Thursday, June 2, 2022

Just like MulgrewCare - The Lever- Biden Hikes Medicare Prices And Funnels Profits to Private Insurers -$47M in campaign contributions buys a lot

Do you ever wonder, If $50 million in campaign contributions from private insurance can buy the Dem Party, what do they do to buy the UFT and other unions?

Medicare’s sturdiness as an American institution is being steadily chipped away by well-connected corporate interests... 
“[The] privatization effort is reaching a frantic state, and Medicare Advantage is going to fail,” said Bill Kadereit, president of the American Retirees Education Foundation, due to the fact that the plans must pay profits to investors, unlike traditional Medicare plans. “The industry is hoping to cover up that failure with taxpayer subsidies that none of the taxpayers understand.”  “ 
Medicare Advantage insurers such as United Healthcare, Anthem, and CVS/Aetna are celebrating record profits in the tens of billions of dollars,” said Dr. Susan Rogers, president of Physicians for a National Healthcare Program. “Their business plan is simple: inflate their Medicare payments by making seniors look sicker than they are, and then pocket more of those Medicare dollars by ruthlessly denying seniors’ care.”
........The Lever
Thursday, June 2, 2022
These are reasons I would have opposed MulgrewCare even if it wouldn't have cost me a dime or there was no reduction in service with MedAdv. But of course everyone recognizes the truth - except UFT leadership and their apologists.

All Medicare recipients pay premiums for outpatient care, which is called Medicare Part B. That money can be funneled into traditional government Medicare plans, or into Medicare Advantage plans run by private insurers that are incentivized to limit the amount of care that elders receive. The standard Part B premium for Medicare patients is now $170.10 per month — up 14.5 percent from last year, when it was $148.50. 

Once you claim, as Mulgrew did, that we do better with a privatized as opposed to a public plan, you open the door to other areas -- like why public education if private can do it better? Let's sell off the transit and sanitation systems.

Union leaders take us down a slippery slope when they stand against a universal public health system.

Here are a few quick takeaways from The Lever article (which you can read in full below the break:
  • Biden officials move forward with a jolting 8.5 percent hike in payments made to private insurers under Medicare Advantage plans next year.
  • The juxtaposition between dramatically increasing payments to private insurance plans that provide less care for higher costs on the one hand, and keeping seniors’ premiums artificially inflated on the other
  • Biden has expanded Medicare privatization by launching the involuntary ACO REACH program and through continuing to promote ever-increasing Medicare Advantage enrollment, and he has also raised premiums for Medicare recipients. 
  • So who benefits from the explosive rate increase? The major private insurance companies that funneled nearly $50 million into Biden’s 2020 presidential campaign.
This deep dive by David Sirota's The Lever (independent journalism worth supporting) provides insight into the possible reasons behind the push by the UFT and other unions for MulgrewCare by taking us out of traditional Medicare and into a privatized MedAdv plan. Mulgrew initially bragged how a lot of the costs would be picked up by the feds but ignored the fact that much of the money was going into subsidizing private insurers with tax payer money and short changing the publicly managed Medicare system. 

The UFT ideology lines up with the neo-liberal corporate branch of the Dem party which opposes any Medicare for all system which would reduce costs and provide better service - just imagine the savings in admin costs that would go to patient care.

You know, there comes a point where you wonder. If $50 million in campaign contributions from private insurance can buy the Dem Party, what do they do to buy the UFT and other unions?
 
ADDED June 9, 2022: Comment from Julie W:
Agreed it’s an important issue. My biggest concern with unions is that most of them (particularly ours) have horse-traded higher salaries for healthcare for decades and are thus resistant to single-payer in the first place. On top of this, there’s enough opposition to single-payer tax hikes already (e.g. https ….freopp.org / how-new-yorks-single-payer-health-care-bill-affects-the-working-poor-2e242921bbb9). I can’t see UFT — entangled as it is already with the EmblemHealth HMO to the degree that it is — putting even a single toe in the water to work through the details of a viable NYHA.

