Medicare Advantage

WASHINGTON - Turning a usually routine announcement into a pointed rebuttal of its GOP critics, the Obama administration said Thursday that premiums for popular Medicare Advantage insurance plans would drop for 2012, while enrollment is expected to rise. That's welcome news for President Obama and Democrats, who are struggling with older voters ahead of a hard-fought election looming next year. Republicans have accused Obama of undermining Medicare to finance his health-care overhaul.

WASHINGTON - Millions of seniors in popular private insurance plans offered through Medicare will get a reprieve from some of the most controversial cuts in President Obama's health-care law. In a policy shift critics see as political, the Health and Human Services Department has decided to award quality bonuses to hundreds of Medicare Advantage plans rated merely average. The $6.7 billion infusion could head off service cuts that would have been a headache for Obama and Democrats in next year's elections for the White House and Congress.

IT'S HARD to believe, but Medicare's open-enrollment season ends today. And this year, as a result of the federal health-reform law, seniors who rely on privately administered Medicare Advantage plans for their benefits will face some big adjustments. Under the Medicare Advantage (M.A.) program, private insurers offer competing Part A Hospital and Part B Physician Care plans, and patients themselves choose which coverage option works best for their health and financial needs. M.A. insurers must provide at least the same benefits as traditional Medicare, but most offer more.

Much has been made recently of proposals to reduce excessive Medicare Advantage payments, speciously labeled the "gutting of Medicare. " Insurance companies, along with other private health-care interests, are spending upward of $2 million a day to influence the debate, according to the Center for Responsive Politics. Seniors and their families should not be misled by the latest attempt to derail successful health-care reform. The vote-rich senior population has proven a prime target for such scare tactics (see: Death Panels)

Nothing is more critical to the success of President Obama's health-care legislation than his promise that no American will have to give up his or her health plan. A related promise runs a close second: that the "government option" will create competition for the private sector, not replace it. Why are these promises so critical? Because, while most Americans are open to fixing health care, they're also happy with their private insurance. One would think Obama would oppose any provision that appears to force Americans into a government plan.

THERE are two glaring problems with the Senate health bill. First, it takes $464 billion out of Medicare over 10 years, of which $120 billion comes out of Medicare Advantage, unless you live in New York, Oregon or Florida, exempted cuts through a special deal made before the bill went to the floor. These cuts can't be good for Medicare, which is already becoming insolvent. Those with Medicare Advantage will be forced to buy a Medigap policy to replace the coverage they now have.

Being in the insurance business, Cigna Corp. knows all about weighing odds. Yes, funding for Medicare and other entitlements are on the chopping block, or at least on the trimming block, in Washington, but that did not stop Cigna, one of the nation's largest health insurers, from making a big cash bet on Medicare's future. Cigna said Monday it would spend $3.8 billion to acquire HealthSpring Inc., a Tennessee company that specializes in selling Medicare-managed care plans, known as Medicare Advantage plans.

HealthSpring Inc. said today that it would acquire Bravo Health Inc., a privately held operator of Medicare Advantage coordinated-care plans in Pennsylvania, the mid-Atlantic region and Texas, as well as Medicare Part D prescription drug plans in 43 states. HealthSpring, a publicly held company based in Nashville, said the $545 million deal would extend the Nashville based company's reach into Pennsylvania as well as other markets around the country. The deal is expected to close by the end of the year.

After 50 years as an Independence Blue Cross subscriber, retired electrical engineer Russell Philipp, 74, is taking his business elsewhere. The region's largest health insurer eliminated Philipp's plan and suggested that he and his wife, Lois, switch to one that would cost more and cover less. But what bothers Philipp is that the Philadelphia-based nonprofit organization continues to report a growing surplus that topped a billion dollars last year. "It really irks me to think they have the surplus and yet they keep raising their premiums and decreasing the coverage," said Philipp, who lives in Broomall.

In the television commercial, the camera pans slowly over a worried-looking elderly woman. "Most people agree that we need to reform health care," a narrator begins in the 30-second spot, "but is it right to ask more than 10 million seniors on Medicare Advantage for more than their fair share?" Even as House Democrats yesterday revealed their version of a major overhaul to the nation's health-care system, activists on both sides of the debate were marshaling a potent force to push their viewpoints.

