President’s Forum 133 – Medicare Direct Contracting – A Threat to Seniors and to Medicare’s Future

Direct Contracting Threatens Medicare’s Future

The NRLN announced its opposition to the CMS (Centers for Medicare and Medicaid) Direct Contracting program’s threat to Medicare with an Action Alert on December 7, 2021. More than 8,700 letters were sent to President Biden and members of Congress to urge them to stop CMS’ dangerous action to destroy Medicare.

The Action Alert is still available at https://www.nrln.org/action-alert/#/home/ if you have not voiced your concerns to lawmakers.

The Action Alert was followed on January 8 with an NRLN video podcast on Wall Street’s Takeover of Medicare. It is available view on the NRLN website’s home page at www.nrln.org.

In this message I am asking you to click the button below to read the transcript of testimony presented on February 2 to the Senate Finance Committee Subcommittee on Fiscal Responsibility and Economic Growth by Dr. Susan Rogers, MD, President, Physicians for a National Health Program. Dr. Rogers is an Internal Medicine Specialist who is retired from Stroger Hospital of Cook County, Illinois, where she was co-director of medical student program for the Department of Medicine.

Dr. Rogers began her testimony with this statement: “To understand how Direct Contracting works and why it threatens Medicare’s future, it’s important to understand the first wave of Traditional Medicare privatization through Medicare Advantage.”

As I have written about Medicare Advantage (MA) in NRLN white papers and addressed in the 2021 NRLN video podcast series, Dr. Rogers pointed out that, “First, MA insurers maximize payments from Medicare by making their enrollees appear sicker than they really are. Medicare’s capitation payments to MA insurers are based on each enrollee’s “risk score” — the sicker the enrollee, the higher the score and the payment. However, MA insurers engage in a kind of fraud called ‘upcoding’ exaggerating and even fabricating diagnoses to inflate enrollees’ risk scores.”

We know $20 billion of taxpayer rebate money was used to buy MA vision, hearing, dental, and other benefits denied to 40 million others in original Medicare in 2021; that MA plans cost taxpayers 4% more per enrollee than original Medicare, and now we know Direct Contracting Entities (DCEs) will cost even more and that both original Medicare and MA plans could both be at risk.

Dr. Rogers moved into her testimony on Direct Contracting with this opening paragraph: “A majority of seniors and disabled Americans choose Traditional Medicare (TM) over Medicare Advantage (MA) because they value the free choice of providers and the power to manage their own care. However, under the Medicare Direct Contracting (DC) pilot program, millions of beneficiaries who actively chose TM are being automatically enrolled into third-party Direct Contracting Entities (DCEs) without their full knowledge or consent.”

She noted: “If a senior is auto-aligned into a DCE, their only way to remove themselves from the DCE is to change primary care providers.

Dr. Rogers closed her testimony stating: “Traditional Medicare is our nation’s most important and popular health care program; it has proven its value for more than half a century as a lifeline for America’s seniors and younger adults living with disabilities. Medicare is not a playground for Wall Street investors…”

I have only touched on a small part of Dr. Rogers’ testimony. If you are interested in learning about where CMS is attempting to drive healthcare for seniors, you need to click here to read, Medicare Direct Contracting – A Threat to Seniors and to Medicare’s Future.

Bill, Kadereit, President
National Retiree Legislative Network