Friday, September 30, 2011

Online “Plan Finder” offers unbiased resource for people with Medicare to review 2012 plan options

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Room 352-G
200 Independence Avenue, SW
Washington, DC 20201
Office of Media Affairs

Online “Plan Finder” offers unbiased resource for people with Medicare to review 2012 plan options

In advance of the new, earlier annual enrollment period, people with Medicare can begin reviewing plan benefit and cost information on Saturday, October 1st, 2011. The Centers for Medicare & Medicaid Services (CMS) will launch access to its popular web-based Medicare Plan Finder that allows beneficiaries, their families, trusted representatives, and senior program advocates to look at all local drug and health plan options that are available for the 2012 benefit year.

“With Open Enrollment coming early this year, it is important that people with Medicare take advantage of the next couple weeks to review their current coverage and compare it with the options that are available for next year,” said CMS Administrator Donald M. Berwick, M.D.  “The information that’s available now on the Plan Finder will also help caregivers, health providers, and partners that support and counsel seniors and people with disabilities in selecting the best plan for their needs.”

The annual enrollment period begins earlier this year, on October 15th, and runs through December 7th.  People with Medicare will have seven weeks to review Medicare Advantage and Part D prescription drug coverage benefits and plan options, and choose the option that best meets their unique needs. The earlier open enrollment period also ensures that Medicare has enough time to process plan choices so that coverage begins without interruption on January 1, 2012. 

This year, as beneficiaries look over their available plan options, they will see better value in the Medicare Advantage (Part C) and Prescription Drug (Part D) plan benefits.  All beneficiaries will have access to Medicare-covered preventive services at zero cost-sharing, including an Annual Wellness Visit.  Those in the Part D coverage gap, or donut hole, will continue to receive 50 percent discounts on covered brand name drugs thanks to the Affordable Care Act.  On average, Medicare Advantage premiums will be four percent lower in 2012 than in 2011, and plans expect enrollment to increase by 10 percent. Average premiums for Part D prescription drug plans will also decrease to $30 in 2012, about 76 cents less compared to the average 2011 premium.  The premium amount is based on bids submitted by Part D plans for the 2012 plan year.   Benefits in 2012 remain consistent with those offered in 2011.

People can use the Plan Finder – available at www.Medicare.gov  by inserting their home zip code to find out which Medicare Advantage (Part C) and Prescription Drug (Part D) plans are available in their areas.  If the zip code search shows multiple counties it will prompt users to select one county to continue the search.  For 2010, the Plan Finder was the most popular tool on www.Medicare.gov, with more than 280 million page views.  Also available online is Medicare’s Formulary Finder, which allows beneficiaries to insert their prescribed medications and zip code to see a display of plans offered locally that cover their drugs.

Due to provisions in the Affordable Care Act, Medicare will begin to financially reward Medicare Advantage plans which achieve high quality ratings.  Part D plans will also continue to receive quality ratings.  Beginning October 12, the Medicare Plan Finder will include each plan’s quality star rating for 2012.  For the first time this year, people who use the Plan Finder will also see a gold star icon designating the top rated 5-star plans, and will continue to see warnings for those plans who consistently are poor performers. “We encourage all Medicare beneficiaries enrolled in private plans to know their plan’s overall star rating and to consider enrolling in plans with high ratings,” said Jonathan Blum, CMS Deputy Administrator and Director, Center for Medicare. When comparing plans, beneficiaries should consider the plan’s quality in addition to its costs, coverage, and other conveniences. On October 15, people with Medicare will be able to make informed decisions when they select their plan for the coming year.

More information is available at www.healthcare.gov , a new web-based portal brought to you by the U.S. Department of Health & Human Services.

