Preserve Medicaid and de-privatize Medicare for cost savings

Most Americans will agree that our many government departments could use a careful examination of operations for improving efficiencies and reducing costs, fraud and waste. But there should be careful oversight, with checks and balances, before slashing personnel and funding.

Right now, we are in a fight to preserve Medicaid, which provides health insurance coverage for over 80 million Americans. It will be the biggest health care fight of the 119th Congress. If Congress imposes huge cuts, it will be financially harming nearly every American with private health insurance.

Consider the math. If poor people are denied coverage, they will still use health care. They just don't access it in a preventive or timely way. They don't access it at a doctor's office, but at the emergency room, where the cost of care is most expensive. They wait until they're so sick that they can't avoid seeking care, which means their ER visit often involves very expensive emergencies.

And when they don't pay for that care, who does? Everyone with health insurance, whose rates (whether it's insurance premiums or out-of-pocket costs) must rise to cover the cost of uncompensated care. Gutting Medicaid is essentially a way to shift costs from government to the private sector, a prescription for a returning to the pre-Affordable Care Act era of rapidly rising health insurance premiums for both employers and individuals.

Cutting Medicaid will not just be a pocketbook issue for the poor. It will affect the middle class and seniors who are dual enrolled in Medicaid and Medicare. Cuts to Medicaid could take coverage away from up to 20 million people, with devastating impacts on children, low-income workers, the elderly and their families.

Bringing this close to home, any cuts at the federal level, will lead to devastating cuts at the state level. Colorado would be disproportionately harmed.

There are 1.1 million Coloradans in the Medicaid population. Proposed cuts to Medicaid expansion alone would mean Colorado loses $1 billion a year, and as many as 400,000 Coloradans lose coverage. Hospitals, clinics and providers (especially in rural areas) would be at extreme risk of closing (Herald, March 23), causing further economic fallout, higher costs and limited access.

This is a measure that rips away life-sustaining health care and retirement benefits from everyday Americans.

Here are some suggestions for cutting health care spending, fraud and waste without causing fear, pain and lack of access to care.

Cut prices on more drugs now. Originally, some pharmacy benefit managers helped cut prices, but recently an FTC study showed that big insurance's PBMs profit at the expense of patients by inflating drug costs and squeezing pharmacies. Americans should pay no more for medications than citizens of other prosperous countries.

Eliminate "upcoding" (falsely exaggerating ill health) in Medicare Advantage plans. A recent report by the Congressional Medicare Payment Advisory Commission, an independent advisory agency, found that upcoding generated nearly $124 billion in excess payments to Medicare Advantage plans annually. Now, there's some fraud that could be clawed back by the government.

Decrease the allowable percentage of MA insurance revenues that go for "administration" instead of medical care from 15% to 10%. By comparison, Traditional Medicare's administration is an efficient 2% to 3%. MA programs annually cost the Centers for Medicare & Medicaid Services over $83 billion more than Traditional Medicare annually and have more limited networks of providers, more prior authorizations delaying care (sometimes resulting in deaths) and higher rates of claim denials.

Reduce misleading and inaccurate ads during the Medicare and MA open enrollment period.

It's time to call our federal and state legislators and let them know how you feel about these pending cuts and privatization and "profitization" of health care.

"When the people lead, the leaders will follow."

-Gandhi

Jan Phillips is a retired small-business owner and 35-year resident of Durango. After 45 years as a health educator, she is currently involved in advocating for health care reform.

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