Wed 4/10: Medicare-For-All is now in the Senate! Remind your legislators to sign on to the House version, & that “Medicare Advantage” is an HMO, not a safety net!

Action #1: Call your senators if they aren’t a “YES”. Thank them if they are.

“At least in my view, the current debate over Medicare for All really has nothing to do with health care. It has everything to do with greed and profiteering,” he told a room full of supporters in a Senate office building. – Bernie Sanders

Bernie has finally introduced S.1129 the reworking of his 2017 bill, with improvements in long-term care and disabilities that mirror Pramila Jayapal’s H.R 1384. The bill is still unnumbered.

Explainer: Bernie Sanders’s Medicare-for-all plan, explained. (vox)

Minimal script for senators: I’m calling from [zip code] and I want Senator [____] to know that I voted for [him/her] to put “Medicare For All” on the map, just like Social Security in 1935, and Medicare in 1965.

Minimal script for supporting senators: I’m calling from [zip code] and I want to thank Senator [____] for supporting “Medicare For All”.

Sen-check here. (Harris is a cosponsor, Feinstein is not! CALL her!)

Contact
Senator Feinstein: email, DC (202) 224-3841, LA (310) 914-7300, SF (415) 393-0707, SD (619) 231-9712, Fresno (559) 485-7430
and Senator Harris: email, DC (202) 224-3553, LA (213) 894-5000, SAC (916) 448-2787, Fresno (559) 497-5109, SF (415) 355-9041, SD (619) 239-3884
Who is my representative/senator?: https://whoismyrepresentative.com

Action #2: – Call your Representative if they aren’t a “YES”. Thank them if they are.

Minimal script for reps: I’m calling from [zip code] and I want Rep. [____] to know that I voted for [him/her] to put H.R.1384 – “Medicare For All” on the map, just like Social Security in 1935, and Medicare in 1965.

Rep-check here.

Read about the bill here and here

Read this article in USA Today “Take it from an economist, Medicare for All is the most sensible way to fix health care.“
Read here why “Medicare For All” is better than the six other bills with similar names which all seek to sustain the private insurance market to varying degrees.

Action #3 – Um, you legislators remember that “Medicare Advantage” is private insurance, run by for-profit corporations, right?

You can believe Matt Eyles, President and CEO of American Health Insurance Plans (AHIP) …

Or this…

“Part of the promise of allowing private plans to participate in Medicare was that such plans could provide better quality care at a lower cost. Neither of these propositions, though, appear to have borne out.” (Center for Medicare Advocacy)

That’s why we are surprised to see 368 otherwise rational legislators sign on to a letter in support of Medicare Advantage, a big step towards privatizing Medicare, addressed to the queen of privatization – Seema Verma, Admistrator for the Centers for Medicare and Medicaid Services. Music to her ears, indeed!

Here’s the Senate letter. (No Feinstein or Harris. Yay! Thank them!)
Here’s the House letter. (Carbajal, Brownley and Hill signed! What?)

Minimal script: I’m calling from [zip code] and I’m very concerned with your letter to Seema Verma in support of Medicare Advantage, a private insurance program, which doesn’t serve all patients and routinely overcharges taxpayers. What have you done to support and improve traditional Medicare services, which are cost-effective and available to all Americans who qualify, no matter how sick they are or where they live?

Contact
Rep. Julia Brownley: email, (CA-26): DC (202) 225-5811, Oxnard (805) 379-1779, T.O. (805) 379-1779
or Rep. Salud Carbajal: email. (CA-24): DC (202) 225-3601, SB (805) 730-1710 SLO (805) 546-8348
Senator Feinstein: email, DC (202) 224-3841, LA (310) 914-7300, SF (415) 393-0707, SD (619) 231-9712, Fresno (559) 485-7430
and Senator Harris: email, DC (202) 224-3553, LA (213) 894-5000, SAC (916) 448-2787, Fresno (559) 497-5109, SF (415) 355-9041, SD (619) 239-3884
Who is my representative/senator?: https://whoismyrepresentative.com

Background – Medicare Advantage (MA) vs. traditional Medicare (TM)

The GOP would like nothing better than to privatize all our safety net programs, including Social Security and Medicare. Their 2019 budget included a private Medicare “premium support” system to compete with traditional Medicare, along with creating work requirements for Medicaid, and trimming other welfare programs.

Since the 1970s, Medicare beneficiaries have had the option to receive their benefits through private health plans, mainly HMOs, as an alternative to the federally administered traditional Medicare program. In 2003, Congress created Medicare Advantage (MA), which contracts out selected services to private insurers. Lawmakers expected these insurers to use managed-care principles to reinvigorate the 52-year-old tradidional Medicare program (TM), giving rise to better health care at a lower cost to taxpayers. This is an integral part of the GOP myth that private markets are best at bringing costs down through competition. Maybe for widgets, but as James Kwak explains, when talking about people’s health care, they automatically create morally monstrous outcomes — rationing insurance by price, gouging the sick and the uninsured. That is why ObamaCare had to have so many regulations.