CMS Announces Release of Fiscal Year 2011 State Health Insurance Assistance Program Performance Awards Funding

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Room 352-G
200 Independence Avenue, SW
Washington, DC 20201
Office of Media Affairs
MEDICARE NEWS

For Immediate Release:                                                  Contact:  CMS Office of Media Affairs
Friday September 30, 2011                                               202-690-6145

CMS Announces Release of Fiscal Year (FY) 2011 State Health Insurance Assistance Program Performance Awards Funding

The Centers for Medicare & Medicaid Services (CMS) announced today $1.5 million in performance awards released to support local agencies that assist people with Medicare and their caregivers.  State Health Insurance Assistance Programs (SHIPs) that have provided outstanding counseling services to Medicare beneficiaries through innovative outreach efforts received the awards. Additionally, awardees reached and provided enrollment assistance to people eligible for Medicare benefits, but not currently receiving benefits. 
“CMS is proud to recognize the SHIP network as a highly valued, trusted and unbiased source of Medicare and health plan information for Medicare beneficiaries and caregivers across the nation,” says Donald Berwick, M.D., administrator for the Centers for Medicare & Medicaid Services.
The SHIP Performance Awards were awarded to eligible SHIPs from the 54 states and U.S. territories, following the Basic Grant Award funding that was released to SHIPs in April 2011.   Eligibility for a performance award is based on timely submission of data into CMS’ SHIP National Performance Reporting (NPR) system for the period July 1, 2010, through June 30, 2011, and attainment of certain performance levels.
SHIP services are provided at the community level and offer information, counseling, and enrollment assistance to Medicare beneficiaries, beyond what they might receive on their own through the other CMS information channels, including 1-800-MEDICARE and www.medicare.gov.  
“CMS is pleased to reward SHIPs with these funds for their implementation of CMS grants program objectives and delivery of services to Medicare beneficiaries in innovative ways,” said Teresa Niño, Director of the CMS Office of Public Engagement.  “SHIPs have created model approaches to increase enrollment and awareness about changes in Medicare benefits and services, including preventive benefits.”
This additional funding will help to ensure that the community networks remain fully capable of accessing and using CMS’ 1-800-MEDICARE (1-800-633-4227) and regional office resources, as well as the online tools at www.medicare.gov and www.SHIPTalk.org to provide assistance to beneficiaries.
“SHIPs are critically important, especially this year with the change of dates for the Medicare Annual Enrollment Period to October 15, 2011, through December 7, 2011,” said Niño. “CMS is hopeful that these funds will help SHIPs increase their outreach efforts and increase awareness to the change in the dates to ensure that beneficiaries receive the counseling services routinely available to them.”

Thursday, September 29, 2011

The President's Plan for Economic Growth and Deficit Reduction: A First Look at the Impact on Medicare

