Will Privatization Force Traditional Medicare Out of Business?

[douglas9]

Five or ten years from now, seniors may wake up one morning and discover that their beloved Medicare program has been completely privatized. And it will not be because that’s what seniors want; it will be due to corporate influence and profiteering. Medicare was not created as a private program. In fact, it was enacted in 1965 as federal health insurance for seniors because many private insurers refused to cover them. But over the past three decades, insurance companies and private investors have found a way to capture a growing share of federal Medicare dollars—money that should go toward patient care, not corporate profit.

The most recent sign of this trend: The Trump administration initiated a pilot program called Direct Contracting to improve upon the Accountable Care Organizations (ACOs) first authorized by the Affordable Care Act. ACOs were created to emphasize better care coordination for the purpose of managing chronic conditions rather than treating them episodically. But the problem with the Trump administration’s version of ACOs—Direct Contracting Entities (DCEs)—is that it allowed 75 percent of their governance to be controlled by private insurers and other investor-backed companies. The Biden administration allowed part of this program to continue, but faced blowback from the National Committee to Preserve Social Security and Medicare and progressives concerned about for-profit interests expanding their role in traditional Medicare.

After drawing fire from seniors’ champions on Capitol Hill and in the advocacy community, the Center for Medicare and Medicaid Services (CMS) re-branded the Direct Contracting program as Accountable Care Organization/REACH, changed the governing requirements to require 75 percent provider governance, and removed other objectionable aspects of the model. However, private insurers and other investor-backed entities can still fund traditional and REACH ACOs—and participate as significant minority representatives on their boards. Some investors view these care coordination models as ripe for financial exploitation.

https://www.commondreams.org/views/2022/03/25/will-privatization-force-traditional-medicare-out-business

[Hoyt]

1. Medicare has been direct contracting since Prez Clinton. And, Biden's Admin changed trump's proposal

Does CommonDreams think Biden is trying to scuttle Medicare? I hope not because Biden is not.

[douglas9]

3. Seniors' Medicare Benefits Are Being Privatized Without Consent

The Biden administration is expanding a Trump scheme that is forcing hundreds of thousands of seniors onto for-profit health plans.


The Lever, March 24, 2022

A new Medicare privatization scheme developed under President Donald Trump and now being expanded under President Joe Biden is forcing hundreds of thousands of seniors onto new private Medicare plans without their consent.

The development represents a troubling new dimension in the fight by corporate interests to privatize Medicare, the federal health insurance program for people 65 or older. Medicare Advantage, which allows for-profit health insurers to offer privatized benefits through Medicare, already results in unexpected costs for routine procedures and wrongful denials of care. Private plans have cost Medicare an astonishing $143 billion since 2008, and are now driving some health insurers’ record profits.

The new Direct Contracting Entity (DCE) program similarly adds a private-sector third party between patients and Medicare services. Medicare allows these intermediary companies to offer unique benefits, like gym membership coverage. But as for-profit operations ranging from private insurers to publicly traded companies to private equity firms, these intermediaries are incentivized to limit the care that patients receive, especially when they are very sick.

snip>

Late last month, critics of DCEs say the Biden administration effectively expanded the DCE effort under a new name — the “ACO REACH” program.

The new program — which stands for Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model — allows hospital-led managed care organizations to access the new Medicare privatization scheme, too. ACO REACH similarly assigns patients with little informed consent to for-profit plans that benefit health care profiteers and creates incentives to deny care.


snip>

What then, explains the Biden administration’s recent decision to expand the program?

As always in our campaign finance system, money could play a role. In 2020, the leadership of DCE contractor Clover Health donated $500,000 to the main super PAC for Senate Democrats, while the company’s financier Chamath Palihapitiya donated $750,000 to the same super PAC plus $250,000 to the Biden Victory Fund.

One Medical — which employed Suzanne Gordon’s doctor and owns Iora Health, the company that tried to enroll her in a DCE -— is backed by the Carlyle Group, a prodigious donor to both parties. Biden enjoyed Thanksgiving dinner last year at the $30 million Nantucket home of Carlyle co-founder David Rubenstein.


https://pnhp.org/news/seniors-medicare-benefits-are-being-privatized-without-consent/

[Hoyt]

4. 35% of Medicare beneficiaries voluntarily select Medicare Advantage, mostly because it saves them

$200 to $300 a month in premiums.

Yes, there are legitimate criticisms of Medicare Advantage. There is also criticism of traditional Medicare that saddles beneficiaries with 20% coinsurance and cost of prescription drugs. But, that is not going to change anytime soon, not matter what we all want.

I trust the Biden Admin to do the right thing. His Addmin knows what is going on. CommonDreams and the small PNHP group, I'm not so sure.

[gab13by13]

2. All of those Medicare Advantage commercials

you see on TV are destroying Medicare.

[slightlv]

5. I agree with you 100%!

As one who got "tricked" into a Medicare "Advantage" program (without the rep ever calling it that, of course!), I think one of the sticking points is the way they refer to the "parts" of Medicare and how the insurers can play on that and the requirements for those parts. It's totally confusing, even to those with their wits about them, and totally beyond the reach of those whose faculties are failing them.

