Latest News on the Medicare Advantage Program

New Medicare privatization scheme raises alarm bells

There is good and bad news about the ongoing research into Joe Biden’s administration of the Direct Contracting Entity (DCE) program, also known as ACO REACH. The bad news is that the idea remains a threat to the health of the elderly and an alarming Trojan horse that could lead to the privatization of Medicare. The good news is that resistance to it is starting to gain strength.

Late last month, Seattle City Council unanimously passed a resolution “to stop privatizing the U.S. Medicare system.” The resolution, which warns that the implementation of the DCE pilot program “opened the door to the full privatization of Medicare” and urges the resolution of equity issues “within the traditional Medicare system,” was introduced by Councilwoman Teresa Mosqueda , which is far from a radical.

Three days earlier, the Arizona Medical Association (ArMA), the four-member American Medical Association (AMA) chapter of the state, passed a similar resolution in its House of Representatives, calling for the program was “terminated” and warned. that older people could find themselves in a money-making system that “limits attention to provide maximum benefit.” The ArMA, which has previously voted against a resolution supporting a single-payer healthcare system, also based its opposition on concerns about doctors, noting that they could end up enrolled in the program without choosing to be one.

It’s a good sign for DCE opponents, for whom half the battle has involved simply alerting people to its existence. Although the controversial program began under Donald Trump, the Biden administration has continued it in silence, with late opposition earlier this year forcing the Centers for Medicare and Medicaid Services (CMS) to change. lo as “ACO REACH”, but fundamentally nothing has changed. about the actual program or what caused that scream in the first place. Meanwhile, seniors continue to receive an email informing them that their doctor is now part of the pilot program, but don’t worry, because their Medicare benefits haven’t changed.

But this is not true. The closest comparison to ACO REACH is the Medicare Advantage program that played a role for private insurers in the public health insurance program. But while Medicare Advantage enrollees have the option to abandon traditional Medicare, ACO REACH is specifically aimed at seniors who have refused to do so.

Then, whether they like it or not, a for-profit third party such as a health insurer or private equity firm can step in and receive Medicare payment to manage the care they receive, taking whatever benefit they can. Do not spend on the patient. Critics have warned that beyond taking the unthinkable step of partially privatizing all Medicare, CMS has made it clear that it now wants to switch everyone from traditional Medicare to a relationship with a “responsible care organization” or ACO, by 2030. , the idea is ripe for abuse.

Just look at the Medicare Advantage history to see what that means. Just two weeks ago, the Inspector General of the Department of Health and Human Services issued a scathing report on Medicare Advantage plans, accusing that there were “widespread and persistent problems with denials of services and inadequate payments.” involved denying. services that would have been approved under traditional Medicare in 13% of cases and denying 18% of reimbursements that complied with Medicare and Medicare Advantage rules.

Therefore, the continued existence of ACO REACH is a serious threat to Medicare as we know it and to the elderly themselves. And, in a sadly typical trend, he’s a Democratic president trying to get away with his Medicare elimination, something a Republican could never expect to get away with.

But resolutions passed by Seattle City Council and ArMA suggest that opposition to the program is being built not only at the federal level but also at the local level. It’s a good start, but it will take much longer to defeat him once and for all.

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