The Obama administration should cancel plans for $8.4 billion in "quality" bonuses to insurance companies that provide Medicare coverage because Congress didn't authorize the spending and it's unlikely to improve care for the elderly, government auditors said. The bonuses for Medicare Advantage plans run by companies including UnitedHealth Group Inc. and Humana Inc. would pay about $5 billion more through 2014 than what Congress authorized in the U.S. health-care system overhaul, the Government Accountability Office said in a report today.

IT'S HARD to believe, but Medicare's open-enrollment season ends today. And this year, as a result of the federal health-reform law, seniors who rely on privately administered Medicare Advantage plans for their benefits will face some big adjustments. Under the Medicare Advantage (M.A.) program, private insurers offer competing Part A Hospital and Part B Physician Care plans, and patients themselves choose which coverage option works best for their health and financial needs. M.A. insurers must provide at least the same benefits as traditional Medicare, but most offer more.

Being in the insurance business, Cigna Corp. knows all about weighing odds. Yes, funding for Medicare and other entitlements are on the chopping block, or at least on the trimming block, in Washington, but that did not stop Cigna, one of the nation's largest health insurers, from making a big cash bet on Medicare's future. Cigna said Monday it would spend $3.8 billion to acquire HealthSpring Inc., a Tennessee company that specializes in selling Medicare-managed care plans, known as Medicare Advantage plans.

WASHINGTON - Turning a usually routine announcement into a pointed rebuttal of its GOP critics, the Obama administration said Thursday that premiums for popular Medicare Advantage insurance plans would drop for 2012, while enrollment is expected to rise. That's welcome news for President Obama and Democrats, who are struggling with older voters ahead of a hard-fought election looming next year. Republicans have accused Obama of undermining Medicare to finance his health-care overhaul.

Every few months, James S. Miller, a 68-year-old retired transit worker and jazz saxophonist, would arrive by electric wheelchair at North Philadelphia hospital emergency rooms, short of breath and with the swollen legs that mark his illness, congestive heart failure. He dreaded the visits. His hospital stays drained not only the fluid in his legs, but the small income of his pension and Social Security. That went on for years, until Miller enrolled last September in a private Medicare plan, Bravo Health, with a financial interest in keeping him well.

WASHINGTON - Millions of seniors in popular private insurance plans offered through Medicare will get a reprieve from some of the most controversial cuts in President Obama's health-care law. In a policy shift critics see as political, the Health and Human Services Department has decided to award quality bonuses to hundreds of Medicare Advantage plans rated merely average. The $6.7 billion infusion could head off service cuts that would have been a headache for Obama and Democrats in next year's elections for the White House and Congress.

Privatizing Medicare would cut coverage, not costs By Rob Field, professor of law and public health at Drexel University   Should Medicare as we know it come to an end? U.S. Rep. Paul Ryan (R., Wis.) and fellow Republicans say it must to avoid financial collapse. They want to turn the program over to private insurers and get the government out of providing benefits directly. The idea isn't new. In fact, it is being tried out right now. Under a program known as Medicare Advantage, beneficiaries can opt to receive coverage from a private company, usually an HMO, instead of traditional Medicare.

HealthSpring Inc. said today that it would acquire Bravo Health Inc., a privately held operator of Medicare Advantage coordinated-care plans in Pennsylvania, the mid-Atlantic region and Texas, as well as Medicare Part D prescription drug plans in 43 states. HealthSpring, a publicly held company based in Nashville, said the $545 million deal would extend the Nashville based company's reach into Pennsylvania as well as other markets around the country. The deal is expected to close by the end of the year.

Much of the discussion about the health-care reform legislation just signed into law has focused on the uninsured and the problems of private insurance. But what about a large group of Americans who face none of these issues - namely, those covered by Medicare? While much of the reform will not impact them, there are three areas in which older adults definitely will be affected: prescription drug coverage, managed care, and access to primary-care providers. The impact on those facets of their health care is likely to be good, bad, and potentially ugly.

Reform would not violate Constitution Re: "Reform legislation is unconstitutional," Monday: Regularly heard is the assertion that health-care reform violates the Constitution. While people might legitimately argue that the current proposal is good or bad, or that it does too much or too little, the argument that it is unconstitutional is nonsense. Congress has plenary power to tax and spend, broad power to provide for the general welfare, and unlimited power to regulate matters affecting interstate commerce.