Local Opinion: Medicare

The following is the opinion and analysis of the writer:

Receiving your paycheck and being shocked and appalled by how much is taken out by taxes is often used as a joke amongst some, but it's the reality for many Americans. If there is any silver lining to seeing how much Uncle Sam has taken, it is the belief that much of those funds will pay for our health care and Social Security once we reach our 60s.

Unfortunately, just as America's largest working generation begins to retire, the United States faces the frightening reality that Social Security and Medicare are running out of money, and Washington is running out of time to fix it.

Despite being the younger program by 40 years, it is Medicare whose funding will fall short first — and recent reports have suggested that might happen as soon as 2028.

President Biden's 2024 budget proposes raising revenue for Medicare by increasing the Medicare Tax on Americans making more than $400,000 and allowing the federal government to negotiate drug prices with pharmaceutical companies. But given the divided government, it feels unlikely tax increases can pass. However, a fix could be worked out by boosting a bipartisan law that is already on the books: the Medicare Secondary Payer Act (MSP Act).

Medicare was signed into law by President Lyndon Johnson close to six decades ago, and it was intended to provide health care and a safety net for seniors whose health care costs had forced them into poverty. Less than 15 years later, Congress passed the MSP to address concerns that Medicare was paying for medical expenses that other insurance plans should have covered. To this day, Medicare often covers expenses (to avoid onerous delays) and then expects to be paid back by the primary payer.

But expectations are nothing if not hopes that are unfulfilled, and insurance companies are understandably reluctant to reimburse the U.S. government for billions of dollars in claims that they are responsible for paying. In fiscal year 2021, MSP provisions saved the Medicare program about $9.7 billion, according to CMS.

Unfortunately, there is little incentive for insurers to do the right thing in a timely fashion…or ever. One Medicare watchdog group recently uncovered that insurers are deliberately gaming the system. The country's largest auto insurers admitted that in some cases, they do not pay Medicare what it should have been paid as much as 98% of the time.

You'd think that sort of admission would result in an end to the fraud. But, thanks to insurers pursuing relief through the courts, they managed to find a lower court that said that recovery efforts are subject to state procedural requirements. The ruling goes against decades of precedent in MSP cases and against the original intent of the law.

Washington cannot allow the insurance industry to continue this abuse and fraud, costing taxpayers billions yearly and putting Medicare at risk. We need our government to push back and protect the MSP Act in the courts and Congress so that Medicare has the funding it needs. As a member of the Health and Human services committee, I know that protecting low-income seniors from losing their benefits is a priority not only for me but for all of Arizona.