Rep. Mark Pocan wants to strip the "Medicare" name away from the Medicare Advantage program.
The Wisconsin Democrat — who is fighting for a shift to a fully government-run health finance system — introduced H.R. 9187 last week.
Pocan hopes to change the name of the program to the "Alternative Private Health Plan." The bill would impose a fine of $100,000 for each instance of an insurer or other issuer advertising a plan with the name "Medicare" in the plan title, according to a version of the text posted on Pocan's House website.
The Medicare Advantage program gives private health insurers a chance to sell policies that look to the consumer like an alternative to Original Medicare.
Pocan filed his bill five days before the Better Medicare Alliance, an organization for Medicare Advantage program supporters, was set to start its 2022 Medicare Advantage Summit. The two-day conference starts Tuesday in Washington.
What It Means
The Medicare Advantage program may now look as if it has strong bipartisan backing, including support from a 63-senator coalition in the Senate and a 346-representative coalition in the House.
But the Medicare Advantage program still faces opposition from critics who believe it leads to too much or too little government involvement in health finance.
Brokers and agents need to watch Washington carefully to understand how clients' health coverage might change, and when.
The History
Congress created Medicare — the federal health insurance program for the elderly — by adding Title XVIII to the Social Security Act in 1965.
In 1972, Congress extended Medicare coverage to many people with Social Security Disability Insurance and to people who are getting kidney dialysis or kidney transplants.
The "Original Medicare" Medicare Part A inpatient hospitalization program and Medicare Part B physician and outpatient services program include complicated rules for deductibles, copayments and coinsurance amounts.
Private companies called "Medicare administrative contractors" run the Original Medicare programs. The MACs are affiliates of companies such as Blue Cross Blue Shield of South Carolina and Blue Cross Blue Shield of North Dakota.
Enrollees can use Medicare supplement insurance policies to fill in the gaps in Original Medicare, without appearing to replace the Original Medicare coverage, or they can buy Medicare Advantage plans.
Health insurers have been offering Medicare supplement insurance policies — also known as Medigap policies — since the 1980s. Congress created the current regulatory framework for Medigap policies in the Omnibus Budget Reconciliation Act of 1990.
Congress created the current framework for Medicare alternative plans in 1997 by putting Part C in Title XVIII of the Social Security Act.
Medicare Part C created a private Medicare plan program that was originally known as the Medicare+Choice program. The name changed to Medicare Advantage in 2003.
The annual election period for Medicare Advantage plan coverage started Saturday and is set to run until Dec. 7. Coverage sold during the period will take effect Jan. 1, 2023.
About 29 million of the 65 million people now enrolled in Medicare have Medicare Advantage plan coverage.
The Money
Medicare program trustees expect Medicare to pay about $420 billion to private health plan issuers this year, and about $473 billion in 2023, according to the trustees' 2022 report.
The New York Times recently ran an article, cited in the Pocan H.R. 9187 filing announcement, noting that the federal Medicare Payment Advisory Commission has estimated that Medicare Advantage plan issuers had received about $12 billion in overpayments in 2020.
That's equal to about 3.8% of the plans' $317 billion in payments from the federal government.
