The Center for Medicare Advocacy is part of a broad coalition of stakeholders fighting to protect the Affordable Care Act (ACA), Medicare and Medicaid and call attention to the devastating impacts of current health reform proposals under debate in Congress (see, e.g., https://www.medicareadvocacy.org/protect-our-health-care/). As part of an effort to better inform both journalists and the public, USC Annenberg’s Center for Health Journalism blog recently posted an article by the Center for Medicare Advocacy highlighting how the American Health Care Act (AHCA), passed by the House and currently under consideration by the Senate, would negatively impact older adults, ranging from those aged 50-64, those on Medicare, and, in particular, those dually eligible for Medicare and Medicaid: https://www.centerforhealthjournalism.org/2017/05/21/here%E2%80%99s-how-house-passed-health-care-bill-would-especially-harm-older-adults.
Among other things, the article compares the current protections under the ACA with how people age 50-64 would fare under AHCA, including a dramatic rise in premiums and other out-of-pocket costs, discusses how the repeal of certain taxes would undermine Medicare financing and increase premiums, and highlights the impact of a projected $834 billion cut to the Medicaid program, which is relied upon by 1 in 5 people with Medicare.
The Government Accountability Office (GAO) recently released a report entitled “Medicare Advantage: CMS Should Use Data on Disenrollment and Beneficiary Health Status to Strengthen Oversight” (GAO-17-393: Published: Apr 28, 2017, Publicly Released: May 30, 2017, available at http://www.gao.gov/products/GAO-17-393). In response to a request by Senator Sherrod Brown and Rep. Rosa DeLauro, GAO reviewed Medicare Advantage (MA) disenrollment by health status and the extent to which the Center for Medicare & Medicaid Services (CMS) used such data in their oversight of plan contracts. GAO examined 126 MA contracts with higher disenrollment rates (above the median rate) and found 35 contracts with “health-biased disenrollment.” GAO found that “[i]n these contracts, beneficiaries in poor health were substantially more likely (on average, 47 percent more likely) to disenroll relative to beneficiaries in better health. Such disparities in contract disenrollment by health status may indicate that the needs of beneficiaries, particularly those in poor health, may not be adequately met.” The contracts with health-biased disenrollment tended to share several characteristics, including having lower enrollment, being HMOs, having less time in in the MA program, and having lower scores on overall quality and individual performance measures than other contracts. GAO also highlighted that CMS does not use available data to examine disenrollment by health status, and urged CMS to do so as part of its ongoing oversight.
As noted in the report, some studies have found that beneficiaries in poor health may be more likely than beneficiaries in better health to leave their MA contracts and join traditional Medicare (see citations in footnote 8 of the report). At the same time that such reports are finding that sicker individuals tend to leave their MA plans more frequently, the Medicare program is making tens of billions of dollars annually in inappropriate payments to MA plans due to plan “upcoding” – when an MA plan inappropriately reports an enrollee as being more sick than they actually are in order to obtain a higher risk-adjusted payment from the Medicare program (see, e.g., our comments to CMS' request for information concerning Part C and D plans). In addition, while CMS has recently signaled giving the insurance industry more flexibility in terms of rules and oversight, Congress has delayed CMS’ ability to terminate consistently poor performing plans.
The Center agrees with GAO that CMS should strengthen its oversight of MA contracts by examining data on disenrollment by health status and the reasons beneficiaries disenroll. We are encouraged that CMS concurred with GAO’s recommendation.
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