Having Medicare split into care parts, and naming them "Part A, "Part B," "Part D" and then here comes the private insurers with "Part C." Under Medicare, if you don't do "X" you won't have "Part Y" and it'll be that way for as long as you're on Medicare. The Insurers play on this. The best thing Bush did for the Private Insurers was name his Medicare Drug Program "Part D". It made a natural gap that people think automatically should be filled. So, the Insurers stepped in and named their programs "Part C." Selling it as though it was the next step of Medicare that should be taken.

I totally had all my wits about me. I'd only been retired for 1 year when I went on Medicare and got hit with this. And even *I* got taken in. In fact, the last thing I told the rep was not to sign me up for anything... that I wasn't through "interviewing" Part C providers, and trying to make sure I didn't sign anything that allowed their coverage. The next day I went to pick up scripts, only to find that all my old cards (Medicare and my DoD insurance agency medical which was still in affect), had been supplemented by Aetna Medicare. Talk about raging hot! I attempted a call to the rep, didn't get him and talked instead to some other very ho-hum individual. I then wrote a scathing email to the actual rep and called everyone I could think of about how to get myself off this crap and back onto Medicare proper. The hoops to jump through to make that a reality turned out to be more than I could handle, as being caregiver for my 82 year old mother and trying to get her into a nursing home at the time, ended up taking all my time and effort. So, in effect, I'm basically screwed.

So, take a word of warning -- anyone who is turning 65 and trying to find out about Medicare. The wolves are out there, just waiting for you.

Edited to Add: I personally think Medicare should make a range of commercials explaining how Medicare works and advertising them on TV, as well. Making sure to Explain the difference(s) between Medicare and Advantage programs, how they impact Medicare, and what one can do if one finds themselves in the situation I did. And then, make it easier to cry "Foul!" and switch back to Medicare.

And do something about the umpteen million scam phone calls that come in from scammers saying, "I'm with Medicare" that come in everyday, 10 times a day or more. I'm ready to strangle those people with my bare hands!

[Skittles]

6. may I ask

were you eventually able to get out of that, and what did you subsequently opt for....thanks

[slightlv]

7. Nope. I'm still with Aetna.

Being the main caregiver for my Mom, and now having to navigate the nursing home issues as well as me the memory person in my marriage is more than I can handle. My stuff all gets pushed to the back, to sometime I'll try to work on it.

The first step in trying to get out is to contact Medicare. But oh.... the phone hold wait times! They let you opt for "we'll call you back" and sometimes they do. But I've had variable luck with that option. I had a hard enough time trying to get my Mom our of her BCBS advantage program. And that happened (I think) because we just quit paying them... period! When all else fails, vote with your pocketbook, right? (LOL)

[halfulglas]

12. Back in the 2000s, was when Advantage, BCBS, etc made their big pitch.

The plans were originally to be in the more rural states to encourage medical groups to move there and set up good comprehensive care for seniors who couldn't get to the cities or suburbs for ongoing care, would pay a little more for this service, but the medical money people took note and decided there was a lot of money to be made from the money saved by consolidation, which really turned out to be insurance gatekeepers. I was not yet retired but noticed some of my relatives bragging about getting "free gym membership, etc." by signing up to BCBS Medicare plan. The old grift, give them something "free" they might use a few times and not use again, but such a value!! In the meantime one of my cousins who worked for BCBS was gleefully telling us she and the other employees were getting $25 bonuses for each person they could get signed up for the plan. They nickel and dime the care and drugs and try to make you feel like they are treating you so well.

When I retired I made sure I researched the supplemental plans. Every year Medicare sends emails telling you about your rights to change, etc., but I noticed the language in the wording of those emails sounds a little bit more like they are encouraging Medicare Advantage, but this may be because in the last 4 years the administrator was a Trump appointee.

[douglas9]

9. How Do You Switch from Medicare Advantage to Original Medicare?

If you’re thinking about changing Medicare plans, you’ll always have the option to switch from Medicare Advantage to Original Medicare and vice versa. However, you may not be able to change your coverage right away. Let’s talk about how and when you can do so.

snip>

The easiest way to move from Medicare Advantage to Original Medicare is during one of two annual periods that allow anyone to leave Medicare Advantage with no questions asked. The second way to leave your Medicare Advantage plan is if you’ve had it for less than one year (that is: you’re entitled to a “trial right”).


https://medicareguide.com/medicare-advantage-to-original-medicare-180767

[Hoyt]

10. Not as anti-Advantage as some. But one problem if you switch is getting affordable Supplemental

coverage.

You have to undergo medical underwriting, meaning if you are really sick -- one reason people change -- you might not be able to get a Supplemental policy. Of course, if you are really bad off, odds are you are eligble for Medicaid to cover what Medicare doesn't.

I was quite happy with Kaiser at one time, but moved to a locality where it was not available. Hence, I have traditional Medicare and pay close to $250 a month for supplemental and drug coverage. If I simply could not afford that $250, I'd probably have to go with an Advantage Plan.

[Rebl2]

8. I was warned

by my rheumatologist not to go on Medicare advantage because they won’t cover some of my expensive medications. I also have insurance through my retired husband’s work. We pay a good portion of it, but they pay some of it. They haven’t threatened to cut us off yet. I turn 65 in a few months and hopefully they wouldn’t wait until the last minute to kick me off.

[c-rational]

13. +1

[appalachiablue]

11. I'll cross post in the SS & Medicare Group. Thanks for posting.