By Mary Johnson
Analysts say that deeper Medicare cuts may be back on the table by the end of the year. One of the most controversial proposals would convert Medicare into a system called “premium support.” Under the proposal, the government would allocate a fixed amount of money for Medicare beneficiaries’ premiums; and people would then purchase coverage from private health plans that would provide all their care.
Last year a premium support plan that passed in the House prompted a firestorm of opposition from seniors and critics concerned that the plan cut federal spending too much — shifting too great a portion of costs -- and would make Medicare unaffordable for beneficiaries. But premium support itself is nothing new, nor would it “end Medicare as we know it.” To the contrary, seniors already know it, and like it. Medicare operates two premium support programs — Medicare Part D, and Medicare Advantage.
Premium support by itself is no shoo-in for cutting federal spending. In fact, the track record is pretty messy. The costs for Medicare Part D have been lower than originally projected. Competition between Part D drug plans seems to be working, for now, to keep costs down both for the government and for some seniors — particularly those who carefully shop and compare drug plans each year.
Medicare Advantage, and its predecessor Medicare+Choice —both known as Medicare Part “C” — however, has no clear track record of saving the government money. In fact, for a number of years, Medicare Advantage cost more than traditional Medicare.
Medicare first began offering beneficiaries the chance to enroll in private Medicare HMOs’ in the mid 1980’s. That program was absorbed and expanded under the 1997 Balanced Budget Act, creating Medicare+Choice. To cut federal spending on Medicare, the Balanced Budget Act set payments to the private plans at 5% below the fee-for-service rates of traditional Medicare. But by 1999, Medicare+Choice plans were not renewing their contracts with Medicare and there was a widespread exodus, leaving more than 2 million seniors scrambling to find other coverage.
A few years later, under 2003 Medicare drug legislation, funding for private plans was significantly boosted and the program got rebranded as “Medicare Advantage.” Enrollment grew steadily and rapidly ever since. But by 2009, government economists reported that the payments to the plans cost the federal government 14 percent more than the same services would have cost under traditional Medicare.
Payments to the plans were cut $136 billion over 10 years under 2010 healthcare reform legislation. So far the program has remained relatively stable and continues to grow in enrollment.
While Part D and Medicare Advantage have proven popular with seniors, nobody is lining up at the doors during the fall Open Enrollment to shop for and compare plans. The vast majority of beneficiaries, more than 80% according to TSCL Senior Surveys, don’t compare their Part D or Medicare Advantage plan, and consequently don’t reap any savings from competition between plans. If Congress were to convert all of Medicare to premium support in the future, the devil will be in the funding details — finding the balance between saving the federal government money while still keeping the program affordable for beneficiaries. And so far premium support hasn’t been any magic bullet for reducing federal spending on Medicare.
Source: The Federal Government’s Long-Term Fiscal Outlook, Government Accountability Office, October 2011. “Monitoring Medicare+Choice, What Have We Learned?” Mathematica Policy Research, Inc., August, 2004.
