Stacy Sanders Federal Policy Director Defending Medicare in 2017 Stacy Sanders Federal Policy Director

About Medicare Rights National helpline: Around 20,000 questions answered per year. Affordability, denials, and enrollment confusion are perennial problems Education: Uses helpline information to develop educational programming serving millions annually Policy: Regulatory and legislative comments, education of policymakers, voice for consumers in Washington, DC and New York

Threats to people with Medicare Repealing the Affordable Care Act (ACA) Adopting premium support (or vouchers) Balance billing (or private contracting) Raising the Medicare eligibility age Restructuring cost sharing Cutting Medicaid

Threats to people with Medicare These proposals share a common theme— Cost shifting to people with Medicare Medicare households already spend 14% of their income on health care costs, nearly three times that of non-Medicare households

ACA repeal—under age 65 Almost 30 million Americans could lose health coverage—19% of people ages 55-64 People ages 50+ often find it hard to stay in the full-time job market, making access to health coverage critically important People with disabilities who previously lacked coverage during the two-year waiting period for Medicare are also at risk Over 4.5 million 55-64 overall; 3.3 million people ages 55-64 are enrolled in an ACA Marketplace plan in 2016, making up the largest share of Marketplace enrollees (26%) Over 1.5 million people with disabilities are in the two-year waiting period at any given time

ACA repeal—Medicare benefits Could reopen the Part D donut hole—ACA has saved nearly 12 million people over $26 billion on needed medications Could eliminate ACA coverage for preventive care—40.1 million people with Medicare received at least one such service in 2016 Could undo consumer protections in Medicare Advantage—plans must spend 85% of premium dollars on care; no increased costs for key services, like cancer care

Premium support Idea: Premium support (a voucher) to buy a private health plan or Original Medicare Justification: Private plans and Original Medicare will compete to drive down costs and premiums People with Medicare want and would benefit from more choice in the health care market

Premium support Impact and Opposing Points: Vouchers are unlikely to keep pace with rising health care costs—shifting higher costs to people with Medicare Under one proposal, a 2012 study shows almost six in 10 people with Medicare would pay more Another analysis found that seniors turning age 65 in 2023 would pay $59,500 more (in 2012 dollars) in Medicare costs throughout retirement http://kff.org/medicare/report/transforming-medicare-into-premium-support/

Premium support Key Questions: What plan benefits would be guaranteed? Will Original Medicare have a level playing field? What are the effects on those 55 and older who are “grandfathered” into Original Medicare? Will people with Medicare retain adequate access to health care providers? Will people with Medicare be supported to shop?

Balance billing Idea: Give Medicare providers the right to make and enforce private contracts with Medicare patients for higher rates—currently illegal Justification: Physicians and other providers are refusing to accept Medicare patients because of low rates and regulatory burden Note—Emergency care would be exempted.

Balance billing Impact and Opposing Points: Medicare providers already have flexibility to decide how to participate in Medicare and what cost sharing to accept An overwhelming majority—96%—of people with Medicare report having regular access to care More than 9 in 10 primary care physicians accept Medicare, and more than 70% accept new Medicare patients

Balance billing Impact and Opposing Points: Providers could freely choose what to charge people with Medicare—eradicating cost predictability for beneficiaries and undermining the doctor-patient relationship Creates a two-tier Medicare program where some people with Medicare could lose access to needed care due to increased costs

Raising the age Idea: Raise the eligibility age from 65 to 67 Justification: Americans are living longer and delaying retirement. Most will not need Medicare at 65 Creates savings for the federal government

Raising the age Impact and Opposing Points: By age 63, nearly half of the population is no longer working Particularly harmful for people with jobs that require physical activity and manual labor who are often unable to delay retirement Also harmful to people of color who tend to be in poorer health at earlier ages, with lower incomes and less wealth

Raising the age Impact and Opposing Points: Leaves an older, sicker, and more expensive population for Medicare to insure—meaning premiums go up for all people with Medicare Saves cost for the federal government merely by shifting costs to individuals, employers, and states If implemented in 2014, federal spending would have decreased by only $5.7 billion while health care spending would have increased by $11.4 billion -Employers would have paid an increase of $4.5 billion in employer retiree health care costs in 2014

Restructure cost sharing (Part A & B) Idea: Simplify cost sharing design, consolidate deductibles, and add out-of-pocket maximum One common plan includes a $550 combined (Part A and Part B) deductible, uniform 20% coinsurance, and a $5,500 out-of-pocket limit Added home health copayments are also a common feature along with increased deductibles in Medigap supplemental plans Justification: Out-of-pocket cap helps people with high needs Creates savings for the federal government

Restructure cost sharing (Part A & B) Impact and Opposing Points: The underlying purpose, details, and design of restructured cost sharing would determine its impact on people with Medicare If that underlying purpose is cost savings— restructuring is likely to shift costs to a sizable subset of people with Medicare Under a common proposal, 71% of people with Medicare could see an increase in costs

Restructure cost sharing (Medigap) Idea: Limit cost sharing protection by Medigap supplemental plans to curb utilization of “unnecessary” Medicare services Justification: People with Medicare need more “skin in the game” to more efficiently use health care

Restructure cost sharing (Medigap) Medigap first-dollar coverage was eliminated in 2015 (starting in 2018) and recent proposals would further limit Medigap coverage A common plan would include an even higher deductible before Medigap pays and limit how much cost sharing Medigap could cover after the deductible is met

Restructure cost sharing (Medigap) Impact and Opposing Points: Decades of empirical research demonstrate increased cost sharing causes people to forgo both necessary and unnecessary care Increased cost sharing is a blunt tool that limits access to needed care, like primary care visits and prescription drugs It may also increase the use of more costly care, like ER visits, ambulance rides, and hospital stays

Medicaid Block Grants/Per Capita Caps Cuts the federal share of Medicaid spending—either through grants to states or caps at per person rates Likely will lead states to limit eligibility, scale back Medicaid benefits, or create waiting lists   

Medicaid Block Grants/Per Capita Caps Medicaid payments to aid people with Medicare (Medicare Savings Programs) at risk Puts states with higher income thresholds for eligibility or eliminated asset tests under heightened budgetary pressure Depending on flexibilities granted to states, could significantly diminish access to Medicare cost sharing protections altogether

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