The Argument Over Medicare Advantage, Explained

Republicans are livid at the suggestion that their demand for unspecified spending cuts, which they’ve laid out as a condition for raising the nation’s debt ceiling, means that they are actually trying to gouge Medicare Social Security.

You could clearly see it last week during the State of the Union Address, when President Joe Biden spoke out about the fact that many Republicans have called for the removal of the two entitlement programmes. Multiple Republicans shouted at Biden, calling him a liar ― an accusation These statements have been repeatedly repeated in many opinion articles and speeches as well as interviews, both past and present.

The debate has been a topic of particular interest to me. Medicare Because I am a health insurance provider. I haven’t seen any polling on the question of Medicare cuts specifically, so I can’t say definitely whether these Republican protestations are playing well with the public.

But my hunch is that they are not, given the intensity of the GOP reaction ― and a new argument they are trying out now. They are saying that it’s the Democrats who are trying to cut MedicareIt is the Republicans, not you.

It started out as a talking point among GOP officials, and now it’s become the focus of advertisements that the National Republican Senate Committee has launched against Democrats. (You can see one here if you’d like.)

The GOP argument may sound a bit more complex than it actually is. “I’m rubber, you’re glue; whatever you say bounces off me and sticks to you,” then you’re not the only one.

And if you’re skeptical of their claim, you have good reason to be.

The Argument Republicans make is really about Medicare Seniors can opt for Advantage Plans, which is a private policy that seniors can select instead of traditional government programs.

You can choose one of the plans and the federal government will reimburse the insurer that manages it. The The insurer will then cover your medical costs.

There will be plenty of people to share your company with!

Private versions of this version Medicare While plans have existed for decades, their popularity really took root in the late 2000s. More than 28 million Americans were in Medicare About half of all the benefits plans are covered by Advantage Plans Medicare population. Projections The number of people affected by the crisis is expected to continue rising.

It’s a big transformation and significant victory for conservatives, who have long championed private alternatives to government health insurance ― or any government programs, for that matter.

The The federal government adjusts its payments to insurers constantly, based upon financial performance analysis. Over This type of analysis has been repeated over the years. evidence The government is paying too muchGiven the benefits that these plans provide for their beneficiaries, it is quite surprising.

A reason could be the well-documented problem with “upcoding,” which is basically insurers using the payment system to get extra money This’s supposed to compensate them when they take on beneficiaries in worse health. And though there’s (some) evidence that Medicare Advantage plans are better than traditional Medicare when it comes to supporting preventative care, there’s also evidence ― well-documented in this New York Times article ― that they deny essential care more frequently.

Changes Medicare Advantage payments come from the Department of Health and Human Services, which today is under the Biden administration’s management. The administration announced that in January it would make a series adjustments to ensure that the plan will receive an average 1% increase for each patient by 2024.

We now reach the first major dispute.

An organization called Better Medicare Alliance The independent actuarial firm has been commissioned to perform its own analysis AvalereAccording to, the reduction in payment would be 2.27%.

“We’re confident that this proposal does result in unprecedented cuts to Medicare Advantage for seniors and those with disabilities,” Mary Beth Donahue is the Alliance’s president.

Don’t worry, readers, I am not about to litigate that dispute here. It’s a highly technical argument involving benchmarks, risk scores and (have your eyes glazed over yet?) Regional adjustments.

Here’s what I can tell you.

Avalere has many highly-respected employees and analysts. This also included contract work for the alliance’s members CVS/Aetna/Humana and UnitedHealth. These three largest sellers are among the most prominent. Medicare Advantage plans. Just half of all the market’s sales are made by UnitedHealth or Humana.

(Donahue confirmed that more than half of the alliance’s funding comes from insurance plans.)

Whether the administration’s proposed changes would work out to a 1% increase, a 2.27% decrease or something in between, there’s a separate question of whether those changes lead to changes in benefits. The alliance says they will ― that if the insurers get less money, they’re bound to cut back on the benefits the plans offer.

It would mean that some extra benefits will be cut in practice. Medicare Benefit plans like dental or routine vision coverage are a better option than traditional Medicare doesn’t cover. These are the benefits that make it so special. Medicare Advantage is attractive in the beginning.

“These policy changes add up to an average of $540 in new costs for beneficiaries next year,” Donahue quoted a figure in the Avalere analysis. “That is very, very dramatic.”

But many experts are skeptical that plans would cut back substantially on benefits ― or cut back at all.

“There’s not a lot of evidence to suggest that lower payments to MA will necessarily result in lower benefits to beneficiaries or to higher premiums,” Richard Kronick, an economist at the University of California, San Diego, and one of the nation’s leading experts on Medicare Advantage was told to me

He is in line with the conclusions of a new brief The following is a link to the topic: KFFCalifornia-based, non-profit analysis and research organization that focuses on health care. KFF’s brief notes that past experience Also, recent analyses from nonpartisan sources Medicare Payment Advisory Commission According to MedPac, plans respond well when overhead is reduced or profit margins are decreased.

To be precise, there are many profits they can reduce. Medicare For health insurance companies, advantage is the highest-profitable line of business.

“My read of the evidence is that reductions in payments to Medicare Advantage plans are largely borne by the plans themselves, either through lower profits or cost reductions,” Matthew Fiedler, a senior fellow at the University of Southern California’s Brookings Schaeffer Initiative for Health Policy, told Politifact This week.

Kronick, Fiedler and others served in the Obama government. Not all experts were so skeptical. Joseph AntosPolitifact was told by a conservative-leaning economist from the American Enterprise Institute that he believed the benefits would be reduced. But even he didn’t say they’d be drastic.

These kinds of debates are not only common in the area of health care policy, but also elsewhere. The federal government is constantly battling with industries over the amount of money that they should be receiving to provide various services.

The routine appeals of health insurance companies this year coincide with the desperate attempts of GOP leaders and others to minimize (or divert attention away from) the actions of Republicans such as Sen. Rick Scott (R.Fla.) House Republican Study Committee Calling to request cuts Medicare.

The Many conservative intellectuals agree with the GOP argument that any reduction in federal government sendings will result in a decrease. Medicare It is a “cut.” This could lead to lower payments Medicare Advantage: Using government negotiation power to decrease what, Medicare The principle of paying drug companies to pay is basically the same as raising eligibility (as Scott recommended) or requiring the program receive new authorization from Congress every five years (as Scott suggested).

But there’s a difference in the two approaches. Democrats propose a different approach to managing the program, which does not alter the fundamental commitment of seniors and disabled people. “I don’t think these are equivalent changes at all,” Kronick stated.

University of Southern California economist Paul Ginsburg Had a similar view, telling Politifact that the Biden administration’s proposed payment changes are about “running the program better and more efficiently to protect the integrity of the federal funds being used for it.”

Whether that distinction matters to the public, obviously, is a separate question ― and one that depends on how the debate plays out in the coming weeks. White House press secretary Karine Jean-Pierre got a question about the topic at Friday’s briefing, not long after Scott clarified that his call to put federal programs up for regular re-authorization every five years did not include Medicare.

This statement could be taken as an indication that Scott truly believes. Medicare the only way to know that it is holy and that he knew this all along. Or you can take it as a sign that he senses the political vulnerability of his position ― and that the rest of his party does, too.