|
Dissenting Views on H.R. 4985 A Bill to Amend Title XVIII of the Social Security Act to Revitalize the Medicare+Choice Program, Establish a Medicare+Choice Competition Program, and to Improve Payments to Hospitals and Other Providers under Part A of the Medicare Program. Today, seniors who enroll in Medicare fee-for-service are guaranteed the same set of defined benefits at the same predictable and affordable premium, regardless of where they live or what other private Medicare+Choice plans are participating in their area. H.R. 4985 contains several provisions that if enacted, would mark the beginning of the end of that guarantee. In particular, this bill includes a demonstration program that sets the stage for the privatization of Medicare. Under this demonstration, the Federal Government’s subsidy for each senior would be based on something other than the full cost of the fee-for-service program. By definition, this is premium support system. Instead of entitling seniors to a package of defined benefits, a premium support system would entitle Medicare beneficiaries to a monetary contribution -- a voucher -- that could be used toward the purchase of health insurance coverage. In this demonstration, the amount of the voucher would be determined by the value of the "reference premium" for the county in which a senior lived. Seniors would enroll in either fee-for-service or an Medicare+Choice plan, and make up the difference between the fee-for-service or Medicare+Choice premium and the reference premium. The coverage seniors could buy with this voucher would depend on the type of benefits Medicare+Choice plans decided to offer, which plans decided to offer coverage in these demonstration areas, and how much plans in these areas decided to charge. Different plans participating in the demonstration could charge different premiums, and the same plan could charge different premiums in different demonstration sites. In addition, the reference premium would vary among demonstration sites, so seniors in higher-cost demonstration sites would receive larger vouchers than seniors in lower-cost demonstration sites. As a result of this variation, the free-for-service premium would be different in each demonstration site. Also, seniors living in demonstration areas would pay different fee-for-service premiums than seniors in the rest of the country. This geographic disparity in premiums would be a first for the Medicare fee-for-service program, which has always charged seniors the same premium regardless of where they lived. Another effect of the demonstrations is that seniors in these areas would pay more for the same coverage they have today. Fee-for-service premiums in the demonstration sites would almost certainly increase due to the difference in the populations enrolled in the fee-for-service program versus Medicare+Choice plans. Several studies from the General Accounting Office have demonstrated that seniors who enroll in Medicare+Choice plans tend to be younger and healthier than seniors in the fee-for-service program.* Consequently, the initial reference premium would be lower than the fee-for-service premium. Seniors in these demonstration sites who wanted or needed to stay in fee-for-service would have to pay more out of their own pockets than the seniors who joined Medicare+Choice plans. The seniors who would be particularly hurt by this premium support, or voucher experiment, would be the poorest seniors, who would no longer have the "choice" of staying in fee-for-service Medicare because it was too expensive. Their "choice" would be limited to the lowest-cost Medicare+Choice plan in their community. Seniors with chronic health care conditions would also be hurt, because they would have to pay more to preserve their "choice" of doctors and hospitals. H.R. 4985 would unfairly penalize seniors who had the misfortune of living in one of these demonstration sites, who would not have chosen to participate in such an experiment. Instead, they would find themselves paying more for Medicare fee-for-service simply because the Secretary of Health and Human Services had designated their communities as testing grounds. We believe it is wrong to experiment with the Medicare program by shifting costs to seniors and the disabled. The Committee bill includes another section that lays the groundwork for a privatized Medicare program. Beginning in 2005, H.R. 4985 establishes a Medicare+Choice "competition" program. This program also includes the concept of a "reference premium," which is the foundation for a premium support system. Apart from the demonstration and competition sections, H.R. 4985 increases payments to Medicare+Choice plans. While we support this increase in funds, we disagree with several other pieces of the bill that make changes to the current Medicare+Choice program. First, the bill exempts Medicare+Choice plans from all state regulations, including laws that protect people enrolled in managed care plans. We oppose this provision because it takes away protections that seniors currently enjoy. Second, H.R. 4985 permanently delays from July to September the adjusted community rate (ACR) filing deadline for Medicare+Choice plans. The bill, however, does not permanently delay the "lock-in provision," which limits seniors’ ability to move in and out of managed care plans. The Bioterrorism Preparedness and Response Act of 2002 included equal delays in these two provisions, but the Committee bill only addresses the provision that is most favorable to Medicare+Choice plans. Finally, H.R. 4985 re-institutes payments to Medicare+Choice plans for Indirect Medical Education (IME) payments, which have been carved out of plan payments since 1997. Again, we are not opposed to an increase in Medicare+Choice plan payments. We do object to the fact that Medicare+Choice plans are not required to pass along these IME payments to teaching hospitals. This provision is especially ill-conceived because a later section of H.R. 4985 allows IME adjustments to teaching hospitals to decrease from 6.5% to 6.0% in 2003, to 5.9% in 2004, then to 5.5% in 2005 and beyond. We would much rather have used additional IME payments to maintain the adjustment for teaching hospitals at the current level of 6.5%. * GAO, Medicare+Choice: Reforms Have Reduced, but Likely Not Eliminated, Excess Plan Payments, June 1999, GAO/HEHS-99-144. John D. Dingell | |
|
 |
 |
 |
 |
 |
 |
 |
 |
