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Medicare evolution overdue? – Press Telegram

Kaiser Health News by Julie Robner

Excuse me, Joe Namath. Despite what you continue to say in these television ads, under Medicare, older people “eliminate out-of-pocket costs, dental care, dentures, eyeglasses, prescription drug compensation, home assistance, unlimited transportation, And you do not have the right to receive home delivery meals at no additional cost. “

But if Congressional Democrats give way, older people can quickly qualify for some of those services.

Namath commercials tout private Medicare Advantage plans, which often offer benefits not found in traditional Medicare, in exchange for being limited to specific doctors and hospitals.

“Traditional” Medicare does not cover many of the benefits that beneficiaries use overwhelmingly, such as most visual, dental and hearing care. Also, the medication cover is only available by purchasing another insurance plan, Medicare Apartment D.

But Democrats in the House and Senate are trying to change that. In August, Senate leader Chuck Schumer released an overview of the upcoming budget, including a directive to the Senate Finance Committee to expand Medicare “to include dental, visual and auditory benefits.”

Catch — All Democrats in the Senate and almost every Democrat in the House need to agree on the entire budget for it to become a law, updating Medicaid and Medicare plans as of mid-September. A $ 3.5 billion plan was expected and probably needs to be trimmed.

The expansion of benefits is rare

Still, it raises the question about Medicare: why did it take so long to add such apparently necessary benefits?

As with almost everything related to the US healthcare system, the answer is complex, a combination of policy and politics.

“Medicare is a type of program where you can expect the benefits to grow over and over again. Jonathan Overlander, a professor of health policy at the University of North Carolina at Chapel Hill and author of the book The Political Life of Medicare. States:

“This is one of the big puzzles in Medicare politics. Why is profit growth so rare,” he added.

In fact, in the 56 years since Medicare was enacted, the benefits added to the package created to emulate the 1965 Blue Cross / Blue Shield project are negligible.

From the 1980s to the 90s, preventive care such as pneumonia vaccines and mammograms was added.

The Republican Party led the addition of prescription drug coverage in 2003, when it dominated both Congress and the White House. However, they decided to set the coverage separate from the program’s traditional benefits.

Other efforts to increase profits have not been very successful. In 1988, a bipartisan effort in Parliament enacted the Medicare Catastrophic Compensation Act. This adds drug compensation to traditional Medicare and closes the hole. Target service.

However, the law was abolished just a year after rebelling against older people being required to bear most of the new benefits through a new income “additional tax.”

Even today, Medicare beneficiaries face the risk of unlimited costs.

Medicare is funded by a combination of money paid directly to the government from salaries and taxes paid by working Americans and their employers. That leads to another major reason why Medicare’s benefits packages aren’t being enhanced anymore: the cost of the current program.

“When Medicare was created, the architect envisioned expansion in terms of both population and subsequent profits,” Overlander said.

“They didn’t expect American politics to shift to the right, and Medicare was seen as a financial problem, avoiding the next shortage of trust funds rather than policymakers expanding profits. I didn’t expect it to be of interest. “

In fact, in the 1980s and 1990s, Medicare spending was often restrained rather than expanded. A series of budget adjustment bills have saved millions of dollars from Medicare, typically at the expense of payments to doctors, hospitals and other healthcare providers.

Origin of Medicare Advantage Plan

Over the years, Medicare has remained popular, but less generous than most private insurance policies.

However, many Medicare patients provide supplementary coverage to fill what Medicare does not cover through a private “Medicare” policy, employer-provided retirement plans, or Medicaid for low-income earners. I was able to find it.

Increasingly popular in recent years is the Medicare Managed Care Plan, now known as Medicare Advantage, which was first approved in 1982 and often offers additional benefits to its members.

All of this “removed some of the pressure” on lawmakers to expand the program, Overlander said. And the last reason visual, auditory, and dental treatments aren’t added to standard Medicare is that they are far from the most critical gaps in Medicare benefits.

For example, Medicare does not cover long-term care. This is a type of non-nursing personal care that supports activities of daily living such as bathing, changing clothes, eating, and getting in and out of beds and chairs. Bathroom and meal preparation.

Long-term care is very expensive ($ 50,000 to over $ 100,000 per year) and tends to be needed by many beneficiaries, especially after the age of 80. Years of effort to create government long-term care benefits have been largely unsuccessful.

The very limited program, CLASS Act, was part of the 2010 Affordable Care Act, but was deprecated before it came into effect because it was considered underfunded.

Current impetus for updating Medicare

President Joe Biden has asked Congress to include billions of dollars in long-term care in the infrastructure package that the Democratic Party is working on this fall.

Also, as mentioned earlier, traditional Medicare does not limit the patient’s share of costs, that is, the proportion or amount of medical costs that the beneficiary must pay. Its basic hospital benefits disappear after 90 days, and 20% of outpatient co-insurance (patient-responsible percentage) is indefinitely implemented.

So why are front burner dental, visual, and auditory coverage now, when lawmakers are considering strengthening the program?

Some may be self-serving for lawmakers whose mission is to allocate funds. All three benefits are ” [adding] The Nursing Home report was said by Overlander.

But the big part is politics. In the course of the campaign, Biden has promised to reduce Medicare’s eligible age from 65 to 60.

Supporters of “Medicare for all”, such as Senate Budget Committee Chairman Bernie Sanders (I-Vt.), Promised to try the same, and lowering the qualification age was an option in the Senate. Included in Schumer’s overview shared with the Democratic Party.

However, lowering the qualification age is strongly opposed by hospitals and other healthcare providers. Hospitals and other health care providers are afraid to lose money if those who currently have high-value private insurance have Medicare instead. It makes profit growth a much easier choice for Congress.

I’m not saying it will happen. The Congressional Budget Office said the sight, hearing, and dental benefits contained in the bill passed by the House of Representatives in 2019 would cost an estimated $ 358 billion over a decade. But this is the closest thing to the profits that have been enacted since the inauguration of Medicare.

Julie Rovner, a Washington correspondent at Kaiser Health News, has been dealing with medical politics and policy for over 30 years. Kaiser Health News is a national news room that produces detailed journalism on health issues. KHN has nothing to do with Kaiser Permanente.

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