JustCare

Tag: Wyden

  • Senate Finance Chair looks into deceptive Medicare Advantage marketing practices

    Senate Finance Chair looks into deceptive Medicare Advantage marketing practices

    Senate Finance Committee Chair, Ron Wyden, has written the Oregon Department of Consumer and Business Services and the Oregon Department of Human Services along with several other state insurance departments regarding “potentially deceptive” Medicare Advantage marketing practices. Senator Wyden would like to know more about growing complaints surrounding Medicare Advantage marketing practices that these state agencies might be hearing about. It is unknown whether Senator Wyden has also contacted the Centers for Medicare and Medicaid Services, which is responsible for regulating Medicare Advantage marketing materials.

    As Chair of the Senate Finance Committee, Senator Wyden is responsible for oversight of Medicare Advantage. And, it is good news that he is concerned about MA marketing complaints and aggressive sales practices. Recently, CMS reported a doubling of MA marketing complaints in the year between 2020 and 2021.

    Too often people with Medicare have little clue what they are doing when they enroll in a Medicare Advantage plan. CMS’ review of sales calls showed significant confusion among people with Medicare, including “that the beneficiary may be unaware that they are enrolling into a new plan during these phone conversations.”  That aside, of those people who understand differences between traditional Medicare and MA, few appreciate the grave risks of enrolling in a Medicare Advantage plan.

    We now have compelling evidence from the HHS Office of the Inspector General, the Government Accountability Office and MedPac that Medicare Advantage is in need of an overhaul. A wide range of MA plans are engaged in consumer protection violations and overcharging the federal government for their services. To date, CMS has not been able to address, let alone correct, these serious violations. Moreover, CMS has not disclosed to people which MA plans are the worst actors, which would help protect them from making a dangerous MA choice.

    Senator Wyden recognizes that MA plans have been engaged in misleading ads and fraudulent marketing and sales practices for more than a decade. Hopefully, the Senate Finance Committee will act swiftly to address these bad acts. For now, Senator Wyden simply asks state officials to report on different types of misleading marketing and sales practices in their states. The Senator does not appear to have expressed concern publicly, let alone taken action, regarding threats to the health and well-being of people enrolled in MA plans.

    It’s always smart to create a record. But, time is not on the side of people with Medicare who are misled into joining an MA plan. Already, we know about many types of misleading MA marketing. Moreover, CMS engages in misleading marketing of Medicare Advantage plans by not explaining to people in its Medicare and You handbook and other publications that out-of-pocket costs in most MA plans can be well over $5,000 and could be as high as $7,550, two to three times the cost of Medicare supplemental coverage in traditional Medicare. CMS also fails to explain the administrative hurdles people often face accessing care, as a result of MA plans’ prior authorization requirements.

    Congress and CMS work at a snail’s pace. Some Congressional attention is finally focused on the serious risks facing people in some Medicare Advantage plans, along with billions of dollars in overpayments to MA plans. But, how long will it take for Congress and CMS to act in ways that protect the health and well-being of people in MA from the bad actors? And, how many people will die needlessly during that time?

    Here’s more from Just Care:

  • Will Medicare continue to cover telehealth mental health services?

    Will Medicare continue to cover telehealth mental health services?

    Senate Finance Committee Chair Ron Wyden (D.Ore.) and others on his committee would like Medicare to continue to cover telehealth mental health services after the public health emergency ends, according to HealthcareFinanceNews. Since the Covid-19 pandemic, Medicare has covered a wide array of telehealth services for the first time, and it has worked well for millions of people with Medicare. But, unless Congress acts swiftly, after the public health emergency ends, Medicare coverage for almost all telehealth services will also end.

    Under federal law, Medicare’s coverage of telehealth services will end 151 days after the Covid public health emergency ends. As of now, the public health emergency will end mid-July, but President Biden is expected to extend it at least another 90 days to mid-October and, more likely, through the end of the year. In that event, Medicare coverage of telehealth services would end around July 2023.

