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Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries

On October 3, 2019, President Trump issued his “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors” (EO).[1] Much of the language of the EO is vague, and much is unknown about what polices might emerge from it. Some of the proposals are clear in their intent, and would cause clear harm to Medicare beneficiaries. While other proposals are ambiguous in their language, we can generally infer intent based upon previous actions by this Administration. The Center’s analysis of the EO expresses some of our concerns about the impact on Medicare beneficiaries, and the Medicare program in general, if some of the proposals outlined in the President’s Executive Order are implemented. Among other thing, the EO would:

  • Exacerbate the Growing Imbalance between Traditional Medicare and Medicare Advantage – Provisions of the EO exacerbate an existing imbalance between traditional Medicare and the Medicare Advantage (MA) program, and demonstrate the Administration’s ongoing efforts to maximize enrollment in, and the scope of, coverage of MA plans. This includes a directive to “ensure that, to the extent permitted by law, FFS [aka traditional, or Original] Medicare is not advantaged or promoted over MA with respect to its administration.” It also promotes Medicare Medical Savings Programs, which would primarily benefit the wealthy, and could erode network adequacy requirements by relying on access to providers through telemedicine.
  • Push People Away from Medicare – The EO directs policy changes that would allow people to keep their Social Security retirement benefits, but decline Part A of Medicare, which would incentivize those wealthy enough to self-fund their health care to leave Medicare, eroding the universality of the program and potentially impacting the program’s risk pool. In addition, the EO requires the Medicare program to “remove unnecessary barriers” to private contracting between providers and beneficiaries, which at best would only serve those who could afford to pay for their own care, and at worst, open the door to unfair bargaining advantages and unequal power dynamics between providers and patients.
  • Roll-back Important Consumer Protections – the EO would continue this Administration’s efforts to “reduce regulatory burden” which frequently results in weakening consumer protections.

There is much in the President’s Executive Order that is unclear and must be further defined in order to assess its impact.  Most of the provisions that are discernable, though, are not consumer friendly. Instead, they are a gift to both the Medicare Advantage insurance industry and beneficiaries who are well off enough to pay for their own health care.

October 10, 2019 – D. Lipschutz

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[1] Available through the White House website at: https://www.whitehouse.gov/presidential-actions/executive-order-protecting-improving-medicare-nations-seniors/ and in the Federal Register at 84 Fed Reg 53573 (Oct. 8, 2019) at: https://www.federalregister.gov/documents/2019/10/08/2019-22073/protecting-and-improving-medicare-for-our-nations-seniors.

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