Higher payment to MA plans, coupled with MA-only coverage expansions and enrollment advantages, continue to drive higher enrollment in MA plans and exacerbate the differences between MA and traditional Medicare. As discussed below, recent projections by the Congressional Budget Office (CBO) show that Medicare Advantage will cost the Medicare program even more than previously thought. As pressure grows on the federal budget – and Medicare specifically – indiscriminate cuts to the program would inevitably harm beneficiaries. A recent Health Affairs Blog by researcher Dr. Ricard Kronick outlines a policy change Congress can enact that would both rein in wasteful payments to MA plans and help level the playing field between MA and traditional Medicare.
Congressional Budget Office Points to Medicare Advantage for Increased Spending Projections
On January 28, 2020, the Congressional Budget Office (CBO) released a report entitled The Budget and Economic Outlook: 2020 to 2030 in which it “provides detailed projections of the federal budget and the U.S. economy under current law for this year and the decade that follows as well as projections for the following two decades.”[1]
Among other findings, the Report notes that mandatory federal spending, including Medicare, will be higher than previously projected, primarily due to the “aging of the population and the rising costs of health care.”[2]
CBO explains the projected increases in its estimated mandatory outlays for the Medicare program in 2020 and beyond:
Several factors led CBO to increase its estimate of Medicare spending
in 2020. First, actual net outlays for Medicare in 2019 exceeded CBO’s
projection for the year by about $8 billion (or 1.3 percent); higher spending for Medicare Advantage
(MA) accounts for most of that difference. Second, in August
2019, CBO increased its projection of outlays for MA only for 2019 because at
the time, the agency thought that the higher-than-expected spending was driven
by one-time payments that would not affect spending in future years. On the basis
of additional spending data, CBO
now anticipates that spending for MA will be higher than previously projected
in 2020 and later years. Third, the increase in MA payment rates in 2020 that was announced
earlier this year was larger than CBO had projected. Finally, CBO now expects that, on average, MA
beneficiaries will be coded as being in poorer health than the agency
previously anticipated.[3]
Medicare in the Crosshairs
The CBO Report will likely intensify cries to cut Medicare, Medicaid and Social Security – a long-standing goal of some policymakers. As noted by the New York Times, President Trump recently suggested that he “would be willing to consider cuts to social safety-net programs like Medicare to reduce the federal deficit if he wins a second term, an apparent shift from his 2016 campaign promise to protect funding for such entitlements.”[4]
As noted by the Washington Post, “[t]he CBO projection […] appears to cast doubt on recent statements by President Trump and other administration officials that the 2017 Republican tax cut is creating enough revenue through new economic growth that it will offset all near-term losses.”[5] In fact, it was clear during the debate leading to the passage of the 2017 tax cut bill that the resulting increase in the national deficit would inevitably lead to calls to cut Medicare, Medicaid and Social Security.[6]
Rather than indiscriminate cuts to the Medicare program that would inevitably harm beneficiaries, there are ways to reduce wasteful spending on private MA plans that would also serve to foster greater equity between traditional Medicare and Medicare Advantage. Reforming the way that MA plans are paid is an avenue that should be explored in any discussion of Medicare reform.
Health Affairs Blog Outlines Proposal to Level the Playing Field
In a recent Health Affairs Blog post entitled “Why Medicare Advantage Plans Are Being Overpaid By $200 Billion And What To Do About It", Dr. Richard Kronick outlines how to bring MA payment more in line with other providers by implementing a statutory formula for measuring coding intensity relating to risk adjusted payments.[7]
Current methods used to determine payment to MA plans employ a “coding intensity adjustment” used “to adjust for differences in patterns of diagnosis coding between MA and traditional Medicare.” Dr. Kronick notes that “under reasonable assumptions about the rate of growth of MA coding, CMS will overpay MA plans by $200 billion over the next decade if the coding intensity adjustment remains at 5.91 percent, its current level.”[8]
Dr. Kronick explains:
Why does this overpayment persist? The annual decision about the
size of the coding intensity adjustment is made by political appointees at CMS,
the Department of Health and Human Services, and the White House, and the political
benefits from implementing a smaller than empirically justified coding
intensity adjustment far outweigh the potential political gains from protecting
the taxpayers and creating a stable and level playing field between MA and
traditional Medicare. To fix this problem, Congress should remove discretion from CMS and specify in
statute an even-handed method of computing coding intensity. A statutory
formula for measuring coding intensity would bring MA payment more in line with
payment for other providers, in which Congress, not CMS, decides how much
providers will be paid.[9]
Conclusion
Medicare Advantage payment rates for the coming year are released early in the prior year. As of this writing, the 2021 rates are imminent. Release of this information coincides with the annual ritual of the insurance industry rounding up support on Capitol Hill for the MA program and loudly protesting any reductions in MA payment rates. We expect to see yet another letter signed by hundreds of members of Congress saying, essentially, “don’t touch a dime of Medicare Advantage money.”
As discussed in the Center’s 2019 Alert regarding the proposed 2020 payment rates:
Despite coding practices that can inflate payment to MA plans,
many policymakers continue to promote the MA program without regard to growing
inequity between MA and traditional Medicare. For example, every year, CMS
issues a draft Call Letter which includes proposed policy changes and payment
rates for Part C Medicare Advantage and Part D plans for the following calendar
year. Every year, the insurance industry gathers support in Congress to ensure
that MA plans receive steady payment.
_____________
[1] CBO Report, p. 1.
[2] CBO Report, p. 2; also see pp. 16-17.
[3] CBO Report, pp. 70-71; emphasis added; footnote omitted.
[4]“Trump Opens Door to Cuts to Medicare and Other Entitlement Programs” by Alan Rappeport and Maggie Haberman, New York Times (Jan. 22, 2020), available at: https://www.nytimes.com/2020/01/22/us/politics/medicare-trump.html ; also see, e.g., Washington Post at: https://www.washingtonpost.com/business/2020/01/22/trump-appears-open-overhauling-social-security-medicare-break-2016-campaign/ and Los Angeles Times https://www.latimes.com/business/story/2020-01-23/trump-social-security.
[5]“U.S. deficit to eclipse $1 trillion in 2020, CBO says, as fiscal imbalance continues to widen” by Jeff Stein, Washington Post (Jan. 28, 2020): https://www.washingtonpost.com/business/2020/01/28/us-deficit-eclipse-1-trillion-2020-cbo-says-fiscal-imbalance-continues-widen/
[6] See, e.g., “More than 40 Organizations Join Together in Opposition to Senate’s Tax Cuts & Jobs Act” joint press release by Center for Medicare Advocacy, Justice in Aging and Medicare Rights Center (Nov. 28, 2017), available at: https://www.medicareadvocacy.org/more-than-40-organizations-join-together-in-opposition-to-senates-tax-cuts-jobs-act/.
[7] “Why Medicare Advantage Plans Are Being Overpaid By $200 Billion And What To Do About It" Health Affairs Blog, January 29, 2020. DOI: 10.1377/hblog20200127.293799.
[8] Note: hyperlink to earlier study by Dr. Kronick in quoted text removed.
[9] Emphasis added.
[10] Emphasis added.
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