Last week, President Obama unveiled his recommendations to Congress's Joint Select Committee on Deficit Reduction ("Super Committee").[1] The President's Plan for Economic Growth and Deficit Reduction seeks to pay for the President's jobs bill and produce net savings of more than $3 trillion over the next decade.[2] The proposal includes $320 billion in savings from changes to federal spending on Medicare and Medicaid (including $248 billion in Medicare savings). In addition, the President has threatened to veto any bill that takes away Medicare benefits without an increase in contributions from "the wealthiest Americans and biggest corporations."[3]
This Alert looks at specific aspects of the President's plan that would affect future Medicare beneficiaries.  While we applaud a focus on increasing revenue to address our nation's debt and deficit concerns, we are troubled by proposals that shift costs to Medicare beneficiaries who already pay significant out-of-pocket expenses for their health care.
Promising Proposals
One strength of the President's plan is that it seeks new revenues as part of any discussion about overall debt and deficit reduction. We are glad to see the following included (or not included) in the President's Plan:
  • Rebates from drug manufacturers for prescription drugs provided to dually eligible beneficiaries and those receiving the Part D Low-Income Subsidy (LIS): While not the full negotiation of drug prices that could save Medicare billions or dollars, this proposal would allow Medicare to benefit from the same rebates that Medicaid receives for brand name and generic drugs provided to individuals who receive the LIS. By restoring the law as it applied to dual eligibles prior to the creation of Part D in 2006, and extending the rebate to all LIS enrollees, Medicare would save an estimated $135 billion over 10 years.
  • NO  increase in eligibility age: This Plan from the President does not call for raising the age of Medicare eligibility from 65 to 67, which experts have reported would increase and shift costs onto employers, individuals, and states.[4] We are pleased that the President has eliminated this change in his proposal.
Proposals of Concern
However, we are concerned about certain aspects of the President's plan that, if implemented, would shift significant cost-sharing to beneficiaries who already pay considerable costs for their medical care.[5]  For example, the Medicare Payment Advisory Commission (MedPAC) reports that premiums and cost-sharing for Parts B and D alone absorbed 30 percent of the average Social Security benefit in 2010.[6]
Many provisions of the President's Plan aim to achieve Medicare savings by creating "financial incentives for newly eligible beneficiaries to seek high-value health care services."[7]   Starting in 2017, higher costs would be imposed on beneficiaries under the misguided assumption that greater out-of-pocket expenses will lead to more reasonable decisions about obtaining various types of medical care. On the contrary, these proposals would fail to steer people toward high-value services, and, at worst, simply charge people more for accessing needed health care, or deter people from seeking care altogether.[8]  
The following provisions are troubling because they would directly shift costs to Medicare beneficiaries:
  • Implementing a Co-Payment for Home-Health Care:  Starting in 2017, this proposal would create a home health copayment of $100 per home health 60-day episode, applicable for episodes with five or more visits not preceded by a hospital or other inpatient post-acute care stay.  Imposing such co-pays would have a staggering impact on individuals with long-term and chronic conditions, who would essentially incur $600 in new out-of-pocket costs annually.  Additionally, it could lead to higher hospitalizations (and thus, higher costs) as a result of beneficiaries forgoing needed care when they cannot afford the co-payments. Moreover, eliminating the co-pay requirement to situations where there has been a hospital or nursing home stay creates a perverse incentive toward hospitalization or nursing home care.
  • Increasing Part B deductible for new beneficiaries: The President's plan would increase the Part B deductible only for new beneficiaries by $25 dollars in 2017, 2019 and 2021 (for a total $75 increase). This proposal would have a significant impact on Medicare beneficiaries, nearly half of whom have annual incomes below $22,000.[9]  Only about 14% of Medicare beneficiaries – those with incomes of about $11,000 or less - get financial help to pay their Medicare cost-sharing. The proposal shifts costs to beneficiaries and could result in increased costs when needed care is postponed until an illness is more complicated and more costly to treat. Further, this proposal draws an arbitrary line between current beneficiaries and near retirees who would be unaffected and those who will join Medicare in the future and will permanently pay more.
  • Further income-basing Medicare Part B and D premiums:  Medicare is already a means-tested program, with higher-income beneficiaries paying more for Part B and Part D premiums. The current requirements affect only about 5% of beneficiaries – those with incomes at or above $85,000 a year. The President's proposal would not only raise the income-related premium by 15%, it would also freeze the income level for higher payments at $85,000, not adjusting for inflation, cost of living, or any other such factors, until 25% of beneficiaries were paying the higher premiums. Using today's dollars, this means that beneficiaries with current incomes of $43,500 belong in the top 25% of Medicare beneficiaries based on income. In the future, Medicare beneficiaries in the top 25% who are far from wealthy would find themselves paying disproportionately for their healthcare costs.[10]  Not only would this proposal shift more costs to people who have incomes well below the highest levels, it might lead to more people choosing not to participate in Medicare.  Fewer participants in parts B and D would result in increased costs for the remaining participants.  
  • Increasing the cost of certain Medigap policies: In another effort to discourage utilization of health care, the Plan proposes a surcharge on Part B premiums for people who purchase Medigap policies with low cost-sharing.  This surcharge would be equivalent to about 15% of the average Medigap premium (or roughly 30% of the Part B premium). Eliminating or discouraging first-dollar coverage in Medigap only shifts those costs to beneficiaries, who may go without necessary medical care prescribed by their doctors. In fact, since Medigap policies only cover care that Medicare deems "medically necessary," such changes should not be needed to deter unnecessary utilization and would instead inhibit use of necessary care.[11] This proposal would penalize future beneficiaries who rationally seek to fill in Medicare's gaps in coverage for care they need.  
Other Options Are Available to Save Money
Other steps could be taken to lower costs and save money that would not reduce the care for, or increase cost-sharing for, current or future beneficiaries.  In addition to the drug rebate for low-income enrollees which is included in the President's Plan, the Center has written about other ways to improve care while saving money for Medicare. Our proposals include requiring the Secretary of Health and Human Services to negotiate drug prices with pharmaceutical companies and allowing traditional Medicare to offer a prescription drug option, rather than relying solely on private, commercial plans to do so.[12]  
Conclusion
The President's plan contains broad proposals, well beyond the health care arena, that seek to both raise revenues and achieve further reductions in federal spending. With respect to Medicare, we believe there are some strong proposals that could achieve significant savings – in particular, we support the proposed drug rebate for low-income beneficiaries. However, we are concerned about the many provisions of the plan that discourage the use of medically necessary services by increasing out-of-pocket costs for beneficiaries. These provisions are more likely to lead lower- and middle-income people to forego necessary and preventive care than to limit all beneficiaries' use of unnecessary care.
For more information, contact attorney David Lipschutz (dlipschu@medicareadvocacy.org) in the Center for Medicare Advocacy's Washington, DC office at (202) 293-5760.


