Medicare

Two Large Medical Groups Shun Medicare Advantage Plans

September 26, 2023 Cheryl Clark, MedPage Today. Resist! California, Health Care, Medicare, Medicare Advantage, Physicians, Private health insurance

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.

Whipping Egg-Whips: Retirees Win Battles Against Medicare Advantage

August 26, 2023 Kay Tillow, Common Dreams. Resist! Health Care, Medicare, Medicare Advantage, Retirees

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.

The Journey To Medicare’s 58th Anniversary

July 28, 2023 F. Douglas Stephenson, Informed Comment. Educate! Congress, Health Care, History, Medicare, Medicare for all

The most successful U. S. health insurance program, Medicare, was enacted ln July,1965, to provide health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 58 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has for-profit/administrative costs above 15 percent. Medicare’s costs have risen more slowly than those of the private health insurance industry.

Judge Blocks Medicare Advantage Switch For 250,000 Retirees

July 8, 2023 Caroline Lewis, Gothamist. Resist! Health Care, Medicare, New York City (NYC), Retirees

A Manhattan judge is pressing pause on a controversial plan to push New York City government retirees onto a new privatized version of Medicare this fall – a major victory for critics of the switch. In a plan that city officials said would save some $600 million a year, municipal retirees were supposed to be moved from their existing coverage – a combination of traditional Medicare with supplemental coverage paid for by the city – onto a private Medicare Advantage plan run by Aetna this fall. City officials had scheduled the deadline to opt out for this coming Monday, but seniors who decided to stay on traditional Medicare would have had to waive their city benefits and pay for their health coverage themselves.

The $20 Billion Scam At The Heart Of Medicare Advantage

May 26, 2023 Matthew Cunningham-Cook, The Lever. Educate! Health Care, Joe Biden, Medicare, Medicare Advantage

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 Health Care By Unitedhealth Group

May 7, 2023 John P. Geyman, Counterpunch. Educate! Capitalism, Health Care, Medicaid, Medicare, Medicare Advantage, Privatization

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.

Medicare Advantage Is Not An Advantage For Seniors With Cancer

April 23, 2023 Dr. Harlan Levine, The Hill. Educate! Health Care, Medicare, Medicare Advantage, Seniors

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.

How Canadians Are Losing Medicare

March 17, 2023 Dr. Susan Rosenthal, Consortium News. Strategize! Canada, Health Care, Medicare, Privatization

Ontario’s Bill 60 has delivered a potential death blow to public Medicare. If it becomes law, the provincial medical system will no longer operate as a public service but as a profit-taking business managed by the private sector. While defenders of public Medicare blame Conservative Premier Doug Ford, British Columbia, Quebec and Saskatchewan are going down the same road. If we hope to reverse this disaster, we need to know how Canadians won Medicare in the first place, and why they are losing it. World War II saw a global upsurge of labor protest.

New York City Retirees Fight Their Own Unions To Stop Health Care Cuts

March 10, 2023 Jenny Brown, Labor Notes. Resist! Health Care, Medicare, New York City (NYC), Unions, Worker Rights and Jobs

New York City, New York - Defying two years of protests and lawsuits by union retirees, New York City’s Municipal Labor Committee voted Thursday to scrap some of the best retiree health care coverage in the country. The change aims to put 250,000 city retirees into a for-profit Medicare Advantage plan run by Aetna. Twenty-six unions in the MLC voted no, while others abstained. But their votes were swamped by the votes of the largest unions on the committee, AFSCME District Council 37 and the New York United Federation of Teachers. Retirees and active members protested during the MLC vote and marched to City Hall.