    There appears to be bi-partisan support on the Senate Finance Committee for Medicare coverage of mental health services delivered by phone or computer, in which case an in-person visit would no longer be required for coverage. A Finance Committee discussion draft clarifies that, if legislation were enacted, everyone with Medicare would be eligible for audio-only or video telehealth mental health services.

    The goal is to help increase mental health parity in Medicare, by making it easier to get mental health care. If this policy were to become law, Medicare costs would go up, and Congress would need to find an offset to pay for the increased cost.

    A recent poll shows that a wide range of Americans, including people over 65, are more concerned with mental health issues and getting care to treat these issues. During the pandemic, people used telehealth services in large part to treat mental and behavioral issues.

    Logic and reason would dictate that a move for Medicare to cover mental health telehealth services would allow more people with Medicare to benefit from mental health care. However, outreach would be critical to ensure that not only better-educated and more affluent individuals benefited. There’s some evidence from a recent study of cancer patients that coverage of telehealth services for mental health care could widen health disparities. In the study of cancer patients, Black and uninsured individuals and people who live in rural areas and had lower incomes were less likely to use telehealth services.

    Here’s more from Just Care:

  • Senator Wyden sets forth principles for drug price reform

    Senator Wyden sets forth principles for drug price reform

    Jonathan Cohn reports for The Huffington Post that Senate Finance Committee Chair, Ron Wyden, just announced his principles for drug price reform. They should appeal to both progressive and conservative members of Congress. They speak to the need for lowering prescription drug costs for everyone in the US, without compromising innovation. Now, we need Congress to pass legislation that adheres to these principles.

    Principle number one recognizes that the federal government should have the power to negotiate drug prices directly with manufacturers. That is a no-brainer. Without that federal power, because there is no meaningful drug price competition for brand-name drugs, Congress is allowing pharmaceutical companies to set drug prices.

    Because pharmaceutical companies are setting drug prices in the US, tens of thousands of Americans are dying prematurely each year. They cannot afford their cancer, diabetes and heart medicines. If we paid the prices that other wealthy countries pay for drugs, we’d be paying less than half and sometimes as little as one fourth of what we pay today.

    The government would negotiate drug prices for people with Medicare, but Senator Wyden wants private health insurers and the people they cover to benefit from lower drug prices, as well. How Congress achieves that goal is an open question. It would be easiest if it gave everyone Medicare simply for the purpose of benefiting from Medicare’s negotiated drug price. That likely won’t happen. Short of that, Congress might be able to make these low prices available through the thousands of Federally Qualified Health Centers.

    Senator Wyden does not specify how Medicare would decide the prices of different drugs. He does not call for international reference pricing, which is the simplest way to ensure that drug prices come down without letting politics get in the way. It is the approach described in HR3, the House bill passed in 2019 that would lower drug prices for 250 drugs over ten years.

    Some say that international reference pricing is “passing the buck.” They want an “American” solution. Really? If Congress passes it, it will be an American solution. Congress will have to decide which countries it should benchmark US drug prices to and under what circumstances. Congress will still have to decide what happens when Pharma fails to adhere to these prices.

    International reference pricing is about as close to a “market solution” as we can get. If Congress allowed drug importation, drug prices in the US would end up being an international reference price of some sort.

    Senator Wyden would also cap drug price inflation from one year to the next.

    In short, Senator Wyden wants everyone to see lower drug costs at the pharmacy. Good idea. Everyone needs lower drug prices. Moreover, unless everyone enjoys lower prices, the pharmaceutical industry will threaten to raise everyone else’s prices. And, millions of Americans who don’t have Medicare will continue to die prematurely because they can’t afford their medications.

    Senator Wyden’s principles for prescription drug reform should also lead to several hundred billion dollars in savings. That’s money that could go towards putting an out-of-pocket cap in traditional Medicare as well as adding vision, hearing and dental benefits.

    Senator Wyden recognizes that reining in drug prices will not affect the innovation we need. Rather, it will allow us to direct more money toward critical and effective innovations. Right now, pharmaceutical companies spend relatively little on innovation. Moreover, a lot of their innovation money is focused on developing me-too drugs (variations on a drug already available) that do not add meaningful value.

    Here’s more from Just Care: