Obama administration caves to health insurers; restores (extra) profits for Medicare Advantage plans

[ProSense]

Obama administration caves to health insurers; restores (extra) profits for Medicare Advantage plans

by james321

Whether you love Obamacare or hate Obamacare -- I, for one, would prefer single-payer, but recognize the value of incremental progress -- this move by the Obama administration should enrage anyone who believes in good and efficient governance.

Medicare has reversed proposed payment cuts to private heath plans in the popular Medicare Advantage program for the second straight year amid strong pushback from health insurers and Capitol Hill.

The Centers for Medicare and Medicaid Services on Monday, after proposing in February a 1.9 percent cut to private plans, said government payments to insurers in the Medicare Advantage program will increase .4 percent on average in 2015. The increase, CMS said, is slightly higher than what insurers had requested.

"That gives us great confidence with this final rate structure we'll continue to see a strong program," said CMS principal deputy administrator Jonathan Blum.

The reversal comes after a major lobbying effort from the health insurance industry and signals that Republicans would use the cuts to attack Democrats in this year's midterm elections. The Medicare Advantage program, according to the Avalere Health consulting firm, now covers about 16 million seniors, or 30 percent of all Medicare beneficiaries, through private health plans that can offer extra benefits, like wellness plans.

The reason Obama -- and Paul Ryan -- consistently proposed these cuts in the first place is because they do not cut Medicare, but instead serve to chip away at the prodigious, huge, ginormous economic rent-seeking by private health insurers who operate so-called Medicare Advantage plans for seniors. In a nutshell, insurers are paid by the government more than they need to be paid in order for insurers to pay the medical bills of seniors opting out of traditional Medicare -- about 30 percent of seniors -- and they get to keep all that extra money as profits to make fat cats on Wall Street happy. Obviously, the folks at Aetna and Humana -- represented by America's Health Insurance Plans, or AHIP -- were none too pleased.

America’s Health Insurance Plans, the nation’s largest industry group representing health insurers, ran an aggressive lobbying effort last year that helped turn a proposed 2.3 percent cut for 2014 Medicare Advantage plans into a 3.3 percent raise.

For the record, "Democrat" Chuck Schumer led the heroic battle for health insurance company shareholders.

About half of all the members of Congress, across party lines, raised concerns about the proposed cuts. A group of 40 Republican and Democratic senators, lead by Chuck Schumer (D-N.Y.) and Mike Crapo (R-Idaho), had called on CMS to maintain Medicare Advantage payment levels in 2015. Democrats had been especially fearful that the cuts would be used against vulnerable lawmakers in the November elections.

"In many parts of the country, including New York, Medicare Advantage works very well," Schumer said in a Monday evening statement. "They’ve shouldered their share already and this proposed cut would have been disproportionate, hurting seniors who would lose doctors or pay more. We’re glad the administration heeded our call and reversed the policy.”

Now, is this a disaster? Not really -- repealing Obamacare would be a disaster. Turning Medicare into a voucher program would be a disaster. This, however, is disgusting politics.

In a post-Obamacare era when America's bloated health care system -- representing nearly 20 percent of our GDP -- still forces individuals to put their health care -- even their premiums -- on a credit card, these kind of cynical and transparent giveaways to powerful financial interests (and, really, health insurers are nothing more than investment banks who gamble with your premium dollars and pay some medical bills when they feel like it) do nothing to structurally transform a broken system, or even set that system on a path towards a more reasonable future.

Today, we should be disappointed by Barack Obama's behavior. This was absolutely unnecessary. On April 15th, be aware -- just a little bit more of your hard-earned wages will be going to build the unearned wealth of these assholes.

http://www.dailykos.com/story/2014/04/07/1290388/-Obama-administration-caves-to-health-insurers-restores-extra-profits-for-Medicare-Advantage-plans

Oh well. It's not like anyone gave a shit anyway. I mean, people were no doubt lining up to portray these as cuts to Medicare. Ugh!

Decoding The High-Stakes Debate Over Medicare Advantage Cuts
http://www.democraticunderground.com/10024790479

[okaawhatever]

1. I'll bet you anything he did this to get them to pass the bill they did earlier today and to get

the Repubs and insurance companies to not sue. There was a loophole created when scotus gave their ruling and said states didn't have to create their own exchanges. I knew the repubs closed the loophole earlier for a reason. Oh well, it was worth it if it kept the program going and kept the ACA out of the courts.

