The Center for Medicare Advocacy is warning older Americans that the Medicare bills recently passed by the House and Senate do more than add a prescription drug benefit to Medicare. "Both bills," the Center says, "make substantial changes to the Medicare program, including imposing additional costs on beneficiaries for current Medicare services. Both bills increase reliance on private insurance to provide Medicare services. These changes are so dramatic in scope that, given the inadequacy of the prescription drug benefits proposed, they raise serious questions about the overall merits of both bills."
Following is the Center''s analysis of the Medicare bills'' impact. For more, including an evaluation of the prescription drug benefit in both bills, click here.
- Both bills are designed to force elders and people with disabilities who rely on Medicare into HMOs and other private insurance plans.
- Both bills would increase the cost of traditional Medicare, making the traditional program too expensive for many people. Both dramatically increase the Part B deductible, the House starting immediately and the Senate in 2006. The House bill would make traditional Medicare even more expensive starting in 2010, when the program would have to compete against private plans. Both bills also add co-payments for services for which Medicare currently charges no co-payment.
- Both bills require HMOs and private plans to offer benefits like catastrophic coverage and coordinated care for chronic conditions that will not be available in traditional Medicare. These benefits are crucial for all beneficiaries and should be added to the traditional program as well.
- Both bills increase the reimbursement for HMOs and private plans so that these plans will receive even more funding than traditional Medicare. HMOs are already paid more than Medicare pays on behalf of people in the traditional program. The majority of beneficiaries who prefer the traditional program need assurance that traditional Medicare will be adequately funded.
- Both bills increase the bureaucracy and complexity of Medicare by creating a second government agency to share in the running of the Medicare program. This will result in duplication of effort and the need for coordination of activities, and will cause confusion for beneficiaries who seek assistance.
- Once a beneficiary makes a choice of a plan, the beneficiary will be stuck with the plan. Currently, beneficiaries may enroll in or disenroll from an HMO or other private plan at any time. Both bills will limit the ability of beneficiaries who realize an HMO is not meeting their health care needs to change plans in order to get the required health services. Under the House bill, beneficiaries could only change plans during the annual enrollment period in the fall. The Senate bill phases in this "lock-in" a little more slowly, allowing one change early in the year during the first two years the law is in effect.
- Both bills weaken beneficiary rights. Changes made by these bills to the traditional Medicare appeals process will weaken the ability of beneficiaries to present all of the evidence on their behalf and to be assured of an impartial hearing by an independent administrative law judge.
- Although Congress wants to promote "choices" by beneficiaries, the House bill would allow Medicare to provide less of the information beneficiaries need to make those choices. Currently, Medicare mails to all beneficiaries, in the Medicare & You Handbook sent out in the fall before the annual coordinated enrollment period, information about any HMOs or other plans in their community. The House bill says that Medicare will only have to mail the information required by law "if it is available." Thus, an HMO that plans to increase its co-payments or otherwise changes its benefits may decide not to make that information available until after the Handbook is mailed, meaning that beneficiaries will not know about the changes when they decide which, if any, plan is best for them.
The Center for Medicare Advocacy is a private, non-profit organization that provides education, advocacy, and legal assistance to help elders and people with disabilities obtain necessary healthcare.
Currently, key members of Congress are in conference to reconcile the differences between the House and Senate bills. According to the National Senior Citizens Law Center, due to the vast differences, the bills will not likely be reconciled by mid-September, if at all.