New Data on CHIPRA, Medical Malpractice, Childhood Obesity Laws, HCBS, State Budgets, and More

Statehealthfacts.org has recently added new and updated data on Demographics & the Economy, Health Status, Medicaid & CHIP, Medicare, Providers & Service Use, Minority Health, HIV/AIDS, and Health Reform. You can also view a list of all recent updates.

Demographics & the Economy

• State Fiscal Distress
  Measures of aggregate state rankings in foreclosures, unemployment, and food stamp participation have been updated with the latest information from RealtyTrac, the United States Department of Agriculture (USDA), and the Bureau of Labor Statistics (BLS). Updated data on states with projected budget shortfalls for state fiscal year (SFY) 2012 have been added from the Center on Budget and Policy Priorities (CBPP).
• State Budgets
  The latest state-by-state information from the National Association of State Budget Officers (NASBO) on total state expenditures, per capita state spending, and the distribution of general fund spending is available for SFY2009.
  
• State or Federal Inmates
  Updated data from the Bureau of Justice Statistics on the number of adult prisoners under state jurisdiction, adult prisoners by gender, and the incarceration rate per 100,000 population have been added for all states and the nation for 2009.
• Union Employees
  Information on the number of workers represented by unions has been updated for 2010 based on data from the BLS.
• Cigarette Excise Tax
  The most recent data from the American Lung Association on state cigarette excise taxes are available for 2010.

Health Status

• Childhood Obesity and Firearm Safety
  The latest data on state laws addressing childhood obesity and states with firearm laws designed to protect children are now available for 2010 from the American Academy of Pediatrics’ State Legislation Report.
• Public Place Smoking Bans
  Updated information on states with public place smoking bans has been added for all states from the American Nonsmokers’ Rights Foundation for 2011.
  

Medicaid & CHIP

• Medicaid and CHIP Eligibility
  New data from the Kaiser Commission on Medicaid and the Uninsured (KCMU) and the Georgetown University Center for Children and Families on CHIP program type and children’s upper income eligibility limit for Medicaid/CHIP have been added as of January 2011.
• Co-Payments and Premiums for Children in Medicaid/CHIP
  Also new from KCMU and Georgetown University is information on premium and co-payment amounts and requirements as of January 2011.
  
• Children’s Health Insurance Program Reauthorization Act (CHIPRA)
  New data on state adoption of coverage and enrollment options in CHIPRA have been added for all states and the nation as of January 2011 from KCMU and Georgetown University. Also new are data on CHIPRA performance bonus awards for FY2009 and FY2010 from InsureKidsNow.gov.
• Home and Community-Based Services (HCBS)
  Updated data from KCMU and University of California at San Francisco analysis of CMS Form 372 are now available for all states and the nation for 2007. Updated topics include total HCBS waivers, expenditures by waiver type, aged/disabled participants, home health participants, and personal care expenditures.
• State Medicaid Spending
  The latest information from NASBO on the distribution of state Medicaid spending has been added for all states and the nation for SFY2009.

Medicare

• Medicare Drug Benefit
  The latest data on Medicare beneficiaries with prescription drug coverage and low-income subsidy eligible beneficiaries with Medicare prescription drug coverage have been added from the Centers for Medicare and Medicare Services (CMS) as of February 2010.
• Medicare Prescription Drug Plans (PDPs)
  Updated data from Mathematica Policy Research and Kaiser Family Foundation (KFF) analysis of the CMS Prescription Drug Landscape File on the number of Medicare PDPs, PDPs with no deductible, and PDPs with no coverage in the benefit gap are available for all states and the nation for 2011.
  
• Medicare Advantage
  Data on the number of Medicare Advantage contracts and Medicare special needs plan (SNP) offerings have been updated for 2011 from KFF analysis of CMS Landscape Source files.
• Medicare Service Use
  The most recent information on Medicare service use, including short-stay hospitals, skilled nursing facilities, and home health services, has been added from CMS for 2009.