[1] For a discussion of the Super Committee and the potential impact on Medicare, see, e.g., the Center's Weekly Alert "What Does the Debt Ceiling Mean for Medicare?" (August 4, 2011) at:http://www.medicareadvocacy.org/2011/08/
what-does-the-debt-ceiling-agreement-mean-for-medicare/
.[2] White House Press Release: "Fact Sheet: Living Within Our Means and Investing in the Future – The President's Plan for Economic Growth and Deficit Reduction" (September 19, 2011), available at: http://www.whitehouse.gov/the-press-office/2011/09/19
/fact-sheet-living-within-our-means-and-investing-future-president-s-plan
. For the full text of the President's proposal, see http://www.whitehouse.gov/sites/default/files/omb/budget/f
y2012/assets/jointcommitteereport.pdf
.[3] Id.[4] See, e.g., Kaiser Family Foundation, "Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform (July 2011), available at: http://kff.org/medicare/upload/8169.pdf; also see Center for Budget and Policy Priorities, "Raising Medicare's Eligibility Age Would Increase Overall Health Spending and Shift Costs to Seniors, States and Employers" (August 2011), available at: http://www.cbpp.org/files/8-23-11health.pdf. [5] See, e.g., Kaiser Family Foundation's Data Spotlights Examining the Financial Burden of Health Care Costs on Medicare Beneficiaries (June 2011), available at: http://www.kff.org/medicare/medicare-spending-briefs.cfm.[6] MedPAC Public Meeting Presentation: "Context for Medicare Payment Policy" (September 15, 2011), at: http://www.medpac.gov/transcripts/Context%202012.pdf.[7] The President's Plan for Economic Growth and Deficit Reduction (September 2011), page 35, available at: http://www.whitehouse.gov/sites/default/files/omb
/budget/fy2012/assets/jointcommitteereport.pdf
.[8] Trivedi, Amal, Rakowski, William & Ayanian, John Z (2008) "Effect of Cost Sharing on Screening Mammography in Medicare health Plans," The New England Journal of Medicine, 358, 375-383.[9] See, e.g., Kaiser Family Foundation's Data Spotlights Examining the Financial Burden of Health Care Costs on Medicare Beneficiaries (June 2011), available at: http://www.kff.org/medicare/medicare-spending-briefs.cfm.[10] MEDPAC Data book, June 2011, http://www.medpac.gov/document_TOC.cfm?id=617.[11] See, e.g., National Association of Insurance Commissioners, Letter to the Joint Committee on Deficit Reduction (September 21, 2011), available at: http://www.naic.org/documents/committees_ex_grlc_
110921_letter_murray_hensarling_medigap_first_dollar.pdf
.[12] See, e.g., the Center's Weekly Alerts, including: "Real Solutions For Medicare Solvency" (June 9, 2011), available at http://www.medicareadvocacy.org/hidden/
so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/
; "Real Solutions to Save Medicare Dollars in Skilled Nursing Facilities" (June 30, 2011), available at: http://www.medicareadvocacy.org/2011/06/
real-solutions-to-save-medicare-dollars-in-skilled-nursing-facilities/
; and "Debunking Medicare Myths: Drug Rebates for Dual Eligibles" (July 21, 2011), available at: http://www.medicareadvocacy.org/2011/07/
debunking-medicare-myths-drug-rebates-for-dual-eligibles/

