What We Have to Do to Save Medicare
This administration has gotten us used to spectacles that signal the destruction of an agency (like USAID) or the unleashing of ICE on city streets, especially in blue cities and states. But when it comes to things that Trump said he would protect – like Medicaid and Medicare – the attack is much quieter. It has happened behind the scenes with budget manipulations that result in massive cuts to Medicaid, new regulations designed to exclude many currently receiving aid, and drastic cuts to staff that make it harder to secure the services that we have been promised.
There’s one of these behind-the-scenes operations going on right now with Traditional Medicare, and we need to speak up to stop it. More than a dozen House Democrats have written to Centers for Medicare and Medicaid Services Administrator Mehmet Oz (yes, that Mehmet Oz), requesting information and urging cancellation of a planned prior authorization pilot for traditional Medicare.
The Democratic lawmakers wrote that “traditional Medicare has rarely required prior authorization.” They added that while prior authorization is “often described as a cost-containment strategy, in practice it increases provider burden, takes time away from patients, limits patients’ access to life-saving care, and creates unnecessary administrative burden.”
CMS has planned to roll out the prior authorization program in six states starting in January. We need to stop it!
Of course, Thom Tillis is supporting this as reducing waste, fraud, and abuse. And you can be sure Senator Budd is also.
Certainly there are problems with Medicare Advantage – the privatized version of Medicare – but we have already seen the impact of prior authorization in private health care: the reliance on AI algorithms to determine what does and doesn’t get authorized has a 90% error rate. In other words, nine of 10 appealed denials were ultimately reversed. This is cost savings at the expense of necessary health care – leading to protracted wait times, worse health outcomes, and sometimes even death, before the denial could be reversed.
Please write or call both our Senators and your Representative in Congress to demand that CMS cancel this prior authorization pilot on the grounds that it will make access to necessary health care more difficult for seniors. Feel free to tell your own stories about health care denied. And ask for a response from our senators and representatives.
Thank you.