A study published online today finds that the private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985,
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The findings appear in an article published in the International Journal of Health Services by Drs. Ida Hellander,
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Hellander is policy director at Physicians for a National Health Program (PNHP), a nonprofit research and advocacy group. Woolhandler and Himmelstein are professors at the City University of New York School of Public Health, visiting professors at Harvard Medical School and co founders of PNHP.
Medicare has contracted with private insurance plans previously referred to as Medicare HMOs and now called Medicare Advantage plans since 1985. Such plans, most of them for profit,
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Medicare pays these privately run plans a set "premium" per enrollee for hospital and physician services (averaging $10,123 in 2012) based on a prediction of how costly the enrollee’s care will be.
Private plans cherry pick healthier beneficiaries who cost less to care for, guaranteeing large profits. Although private plans must accept all seniors who choose to enroll,
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They recruit otherwise healthy seniors with very mild (and inexpensive) cases of sometimes serious conditions automatically triggering higher premiums for these beneficiaries from the risk adjustment scheme implemented in 2004,
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They enroll patients who get most of their care free at the Veteran’s Administration.
They heavily lobby Congress to raise their reimbursement. The insurance industry successfully induced Congress and the Bush administration to add bonus payments to Medicare Advantage premiums beginning in 2003.
Since the study was completed,
, the industry has again successfully lobbied the administration to raise payments to Medicare Advantage plans, reversing a planned cut of 2.2 percent in reimbursement rates and instead obtaining a 3.3 percent increase. Stock prices of private insurers soared over the announcement.
"We’ve long known that Medicare has been paying private insurers more than if their enrollees had stayed in traditional fee for service Medicare,
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"In 2012 alone,
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"It’s time we look to proven, cost effective ways of providing high quality care to Medicare’s beneficiaries and to the entire population," Woolhandler said. International Journal of Health Services, May 10,
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