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WHAT CONGRESS BROKE, CONGRESS MUST FIXJuly 26, 2007 • Volume 7, Issue 29
The Democratic leadership that took over Congress in 2007 unveiled legislation this week that would make dramatic improvements in Medicare, especially the prescription drug benefit. While seniors’ advocacy groups are cheering the proposed “Children’s Health and Medicare Protection Act,” an insurance industry trade group is spending a lot of money on TV ads to convince people it’s a terrible idea. The commercials began running across the country this week, urging viewers to tell their congressional representatives to oppose it.
There are several provisions that the industry doesn’t like that will protect consumers and save taxpayers money.
First, taxpayers would no longer be forced to overpay private Medicare Advantage (MA) plans, which get an average of 12 percent more per member than what it would cost under Original Medicare. These overpayments, which amount to $54 billion over the next four years, would be phased out by 2011.
In addition, MA plans that do not spend at least 85 percent of their payments from Medicare on medical benefits beginning in 2010 would be paid less and eventually would be excluded from participation in the MA program. These payments are a monthly allowance paid by Medicare for each member enrolled. Currently, there is no requirement for how much of that money must go toward providing health care and how much can be diverted to, for example, executive bonuses.
Under another section of the bill, MA plan members could not be charged copayments or other fees for benefits that are higher than what people in Original Medicare pay.
Does that sound so terrible? Only to insurance companies.
There are a number of provisions that would help people with Medicare.
Some of the proposed changes would help people whose incomes are too low to afford Medicare’s out-of-pocket expenses. Eligibility criteria for the Medicare Savings Programs and the Part D drug benefit’s Extra Help program would be expanded so that more low-income people with Medicare will receive discounted premiums. Allowable assets for participation in both programs would be increased to a maximum of $17,000 for an individual and $34,000 for a couple, with annual increases of $1,000 and $2,000, respectively.
People with Medicaid and Medicare would not be randomly assigned to private drug plans with no consideration of whether those plans cover their medications. To ensure that they have access to the drugs they need, they would be enrolled in only those plans that cover 95 percent of the 100 brand-name drugs and 95 percent of the 100 generic drugs most prescribed for people with Medicare.
People who are eligible for Extra Help—which provides drug plan premium discounts—would not have to pay a late penalty when they sign up for coverage.
In addition, the bill includes changes that would help prevent a lot of the rampant marketing fraud and abuse currently being perpetrated by the private plans. The National Association of Insurance Commissioners would be requested to develop standardized national marketing and advertising rules for private Medicare Advantage and stand-alone drug plans. The rules would be adopted by the U.S. Department of Health and Human Services and companies would have to follow them or face penalties for violations. States would be given the power to police the plans and impose fines on those that violate the rules.
The legislation would also protect people who joined a plan because of the drugs covered in its formulary. Members of drug plans that make midyear changes in formularies (the list of covered drugs) would be able to change plans, unless the formulary change was required for safety reasons.
Furthermore, the bill would give Medicare the ability to stay current with medical practice in its coverage of preventive health benefits. The secretary of health and human services would have the discretion to add coverage of new services to prevent or detect illness or disability. Fees for existing preventive services would be eliminated.
The legislation would make these necessary improvements while also expanding the State Children’s Health Insurance Program due to expire in September.
Call your representatives to ask them to support these important improvements to Medicare and the provision of health care coverage to uninsured children. It’s the “Children’s Health and Medicare Protection Act,” House Resolution 3162, and it should be enacted into law. Call the toll-free congressional switchboard at 800-828-0498 and ask to speak to your representatives.
Read stories submitted to the Medicare Private Health Plan Monitoring Project.
Medical Record
“Clearly these [MA insurance] companies need more rigorous oversight and CMS is not prepared or seemingly unable to do the job. With all due respect, I find it highly unlikely, based on our experience during this situation, that CMS will be able to ‘do better,’ as Ms. [Acting Administrator Leslie] Norwalk suggests in a recent press release” (Testimony of Jim Poolman, Insurance Commissioner, State of North Dakota, before the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations on “Predatory Sales Practices in Medicare Advantage,” June 26, 2007).
“So today I ask again, that Congress unencumber me for the unproductive, unnecessary, and dangerous preemptions that expose my citizens to the neglect and abuse I have described and let me do my job. …If government cannot protect our most vulnerable—our children, our frail, our disadvantaged, our elderly—of what use are we?” (Testimony of Kim Holland, Oklahoma State Insurance Commissioner, before the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations on “Predatory Sales Practices in Medicare Advantage,” June 26, 2007).
“I was employed by a large health insurance company to sell Medicare Advantage plans. ... I like to do the right thing for people and I have to go to bed every night knowing that I have done the right thing for people. These plans left me awake nights wondering that very question! It could have been easier to do my job doing what was right for the customer, but the company imposed minimums to sell the MA plans. The things that I heard from VPs of the company were detestable in regards to the profits that were being made off of these products” (Story submitted to the Medicare Private Health Plan Monitoring Project, Medicare Rights Center, June 18, 2007).
* * * *Medicare Part D Appeals Help for Advocates is here!
MRC’s new “Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process” offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
***** MRC’s new “Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process” offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Medicare Part D Appeals Help for Advocates is here! Register for a FREE copy of this great resource.
***** The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a private health plan. With information about what the issues are with Medicare Advantage plans, we will be able to demand that those problems be fixed.
Medicare Private Health Plan Monitoring Project
Submit your story at http://www.medicarerights.org/maplanstories.html.
*****
The Louder Our Voice, the Stronger Our Message Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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