A Shift Toward Medicare Privatization
Today, about one-third of seniors are enrolled in private plans through Medicare Advantage the other two-thirds are in traditional, fee-for-service Medicare. The share of beneficiaries enrolled in Medicare Advantage has grown over the past two decades. Medicare Advantage attracts a relatively healthier, less expensive pool of enrollees than that of traditional Medicare, and its per-beneficiary spending is lower. Some of that difference is attributable to lower health care utilization, although local market conditions and beneficiary health status also contribute. A number of studies have shown how Medicare Advantage plans profit from selection by attracting relatively healthier enrollees while also gaming the Centers for Medicare and Medicaid Services risk adjustment program to make their enrollees appear sicker. Medicare Advantage plans also enjoy distinct advantages over the traditional Medicare program, including integrated plan designs and the ability to avoid providers involved in graduate medical education.
Trump Pledges To Get Better Deals From Drug Companies
Even after paying into the Medicare system throughout their lives through taxes and Social Security payments, some treatments and drugs still require users to pay for them. During his first term Trump lifted the so-called gag orders that were preventing pharmacists advising patients of cheaper alternatives, and capped insulin costs for some users. Publically, Trump has insisted that he does not intend to make cuts to Medicare provision but his March budget announcement revealed plans for a $1.5 trillion spending cut over the next decade.
Trump said he wouldnt cut Medicaid, Social Security, and Medicare. His 2020 budget cuts all 3.
Jon Favreau
Going forward, the President has said that he will send $200 payment cards to 33 million individuals to help with the cost of drugs, although no concrete plans have yet been outlined. Trump would also like to see consumers able to import prescriptions from overseas, thus expanding the market and hopefully bringing down prices across the board.
How Will Cuts To Medicare Benefits Affect Me
You might imagine that cuts to Medicare benefits mean that fewer services will be covered and youâll have to pay more out of pocket. Rather, according to Forbes, the proposed cuts would affect Medicare providers with little direct effect on beneficiaries.
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Have Medicare Benefits Already Decreased Under Trump
According to the Centers for Medicare and Medicaid Services , Medicare spending has actually increased in the Trump presidency, not just in terms of dollars, which are subject to inflation, but in terms of percentages.
Some Medicare premiums also may be slightly lower now. According to CMS, the average Medicare Advantage premium 2019 is estimated to be $28 in 2019, down from $29.81 in 2018.
In terms of dollars, Medicare benefits totaled $702 billion in 2017, according to the Kaiser Family Foundation.
When Does Trumpcare Take Effect
The ACHA first had to pass a vote in the House of Representatives, which it did so on May 4 by a margin of 217-213.1 The bill will still need to pass a vote in the Senate before it can be signed into law by President Trump.
Despite passing the House, the bill has stalled at the Senate level, as many GOP senators have balked at approving the ACHA as it was originally written. A committee of senators has been formed to draft a new version of the bill. There is no deadline for this new version, and no date has been set for a vote.
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Trumpcare Never Became A Law
After narrowly advancing through the House of Representatives in 2017, Trumpcare went on to die on the Senate floor.
Trump hinted at plans to introduce a new plan in early 2019, but Senate Majority Leader Mitch McConnell reportedly warned Trump that the Senate would not revisit major health care legislation again until after the 2020 presidential election.1
That meant Trump would have to win a second term to try and make good on his campaign promise to repeal and replace Obamacare.
Trump Plan To Privatize Medicare Is Alive And Well
Seniors and their loved ones may be alarmed to learn that there is an insidious, but largely unpublicized effort underway to gradually privatize Medicare. According to media reports, some traditional Medicare patients are now being placed in for-profit managed care plans without even knowing, thanks to a Trump administration policy that is still in effect. Under this pilot program, called Direct Contracting, private companies are supervising selected Medicare patients care, even though the beneficiaries signed up for traditional Medicare.
The experiment is likely to make traditional Medicare a gold-mine for for-profit companies, who will make money for executives and shareholders by establishing complex administrative rules that undermine access to care and by imposing high out-of-pocket costs that discourage care. Common Dreams, 3/8/21
Up to now, traditional Medicare has been administered exclusively by the government, with no profit motive unlike the Medicare Advantage program, which is run by private, corporate interests. The Direct Contracting model is a serious, but lesser-known move toward privatizing the entire Medicare program something the majority of the public and seniors advocates fiercely oppose. With good reason.
This should be a huge red flag for taxpayers and anyone concerned about funding Medicare for future generations, says Rep. Japyal, who sits on the House Budget Committee.
