America’s first efforts to provide affordable, accessible healthcare to vulnerable populations—Medicare and Medicaid—remain incredibly popular and necessary for all Philadelphians who depend on them.
But as we’ve seen in the news both here in Pennsylvania and in Washington, the Medicare Trust Fund is facing insolvency within the next 5 years and given the divided Congress, it will take support from both sides of the aisle to find solutions to shore up this crucial program and maintain access to quality healthcare for seniors and people with disabilities.
President Biden’s recent State of the Union, and in his 2024 budget proposal include several proposals to fortify and rebuild the Fund. Among them are increasing an existing Medicare tax on Americans who make more than $400,000 a year and allowing the government to negotiate prescription drug prices. But there is a 40-year-old law already on the books that could also help address the issue and is worth a look as discussions advance: The Medicare Secondary Payer Act (MSP Act).
Passed as a part of an Omnibus package, the MSP Act had overwhelming bipartisan support as a way to protect and preserve the Medicare Fund. It states that Medicare is the secondary payer for medical expenses when an individual has other insurance (auto or employer health plan for example) available.
But despite the law being on the books, enforcing the MSP Act has been difficult because CMS, the federal agency that oversees Medicare, is stretched thin– understandable as it is also responsible for managing Medicaid, CHIP and the federal healthcare marketplace. So, over the past four decades, greedy insurance companies have been able to defraud the system by not reimbursing Medicare for claims that they should have been paying. However, despite insurers’ staunch opposition, the Medicare program was able to save approximately $9.7 billion in the 2021 fiscal year through MSP provisions.
Efforts to recover the funds hit yet another roadblock earlier this year with a court ruling that recovery efforts are subject to state procedural requirements. If allowed to stand, it would mean that insurers will be emboldened to continue their abuse of the Medicare system and the US government will lose out of billions of dollars that belong to millions of seniors who paid in to have an expectation that they will be covered by Medicare.
Upon being appointed Chairman of the Senate Committee on Aging, Senator Bob Casey (PA-D) stated “I intend to build upon that work so that vulnerable seniors get the care they deserve and those who target them are held fully accountable.” There is nothing partisan about protecting seniors nor is there disagreement across the aisle about cracking down on waste, fraud and abuse of the Government. Adding a few words to the Medicare Secondary Payer Act or having the U.S Government weigh in during the ongoing legal fight would help ensure the Act functions as intended and protects the promise made to older Americans that Medicare will be fully funded.
Councilmember At-Large Sharon A. Vaughn is the Chair of City Council’s Committee on Intergenerational Affairs and Aging.