[ProSense]

3. Hey, at least he's not cutting Medicare.

I hope all the people who portray these as cuts are happy to support subsidies to private insurers while they're milking Medicare recipients, seniors.

It's unfathomable to me that people are up in arms about private insurance companies except when these predators are compromising a program that's supposed to be single payer.

I mean, when people are proposing Medicare for all, are people suppose to accept Medicare Advantage as part of the package?

[PoliticAverse]

7. The Supreme Court decision had nothing to do with states not having to create their own exchanges,

the ACA specifically allowed them not to. The Supreme Court decision had to do with
the Medicaid expansion part of the ACA.

[Hoyt]

2. 30% of Medicare beneficiaries have chosen Advantage Plans. It saves them money over

traditional Medicare with a supplemental policy and drug coverage (which those who don't choose Advantage Plans need to purchase to have any reasonable level of coverage, including an out-of-pocket cap that traditional Medicare does not provide).

[ProSense]

4. They need to expand Medicare

"30% of Medicare beneficiaries have chosen Advantage Plans. It saves them money over traditional Medicare with a supplemental policy and drug coverage (which those who don't choose Advantage Plans need to purchase to have any reasonable level of coverage, including an out-of-pocket cap that traditional Medicare does not provide).'

Stop overpaying private insurers ($15.6 billion per year) that are collecting higher premiums than Medicare. They need to move Medicare toward single payer programs that offer better benefits (dental and vision), including better drug coverage, i.e. Medicaid and TriCare.

[Hoyt]

6. Until then, Medicare Advantage is much more affordable for beneficiaries.

I really don't care if insurance companies make a few bucks. Traditional Medicare is not coordinated care, and it leaves beneficiaries open to bankruptcy. Medicare Advantage plans usually have some services traditional Medicare does not cover, like dental and vision (although it is limited, it's better than nothing). The biggest thing is that under Medicare Advantage you get drug coverage and supplemental coverage at a substantial savings over buying that separately under traditional Medicare.

Yes, it would be nice if traditional Medicare were expanded. Do you have a projection when that is likely to occur?

[ProSense]

9. In this

Until then, Medicare Advantage is much more affordable for beneficiaries.

I really don't care if insurance companies make a few bucks. Traditional Medicare is not coordinated care, and it leaves beneficiaries open to bankruptcy. Medicare Advantage plans usually have some services traditional Medicare does not cover, like dental and vision (although it is limited, it's better than nothing). The biggest thing is that under Medicare Advantage you get drug coverage and supplemental coverage at a substantial savings over buying that separately under traditional Medicare.

Yes, it would be nice if traditional Medicare were expanded. Do you have a projection when that is likely to occur?

...thread (http://www.democraticunderground.com/10024790479), there are a couple of anecdotes that counter that, both in terms of benefits and premiums.

Still, that doesn't explain why the Government needs to boost private insurers profits with overpayments that are basically subsidies.

These plans are the reason Medicare is in jeopardy. They're costing too much money and driving up costs.

[Hoyt]

10. God forbid some Medicare beneficiaries save $100 or more a month by choosing an Advantage Plan.

[ProSense]

11. Does that justify $15.6 billion in overpayments to insurance companies?

"God forbid some Medicare beneficiaries save $100 or more a month by choosing an Advantage Plan."

They're paying hefty premiums. That's how insurance works, and it works without milking Medicare funding.

There are a lot of seniors who can't afford those premiums. It would be better if the $15.6 billion were directed to subsidies for them instead of boosting insurance companies profits.

Expand Medicare...when? As soon as possible.

[Hoyt]

13. Actually, you can get an Advantage Plan with no additional premium above the Part B premium.

A decent supplemental policy and drug policy will cost those seniors more than the 15 billion.

What you aren't getting is that Advantage Plans are that expansion, you say you support, until it is enacted for Traditional Medicare. Again, when do you think that will happen?

[ProSense]

14. Ah, so it went from overpayments that boost profits to being justified?

Sounds like defending private insurers at all cost.

