The following is a guest blog post by Trudy Lieberman, who has specialized in health policy and health care reform news coverage throughout much of her career.
Sellers of Medicare Advantage (MA) plans couldn’t have asked for a better result in their latest quest for higher government payments. In February, Medicare announced plans to hit these companies with a proposed 0.95 percent cut in payments. And yet by April — thanks to a concerted lobbying campaign by insurers and their allies — these companies instead were celebrating a 1.25 percent increase.
This is the third time in the last two years that a proposed cut has turned into an increase, even though President Obama came to office vowing to cut the government’s excessive payments to these plans. (It was costing Medicare more to provide benefits under these Advantage arrangements than under the traditional program.) What’s more, there was almost no media scrutiny of the insurers’ campaign for payment increases to get in the way. Our Internet searches turned up almost no coverage of the extensive lobbying that went on or what the changes will mean for people on Medicare.
It’s worth repeating: There was virtually no press oversight of an important health policy issue that affects millions of Americans. Contrast this with the gobs of coverage drug companies get whenever they have a new drug to sell.
Why the difference? The fact that health policy is wonky stuff and new drugs offer hope may be one explanation. Another may be a belief—mistaken in my view—that the public is not interested. Every time I write about the government’s inability to negotiate the prices of drugs it pays for under the Medicare program, readers always ask why. The why behind the Medicare Advantage rate increases is a story about the power of special interest lobbying, unkept presidential promises, and what Medicare will look like in the future. That’s more than enough to qualify as legitimate health journalism in my book.
There were plenty of news releases from America’s Health Insurance Plans (AHIP), the insurers’ trade group, calling attention to the battle over payments. And a newcomer lobbying outfit, the Better Medicare Alliance, also got into the act with a slew of media announcements extolling the benefits of MA plans and calling for a reversal of proposed cuts. And yet the media by and large ignored the story. One exception was a Washington Post op-ed which told of the debut of the Better Medicare Alliance and reported that as of mid-March, the group “has elicited the obligatory letter from 239 members of Congress, from both parties, telling HHS of their ‘serious concern’ over the ‘significant threat to the health and financial security of seniors in our congressional districts.’”
Unlike drug manufacturers, which have a keen interest in reaching ordinary Joes who will demand their products, the insurance companies targeted their campaign squarely at members of Congress. While Congress doesn’t set Medicare payment rates, the Centers for Medicare and Medicaid Services (which does set them) listens to Congress attentively. Over the past few years, lobbying efforts to stop MA cuts have included “grassroots lobbyists” sending mail or calling members of Congress. This year AHIP, as it has done in the past, ginned up its Coalition for Medicare Choices, a group with some two million members, to call or write to members of Congress voicing concern over cuts. Ads from the Better Medicare Alliance strategically placed on the Politico website also made the case to the policymakers who visit the site. And there were TV commercials and stories from satisfied beneficiaries to share with Congress. Fred Schulte, who has been revealing how Medicare Advantage plans have been upcoding their bills to enhance their bottom lines, noted in a recent piece that this year’s lobbying for higher reimbursements featured a food truck in Washington offering coffee and cookies to those who stopped by, including Senators Orrin Hatch and Mark Warner.
One of the few outlets that did devote some coverage to the story ended up treating it in a superficial, slanted way. The Honolulu Star-Advertiser (login required) led with the news that seniors covered by MA plans could face premium increases and lower benefits under the government’s proposal to cut reimbursements to the plans. As evidence, it cited a study by Oliver Wyman, a consulting firm that has worked for AHIP on this study and others. The company’s relationship to the insurers was not disclosed. Other evidence of the need for an increase was pulled from an AHIP press release. The brief story noted AHIP’s grassroots campaign “to urge policymakers to protect Medicare Advantage from proposed cuts that could affect their coverage.” Where’s the other side, other studies, other spokespeople? Will people really lose benefits? Where’s the real reporting? There wasn’t any. Instead, readers got the health policy equivalent of a cheerleading, one-sided puff piece that hypes benefits and ignores the harms of a new drug or device — the kind of weak health reporting that reviewers at HealthNewsReview.org have been skewering for years.
While the press seems to be snoozing when it comes to Medicare, some members of Congress are waiting in the wings for the right time to make what they call “structural” changes to the program. Such changes could transform the program from social insurance to a more privatized arrangement similar to the Affordable Care Act. Seniors would get a government subsidy euphemistically called “premium support” that they could use to buy insurance in the private market. If they wanted more coverage than the subsidy covered, they’d have to pay the difference. In a year-end interview with Politico, Rep. Paul Ryan, who chairs the House Ways and Means Committee, dropped a big hint: “the best days are yet ahead on comprehensive Medicare reform and premium support. It’s an idea whose time is coming.”
About the same time that Medicare announced this year’s rate increase to MA plans, the House passed legislation that fixed the doctors’ payment formula and also began to change Medicare. (The Senate later passed similar legislation.) Five years from now, no one eligible for Medicare will be able to buy coverage under a Medigap policy for Medicare’s Part B deductible which applies to physician and out-patient services. The pols and policymakers, it seems, want old people and those with disabilities to pay more of the cost for their care—to have more skin in the game. There hasn’t been much media coverage of that story, either.