Is the evolution of health insurance behind schedule? – Press telegram

Kaiser Health News by Julie Robner

Excuse me, Joe Namath. Despite what you keep saying in those TV commercials, under Medicare, seniors are “eliminating out-of-pocket expenses, dental care, dentures, eyeglasses, prescription drug benefits, home help, unlimited transportation, And you are not entitled to receive meals at home at no additional cost. “

But if Congress Democrats give in, seniors can quickly take advantage of some of these services.

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

“Traditional” health insurance does not cover many of the benefits that beneficiaries use overwhelmingly, such as most eye, dental and hearing care. Additionally, drug coverage 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, vision and hearing benefits.”

Catch – All Senate Democrats and nearly all House Democrats must agree on the entire budget for it to become law, updating Medicaid and Medicare plans from mid-September . A $ 3.5 billion plan was expected and likely needs to be trimmed.

Expansion of benefits is rare

Nonetheless, this raises the question of Medicare: why has it taken so long to add seemingly necessary benefits?

As with almost everything about the American health care system, the answer is complex, a combination of politics and politics.

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

“This is one of the great puzzles of Medicare policy. Why is earnings growth so rare, ”he added.

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

From the 1980s to the 1990s, preventative care such as pneumonia vaccines and mammograms were 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 separate the coverage from the traditional benefits of the program.

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 it rebelled against requiring older people to bear most of the new benefits through a new “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 wages and taxes paid by American workers and their employers. This leads to another major reason why Medicare benefit packages are no longer enhanced: the cost of the current program.

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

“They didn’t expect US policy to shift to the right, and Medicare was seen as a financial problem, avoiding the next shortage of trust funds rather than policymakers increasing their profits. I didn’t expect it to be interesting. “

In fact, in the 1980s and 1990s, spending on health insurance was often restricted rather than increased. A series of budget adjustment bills saved Medicare millions of dollars, usually at the expense of payments to doctors, hospitals and other health care providers.

Origin of Medicare Advantage

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

However, many Medicare patients offer additional coverage to cover what Medicare does not cover through a private “Medicare” policy, employer-provided pension plans, or Medicaid for low-income people. 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 “took some of the pressure” on lawmakers to expand the program, Overlander said. And the final reason why vision, hearing, 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. It is a type of non-nursing personal care that supports activities of daily living such as bathing, changing clothes, eating, and getting up and out of bed 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 recipients, especially after the age of 80. Years of efforts to create government long-term care benefits have been largely unsuccessful.

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

Current momentum for updating Medicare

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

Moreover, as mentioned earlier, traditional health insurance does not limit the patient’s share of costs, i.e. the proportion or amount of medical costs that the beneficiary has to pay. Its basic hospital services disappear after 90 days, and 20% of the outpatient co-insurance (patient-responsible percentage) is put in place indefinitely.

So why is leading dental, vision and hearing coverage now, as lawmakers consider stepping up the program?

Some may be selfish to lawmakers whose job it is to allocate funds. The three advantages are ” [adding] The nursing home report was told by Overlander.

But the big part is political. During the campaign, Biden pledged to reduce the Medicare eligible age from 65 to 60.

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

However, lowering the age of admission is strongly contested by hospitals and other health care providers. Hospitals and other health care providers fear losing money if those who currently have high-value private insurance have Medicare instead. This makes profit growth a much easier choice for Congress.

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

Julie Rovner, Washington correspondent at Kaiser Health News, has been involved in medical policy and policy for more than 30 years. Kaiser Health News is a national newsroom that produces in-depth journalism on health issues. KHN has nothing to do with Kaiser Permanente.

Is the evolution of health insurance behind schedule? – Telegram Press Source link Is the evolution of Medicare lagging behind? – Press telegram

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