’s Resolution: Dismantle Medicare

    The New Year is a time of resolutions.  Consistent with that tradition, the Republican New Year’s Resolution is clear: Dismantle Medicare, ending Medicare as we know it. What’s most scary is that with Republican majorities in both the U.S. House of Representatives and the Senate, they have the power to make good on their intention to destroy Medicare.

    To be sure, you are not likely to hear the Republican leadership talk about gutting Medicare.  Instead, they euphemistically talk about “saving” Medicare. Simply put, they are “saving” the government money by cutting Medicare spending and forcing older adults and people with disabilities to spend more out of their own pockets for their care–if they can even afford the medical care they need. Let there be no doubt that, in the view of the Republican politicians, Medicare (and Social Security, for that matter) need not continue to guarantee people’s health and retirement security.

    The truth is that Medicare doesn’t need “saving.” As the wealthiest nation in the world, the United States can afford a greatly expanded Medicare that offers far more coverage and covers far more people than it does today. In 1965, when Medicare was enacted, the nation’s Gross Domestic Product was, in real terms, a quarter of what it is today ($4.1 trillion in 1965 versus $16.7 trillion today.)

    Expanding Medicare is the way to provide high quality, cost effective access to care for everyone in the U.S.  Because we rely on for-profit insurers, the United States is unable to rein in health care costs or to drive the system changes that we need to improve our quality of care. Other countries have, essentially, Medicare for All, and pay a fraction of what we pay, frequently with better health outcomes.   We spend three times more per capita than Japan on health care, for example, and live, on average, around five fewer years!

    Ryan and the Republican leadership’s Medicare plan will only drive up costs and undermine quality further. They want to return the country to pre-Medicare days, allowing insurers the freedom to offer inadequate coverage or no coverage at all. “Free choice” in their world simply means freedom to fall into medical bankruptcy or to forego needed care. Medicare was enacted because commercial insurers were unwilling to offer older adults good coverage at an affordable price.

    The Republican plan will simply empower commercial insurers by giving people a voucher to help cover the cost of their commercial insurance. At the same time, it will disempower older adults and people with disabilities who will not be able to buy reliable cost-effective coverage they can count on. To make matters worse, the Republican plan proposes to raise the age of Medicare eligibility to 67; and, though it would permit people to use their vouchers to buy Medicare, the program will, foreseeably, wither on the vine, as a result of a vicious circle: Medicare will be available only to the oldest and least healthy part of the population, and so will become more and more expensive, covering people with the greatest health care needs, while commercial insurers cherry pick the healthy.  Even fewer healthier people will opt for Medicare, and the price will go up even more.

    Rather than giving all Americans the option of cost effective coverage through a robust federal Medicare program, people in Medicare today and their children and grandchildren increasingly will, under the Republican plan, be forced into a commercial insurance plan that they cannot rely on to meet their health care needs.

    We need to expand Medicare, not end it, if we care about the lives of people in the U.S. If the Republicans end Medicare, we are destined to have an unsustainable health care system that increasingly rations care based on people’s ability to pay. Medical bankruptcies will rise. And, life expectancies in the U.S. will continue to be shorter than in other countries.

    To stop the Republicans, I urge everyone who is old or hopes to be old someday to make your own Medicare resolution for 2017. Tell your elected leaders: Hands off Medicare except to expand it.

    Sign this petition and ask your friends to join you. Mobilize and make your voices heard. Then, as a resolution for 2018, we can all resolve to elect leaders who listen to us and have the good sense to expand, not destroy, Medicare.

    Here’s more from Just Care:

  • One million “hands off Medicare” petitions delivered to Congress

    One million “hands off Medicare” petitions delivered to Congress

    On Wednesday, Social Security Works, Just Care, and several other organizations delivered more than one million petitions to Congress demanding that it and president-elect Trump keep their hands off Medicare. At the press conference, on behalf of the Democrats in Congress, Senator Chuck Schumer promised to fight “tooth and nail” to protect Medicare, with Senator Bernie Sanders and Congresswoman Nancy Pelosi by his side.

    Donald Trump pledged not to touch Medicare, Medicaid or Social Security during his presidential campaign. And, Bernie Sanders reminded everyone of that. “He said ‘I am not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,’” […] “Mr. Trump, we are going to hold you accountable.”

    President-elect Trump’s campaign website makes clear that he supports House Speaker Paul Ryan’s agenda. It used to include this language: “I’m not going to cut Medicare or Medicaid.” It now promises to “modernize Medicare,” a euphemism for cutting Medicare, turning Medicare over to private insurance companies, capping government support for the program, and shifting more costs onto older adults and people with disabilities.

    If you believe the government should keep its hands off of Medicare, please sign this petition.

    Watch these highlights from the petition delivery on Capitol Hill:

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  • Five ways Congress could weaken Social Security

    Five ways Congress could weaken Social Security

    Of all the federal government programs in the U.S., Social Security is perhaps the most treasured. Democratic and Republican voters alike value Social Security deeply. But, Republican leaders in the House and the Senate want to end Social Security as we know it. What keeps me up at night? If Trump becomes President, here are five ways Congress could weaken Social Security.

    1. Republicans in Congress want to privatize Social Security: Privatizing Social Security means investing Social Security monies in the stock market. Stock market dips, drops or crashes would mean cuts in people’s benefits. The amount of their monthly Social Security benefits would no longer be guaranteed each year.
    2. Republicans in Congress want people to get smaller Social Security checks, not guarantee them what they currently get or increase their checks: They tend to claim that the way to “save” Social Security is to reduce its benefits. They do not see lifting the cap on Social Security contributions or otherwise raising additional revenue for Social Security as an option. They do not want the wealthiest Americans to contribute more to Social Security.
    3. Republicans in Congress want to make people wait longer to receive their full Social Security retirement benefits: Today, the full Social Security retirement age is 66 for people born between 1943 and 1954, up from age 65. And, it is going up further to age 67. Raising Social Security’s retirement age means fewer benefits for everyone in retirement. And, it does particular harm to people with lower incomes, people who likely had no choice but to retire early because of work-related health conditions. It is unfair and inequitable. People who claim benefits at age 62 receive a 25 percent cut in their monthly check and, because they are more prone to serious health conditions, they tend to have shorter life expectancies than others.
    4. Republicans in Congress want to limit Social Security benefit inflation adjustments.They support a “chained CPI,” which effectively would keep benefits from increasing in tandem with inflation because of the way the Social Security cost-of-living adjustment is calculated. Already, Social Security benefits do not increase in tandem with the increases in total expenses for older adults because they do not take account of the larger amount older adults spend on health care relative to younger adults; health care costs are increasing much more quickly than other household expenses. For this reason, it’s likely that Social Security checks will not increase in 2017.
    5. Republicans in Congress want to “means test” Social Security benefits: They want to take away from wealthier Americans their earned Social Security benefits, arguing that Social Security should be for people who lack adequate means or “means-tested.” But Social Security is not a welfare program, it’s insurance. As with any insurance, people who pay in receive benefits when triggered, regardless of need. With Social Security, they receive benefits upon disability, death, or retirement. Means-testing benefits also will increase Social Security’s administrative costs.  Social Security is now the most efficient insurance around, with administrative costs of less than one percent. More than .99 cents of every Social Security dollar is paid in benefits. Means-testing benefits makes no sense.

    The U.S. is facing a retirement security crisis. Americans do not want to see benefits cut. They believe that they are too modest. In response, the 2016 Democratic Party Platform, in sharp contrast to Republican policymakers, focuses on expanding Social Security benefits, while requiring the wealthiest to pay their fair share. Sign this petition if you support expanding Social Security benefits.

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