Medicare Advocates Call for Keeping Program as It Is, Cite Voter Concerns About Costs

By large margins, seniors who use Medicare will go to the polls in November with healthcare on their minds, including drug costs. This is especially true among women, according to experts.

Medicare beneficiaries want to keep the program as it is, according to experts convened by the Center for Medicare Advocacy, who briefed reporters Tuesday on what voters are thinking about as they go into the midterm elections. The experts said the election results could shape the future of the healthcare program that serves nearly 60 million Americans, including those over age 65 and people with disabilities.

“We know healthcare matters to voters,” said Judith Stein, executive director of the Center for Medicare Advocacy. “We know Medicare is a nationally treasured program. But we fear current efforts to privatize Medicare, and longer-term plans to cut and change the program entirely, are flying way below the radar. Our goal is to remind media, voters, and candidates that Medicare matters—to voters of all persuasions throughout the country. We are launching a SaveMedicareNow campaign, to help raise the future of Medicare as a key concern for midterm candidates and voters.”

The campaign will have a website and will be reaching out to candidates to gauge their position on issues related to the future of the program, which was created in 1965. Medicare has been credited with raising the life expectancy of a person 65 years of age from 79.3 years in 1965 to 83.6 years in 2007, and cutting the poverty rate by more than half, from 33% to 14%. Medicare enrollment has climbed steadily from 44 million in 2009 and could reach 80 million by 2030 as the population ages, according to MedPAC. Along with rising numbers, Medicare will serve a rising share of the population, according to Marilyn Moon, an institute fellow at the American Institutes for Research. At present, Medicare serves 20% of the population.

Polling Data Shows Voter Interest

For more than 2 years, polls including the Kaiser Health Tracking Poll have shown that voters are concerned about rising healthcare costs and the cost of prescription drugs in particular. But Tuesday’s briefing included a presentation by well-known Democratic pollster Celinda Lake that showed just how much these issues are on the minds of older voters, particularly women.

Lake said:

• Democrats enjoy a generic ballot advantage of 7.8 points in Congressional races as of September 23, 2018, which, in part, stems from women over age 55 turning more strongly toward the party than they have in in the past.
• 80% of all voters over 65 years of age and 77% of all women over age 55 are “very convinced” of the need to lower prescription drug prices by allowing Medicare to negotiate prices, similar to the Department of Veterans Affairs. Overall, 93% of voters support this idea.
• 73% of all voters over 65 years of age and 73% of all women over age 55 are “very convinced” of the need to ensure that prescription drugs “developed with taxpayers dollars are affordable for every American.” Overall, 92% of voters support this idea.
• When asked to rank a list of healthcare issues in order of importance, 28% of adults selected the cost of health insurance premiums, 26% listed out-of-pocket costs, 15% listed hospital care, and 12% listed prescription drugs. Among those on Medicare, 24% listed out of pocket costs, 18% listed prescription drugs, and 15% listed premiums (Ipsos poll, 1700 adults).
• In the survey of 1700 adults, when asked how worried they were about others not being able to afford prescription drugs, 88% of those age 50 to 64 said they were concerned, and 90% of those age 65 and older said they were concerned. Overall, 87% of Americans across age groups are concerned (Ipsos poll 1700 adults).

Advocates speaking in Tuesday’s briefing said the budget pressures created by the Trump administration tax program have brought to the fore long-term efforts by conservatives to cut Medicare and other safety net programs, even though Medicare in particular is popular with the public. The administration’s budget proposal includes $537 billion in Medicare cuts and loosens rules to allow more versions of private health plans within the system, which the advocates say is occurring just as the administration has pulled back on funding for independent navigators to select a plan that suits their needs.

CMS has also introduced a proposal that would let seniors select Medicare Advantage (MA) plans that allow “step therapy,” which can require patients to go through older, less expensive drugs before they try higher-priced treatments. Oncologists have decried this policy as a “fail first” strategy and say many seniors will select plans based on price and later be diagnosed with cancer and not be able to access the drug their physician recommends.

In the data Lake presented, 86% of respondents age 65 and older supported the statement, “Let doctors decide what to prescribe based in part on how much better the treatment is than an alternative and how much it costs.”

Shift to Medicare Advantage Discussed

Both Moon and Judith Stein, executive director of the Center for Medicare Advocacy, decried what they called CMS’ shifting priorities, which they say give preference to MA and capitated payments to managed care companies at the expense of traditional Medicare. MA expanded rapidly under the Affordable Care Act, from less than one-fourth of beneficiaries a decade ago to more than one-third today, as programs offered bonuses for quality improvement and more flexibility to provide benefits not provided under traditional Medicare.

Moon said the current shift will be even more confusing for seniors because there will be fewer clear distinctions between plans, and seniors may end up with increased cost sharing. Letting seniors shop around “is great if you’re talking about groceries—it’s not so great if you’re talking about life-saving treatment.”

Today, Stein said, Medicare retains its core features as a defined benefit program without lifetime limits. But that future is in jeopardy: proposals floated by House Speaker Paul Ryan, (R-Wisconsin) include “premium support,” essentially a voucher program that would give every senior a set amount to spend on insurance in the private market. “This is what privatization is really all about—giving beneficiaries an allowance and saying, ‘good luck, you’re on your own.’”

In an April 2018 statement, CMS detailed its 2019 MA and Part D Rate Announcement and Call Letter, which outlined plans for employer groups, for methods to address the opioid crisis and which allowed MA plans to offer “targeted cost sharing and supplemental benefits for specific enrollee populations based on health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly. This flexibility helps [MA] plans better manage health care services.”

However, the advocates say that CMS is slowly giving MA plans an advantage over traditional Medicare, while creating so many different options within MA that beneficiaries will have a hard time understanding the differences.

While Moon acknowledged there are some cutting edge MA plans that are doing great work—such as CareMore Health’s initiatives that address loneliness and use Medicare dollars to pay for rides with Lyft—she said most beneficiaries cannot access these kinds of plans. For many people who are eyeing open enrollment next month, “These are tough choices for individuals, and there’s not much evidence that they are very good at it,” Moon said.

A 2010 study by Polinski et al found that beneficiaries had a tough time in the early years of the Medicare Part D program understanding how to select the lowest-cost plan and how to navigate the low-income subsidy even if they qualified for it. A 2017 study by Han and Urmie found that Part D beneficiaries tend not to switch plans “despite the government’s best efforts to engage beneficiaries in the plan switching process,” and that “knowledge about alternative plans was especially poor.”

“If only 13% of people in those plans are switching every year, that means that the competition between plans isn’t as great as it could be and that’s one of the reasons why these plans are not achieving the cost savings that proponents of private Medicare plans would have you believe,” said Dan Adcock, director of Government Relations and Policy, National Committee to Preserve Social Security and Medicare.

Moon said Medicare needs more revenue support. not less. But she acknowledged that any discussion of taxes causes “heartburn” in Washington, DC.

Open enrollment for Medicare for 2019 begins October 15, 2018, and runs through December 7, 2018.