Medicare Advantage advocacy groups are concerned the Biden Administration’s Build Back Better reconciliation bill will, in expanding Medicare fee-for-service (FFS), disadvantage MA.
Advocacy and research group Better Medicare Alliance (BMA) on Wednesday hosted Reps. Brett Guthrie (R-Ky.) and Terri Sewell (D-Al.) to discuss the legislation further, and implications for the Part C plan under Build Back Better. Conversations with the representatives were pre-recorded.
“There’s well over 100 [members], which is a majority of the members of the Democratic Party who voted for, who have co-sponsored Medicare for all, which isn’t Medicare Advantage for all, it’s fee-for-service Medicare for all, which essentially eliminates Medicare Advantage,” said Rep. Guthrie.
MA plans are offered by Medicare-approved private companies, subsidized by the federal government. Under fee-for-service Medicare, or traditional Medicare, the government pays directly per health service.
Medicare Advantage covers up to 100 days of care in a skilled nursing facility, and most services in long-term care.
Build Back Better would expand Medicare FFS coverage to include vision, hearing and dental needs, something that is only found in MA plans for Medicare beneficiaries.
“We’re not opposed to adding new benefits in fee-for-service Medicare, but there’s particular interest in ensuring that it’s not paid on the backs of Medicare Advantage beneficiaries,” said Mary Beth Donahue, president and CEO of BMA during the session.
While Congress finalizes the package, Rep. Guthrie considers how FFS expansion could double dip into what makes MA plans unique to beneficiaries.
“I’m not sure what the final package is going to look like,” added Guthrie. “Medicare Advantage isn’t specifically disadvantaged in the bill, but by adding to the fee for service, the way the benchmark system works for the benefits to fee for service can disadvantage Medicare Advantage.”
Sewell said her senior constituents get their vision and dental services through MA plans. Instead of doing an “across the board haircut” to various services in the reconciliation bill, representatives should focus on four or five things and do them really well.
The Selma, Ala., native said her areas of focus would be to primarily close the Medicaid gap and expand access to vision and dental through Medicare, but she was not invited to Washington to rewrite or finalize the bill.
“I’m not in the room, I’m one of the centrists who will be voting for the bill,” added Sewell of her involvement in Build Back Better.
Guthrie pointed to the Democratic Party’s shift in tone on Medicare Part D, used as private health insurance to provide prescription drugs, in discussing possible fallout from Build Back Better: the bill disadvantages Part D in order to “fit a broad philosophy” to expand Medicare FFS.
A key provision of Build Back Better permits Medicare to negotiate drug prices with pharmaceutical companies, potentially saving the government billions of dollars every year, according to a report from CNBC — likely to be left on the cutting room floor.
Widely assumed to be a “cherry-picked” insurance plan for the upper middle class, MA’s services help the chronically ill, low-income population, something Medicare FFS “is just not set up to do,” explained Guthrie.
Allison Rizer, principal at ATI Advisory and panelist on another BMA session Wednesday, presented data showing a higher percentage of low-income Medicare beneficiaries use MA as opposed to FFS across white, black and latinx populations.
“More than half of enrollees in Medicare Advantage are below 200% of the federal poverty level — what we would refer to as low income, meaning they’re earning less than $24,000 a year,” said Rizer.
CMMI Plans for the Next Decade
Since March, the Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI) has been exploring a “strategic refresh” in order to chart a course for the next decade, CMMI Chief Strategy Officer Rawal said during another MA Summit conversation with Better Medicare Alliance (BMA).
“The goal that they’ve laid out at a very high level is for us to keep the ball on broad system transformation,” added Rawal. “When the Innovation Center was established, over 50 models had been launched, lots of seeds planted, and lots of lessons have been learned. [CMS has] looked critically at the portfolio.”
Rawal said CMMI is reigniting a sense of inevitability around value-based care as part of its “strategy refresh,’ accelerating momentum toward this model.
Other efforts include a push for accountable care, advance health equity, supporting innovation when new models are put into practice, focus on affordability, and transforming health systems, explained Rawal. These “pillars,” as Rawal puts it, were initially released in an August blog post.
On MA, Rawal recognized that enrollment in the plans almost doubled from 2010 to 2020, and is expected to make up more than half of Medicare beneficiaries by 2030. CMMI will continue to test different kinds of “programmatic flexibilities” with MA plans to reduce program expenditures and improve beneficiary quality.
“Enrollment increases in MA have been concentrated among dual-eligible beneficiaries. Black beneficiaries, Hispanic beneficiaries and individuals under certain geographic areas. These are all data points from the marketplace that we are looking at to inform our own efforts,” said Rawal. “To date, CMMI has been focused on testing flexibilities and how MA benefits are provided through the value-based insurance design, or the VBID model, which tests a broader array of MA health plan innovations.”
VBID has grown from 45 plans in 2017 to more than 1,000 for 2022, Rawal said.
During her conversation with BMA, Rep. Sewell said CMMI needs to be more transparent in how it waives certain Medicare and Medicaid rules to test new health plan approaches, and the actual testing of said plans.
“Requesting that [CMMI] have more transparency in their process and greater reliance on the use of present data to immediately understand the impact of the models on healthcare providers and patients, I think it’s something that’s really important,” said Sewell.
Added Sewell: “There’s a real opportunity here to test different models, but I think that we have to be transparent.”
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