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Reporters are waking up to the Medicare story, but more digging is needed

Reporters are waking up to the Medicare story, but more digging is needed

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(Photo by Progress Ohio via Flickr/Creative Commons)

Millions of Americans in traditional Medicare are unaware of the changes coming to their health care arrangements, and one big reason for that is the lack of coverage from the media. As I wrote in this space in 2019, reporters, once reliable Medicare hounds, had taken a pass, barely covering the program at the time. In the last few months, however, there’s been a glimmer of interest in Medicare. That’s a good thing, since the media needs to cover what’s happening to the program with the same intensity reporters once covered the passage of the Affordable Care Act.

In late April, the Office of the Inspector General (OIG) released an alarming report. The OIG found that tens of thousands of people enrolled in Medicare Advantage plans are denied necessary care that should have been covered under the program. In an important story by Reed Abelson, The New York Times reported that investigators found evidence of “widespread and persistent problems related to inappropriate denials of services and payment.” In some cases, these denials “may delay or even prevent a Medicare Advantage beneficiary from getting needed care,” said the team leader who worked on the report. CNN ran a piece by Tami Luhby about the OIG report. Her story was important because it meant another mainstream media outlet with a large audience was finally paying attention to Medicare.

RELATED: One way or another, the federal government is still bent on pushing Medicare into private hands

Since the first of the year, The American Prospect has run two sharp pieces about the privatization. In “Medicare Advantage Is a Massive Scam,” the Prospect covered the OIG story but also Joe Namath’s sales pitches, calling them an “abject lie.” Earlier in the year, the Prospect ran an excellent piece titled “The Dark History of Medicare Privatization,” by Barbara Caress, who teaches health policy at Baruch College in New York City. These should be required reading for all those — especially current and future beneficiaries — who are concerned about their health insurance coverage. Last December, Joanna Robin, an Australian digital journalist, wrote a fascinating story for The New Republic about the insurance marketing firm and its parent company behind the Joe Namath ads.

Two other outlets that reach more specialized audiences have also weighed in with excellent stories. Matthew Cunningham-Cook, writing for The Lever, told readers how the latest privatization scheme was hatched by a Trump administration official and “is quietly being expanded by the Biden administration through its new ACO REACH program, under the direction of two former Obama administration officials who have revolved between jobs in government and the corporate health care industry.” Truthout, a nonprofit news organization offering independent reporting and commentary, ran a lengthy piece by Dr. Ana Malinow, a pediatrician and past president of Physicians for a National Health Program.

Mark Miller, a well-known financial columnist for Reuters and publisher of a newsletter called RetirementRevised, told his readers accountable care organizations may replace the fee-for-service model and explained why that’s concerning. In April, he wrote in his column he was “surprised that Medicare’s ACO plan has not yet captured more attention in the media and with political leaders,” noting that Medicare planned to “enroll everyone in this new model by the end of this decade and as early as next year, in some cases — without prior consent.” Miller noted he was surprised this plan had not captured more media attention, “but this fits with a general lack of public debate about the steady growth of Medicare’s privatization.”

It’s well past time for the broader media to take a cue from these examples and report more to the public on what is happening. Reporters can still be the Medicare hounds they once were.

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care column.


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Recent letters from Congress to CMS have been hailed as "historic, bipartisan support" for Medicare Advantage. House and Senate Member signatories have been labeled as Medicare Advantage "Protectors". However, the letters negligently "protect" overpayments that subsidize more benefits and higher sales commissions to agents.

Unfortunately, the letters display a negligence ignoring the 56% of Medicare beneficiaries enrolled in Original Medicare and the original purpose of Medicare Advantage to compete with Original Medicare on a level playing field. This negligence fails to perform the duties owed to these beneficiaries and these purposes.

Where the Democrats Are Negligent

Democrats have forgotten Original Medicare. Over half of today's Medicare beneficiaries are enrolled in Original Medicare and are satisfied. Original Medicare enrollees comprise a large majority - over 50% - in each of forty-seven (47) states. These enrollees are ignored in favor of overpaying Medicare Advantage plans.

Instead of a level playing field Medicare Advantage has been given a financial advantage. Originally, the Medicare Advantage program had been expected to reduce Medicare spending and payments were set at 95 percent of Original Medicare. The government now overpays Medicare Advantage plans - over $106 billion between 2010 and 2019 (Health Affairs, 2021).

The excess government payments to Medicare Advantage plans are used to provide extra benefits that Original Medicare beneficiaries do not have. Originally these extra benefits were to be paid for out of the managed care savings alone. Original Medicare beneficiaries must pay for extra benefits out of their own pocket.

Where the Republicans Are Negligent

Republicans have forgotten the idea of "competition." Medicare Advantage was intended to compete on a level playing field with Original Medicare. Using managed care Medicare Advantage would improve health and lower costs and add some extra benefits to be a better value when compared to Original Medicare.

Market-based efficiency and competition are traded away for private plan "largesse". Total Medicare payments to Medicare Advantage (including rebates for extra benefits) are estimated at 104 percent of Original Medicare spending. This amounts to hundreds of billions in extra spending above Original Medicare.

The extra spending is "government excess" at the expense of taxpayers and Original Medicare enrollees. The excess payments to Medicare Advantage plans are used to provide extra benefits that Original Medicare beneficiaries do not have. Originally these extra benefits were to be paid for out of the managed care savings alone.

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While many of the criticisms of Medicare Advantage are accurate, I wonder how many of the journalists writing about it are actually old enough to be actual Medicare subscribers. The fact is that a large number of people enroll in Advantage plans voluntarily, myself included, with the only alternative being much worse and resulting in mass homelessness. Efforts should be made to report on why people choose and need these plans, and why this should be a separate issue from ACO. With a zero premium advantage plan, a retiree does not have to purchase a supplement plan or Part D.

Consider the costs for a subscriber who is not wealthy and doesn't have advantages such as inheritance. When I moved into my senior apartment complex, I was cautioned by my neighbors that when I reach 65, I will enroll in an Advantage plan just like them. The premium for Part B is about $170 per month. Without a zero-premium Advantage plan, such as that associated with the AARP, a subscriber has to pay premiums for Part D and a supplement plan. This means that subscribers could be paying at least $450 per month for premiums if they don't have an Advantage plan. Then consider that if one's income is below 300% FPL, the other government programs pay the deductibles and copays for Part C. If a subscriber gets health care from a large public health care system, such as a university medical center, all medical care is *free* beyond the $170 per month Part B premium. It would be very dangerous to tell senior citizens that you want to abolish their Advantage plans without offering them an alternative.

The new privatization is a completely separate issue and, as a change from a system that is delivering care to people, could be harmful.

My experience is just one data point, but everything time a claim has been denied, the fault was with the provider for not writing a claim properly, including deliberate refusals to provide answers to questions or failure to send imaging.

I am aware, however, that there are some modern treatments that Medicare denies, and that it hasn't caught up with modern times.

Before tearing down Medicare Advantage, lawmakers need proposals that preserve the system in which low-income subscribers are getting health care while only paying $170 per month for Part B.


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