Providers & Service Use

• Medical Malpractice
  Updated data from KFF analysis of the National Practitioner Data Bank Public Use Data File on the number of paid medical malpractice claims, total dollars in paid claims, and average claims payments are now available for all states and the nation for 2009. 
• Medical School Graduates
  The latest information on the number of medical school graduates and medical school graduates by gender has been added from the Association of American Medical Colleges for 2010. Data from 2002 through 2010 are available for trend analysis.
  

Minority Health

• Medical School Graduates
  Also updated from the Association of American Medical Colleges are state-by-state data on medical school graduates by race/ethnicity and Hispanic ethnicity.

HIV/AIDS

• Syringe Exchange Programs
  The most recent information from the North American Syringe Exchange Network on states with sterile syringe exchange programs has been added for 2011.

Health Reform

• Federal Lawsuit
  Updated information on states that have joined the federal lawsuit against the Affordable Care Act is now available from the National Council of State Legislatures for 2011.

Statehealthfacts.org is a Kaiser Family Foundation website.

U.S. GAO - Medicare Advantage: Comparison of Plan Bids to Fee-for-Service Spending by Plan and Market Characteristics

GAO-11-247R February 4, 2011
Full Report (PDF, 36 pages) Accessible Text

Summary

While most of Medicare's 46 million beneficiaries are covered by the traditional fee-for-service (FFS) program, about one in four beneficiaries receives benefits through private health plans under the Medicare Advantage (MA) program. Under the FFS program, Medicare pays health care providers for each covered service they furnish. While Medicare sets the price it pays, the volume of services--and, as a consequence, total spending--remains largely uncontrolled. In contrast, MA plans have more control over both the price they pay to providers and the quantity of services they deliver. As of September 2010, more than 11 million beneficiaries were enrolled in approximately 3,900 MA plans sponsored by 181 parent MA organizations (MAO). MAOs generally offer beneficiaries one or more plans to choose from--with different coverage, premiums, and cost sharing features--in the areas they serve. Also, MA plans may provide additional benefits not offered under FFS Medicare, such as reduced cost sharing or vision and dental coverage. Medicare pays plans a fixed amount per enrolled beneficiary monthly. In 2010, Medicare payments to MA plans totaled an estimated $115 billion. In June of each year, MA plans submit bids to the Centers for Medicare & Medicaid Services (CMS)--the agency that administers the Medicare program--prior to the start of the contract year that begins January 1. To assist plans in preparing their bids, CMS publishes projections of FFS spending by county. Plans' bids consist of their projected revenue requirements (including profit) for providing standard Medicare services to an average enrollee (risk- adjusted for differences in health status) in its service area. The bids also include county-level projections of enrollment and average beneficiary risk scores. Comparisons of plan bids to projected FFS spending indicate the extent to which MA revenue requirements are less or greater than spending for the same services under traditional Medicare. The payment to each plan is determined by the bid and a benchmark--the maximum amount Medicare will pay in each county within the plan's service area. The relationship of the bid to the benchmark determines whether the plan's enrollees pay additional premiums or receive additional benefits. If a plan's bid is higher than the benchmark, Medicare pays the plan its benchmark and enrollees pay the remainder in their monthly premium. If the bid is lower than the benchmark, the plan receives its bid and a portion of the difference as a rebate, which must be used to reduce premiums, reduce cost sharing, or provide extra coverage. However, because the benchmarks are generally greater than spending in FFS, even plans that bid below FFS spending levels in their service areas are paid above FFS spending amounts. Congress asked us to examine the relationship between MA plan bids and service area spending. In this report, we assessed:

(1) how MA plan bids compare to FFS spending in their service areas overall and by plan type, FFS spending level, and payment benchmarks;

(2) the association between the level of MAO market concentration and plan bids relative to FFS spending in their service areas; and

(3) how the components of MA plan bids compare by plan and market characteristics.

Complete Summary

Effort To Reward Medicare Advantage Plans Draws Criticism - Kaiser Health News

By Julie Appleby

Lake Wobegon has come to Medicare – and a key advisory panel doesn't like it.

The panel, the Medicare Payment Advisory Commission (MedPac), in a Jan. 6 letter does not mention the fictional Lake Wobegon, where all the children are above average. But it hints that not every Medicare Advantage insurer deserves to be above average.