The President's Plan for Economic Growth and Deficit Reduction: A First Look at the Impact on Medicare

Last week, President Obama unveiled his recommendations to Congress's Joint Select Committee on Deficit Reduction ("Super Committee").[1] The President's Plan for Economic Growth and Deficit Reduction seeks to pay for the President's jobs bill and produce net savings of more than $3 trillion over the next decade.[2] The proposal includes $320 billion in savings from changes to federal spending on Medicare and Medicaid (including $248 billion in Medicare savings). In addition, the President has threatened to veto any bill that takes away Medicare benefits without an increase in contributions from "the wealthiest Americans and biggest corporations."[3]
This Alert looks at specific aspects of the President's plan that would affect future Medicare beneficiaries.  While we applaud a focus on increasing revenue to address our nation's debt and deficit concerns, we are troubled by proposals that shift costs to Medicare beneficiaries who already pay significant out-of-pocket expenses for their health care.
Promising Proposals
One strength of the President's plan is that it seeks new revenues as part of any discussion about overall debt and deficit reduction. We are glad to see the following included (or not included) in the President's Plan:
  • Rebates from drug manufacturers for prescription drugs provided to dually eligible beneficiaries and those receiving the Part D Low-Income Subsidy (LIS): While not the full negotiation of drug prices that could save Medicare billions or dollars, this proposal would allow Medicare to benefit from the same rebates that Medicaid receives for brand name and generic drugs provided to individuals who receive the LIS. By restoring the law as it applied to dual eligibles prior to the creation of Part D in 2006, and extending the rebate to all LIS enrollees, Medicare would save an estimated $135 billion over 10 years.
  • NO  increase in eligibility age: This Plan from the President does not call for raising the age of Medicare eligibility from 65 to 67, which experts have reported would increase and shift costs onto employers, individuals, and states.[4] We are pleased that the President has eliminated this change in his proposal.
Proposals of Concern
However, we are concerned about certain aspects of the President's plan that, if implemented, would shift significant cost-sharing to beneficiaries who already pay considerable costs for their medical care.[5]  For example, the Medicare Payment Advisory Commission (MedPAC) reports that premiums and cost-sharing for Parts B and D alone absorbed 30 percent of the average Social Security benefit in 2010.[6]
Many provisions of the President's Plan aim to achieve Medicare savings by creating "financial incentives for newly eligible beneficiaries to seek high-value health care services."[7]   Starting in 2017, higher costs would be imposed on beneficiaries under the misguided assumption that greater out-of-pocket expenses will lead to more reasonable decisions about obtaining various types of medical care. On the contrary, these proposals would fail to steer people toward high-value services, and, at worst, simply charge people more for accessing needed health care, or deter people from seeking care altogether.[8]  
The following provisions are troubling because they would directly shift costs to Medicare beneficiaries:
  • Implementing a Co-Payment for Home-Health Care:  Starting in 2017, this proposal would create a home health copayment of $100 per home health 60-day episode, applicable for episodes with five or more visits not preceded by a hospital or other inpatient post-acute care stay.  Imposing such co-pays would have a staggering impact on individuals with long-term and chronic conditions, who would essentially incur $600 in new out-of-pocket costs annually.  Additionally, it could lead to higher hospitalizations (and thus, higher costs) as a result of beneficiaries forgoing needed care when they cannot afford the co-payments. Moreover, eliminating the co-pay requirement to situations where there has been a hospital or nursing home stay creates a perverse incentive toward hospitalization or nursing home care.
