The Center's work on 'Medicare' Issues


MedPAC: Medicare Advantage Overpayments Not the Right Way to Aid Low-Income Beneficiaries

July 8, 2014 at 1:41 pm

Overpaying the insurance companies that serve some Medicare beneficiaries through the Medicare Advantage (MA) program is not a targeted, effective way to help low-income beneficiaries with their out-of-pocket costs, the Medicare Payment Advisory Commission’s (MedPAC) latest report to Congress explains.

Insurers have long defended the overpayments as helping low-income beneficiaries and have claimed that repealing or scaling back health reform’s MA savings is necessary to protect such beneficiaries from benefit cuts.  But as we’ve explained, recent research shows that before health reform, insurers didn’t pass on most of the overpayments to enrollees in the form of better benefits.  And MedPAC’s report reiterates its longstanding position that higher MA “payments are not a direct or efficient way to target assistance to low-income beneficiaries.”

That’s because, as MedPAC puts it, “higher MA payments and extra benefits financed by those payments do not go only to low-income beneficiaries.  Rather, all enrollees in a given MA plan receive the same extra benefits, low-income or not.”  Insurers’ own data show that 59 percent of MA enrollees had incomes over $20,000 in 2011.

The Government Accountability Office similarly concluded in 2008 that “if the policy objective is to subsidize health care costs of low-income Medicare beneficiaries, it may be more efficient to directly target subsidies to a defined low-income population than to subsidize premiums and cost-sharing for all [Medicare Advantage] beneficiaries, including those who are well off.”

A direct and efficient way to help Medicare beneficiaries with limited incomes, according to MedPAC, is to expand the Medicare Savings Programs, through which Medicaid helps low-income beneficiaries cover their premiums and/or cost-sharing charges.

Emerging Trade Agreement Would Make Drugs Less Affordable

May 6, 2014 at 10:19 am

The Trans-Pacific Partnership (TPP) — a trade agreement that the United States and 11 other Pacific-rim countries are negotiating — threatens to make prescription drugs less affordable for consumers and taxpayers.  CBPP recently joined with ten other organizations, including AARP and Consumers Union, to express our concerns to the Office of the U.S. Trade Representative.

Our concerns fall into three main areas.

First, the draft TPP would restrict Medicare’s ability to limit the prices it pays for drugs for Part B beneficiaries.  The recent release of Medicare physician payment data has vividly illustrated the large sums spent on Part B drugs, such as Lucentis, a macular degeneration treatment that costs $2,000 per monthly injection.  The TPP could allow drug companies to challenge existing Part B payment policies that hold down costs and foreclose some future cost-containment steps, such as discouraging the use of new drugs that are costlier but no more effective than existing alternatives.

Second, the draft TPP would raise health care costs further by expanding patent protections for drugs and medical devices.  Drug companies use various strategies — such as making small changes in their products — to extend their patents and fend off competition from generic drugs.  The TPP could limit efforts to combat these “evergreening” strategies.  It would also make it easier for companies to obtain patents for therapeutic and diagnostic techniques that now aren’t patentable.

Third, the draft TPP would give companies a new legal avenue to challenge U.S. pricing and patent policies for drugs and medical devices:  the ability to sue the U.S. government before an international arbitration panel that wouldn’t be subject to normal democratic checks and balances.  Under a similar provision of the North American Free Trade Agreement, for example, the drug company Eli Lilly is suing the Government of Canada for $500 million because Canadian courts invalidated patents for two drugs that didn’t meet Canada’s legal standards.

Click here for the full text of our letter.

Flawed Analysis Exaggerates How Health Reform’s Medicare Advantage Savings Will Affect Enrollees

April 24, 2014 at 10:56 am

Insurers and others who oppose the health reform provisions that scale back Medicare Advantage overpayments often imply that the payment reductions will mean a dollar-for-dollar benefit cut for Medicare Advantage enrollees.  That’s exactly what the American Action Forum (AAF) did last week when it issued a flawed analysis substantially overstating health reform’s impact on Medicare Advantage enrollees.

But as we have previously explained, recent research challenges this claim, finding that before health reform, most of the Medicare Advantage overpayments were not passed through to enrollees.  Insurers thus can still provide additional benefits to attract enrollees if they trim profits and become more efficient.

