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Lesson for Congress: Medicare Advantage

New Report Highlights Medicare Advantage Insurers’ Higher Administrative Spending

Committee on Energy and Commerce
U.S. House of Representatives
December 9, 2009

Today Energy and Commerce Committee Chairman Henry A. Waxman and Oversight and Investigations Subcommittee Chairman Bart Stupak released a new report which found that 34 Medicare Advantage insurers expend significant sums on profits, marketing, and other corporate expenses.

The report found:

From 2005 through 2008, the average Medicare Advantage insurer spent over 15% of premium revenue on profits, marketing, and other corporate expenses. Two-thirds of the Medicare Advantage insurers surveyed by the Committee had a medical loss ratio below 85% during at least one of the four years examined. Six of the insurers had medical loss ratios below 75% in one or more years. In comparison, traditional Medicare spends less than 1.5% on administrative expenses and over 98% on health care. In the aggregate, the Medicare Advantage insurers spent $1,450 per beneficiary in 2008 on profits, marketing, and other corporate expenses, nearly ten times as much as traditional Medicare spent on administrative expenses per beneficiary.

Requiring all Medicare Advantage insurers to have a medical loss ratio of 85% would provide billions of dollars in additional medical services to seniors. The total amount spent on profits, marketing, and other expenses by Medicare Advantage insurers over the last four years was $27 billion. The House health care reform bill requires Medicare Advantage plans to spend at least 85% of their total premium revenues on medical claims. If this threshold had been in effect from 2005 through 2008, the Medicare Advantage insurers would have spent an additional $3 billion on their beneficiaries' medical care, enough to eliminate all copays for preventive care for all Medicare beneficiaries for ten years.

In 2007 and 2008, Medicare Advantage insurers with medical loss ratios lower than 85% paid their executives over $1.2 billion. In 2007, a company that had a medical loss ratio of 79% paid an executive over $35 million. The same company paid 16 more executives salaries and bonuses worth $1 million or more. Another company with a medical loss ratio of 79% paid more than $210 million in compensation to 260 executives.

Medicare Advantage insurers have spent millions on expensive retreats. In 2007, one company with a medical loss ratio of 83% spent $3.1 million for two events in Hawaii. In 2007, a company with a medical loss ratio of 84% spent $2.5 million on employees and agents at a retreat in San Jose del Cabo, Mexico and $1.4 million on an event in Rome, Italy. In 2008, a company with a medical loss ratio of 82% spent $1.5 million on a meeting in Edinburgh, Scotland and $1.8 million on a trip to Cancun, Mexico.

http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1851:new-report-highlights-medicare-advantage-insurers-higher-administrative-spending&catid=122:media-advisories&Itemid=55

Full report:
http://energycommerce.house.gov/Press_111/20091209/MedicareAdvantageReport120909.pdf

Comment:

By Don McCanne, MD

Congress and the Obama administration decided up front that reform would be based on private insurance plans, rejecting without consideration the single payer Medicare for all model.

They are proposing innovative pilot programs as experiments in containing health care costs, glossing over the logistical nightmares and the lack of a foundation in policy science, as they move forward with these untested policies. Yet they have right in front of them one of the most important, most expensive, and most credible real-life experiments ever conducted: contrasting the government Medicare model with the private Medicare Advantage insurance plans.

In comparing traditional Medicare with Medicare Advantage, we need to set aside from consideration the funds that are used to pay for actual health care since these are our funds merely held in trust for the payment of medical bills. What we need to compare are the costs of the administrative services that are being provided by each entity.

The experiment has been completed, and the results are in. The private Medicare Advantage insurers spend nearly ten times the amount per beneficiary that is used to administer the government Medicare program. TEN TIMES!

Some might say that we aren't being fair because some of the ten fold increase in spending goes to profits and to expensive retreats for the private insurance executives, whereas the traditional Medicare program doesn't have those obligations. In this instance, what's fair in the business community is fraud in the government.

Congress has the results of this study. The report has been generated by one of its own committees. Our legislators have a fundamental moral obligation to study this crucial real-life experiment. They then need to act upon it instead of upon the magical thinking behind the nebulous pilot projects.

In fact, even this report contains one such flawed policy recommendation. They recommend that the private insurers be limited to 15 percent of the insurance pool to use for administration and profits. That is still about eight times the administrative costs of Medicare. EIGHT TIMES! Is that the best that Congress can come up with?

Medicare is already under attack for its perceived parsimoniousness. Since the pilot projects would be designed to further reduce spending within the Medicare program, that perception would be amplified, seriously threatening the support of the health care providers.

We first need the broad, solid infrastructure of single payer Medicare for all and only then should we consider new pilot projects that are based on sound policy science that would work for all of us, providing quality care while protecting our finances. The probability of getting the policies right would be much greater in a single system in which patients, providers and the government are all working together toward a common goal: quality, affordable health care for all.

There is something for those who disagree: a little vicarious serendipity. You can check out the brochures and websites of the expensive resorts, and then close your eyes, lean back and dream about the great time that the insurance executives are having with the money you paid them in the form of excessive insurance premiums. Pleasant dreams.