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The Policy, and Politics, of Medicare Advantage

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Thu, 23 Mar 2023 18:00:00 +0000

The Host

Julie Rovner
KHN


@jrovner


Read Julie’s stories.

Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Medicare Advantage, the private-sector alternative to original Medicare, now enrolls nearly half of all Medicare beneficiaries. But it remains controversial because — while most of its subscribers like the extra benefits many plans provide — the program frequently costs the federal government more than if those seniors remained in the fully public program. That controversy is becoming political, as the Biden administration tries to rein in some of those payments without being accused of “cutting” Medicare.

Meanwhile, President Joe Biden has signed a bill to declassify U.S. intelligence about the possible origin of covid-19 in China. And new evidence has emerged potentially linking the virus to raccoon dogs at an animal market in Wuhan, where the virus reportedly first took hold.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Jessie Hellmann of CQ Roll Call, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.

Panelists

Jessie Hellmann
CQ Roll Call


@jessiehellmann


Read Jessie’s stories

Joanne Kenen
Johns Hopkins Bloomberg School of Public Health and Politico


@JoanneKenen


Read Joanne’s stories

Margot Sanger-Katz
The New York Times


@sangerkatz


Read Margot’s stories

Among the takeaways from this week’s episode:

  • The Biden administration recently changed the formula used to calculate how much the federal government pays private Medicare Advantage plans to care for patients with serious conditions, amid allegations that many of the health plans overcharge or even defraud the government. Major insurers are making no secret about how lucrative the program can be: Humana recently said it would leave the commercial insurance market and focus on government-funded programs, like its booming Medicare Advantage plans.
  • The formula change is intended to rein in excess spending on Medicare — a huge, costly program at risk of insolvency — yet it has triggered a lobbying blitz, including a vigorous letter-writing campaign in support of the popular Medicare Advantage program. On Capitol Hill, though, party leaders have not stepped up to defend private insurers as aggressively as they have in the past. But the 2024 campaign season could hear the parties trading accusations over whether Biden cut Medicare or, conversely, protected it.
  • The latest maternal mortality rates released by the Centers for Disease Control and Prevention show the problem continued to worsen during the pandemic. Many states have extended Medicaid coverage for a full year after women give birth, in an effort to improve care during that higher-risk period. But other problems limit access to postpartum care. During the pandemic, some women did not get prenatal care. And after the fall of Roe v. Wade, some states are having trouble securing providers — including one rural Idaho hospital, which announced it will stop delivering babies.
  • The federal government will soon declassify intelligence related to the origins of the covid pandemic. In the United States, the fight over what started the pandemic has largely morphed into an issue of political identity, with Republicans favoring the notion that a Chinese lab leak started the global health crisis that killed millions, while Democrats are more likely to believe it was animal transmission tied to a wet market.
  • And in drug price news, Sanofi has become the third major insulin maker (of three) to announce it will reduce the price on some of its insulin products ahead of a U.S. government policy change next year that could have cost the company.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Vice News’ “Inside the Private Group Where Parents Give Ivermectin to Kids With Autism,” by David Gilbert

Jessie Hellmann: The Washington Post’s “Senior Care Is Crushingly Expensive. Boomers Aren’t Ready,” by Christopher Rowland

Joanne Kenen: The New Yorker’s “Will the Ozempic Era Change How We Think About Being Fat and Being Thin?” by Jia Tolentino

Margot Sanger-Katz: Slate’s “You Know What? I’m Not Doing This Anymore,” by Sophie Novack

Also mentioned on this week’s podcast:

Credits

Francis Ying
Audio producer

Emmarie Huetteman
Editor

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Title: The Policy, and Politics, of Medicare Advantage
Sourced From: khn.org/news/podcast/podcast-khn-what-the-health-290-medicare-advantage-policy-politics-march-23-2023/
Published Date: Thu, 23 Mar 2023 18:00:00 +0000

Kaiser Health News

TV’s Dr. Oz Invested in Businesses Regulated by Agency Trump Wants Him To Lead

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kffhealthnews.org – Darius Tahir – 2024-11-21 18:01:00

SUMMARY: President-elect Donald Trump nominated celebrity doctor Mehmet Oz to head the Centers for Medicare & Medicaid Services (CMS). Oz, known for his investments in healthcare, tech, and food companies, holds significant stakes in UnitedHealth Group, CVS Health, Amazon, and other companies involved in health insurance and pharmaceuticals, raising potential conflicts of interest. His financial ties include hospital stocks and pharmaceutical investments. Oz has expressed support for Medicare Advantage and criticized the food and healthcare industries. Critics question whether Oz can separate his financial interests from his role, particularly with companies doing business with the federal government.

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Kaiser Health News

Florida Gov. DeSantis’ Canadian Drug Import Plan Goes Nowhere After FDA Approval

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kffhealthnews.org – Phil Galewitz, KFF Health News – 2024-11-21 10:58:00

SUMMARY: Florida’s plan to import lower-cost prescription drugs from Canada, approved by the FDA nearly a year ago, has yet to launch. Governor Ron DeSantis praised the program, anticipated to save state agencies up to $180 million, but officials lack a start date. Despite bipartisan support for drug importation, complications persist, including operational challenges and safety concerns from the pharmaceutical industry. DeSantis has filed lawsuits against the FDA for delays and Florida has already spent $50 million on the initiative with no drugs imported. Other states, like Colorado, face similar hurdles in establishing importation programs.

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Kaiser Health News

California Sets 15% Target for Primary Care Spending Over Next Decade

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kffhealthnews.org – Vanessa G. Sánchez – 2024-11-21 04:00:00

SUMMARY: California’s Office of Health Care Affordability has set a goal for insurers to allocate 15% of their spending to primary care by 2034, aiming to address the state’s shortage of primary care providers and improve preventive care. The current spending rate is 7%. This ambitious target seeks to reduce long-term healthcare costs by emphasizing early diagnosis and disease prevention. However, the state’s plan faces challenges, as it conflicts with a 3.5% cap on overall healthcare spending growth. The state will monitor progress, offering financial incentives to insurers who meet primary care spending goals, with the hope of expanding access and improving health outcomes.

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