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For those of us HD readers who have warned against the problems in using Medicare Advanatge (MA), you may want to read an op-ed published in the The Hill on Sunday. Former Republican Rep. Jim Greenwood of Pennsylvania, who helped write the Medicare Modernization Act that created Medicare Advantage, stated directly: “The program no longer lives up to [its] promise.”
Greenwood once believed private competition would drive innovation and efficiency. But today, he says, MA has been overtaken by “a handful of massive insurers who are gaming the rules for profit.” Overpayments, cherry-picking, and risk-score manipulation are now “endemic.” “It pains me to say this, but the system we helped create is being abused. And it’s not just hurting taxpayers. It’s hurting patients.” “Seniors… are too often finding out — at the worst possible time — that their plan won’t cover what they need.”
While Greenwood still believes there is a place for private-sector involvement in Medicare, he now calls for rigorous oversight, transparency, and enforcement. He also warns against insurers’ predictable scare tactics whenever reform is on the table.
According to Wikipedia “Greenwood announced in the midst of the 2004 congressional election that he would not seek re-election and retire. He had already won the 8th district’s Republican primary, and his abrupt withdrawal raised many questions . . . After serving six terms in Congress, Greenwood was appointed president and CEO of the Biotechnology Innovation Organization (BIO), a biotechnology trade association based in Washington, DC.”
I’m no fan of Medicare Advantage but some 22 years later, Mr. Greenwood suddenly admits “the program no longer lives up to that promise,” but still believes “that private-sector participation can play a meaningful role in Medicare.”
Pardon me if I find his doe-eyed mea culpa a little late and a little weak. He’s working an angle and I’d prefer it if everyone would just stop wasting my time by propagating his copy.
And what course of action do Greenwood and other MA critics recommend for MA plan members?
Prepare to pay higher premiums?
That’s correct. Under a fair playing field MA is not sustainable at current premium and benefit levels.
In my state, a hospital group that includes about half the hospitals in the area finally just “gave up” in trying to negotiate with UHC (United Health Care) due to the low reimbursement and ridiculous pre-authorizations (“need a bandaid? you’ll have to get the MA (Medicare Advantage) plan to authorize that, that could take a while”) and dropped MA altogether. Hmmm….
So, perhaps there is some hope for real change when the providers stop providing. Yes it is unfair to the MA plan members who are caught in the middle, but it should be a clear warning to anyone else considering an MA plan.
Another reason I chose Medigap. Both university medical systems in my area have come within days of dropping UnitedHealth MA plans recently. Super stressful for people potentially affected.
“Greenwood…. calls for rigorous oversight, transparency, and enforcement.” Medicare Advantage (Medicare Part C) was established by the Balanced Budget Act of 1997. That’s basically 28 years with inadequate oversite. What does Congress really do besides pass bills that poorly spend taxpayer money?
Oversight is not their strong suit
Isn’t most of the ACA basically a Medicare Advantage plan?
I think a key difference is that Medicare Advantage insurers get paid based on the health status and expected healthcare costs of enrollees whereas in the ACA, the insurers bear that risk. This has enabled the insurers to game the system.
The proper level subsidy for MA plans is the key and may well shift more risk to Medigap plans. MA was supposed to save Medicare money. It doesn’t.
ACA plan premium subsidies distort the real cost to participants and affects the incentive to control costs. Watch what happens if the extra subsidies are removed.
What I have read is the premium subsidies are based on how poor the health of the insured is. What the MA insurers are doing is coding (risk scoring) the insured as sicker than they actually are so the insurance company gets a larger subsidy. It’s flat out fraud.
Not if. When. There is virtually zero chance they get renewed.
Nor could it ever.
As I have mentioned more than once. Giving people choice especially among different types of plans, when it comes to health care does not work. Sooner or later adverse selection and cost shifting will happen and somebody will be disadvantaged.
People will always act in their own interest and that means an effort to use a plan most advantageous to them when they need it most.
Health care premiums like any insurance relies on a mix of high, moderate and low or non users. Everyone can’t be a winner all the time.
Maybe some day if we ever get serious about reasonable coverage for every American, we will adopt a universal insurance plan with all 340 million of us in the same risk pool.
Until then, you pays your money and takes your chance.
How right you are!
Hmm the corporate interests and their well paid lobbyists were looking to pull a fast one….who would ever have suspected that?
Glad that he has seen some light, but it’s a pity he still wants private sector involvement.
Nothing wrong with private sector involvement if done right.
Medicare has its own problems. It is subject to fraud because it does very limited concurrent review of claims, and virtually no pre certification relying on a few weak checks for limited services and retroactive review which means fraud can go on for a long time before detection. .
Over the years several audits by government auditors have pointed this out. Nothing much changed but if it did doctors and patients would be screaming.
I used to ask each doctor’s office we visited which coverage was the easiest to deal with. In every case the answer was Medicare. The reason? No questions asked.
There needs to be some campaign finance reform before there is any improvement to Medicare Advantage plans and their ability to function as they were intended.