Before you get to the full article, let's point to some provisions of the NY Health Act which Mulgrew and crew vehemently oppose.

Here are the key provisions of the NY Health Act:

  • $5104.1. [The program provides coverage for anything covered by Medicare, Medicaid, Child Health Plus, the state’s public employee program, or any public employee program in the state.]

  • 2. No member shall be required to pay any premium, deductible, co-payment or co-insurance under the program.

  •  4.c. Prescription drugs eligible for reimbursement under this article and dispensed by a pharmacy shall be provided and paid for under the preferred drug program and the clinical drug review program.

  •  5. The program shall not require prior authorization for any health care service in any manner more restrictive of access to or payment for the service than would be required for the service under Medicare Part A or Part B.

  • The fact that funds from the federal government arrive through the MA program doesn't affect these requirements at all.

Biden Hikes Medicare Prices And Funnels Profits to Private Insurers

Last week, the Biden administration quietly reaffirmed its decision to enact the highest Medicare premium hikes in history right before this year’s midterm elections — all while President Joe Biden is endorsing a plan to funnel significantly more Medicare money to insurance companies and further privatize the government health insurance program for Americans age 65 and over and those with disabilities.

In effect, the higher premium increases will subsidize the larger payments to — and profits for — private insurance corporations. This comes after Biden raked in roughly $47 million from health care industry executives during his 2020 campaign.

The Biden administration announced on May 27 that due to “legal and operational hurdles,” Medicare recipients won’t see their premiums lowered this year, even though that rate was originally hiked last November due to the projected costs of paying for a controversial Alzheimer’s drug that Medicare now says it generally will not cover.

The administration’s announcement comes as Biden officials move forward with a jolting 8.5 percent hike in payments made to private insurers under Medicare Advantage plans next year.

The juxtaposition between dramatically increasing payments to private insurance plans that provide less care for higher costs on the one hand, and keeping seniors’ premiums artificially inflated on the other, underscores the Biden administration’s conflicting commitments when it comes to Medicare. On the 2020 campaign trail, Biden pledged as president to “...continue to defend our nation’s commitment to older Americans and people with disabilities through Medicare.”

But since taking office, Biden has expanded Medicare privatization by launching the involuntary ACO REACH program and through continuing to promote ever-increasing Medicare Advantage enrollment, and he has also raised premiums for Medicare recipients. The result, advocates say, is a situation in which Medicare’s sturdiness as an American institution is being steadily chipped away by well-connected corporate interests.

“[The] privatization effort is reaching a frantic state, and Medicare Advantage is going to fail,” said Bill Kadereit, president of the American Retirees Education Foundation, due to the fact that the plans must pay profits to investors, unlike traditional Medicare plans. “The industry is hoping to cover up that failure with taxpayer subsidies that none of the taxpayers understand.”

All Medicare recipients pay premiums for outpatient care, which is called Medicare Part B. That money can be funneled into traditional government Medicare plans, or into Medicare Advantage plans run by private insurers that are incentivized to limit the amount of care that elders receive.

The standard Part B premium for Medicare patients is now $170.10 per month — up 14.5 percent from last year, when it was $148.50. Half of the increase in premiums came from a single drug, Aduhelm, which, despite its June 2021 approval by the Food and Drug Administration (FDA) to treat Alzheimer’s disease, is not proven to do so.

The timeline of Biden’s Medicare moves, then, is this:

