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This year brings another election season, another Congressional session, and another opportunity to fortify Medicare, both for those who rely on it now and for future generations. Medicare has been strengthened during the past few years.  However, dangerous rhetoric and schemes to weaken and dismantle the program threaten the health and economic security of millions of American families.

The Affordable Care Act (ACA) improves Medicare in many ways, including: closing the so-called "Donut Hole" – the gap in prescription drug coverage – over several years; strengthening prevention coverage in the program; reducing payment disparities between traditional Medicare and private plans;  promoting innovations in payment and care delivery; and strengthening the program's focus on eliminating fraud, waste and abuse.  The ACA also promotes policies aimed at reducing health care costs throughout the economy, costs that threaten not only the Medicare program and the people who use it, but all who rely on our health care system.

Nonetheless, in the name of "saving" Medicare, some actually seek to dismantle it and turn it into a system of coupons or vouchers, shifting costs and liabilities to America's most vulnerable individuals. The Republican plan – passed last year by the House of Representatives but not by the Senate – and other similar proposals to privatize Medicare, would severely harm those least able to afford it.[1]  In addition, election year politics make Medicare a target for candidates who rely on scare tactics to frighten Medicare beneficiaries with misinformation while advocating ill-conceived polices that would gut the traditional Medicare program and siphon taxpayer dollars into the coffers of private insurance companies.

The Center for Medicare Advocacy believes that Medicare should be strengthened, not threatened.  Improving benefits and ensuring the continuation of Medicare for the people who use it now and the people who will use it in the future will save lives, save money, and make our country stronger. Policymakers should give serious consideration to common-sense ideas to improve Medicare by providing greater access to the care and services people need and by improving the programs that are already in place to lighten the burdens of our sickest and poorest Americans.

Below are a few sound policies that would have a positive impact on the health of people who use Medicare and would be a sound investment in our nation's future.

Put a Drug Benefit in Traditional Medicare

Currently Medicare beneficiaries can only get Medicare coverage for prescription drugs by enrolling in a private, for-profit commercial plan. Offering a drug benefit in traditional Medicare and allowing the Medicare program to negotiate drug prices would give beneficiaries a choice they do not now have.  These changes would also result in enormous cost-savings for Medicare, taxpayers and beneficiaries.  Such a benefit in traditional Medicare would encourage people to remain in traditional Medicare, increasing the risk pool and making it even more cost-effective.  A drug benefit in traditional Medicare would provide an alternative to profit-driven and administratively inefficient private plans and would protect beneficiaries against expensive and sometimes abusive marketing practices.  Lower administrative costs through the traditional Medicare program could free up money for quality care, result in lower drug prices for beneficiaries, and save taxpayers over $20 billion a year.[2]

Let People Between Age 55 and 65 Buy-In to Medicare

Most people between 55 and 65 who are not eligible for Social Security disability benefits are currently unable to enroll in Medicare. Including this population, which is generally healthier than those 65 and older, in the traditional Medicare program would provide a needed avenue for obtaining health coverage and would add revenue to the Medicare program.

Include Dental, Vision, and Hearing Coverage in Medicare

People who rely on Medicare identify the need for basic dental and vision coverage (which Medicare does not currently provide) as critical to their well-being and highly desirable.[3]  Most people with Medicare, however, go without basic dental and vision care.  In 2004, for example, 70% of individuals 65 and older were not covered by dental insurance.[4]

Basic dental and vision care not only improve the quality of life for people, they also promote overall health and save taxpayer money by preventing later, more serious issues that result from untreated routine issues.  The horrifying 2011 death of a young father due to an untreated toothache, for example, illustrates the human and financial costs of the absence of access to these basic services.[5]

Improve Assistance to Low-Income Medicare Beneficiaries

Assistance for poor people who have Medicare should be more generous.  The ACA, when fully effective in 2014, will offer Medicaid services (a federal-state income-based health and social services program) to people with low annual incomes (about $15,000  in 2012 dollars) and will offer help with paying private insurance premiums to people with higher incomes (up to about $45,000 in 2012 dollars).  But this assistance is not available to people with Medicare. Only people with incomes up to about $12,000 get full financial assistance to pay for their Medicare benefits.  For other poor people with Medicare, only partial assistance is available (for people with incomes just under $17,000.) 

