Together, Medicare, Medicaid, and the Affordable Care Act (ACA) build health security for Americans of all ages. Any changes to these vital programs must aim for healthier people, better care, and smarter spending—not paying more for less. As policymakers debate the future of health care, Medicare Rights will provide ongoing updates and information. Watch this space!
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Our series of issue briefs below cover aspects of the debates surrounding health care and Medicare, including the ways the Affordable Care Act interacts with and supports the Medicare program. Additional briefs cover the impact of various suggested changes to Medicare, including privatization through premium support or vouchers, raising the eligibility age, and changes to bans on private contracting or balance billing.
Strong & Built to Last
This brief gives a quick summary of Medicare’s strength, popularity, and status as a bulwark against unaffordable, low-quality health care. Highlights of the brief include facts about people with Medicare, the program’s financial future, and stories from the Medicare Rights national helpline.
“Means testing” the Medicare program is making higher income people pay more or get less by raising premiums or cutting benefits for people above a certain income level. Such proposals not only threaten to undermine the Medicare guarantee but also fail to recognize that older adults with higher incomes already pay more for Medicare during their working lives and/or after retirement.
Some lawmakers support increasing the Medicare eligibility age from 65 to 67. This costly benefit cut is sometimes defended by arguing that as Americans live longer and delay retirement, most people will not need Medicare at age 65. But most Americans retire well before age 67—half of all men are retired by age 64 and half of all women by age 62.
Some policymakers endorse proposals to give
Medicare providers the right to charge seniors and
people with disabilities more for their care through
balance billing or private contracting. Balance billing would allow doctors to bill
whatever they choose.
Today, physicians may choose to privately contract with their Medicare patients, though very few do. Under such arrangements, providers can charge any amount they deem appropriate, rather than be bound by Medicare’s set fees and billing limits, so long as the patients agree. Some policymakers support broadening the conditions under which providers can privately contract with people with Medicare for the price of their services.
Currently, all people with Medicare are entitled to the same set of basic benefits. Some policymakers support replacing Medicare’s defined benefit package with a fixed-dollar amount (often called a voucher) that beneficiaries would use to purchase health coverage through a private plan or Original Medicare. Converting Medicare to such a system, known as premium support, raises a number of beneficiary-related concerns.
For more than 25 years, the State Health Insurance Assistance Program (SHIP) has helped Medicare beneficiaries, their families, and caregivers navigate Medicare’s complex coverage rules and enrollment processes. The individualized assistance provided by SHIPs has nearly tripled over the past 10 years, and with 10,000 people reaching Medicare eligibility age each day, demand is likely only to grow.
Protect and Strengthen:
Medicare and Medicaid
For decades, Medicare and Medicaid have served as building blocks for health care and well-being for older adults and people with disabilities. The programs, with some overlap, serve different populations, provide different benefits, have different structures, and often face different political obstacles.
Some policymakers support efforts to fundamentally restructure and severely cut Medicaid, including by transforming the program from a guaranteed benefit to a per capita cap or block grant system. Block grants and per capita caps are both designed to produce large federal savings over time by shrinking federal funding for state Medicaid programs.
Under current law, the federal government matches state Medicaid spending based on a statutory formula, without a pre-set limit. If state spending increases, for example due to increased enrollment or unexpectedly high program costs, then federal spending increases as well. This open-ended financing structure allows federal funds to flow to states based on actual costs and needs as economic and other circumstances change.
Protect and Strengthen
Medicaid 1115 Waivers
Section 1115 waivers are statutorily required to promote the key objective of the Medicaid program: to furnish medical assistance to low-income individuals. Troublingly, in recent years CMS has approved state waivers that condition eligibility on compliance with burdensome employment and administrative requirements or otherwise restrict Medicaid coverage—seemingly in conflict with the program’s aim.
The Affordable Care Act (ACA) strengthened Medicare and Medicaid and created important coverage
avenues and consumer protections for people of all ages. Despite these successes, the health law remains
under attack in Congress, the states, and the courts.