[ The Medicare privatization program "presents a threat to the
integrity of traditional Medicare, and an opportunity for corporations
to take money from taxpayers while denying care to beneficiaries,"
said Physicians for a National Health Program.]
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‘CANCEL THIS FAILED EXPERIMENT’: PHYSICIANS TELL BIDEN HHS TO END
MEDICARE PRIVATIZATION PILOT  
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Jake Johnson
January 19, 2023
Common Dreams
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_ The Medicare privatization program "presents a threat to the
integrity of traditional Medicare, and an opportunity for corporations
to take money from taxpayers while denying care to beneficiaries,"
said Physicians for a National Health Program. _

Homage to Medicare and Medicaid: Sculpture Art., Via Pixabay. // Juan
Cole's Informed Content

 

A national physician group this week called for the complete
termination of a Medicare privatization scheme that the Biden White
House inherited from the Trump administration and later
rebranded—while keeping intact
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most dangerous components.

Now known as the Accountable Care Organization Realizing Equity,
Access, and Community Health (ACO REACH) Model, the experiment inserts
a for-profit entity between traditional Medicare beneficiaries and
healthcare providers. The federal government pays the ACO REACH
middlemen to cover patients' care while allowing them to pocket a
significant chunk of the fee as profit.

The rebranded pilot program, which was launched without congressional
approval and is set to run through at least 2026, officially began
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month, and progressive healthcare advocates fear the experiment could
be allowed to engulf traditional Medicare.

In a Tuesday letter
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Health and Human Services Secretary Xavier Becerra and Centers for
Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure,
Physicians for a National Health Program (PNHP) argued that ACO REACH
"presents a threat to the integrity of traditional Medicare, and an
opportunity for corporations to take money from taxpayers while
denying care to beneficiaries."

The group, which advocates for a single-payer healthcare system,
voiced alarm over the Biden administration's decision to
let companies
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records of fraud and other abuses take part in the ACO REACH pilot,
which automatically assigns traditional Medicare patients
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private entities without their consent.

CMS said in a press release
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that "the ACO REACH Model has 132 ACOs with 131,772 healthcare
providers and organizations providing care to an estimated 2.1 million
beneficiaries" for 2023.

"As we have stated, PNHP believes that the REACH program threatens the
integrity of traditional Medicare and should be permanently ended,"
Dr. Philip Verhoef, the physician group's president, wrote in the new
letter. "Whether or not one agrees with this statement, we should all
be able to agree that companies found to have violated the rules have
no place managing the care of our Medicare beneficiaries."

Among the concerning examples PNHP cited was Clover Health, which has
operated so-called Direct Contracting Entities (DCEs)—the name of
private middlemen under the Trump-era version of the Medicare
pilot—in more than a dozen states, including Arizona, Florida,
Georgia, and New York.

PNHP noted that in 2016, CMS fined Clover—a large Medicare
Advantage
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"using 'marketing and advertising materials that contained inaccurate
statements' about coverage for out-of-network providers, after a high
volume of complaints from patients who were denied coverage by its MA
plan. Clover had failed to correct the materials after repeated
requests by CMS."

Humana, another large insurer with its teeth in the Medicare
privatization pilot, "improperly collected almost $200 million from
Medicare by overstating the sickness of patients," PNHP observed,
citing a recent federal audit
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"It appears that in its selection process [for ACO REACH], CMS did not
prevent the inclusion of companies with histories of such behavior,"
Verhoef wrote. "Given these findings, we are concerned that CMS is
inappropriately allowing these DCEs to continue unimpeded into ACO
REACH in 2023."

While the Medicare pilot garnered little attention
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lawmakers when the Trump administration first launched it during its
final months in power, progressive members of Congress have recently
ramped up scrutiny of the program.

Last month, Sen. Elizabeth Warren (D-Mass.) and Rep. Pramila Jayapal
(D-Wash.) led a group of lawmakers in warning
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ACO REACH "provides an opportunity for healthcare insurers with a
history of defrauding and abusing Medicare and ripping off taxpayers
to further encroach on the Medicare system."

"We have long been concerned about ensuring this model does not give
corporate profiteers yet another opportunity to take a chunk out of
traditional Medicare," the lawmakers wrote, echoing PNHP's concerns.
"The continued participation of corporate actors with a history of
fraud and abuse threatens the integrity of the program."

_[JAKE JOHNSON is a staff writer for Common Dreams.]_

_Licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to
republish and share widely._

* Medicare
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* Medicare Advantage
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* Medicare Advantage Plans
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* Accountable Care Organization Realizing Equity Access and
Community Health
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* ACO REACH
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* Biden Administration
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* Healthcare
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* health insurance
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* private insurance
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* privatization
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* Medicare for All
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