Mark Farrah Associates, October 31, 2018
As of October 1, 2018, total Medicare Advantage (MA) membership stood at over 21 million, representing approximately 34% of the 63.3 million Americans eligible for Medicare. Medicare Advantage plans can either be acquired individually through direct purchase policies or through employer/group retiree programs, commonly known as Medicare Advantage Employer Group Waiver Plans (MA-EGWPs). Since the inception of Medicare Advantage in 2003, Individual MA policies have historically dominated the market as 17.1 million beneficiaries purchased MA plans as of October 1, 2018. However, despite a decrease over the years in the number of private sector employers offering retiree health benefits, membership trends in MA-EGWPs have demonstrated notable enrollment growth, especially within the past two years.
Since December 2017, employer-group Medicare Advantage enrollment has increased by over 443 thousand. In fact, over the past four years, group market enrollment has increased by approximately 1 million members, nearly a 125% increase in enrollment since December 2015. This brief provides insights about the current employer-group Medicare Advantage market and assesses membership trends over the past four years by carrier and state.
By Don McCanne, M.D.
The continued growth in enrollment in private Medicare Advantage plans should be of concern to those who support Single Payer Medicare for All. The privatized Medicare program would not be suitable for a single payer system for the obvious reason that it would be a multi-payer system using private sector insurance plans.
This report shows that there is even more rapid growth in Medicare Advantage Employer Group Waiver Plans (MA-EGWPs) – plans that are used for employer/group retiree programs. Locking retired employees into these plans would make it even more difficult to transition into Single Payer Medicare for All since retirees tend to be quite supportive and defensive of their health benefit programs.
Right now there is an intensive effort taking place to defer, perhaps forever, the enactment of Single Payer Medicare for All through a strategy to create a Medicare for Some by offering the purchase of Medicare as an option (a public option) for those currently not yet qualified for Medicare. It is highly likely that the public option will be private health plans comparable to the Medicare Advantage plans, just as the plans offered in the government exchanges under the Affordable Care Act are private health plans.
In the meantime, the traditional Medicare program is being neglected, likely by design, and, as such, it would be unsuitable for Single Payer Medicare for All without significant improvements. However, as the private Medicare Advantage plans become more pervasive within the system, there is great risk that the traditional Medicare program will be reduced to a Medicaid-style welfare program, if not entirely abandoned.
The more we accept these incremental changes such as the Medicare Advantage Employer Group Waiver Plans and the pending Medicare Advantage public option – Medicare for Some – the greater the likelihood that we will never see Single Payer Medicare for All. As a reminder, Single Payer Medicare for All corrects the major deficiencies in health care financing, making health care equitable, accessible, and affordable for everyone, whereas the Public Option Medicare for Some perpetuates our highly dysfunctional, fragmented, inequitable, and often unaffordable health care financing system and merely adds one more option that increases the administrative complexity of our system.
The Medicare Advantage Employer Group Waiver Plans may seem relatively benign and perhaps even an incremental benefit, but these creeping programs are locking in stone a privatized system that is not even worthy of the name “Medicare.” The longer we wait, and the more we tolerate creeping incrementalism, the less likely we’ll ever see Single Payer Medicare for All.
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