(Story was updated at 4:27 p.m. ET)
Lawmakers, health policy experts and the chief executive of one of the nation's largest insurers believe Medicare Advantage could help keep the Medicare program solvent.
On Wednesday, the House Ways and Means Committee's Health Subcommittee held a hearing on Medicare's future. The Medicare board of trustees said in its most recent annual report that Medicare will be able to cover its costs until 2030, but suggested congressional action to strengthen the program's future.
Robert Moffit, a senior fellow at the right-leaning Heritage Foundation, suggested increasing the age of eligibility for Medicare, implementing means testing, expanding direct contribution abilities and combining Medicare Parts A and B.
Health Subcommittee Chairman Rep. Pat Tiberi (R-Ohio) said he agreed with many of those proposals and that changes had to be made to account for the increasing elderly population.
“Despite major improvements and innovations in the healthcare sector that have transformed how care is delivered, traditional Medicare has barreled through the last 50 years on the same trajectory of increased costs and little innovation,” he said.
Medicare reforms pop up every year in Congress during budget battles, but little is actually done. Conservatives traditionally have supported a premium-support model for Medicare, while liberals have championed a more streamlined approach. Single-payer, or Medicare-for-all, also has wide support from many left-leaning economists and supporters, although the industry has opposed that model.
Aetna CEO Mark Bertolini said Wednesday he has another idea.
Medicare Advantage, the private managed-care version of traditional Medicare, will be “the solution to entitlement reform around health benefits,” he said at the annual Barclays Global Healthcare Conference.
Aetna has more than 1.36 million Advantage members, according to March figures from the CMS, and it stands to become the largest Medicare insurer in the country through its $37 billion buyout of Humana.
Bertolini's comments came after he was asked his thoughts about last summer's speed-dating among health insurers. If federal and state regulators approve Aetna's acquisition of Medicare powerhouse Humana, which remains a big “if,” the combined company would have a presence in markets that make up more than 90% of the eligible Medicare population. It would allow Aetna to offer a “nationally portable” Medicare Advantage product that the government believes can help slow down the growth of Medicare's costs, he said.
“I think Medicare fee-for-service is a moving target,” Bertolini said, adding that Medicare Advantage would then become “more of a default program.”
Medicare Advantage already enrolls more than 18 million people and has garnered support from Democrats and Republicans alike, although serious issues have been raised about the program.
For instance, some observers have said Advantage plans are acting “unethically” by inflating patient risk scores conducted during home visits to gain higher payments, but then aren't pursuing follow-up care. Federal policy moves to save Medicare revenue at large players also have caused consternation.
At Wednesday's House committee hearing, Katherine Baicker, a health economics professor at the Harvard Chan School of Public Health, said Medicare Advantage plans should be key to keeping Medicare available for future generations.
A "one size fits all" Medicare program will be increasingly difficult to maintain, she said. “A thriving and competitive Medicare Advantage program can be a vital contributor to high quality beneficiary care in a sustainable healthcare system.”
Rep. Jim McDermott (D-Wash.), the ranking member of the subcommittee, pushed back on the ideas brought forth by his Republican counterparts, saying those plans could “have devastating effects.” He also said Medicare Advantage plans are being overpaid and allowed to cherry-pick healthier beneficiaries.
Stuart Guterman, a senior scholar in residence at AcademyHealth, agreed and said the elderly and disabled are the “least prepared to bear that additional burden.”
“Policymakers are confronted, therefore, with the question of how to continue to slow the growth of total Medicare spending when the spending per beneficiary already is increasing so slowly,” he said.
Harvard's Baicker said more radical changes are needed because the system is out of balance.
“I think something fundamental about the system has to change to preserve the viability of the program,” she said.
