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In modern versions of Medicare and Medicaid, private insurers play major role


Private health insurance companies are playing a bigger role than previously anticipated when it comes to covering Medicare and Medicaid beneficiaries.

Case in point: The two government-led programs insure more than one-third of Americans--and more than 30 percent of the 55 million Medicare beneficiaries and nearly half of the 66 million Medicaid beneficiaries are covered through private plans from the likes of UnitedHealth Group, Humana and Anthem, reports the New York Times.

Fifty years ago, when President Lyndon B. Johnson signed Medicare and Medicaid into law, the goals of the programs were clear: To extend "the miracle of healing to the old and to the poor," notes the Times. At the time, the programs' architects believed that private insurance was not feasible for many qualified beneficiaries--instead, they wanted to replace the bill with social insurance.

Fast forward to present day. Recent analysis finds that care for people ages 19-64 who were enrolled in Medicaid all year was on par with patients who had consistent private insurance. Additionally, privately insured and Medicaid patients both were more likely to receive preventive care services such as flu shots and blood pressure tests and to have a doctor who knew their medical history, FierceHealthPayer previously reported.

And while the government pays private insurers to cover both programs' beneficiaries, critics wonder if the private plans will end up losing money down the road.

As Florida Gov. Rick Scott (R) recently pointed out, "Name the healthcare program--I think the only one is Medicare Part D--that cost less than what they initially anticipated. … Historically, if you look at the numbers, with the growth in Medicare costs, Medicaid costs, it's always multiples."

But when the Affordable Care Act was passed into law, Congress reduced payments to private Medicare Advantage plans to help offset the cost of the legislation, according to the Times. This led insurers to believe enrollment would decline. However, enrollment spiked from 11 million in 2010 to 16.6 million so far--that number is expected to reach 30 million by 2025.

Still, difficulties remain for covering Medicare and Medicaid beneficiaries. Challenges include some doctors' reluctance to cover Medicaid patients as well as skyrocketing drugs costs, FierceHealthPayer has reported. 

For more:
- here's the Times article

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