Medicare and access

Something has been bothering me lately about the claims that FFS Medicare cuts to provider payments will lead to access problems for beneficiaries. It’s not that I think they won’t lead to access problems. In fact, I’ve written many times that if FFS Medicare payments diverge too far from payments by private plans, beneficiaries will have some access issues.

What bothers me is that discussions of access issues always ignore Medicare Advantage (MA). Every beneficiary has access to MA plans. Those plans are not required to pay providers FFS rates. They pay them whatever they can negotiate. Maybe it’s more. Maybe it’s less. That’s the way the market works. That’s they way it’d work under premium support proposals too. Do private plan payment rates bother anyone? If so, speak up. If not, it is inconsistent to go after FFS Medicare on that issue.

If FFS Medicare cuts too much and beneficiaries can’t find doctors, why won’t they just enroll in MA plans? Plan switching by savvy consumers is precisely what is supposed to drive the market under premium support. If it is to work under such a plan, it ought to work under current Medicare too. Sure, the price signal is not as clean since plan payments aren’t closely tied to bids. But consumers still know when they are getting a lousy product because they don’t have access to enough of the doctors they want to see, right?

Well, I’m skeptical beneficiaries can be savvy insurance product shoppers. But those that are attacking Medicare for its access-threatening payment cuts tend to be the same ones who are not skeptical about grandma’s ability to find a good deal.

But, I don’t mean to turn this into a snarky political point. I really just want to ask a basic question: if FFS Medicare commits suicide by pricing its way to access problems, don’t we have MA as a backstop? Isn’t that good enough? If not, why not?


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