This issue is complicated, and although it is typically framed as either an assault to or protection of Medicare, the facts underlying the issue are often misunderstood and misrepresented. During President Obama’s administration, three retired federal employees – among them former Republican House Majority Leader Dick Armey -- sued the federal government because they wanted to drop their Medicare Part A coverage without losing Social Security benefits. They claimed participation in Medicare threatened their coverage under the Federal Employees Health Benefit (FEHB) program.
John Kraus, one of the plaintiffs in the original suit, explained to ElderLawAnswers that “[t]here isn't any law, statute, or regulation that memorializes in the U.S. Code this linkage of the two programs. It is only found in the Social Security Administration's (SSA) Program Operations Manual System (POMS).”
When asked why he and his fellow plaintiffs wanted to separate from Medicare, Kraus explained that the reasons
“are several. The foremost is that one enrolled in Medicare cannot have a High Deductible Health Plan with a Health Savings Account. Secondly, for FEHB participants, their coverage becomes secondary to Medicare, without a premium reduction for FEHB coverage. Third, there is the issue of Medicare solvency, which could be a serious consideration in the near future. Lastly, there is the consideration of reduced choice and availability of health care providers because they are either leaving the Medicare program or not accepting additional Medicare recipients as new patients.”
A U.S. district court judge dismissed the case in March 2011, a decision that was upheld the following year by a three-judge panel of the U.S. Court of Appeals for the District of Columbia, with then-judge Brett Kavanaugh writing for the majority that the federal statute offers the plaintiffs no path to disclaim their legal entitlement to Medicare Part A benefits. The U.S. Supreme Court declined to review the decision. Of course, the decision had nothing to say about whether such a path should exist, or indeed, about the merits or concerns the individual litigants raised.
At the time the 2019 executive order was issued, the Center for Medicare Advocacy noted that allowing individuals to access Social Security benefits without participating in Medicare Part A coverage had been a "long-standing conservative goal" and could potentially damage the program:
“Allowing individuals who can self-fund their health care to decline Medicare erodes shared experiences, commitment to, and investments in our nation’s flagship insurance program, and therefore can erode widespread, popular support for the program and make it more susceptible to negative changes.”
The group also stated that the Medicare risk pool would be fundamentally altered if healthier and wealthier people were permitted to opt out, but since Medicare is not private insurance one wonders why "risk pools," are even relevant.
Regardless, separation from Medicare is no longer possible.
No comments:
Post a Comment