The MA program was supposed to save taxpayers money by allowing insurers to offer older Americans private alternatives to Medicare. Although satisfaction is high among relatively healthy enrollees, the promised “savings” aren’t happening. In fact, these corporations are overcharging taxpayers for their services, along with having us pay for their administrative and marketing expenses. These simple graphics from the NY Times make us wonder what our legislators were thinking.

We pay MA insurers a predetermined amount for each person they enroll in Medicare Advantage, rather than paying doctors and hospitals a fee for every service provided, like TM. And to keep the insurers from enrolling only healthy people, our government agreed to pay them more for unhealthy enrollees based on a complex “risk scoring” formula, which opened the door to gaming the system by exaggerating the expected health care costs. UnitedHealth Group was sued for overbilling us by $3 billion dollars in 2017, and in 2019, this unethical company is still providing services to Medicare enrollees.

Even leaving out the big cheaters, according to the Medicare Payment Advisory Commission (MedPAC), “after accounting for all coding adjustments, payments to MA plans were about 4 percent higher than Medicare payments would have been if MA enrollees had been treated in [traditional] Medicare.” MA uses some of this money to offer benefits not covered by traditional Medicare, such as some vision, hearing and dental coverage (which TM could do too if it had 4% more funding), but steps aside for the following:

when enrollees, who usually signed up as active, healthy seniors, start to get really sick
when potential patients live in rural areas, such as one of the 147 counties, across 14 states that have no Medicare Advantage insurer this year.
when patients have certain serious illnesses like End-Stage Renal Disease. They won’t be able to sign up for MA until 2021.
when patients need more care. MA beneficiaries discharged from a hospital are much more likely to be sent home rather than to an acute care facility than TM beneficiaries.
when patients need more specialized care. MA and TM beneficiaries are going to primary care physicians at about the same rate, but TM beneficiaries get to see specialists at a much higher rate.

A recent article in the Journal of the American Medical Association (JAMA), noted that “some studies show that MA has higher quality in certain dimensions, such as higher rates of preventive care and screenings among recipients” but, on the other hand, other studies “suggest that it does not serve certain beneficiaries well, such as those with greater illness severity.”

Our government is favoring MA over TM, even beyond those ridiculous letters our legislators signed. This bias towards the MA program not only costs Medicare more, but disadvantages the majority of Medicare beneficiaries who access their coverage through the traditional program, through choice or necessity. The MA program already has several built-in advantages over TM, which could be rectified by our legislators if they choose to do so. These advantages include:

an out-of-pocket cap, absent from traditional Medicare;
a requirement to accept almost all Medicare beneficiaries on an annual basis, as compared to federally-mandated enrollment rights regarding Medigap supplemental insurance plans based on age minimums.
the ability to waive the 3-day prior hospital stay requirement for coverage in a skilled nursing facility.
expansion of access to telehealth services available to enrollees of MA plans, including offering such services as a basic benefit.
expansion of supplemental benefits coverage that MA could provide for individuals with chronic conditions as long as there’s a reasonable expectation of improving or maintaining the health or overall function
allowing MA plans 3 months for a continuous open enrollment, which favors MA enrollment over TM by giving enrollees more flexibility to make changes to their coverage.
an unequal playing ground, like legislation that prohibits people eligible for TM on or after January 1, 2020 from purchasing a Medigap policy that covers the Part B deductible (sometimes referred to as policies that offer “first dollar coverage” as part of the Medicare & CHIP Reauthorization Act.

MA is not a magic pill. Instead of democratizing healthcare for our older citizens, MA creates another pay-to-play system, leaving the poorest and the sickest behind, as the private insurance industry embeds itself into our Medicare safety net. Their involvement should have continual and aggressive oversight to ensure that the health and safety of enrollees is protected and that our Medicare funds are being used wisely, but we now have an administration allergic to oversight or regulations of any kind. And when it gets large enough, we won’t be able to control it, any more than we are able to control the costs of life-saving drugs like insulin, when large drug companies decide on maximum profits.

We already pay enough in taxes to fund a Medicare-for-all program, that could have all the bells and whistles the MA plans offer back to us with our own tax dollars. We need to shed the complicated plans and rules that put TM at a disadvantage to MA. Remember, ultimately, this is the motto that Matt Eyles, President and CEO of American Health Insurance Plan (AHIP) and all their members adhere to. Not comforting at all.