America’s Health Insurance Plans says the extra services its members provide for Medicare beneficiaries through the Medicare Advantage program really do improve patients’ health.
President Obama and other Democrats argued during the recent health reform summit in Washington that the Medicare Advantage program – which gives private carriers a chance to offer alternatives to the basic Medicare plan, rather than Medicare supplement insurance products that simply fill in the many the gaps in Medicare coverage – costs more than the traditional Medicare plan without doing much to improve participants’ health. Medicare Advantage plans usually offer lower deductibles, extra coverage for preventive care services and care coordination in exchange for members agreeing to use in-network care providers.

The Obama administration has been pushing for a shift back toward traditional Medicare – which imposes relatively high deductible requirements on enrollees who do not pay extra for Medicare supplement insurance – while supporting requirements that plans offered to working-age patients through a proposed health insurance exchange system provide richer benefits, with fewer gaps than many individual health insurance policies now leave in coverage.

AHIP, Washington, has responded to the Democrats’ allegations about Medicare Advantage plans with a “fact check” report full of statistics suggesting that comprehensive Medicare Advantage can help participants live longer, more comfortable lives than the less comprehensive traditional Medicare plans do.

AHIP analysts originally published the statistics in October 2009. They drew on 2006 California and Nevada hospital admissions data compiled by the federal Agency for Healthcare Research and Quality.

After adjusting for factors such as age, sex, and medical condition, the analysts found that Medicare Advantage plan enrollees in California spend 30% fewer days in the hospital than patients in traditional Medicare plans do.

In Nevada, Medicare Advantage plan enrollees spend 23% fewer days in the hospital than traditional Medicare plan enrollees do, the analysts report.

Similarly, Medicare Advantage enrollees were re-admitted to the hospital in the same quarter for the same condition 15% less often than traditional Medicare enrollees in Nevada and 33% less often than traditional Medicare enrollees in California.

In both California and Nevada, Medicare Advantage enrollees were 6% less likely than traditional Medicare enrollees to be admitted to the hospital for “potentially avoidable” conditions such as dehydration, urinary tract infection or uncontrolled diabetes, the AHIP analysts report.

"A recent comprehensive study on [traditional plan fee-for-service plan] readmissions noted that in half of the re-admissions studied among FFS patients, there was no physician contacted billed to Medicare prior to re-admission," the AHIP analysts write in the October 2009 commentary. "We assume that the [Medicare Advantage] plans are able to lower re-admission rates precisely because of their emphasis on discharge planning and coordinated care follow-up."

An earlier AHIP study found that Medicare Advantage enrollees had 27% fewer emergency room visits than traditional Medicare plan enrollees did and spent 18% fewer days in the hospital, the analysts report.

AHIP also has come out with a commentary reminding policymakers about the sharp cuts in Medicare alternative plan enrollment that occurred in the late 1990s, when Congress less tried the shift the country back toward relying on traditional Medicare and Medicare supplement insurance.

Health Care Summit Leads to Reconciliation

White House Healthcare Summit Said To Set Stage For Democrats-Only Bill.

Coverage of yesterday's White House summit on healthcare reform (including the lead stories on all three networks) tends to highlight partisan sniping and broad policy disagreements. Ultimately, most analysts agree that yesterday's failure to reach a bipartisan deal sets the stage for Democrats to enact their bill through the tactic known as "reconciliation."

The AP's Ron Fournier (2/26), for example, says that "from its conception, Thursday's healthcare 'summit' was destined to be little more than a stage where Democrats and Republicans would recite their lines and further their political agendas." Thus Obama's was "to cast the Republicans as obstructionists," because he "hopes to ram his proposal past a GOP filibuster." And by "that narrow and cynical scale, the summit was a success."

Along similar lines, on the CBS Evening News (2/25, story 3, 1:00, Couric), reporter Chip Reid was asked whether Obama accomplished "what he needed to do" at the summit. Reid said, "He really did. ... What he really wanted to do was convince the American people...and, wavering Democrats in Congress, that the Republicans are the party of no," and that "he now has no choice but to move ahead with Democrats alone."

From our good friend, Jesse Slome, Exec Director of the Am. Assn for LTCI:

My crystal ball is still cloudy in terms of how long term care (LTC) will be impacted by the final provisions of the great health care debate. Chances are it will remain an issue left for another day.

