The Medicare Sales Job Moves Along

More media skepticism needed

In his radio message this weekend, the president focused on Medicare, trying as hard as he might to convince skeptical seniors that health reform would be good for them. The president has reason to worry about the older demographic. A recent poll by the National Council on Aging revealed that most seniors don’t know beans about the new law, or about how it affects them. Only nine percent correctly answered two thirds of the questions. Bad showing, indeed!

So the president promoted the $250 rebate, sent awhile back to elders who had very high prescription drug expenses—the donut hole crowd of some three million. He told about the half-price discount on brand name drugs next year, a gift from Phrma as part of the deal to stop them from bashing reform. Never mind that this present encourages the use of expensive brand-name drugs instead of lower-cost generics.

And he touted the news (pdf) that health reform will extend the solvency of the Part A (hospital) trust fund for twelve years—reason to cheer if the government really, really can achieve the savings the administration is counting on. Said the president:

We’ve made Medicare more solvent by going after waste, fraud, and abuse—not by changing seniors’ guaranteed benefits. In fact, seniors are starting to see that because of health reform, their benefits are getting better all the time.

Presumably he was talking about some preventive benefits that will not require copayments or coinsurance—a good thing, if more people get colonoscopies.

It’s not surprising seniors don’t know much about the Medicare provisions. As Campaign Desk has pointed out, the media didn’t talk much about Medicare during the debate—or during the presidential campaign, for that matter—largely because the candidates and later the pols didn’t talk about it. One pollster told me they advised the pols not to go there. The potato was too hot.

Advocacy groups knew where the skeletons lay, but didn’t want to dig them up for fear of scotching the reform effort. Now they are working in overdrive to help the president sell reform. The National Council on Aging came out with more fact sheets. Families USA is pushing Medicare positives at town hall meetings attended by lots of seniors. At one in Philadelphia last week, the group’s deputy executive director, Kathleen Stoll, said “there’s been a lot of misinformation about Medicare and it’s very frustrating,” and then gave a carefully worded talk listing all of the Medicare goodies and avoiding the unsavory ones.

Seniors are right to be suspicious. The not-so-nice surprises are yet to come. Last week, though, a few news outlets began to question what the Medicare trustees report really said. Tucked away in the report were warnings from Medicare’s chief actuary, Richard Foster, which were picked up by USA Today and The New York Times. Foster noted that the $500 billion cuts to Medicare generate uncertainty in the long run that could affect seniors’ ability to get health care. “The financial projections shown in this report for Medicare do not represent a reasonable expectation for actual program operations,” Foster wrote.

OK, so much for the big picture. For the most part, though, the media haven’t reported on the little picture Congress has drawn for Medicare recipients. Charles Wallace, writing for AOL’s Daily Finance site, noted one change to the rules, which he said “has not been widely reported.” Those enrolled in a Medicare Advantage (MA) plan will no longer be able to switch to another MA plan if the one they belong to hikes its premiums or whacks the benefits they’ve come to enjoy. Come January 1, they will have forty-five days to return to traditional Medicare and buy a Medigap policy to fill in the coverage holes.

What will they find? The much-ballyhooed protections about preexisting conditions may not apply to them. Vicki Gottlich, a senior attorney with the Center for Medicare Advocacy told me that, generally, if you have had an MA plan for the first time and don’t like the new prices or the cuts, you can go back to traditional Medicare and buy a Medigap policy without facing restrictions on preexisting conditions. But if you’ve had two or three different MA plans over the years and try to buy a Medigap policy, sellers can impose health restrictions. How’s that for simplicity?

Then there’s the matter of premiums for these policies; they will continue to rise, too. There’s also the little-reported new twist to the benefits offered by Plans C and F, the most popular Medigap policies. Changes mandated by the reform law will shift more of the cost of medical care to the seniors who buy them. That may mean, for example, that instead of these policies covering the 20 percent coinsurance Medicare requires for doctors’ visits, the new rules could mean the policies will pay only 10 percent. Guess who pays the rest?

So when the president and the pols say no one is cutting “basic or guaranteed benefits,” that’s true. But they are telling only half the story. How about the press telling the other half?

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.