Moreover, by curbing overpayments to Medicare Advantage plans, the Affordable Care Act lowers premiums for all Medicare beneficiaries and extends the solvency of Medicare’s trust fund.

Ryan’s Medicare Proposals: the Latest

April 9, 2014 at 4:42 pm

House Budget Committee Chairman Paul Ryan’s Medicare proposals — summarized in a new CBPP analysis — have evolved since Ryan issued his Roadmap for America’s Future in 2010, but much is still the same in the budget plan he released last week.

The centerpiece of Ryan’s Medicare plan remains premium support — replacing Medicare’s guarantee of health coverage with a flat payment, or voucher, that beneficiaries would use to purchase coverage.  But the details have changed significantly over the years.

  • Ryan now retains a form of traditional fee-for-service Medicare as an option.  His earliest proposals would have phased out traditional Medicare, which would have substantially increased health care costs, since traditional Medicare has lower administrative expenses and payment rates than private insurance plans.
  • Ryan now bases the amount of the premium-support payment on a weighted average of bids by private plans and traditional Medicare.  In last year’s proposal, the payment would have been set below the average bid.
  • Ryan no longer mentions a limit on the annual growth of the premium-support voucher, as did his previous proposals.

Even with these modifications, Ryan’s premium-support proposal would disadvantage beneficiaries in at least two ways.  First, in many regions, traditional Medicare would cost more than the premium-support voucher, and, in these regions, beneficiaries who chose to enroll in traditional Medicare would have to pay higher premiums than under current law.  Second, beneficiaries who enrolled in a private plan would not receive the federally subsidized supplemental benefits that enrollees in private Medicare Advantage plans receive under current law.

Moreover, premium support could cause traditional Medicare to unravel — not because it was less efficient than the private plans, but because it was competing on an unlevel playing field in which private plans captured the healthier beneficiaries and incurred lower costs as a consequence.

The Ryan budget again proposes to raise Medicare’s eligibility age — now 65 — by two months per year, starting in 2024, until it reaches age 67 in 2035.   (Ryan’s Roadmap proposed raising the eligibility age to 69½.)  At the same time, the plan would repeal health reform’s coverage provisions.  Consequently, 65- and 66-year-olds would have neither Medicare nor access to health insurance marketplaces in which they could buy coverage at an affordable price and receive subsidies to help them secure coverage if their incomes are low.  Many would end up uninsured.

Finally, the Ryan budget includes other Medicare proposals from past years — increases in income-tested premiums, a cap on medical malpractice awards, and repeal of the benefit improvements in health reform (including closure of the prescription drug “donut hole”) — as well as a new proposal to increase Medicare cost sharing.  For more details, see our new paper.

Medicare Advantage Overpayments Help Insurers More Than Beneficiaries

April 9, 2014 at 2:29 pm

I noted yesterday that health reform scales back overpayments to private Medicare Advantage plans, thereby lowering premiums for all Medicare beneficiaries and extending the solvency of Medicare’s trust fund.  Insurers, arguing that curbing the overpayments results in direct benefit cuts for enrollees, often imply that they have used the overpayments solely to provide increased benefits.  But findings from a recent National Bureau of Economic Research study challenge this argument.

The study examined certain urban counties in which Medicare Advantage plans received substantial overpayments in the four years before health reform started phasing down the overpayments in 2012.  Here’s what it found:

  • The results of the study suggest that the “additional plan reimbursement for plans in [the counties studied] does not translate into more generous benefits for Medicare Advantage recipients.”
  • Most of the overpayments are not passed through to enrollees: the higher reimbursement “is not accompanied by significant differences in premiums, out-of-pocket costs, or rebates.”
  • The study finds no evidence of improved quality of care as a result of the overpayments.
  • The study suggests that insurers retain about one-fifth of the overpayments as higher profits.   They also use the overpayments to boost advertising spending in order to promote further enrollment in Medicare Advantage.

Despite insurers’ “doom and gloom” warnings that health reform will devastate the program by scaling back the overpayments, Medicare Advantage continues to thrive.  Insurers can still provide additional benefits to attract enrollees by trimming profits and becoming more efficient.

That’s likely why the Congressional Budget Office expects Medicare Advantage enrollment to continue to grow through 2019 and why Wall Street analysts also still have a “positive long-term view of Medicare Advantage.”