Maine Medicare crisis ahead

Medicare and its 220,000 members in Maine are facing trouble ahead as the program that once promised high-quality, affordable health care for older and disabled Americans reaches a crisis.

Next year a scheduled pay cut will reduce Medicare payments to doctors by at least 10 percent. For Maine’s physicians that means a loss of $27 million for the care of older and disabled patients in Medicare. Most physicians say they will be forced to limit the number of new Medicare patients they see, which would only make it harder to find a doctor.

Meanwhile, the people in Medicare are watching their costs skyrocket – the premium for doctor visits and outpatient care has doubled since 2000. This is surely disturbing news for patients who rely on Medicare, especially for those with fixed incomes. It’s even more disturbing when you consider that the growth of Maine’s 65-plus population will substantially exceed the growth of the total population in the state from 2000 to 2030.

With Medicare’s current physician payment rates unchanged for more than five years, we are already seeing the beginnings of bigger problems. The commission that advises Congress on Medicare, MedPAC, reports that one in four Medicare patients seeking a new primary care physician already has problems finding one. Maine has the second highest proportion of Medicare patients in the country, but a below-average ratio of physicians to Medicare members even before next year’s cuts take effect.

And it gets worse. The government is predicting a shortage of 85,000 physicians by 2020. Almost half of Maine’s practicing doctors are over 50 – the age when most consider reducing their patient care activities. Couple that with the first baby boomers turning 65 in just three years and Medicare’s future is grim unless we take action now.

AARP is supporting congressional action that stops the next two years of Medicare cuts to doctors, ensures access to physicians, and helps lower-income seniors with their out-of-pocket health care costs.

But we can’t just let our lawmakers put the cost of these changes on the backs of people in Medicare, raising premiums even higher. When the U.S. House of Representatives considered a Medicare bill earlier this year, they paid for these changes in a smart and responsible way. By restoring the balance between traditional Medicare and private plans offered by insurance companies, Congress can save $54 billion that can be used to ensure access to doctors while holding down premium increases.

Today, these private plans cover just one in five Medicare patients, but they are costing the government 12 percent more than the traditional program. The insurance companies promised the efficiency of managed care would keep costs below Medicare, but now they’re raking in profits at the expense of taxpayers and all Medicare members. Because the insurance companies haven’t kept their promise, the entire Medicare program is threatened.

Restoring the balance between Medicare and private plans will allow Congress to pay for fixes that ensure access to doctors and better help lower-income people in Medicare-without adding the already-rising premiums. Unfortunately, many lawmakers have not supported stopping excess payments to the private insurance companies.

Older Americans are counting on Congress to take action now so that they can get the health care they need. If lawmakers fail to act, Medicare patients will pay the price with reduced access to their doctors and even bigger premium hikes. Military families, whose government health care is tied to Medicare payment rates, will also suffer.

The private insurers have failed to keep their promise of lower costs for Medicare, which is making it hard for Medicare to keep its promise to 44 million older Americans. Now Congress has a choice between continuing to line the pockets of the insurance industry and keeping its commitment to a strong, affordable Medicare for Americans. Seems like an easy choice to us.

Nelson Megna is the president of AARP Maine.