Democrats ask Sebelius for 'robust' review of 2011 Medicare Advantage plan changes

The trade association America's Health Insurance Plans (AHIP) is fighting back against Democratic leaders who have asked U.S. Department of Health and Human Services Secretary Kathleen Sebelius to "undertake a robust and thorough review" of any Medicare Advantage plan 2011 bid submissions that include premium increases or benefit reductions. (Bid submissions are due June 7.)

Senate and House Finance, Ways and Means, Energy and Commerce Committee leaders all signed the letter to Sebelius, concerned that Medicare Advantage plans might use the reduction in Medicare Part C funding under health reform as an excuse to raise prices or cut services, reports Dow Jones Newswire in the Wall Street Journal.

Lawmakers once again trotted out WellPoint Inc. as the poster child of a problematic health plan. "Substantial errors made by WellPoint in projecting medical cost trends in California for 2011--uncovered and corrected only after a rigorous assessment of the company's rate filing documents--are an example of the kind of review that would protect Medicare beneficiaries and the program from unjustified premium increases or benefit changes. The Office of the Actuary at CMS already collects detailed actuarial information in the bid submissions and has statutory authority to request additional documents as needed during the bid reviews," they said.

Congress is being unreasonable and unrealistic, charges Robert Zirkelbac, AHIP press secretary. "Washington can't slash $200 billion out of Medicare Advantage and then try to shift the blame to the health plans that administer the program when those cuts inevitably result in higher premiums and benefit reductions for seniors. The Congressional Budget Office has stated that additional benefits provided by Medicare Advantage will be cut in half and that millions of seniors will lose their current coverage [by 2019]."

The Centers for Medicare and Medicaid Services contradicts the $200 billion figure, a representative telling National Underwriter Life and Health that the cuts should total $136 billion.

UPDATE: Late last week, Sebelius sent a letter to four insurers in the Medicare Advantage market, including WellPoint, advising them against trying to increase premiums or co-payments for vulnerable senior citizens, reports the Wall Street Journal.

To learn more:
- read this Dow Jones Newswire report in the Wall Street Journal
- read this National Underwriter Life and Health article
- read the Senate Finance Committee statement and letter to Sebelius

- read this Wall Steet Journal article

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