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Posts Tagged 'medicare advantage'

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Powerful new Ads target Obamacare Repeal

The Alliance for Healthcare security, of which the National Committee is a member, has released the latest in a series of tv spots opposing repeal of the Affordable Care Act.  Watch the new ad here.  It's worth the 30 seconds of your time.  

This latest one is probably the most powerful of the series, which began airing in December.  The opening narration pulls no punches. "Congress has taken the first step to rip apart our healthcare with no plan to replace it," says the announcer.  The bulk of the ad features actual health care professionals in blue scrubs and white coats talking right into the camera about why repeal is such a bad idea.

"They don't have a plan to insure the 30 million people who will lose their healthcare," says Theresa, a registered nurse.  "No plan to cure existing conditions, like cancer," says Michelle, another RN, while a third nurse states simply, "It's gonna cause pain."

The tagline is:  "Tell Congress we need a plan that protects our care."

The ad is elegant, clean, and effective.  Pressure from advocacy groups and negative media coverage of the repeal efforts on Capitol Hill seem to be having an impact.  As the Associated Press reported today, some Congressional Republicans are starting to back away from repeal and talking more about what sounds like "repair," which is something even President Obama and Democrats had always said they would welcome. The Associated Press describes "a softer tone that comes as [the GOP's] march to fulfill a keystone campaign promise encounters disunity, drooping momentum and uneasy voters."

Last week, Congressional Republicans seemed like they were on a tear to repeal - ramrodding through a budget resolution that would defund Obamacare with the promise of a replacement bill soon after.  Not anymore, apparently.  

"Republicans triumphantly shoved a budget through Congress three weeks ago that gave committees until Jan. 27 to write bills dismantling the law and substituting a Republican plan. Everyone knew that deadline meant little, but now leaders are talking about moving initial legislation by early spring." - Associated Press

Seniors, especially, have a lot at stake in any repeal and replacement because of the Affordable Care Act's improvements to Medicare - including free preventative screenings and wellness exams, the closing of the Medicare Part D prescription drug "donut hole," and the extended solvency that the ACA provided to the Medicare Part A trust fund.  

Let's hope that this continued ad campaign by the Alliance for Healthcare Security, and the voices of organizations like ours along with pressure from the public will convince the GOP that outright repeal without a replacement that protects the healthcare of all Americans is a really unhealthy choice.  



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Vast Majority of Private Medicare Advantage Plans Overcharged the Government

New analysis by the Center for Public Integrity of Medicare Advantage audits show that 35 of the 37 companies audited by the Centers for Medicare & Medicaid Services (CMS) overcharged the government by millions of dollars each year. By “upcoding” claims, insurance companies report patients as being sicker than they are and thus collect higher payments from Medicare. 

By overstating the severity of medical conditions like diabetes and depression, extra payments are made to health plans which claimed some diabetic patients also had complications of the disease, such as eye or kidney problems. After the CMS audits, these claims were ultimately reduced or invalidated in nearly half the cases, sometimes more.  This CPI report isn’t the first time private insurers in Medicare Advantage have come under fire. In May, a Government Accountability Office report called for “fundamental improvements” to curb excess charges linked to faulty risk scores.  In addition, at least half a dozen health-industry insiders have filed whistleblower lawsuits that accuse Medicare Advantage insurers of manipulating risk scores to boost profits.

CPI also found: 

Auditors on average could confirm just 60 percent of more than 20,000 medical conditions plans were paid to treat. The confirmation rates were much lower for some conditions, such as diabetes with serious complications, depression and some forms of cancer.

Overpayments triggered by unsupported medical diagnoses at the 37 plans audited topped $10,000 per patient for more than 150 patients. The health plans overcharged the government by $2,000 or more for at least 3,500 people in the 2007 sample group.

The health plans overall were three times as likely to charge Medicare too much as too little for some of the 70 medical conditions examined as part of the audits.

None of the plans faced closer scrutiny following the audits, no matter the size of the overpayment. The 2007 audits, which collected a total of $12 million in overpayments, are the only ones CMS has completed since officials adopted risk scores in 2004 at the behest of Congress. In some cases, health plans are still appealing the results, nine years later.  

17 million seniors are enrolled in Medicare Advantage and in 2014, Medicare paid the health plans more than $160 billion. The Center for Public Integrity reported that overspending tied to inflated risk scores has cost taxpayers tens of billions of dollars in recent years.

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New Report Shows Ethnic Discrepancies in Medicare Advantage

For the first time, the Centers for Medicare and Medicaid Services has released data on the racial disparities reported by Medicare Advantage patients. 

Despite advances in healthcare access, increases in spending, and improvements in quality over the last decade, there is well-documented evidence that members of racial and ethnic minority groups continue to experience worse health outcomes, CMS said.

The data in disparity of care for eight patient experience measures shows that in seven areas, Asians and Pacific Islanders rated their experience in scores worse than that of whites, compared to five areas for Hispanics, three areas for blacks and only two areas for American Indians and Alaska natives...Healthcare Finance News

The CMS report surveyed customer service responses in a variety of categories. In categories of how easy it is to get needed care; getting needed prescription drugs; and getting information from their health plan about prescription drugs, whites gave the highest ratings, according to the survey.

In a question of getting appointments and care quickly; getting customer service from a health plan; and care coordination, American Indians/Alaska natives gave the highest scores. Blacks gave the highest score when asked how well doctors communicate with them. Asians and Pacific Islanders gave the highest score in a question of getting an annual flu vaccine.

"These data are a good first step in understanding disparities in Medicare Advantage," said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. "We look forward to working with plans in closing the differences in the quality of care that people with Medicare Advantage receive." 