The letter, to Dr. Donald Berwick, who heads the agency overseeing Medicare, criticizes a move to extend quality bonus payments meant for top-performing health insurers to those with lower scores. In fact, the new bonus program will reward even those plans highlighted on Medicare's own website as being poor performers over three consecutive years, according to the letter signed by MedPac Chairman Glenn Hackbarth.

The effort by the Centers for Medicare and Medicaid Services (CMS) will likely result in "far greater program costs" than the reward system called for by Congress in the health law and reduces insurers' incentive to achieve high performance, the letter concludes.

Full Article

New Disenrollment Period Offers Some Medicare Consumers One More Chance To Change Their Health Coverage

-- Consumers Should Carefully Review Their Options Before Making a Change --

New York, NY—Medicare consumers who are enrolled in Medicare private health plans, commonly known as Medicare Advantage plans, and who become dissatisfied with their choice, can disenroll during the Medicare Advantage Disenrollment Period (MADP), which runs from January 1 to February 14. Consumers who disenroll from their private plan can switch only to Original Medicare—the traditional Medicare program administered by the federal government. Most people who switch to Original Medicare can also change their Medicare prescription drug coverage. The MADP replaces the Open Enrollment Period, which ran from January 1 to March 31 in past years.

“People with Medicare who become unhappy with their Medicare Advantage plan have one more opportunity to change their coverage before being locked in until next fall,” said Joe Baker, president of the Medicare Rights Center. “Because the window is shorter than in past years, consumers should review their coverage options carefully and consider all of the implications of making a change before doing so.”

What are my options during the Medicare Advantage Disenrollment Period? If you have: A Medicare Advantage private health plan with prescription drug coverage, you can switch to Original Medicare plus a prescription drug plan OR Original Medicare without a prescription drug plan A Medicare Advantage Private Fee-For-Service (PFFS) plan that does not include prescription drug coverage and a stand-alone prescription drug plan, you can switch to Original Medicare, but you must keep your current prescription drug plan Original Medicare or Original Medicare and a prescription drug plan, you cannot make any changes during this time

Although Original Medicare covers most necessary services and is accepted by most doctors and facilities across the country, it does not cover the full cost of care. Many consumers who enroll in Original Medicare choose to purchase supplemental coverage to help pay for out-of-pocket costs such as deductibles and coinsurance.

However, people who disenroll from their Medicare private health plan may have limited ability to buy supplemental coverage. State laws vary on when consumers can purchase Medicare supplemental policies, also known as Medigaps. Call your State Health Insurance Assistance Program (SHIP) to find out if and when you can enroll in a Medigap plan in your state. You can find the number for your local SHIP by visiting www.shiptalk.org or calling 800-MEDICARE.

Consumers who disenroll from their private plan should be aware that they may need to join a stand-alone Medicare prescription drug plan in order to maintain drug coverage. Medicare Rights advises consumers who are choosing a plan to consider not only premium and copayment costs, but also whether the drugs they take are on the plan’s formulary (list of covered drugs). Consumers should also check to see whether the plan places any restrictions on the drugs they take. Restrictions can take the form of quantity limits, prior authorization, and step therapy. To learn more about choosing a Medicare prescription drug plan that best meets your needs, visit Medicare Interactive.

Medicare Rights advises consumers who wish to change their health coverage to do so by calling 800-MEDICARE rather than their plan. If you need to keep or add Medicare prescription drug coverage, it is best to make your coverage change by enrolling in a stand-alone drug plan. When you enroll in a drug plan, you will automatically be enrolled in Original Medicare. Changes made during the MADP are effective the first of the following month.

Learn more about changing your Medicare private health plan on Medicare Interactive.

Resources

• Find the number for your local State Health Insurance Assistance Program (SHIP) at www.shiptalk.org.
• 800-MEDICARE
• Medicare Interactive (www.medicareinteractive.org), the Medicare Rights Center’s free web-based counseling tool, can help you evaluate your coverage options.

