Louisville - With open enrollment underway, older Americans are getting barraged with television ads, mailings and online notices hawking a variety of Medicare Advantage plans for health coverage. But many Kentuckians, including thousands of state retirees, are largely captive customers with such plans selected by their employer as part of health coverage promised for those 65 or older — an increasingly popular means to cover retirees. And members of such plans may have fewer choices for care because of ongoing contract disputes between Baptist Health and three national companies that offer Medicare Advantage plans in Kentucky including Louisville-based Humana, which covers most state retirees.
The federal government is losing as much as $140 billion per year by subsidizing private Medicare Advantage plans, according to a bombshell new report. In the groundbreaking investigation, health care researchers identified the four major ways that private insurers systematically exploit the taxpayer-funded national health insurance program while denying care to the nation’s most vulnerable patients. The researchers additionally found that seniors could save over $1,800 in annual fees taken from their Social Security checks if the government redirected what it spends subsidizing Medicare Advantage plans to instead reduce premium costs. Under the current arrangement, “traditional” Medicare pays about $12,000 a year to private Medicare Advantage insurers for every patient whose care they “manage.”
Signaling what may be an emerging national trend, two influential medical groups with San Diego-based Scripps Health are cancelling their Medicare Advantage contracts for 2024 because of low reimbursement and prior authorization hassles, leaving 30,000 enrolled seniors to look for new doctors, or different coverage. "Negotiations with the payers for MA with our medical foundation groups and Scripps Health were unsuccessful and we have been forced to withdraw from those plans due to annual losses that exceeded $75 million," Scripps CEO Chris Van Gorder told MedPage Today in an early morning email.
An Egg-Whip sounds like a festive, holiday drink or a merengue dessert. It is anything but a delightful treat. Egg-Whip is the healthcare industry’s name for Employer Group Waiver Plans (EGWP), a provision for privatization of employer-based, retiree Medicare benefits that was written into the Medicare Modernization Act (MMA) of 2003. That law, which House Energy and Commerce Chair Billy Tauzin twisted arms to pass, added a drug plan to Medicare, not by including drugs as covered Medicare benefits, but by compelling seniors to purchase private drug plans. Big Pharma gained a massive influx of government money into its coffers and rewarded Tauzin with a $2-million-a-year job.
Jenn Coffey was so tired of having her care denied by her Medicare Advantage insurer that she signed a do-not-resuscitate order. “There was no more hope,” she said. “There was nothing left for me to hope for.” Coffey, a former EMT from Manchester, New Hampshire, went on Medicare, the government health insurance program for seniors and others with disabilities, after a breast cancer diagnosis left her unable to work. Like an increasing number of Medicare beneficiaries, she ended up on a for-profit Medicare Advantage plan; a marketer directed her to an option administered by UnitedHealth Group, a $450 billion insurer.
The health insurance behemoth Humana enjoyed a banner 2022. The Louisville, Ky.-based insurer made $2.8 billion in profits last year, while paying out $448 million in dividends to shareholders and more than $17 million in compensation to its CEO. The main driver of those earnings? The federal government spent $20.5 billion overpaying Humana and other private insurers for the Medicare Advantage plans they manage on behalf of seniors and people with disabilities. If not for those overpayments, Humana could have suffered a nearly $900 million loss in 2022, according to a Lever analysis.
Privatization of public programs such as Medicare and Medicaid has been proceeding rapidly in recent years with little coverage by the media of its harms to patients, the public and taxpayers. This article has four goals: (1) to bring brief historical perspective to this trend in the U. S.; (2) to shed light on the experience over the last 12 years of profiteering by UnitedHealth Group, now the largest U. S. private health insurer; (3) to describe negative impacts on our health care system; and (4) to briefly consider lessons that can be learned from this concerted and stealthy exploitation of the public interest through the corporate greed of UnitedHealth.
When America’s seniors enroll in Medicare, they enter the most medically vulnerable stretch of their lives. And if they are unfortunate enough to be among the 1.9 million Americans each year who hear the terrifying words “you have cancer,” it is imperative they have access to the support and care they need to survive. About 60 percent of cancers occur in people ages 65 or older, accounting for approximately 70 percent of all deaths caused by the disease. But as recently diagnosed cancer patients embark on this unwanted, unexpected care journey, what many seniors do not realize is that their Medicare Advantage (MA) plan can often put them at a disadvantage by restricting access to the care they need and deserve.
In 2016, the Trump administration instituted a new little-known federal agency, the Center for Medicare and Medicaid Innovation, which has been moving enrollees, often without their consent, to for-profit middlemen known as Direct Contracting Entities (DCEs). Rather than saving money and supposed greater efficiency, they add to the cost of coverage by taking their own cut of profits. As a redesign of the DCE model, the Centers for Medicare and Medicaid Services (CMS) has allowed an expanded ACO REACH (Accountable Care Organization Realizing Equity, Access, and Community Health) program to start on January 1, 2023, with more than twice the number of DCEs. This is a corporate agenda being promoted and accelerated by CMS, with the ultimate goal to privatize and replace traditional Medicare altogether by 2030, without even a vote in Congress. Despite all those good words in its title — equity, access and community health — the 35-year track record of Medicare Advantage has failed on all of those counts.
Ask your liberal friends about Danny Glover. They will say – superstar actor featured in the Lethal Weapon film series. Civil rights activist. Democracy Now regular. Supporter of Bernie Sanders for President and for single payer national health insurance. But ask older Americans who watch a lot of cable television about Danny Glover, and they will tell you about Danny Glover – paid actor for big pharma and the insurance industry. As it turns out, Glover is the civil rights face of corporate liberalism. I didn’t believe it when I first heard about it this week. But then, reality was just a few Google clicks away. Issue one: single payer national health insurance. Danny Glover supports single payer. He was a major supporter of Bernie Sanders for President. Single payer would effectively eliminate the insurance industry.
While the Democratic presidential candidates are debating full Medicare for All, giant insurance companies like UnitedHealthcare are advertising to the elderly in an attempt to lure them from Traditional Medicare (TM) to the so-called Medicare Advantage (MA) – a corporate plan that UnitedHealthcare promotes to turn a profit at the expense of enrollees. Almost one third of all elderly over 65 are enrolled in these numerous, complex MA policies the government pays so much for monthly. The health insurance industry wants more enrollees as they continue to press Congress for more advantages. Medical Disadvantage would be a more accurate name for the programs, as insurance companies push to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.
As the movement for National Improved Medicare for All grows, we need to make sure that Medicare Advantage, which is just a front for the private insurance industry, is not allowed to be part of a single payer health system. Medicare Advantage costs the healthcare system more money as it feeds profits of private insurance and it provides worse coverage for seniors. We need to rid the system of the insurance industry and that means rid the system of Medicare Advantage.