Differences between Original Medicare and Medicare Advantage Plans
http://www.medicarerights.org/fliers/Medicare-Advantage/Differences-Between-OM-and-MA.pdf?nrd=1

http://www.medicare.gov/supplement-other-insurance/medigap/medigap-and-medicare-advantage/medigap-and-medicare-advantage-plans.html

http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html

[pangaia]

18. I have tried following the discussion between you and Hoyt.

All I can say for sure is my own experience the last 6 years with my Medicare Advantage plan.

My premiums have been $30,$23, $23, $00, $43, and this year $72 because I finally added Part D.
My max total premiums incl Medicare and the Advanrtage was $1764.
My PCP is $15 co-pay. Specialists are, $30-40, I think.
It seems every doctor in a 4-5 county area, which includes Rochester, NY, accepts my insurance. I have never been turned away.
This includes cataract surgery 2x (cost me $120 each time--seemed a little steep, personally), Bell's Palsy, 4 chemo sessions, 4 lumbar punctures, bone marrow test, Cat/Pet scans, x-rays, MRI's, you name it.
One day hospital stay for spinal surgery for the cancer on my spinal cord was $160 !.. for a private room. Double would have been $120. I think the max/year out of pocket for hospital days is $600. Don't quote me on the exact amount. Blood tests are $10.
No deductibles. Just very reasonable co-pays. reasonable being relative of course..

Plus, I get free membership at the Y ($800 worth), and the Advantage offers anyone free in home health evaluations and advice...not something I need but many do. Basically no dental, though.

So I am damn glad I have that Advantage plan,

Now, should there be Medicare for all that INCLUDES the benefits of MY Advantage plan? Absolutely.. tomorrow!

I am sure you know the nitty gritty of how it all works better than I do and I generally HATE, just HATE insurance companies. But...I feel pretty lucky that I have (at least so far) a pretty good one (is that an oxymoron?).. I wish the same for everyone..

[ProSense]

19. Based on your comment

"Now, should there be Medicare for all that INCLUDES the benefits of MY Advantage plan? Absolutely.. tomorrow! "

...maybe it should be Medicare Advantage for all? Seems like you have a good deal.

I still see no reason to subsidize private insurers with Medicare dollars. People have been complaining about the rising cost of health care. Medicare costs have been climbing out of control, driven in large part by the effects of private insurance on Medicare.

Hey, but I guess everyone should overlook that and carry on. Anyone who supports these overpayments should have nothing to say about rising health care costs.

[pangaia]

20. I didn't say "Medicare Advantage for all."

I said, "...Medicare for all that INCLUDES the benefits of MY Advantage plan."

[Hoyt]

29. Thank you, Pangaia. I am working through the decision process for me as I become eligible in a few

Thank you, Pangaia. I am working through the decision process for me as I become eligible in a few e until you are actually using it. I know that straight Medicare without drugs and/or a supplemental is a prescription for poor care and possible bankruptcy if I get really sick.

[pangaia]

49. Hoyt, I think part of your reply got left out. ??

But, yes. regardless of what Prosense says about $$ going to insurance companies' profit. etc etc.,for the person on the street who can afford it, an Advantage Plan IS the way to go. For one thing, mine pays that additional 20% of a lot of services that Medicare does not. That can be a WHOPPER!

I will say, the insurance company I have seems to be 'very good,' so far,, low rates excellent coverage. Virtually every doctor in a wide area is included. (Except my acupuncturist HA HA) When they get extra payments from the gov, they pass a lot of it on to the customers. And a lot more goes to doctors on the lower end of the pay scale.. LIKE PCPs! As you can see, one year my premium was ZERO.. (That won't continue, I am sure)

Before I turned 65 in 2008 I spent months trying to figure it all out.
Which Medicare Plan -A B C D E F-- POS (is that it), HMO, MGM, NBC, in network, who is in, who is out.. will I travel?
It is mind boggling and stupid.

I doubt every company has the rates/service that mine does but...

Good luck in your hunt. Keep it simple...if you can.

[Hoyt]

50. Thanks for the tips, it is mind boggling. At least one can change if not happy.

That keeps them honest, at least some of them.

Yeah, my post got messed up. These darn "smart" phones. But, you got the gist of it.

Thanks again.

[ProSense]

51. Well,

"But, yes. regardless of what Prosense says about $$ going to insurance companies' profit. etc etc.,for the person on the street who can afford it, an Advantage Plan IS the way to go....When they get extra payments from the gov, they pass a lot of it on to the customers."