But long term care cannot be ignored for long. The nation’s next great health care debate will focus attention on Medicare and Medicaid. LTC is such a large and growing component of these taxpayer-funded plans that you can’t discuss saving these programs without dealing with LTC.

The proposed CLASS Act (which gained favorable support from many influential organizations) probably gives a good sense of what’s likely to be the basis of proposed LTC plans. Unless the economy comes roaring back and Washington is again flush with taxpayer dollars, the best legislators will be able to accomplish is an underfunded, initially voluntary plan. In simple terms, get a plan in place, but kick the can down the road a bit further in terms of financial solvency.

Is this good or bad for long term care insurance? The answer - yes!

Some good outcomes
Such a significant change provides the industry with an opportunity to “retool” policies. As an example, level premiums really no longer serve the intended purpose (making products attractive for elderly buyers). In fact, they make insurance costly for younger buyers. LTCI supplement policies
(like Medicare Supplement) could gain traction. Finally, some producers are chomping at the bit waiting to compete head-to-head with a poorly financed, minimal-benefit government plan.

Some bad outcomes
Hearing about a new government LTC plan, consumers start to believe they have LTC “covered.” The 15-second media soundbites reinforce this impression. There is less consumer interest, smaller insurers exit the marketplace and the private market rapidly collapses. Stay tuned.

I thought there would be no cuts to Medicare under Obama's Plan?

According to the latest Congressional Budget Office score, the Senate Finance Comm ittee Health Care Bill has a total cost of $829 billion over 10 years, imposes $424 billion in new taxes and fees over the first 10 years and has over $400 billion in Medicare cuts. I have listed the proposed cuts to Medicare below:

Cuts to Medicare

-$133B Medicare Advantage
-$128.8B Hospitals
-$106.3B Inpatient Prospective Payment System
-$22.5B Medicare DSH payments
-$56B Home Health
-$22.2B Medicare Commission
-$22.3B Medicare Improvement Fund
-$19.8B Medicare Part D
-$14.6B Skilled Nursing Facilities
-$23.1B Part B Schedules, Except Physician Services
-$8B CMS Innovation Center
-$11B Hospices
-$4.9B Accountable Care Organizations
-$3B Medical Imaging
-$800M Power Wheel Chairs
-$300M Comparative Effectiveness Medicare Component
-$100M Medigap

Intimidation Over 1st Amendment Rights!

Medicare Advantage was created to do what the Center for Health Transformation (CHT) has long fought for: To give all seniors more private choices of higher quality health care. It currently provides almost 11 million Americans coverage through private insurance plans. Recent data shows that these seniors have better health outcomes than those in traditional Medicare.

Current legislation in Washington will gut the program. H.R. 3200 in the House will cut Medicare Advantage by $172 billion. The bill sponsored by Sen. Max Baucus in the Senate will cut the popular program by $123 billion.

If you're just hearing about this now, here's the reason: When Humana (with whom we've worked with in the past at CHT) tried to inform its Medicare Advantage members that Democratic health care reform could lower their benefits, the government ordered them to cease and desist and opened an investigation of the company.

Sen. Jon Kyl (R-Ariz.) subsequently introduced legislation in the Senate Finance Committee to protect the 1st Amendment rights of private insurance companies to criticize health care reform proposals.

Democrats on the committee unanimously defeated the bill.

Medicare Fraud

A standard power wheelchair costs the government about $4018 to lease to a senior compared with $1048 for suppliers to buy, according to the Department of Health and Human Services. If you ever wondered why Durable Medical Equipment vendors are driving around in pretty new trucks and are housed brand new buildings, now you may begin to know how they afford this luxury.

I am not saying all DME vendors are crooked, but I have personally witnessed fraud like this and it is really disgusting, like a $10 hammer that the government bills for $700. Remember those toilet seats that cost US Taxpayers north of $500 per seat?

People who live in glass houses should not throw stones.

School has started. You may be thinking of school kids, like 18 or younger. However, I am talking about Medicare school has started. The time to spend 10-12 hours getting certified to sell Medicare part c and d products (per carrier!) has started...

AHIP certification, face to face training, more online certification - brokers make a huge investment just to get ready to sell during the meager six week AEP. If they are lucky, they get three more months in the OEP to sell - but for what? 10% of what they produced in the AEP? During the 6 week AEP period? Why?

Because brokers are counselors, they are ombudsmen, they care...will someone tell Pelosi, Reid, Obama, Frank, etc., what an agent really does?