  • Increasing Part B deductible for new beneficiaries: The President's plan would increase the Part B deductible only for new beneficiaries by $25 dollars in 2017, 2019 and 2021 (for a total $75 increase). This proposal would have a significant impact on Medicare beneficiaries, nearly half of whom have annual incomes below $22,000.[9]  Only about 14% of Medicare beneficiaries – those with incomes of about $11,000 or less - get financial help to pay their Medicare cost-sharing. The proposal shifts costs to beneficiaries and could result in increased costs when needed care is postponed until an illness is more complicated and more costly to treat. Further, this proposal draws an arbitrary line between current beneficiaries and near retirees who would be unaffected and those who will join Medicare in the future and will permanently pay more.
  • Further income-basing Medicare Part B and D premiums:  Medicare is already a means-tested program, with higher-income beneficiaries paying more for Part B and Part D premiums. The current requirements affect only about 5% of beneficiaries – those with incomes at or above $85,000 a year. The President's proposal would not only raise the income-related premium by 15%, it would also freeze the income level for higher payments at $85,000, not adjusting for inflation, cost of living, or any other such factors, until 25% of beneficiaries were paying the higher premiums. Using today's dollars, this means that beneficiaries with current incomes of $43,500 belong in the top 25% of Medicare beneficiaries based on income. In the future, Medicare beneficiaries in the top 25% who are far from wealthy would find themselves paying disproportionately for their healthcare costs.[10]  Not only would this proposal shift more costs to people who have incomes well below the highest levels, it might lead to more people choosing not to participate in Medicare.  Fewer participants in parts B and D would result in increased costs for the remaining participants.  
  • Increasing the cost of certain Medigap policies: In another effort to discourage utilization of health care, the Plan proposes a surcharge on Part B premiums for people who purchase Medigap policies with low cost-sharing.  This surcharge would be equivalent to about 15% of the average Medigap premium (or roughly 30% of the Part B premium). Eliminating or discouraging first-dollar coverage in Medigap only shifts those costs to beneficiaries, who may go without necessary medical care prescribed by their doctors. In fact, since Medigap policies only cover care that Medicare deems "medically necessary," such changes should not be needed to deter unnecessary utilization and would instead inhibit use of necessary care.[11] This proposal would penalize future beneficiaries who rationally seek to fill in Medicare's gaps in coverage for care they need.  
Other Options Are Available to Save Money
Other steps could be taken to lower costs and save money that would not reduce the care for, or increase cost-sharing for, current or future beneficiaries.  In addition to the drug rebate for low-income enrollees which is included in the President's Plan, the Center has written about other ways to improve care while saving money for Medicare. Our proposals include requiring the Secretary of Health and Human Services to negotiate drug prices with pharmaceutical companies and allowing traditional Medicare to offer a prescription drug option, rather than relying solely on private, commercial plans to do so.[12]  
Conclusion
The President's plan contains broad proposals, well beyond the health care arena, that seek to both raise revenues and achieve further reductions in federal spending. With respect to Medicare, we believe there are some strong proposals that could achieve significant savings – in particular, we support the proposed drug rebate for low-income beneficiaries. However, we are concerned about the many provisions of the plan that discourage the use of medically necessary services by increasing out-of-pocket costs for beneficiaries. These provisions are more likely to lead lower- and middle-income people to forego necessary and preventive care than to limit all beneficiaries' use of unnecessary care.
For more information, contact attorney David Lipschutz (dlipschu@medicareadvocacy.org) in the Center for Medicare Advocacy's Washington, DC office at (202) 293-5760.