Changes Wrought By Health Reform? Well, Maybe Not - Kaiser Health News

By Jonathan Cohn, Senior Editor of The New Republic

During the past few weeks, employers, insurers, and providers of medical care have frequently made news by talking about how reform might change the way they do business. Each time, critics of the Affordable Care Act have insisted it was bad news. Each time, the true story has been a lot more complicated.

Maybe the obfuscation is unintentional. Health care policy is pretty complicated, after all. So, for the sake of my friends at Fox News and anybody who might be listening to them, here are three basic questions to ask every time you hear a story about changes the Affordable Care Act is unleashing:

1) Is something actually changing?

2) Is the change related to the Affordable Care Act?
3) Is the change really for the worse?
Full Article

Ask Ms. Medicare: How Does Medigap Differ From Medicare Advantage Insurance Plans? - AARP Bulletin

by: Patricia Barry  from: AARP Bulletin

There are very big differences between these two types of insurance, although both are options for people with Medicare. Technically, only medigap counts as "Medicare supplemental insurance"—in fact, that's its formal name—but Medicare Advantage plans may provide some extra benefits that could be considered as supplementing Medicare.

Full Article

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TIME GOES BY | GRAY MATTERS: Republicans and the Health Care Reform Law

by Saul Friedman

Nobody likes a sore loser. But congressional Republicans, who have not yet come to terms with the election of Barack Obama, cannot get over the passage, with not a single one of their votes, of the health insurance reforms called the Patient Protection and Affordable Care Act.

Thus the Republicans plan to campaign this summer to repeal the law, which they call unpopular. They have not read the latest polls which say otherwise.

The Wall Street Journal poll found that 55 percent want the reforms to have a chance to work. A Vanity Fair poll found that 42 percent would keep all the provisions. That may be why the Republicans won’t say, specifically, which provision should be repealed.

If they did, they would have to support denying insurance coverage to children with pre-existing conditions like asthma or diabetes which is outlawed by the reforms. Or perhaps the Republicans would force middle-class parents to buy separate policies for their adult children; the reforms would cover them until age 26.

How about getting rid of the provisions lowering the Part D cost of drugs, gradually closing the infamous doughnut hole or paying for cancer-preventive screenings?

Or maybe the Republicans simply don’t want coverage that will be available at low cost for the 40 million men, women and children who have no insurance.

More than a dozen state Republican attorneys general have taken a different tack – a fool’s errand, paid for by taxpayers, which pleads that the courts to stop the reforms and declare unconstitutional the provision mandating that all of us purchase insurance (with and without help from the government), the better to create a healthy risk pool.

I don’t have a clue how Republican-dominated courts may rule, but chances are the mandate will stand for each state similarly requires drivers to buy insurance. State laws regulating real estate also require the purchase of homeowners insurance. Becoming eligible for Social Security generally means automatically becoming a beneficiary for Medicare Part A, and Medicare sets a stiff penalty if beneficiaries do not sign up for Part B or Part D when they are first eligible and have no equivalent coverage.

The latest whine of the sore loser is the Republican criticism of the perfectly straight-forward brochure from Health and Human Services (HHS) Secretary Kathleen Sibelius, explaining the admittedly complicated, many-faceted law, which will take years to have full effect. Republicans call it “propaganda” as if their flacks never heard of such a thing.

Her biggest boo-boo, according to the Republicans, was her defense of the law’s reduction of the slush fund for Medicare Advantage plans which George W. Bush gave us as part of the GOP effort to privatize Medicare. Said Sebelius:

“Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare...The new law levels the plying field by gradually eliminating Medicare overpayments to insurance companies.”

More important, she added, “If you are in a Medicare Advantage plan you will still receive guaranteed Medicare benefits.”

That has not been the case with MA insurers for in April, the Government Accountability Office reported that in 43 percent of MA plans, more than half the beneficiaries were in the “average or poor health group,” meaning they did not receive the best of care.

The reforms will hold all private insurers to a higher stand, mandating that 85 percent of premium income be spent on care. Perhaps the Republicans would repeal that provision.

