Saving Medicare: watching our back while looking forwards

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Saving Medicare watching our back while
looking forwards

• Laura S. Boylan, MD
• Assistant Professor of Neurology
• Bellevue Hospital Center,
• New York University School of Medicine

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Medicare Prescription Drug Improvement and
Modernization Act of 2003
"With the Medicare Act of 2003, our government is
finally bringing prescription drug coverage to
the seniors of America.  With this law, we're
giving older Americans better choices and more
control over their health care, so they can
receive the modern medical care they
deserve...Our nation has the best health care
system in the world. President George W. Bush,
White House Press Release, 12/08/2003
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Top 3 things you dont know about MMA 2003 that
can hurt you.

• Means testing
• The 45 cap
• Medicare Advantage

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Means Testing

• 1/1/2006, Higher Part B premiums for those
  earning over 80K.
• For individuals with incomes over 200,000, the
  premium, now 88.50 a month, is expected to
  quadruple by 2009
• More generous Part D benefit for low income
  seniors

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45
Tax on SS benefits
General Revenue accounts for 75 of SMI but less
than 45 of total support for Medicare. MMA 2003
caps General Revenue at 45 of total
expenditures. Since Part D largely expanded SMI
it accelerates the arrival of the cap. The cap
will lead to increased premiums and/or decreased
benefits. Joint Economic Committee May 2006
Economic Fact Sheet, highlights of MCR trustees
report
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Medicare BasicsMedicare You 2007, CMMS
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Medicare Advantage Plans

• Private plans
• Cost on average 11 more per beneficiary than
  traditional medicare despite selective enrollment
  of the healthy
• Annual additional cost of 5.4 Billion dollars

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Key Events in Medicare Privatization

• Medicare enacted 1965
• Limited private plan offerings 1966-1985
• Medicare risk (HMO) authorized 1982
• Medicare Choice program adopted, 1997
• Balanced Budget Act
• Balanced Budget Refinement Act 1999
• health adjusts HMO payments
• Medicare Modernization Act 2003

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www.whitehouse.gov
reimbursements, Plans withdraw
MMA 2003
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Misc Pet Peeves

• With MMA Medicaid/Medicare dual-eligibles lost
  Medicaid Rx coverage and were forced into Part D
• Part D plans can negotiate with drug
  manufacturers, but they need not pass on their
  savings to beneficiaries
• The joy of Choice/the fear of Bamboozle

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Looking Forwards Role of Private Health
Insurance

• Budget busting has been acceptable if it supports
  privatization
• Cost effectiveness and equity of traditional
  Medicare over private insurance has been
  demonstrated
• Importance of one risk pool, universal buy in
• If taxpayers will pick up the tab for the sickest
  and poorest, lets pick up the revenues from the
  healthier and wealthier