  • In June 2021, Biden’s FDA approved the drug Aduhelm for treatment of Alzheimer’s, despite controversy involving alleged scientific disputes inside the agency over the drug’s efficacy and industry pressure on the internal review process.
  • In November 2021, the Centers for Medicare and Medicaid Services (CMS), which administers and oversees Medicare, approved the historic 14.5 percent premium increase for all Medicare beneficiaries. The announcement noted that among other reasons, the hike “reflects the need to maintain a contingency reserve for unanticipated increases in health care spending, particularly certain drug costs,” and specifically mentioned covering Aduhelm.
  • A few days later, in response to questions from CNN, CMS revealed that the projected cost of Aduhelm was alone responsible for half of the premium increase.
  • The resulting outcry led Aduhelm’s manufacturer, Biegen, to halve the drug’s price the following month.
  • In January 2022, Health and Human Services Secretary Xavier Becerra called on CMS to reassess those premium hikes this year.
  • In April 2022, Medicare instituted strict rules regarding who could receive the Aduhelm under its plans — but kept the higher premiums in place.
  • Around this same time, CMS announced a massive 8.5 percent increase in the rates paid to for-profit Medicare Advantage plans, despite the official body overseeing Medicare payments, the Medicare Payment Advisory Commission  concluding that Medicare Advantage is more costly than traditional Medicare.
  • On May 27, the White House announced that despite the extraordinary premium hikes that stemmed from inaccurate price assumptions, they would not be lowering the monthly premium deducted from social security checks, instead saying any overcharges will be factored into next year’s Medicare premium calculations.

The Biden administration’s decision to keep Medicare premiums artificially inflated won’t just constrain the budgets of cash-strapped seniors — it also appears to be a politically suicidal move in an already fraught election year.

So who benefits from the explosive rate increase? The major private insurance companies that funneled nearly $50 million into Biden’s 2020 presidential campaign.

“Medicare Advantage insurers such as United Healthcare, Anthem, and CVS/Aetna are celebrating record profits in the tens of billions of dollars,” said Dr. Susan Rogers, president of Physicians for a National Healthcare Program. “Their business plan is simple: inflate their Medicare payments by making seniors look sicker than they are, and then pocket more of those Medicare dollars by ruthlessly denying seniors’ care.”

Meanwhile, more than 7 million seniors live in poverty and 7.3 million seniors are food insecure.


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5 comments:

  1. I agree with everything said here, but one notable thing missing in the Lever article: ACO REACH is a tweaking of the Direct Contracting program instuted by the Trump administration, which was supposedly "discontinued" (yet not) after fierce protesting. In actuality, DC turned into ACO REACH). By not mentioning this, it's portrayed that the Biden neo-cons are the full culprits, when as usual, they just find it convenient to go along what was initially installed by conservative right, in this case: the Trumpists (who by the way also expanded Medicare Advantage a year or two earlier). Not the first time Dems cloned Republican schemes: think Obamacare = Romneycare. Also not stressed in this article, though mentioned, is that once your doctor goes into ACO REACH, you as the patient have to go along with this, you can't opt out and choose another plan or traditional Medicare. To remove yourself from the REACH structure (which is Advantage on steroids -- the private entity who owns the company can keep 40% for profit/admin) means dropping your physicians altogether. Another thing not mentioned (unless I read it too fast) -- Congress does not have to approve the REACH entities: they can be hedge funds, businesses, any kind of for-profit company. REACH - 40% , Medicare Advantage - 15%. Thank the Republicans for those numbers. Kick Democrats in the shins for going along with this.

    ReplyDelete
  2. The New York Health Act needs revision before being passed. We should be sitting down with the sponsors to work towards those revisions.
    The largest concern for UFT members is making certain that out of state members do not lose coverage. My assembly person, who supports the bill, met with me, and assured me that the NYHA would not be passed without this being addressed, but also indicated that the UFT has not been trying to sit down and work this out.

    ReplyDelete
  3. Agreed it’s an important issue. My biggest concern with unions is that most of them (particularly ours) have horse-traded higher salaries for healthcare for decades and are thus resistant to single-payer in the first place. On top of this, there’s enough opposition to single-payer tax hikes already (e.g. https ….freopp.org / how-new-yorks-single-payer-health-care-bill-affects-the-working-poor-2e242921bbb9). I can’t see UFT — entangled as it is already with the EmblemHealth HMO to the degree that it is — putting even a single toe in the water to work through the details of a viable NYHA.

    ReplyDelete
    Replies
    1. I agree - but also think that the industry throws so much money into lobbying, what are they throwing into unions and how are they doing it?

      Delete
  4. Good questions. Never thought if that angle. How do we find out?

    ReplyDelete

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