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Trump Sidesteps Seniors Most Pressing Concerns
A glaring omission in the presidents plan is any provision to directly take on one of seniors widespread concerns: the high cost of health care. Although Americans have overwhelmingly favorable experiences with the existing Medicare program, it is far from perfect. According to a report from the Commonwealth Fund, about 1 in 4 Medicare beneficiaries is underinsured, meaning their out-of-pocket health care costs are 10 percent or more of their income. A 2011 analysis by the Medicare Payment Advisory Commission found that Medicare beneficiaries without supplemental plans, also known as medigap coverage, paid 12 percent of their medical costs out of pocket, on average.
For example, traditional Medicare has no limit on out-of-pocket costs. By contrast, the CMS limits out-of-pocket costs in Medicare Advantage to $6,700 for in-network services, and many individual plans offer lower out-of-pocket limits. In 2012, the MedPAC commissioners voted unanimously to recommend that Congress rework Medicares benefit design to include an out-of-pocket maximum. Doing so would give Medicare beneficiaries better financial protection against high health care costs.
What Is Trump’s Healthcare Plan It Looks A Lot Like Obamacare
- For years, Republicans have lambasted Obamacare, and promised that a full replacement for the Affordable Care Act is in the works.
- But more than 10 years after the ACA was signed into law, no major GOP replacement plan has surfaced.
- Trump’s administration has instituted incremental changes to the landmark healthcare law, and zeroed out the universal coverage mandate.
- Evidence suggests he would do more of the same if given a second term, largely leaving the ACA alone.
- Biden, if elected, would likely usher in a different set of tweaks to the law: he’s floated the ideas of a public option, and more health insurance tax credits available to middle- and upper-class Americans on ACA plans.
President Trump talks a lot about getting rid of President Obama’s landmark Affordable Care Act, which has extended health insurance to 20 million more Americans.
He often says he’ll be replacing that 2010 law with “something terrific” and/or “something great.”
But the truth is that Trump and Republicans in Congress haven’t unified behind replacing Obamacare at all.
Trump’s domestic policy chief Brooke Rollins recently told Business Insider that a backup for the ACA is still “being worked on.”
Ezekiel Emanuel, a health policy expert who was an architect of the original ACA in the Obama administration, is skeptical that any major Republican changes to his legislation are truly in the works.
Perhaps that’s because Republicans don’t really want to get rid of the whole ACA.
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Improve Medicare For All Beneficiaries
Medicare is extremely popular, but it needs attention to ensure all beneficiaries receive comprehensive coverage and equitable treatment. The Medicare program that Americans know and cherish has been allowed to wither. Traditional Medicare, preferred by most beneficiaries, has not been improved in years, yet private Medicare Advantage plans have been repeatedly bolstered. Its time to build a better Medicare for all those who rely on it now, and will in the future.
How Many Presidents Have Cut Medicare Benefits
The Medicare program has survived eight presidents between Lyndon B. Johnson and Donald J. Trump, including Nixon, Ford, Carter, Reagan, Bush, Clinton, Bush, and Obama.
Since its inception, Medicare has expanded to cover people with disabilities and end-stage renal disease requiring dialysis or kidney transplant, as well as people 65 or older. People under 65 with serious illnesses may require expensive medical care. So Medicare funding had to expand to cover these people.
In 2003, the Medicare Prescription Drug Improvement and Modernization Act under President George W. Bush made the biggest changes to the program since it was founded. This act introduced Medicare Advantage plans and the optional prescription drug Medicare benefit, Medicare Part D.
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Trump Opens Door To Cuts To Medicare And Other Entitlement Programs
The president signaled a willingness to scale back Medicare, a shift from his 2016 platform of protecting entitlement programs.
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By Alan Rappeport and Maggie Haberman
WASHINGTON President Trump suggested on Wednesday 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.
The president made the comments on the sidelines of the World Economic Forum in Davos, Switzerland. Despite promises to reduce the federal budget deficit, it has ballooned under Mr. Trumps watch as a result of sweeping tax cuts and additional government spending.
Asked in an interview with CNBC if cuts to entitlements would ever be on his plate, Mr. Trump answered yes.
At some point they will be, Mr. Trump said, before pointing to United States economic growth. At the right time, we will take a look at that.
Mr. Trump suggested that curbing spending on Medicare, the government health care program for the elderly, was a possibility.
The Effects Of Trumpcare
Its hard to say exactly what the new version of the bill may look like, but here are some things we know about the version of the bill that passed through the House of Representatives and was proposed to the Senate:
- The Obamacare “individual mandate” that requires everyone to have health insurance would be repealed. Some experts contend it could be one factor that contributes to 24 million more uninsured Americans.
- Subsidies granted to lower-income Americans for the purchase of health insurance would be replaced by tax credits.
- States could obtain a right to waive currently federally-mandated essential health benefits.
- States could obtain a right to charge more for preexisting conditions, but some of those costs can be offset by subsidies offered to people with such conditions.
- Medicaid expansions introduced during the Obama administration would be phased out.
Its important to keep in mind that if Trumpcare does goes into law, it may look quite different than the version outlined above.
