To: mishedlo who wrote (51162 ) 1/24/2006 10:37:06 PM From: shades Respond to of 110194 =DJ US Sen Clinton Targets Medicare 'Giveaway' To Insurers By John Godfrey OF DOW JONES NEWSWIRES WASHINGTON (Dow Jones)--U.S. Sen. Hillary Rodham Clinton, D-N.Y., wants to end a corporate "giveaway" that could allow insurers to recoup, over the long run, roughly a third of the $6.5 billion in Medicare payment cuts proposed for them in a budget bill Congress is poised to approve. "Republicans in Congress are cutting Medicaid for children and seniors so they can protect huge giveaways to insurance companies," Clinton said in a statement released by her office Tuesday afternoon. Clinton said she and Rep. John Dingell, D-Mich., would introduce legislation that would close the so-called loophole. Coupled with another $10 billion cut in Medicare payments, Clinton and Dingell's plan would leave insurers facing a total of $36 billion in payment cuts over the next 10 years. Karen Ignagni, President and CEO of the industry group America's Health Insurance Plans, said Clinton and Dingell are misrepresenting the budget bill's impact. Ignani said the payment cuts proposed in the bill will be borne by plan beneficiaries. Senate Finance Committee Chairman Charles Grassley, R-Iowa, scoffed at the idea that the budget bill is a "giveaway," noting that as written it still cuts payments to insurers by $6.5 billion over the next five years. "Beyond that, I'm happy to work with my colleagues on legislation to cut other overpayments made by Medicare and Medicaid," Grassley said. The fight comes as Congress faces another year with a predicted annual deficit above $400 billion and with President George W. Bush rumored to be considering further cuts to Medicare in his next budget proposal for Congress. Driving the issue is how Medicare takes into consideration the relative health of clients of so-called Medicare Advantage plans. Medicare Advantage plans are offered through health management organizations, preferred provider organizations, private-fee-for-service (PFFS) plans and point-of-service plans. The issues are complex. They deal with Medicare Advantage plans' tendency to attract healthier beneficiaries than Medicare's traditional fee-for-service program. Also at issue is evidence that Medicare Advantage doctors are more likely to overstate their patient's illness, known in the industry as upcoding, than fee-for-service doctors. During the first five years of the budget bill, both factors are taken into consideration when setting Medicare Advantage payments. As a result, payments to Medicare Advantage plans will fall and the government is expected to save $6.5 billion from 2006 through 1010. After 2010, adjusting the payments for health risk will continue, but the upcoding provision will be ended. Industry foes say the effect is clear. At a time when a plan's Medicare payments will depend on its clients' health, Medicare will no longer be required to consider Medicare Advantage doctors' tendency to overstate their patients' illness. The Congressional Budget Office estimated that if upcoding were extended beyond 2010, the government would save an extra $22 billion. Instead, without upcoding, health plans will see their Medicare payments increase from 2011 through 2016 by a total of roughly $2.4 billion, CBO estimated. Congressional aides on all sides of the issue agree that much of CBO's 10-year estimate is based upon assumptions on how the next administration will set Medicare payments. Some say the Department of Health and Human Services could continue to set payments to reflect upcoding. Others say the bill's wording makes it clear the department would have to end the policy. And the insurance industry's Ignani said there is no research showing differences in coding practices between Medicare Advantate doctors and fee-for-service doctors. "We have raised concerns about reducing funding based on speculation," Ignani said. Medicare legislation in 2003 included an increase in payments to insurers, allowing them to move into new geographic areas. UnitedHealth Group Inc. (UNH) announced last week that it had posted stronger fourth-quarter earnings, based in part on its signing 20,000 more people into Medicare Advantage plans that quarter. While Humana Inc. (HUM) shares hit a 52-week high in December on news that the health insurer was well on its way to meeting ambitious 2006 enrollment targets for its Medicare-related plans. Humana has credited the 2003 bill as part of the reason for its ability to expand in the Medicare market. Still, some market watchers are taking a cautious view. In a credit rating report on CareMore Holdings, Inc., Moody's Investor Services said "while current reimbursement levels and market conditions are favorable in the Medicare Advantage market, there are risks associated with this business." Moody's said "the chief concern is the uncertainty of the future level of reimbursements, as budgetary and political pressures could change the government's perspective towards the Medicare program." -By John Godfrey, Dow Jones Newswires; 202-862-6601; John Godfrey@dowjones.com