Achieving Health Equity will also be the topic of a Congressional forum later this week, hosted by House Energy and Commerce Committee Democrats in partnership with the Congressional Black Caucus (CBC), Congressional Hispanic Caucus (CHC), and Congressional Asian Pacific American Caucus (CAPAC). 

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GOP Plans for Medicare? All Slash No Strengthen

The House Ways & Means Subcommittee on Health held a hearing entitled "Preserving and Strengthening Medicare."  Unfortunately, as the ranking member Rep. Jim McDermott (D-WA) made clear, this hearing actually had virtually nothing to do with preserving and strengthening Medicare:

“This is the first Health Subcommittee hearing of the year, and it could have been an opportunity to have a fresh, constructive conversation about Medicare. Unfortunately, this won’t be the case. It looks like we should expect more of the same from my Republican colleagues this morning – bad ideas repeated incessantly in the hope that the American people eventually fall for them.

The core proposal that my Republican colleagues have offered – to end Medicare as we know it – will have devastating effects on seniors. It will shift costs onto beneficiaries, create more losers than winners, and lead to a death spiral in traditional Medicare.

We all know this.”

NCPSSM President/CEO, Max Richtman, submitted testimony to the Committee and reacted to the day’s proceedings:

“Unfortunately, today’s Congressional hearing on ‘Preserving and Strengthening Medicare’ offered no new ideas and was instead an Orwellian political exercise in which politicians say preserve when they actually mean privatize, and strengthen when they mean slash. 

Republicans in the House envision a future in which millions of seniors will lose their guaranteed Medicare benefits in favor of a privatized CouponCare system in which they receive a government coupon to try and buy private insurance. Millions of seniors in Medicaid will lose their benefits due to block-granting to states without providing the resources to pay for it.  The repeal of the Affordable Care Act will leave tens of millions without insurance and strip benefits from seniors in Medicare.  

The Republican leadership has offered no plans to improve benefits in Medicare or make reforms to reign in the skyrocketing price of drugs and healthcare costs system wide.  Instead, the GOP vision for seniors in Medicare is they must just do more with less. Stagnant wages are grinding away at the middle class’s ability to save for retirement.  Many employers have significantly scaled back or eliminated the traditional retirement benefits offered to their employees.  As a result, current and future retirees simply cannot afford proposals to cut benefits, raise the eligibility age or privatize the program.”...Max Richtman, NCPSSM President/CEO

While the House Ways and Means Health Subcommittee promoted destroying traditional Medicare in favor of a fully privatized system during today’s Congressional hearing, their GOP colleagues are moving a budget through Congress that would make that plan reality.

The House budget would cut Social Security and Medicare by $463 billion over 10 years, while cutting Medicaid and other health programs by $1.028 trillion, not including the Affordable Care Act.  The GOP budget protects the wealthiest Americans and big corporations from any tax increases while imposing massive spending cuts on average Americans and their families.

Max Richtman’s full testimony as submitted to the House Ways and Means Health Subcommittee is here.  

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CMS Caves to Political Pressure from the Insurance Industry, Again

The Centers for Medicare & Medicaid Services (CMS) has quietly scrapped a policy that required private Medicare Advantage insurance companies facing sanctions to face a reduction in the star ratings consumers use when picking their private health insurance plans.  Unbelievably, CMS (caving to political pressure from the insurance lobby) will allow sanctioned companies to keep their violations hidden from consumers by protecting their star ratings.  Modern Healthcare reports:

The move, which was quietly released by the CMS in a memo (PDF) and shocked many in the industry, will immediately protect hundreds of millions of dollars at Cigna Corp., which had its Medicare Advantage plans sanctioned in January.

“It does seem pretty unusual to make this kind of dramatic change in a memo,” said Tom Kornfield, a vice president at consulting firm Avalere Health and former CMS official. “It sort of comes out of nowhere.”

Richard Lieberman, a Medicare Advantage data consultant at Mile High Healthcare Analytics, said the CMS' decision could be characterized as “a huge gift or even corporate welfare” even though it could help insurers that quickly resolve problems.

“CMS' actions definitely send a mixed message to plans,” he said.

Clearly, there are huge financial rewards for the insurance industry if companies are allowed to violate CMS’ rules and seniors are left in the dark about a company’s sanctions.  CMS is allowing companies like Cigna which has been found guilty of “egregious instances of noncompliance,” including blocking the appeals process for its customers, to continue to reap the rewards of government subsidized bonuses and over payments.

“Star ratings carry clinical and financial impact. The CMS ties bonus payments to Medicare Advantage plans that have at least four stars. Highly rated plans that get sanctioned and thereby lose their high ratings stand to lose millions of dollars in extra payments. But the goal is motivate more insurers to improve their Medicare Advantage operations.” Modern Healthcare

It’s impossible to imagine how -- in this political environment where cutting Medicare benefits has become the “go-to” solution for Members of Congress who claim we can’t afford the program – allowing the nation’s multi-billion dollar insurance industry to keep taxpayer funded bonuses while they are violating federal standards is acceptable policy. 

This decision didn’t happen in a vacuum.  If follows another political cave by CMS last month when it bowed to industry lobbying pressure and decided to raise reimbursement rates for insurance companies rather than trimming back the billions of federal overpayments as required in the Affordable Care Act.  Wall Street and the insurance industry loved the news that taxpayers will continue to overpay Medicare Advantage plans.  They’ll surely love it now that these massive companies will keep their taxpayer-funded overpayments while not being held accountable to serving the seniors who’ve signed up for medical coverage, blissfully unaware that anything is amiss. 

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