[1] For a discussion of the Super Committee and the potential impact on Medicare, see, e.g., the Center's Weekly Alert "What Does the Debt Ceiling Mean for Medicare?" (August 4, 2011) at:http://www.medicareadvocacy.org/2011/08/
what-does-the-debt-ceiling-agreement-mean-for-medicare/
.[2] White House Press Release: "Fact Sheet: Living Within Our Means and Investing in the Future – The President's Plan for Economic Growth and Deficit Reduction" (September 19, 2011), available at: http://www.whitehouse.gov/the-press-office/2011/09/19
/fact-sheet-living-within-our-means-and-investing-future-president-s-plan
. For the full text of the President's proposal, see http://www.whitehouse.gov/sites/default/files/omb/budget/f
y2012/assets/jointcommitteereport.pdf
.[3] Id.[4] See, e.g., Kaiser Family Foundation, "Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform (July 2011), available at: http://kff.org/medicare/upload/8169.pdf; also see Center for Budget and Policy Priorities, "Raising Medicare's Eligibility Age Would Increase Overall Health Spending and Shift Costs to Seniors, States and Employers" (August 2011), available at: http://www.cbpp.org/files/8-23-11health.pdf. [5] See, e.g., Kaiser Family Foundation's Data Spotlights Examining the Financial Burden of Health Care Costs on Medicare Beneficiaries (June 2011), available at: http://www.kff.org/medicare/medicare-spending-briefs.cfm.[6] MedPAC Public Meeting Presentation: "Context for Medicare Payment Policy" (September 15, 2011), at: http://www.medpac.gov/transcripts/Context%202012.pdf.[7] The President's Plan for Economic Growth and Deficit Reduction (September 2011), page 35, available at: http://www.whitehouse.gov/sites/default/files/omb
/budget/fy2012/assets/jointcommitteereport.pdf
.[8] Trivedi, Amal, Rakowski, William & Ayanian, John Z (2008) "Effect of Cost Sharing on Screening Mammography in Medicare health Plans," The New England Journal of Medicine, 358, 375-383.[9] See, e.g., Kaiser Family Foundation's Data Spotlights Examining the Financial Burden of Health Care Costs on Medicare Beneficiaries (June 2011), available at: http://www.kff.org/medicare/medicare-spending-briefs.cfm.[10] MEDPAC Data book, June 2011, http://www.medpac.gov/document_TOC.cfm?id=617.[11] See, e.g., National Association of Insurance Commissioners, Letter to the Joint Committee on Deficit Reduction (September 21, 2011), available at: http://www.naic.org/documents/committees_ex_grlc_
110921_letter_murray_hensarling_medigap_first_dollar.pdf
.[12] See, e.g., the Center's Weekly Alerts, including: "Real Solutions For Medicare Solvency" (June 9, 2011), available at http://www.medicareadvocacy.org/hidden/
so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/
; "Real Solutions to Save Medicare Dollars in Skilled Nursing Facilities" (June 30, 2011), available at: http://www.medicareadvocacy.org/2011/06/
real-solutions-to-save-medicare-dollars-in-skilled-nursing-facilities/
; and "Debunking Medicare Myths: Drug Rebates for Dual Eligibles" (July 21, 2011), available at: http://www.medicareadvocacy.org/2011/07/
debunking-medicare-myths-drug-rebates-for-dual-eligibles/