THE BLOG
10/18/2013 10:44 am ET Updated Jan 23, 2014

While Obamacare Addresses the Uninsured, Medicare Advantage Plans Throw Seniors Under the Bus

While the dysfunctional sideshow on the Potomac played out, world financial markets went into panic mode, expecting a global free fall. The bluster in D.C. came mainly from House Speaker Boehner and Senate Majority Leader Reid, with torch thrower and upstart Tea Party Senator Ted Cruz adding to the craziness. To the president's credit, he held firm on no negotiations until the government was reopened, and ultimately there was significant support in both houses of Congress by the GOP, along with a refreshing display of leadership and firm backbone by President Obama. The Democrats united behind the president and refused to negotiate with "hostage takers" in the face of demands from the right-wingers for more and more concessions to let Obamacare live and move forward. This was the issue that precipitated this whole piece of insanity. Of course, the Tea Party and their ilk clearly must fear Obamacare's potential success -- which is still a great unknown -- to go to these lengths to stop it.

The only tangible result of this game of political chicken was that the government was shut down and paralyzed for 16 days, at an estimated cost to our economy of $24 billion dollars. Yet our so-called "public servants" still managed to keep in shape at the Congressional gym and spa, which remained open throughout the crisis. They also received their salaries, except for the few who refused to accept their paychecks and a few others who donated their salaries to charity.

The deadline for raising the debt ceiling or defaulting ended at midnight Wednesday. In the face of that unthinkable disaster, Congress finally passed a short-term solution that reopened the government Thursday and will fund it through January 15, 2014. The government's debt limit was also increased, which will last until February 7, 2014. Will all of this be repeated again at that time, with new demands by the Tea Party led GOP despite the fact that they lost big this go around? Will the Republicans -- a failing political party by any standard -- use the next few months to reconsider its potential demise, or will they be re-entrenching and plotting more anti-government actions? They have made our country the laughing stock of the world and have cost us our credibility on the global stage, with countries like China -- arguably our largest creditor -- now calling for a "de-Americanized world." This would have been the first time in 237 years that our nation would have defaulted on its debts, all because those petulant Tea Partiers in Congress continue to want to revoke Obamacare -- which is the law of the land -- and thwart our president every chance they can get. Of course, we now know from an article in the New York Times a few days ago that those kooky, greedy Koch brothers are really behind this grand scheme. Are they seeking to become Co-Emperors of the U.S.A.?

Our country suffered deeply these past weeks, as vital services were curtailed and hundreds of thousands of government workers were furloughed. The people nationwide felt the heat, too, including children cut out of Head Start, researchers losing funding at the N.I.H., and the loved ones of fallen military personnel, who had been unable to receive those death benefit checks of $100,000.00, which have now been restored. Homeland Security was also in jeopardy, as well as the agencies monitoring the safety of our food supply -- a domino effect nationwide that would have been devastating had it been allowed to continue any longer. Even so, 144 Republican House members and 18 Republican senators would apparently have been happy to see that happen, having voted against the measure ending the shutdown.

On top of all of this, if America had defaulted on our debts, no more Social Security checks, veteran's benefits or service members checks would have gone out , and payment to providers from Medicare would have been cut off -- a catastrophic ripple effect that could have led to a worse recession than the one we are still trying to drag ourselves out of. The Chinese and Japanese, who hold trillions of dollars of our debt, were also certainly worried about being repaid. The good news -- which has been barely acknowledged by the right wing -- is the fact that the deficit has been halved since 2009, as mentioned by the president in a news conference some days ago.

The deficit is supposedly at the core of the right wing's demands for more and more unreasonable concessions, yet they have had little to say about this remarkable deficit reduction. Of course, the right-wingers really just want to dismantle and privatize -- or at least cut funding for -- as many safety net programs as they can, with their main targets, as usual, being Social Security, Medicare and Medicaid. The cost to our world standing and credit rating after this debacle -- if it had ended in a debt default -- would have been incalculable, and would have affected financial markets globally. Perversely, Democrats must be delighted by this turn of events, as they see electoral victories on the horizon that could help them retake the House, based on the disgust most Americans have with the House Republicans over this GOP-made crisis. The overall approval rating of Congress is also abysmal, hovering at 5 percent, with the president's poll numbers tanking, too, with a 36 percent approval rating.

