A Trump-era pilot program that could lead to the full privatization Traditional health insurance within a few years progressed under the Biden administration, a development which, despite its potentially massive implications for patients across the United States, received little attention from the national press or Congress.

“If left unchecked, the direct contracts program will hand traditional health insurance back to Wall Street investors.”

On Tuesday, a group of doctors from across the country will try to get the attention of lawmakers, the Biden White House and the public by traveling to Washington, DC and demanding that the Department of Health and Human Services immediately stop the Medicare experience, which is known as the direct contract (DC).

Doctors plan to present HHS with a petition signed by over 1,500 physicians who believe the DC pilot project threatens “the future of Medicare as we know it”.

Advocates have publicly sounded the alarm bells about the DC program for months, warning that it could hand over traditional Medicare entirely to Wall Street investors and other profit seekers, resulting in more costs. high for patients and lower quality of care.

“Everything we know about direct contracts should cause the pilot to stop,” said Diane Archer, founder of Just Care USA and senior health insurance advisor at Social Security Works. Common dreams in an email. “Direct contracts effectively eliminate the more cost-effective traditional health insurance program designed to ensure that people with complex health conditions receive the care they need. “

“The direct contract experience is likely to be both a health policy and a political nightmare,” Archer argued. “We already know, through the Medicare Advantage experience, that the direct contract will not save money and will not be able to improve quality. “

But the concerns of health activists fell largely on deaf ears in Congress and the Biden administration, allowing a large part of the pilot program proceed as planned.

In a telephone interview with Common dreams Ahead of Tuesday’s protest at HHS headquarters, Dr Ed Weisbart – president of the Missouri Section of Physicians for a National Health Program (PNHP) – said Congress is largely “asleep on the switch” as Wall Street-backed startups and private insurance giants are getting closer to traditional Medicare, a 56-year program that covers tens of millions of seniors in the United States.

“People don’t know this is happening,” Weisbart, one of the doctors visiting the nation’s capital, said of the DC experiment. “Most people in Congress don’t know this is happening. We’ve started having some of these conversations with Congress staff, and we’re hoping to have a lot more next week when we’re there, but it’s not. not on their radar either. “

“This is the disturbing part,” he added. “How drastic the transformation of Medicare becomes under this new model, how widespread it will be – it will be the whole book of business – and yet it is happening without the awareness and consent of Congress. “

The DC program was created by the Center for Medicare and Medicaid Innovation (CMMI) during the final months of the Trump administration, which included former executives from the pharmaceutical industry, Wall Street Bankers, and right-wing political consultants notorious for undermining public health programs.

In the DC model, so-called direct contracting entities (DCEs) are paid monthly by the Centers for Medicare and Medicaid Services (CMS) to cover a specified portion of a patient’s medical care, a significant change from direct reimbursement. traditional Medicare providers.

CEDs are allowed to pocket the funding they don’t spend on care, an arrangement that critics say will cause private intermediaries to skimp on Medicare patients, many of whom could be automatically entered in the CED without their knowledge or permission.

According to a guidance note published by PNHP, “Virtually any business can apply to become a DCE, including investor-backed startups that include primary care physicians, [Medicare Advantage] plans and other commercial insurers, responsible healthcare organizations (ACOs) or ACO-type organizations, and for-profit hospital systems. “

“Candidates are approved by CMS without input from Congress or other elected officials,” the group notes.

At present, the pilot understands 53 DCE in 38 states, Washington, DC and Puerto Rico. Drs. Richard Gilfillan and Donald Berwick underline in a September article for Health affairs that 28 of the current CEDs are controlled by investors and not by healthcare providers. A second tranche of DCE is expected to start in January 2022.

Dr. Ana Malinow, a San Francisco doctor who is participating in the Tuesday petition handover, said in a statement that “Medicare Advantage, the first wave of Medicare privatization, has shown us that the insertion of an intermediary in profit in public coverage does not save money. money for the taxpayer, but instead costs more money while removing the choice of elderly care. “

“If left unchecked, the direct contracts program will hand traditional health insurance back to Wall Street investors, without input from the elderly, doctors or even members of Congress,” Malinow said. “Health and Human Services Secretary Xavier Becerra has the power to stop this Trump-era agenda in its tracks, and he must do it now.”

