President Donald Trump has disgusted a government-run healthcare system with an official payer, signed an executive order decrying Medicare-for-all and promoting the role of private insurance in Medicare.
Trump signed an executive order on October 3 to "protect and improve" Medicare with a series of somewhat vague proposals aimed at expanding a more market-based approach to Medicare.
There are some provisions in this executive order that are largely uncontroversial, such as improving network adequacy, expanding access to telecommunications, or reducing the time between FDA-approved medications and their Medicare coverage.
However, the Trump administration's explicit intention to promote Medicare Advantage, a program that allows Medicare enrollees to choose private eligible plans, can have major implications for the current Medicare system. The order is a bit of a "Rorschach test," said Kaiser Family Foundation Medicare expert Tricia Neuman, one with many possible interpretations.
"The biggest implication is that despite the wording that this is designed to protect and improve Medicare, to the extent that there are improvements, they are all focused on the private overpriced Medicare Advantage plans compared to ordinary Medicare, "Paul Van de Water of the liberal think tank Center for Budget and Policy Priorities said of the plan. "The Executive Order continues to privilege the Medicare Advantage plans and make some suggestions that could disadvantage two-thirds of the Medicare registrations."
It should also be noted that Trump's 2020 budget included cuts to Medicare worth $ 575 billion. As Vox explained, the administration said they would achieve these cost reductions by targeting wasteful spending, supplier payments and lowering prescription medical costs.
The intent of this order is to promote Medicare Advantage, but it has very vague language
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"The executive order requires us to examine all practices, regulations, and guidance just to make sure we are not directing people to service fees as opposed to giving them a real choice of Medicare Advantage or service charge," he told HHS Secretary Alex Azar to the Reporters.
Trump's executive order requires federal agencies to ensure that traditional "Medicare is not distributed or promoted over [Medicare Advantage] with regard to its administration. “In particular, experts like Neuman argue that the problem is really the opposite: Traditional medicine doesn't get much attention compared to Medicare Advantage. And it is not entirely clear how the administration plans to do this.
The order also repeatedly requires a "transition to truly market-based pricing in the [fee-for-service] Medicare program." In other cases, the order "Medicare FFS requires payments to reflect more closely the prices paid for services in [Medicare Advantage] and the commercial insurance market, to encourage stronger price competition, and otherwise to inject market prices into Medicare FFS reimbursement." [19659012"TheseprovisionscanbeparticularlyconsistentForonetraditionalMedicareandMedicareAdvantagehaveroughlycomparableratesofpaywhilecommercialinsurancepaysatamuchhighercostThemostextremeinterpretationofthisproposalwouldmeanthatMedicarecostswouldballoon
" An increase in Medicare payment rates would put tremendous pressure on Medicare trust funds, which would create a real problem for funding care for future generations. . Raising prices will also increase premiums, "Neuman said.
But if compliance with Medicare and commercial rates is not actually what the administration thought, the impact would be relatively minimal. There are select services that traditional Medicare pays a higher price than Medicare Advantage or even a commercial insurance policy, such as the cost of a walker, which could be an opening for savings.
Another provision calls for "preserving Social Security retirement benefits" by seniors who choose not to receive benefits under Medicare Part A. ”Medicare Part A is a right, as confirmed by a 2012 court decision in which then DC Circuit Court Judge Brett Kavanaugh ruled that there is“ no statutory opportunity for those age 65 or older and receiving Social Security benefits to waive the legal right to benefits for Medicare Part A. ”It is possible that the administration is trying to open the door to allow seniors to choose take away Medicare rights, which will fundamentally change the Medicare risk base. .
That said, Medicare Advantage has had its problems. Just last year, federal investigators found that the private plans denied allegations "in an effort to increase profits." The government pays the private Medicare Advantage plans for a flat fee per enrollee, while traditional Medicare is a payment system that makes heavy users a liability under Medicare Advantage.
Despite this, Advantage plans have been seen as a win-win for many. For the elderly, Benefit Plans are allowed to offer more benefits than traditional Medicare does, such as hearing, dentists and vision, and the premiums are usually lower than having to purchase additional coverage for traditional Medicare. Insurance companies also like it because they have been profitable. This profitability has been partially controlled because Benefit Plans typically limit the health care network and have healthier enrollments – but it has also been shown that they engage in some fraudulent practice of blowing out government payments, such as claiming that enrolled people are sicker than they actually are. the.
Advocates for one-payer health care, such as Sens. Bernie Sanders and Elizabeth Warren, often point to these cases of misconduct by making a case to eliminate private insurance.
Ironically, the Trump administration's one-payer argument is one of Medicare-for-all's biggest talking points: that Medicare is super popular.