...there are facts to be considered. Like I said, you seem to have good plan, and you pay a premium for it. The overpayments are another story.

Obama Makes Surprise Reversal On Obamacare
http://www.democraticunderground.com/10024794204

[Hoyt]

52. Maybe Obama admin realized when they looked into it that the cuts might actually hurt

the plans and 30% of beneficiaries who voluntarily choose them to save a few bucks and perhaps benefit from better coordinated care.

[ProSense]

53. The overpayments

"Maybe Obama admin realized when they looked into it that the cuts might actually hurt"

.... have been cut from 14 percent to 6 percent, and the opposite has happened. What this shows is that insurers are desperate to keep these seniors and the premiums flowing, and likely making it attractive in order to expand enrollment to the other 70 percent of seniors.

[bornskeptic]

25. $15.6 billion comes to about $300 per Medicare enrollee.

Annual Medicare expenditure by the government was aound $11,000 per enrollee the last time I checked. $300 won't buy much healthcare.

[ProSense]

26. Then

"$15.6 billion comes to about $30 per Medicare enrollee."

...it's a $30 overpayment. Since not every Medicare enrollee has a Medicare advantage plan, it's likely closer to a $100 overpayment.

It's still $15.6 billion added to insurers profits. They also get the added benefit of people defending it.

[bornskeptic]

27. I dropped a zero. It's fixed now.

But $300 won't by a supplemental policy and a drug plan for more than two or three months.

[ProSense]

28. It's still an overpayment.

"I dropped a zero. It's fixed now. But $300 won't by a supplemental policy and a drug plan for more than two or three months."

To my point, it's not all enrollees (about 30 percent), meaning it's $3,000.

This is addition to the per-enrollee cost. Again, people have been complaining about the rising cost of health care. Medicare costs have been climbing out of control, driven in large part by the effects of private insurance on Medicare.

[Hoyt]

30. Nope, it's not an overpayment. It's basically that "expanded" Medicare you keep throwing around.

But it exists right now, not something that should exist. Again, I'm perfectly fine with a government, private insurer partnership as long as it works. I'm really not sure what your problem is with it. You seem to accept the ACA, as an improvement (as do I considering what was doable with Congress) . It's a government/insurer partnership too. When Congress gets around to improving Medicare like you suggest, then we can change the MC Advantage program.

[ProSense]

32. No, it isn't. You can't dismiss facts because they're inconvenient.

"You seem to accept the ACA, as an improvement (as do I considering what was doable with Congress) ."

I accepted improvements to private insurance on the way to single payer.

Medicare Advantage is private insurance that was implemented to Medicare, and has set the program on a path to bankruptcy.

"When Congress gets around to improving Medicare like you suggest, then we can change the MC Advantage program. "

So it's not Medicare "expandeded"?

You know, go ahead and defend private insurance, but please don't try to make it out to be something it's not.

What you're defending here is goverment subsidies used to boost private insurers' profits.

[Hoyt]

34. Nope. You are just arguing for the sake of arguing. If Medicare is expanded

to offer what an Advantage Plan - with a supplemental and drug coverage offers - it will cost more that $15.6 billion.

Copy that with your next argument that old folks need to cancel their Medicare Advantage Plans because private insurers are able to offer something that traditional Medicare can't - at a comparable cost - under today's Congress.

[ProSense]

37. No, I'm

"Nope. You are just arguing for the sake of arguing. If Medicare us expanded. If Medicare us expanded to offer what an Advantage Plan - with a supplemental and drug coverage offers - it will cost more that $15.6 billion. "

...not, and the flaw in your argument is that you ignore that this is an overpayment. The fact is that it is in addition to the cost of Medicare equivalent payments, and in addition to the excessive premiums (by comparison to Medicare) that people are paying.

[Hoyt]

39. They are providing more than traditional Medicare. It's that darn simple.

[ProSense]

40. And people are paying for it. That should be "darn simple" to understand. n/t

[Hoyt]

41. They are paying a heck of a lot less than a comparable supplemental policy and drug coverage

with traditional Medicare.

With traditional Medicare alone, there is no out-of-pocket cap. You have brain surgery and rehab, your share is easily $100,000, probably much more. With Advantage, it's $5000 max.