Here is an example of how ridiculous the sore loser can get. In Britain, the heavy use of alcohol poses a serious health problem for the nation and its National Health Service. As a result, Britain’s National Institute for Health and Clinical Excellence (NICE), which produces guidance on public health, suggested the nation’s doctors question and screen patients on their use of alcohol, the better to understand and treat their health problems and their addiction.

It sounds reasonable. But according to Don McCanne of Physicians for a National Health Plan, America’s Health Insurance Plans (AHIP), a leader in the resistance to the American health reforms, picked on Britain’s socialized health program and blasted NICE for requiring doctors “to invade the privacy of every one of their patients by submitting them to a questionnaire on alcohol use.”

There is no such requirement, but McCanne says AHIP is simply doing its conservative Republican thing, defending the “waste of the superfluous insurance industry” in order to discredit any health reform as “socialist.” I guess we should call this the “booze panel” scare.

Putting aside such silliness, it would be worth understanding how HHS intends to enforce the laws, something advocates have worried about because insurance companies have signaled their intent to poke holes in the reforms. Thus, according to Kaiser Health News, the administration has appointed four watchdogs, with plenty of experience dealing critically with insurance companies.

The new director of the Office of Consumer Information and Insurance Oversight is Jay Angoff, a former Missouri commissioner. They’ll be watching for unseemly premium increases, denials and cancellations of coverage and fraudulent sales pitches.

Finally, there is good news for Medicare Advantage, as well as original Medicare beneficiaries who can get eaten alive by deductibles, co-payments and other out-of-pocket costs. The reforms included changes for the better, including lower costs, in the 10 standard Medigap plans that are now offered in most, but not all states.
The plans with increasing benefits range from A, the most basic; B,C,D, and F, the most popular; G, which is similar to F; and K, L, M and N. You can check them out at the Medicare website.

Depending on the level of coverage one needs and can afford, these plans are designed to fill the gaps in Medicare by paying co-insurance, co-payments, some deductibles and even needed blood transfusions and ambulance service.

Medigap plans cover you throughout the nation and some plans include travel and overseas coverage. With such a policy, many beneficiaries pay virtually nothing towards the cost of their care. And Medicare plus Medigap can end up costing less than Medicare Advantage, which does not have a great record when you’re really sick.

Write to saulfriedman@comcast.net

TIME GOES BY | GRAY MATTERS: Republicans and the Health Care Reform Law

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Senators Concerned About Medicare Advantage Bids; New Rule for E-Prescribing from MedPage Today

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By Emily P. Walker, Washington Correspondent, MedPage Today

A group of Democratic Congressmembers wrote to Health and Human Services Secretary Kathleen Sebelius last week urging her to closely review Medicare Advantage plan bids for 2011.

Insurance companies that run Medicare Advantage plans have until June 7 to submit their bids to the Centers for Medicare and Medicaid Services (CMS).

Insurance companies should justify any proposed increased in premiums or benefits for seniors in the plans, the group -- Sens. Max Baucus (D-Mont.) and Jay Rockefeller (D-W. Va.), along with Reps. Sander Levin (D-Mich.), Pete Stark (D-Calif.), Henry Waxman (D-Calif.) and Frank Pallone (D-N.J) -- said in the letter.

"Health care reform strengthened Medicare and made Medicare Advantage more competitive, but it is critical that we don't let private insurance companies use these changes as an excuse to raise premiums or cut benefits for seniors to bolster their own bottom line," Sen. Baucus said in a statement accompanying the letter's release.
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Off the Charts Blog | Q & A with Paul Van de Water on How the Health Reform Law Reduces the Deficit

Paul, the Congressional Budget Office says that health reform will reduce the deficit by $143 billion dollars over the next ten years. That’s a lot of money. What are some ways that the federal government will save money?

There are four major sources of savings. First, reducing overpayments to Medicare Advantage plans. Second, lowering some Medicare payment rates. Third, cutting Medicaid prescription drug costs, and, fourth, reducing payments to hospitals for treating uninsured patients.

Let’s start with Medicare Advantage.

Sure. One quarter of Medicare beneficiaries get their health coverage through private insurance companies in a program called Medicare Advantage. Medicare pays those private insurance companies about 13 percent more per beneficiary than it would spend on the same beneficiary in traditional Medicare. The health reform law scales back these overpayments.