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1 Pear, R., and Haberman, M. Trump Retreats on Health Care After McConnell Warns It Wont Happen. . New York Times. Retrieved from www.nytimes.com/2019/04/02/us/politics/obamacare-donald-trump.html.
2 Congressional Budget Office. American Health Care Act of 2017. . Retrieved from https://www.cbo.gov/publication/52752.
Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.
How Can Trump Cut Medicare Benefits
Although Trump represents one branch of government, the executive branch, his budget must be approved by Congress, the legislative branch. Typically by the first Monday in February, the president gives Congress his budget proposal for the next fiscal year. Congress then votes on a final budget. Medicare benefit cuts wonât go into effect unless Congress approves them.
Itâs also important to know that Medicare falls into the âmandatory spendingâ category of the federal budget. Medicare benefits are a type of entitlement program which also includes Social Security and Medicaid. According to USA.gov, mandatory spending, including spending on Medicare benefits, typically uses over half of all funding.
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The Better Care Reconciliation Act
The Better Care Reconciliation Act was a revised edition of the AHCA and represented the second attempt at installing Trumpcare. This bill was similar to the AHCA but kept some of the features of Obamacare, such as tax provisions to help pay for low-income insurance premiums.
The BCRA was never voted on in its original form as it became clear the bill would not pass Congress due to opposition from several Republican senators.
How Trump Is Proposing Changing Medicare Medicaid And Social Security
When it comes to Medicare, the White House has been very clear: Hes not cutting Medicare in this budget, Vought said. What we are doing is putting forward reforms that lower drug prices. Because Medicare pays a very large of drug prices in this country, has the impact of finding savings. We are also finding waste, fraud, and abuse.
Heres whats actually happening: This budget proposes finding $845 billion in savings over 10 years from Medicare as we know it. But $269 billion of that figure is reclassified under the Department of Health and Human Services, bringing the Medicare cuts to $575 billion. As Vox explained, the administration says it will achieve these cost reductions by targeting wasteful spending and provider payments and lowering prescription drug costs.
The Committee for a Responsible Federal Budget, which advocates for fiscal responsibility, estimates that 85 percent of these cuts will come from reductions in provider payments, 5 percent would come from policies around medical malpractice, and 11 percent would come from reducing drug costs through the Medicare Part D program. Medicare Part D is the only area of these reforms that could raise out-of-pocket drug prices for some while lowering it for others. Otherwise, premiums, deductibles, and copays would largely be left unaffected.
But when it comes to Trumps proposed changes to Medicaid and Social Security, the intent is unambiguous: These are cuts to benefits.
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How Does It Compare To Biden’s Healthcare Plan
If Biden wins, there will be a different, and seemingly bolder set of priorities for reshaping the ACA.
The possibility of a public option is one of the biggest differences between his plan and Trump’s.
The Biden campaign also says it will eliminate the cap on ACA insurance subsidies, so that people making more than 400% of the federal poverty level qualify for tax credits.
“You’re going to see a big push in trying to make it more affordable,” Emanuel said.
Another campaign promise from the Biden team: lowering the cap on how much coverage in the ACA marketplace can cost, from 9.86% of a person’s income to 8.5%.
Regardless of who wins the election, it’s going to take a lot longer than four more years for this healthcare law to mature.
Just look at how many times Social Security’s been reformed and tweaked, since it was enacted by President Roosevelt in 1935. Or the changes that have been brought to the Medicare and Medicaid systems, since they were signed into law by President Johnson in 1965.
President Obama’s Affordable Care Act has joined this cannon of sweeping reforms. As such, it will take decades to refine, through many more presidents, and many more sessions of Congress. Despite what you might’ve heard about “repeal” or “replace,” improving it will take more continuous, measured improvement of the system than any one President alone can provide.
Trump Broke This Promise From The Beginning
This is Trump on the campaign trail in 2015:
I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me.
Donald J. Trump May 7, 2015
Trumps budgets and the policies he has supported around health care and government spending in Congress reflect the opposite. Some of this can be attributed to Trumps appointed budget chief Mick Mulvaney the former Congress member who was part of the ultraconservative Freedom Caucus has long rallied for cutting Medicare, Social Security, and Medicaid.
In fact, Mulvaney once bragged to a Politico reporter that he tricked Trump into accepting a proposal to cut Social Security by calling SSDI just disability insurance spinning it to the president as general welfare reform. The idea has been in every single one of Trumps budget proposals to Congress since the president came to office.
Then there was the Republican Obamacare repeal push every bill proposed massive cuts to Medicaid in order to pay for tax cuts elsewhere. Trump supported every iteration of Republicans Obamacare repeal-and-replace bills. He even held a party for House Republicans in the White House Rose Garden when the lower chamber of Congress narrowly passed a proposal that slashed more than $800 billion from Medicaid over 10 years.
Now his policy positions around those programs break from that promise.
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