You can get a supplemental and drug coverage with Advantage, and it will be substantially less than under traditional Medicare. The only thing a beneficiary gets with traditional Medicare is they can select any provider, not just in network. What that gets you, unless you know what you are doing, is a bunch of uncoordinated care where one doc doesn't know what the other is doing, etc.
You can choose traditional, but I think there are better plans out there including new ACO's (run by hospitals and doctors) with incentives under the ACA.

[ProSense]

43. Yes, they're "paying" for it, and

"They are paying a heck of a lot less than a comparable supplemental policy and drug coverage with traditional Medicare. "

..."traditional Medicare" doesn't cover drugs.

So again, you're comparing apples and oranges. The fact is that people pay premiums for the coverage under Medicare Advantage. That is how insurance works.

What shouldn't be part of the deal is overpayments to boost insurers profits.

[Hoyt]

44. People pay premiums for a supplemental and drug coverage.

You can take an Advantage Plan that doesn't cost you a penny. You pay the $104 everyone pays for Part B, and you get an Advantage Plan.

You don't have coverage for cost-sharing or drugs (although you do have the out-of-pocket cap which is worth a lot). But, you can purchase supplemental and drug coverage, and it will be substantially less than if you buy them under traditional Medicare.

You are going around in circles now - "funny how the circle goes around, first you are up and then you are down again" (Gene Clark) . I have better things to do.

[ProSense]

45. "People pay premiums," and the Government makes overpayments to boost insurers' profits.

You can deny that they're overpayments, but that's simply denying a fact, and means you're the one going around in a "circle."

[Hoyt]

46. Until you get Congress to pass that expansion you keep posting about, Advantage is the only

way to get it. If an insurer makes a little profit by taking the risk, providing beneficiaries an out-of-pocket cap, negotiating drug prices, insuring quality and posting ratings, coordinating care, pushing prevention, offering a little extra like limited dental and Y membership, etc., I'm OK with it.

You go ahead and encourage Ryan, Paul, Cruz, etc., to make traditional Medicare as good as an Advantage Plan. It'll cost a lot more than your $15.6 billion.

[ProSense]

47. "If an insurer makes a little profit by taking the risk"

Did you mean if the Government overpays insurers by $15.6 billion a year to boost their profits, you're "OK with it"?

Yeah, there is always an excuse for corporate welfare.

I don't expect a bill to change Medicare to pass tomorrow, and that has nothing with ending the overpayments.

[Hoyt]

48. Nope. I meant what I said. For that $15.6 B, seniors get far more than through traditional Mcare.

[Demo_Chris]

36. Wait, aren't you supposed to blindly defend every move the administration makes? WTF?!

[ProSense]

38. I was waiting for nonsense from an expected source. n/t

[Demo_Chris]

42. Actually, you have impressed me with this thread. Well done. nt

[enough]

17. A small point. One pays extra for any dental or vision coverage under Medicare Advantage. (nt)

[postulater]

5. A chiropractic adjustment is $6 through Part B

But it is $30 copayment minimum through the Advantage plans.

[Hoyt]

8. Not all. But major surgery will cost you $20,000 in coinsurance, but nothing in an Advantage Plan.

Traditional Medicare is pretty limited in it's coverage of chiropractic care.

[ProSense]

12. Evidently, Medicare for all

is just a slogan because when it comes to Medicare Advantage, it's all about defending private insurance.

[Hoyt]

15. Private insurance is deeply involved in traditional Medicare too.

Private insurers pay the claims, deal with beneficiaries, etc. The government doesn't do that, they contract with private insurers. And private insurers take risk with supplemental policies, drug policies, and Advantage Plans. So insurance companies are making a profit in just about every aspect of Medicare, except for writing and enforcing regulations (and they actually do some of those aspects).

[ProSense]

16. Oh brother.

"Private insurers pay the claims, deal with beneficiaries, etc. The government doesn't do that, they contract with private insurers. And private insurers take risk with supplemental policies, drug policies, and Advantage Plans. So insurance companies are making a profit in just about every aspect of Medicare, except for writing and enforcing regulations (and they actually do some of those aspects)."

I know how Medicare works, it's a single-payer system. Is that comment lauding Medicare or tearing it down to support private insurers?

[Recursion]

21. I think the point is that Medicare is rather opaque on this, which is troubling

I know how Medicare works, it's a single-payer system.