At the heart of all of this chaos is, of course, the right wing's desperate desire to derail Obamacare. The first stage of that program -- the Healthcare Exchanges -- have been straightening out the glitches that caused their websites to fail in the first few days of October, when some five million of the uninsured sought information or to sign up for an insurance plan through this program that will kick in January 1, 2014. At the same time, literature outlining changes in benefits and costs have been reaching 50 million Americans enrolled in Medicare, with 14 million of them in Medicare Advantage Plans and 65 percent in HMOs. These changes include some benefits not found in the original Medicare program -- such as vision, modest dental care, hearing services, and even a fitness program called Silver Sneakers -- along with a handful of other preventive care features in Medicare Advantage Plans.

There are five private plans now being offered outside of the original Medicare. Seniors do have some choices among these plans, including some that have no premiums and no co-pay for their primary care doctor. To be clear, these so-called Advantage plans are offered by private insurance companies under Medicare contracts. Seniors are being lured out of original Medicare with promises of a few more benefits and savings, which are now becoming more elusive as these plans keep on jacking up costs. Indeed, more costs are shifting not only to seniors, but to all who are insured -- or will become insured -- which is becoming a crisis in the making as the current delivery system of healthcare is already unsustainable and too costly.

But it is the out of pocket costs in 2014 -- before reaching catastrophic coverage -- that will be a real eye opener for seniors, and could, if serious illness strikes, throw all too many into poverty or bankruptcy. This is America's most vulnerable population, living mainly on fixed incomes with an average Social Security benefit of $1,162 per month, an amount which has seen only piddling increases twice since 2010. Indeed, the cost of living increase will only be 1.5 percent in 2014. Even so, too many in Congress are actually seeking to cut benefits from this program, as well as to privatize it.

So who is paying attention to senior healthcare issues? All eyes are only on Obamacare, as if the rest of the insured population are without financial concerns about the insurance they already have. And what of labor -- with its disappearing health benefits thanks to the regressive actions of GOP governors nationwide -- being moved to find insurance on the new exchanges? 150 million now receive their health benefits on the job, but that benefit is rapidly disappearing.

I am a senior, and have spent a week now trying to understand the new increases in my Medicare Empire BC/BS Advantage HMO, and whether or not I can afford to keep it or change to some other Advantage Plan. I might even choose to go back to original Medicare, which requires a private insurance "medigap" plan to fill in the 20% Medicare does not cover for doctors service, as well as the need for a separate Part D prescription drug plan. Both plans have monthly premiums.

Advantage plans must offer the same Part A and B coverage as original Medicare for hospital and doctor coverage. As currently conceived, Advantage plans are delivered by private insurance companies and may have a monthly premium, co-pay for your primary doctor, deductibles and numerous, high out-of-pocket costs for prescription drugs. Each Advantage plan can be different in this regard, but all must be approved by Medicare through The Center For Medicare Services and the Department of Health and Human Services, as they work under contract with Medicare. This is an alphabet soup of such confusion that frankly I needed a translator to understand the vague language in the booklets I received describing changes in 2014 for my healthcare plan. And when I arrived at the pertinent parts about those increased costs in my Annual Notice of Changes for 2014, I was suddenly referred to another booklet called the Evidence of Coverage for 2014. This all couldn't be done in one booklet? There is even a separate, large booklet devoted to the formulary of prescription drugs, with a diminishing list for next year, as well as fewer pharmacies to service your needs. Also included are six tiers of prescription drugs, each at increasingly higher prices.

This needless complexity must be deliberate, so that by the time you transition from one booklet to the other you forget what you're even trying to find out. Thankfully, we have the Medicare Rights Center, a nonprofit advocacy organization that helps Medicare beneficiaries navigate the system. They can be very helpful in sorting through all of this, and their site details the differences between original Medicare and the five kinds of private plans available that are contracted by Medicare. Yet you will still have to research each individual private plan, as the gap costs before catastrophic coverage kicks in can be very high and vary from plan to plan.

For example, Advantage plans include Part D prescription benefits, which needed to be added to original Medicare because it does not include prescription coverage. With a stand alone Part D prescription plan -- as well as with the Part D included in an Advantage plan -- you would have a maximum out-of-pocket cost cap of $4,550.00 for next year, with a savings of $200.00 after you reach the infamous "donut hole," which will be closed in 2020. However, you would fall into that coverage gap sooner, at $2,850.00 in payments from you and your insurer. After that, you are on your own until that $4,550.00 amount is reached. At that point, catastrophic coverage kicks in and the rest is covered by the plan.