You mentioned reducing some Medicare payment rates in your second point. Which rates would be cut and why?

Each year, Medicare increases the amount that it pays hospitals, nursing facilities, and other providers to account for inflation and other factors that increase the cost of providing care. But, Medicare doesn’t consistently factor in productivity improvements that actually reduce providers’ costs. The health reform law scales back annual payment increases to account for increased productivity.

Your third point was Medicaid prescription drug costs. How does the health reform law reduce them?

To participate in Medicaid, drug companies must pay rebates to the federal and state governments for drugs that are prescribed to beneficiaries. The health reform law will increase these rebates. This will save money by ensuring that Medicaid programs don’t pay more than private purchasers for the same drugs.

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Health Care Reform Provisions Affecting Older Adults

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The Gerontological Society of America has prepared a summary of health care reform provisions affecting Older Adults contained in the U.S. House of Representatives' Patient Protection and Affordable Care Act (H.R. 3590), which President Barack Obama signed into law on Tuesday, March 23. This comprehensive health care reform bill previously was passed by the Senate on December 24, 2009, and contains a number of provisions which affect older adults. Read the GSA Summary

BENEFICIARIES REMAIN VULNERABLE TO SALES AGENTS’ MARKETING OF MEDICARE ADVANTAGE PLANS

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The Centers for Medicare & Medicaid Services (CMS) contracts with private companies, known as plan sponsors, to provide health insurance plans under MA. Plan sponsors may market their MA plans through independent sales agents, who may market on their own or through a field marketing organization (FMO), or by employing their own sales agents.

Between June 2007 and June 2008, Congress held three hearings examining sales agents’ marketing of MA plans. During these hearings, witnesses testified that sales agents had marketed without licenses, portrayed themselves as Medicare employees, and misled Medicare beneficiaries about plan benefits. These types of aggressive, deceptive, and fraudulent marketing practices could result in Medicare beneficiaries enrolling in plans that do not meet their health care needs. Several members of Congress raised concerns about sales agents’ marketing to Medicare beneficiaries to the Office of Inspector General (OIG); one specifically requested that OIG examine the marketing practices of MA plans.

In July 2008, Congress enacted the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which prohibited or limited certain marketing activities by sales agents and plan sponsors. In September 2008, CMS published regulations implementing the MIPPA’s marketing provisions, including limiting sales agent compensation to independent sales agents. In addition, CMS regulations required that all sales agents be trained and tested annually and be State licensed. To examine selected MA plan sponsors’ compensation of sales agents and determine whether the selected plan sponsors ensured that their sales agents were qualified, we reviewed compensation, testing, and licensure data for a random sample of sales agents. We purposively selected the plan sponsors based on their size and the rate of marketing complaints they received. We also compared complaints regarding sales agent marketing reported to CMS from 2008 and 2009 to determine whether the number and topics of Medicare beneficiaries’ complaints changed after implementation of the sales agent marketing regulations.

FINDINGS
*All five plan sponsors using independent sales agents had compensation practices that resulted in inappropriate financial incentives.
*Five of the six selected plan sponsors did not ensure that all sales agents were qualified under CMS’s regulations.
*The number and topics of sales agent marketing complaints remained unchanged after implementation of sales agent marketing regulations. Read More/Download Report

Medicare private plans may see more regulation :: American Medical News

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The Centers for Medicare & Medicaid Services issued a proposed rule Oct. 9 that seeks to improve the performance of Medicare prescription drug and health plans.

The changes to Medicare Advantage and Part D would clarify program requirements for the more than 4,000 plan offerings and improve protections for beneficiaries enrolled in these plans, CMS said. Officials said the agency is seeking to improve the overall performance of the programs to ensure that beneficiaries have the best choices available when making decisions about their coverage.
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The Health Care Blog: Why AHIP needs the public option

By Matthew Holt

It’s been a fun week. After years of THCB explaining that neither could AHIP do genuine research nor could its venerable President open her mouth without lying, the rest of the world has caught on. I won’t rehash the blow by blow here—Jonathan Cohn is among many who’s done that already—but essentially AHIP commissioned PWC to include the half of the analysis about the Baucus bill that was favorable to them and leave the rest out. And the fall from grace has been particularly fun to watch. Even the whores from PWC who wrote the report criticizing the bill have been backing away from it. And some astute commentators think that the debacle has helped the likelihood of a more liberal bill’s passage.