On paper, yes. But it's also provisioned almost completely by large private insurance companies. The "2% overhead" we keep hearing refers to the cost of getting the money from the Trust Fund to BCBS and the other big fish that actually pay the claims -- it does not include their overhead once they get the money. In fact, that information is nearly impossible to find. That's actually one reason I prefer the Dutch/Swiss model to the Canadian.

[ProSense]

22. No,

"think the point is that Medicare is rather opaque on this, which is troubling

I know how Medicare works, it's a single-payer system.

On paper, yes. But it's also provisioned almost completely by large private insurance companies. The "2% overhead" we keep hearing refers to the cost of getting the money from the Trust Fund to BCBS and the other big fish that actually pay the claims -- it does not include their overhead once they get the money. In fact, that information is nearly impossible to find. That's actually one reason I prefer the Dutch/Swiss model to the Canadian."

...it's not "opaque." Medicare has alway operated using contractors. That is not unusual, and it's nothing like the private, for-profit insurance structure.

http://www.ssa.gov/history/ssa/lbjhistory.html
http://www.democraticunderground.com/10021854665#post10

It's a single payer because it's run by the government.

[Recursion]

23. Well, it's single payer because there is a... wait for it... single payer of claims

Lots of south and central European countries have non-governmental single payer; sort of Medicare-as-a-co-op.

[ProSense]

24. OK, but

"Lots of south and central European countries have non-governmental single payer; sort of Medicare-as-a-co-op."

...that's getting away from my point, which is that there is no reason the Government should be boosting private insurers profits by overpayments using Medicare funds.

[Hoyt]

31. They are not over overpayments if Mcare beneficiaries are getting something they need and can't get

at a comparable cost under traditional Medicare.

The Advantage insurers are making their money by coordinating care, doing a better job of negotiating drug prices and other provider reimbursement, improving outcomes, and rationing care that needs to be rationed/controlled. If you or grandpa doesn't want it, don't sign up.

[ProSense]

33. Yes

"They are not over overpayments"

...they are. The Obama administration made the first round of cuts because they're overpayments. They are likely going to be cut again. Note this is a concession for this year.

Krugman:

How do you deal with this? Well, ideally, Medicare for all. But since that wasn’t going to happen, you improve the risk pool by requiring everyone to buy insurance — the individual mandate. And since some people won’t be able to afford that, you also offer subsidies...Where does the money for the subsidies come from? Partly by reducing corporate welfare: reducing overpayments for Medicare Advantage, reducing tax breaks for very generous insurance plans; partly with new taxes on the wealthy.

http://www.democraticunderground.com/10023284000

[ProSense]

35. "Why should we care?"

<...>

AHIP, the health insurance lobby organization, has been conducting an intensive campaign to prevent the reductions in overpayments to the private Medicare Advantage plans - reductions required by the Affordable Care Act. A hint at how successful their campaign has been can be inferred from the fact that this letter from 40 senators, calling for perpetuation of the overpayments, but using AHIP rhetoric, was downloaded from the AHIP website.

<...>

Why should we care? The most obvious reason is that it is our tax funds that are being given to these private health plans, paying them more than it costs us to provide care in the traditional Medicare program. A much more important reason is that enrollment in these plans continues to expand, opening the door to converting Medicare into a “premium support” program (vouchers) for a market of private plans. Traditional Medicare will then be allowed to wither as an underfunded welfare program, and perhaps eventually be abolished. Then the value of the premium support vouchers will be allowed to diminish, shifting more health care costs to the beneficiaries.

If these 40 senators really cared about their Medicare beneficiaries, instead of asking CMS to overpay the private insurers, they would pass legislation to increase coverage for those in the traditional Medicare program in order to protect them from excessive out-of-pocket costs that currently require medigap or employee retiree health benefit coverage. Why should those in the private plans receive greater benefits when we’re all paying for them?

For single payer supporters who like to use the “Improved Medicare for All” designation, it is imperative that the traditional Medicare program be protected so that the public can understand that it is nominally a framework on which single payer improvements can be built.

For the time being, instead of Congress insisting on paying more to the private MA plans, we should demand that they move those overpayments to the traditional Medicare program where they’ll be put to better use in reducing financial hardship, rather than giving them to the private insurers to squander on gym memberships or whatever else might be used to market their plans.

http://www.pnhp.org/news/2014/february/bipartisan-support-of-medicare-advantage-overpayments