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Disclaimer: the views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy.

  1. BETTER ADVANCE CARE LEGAL COUNSELING  
  1. HEALTH CARE and the MID-TERM ELECTIONS

As results from the recent mid-term elections continue to come in, it is clear that the Democrats will control the House of Representatives and Republicans will retain control of the Senate in the 116th Congress that starts in January. 

According to polling conducted before and during the election, health care was the top issue for voters (see, e.g., CNBC, Associated Press, Kaiser Health News). As noted by Forbes, it “was the single biggest worry on the minds of the people as they cast their ballot.” It is clear that the American people value access to quality health care and will hold policymakers accountable for attempts to sabotage their coverage protections.

How will the new Congress react to such concerns? 

Overview

As Drew Altman, President of the Kaiser Family Foundation, notes in Axios, we will likely see “two years of maneuvering but little progress on health care — unless you look beyond Washington.” In short, Altman states:

Democratic control of the House stops any Republican efforts to revive their efforts to repeal and replace the Affordable Care Act, block grant Medicaid or impose a per capita cap on federal Medicaid spending. […] The same applies to any big changes Republicans might want to make to Medicare. With Paul Ryan gone — the leading champion of those plans — Republicans will steer clear of premium support or other major Medicare changes. Only smaller Medicare budget savers will stand any chance.

Affordable Care Act

Voters overwhelmingly expressed their support for maintaining protections for those with pre-existing conditions. Even certain candidates with a history of voting to repeal the Affordable Care Act (ACA) began to recognize this, and touted how they would protect people with pre-existing conditions. However, while it may appear that efforts to repeal the ACA are on hold for now, the administration and opponents of the ACA can still do much to undermine the law.

Many ACA opponents, for example, have supported a Texas-led lawsuit to declare the ACA unconstitutional. This lawsuit would destabilize our health care system, and deny millions of consumer’s critical health coverage. People with pre-existing conditions and those who are older and sicker would be especially at risk. Although the president vowed to “always protect Americans with preexisting conditions” his administration decided not to defend against the lawsuit. In fact, the Department of Justice specifically argued against provisions that guarantee coverage to people who are older, sicker, or have pre-existing conditions. Although voters endorsed coverage for pre-existing conditions and rejected health care sabotage, the administration will likely continue to act to undermine the ACA through regulations and other actions.

Medicaid

Kaiser’s Drew Altman also noted that the election was “a good day for Medicaid.” Ballot initiatives to expand Medicaid passed in three states (Idaho, Nebraska and Utah), and “governors elected in Kansas and Maine will now push forward Medicaid expansion.” According to advocates, this will likely lead to nearly 500,000 more people in these states gaining coverage through the ACA’s Medicaid expansion. However, the Administration continues to restrict access to Medicaid through regulation and administrative action, including approving state waivers imposing work requirements. For example, the day after the election, it was reported that the administration is drafting a proposed rule that would restrict non-emergency transportation services for Medicaid beneficiaries. With Congress deadlocked, states can take the lead and expand Medicaid to ensure that people have access to comprehensive health coverage and can also reject unnecessary restrictions on eligibility.

Medicare

Prior to the election, we highlighted threats to Medicare, including some policymakers’ focus on cutting Medicare through “entitlement reform.” With a split Congress, such efforts are less likely, for the time being. It is likely, however, that we will continue to see harmful policy proposals from the Administration that, among other things, scale back consumer protections and oversight of providers (including nursing facilities) and Medicare Advantage plans.  The Administration will also continue efforts to steer people toward enrolling in private Medicare Advantage plans.

It is possible that Congress will try to address the high price of prescription drugs, which increases costs for the Medicare program and beneficiaries. There will also likely be discussions regarding expanding Medicare, both in the scope of what it covers (such as adding dental, hearing and vision) and who is eligible to enroll.  

As we have stated elsewhere, the Center urges policymakers to expand services and coverage equally for all Medicare beneficiaries, not just subsets such as only those in private MA plans. For example, an out-of-pocket cap should be added to the traditional Medicare program as exists in MA. Rights to purchase Medigap

supplemental insurance policies should be expanded to people under 65, and include more ongoing access for all in order to provide truly meaningful choices for Medicare beneficiaries. Both payment and coverage should be equalized between MA and traditional Medicare so that the scales are not irreversibly tipped in favor of privatization. 

Conclusion

While a divided Congress likely forestalls major health care-related legislation in the near term, Medicare, Medicaid and the Affordable Care Act remain under threat from the Administration. We encourage Congress to do its duty to perform robust oversight of these programs. The lives of millions of people all over the country depend on it.

  1. MEDICARE FULLY INFORMED PROJECT

Current ACEP and Medicare Materials

The Annual Coordinated Election Period (ACEP), from October 15 through December 7, 2018, is the time period during which Medicare beneficiaries can enroll in, switch, or disenroll from Medicare Advantage (MA, or Part C) plans and Part D prescription drug plans.  Elections made during this time period will be effective January 1, 2019.  Information about 2019 MA and Part D plan offerings is now available on www.medicare.gov, and marketing of such plans has begun.

Since Fall 2017, the Center for Medicare Advocacy and other advocates have highlighted how CMS materials, including the 2018 Medicare & You handbook and outreach and enrollment documents, have encouraged beneficiaries to choose a private Medicare Advantage (MA) plan over original Medicare instead of more objectively presenting enrollment options.  For example, in November 2017, the Leadership Council of Aging Organizations (LCAO), a member coalition of the nation’s non-profit organizations serving older Americans, sent a letter about this issue to CMS and committees of jurisdiction in Congress. 

When the draft 2019 Medicare & You handbook was released this May for stakeholder input, the Center and other consumer advocates were alarmed at glaring inaccuracies in the document, which, among other things, perpetuated steering beneficiaries towards MA plans. While CMS addressed the most serious inaccuracies and omissions in the final version of the 2019 handbook, it released online tools for consumers that appear to favor enrollment in Medicare Advantage by providing overly broad, blanket suggestions to enroll in MA plans when much more nuance is required.  

For more information about CMS steering towards MA plans, See:

Fully Informed Project

The Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare have partnered to develop an education and outreach project to support Medicare beneficiaries and those who assist them enroll and re-enroll in Medicare. The Medicare Fully Informed Project provides a variety of unbiased, accurate and comprehensive information about the full range of Medicare coverage options, and includes an array of tools to assist in making the best individual enrollment choices.

Making Medicare coverage decisions is a complex task with multiple personal factors that must be taken into account. Beneficiaries need help in understanding all their complex options including all the pros and cons of traditional Medicare and private Medicare Advantage. They need to make fully informed choices given their likely health needs, personal and financial circumstances, and possible cost-sharing assistance. Our organizations and other beneficiary advocates have been concerned about the objectivity of some Centers for Medicare & Medicaid Services (CMS) enrollment materials. We hope to help fill some of the gaps.

The goal of the Medicare Fully Informed Project is to help by providing a variety of educational tools for beneficiaries, and those who help beneficiaries, make enrollment decisions. We hope these various formats will help beneficiaries make fully informed Medicare and related health care coverage decisions. Project materials include the following:

For more information, see: http://www.medicareadvocacy.org/medicare-fully-informed-project/.

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