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Rep. Mark Pocan, D-Wis. (Photo: House)

Life Health > Health Insurance > Medicare Planning

House Democrat Aims to Rename 'Medicare Advantage'

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What You Need to Know

  • Mark Pocan and Ro Khanna say Medicare Advantage plans restrict enrollee access to necessary care.
  • A Medicare Advantage coalition says survey results show 98% of plan enrollees like their coverage.
  • Medicare program managers have a little satisfaction data of their own.

Rep. Mark Pocan wants to strip the “Medicare” name away from the Medicare Advantage program.

The Wisconsin Democrat — who is fighting for a shift to a fully government-run health finance system — introduced H.R. 9187 last week.

Pocan hopes to change the name of the program to the “Alternative Private Health Plan.” The bill would impose a fine of $100,000 for each instance of an insurer or other issuer advertising a plan with the name “Medicare” in the plan title, according to a version of the text posted on Pocan’s House website.

The Medicare Advantage program gives private health insurers a chance to sell policies that look to the consumer like an alternative to Original Medicare.

Pocan filed his bill five days before the Better Medicare Alliance, an organization for Medicare Advantage program supporters, was set to start its 2022 Medicare Advantage Summit. The two-day conference starts Tuesday in Washington.

What It Means

The Medicare Advantage program may now look as if it has strong bipartisan backing, including support from a 63-senator coalition in the Senate and a 346-representative coalition in the House.

But the Medicare Advantage program still faces opposition from critics who believe it leads to too much or too little government involvement in health finance.

Brokers and agents need to watch Washington carefully to understand how clients’ health coverage might change, and when.

The History

Congress created Medicare — the federal health insurance program for the elderly — by adding Title XVIII to the Social Security Act in 1965.

In 1972, Congress extended Medicare coverage to many people with Social Security Disability Insurance and to people who are getting kidney dialysis or kidney transplants.

The “Original Medicare” Medicare Part A inpatient hospitalization program and Medicare Part B physician and outpatient services program include complicated rules for deductibles, copayments and coinsurance amounts.

Private companies called “Medicare administrative contractors” run the Original Medicare programs. The MACs are affiliates of companies such as Blue Cross Blue Shield of South Carolina and Blue Cross Blue Shield of North Dakota.

Enrollees can use Medicare supplement insurance policies to fill in the gaps in Original Medicare, without appearing to replace the Original Medicare coverage, or they can buy Medicare Advantage plans.

Health insurers have been offering Medicare supplement insurance policies — also known as Medigap policies — since the 1980s. Congress created the current regulatory framework for Medigap policies in the Omnibus Budget Reconciliation Act of 1990.

Congress created the current framework for Medicare alternative plans in 1997 by putting Part C in Title XVIII of the Social Security Act.

Medicare Part C created a private Medicare plan program that was originally known as the Medicare+Choice program. The name changed to Medicare Advantage in 2003.

The annual election period for Medicare Advantage plan coverage started Saturday and is set to run until Dec. 7. Coverage sold during the period will take effect Jan. 1, 2023.

About 29 million of the 65 million people now enrolled in Medicare have Medicare Advantage plan coverage.

The Money

Medicare program trustees expect Medicare to pay about $420 billion to private health plan issuers this year, and about $473 billion in 2023, according to the trustees’ 2022 report.

The New York Times recently ran an article, cited in the Pocan H.R. 9187 filing announcement, noting that the federal Medicare Payment Advisory Commission has estimated that Medicare Advantage plan issuers had received about $12 billion in overpayments in 2020.

That’s equal to about 3.8% of the plans’ $317 billion in payments from the federal government.

The Political Context

While conservatives in Congress originally opposed the creation of the Medicare program,  Medicare today has broad support.

The Better Medicare Alliance said last week, in an announcement about its upcoming summit, that its list of supporters includes both Sen. Roger Marshall, R-Kan., and Rep. Linda Sánchez, D-Calif.

Marshall is a medical doctor who has a 76% conservatism rating from the American Conservative Union.

Rep. Linda Sánchez, D-Calif., is a member of the Congressional Progressive Caucus and a co-sponsor of H.R. 1976, the Medicare for All Act of 2021. H.R. 1976 would replace all current forms of public and private U.S. health insurance, including the Medicare program, with new, state-government-run health finance programs.

But some groups with an interest in the federal budget deficit, such as the Committee for a Responsible Federal Budget, argue that overly rich Medigap and Medicare Advantage waste money by encouraging patients to get unnecessary care.

Some patient and physician groups say the efforts Medicare Advantage plans make to manage care hurt patients’ ability to get necessary care.

Survey Data

The Better Medicare Alliance says it has data showing that 94.9% of the Medicare Advantage participants a survey firm polled for it reported being satisfied with their coverage, compared with 96% of Original Medicare enrollees.

About 74.8% of the survey participants with Medicare Advantage coverage reported having a flu shot in the past year, and 93.6% said they had a usual source of care.

Comparably, only 71.1% of the Original Medicare enrollees said they had had a flu shot in the past year, and 90.8% said they had a usual source of care.

The Centers for Medicare and Medicaid Services, the agency that runs Medicare, published its own enrollee survey data, for 2019, in a chartbook. The chartbook shows that the percentages of enrollees who said they were “very dissatisfied” were worse for Medicare Advantage for some indicators and lower for others.

For general care, for example, the extreme dissatisfaction level was 4% for Original Medicare and 5.1% for Medicare Advantage.

But, for ease of access to doctors, the extreme dissatisfaction level was 5% for Original Medicare and 4.4% for Medicare Advantage.

Similarly, the extreme dissatisfaction level for ability to get care from the same location was 11% for Original Medicare and just 9.7% for Medicare Advantage.

Pocan’s Perspective

Pocan said Thursday, during an appearance on The Thom Hartmann Program, a live call-in radio show, that keeping private insurers from using the Medicare name is important because they impose more restrictions on use of care, such as preauthorization review programs and provider network limitations, that “Original Medicare” does not impose.

Pocan said that his own mother went without the care she needed two years ago because her Medicare Advantage plan would not pay it.

“Only Medicare is Medicare,” Pocan said. “We want to make sure that we’re doing everything possible to preserve protect and enhance Medicare. ‘Medicare Advantage’ programs certainly don’t do that.  … Let’s just take away their ability to pretend that they’re something they aren’t.”

Legislative Mechanics

H.R. 9187 is under the jurisdiction of the House Ways and Means and House Energy and Commerce committees.

At press time, H.R. 9187 had one co-sponsor, Rep. Ro Khanna, D-Calif.

Pocan has never seen a stand-alone bill he has introduced signed into law.

Khanna has one passage for five stand-alone bills. One bill signed into law affected apprenticeship programs for military veterans. None of the other bills signed into law had a direct effect on social services programs.

Rep. Mark Pocan, D-Wis. (Photo: House)


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