Add Care Coordination to Traditional Medicare

Many people who use Medicare are older, sicker, and have complex health needs.  People with complex care needs often use several different healthcare providers.  In general, people with complex health needs have multiple chronic and acute care conditions.  This group represents about 25% of the Medicare population and accounts for about 80% of Medicare spending.[6]  Coordinating the healthcare needs of this population is essential, yet traditional Medicare does not pay for care coordination as a benefit in its own right. Such a benefit could improve the lives of people using Medicare and potentially reduce duplication of services and inappropriate use of prescription drugs. A recent report by the Congressional Budget Office reviews demonstration projects providing care coordination and makes recommendations to improve the effectiveness of coordination.[7]

Conclusion

The Center for Medicare Advocacy has long advocated for a Medicare program that promotes health, is fiscally sound, supports deficit reduction, and will be available for future generations.[8]  2012 will be a critical year for protecting Medicare and the families who depend on it. The proposals outlined above would strengthen Medicare for today and tomorrow.

 


[1] See, e.g., the Center's blog entry: "Medicare 'Reform' – Beware the Wolf in Sheep's Clothing" (December 16, 2011), available at: http://cmahealthpolicy.com/2011/12/16/medicare-reform-beware-the-wolf-in-sheeps-clothing/; also see, e.g., the Center on Budget and Policy Priorities' report "Ryan-Wyden Premium Support Proposal Not What It May Seem" (revised December 21, 2011), available at: http://www.cbpp.org/cms/index.cfm?fa=view&id=3645
[2] Senator Dick Durbin, available at http://durbin.senate.gov/public/index.cfm/pressreleases?ID=555cc1e8-cc54-4ead-9d85-d5e6275b3789 (site visited Feb. 2, 2012)
[3] See, e.g., Corrinne Altman Moore, M.P.A., "MassHealth Demonstration to Integrate Care for Dual Eligibles:  Member Focus Groups and Stakeholder Engagement."  Presentation at Alliance for Health Reform Congressional Briefing, Washington D.C., Dec. 12, 2011;  Michael Perry, Mary C. Slosar, Naomi Mulligan Kold, Lake Research Partners; Lynda Flowers, Keith Lind, AARP Public Policy Institute, "Experienced Voices:  What Do Dual Eligibles Want From Their Care?  Insight from Focus Groups with Older Adults Enrolled in Both Medicare and Medicaid." Dec. 2011
[4]    John F. Moeller, Haiyan Chen, and Richard J. Manski  "Is Preventive Care a Good Investment for the Medicare Population? A Preliminary Analysis," American  Journal of Public Health (November 2010), abstract available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951950/; also see http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.184747?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed.  Note the authors concluded that: "Adding dental coverage for preventive care to Medicare could pay off in terms of both improving the oral health of the elderly population and in limiting the costs of expensive non-preventive dental care for the dentate beneficiary population."
[5] See, e.g., http://abcnews.go.com/Health/insurance-24-year-dies-toothache/story?id=14438171 (site visited Feb. 2, 2012)
[6] Medicare Payment Advisory Commission, June 2011 A Data Book  Health Care Spending and the Medicare Program, Chart 1-10, p. 12 available at  http://www.medpac.gov/documents/Jun11DataBookEntireReport.pdf (site visited Feb. 2, 2012)
[7] Congressional Budget Office, "Lessons from Medicare's Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment", Issue Brief, January 2012, available at http://www.cbo.gov/doc.cfm?index=12663 (site visited Feb. 3, 2012).
[8] See, e.g., the Center's Weekly Alerts, including: "Real Solutions For Medicare Solvency" (June 9, 2011), available at http://www.medicareadvocacy.org/hidden/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/; "Real Solutions to Save Medicare Dollars in Skilled Nursing Facilities" (June 30, 2011), available at: http://www.medicareadvocacy.org/2011/06/real-solutions-to-save-medicare-dollars-in-skilled-nursing-facilities/; and "Debunking Medicare Myths: Drug Rebates for Dual Eligibles" (July 21, 2011), available at: http://www.medicareadvocacy.org/2011/07/debunking-medicare-myths-drug-rebates-for-dual-eligibles/.

 

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