Now to be fair (or overly fair as they’d never concede this to the other side), the insurers have a point. They loaded Baucus up with lots of cash and put a former Wellpoint exec in as his chief of staff. They romanced the White House and kept quiet when Pelosi and the rabble criticized them. The deal they thought they’d cut was that they would give up the way they currently make money by underwriting and risk skimming in individual-small group and being overpaid for Medicare Advantage, and in return they’d get 45 million more customers, all forced to buy insurance and subsidized by the government to do so.

But somehow along the way the Democrats, despite lots of tough talk about “bending the curve,” lost the cojones to find even a mere $100 billion a year to redistribute from the probably $1 trillion waste in our $2.5 trillion health care system.
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This Week's Mediscare | The New Republic

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by Jonathan Cohn

The Republican grandstanding on Medicare during Finance Committee hearings this week hasn't been surprising, I suppose. But the audacity is still pretty breathtaking.

As you may have heard or read by now, the Republicans are angry over proposed cuts to Medicare Advantage, the private insurance alternative to traditional Medicare. The insurers who offer Medicare Advantage plans receive a flat fee for every senior that signs up. But virtually every independent expert who has studied the program has concluded that those fees are way too high--that, in effect, the government is getting a lousy deal. So when Democrats, including those drawing up the Finance bill, were looking for revenue to finance expansions of health insurance coverage, they figured that getting rid of those subsidies was a smart idea, particularly since it would generate more than $100 billion over ten years.

The danger of these cuts is that, without the promise of those fat subsidies, some private insurers may decide to pull out of the business altogether. It happened once before, back in the late 1990s, when the Clinton Administration pushed through reductions to Medicare-plus-choice, the predecessor to Medicare Advantage. (It was basically the same program under a different name.)

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Updated Chartpack Details Supplemental and Prescription Drug Coverage Among Medicare Beneficiaries

The Kaiser Family Foundation has issued an updated chartpack presenting sources of supplemental and prescription drug coverage among Medicare beneficiaries in 2007, the most recent year for which national data are available. The majority of people on Medicare have some source of supplemental coverage that helps to pay Medicare’s cost-sharing requirements and for some services not covered by the program. Employer plans are the primary source of supplemental coverage; other sources include individually-purchased Medigap policies, Medicaid for those with low incomes, and Medicare Advantage plans. Since 2006, beneficiaries have also had access to a prescription drug benefit offered through Medicare Part D plans. The chartpack looks at variations in supplemental and prescription drug coverage by income, race/ethnicity, age, urban/rural location, and health status. It also examines characteristics of Medicare beneficiaries with low incomes who are not enrolled in a Part D plan or receiving Part D low-income subsidies. Prepared by Kaiser Family Foundation researchers, the chartpack is based on analysis of the 2007 Medicare Current Beneficiary Survey. Link to Chartpack

Paying Medicare Advantage by Competitive Bidding: How Much Competition Is There? - The Commonwealth Fund

New Report by Brian Biles, M.D., M.P.H., Jonah Pozen, and Stuart Guterman finds private health plans that enroll Medicare beneficiaries—known as Medicare Advantage (MA) plans—are being paid $11 billion more in 2009 than it would cost to cover these beneficiaries in regular fee-for-service Medicare. To generate Medicare savings for offsetting the costs of health reform, the Obama Administration has proposed eliminating these extra payments to private insurers and instituting a competitive bidding system that pays MA plans based on the bids they submit. This study examines the concentration of enrollment among MA plans and the degree to which firms offering MA plans actually face competition. The results show that in the large majority of U.S. counties, MA plan enrollment is highly concentrated in a small number of firms. Given the relative lack of competition in many markets as well as the potential impact on traditional Medicare, the authors call for careful consideration of a new system for setting MA Read More Download Issue Brief