An additional high cost can be found in some Advantage plans in the out of pocket maximum costs for the Part A and Part B of their plan for hospital and doctors services, respectively, before catastrophic coverage takes place. My maximum out of pocket limit for Parts A and B in 2012 was $2,800.00, rising to $3,400.00 in 2013; next year it will soar to $5,900.00. One has to pray that they don't reach these maximums and become ill. I checked another Advantage Plan against mine and found one with a maximum out of pocket limit for Part A and B at $3,400.00, no co-pay for a primary doctor, and a modest $10.00 co-pay for specialists. The in-hospital deductible was less than half the amount of my plan as well. My specialist visits cost me $30.00 a pop, and they can also be much higher in some plans.

Original Medicare has no such maximum out of pocket costs for their Part A and B, but its hospital deductible for the first 7 days is $1,184.00 in 2013 for each hospital benefit period. Premiums in Original Medicare can also add up, depending on the number of years you worked, with a high rate of $441.00 for Part A hospital insurance per month if you worked less than 7.5 years; if you have worked 10 years or more, you would have no premiums. Part B monthly premiums for doctors are $104.90, with a deductible of $147 per year in 2013. Half of the 10 most popular Part D plans will have double-digit premium increases next year, according to an article in the October 7, 2013 New York Daily News entitled, "Plan Ahead: Take Note of Drug Benefit Changes," by Elizabeth Lazarowitz; you can see the online version of this article here.

Meanwhile, the costs for prescription drugs are all over the lot, with six different tiers for types of drugs and prices in the various Advantage Plans. The private insurers have free reign to charge anything they want, with no attempt at reigning in prices by the government. Since these plans are under contract with the government, there should have been some debate and noise about these ever escalating costs that are killing seniors, not to mention the rest of the population. Instead, prescription drug prices are not negotiated by the government, as opposed to the VA, which has the ability to negotiate and has kept their costs 40 percent less than everyone else. You can thank George W. Bush, who created this massive giveaway to the pharmaceutical industry by creating Part D in 2003. And let us not forget that half of all bankruptcies come from folks with health insurance. Seniors are the most vulnerable in this system, with so many living on a fixed and very modest income, and many falling into that "donut hole" when they reach the maximum out of pocket costs for their prescription drugs.

This has been by no means a full explanation of the costs you could realize in 2014, as there are a large number and wide variety of these so-called Advantage Plans from coast to coast. One thing that is certain, the insurers have us by the neck, and the "advantages" of these plans are rapidly disappearing. The main point is that costs vary from plan to plan and can be very hefty, so be alert and do your homework. Sadly, most seniors are not internet savvy enough to research their healthcare needs. But a serious illness could be a physical, emotional and financial disaster, so it is critical that people learn their options.

Our president has said that "...if you've got health insurance (and) you like your plan...you can keep your plan." Well, Mr. President, most of us don't like our health insurance, nor do doctors and their staffs. The only happy campers are the insurers, who are a growth industry and, thanks to Obamacare, will eventually be delivered 30 million more customers to an overpriced system that delivers too little and costs way too much for the bare bones benefits it does deliver.

Of course, there is a solution to this excessively expensive, insurance-industry-dominated healthcare non-system that worsens by the year. Let's join the rest of the industrialized world and deliver an improved and expanded Medicare for All, which would save $592 billion yearly and make most of us much happier and healthier. It is a simple plan, with a delivery system already in place that would take the best of Medicare and expand and improve it. Medicare pays significantly less for its public, nonprofit administration of its program, in comparison to the overly bloated administrative expenses of private insurers.

Obamacare is only a beginning step towards what 28 other nations already deliver to their citizens. The next step down the road should be to morph Obamacare into the bill that already exists: H.R.676, The United States National Health Care Act, which would provide better healthcare with real advantages like no deductibles and no co pays. Here is an issue Hillary might consider running on if she does indeed decide to seek the presidency in 2016. Cradle to grave, affordable, accessible, quality healthcare for all Americans -- talk about a revolution.

- with Jonathan Stone

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