Every week, 2,000 - 3,000 Second District residents write to me about the issues pending before Congress, and I work hard to respond to each person as promptly and thoughtfully as possible.  On this "Letter of the Week" blog, I highlight constituent letters that are of general interest.  If you'd like to share your own views, please feel free to e-mail me at any time!

Dear Nancy,

I am writing to express my support for the Medicare Advantage program. Like many retirees, I live on a fixed income, and I depend on my Medicare Advantage plan to provide affordable health care coverage with better benefits and at a lower cost than traditional Medicare.

I am concerned that some Members of Congress are proposing new cuts in funding for the Medicare Advantage program. Medicare Advantage funding has already suffered major cuts. Over the last three years, more than $14 billion in cuts have been taken from the MA program. These cuts will likely result in higher premiums or reduced benefits for Medicare beneficiaries.

Years of chronic underfunding in the Medicare Choice (M+C) program that preceded Medicare Advantage were devastating for beneficiaries and forced more than half of M+C plans to leave the program. As a result, nearly two million beneficiaries lost M+C coverage and millions more saw significantly increased premiums and/or reduced benefits. Further cuts could put MA and the seniors who have chosen MA on similarly unstable footing. Please don’t let this happen.

As Congress considers Medicare legislation this year, I urge you to oppose any funding cuts that would compromise the Medicare Advantage program. MA funding cuts could cause three million or more beneficiaries to lose Medicare Advantage coverage outright and millions more to face cuts in benefits and higher premiums.

Sincerely,

Mike from Lawrence, KS.

Dear Mike,

You may have heard about dramatic cutbacks in Medicare on July 1.  I’m writing you because you’ve contacted me to express your support for the Medicare Advantage (MA) program.  That program is at the heart of the debate over whether these cutbacks will remain in place.  I wanted to let you know how this debate is playing out on Capitol Hill and what it means for Medicare.

The following changes went into effect on July 1, 2008:

•    Medicare cut its payments to doctors and other providers by 10.6 percent.
•    Tricare cut its payments to doctors and other providers by 10.6 percent.
•    The Medicare bonus payment to rural providers ended.
•    The Medicare subsidy to preserve rural ambulance service ended.
•    Rigid caps went into effect, limiting access to rehab therapy in Medicare.
•    Most providers of wheelchairs, oxygen and other equipment were kicked out of Medicare in Kansas City and nine other metro areas.

As a result of these cuts, scores of doctors in Kansas announced that they would not accept new Medicare patients.  If these changes become permanent, thousands of Kansas seniors and military families will be left with little or no access to health care.  We can not allow this to persist. 

Preventing the Cuts and Preserving Medicare – H.R. 6331:

Congress had a chance to prevent these cuts by passing H.R. 6331, the Medicare Improvements for Patients and Providers Act.  I was proud to vote to stop the cuts, and I was glad to see a broad bipartisan coalition come together to give overwhelming support to H.R. 6331 as it passed the House.

Unfortunately, 39 Senators dug in their heels and were able to block H.R. 6331 in the Senate so the cuts went through.  I think that this is a terrible outcome, and I hope that the great majority of good Americans will pressure their leaders to reverse it. 

H.R 6331 would have blocked all of these cuts and given doctors a 1.1 percent pay increase.  It also would have made some improvements to Medicare, including help for pharmacies, rural clinics, diabetics and low-income seniors.  It would have done all of these things without increasing the debt.  It was a good bill.

Closing Loopholes in Medicare Advantage:

Blocking the cuts and making the improvements costs money, and we’re not going to pay for it by borrowing from China.  I am committed to being responsible with taxpayer dollars, and I have been a strong supporter of the pay-as-you-go budget rules that we put in place at the beginning of this Congress. 

The obvious place to get the money is the Medicare Advantage (MA) program.  As you know, I am very concerned about the fact that MA plans get paid more than traditional Medicare would spend – a taxpayer-funded subsidy for health insurance companies that will cost $65 billion over the next five years.  However, the President has dug in his heels and fought tooth and nail against any cuts to these subsidies, so, in H.R. 6331, Congress tried to compromise by closing loopholes instead of cutting the subsidy.

Congress’ outside experts at the Medicare Payment Advisory Commission identified two loopholes in the original MA program that was designed by President Bush and his allies in 2003:
•    When teaching hospitals treat patients, Medicare makes a bonus payment to offset the higher cost, but the MA program created duplicate payments.
•    One type of MA plan (fee for service) wasn’t required to negotiate contracts with providers. As a result, patients don’t know which doctors they can see, and doctors don’t know how much they’ll get paid.

H.R. 6331 closes both of these loopholes and requires fee-for-service MA plans to start reporting data on quality of care.  The Congressional Budget Office estimates that these changes will save taxpayers $12 billion over the next five years – more than enough to pay for all of H.R. 6331. 

“Lines in the Sand that are Unreasonable”:

The changes to MA in H.R. 6331 are a compromise.  The President wanted to preserve the subsidy for insurance companies, and Congress wanted to make sure that the bill was paid for.  Closing the loopholes let both sides get what they wanted while making sure that Medicare stays intact.  Unfortunately, even with the overwhelming bipartisan support in the House, the President threatened to veto the bill, and the White House worked to kill it.

And the President got his way.  Just enough Senators stayed loyal to the President that they were able to filibuster H.R. 6331.  But even they didn’t agree with him.  Senator Charles Grassley led the filibuster and here’s what he said about President Bush’s position: “The White House has drawn lines in the sand that I think are unreasonable.”

I agree that the White House is being unreasonable, and I found it most disappointing that so many Senators put loyalty to the President ahead of their seniors and ahead of their own common-sense conclusions. 

What’s Next:

I think that H.R. 6331 includes a reasonable compromise on MA, and that compromise pays for absolutely critical programs in Medicare.  I think that the American people feel the same way, and I hope that they make their voices heard while the Senate and House members are back home this week.  I believe that the Senate will vote again on H.R. 6331 after the July 4th recess, and I very much hope that the result is different this time. 

I hope that you will talk with your doctor, nurses, therapists and pharmacist about their experiences with MA, and I hope you will keep in contact with me and with your Senators during the important Medicare deliberations next week.

Sincerely,

Nancy Boyda
Member of Congress