Paying the fox to guard the henhouse
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January 17, 2023 Dear colleague, Commercial insurance companies have a long history of harming patients, whether they’re imposing sky-high deductibles, demanding “prior authorization” for routine treatments, or outright denying medically necessary care. Why? Because their investors demand profits, and these companies have a legal responsibility to deliver. We’ve seen how insurance company practices have impacted workers, Medicaid managed care beneficiaries, and seniors who have enrolled in Medicare Advantage. Now—as if that weren’t enough—millions of Traditional Medicare beneficiaries will have to deal with the interference of middlemen thanks to ACO REACH. That’s why PNHP sent a letter to Health and Human Services Secretary Xavier Becerra and Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure earlier today, demanding an end to the hopelessly compromised REACH program. Our letter highlighted numerous instances of fraud and other malfeasance from companies that were nevertheless approved to administer Medicare benefits through REACH. |
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Over the past year, PNHP investigated a small sample of
Direct Contracting Entities (the precursor to ACO REACH) and uncovered a
range of bad behavior that was as unsettling as it was commonplace. For
example: - Centene subsidiary Health Net overcharged the VA by nearly $100 million;
- Sutter Health agreed to settle
with the state of California for $575 million to resolve allegations of
anticompetitive practices that led to higher prices for patients;
- Clover Health was fined
by CMS for using “marketing and advertising materials that contained
inaccurate statements” about coverage for out-of-network providers;
- Humana was accused by federal investigators of improperly collecting almost $200 million from Medicare;
- Cigna is being sued by the Department of Justice for allegedly gaming the Medicare Advantage program to secure higher capitation payments.
This history should have taught federal policymakers a lesson: Commercial insurance companies cannot be trusted to administer public health benefits. |
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How can we push these policymakers to do the right thing and finally end
the Medicare REACH program? By highlighting the inexcusable behavior of
these contracted companies, and building a grassroots movement that
will be impossible for the Biden administration to ignore. In the immediate term, please join us on Thursday, Jan. 26 at 8:00 p.m. Central / 9:00 p.m. Eastern for a webinar where we’ll talk more about the next steps in this fight to reclaim Traditional—truly public—Medicare. In solidarity, |
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Phil Verhoef, M.D., Ph.D.
President |
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Join us today in asking NYC Comptroller Brad
Lander to conduct a fiscal analysis and report of the
impact of the New York Health Act on the NYC budget!
As NYC braces for another austerity budget battle and the City seeks to shift municipal retirees off of traditional
public Medicare, into restrictive, privatized Medicare Advantage
plans and change the City’s administration code in an
effort to offload costs,
there has been too little attention to systemic solutions that will
provide long lasting relief.
Beyond the clear quality of life
and life-saving benefits, a major advantage of a universal,
single-payer system is the cost-savings benefits that come with the
efficiency, bulk purchasing power, and removal of
private profits accompanying
such a system. While the savings take place at almost all levels, they
are particularly significant for lower levels of
government.
In 2018, the New York City Council
passed a resolution calling on the State
government to enact the New York Health Act. A fiscal and budgeting analysis from the
NYC Comptroller is an opportunity for the City to investigate the
extent of the cost-savings at the City level, to demonstrate an
important and viable alternative to austerity, and to garner more
support for the legislation moving forward.
Please sign the petition today and
share this link with your networks: www.bit.ly/ComptrollerPetition
Thank you for joining us in
struggle now and always,
Oliver Fein, MD
Board Chair, Physicians for a National
Health Program – New York Metro
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