Devereaux: The latest assault on Medicare

As a family practitioner in Giles County I learned that for many of my patients reaching age 65 was actually a welcome event as it brought retirement and the opportunity to benefit from inarguably the most popular health insurance program in the country, Traditional Medicare.

For a modest premium and additional coverage provide by a supplemental policy, my patients were often surprised to learn that that virtually all of their medical costs were covered (except some prescription costs) and they could go to any Medicare provider or hospital in the country for care. These patients were often quite relieved that, after meeting a small annual deductible, there were no co-pays and they were no longer limited to getting care from a particular health system or physician.

Unfortunately, Traditional Medicare, which is chosen by 60% of seniors, is the target of a pilot program initiated by the Innovation Center of the Center for Medicare and Medicaid Services (CMS) during the Trump Administration called Medicare Direct Contracting.

This program has been given the go ahead to enroll up to 30 million of the 36 million current recipients of Traditional Medicare without their consent to a new arrangement with a Direct Contracting Entity (DCE).

These new organizations would be insurance companies, for profit health care groups and even non-health care companies who would be paid a fixed monthly fee to provide care rather than billing for the care rendered as is customary with Traditional Medicare.

These DCE’s have attracted lots of interest from Wall Street investors because they would be permitted to spend as little of 60% of their payments on patient care and could keep the rest for profit and expenses. In comparison Traditional Medicare pays 98% of its expenditures on patient care, with only 2% spent for administrative costs.

With this change your doctor or health care organization would have an incentive to withhold or restrict care in order to maximize their profit, something that cannot happen in Traditional Medicare since the providers of care are only paid for the services rendered.

Furthermore the DCE’s would have a mechanism to maximize their monthly payments through a process know as upcoding, where patients are saddled with additional diagnoses in order to maximize payments from Medicare.

Ever wonder why your medical record often features many diagnoses unrelated to your office or hospital visit? This practice is a sneaky way to increase revenues for insurance companies and health care systems and increase the costs that taxpayers bear for Medicare.

Amazingly this pilot program is proceeding without any approval by our elected representatives in Congress.

Most legislators and other policymakers are not aware of this attack on Medicare although recently 54 members of Congress sent a letter to Health and Human Services Secretary Xavier Becerra calling for an end to the Medicare Direct Contracting program.

This is not the first time we have seen the health insurance industry attempt to profit from Medicare.

Most physicians who treat Medicare patients are not big fans of the insurance companies who already have a strong stake in Medicare in the form of Medicare Advantage plans.

These plans were supposed to save the government money by allowing insurance companies to “manage” their patients’ Medicare coverage for a monthly fee. Instead, these companies have profited mightily with practices that restrict care and charge patients more.

In 2019 Medicare Advantage plans cost the government 7 billion more than Traditional Medicare according to an independent analysis by the Kaiser Family Foundation. Insurance companies profit by marketing these plans to younger, healthier seniors.

The Federal General Accounting Office is currently investigating the phenomenon of many patients switching out of these plans to Traditional Medicare as their health worsens in the last years of their lives.

The last thing we need is an assault on Traditional Medicare by insurance companies and other Wall Street investors whose priority is maximizing profit over the welfare of Medicare recipients. It is time for seniors to tell both Congress and the Biden administration to put an end to this latest attempt to privatize Medicare.