Community Catalyst Deceives Massachusetts Seniors, Voters about Medicare

Martha Bebbinger of WBUR is going far afield from her usual excellent reporting on health-care-delivery issues in Massachusetts and trying to fact check some Massachusetts health-care insurance issues. It looks like Martha has it completely wrong at least on the Medicare side of the equation because of her dependence on a far-left-wing group called Community Catalyst. In its analysis, Community Catalyst purposely leaves out 200,000-300,000 Massachusetts seniors -- disproportionately the poorest of us seniors -- on Part C Medicare health plans. You know, these are the seniors already getting the global-payment/coordinated-care-type plans glorified by Patient Protection and Affordable Care Act (PPACA) advocates and the Massachusetts goo goos that recently gave us our new price-fixing legislation. 

Martha and Community Catalyst¹ are wrong because:

• According to the Medicare actuary, the higher prices paid by the 200,000-300,000 Part C Medicare health plan subscribers because of PPACA will basically wipe out any so-called savings to be realized by Part A/B Medicare Fee for Service beneficiaries from the cuts being made to hospitals and nursing homes and the death panel.
• I say so-called savings because the actuary has also said that the Part A/B PPACA cuts are unlikely to be made (so there will be no savings for FFS Medicare A/B beneficiaries and PPACA will result in a net increase for those on Medicare on average).
• And HHS' Assistant Director of Planning has said the effects of Medicare Savings Programs and state pharmaceutical assistance programs are not factored into the calculations Catalyst is using. So particularly in Massachusetts, these claimed savings are basically zero and/or -- if the Medicare actuary is right about the hospital and nursing home cuts being reversed -- negative.

Another issue Martha discusses in her fact check relates to the effect of the PPACA's "Cadillac tax" on Massachusetts citizens of all ages. She references a report by Josh Ambichault of the right-wing Pioneer Institute but I think Josh has already refuted most of Martha's criticisms from that angle.

-- Dennis Byron

¹ In addition to the major methodological problem with the Community Catalyst report on the effect of PPACA on Medicare beneficiaries (as described above, it left out up to 25% of us Massachusetts seniors and it claims  that few people in the donut hole qualify for Prescription Advantage-PA), there are numerous factual errors, omissions and misleading statements in the Community Catalsyt report:

1. The most PPACA saves someone in the donut hole this year is $2000 and in 2021 $3000 (depending on the exact size of the hole in 2021; it is supposed to get bigger). You can only save the kind of money claimed by Catalyst by spending almost all the way through the hole (about $7000 worth of drugs at retail this year; maybe $8000 by 2021). Only about 15,000 seniors in Massachusetts out of 1,100,000 of us this year spend that much (and I believe most of them would be eligible for PA leaving the number of people saving the money claimed at a few thousand out of 1.100,000)
2. None of the prescription drug savings claimed in the Catalyst report take PA into account at all.  Whether I am correct that many seniors qualify for PA or whether Catalyst is correct that only a few qualify for PA, there are certainly SOME savings due to PA but the Catalyst report does not factor in those savings
3. Almost all the so-called "no cost" preventive care cited by Catalyst was already no cost in Massachusetts (and the vast majority of this preventive care was flu shots)
4. Catalyst claims that seniors pay a $140 deductible and 20% co-pays for services (that is true for Part B services only) but almost all Massachusetts seniors (well over 90%) get some kind of private supplemental insurance so are not paying that deductible and those co-pays (and are therefore not "saving" it)
5. Catalyst's explanation on page 3 of how the donut hole works is incorrect.  That doesn't affect the claimed savings one way or the other but may mislead a senior
6. Catalyst leaves out the cuts to Medicare to be made by the death panel
7. I believe Table 1 is a national average, not Massachusetts data
8. No where in the Catalyst report is the effect of the Medicare Savings Program factored in (the seniors on FFS Medicare not paying a monthly Part B premium cannot "save" it)
9. No where in the report does Catalyst mention that low income seniors are typically (depending on assets) exempt from paying Part D premiums, protected totally from the donut hole and pay nominal co-pays (In Massachusetts, even low-income seniors with a lot of assets -- which is the ideal retirement situation -- get many of these benefits from PA; this is why I don't undersstand Catalyst's claim that few seniors in the donut hole qualify for PA. Catalyst is apparently making some assumpiton that only high income seniors have high drug costs?)