By James
Gutman - April 27, 2016
What a long strange trip it’s been!
When I came to AIS nearly 15 years ago as executive editor, I didn’t even know
what a Medicare + Choice plan, as it then was called, meant. I got educated
quickly, courtesy of a fantastic reporter and writer, Judy Packer-Tursman, who
was the editor of AIS’s newsletter about M+C and then Medicare Advantage for
more than eight years. I saw then an industry with a lot of promise — but also
a lot of problems, some of them caused by the government and some by faults in
the plans themselves.
Providers had been getting into the
business with expectations of cutting out the middlemen and often got out
quickly after big losses, as did some insurers themselves. M+C membership,
which had risen quickly after the Balanced Budget Act of 1997 was enacted,
started falling in 2000 and was continuing to fall in 2001, so M+C sponsors
jacked up premiums more than 50% for 2002. Plan quality was all over the place,
as was regulation, with the Bush administration seemingly unsure of what to do
with this industry that it wanted to prosper and had aided with rate hikes, but
that had some plans guilty of improper marketing and worse, especially in
Florida.
As I discussed stories with Judy and
edited her copy over the years, changes were coming, with the biggest ones
stemming from the 2003 Medicare reform law — via its initiation of a Medicare
drug benefit and more funding for M+C, which the law renamed Medicare
Advantage. The new MA market looked more attractive, so much so that AIS
changed the publication’s name to Medicare Advantage News, and it was.
However, some policymakers started wondering whether the feds were going
overboard to help MA and whether the industry deserved all that help.
Those questions hit a head after the
worst economic recession since the Great Depression struck in 2007 and 2008 and
a “new sheriff” came into town in the form of President Obama. The new
administration brought in a new attitude in CMS, as exemplified by the comments
of its Center for Medicare director, Jonathan Blum, at a meeting of the
America’s Health Insurance Plans trade group. “We are not your partner; we are
your regulator,” said Blum in establishing a different tone than CMS had toward
MA in the previous administration.
But neither the tone change nor the
Affordable Care Act (ACA), enacted shortly after I took over from Judy in
writing the newsletter at the beginning of 2010, deterred the growth of a
product that clearly met the needs of a growing number of seniors, especially
Baby Boomers. Indeed, Blum’s emphasis on consumer protection may have helped
the MA industry grow, and in his later years at CMS he seemed justly proud of
this. The government forecasts of enrollment declines caused by the MA pay cuts
in the ACA did not materialize, as MA’s market penetration kept growing.
Now nearly a third of Medicare
recipients are enrolled in MA, CMS’s policies aimed at steering MA
beneficiaries to plans that have high star quality ratings are succeeding, and
the worst of the unethical business practices found in the earlier days seem to
be disappearing — although there are still problem areas, especially in
coverage determinations and handling of appeals and grievances in Part D. CMS,
under current Center for Medicare Director Sean Cavanaugh, has embraced the
important role of MA and has begun making payment adjustments for those plans
serving the most disadvantaged populations. Many problems for those plans
remain, but the future for the MA product looks bright even in the face of
continued underfunding issues.
It is in this climate that I am
retiring as managing editor of Medicare Advantage News and a full-time
employee of Atlantic Information Services, Inc. at the end of this month and
will become a Medicare beneficiary myself. I am very pleased that the company
has named Lauren Flynn Kelly, an exceptional reporter and writer I’m proud to
have had a role in hiring in the early 2000s, as the new managing editor. And
I’m also glad that I will continue to do some things for the company after my
retirement, including organizing a few webinars and/or virtual conferences.
For those so inclined, you can still
reach me at my AIS email address, jgutman@aishealth.com, as well as my
home-office phone number, (301) 604-4001. It has been a privilege to work since
2001 with a publication serving this important market, and the journey itself
has been part of the reward.
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