The NRLN Review provides a monthly report on National Retiree Legislative Network actions, events in Congress and important retirement news.
Wall Street Is Moving to Takeover Medicare
NRLN announced on January 7 the release of Series 2, Episode 1 of a video podcast that focuses on Wall Street moving to takeover Medicare. The presentation is on the NRLN website at www.nrln.org.
“The video was created to sound the alarm that the Centers for Medicare and Medicaid Services has produced Direct Contracting and Direct Contracting Entities, the latest major threat to Medicare,” said Bill Kadereit, NRLN President.
Kadereit is the host for the video podcast which includes dialogue with Diane Archer, founder and President of Just Care USA and a health policy expert; Jim Bodenner, President of the NRLN Villages Chapter, and Ed Beltram, NRLN Vice President – Communications.
Kadereit cited a 2018 quote from American business magnate Warren Buffett, “The ballooning costs of health care acts as a hungry tapeworm on the American Economy.”
“That tapeworm has morphed into a piranha called privatization of Medicare,” Kadereit said. “Medicare Advantage has not reduced health care costs and Direct Contracting may be an even bigger disaster.”
NRLN Requested Information on DCEs from NRLN Members
On January 12, NRLN President Bill Kadereit sent an email to all NRLN members in Arizona, Florida, Ohio and Texas informing them that the NRLN was interested in learning if anyone had been notified that they were enrolled in a Direct Contract Entity (DCE). The request resulted in two NRLN members providing a letter each had received.
The first letter received was from an NRLN member in Florida. The first paragraph stated that her doctor was now “part of Humana Care Solutions, a Medicare Direct Contracting Entity (DCE) participating in a program within Medicare.”
The other letter, also from an NRLN member in Florida, did not directly state that it was from a DCE. The first sentence of the letter stated: “Your Provider is participating in Orlando Health Collaborative Care, an Accountable Care Organization (ACO).”
After reviewing the letter, Kadereit sent an email to the NRLN member stating in part: “I would say yes and speculate they, the ACO, applied to become a DCE and was accepted as a DCE for the 2022 program. The key is on the second page in these words ‘You can learn more in the Voluntary Alignment Beneficiary Fact Sheet.’ The DCE process includes using the word “alignment” to describe what happens to an original Medicare enrollee when his/her doctor signs up to join a DCE.” The enrollee is automatically aligned with that DCE that then manages the enrollee’s healthcare decisions.
Members Respond to Question from NRLN
An email was sent to all NRLN members on January 12 in the form of a graphic asking: Have You Switched From Medicare Advantage To Original Medicare? If So, Why?
Several responses were sent to firstname.lastname@example.org. Here are a few of the responses:
“My Medicare Advantage plan, Network Health Wisconsin, was denying medical care and telling me what I could do and not do for certain conditions. I switched to Original Medicare to be able to get the care/procedures my doctor and I agreed were necessary.”
“I tried [Medicare] Advantage for one year and switched back to Medicare Plan F supplement. I need to choose my own doctors. Also found it complicated to see my specialists.”
“My husband, now 79, switched away from an Advantage plan to Original Medicare with a supplement several years ago. The primary reasons for the switch were:
1. The limited network of providers;
2. The need for extra appointments with a “gateway” primary doctor required for referrals, as well as the associated delays created;
3. The complications and delays in actually getting the services and tests ordered by a physician while waiting for authorization;
4. The actual cost of services as well as amounts paid by Medicare (taxpayers) to the plan were hidden– nothing was transparent, especially how much money was being paid to the plan compared to what was actually paid to providers for medical services;
5. The “upselling” in which certain providers (dentist, in particular) engaged, making this “perk” virtually worthless;
6. The lack of good value in some of the other “perks” that were offered; for example, low quality brands of OTC [over-the-counter} products that were assigned a high value to quickly absorb the quarterly allotment of “free” OTC items offered with the plan.”
“I changed from Medicare Advantage two years ago to get a supplemental option [Medigap] from Anthem. Advantage was fine while I was healthy, but when I was diagnosed with breast cancer, I enrolled in a clinical trial. Advantage as a rule does not cover clinical trials, and said so in communications with me, but I also saw somewhere that they had to cover what original Medicare would cover. It was difficult to find out the true nature of their policy, so I spent a few weeks in a panic. I did have 3 sessions under Advantage, and – I can’t remember exactly – they covered all or very nearly all costs. But I was not sure what would happen. I nearly dropped out of the trial because of the uncertainty. After the first 3 sessions, it was (hooray) January, and the remaining 9 were covered under [Original] Medicare and Anthem. I am so glad I was able to participate in the trial.”
Two White Papers Updated
The AREF/NRLN white paper on Medicare Advantage was updated on January 3 with the title: 2022 – Time to End Taxpayer Rebates to the Private Healthcare Insurance Industry. Click here to access the document.
The AREF/NRLN white paper on the need to reduce the cost of prescription drugs was updated on January 13 with the title: Congress Continues ‘Much Ado About Nothing’ on Reducing Prescription Drug Prices. Click here to access the document.
NRLN Legislative Committee’s Work
The NRLN’s Legislative Advisory Committee (LAC) composed of Judy Stenberg, Chairwoman, Deb Morrissett, Joe Mazzei, Al Duscher and Bob Martina had conference calls on January 11 and 25 to review bills in Congress. The bills were not submitted to the Legislative Action Planning Committee (LAPC) to consider for action in January. The bills will be considered during the LAPC’s February conference call. The LAPC includes Bill Kadereit, Chairman, Judy Stenberg, Alyson Parker, Bob Martina and Ed Beltram.
Key News Articles Posted in January
During January 37 links to news articles related to retirement issues were researched and posted daily IN THE NEWS on the NRLN website home page. The headlines below are links to the articles. Or, read the articles at www.nrln.org under IN THE NEWS in the right column. Scroll down the right column and click on the headline to access the article you want to read. Below are some of the headlines.