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Trump Administration Releases Vague Medicare Executive Order

Last week, the Trump Administration released a wide-ranging yet ambiguous Executive Order (EO) focused on the Medicare program.

Many of the EO provisions lack specifics, making it difficult to predict what, if any, policies or recommendations may emerge. Since any policies that do emerge would likely require legislative or regulatory action before taking effect, the EO’s prospects for impacting the program are also unknown.

Though details are scarce, the proposals that do allow more insight are often troubling. For example, the EO seems to support a return to “private contracting” in Medicare. Before current protections were in place, far too many people with Medicare were unable to afford care because their providers were permitted to charge amounts far above Medicare’s payment. Congress put a stop to this practice in the 1980s and prohibited providers who accept Medicare from charging beneficiaries more than the Medicare-allowed cost sharing. Private contracting would once again permit providers to charge whatever they wish, violating the Medicare guarantee and leaving many beneficiaries behind.

In addition, we are concerned that a consistent theme of the EO appears to be the promotion of Medicare Advantage plans. In part, the EO directs federal agencies to ensure that “[Original] Medicare is not advantaged or promoted over [Medicare Advantage] with respect to its administration.” From Medicare Rights’ perspective, this directive appears to be a solution in search of a problem. In our experience, it is often the other way around: recent federal agency decisions—in particular from the Centers for Medicare & Medicaid Services (CMS)—seem to favor Medicare Advantage.

Over the past few years, we have observed and sought corrections to CMS tools and communications that inaccurately describe Medicare Advantage in ways that could mislead beneficiaries. While the agency has occasionally fixed such errors, many remain.

This has been a worrisome trend. Medicare coverage decisions are complex and often overwhelming, even under the best of circumstances. On our National Consumer Helpline, we frequently hear from people who are confused about their enrollment options or the process itself. Beneficiaries need to be able to trust that the federal government’s enrollment tools, resources, and communications are free from bias and inaccuracy.

Accordingly, we encourage CMS to empower all people with Medicare to select the best coverage for their unique circumstances, including by remaining a neutral source of trustworthy information and by working to improve existing beneficiary outreach and education strategies.

We also urge CMS to level the playing field between Medicare Advantage and Original Medicare. While many beneficiaries are enrolled in Medicare Advantage plans, an even larger number are not. Nearly two-thirds of all people with Medicare, or approximately 40 million people, are in Original Medicare. They must not be left behind or disadvantaged by agency actions that benefit only those in Medicare Advantage plans, or that steer them into coverage that is not the best fit for them. CMS must ensure that all beneficiaries have access to the services they need to build and maintain their health—regardless of the coverage pathway they choose.

As more becomes known about how the EO might translate into actionable policy proposals, Medicare Rights will work to ensure that proposals are only advanced in ways that will improve health care and prescription drug coverage for all people with Medicare, whether they are in a Medicare Advantage plan or Original Medicare. Any future implementation efforts must promote informed choices, strengthen beneficiary decision-making, and expand benefits and care innovations across the Medicare program. To that end, we will strongly oppose any agency actions that would jeopardize beneficiary health and economic security—including by increasing costs, reducing access, or otherwise creating barriers to care.

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