Experts Address ‘What Went Wrong’ With Medicare+Choice At Conference

Some of the nation's top health policy experts grappled with "what went wrong" in the Medicare+Choice program at a conference in Princeton University last week, concluding that "Medicare has a lot of work to do" to address the program's problems, Julie Rovner writes in a CongressDaily/AM HealthMatters column. Under Medicare+Choice, which Congress passed as part of the 1997 Balanced Budget Act to "expand the then-growing Medicare managed care program," lawmakers hoped to "encourage more beneficiaries to join plans" and to expand the "types of plans members could join" -- but according to Rovner, the law "threw a party to which nobody came." At the same time that lawmakers were trying to promote Medicare+Choice, they also modified the reimbursement system, prompting "dozens of plans" to exit the Medicare market or reduce benefits not covered in fee-for-service Medicare that made Medicare HMOs competitive, such as prescription drug coverage. According to former HCFA Administrator Nancy-Ann DeParle, Congress "tried to give and take at the same time," hoping to "save money and have more Medicare managed care plans." Rovner writes, "Even worse," prescription drug costs had begun to "skyrocket." While "plans' costs, particularly for drugs, were going up, their payments from the government were stagnating." Stuart Altman, a Brandeis University professor and former head of Medicare's hospital advisory commission, said at the conference that the Medicare+Choice "debacle" has "hurt relations" with health care providers, who "just can't trust Washington." Rep. Nancy Johnson (R-Conn.) said, "In Medicare, (providers) don't believe what you say anymore, because they don't believe that's what's going to happen" (Rovner, CongressDaily/AM, 5/24).