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

2. 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

3. 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

4. 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

5. 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 overall; 3.3 million people ages 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

6. 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

7. 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

8. 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

9. 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?

10. 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.

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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   

22. 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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