“Next year, millions more Americans will find themselves in privatized medicare, and most will never know what happened.”

The DC experiment was initiated by the Trump administration but actually has its roots in the Affordable Care Act (ACA), which established CMMI with the stated goal identify “ways to improve the quality of health care and reduce costs in Medicare, Medicaid and Children’s Health Insurance Program (CHIP)”.

The ACA has granted CMMI, also known as the Innovation Center, the power to test alternative payment and service delivery models nationwide without Congressional approval – a latitude that, between the hands of the Trump administration, ultimately gave birth to the DC pilot program.

CMMI is currently headed by Elizabeth fowler, who was previously vice president of public policy and external affairs at WellPoint, Inc., a health insurance giant that would later become Anthem. Fowler also worked as chief health adviser to former Senate finance committee chairman Max Baucus, a right-wing Democrat who notoriously arrested single-payer supporters in 2009 and helped ensure the ACA did not include a public option.

Weisbart said Common dreams that while the creation of the CMMI may have been well-intentioned, the agency’s ability to “so fundamentally and radically transform a public health agenda that so many Americans rely on” without the approval or oversight of the Congress is a real danger that lawmakers must take seriously.

“Somewhere there has to be congressional oversight,” Weisbart said. “When the public will finally discover that [lawmakers] were sleeping at the switch, they are not going to be happy. This is your chance to do what democracy is supposed to do. “

The Biden administration has suspended the most extreme form of direct contract known as geographic (GEO) model—In March, but it allows the Global and Professional Direct Contracts (GPDC) pilot to move forward. According to CMS, the GPDC pilot is expected to run over a six-year period.

While lawmakers have largely remained silent on the Medicare experiment, a handful of Democratic members of Congress have echoed grassroots demands for an immediate end to the DC program in recent months.

“We appreciate that you put the geographic model on hold,” wrote Reps Lloyd Doggett (D-Texas.) Bill Pascrell (DN.J.), Mark Pocan (D-Wis.), Lloyd Doggett (D -Texas) in a May letter to Becerra and Elizabeth Richter, acting CMS administrator at the time. “However, we remain concerned that the 53 DCEs participating in the GPDC model, a policy initiated under the Trump administration, lack oversight to protect the care of Medicare beneficiaries.”

“As members of Congress are committed to protecting Medicare beneficiaries,” lawmakers continued, “we call on CMS to immediately freeze the harmful CMMI DCE pilot program, including the geographic model and the global direct contract model. and professional, and assess the impact on beneficiaries “.

In September, Porter participated in a webinar hosted by PNHP that highlighted the potentially extensive damage to the DC pilot.

“This program was supposed to make Medicare more efficient,” Porter said. “But in reality, it does exactly the opposite. Rather than allowing patients to go directly to traditional health insurance providers, DCEs invite insurers and investors to step in and interfere with the care they receive. Americans.”

“This direct contracting entity model is just one more example of the many attempts by the Trump administration to destroy an effective, efficient and popular government program in an attempt to line the pockets of its corporate donors,” added Carry. “The main thing for direct contracting entities is not to improve the quality of care. They increase costs for patients in order to maximize their profits.”

In a column earlier this month the Houston ChronicleChris Tomlinson argued that the Biden administration’s decision to allow the DC program to continue “reflects the power of for-profit health companies and investors over both political parties.”

“Direct contracts are also likely to kill any chance for progressive Democrats to make Medicare an option for any American who wishes to enroll,” added Tomlinson. “If the government turns responsibility for all Medicare patients to private companies, it will eliminate any opportunity to truly reform our health care system.” “

“Next year,” he added, “millions more Americans will end up in privatized medicare, and most will never know what happened.”


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