Report Shows Big Insurance Profiting Massively From Medicare Privatization

February 28, 2023 Jake Johnson, Common Dreams. Educate! Health Care, Health Insurance, Medicaid, Medicare

A new analysis released Monday shows that insurance giants are benefiting hugely from the accelerating privatization of Medicare and Medicaid, which for-profit companies have infiltrated via government programs such as Medicare Advantage. According to the report from Wendell Potter, a former insurance executive who now advocates for systemic healthcare reform, government programs are now the source of roughly 90% of the health plan revenues of Humana, Centene, and Molina. Over the past decade, Potter found, the seven top for-profit insurance companies in the U.S.—the three mentioned above plus UnitedHealth, Cigna, CVS/Aetna, and Elevance—have seen their combined revenues from taxpayer-backed programs soar by 500%, reaching $577 billion in 2022 compared to $116.3 billion in 2012.

US Funneled Billions To Ukraine While Cutting Health And Education

February 26, 2023 People's Dispatch. Educate! Education, Health Care, Joe Biden, Medicare, Russia, Student Loans, Ukraine, US Congress, US Imperialism

February 24 marks the one-year anniversary of the Russia–Ukraine war, and in the past year, the US Congress has approved $113 billion in aid to Ukraine. Meanwhile, working people in the US are in dire economic straits, and desperately need relief from their government. When US President Joe Biden delivered his State of the Union Address in early February, over 160 million people—almost half of the nation’s population—reported having trouble paying weekly expenses. The cost of living had jumped by 8% while wages had only increased by 4% in the past year.

Physicians Tell Biden HHS To End Medicare Privatization Pilot

January 27, 2023 Jake Johnson, Common Dreams. Resist! Health Care, Joe Biden, Medicare, Privatization

A national physician group this week called for the complete termination of a Medicare privatization scheme that the Biden White House inherited from the Trump administration and later rebranded—while keeping intact its most dangerous components. Now known as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the experiment inserts a for-profit entity between traditional Medicare beneficiaries and healthcare providers. The federal government pays the ACO REACH middlemen to cover patients' care while allowing them to pocket a significant chunk of the fee as profit. The rebranded pilot program, which was launched without congressional approval and is set to run through at least 2026, officially began this month, and progressive healthcare advocates fear the experiment could be allowed to engulf traditional Medicare.

AARP And The AFL CIO Are Pushing Medicare Disadvantage

January 23, 2023 Corporate Crime Reporter. Educate! Health Care, Medicare, Medicare for all, Privatization

Medicare Disadvantage insurance plans induce seniors by offering advantages that traditional Medicare doesn’t offer – like vision and dental coverage. That’s the upside. The downside is that when you actually get seriously ill, the disadvantage is that when you get sick, you might not get the coverage you were promised. Now, about half of all seniors in the United States are in Medicare Disadvantage. The unions should be fighting against the move to privatize Medicare. Instead of fighting, they are joining with the insurance companies to corporatize Medicare. The big daddy of unions, the AFL-CIO, is itself now partnering with the giant insurance company Anthem to push Medicare Disadvantage plans on its retired union members. The first ad for the campaign read: “Introducing AFL-CIO Medicare Advantage group plans, provided by Anthem. Comprehensive coverage available exclusively to retired union members.”

Privatization Scam Threatens To Replace Traditional Medicare

January 13, 2023 John Geyman, Truthout. Educate! Health Care, Medicare, Medicare Advantage, Privatization

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.

Architects Of Medicare Privatization: Congress, Biden And The CMS

December 30, 2022 Sandra M. Fox, Counter Punch. Educate! Health Care, Joe Biden, Medicare, Privatization

It is easy and appropriate to target the private health insurance companies who earn excessive profits from the Medicare Trust Fund through Medicare Advantage plans, especially given the well-documented evidence of overcharging and fraud. But it is essential that we remember that it has been the U.S. Congress and the Executive Office that promoted the privatization of Medicare, to varying degrees, since it was first signed into law by President Johnson in 1965 and enacted the following year. In 2017 The Commonwealth Fund published “The Evolution of Private Plans in Medicare,” which detailed the increasing role in healthcare granted to private companies since 1966 through Acts of Congress and the Office of the President.

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