qotd: Marilyn Tavenner moves from CMS to AHIP to “protect Medicare Advantage”

The New York Times
July 15, 2015
Head of Obama's Health Care Rollout to Lobby for Insurers
By Robert Pear

Marilyn B. Tavenner, the former Obama administration official in charge
of the rollout of HealthCare.gov, was chosen on Wednesday to be the top
lobbyist for the nation's health insurance industry.

Ms. Tavenner, who stepped down from her federal job in February, will
become president and chief executive of America's Health Insurance
Plans, the trade group whose members include Aetna, Anthem, Humana,
Kaiser Permanente and many Blue Cross and Blue Shield companies.

On Aug. 24, she will succeed Karen M. Ignagni, a former health policy
specialist at the A.F.L.-C.I.O., who has led the industry's lobbying arm
for 22 years.

Most recently, Ms. Tavenner was the administrator of the Centers for
Medicare and Medicaid Services, the federal agency that insures one in
three Americans and has an annual budget of more than $800 billion. As
administrator, she was in charge of HealthCare.gov.

Her selection as chief lobbyist for the industry highlights how federal
health programs have become a priority for insurers, which increasingly
depend on revenues from Medicare and Medicaid and the new public
insurance marketplaces.

Asked about her priorities, Ms. Tavenner said she wanted to protect
Medicare Advantage, the program under which private insurers manage care
for more than 30 percent of the 55 million beneficiaries of Medicare.

http://www.nytimes.com/2015/07/16/us/ex-medicare-chief-marilyn-tavenner-top-lobbyist.html

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The Daily Caller
July 12, 2015
Obamacare Chief Nominee Pounded On Conflicts Of Interest
By Richard Pollock

Liberals and conservative have grave ethical concerns about Andy
Slavitt, a former health care executive President Barack Obama nominated
as his top administrator at the U.S. Centers for Medicare and Medicaid
Services.

Of greatest concern to Congress is the apparent conflict of interest
Slavitt poses as a top administrator at an agency that will set the
rules for his old boss and the nation's largest insurance company,
United Health Group.

Slavitt has been acting CMS administrator since his former boss, Marilyn
Tavenner, resigned earlier this year over repeated Obamacare failures.

CMS also is the largest single purchaser of health care in the United
States, paying for almost one-third of the country's health expenditures.

On the other hand, United Health Group is the largest health insurance
company in revenues. It reported $122 million in operating revenues in
2013, about one-third which came from government coffers.

Then there are the profits United Health enjoys from CMS. The company
sold insurance on many Obamacare's state exchanges last year. United
Health Group's major profit centers also are based with Medicare and
Medicaid. About 40 percent of the company's operating revenue comes from
administering Medicare and Medicaid.

http://dailycaller.com/2015/07/12/obamacare-chief-nominee-pounded-on-conflicts-of-interest/

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Comment by Don McCanne

Although the Affordable Care Act included provisions to reduce the
overpayment of private Medicare Advantage plans, each year HHS/CMS has
used innovative measures to offset these reductions to ensure the
viability of these plans. Now former CMS administrator Marilyn Tavenner
has been selected to be president and CEO of the insurance lobbying
organization, AHIP, the most influential outside organization during the
health reform process. When asked about her priorities would be as head
of AHIP, Ms. Tavenner said she "wanted to protect Medicare Advantage."

Selected to replace her at CMS is Andy Slavitt, a former executive of
United Health Group, the largest insurer in the nation, a dominant
player in the market of private Medicare Advantage plans, not to mention
being the provider of AARP Medigap plans and a major provider of
administrative services for Medicare and Medicaid.

Karen Ignagni, AHIP's previous president and CEO, essentially had carte
blanche in the White House as ACA was being crafted. She also was very
influential in obtaining the concessions that protected the excess
payments to the Medicare Advantage plans, measures which greatly benefit
United Health Group and others. It seems more than a coincidence that
United Health Group dropped out of AHIP shortly after the resignation of
Karen Ignagni.

So what is happening? Without insider information, it is very difficult
to determine the degree of control held by each of the players, but
there is no question that HHS/CMS, AHIP, and UnitedHealth and the other
insurers are all participating in advancing the privatization of
Medicare by enhancing the private Medicare Advantage plans with our
taxpayer dollars. It is particularly disconcerting that this agenda is
supported by Congress and the Obama administration.

Imagine what those excess funds could do for our traditional Medicare
program, especially in reducing out-of-pocket expenses for premiums,
deductibles, coinsurance and catastrophic losses. That would be far
better than wasting them on the administrative excesses of the private
insurers and on the dishonest activities they engage in to increase
their profits by measures such as upcoding or gaming risk adjustment.

Why is there no public outcry? It is simply because the Medicare
Advantage plans are able to use about one-third of the extra funds to
reduce deductibles and coinsurance, making them appear to be superior
products, plus there is no need to purchase supplemental Medigap plans.
Most of the beneficiaries who are satisfied with their private plans
would not be inclined to support increased taxpayer funding of the
traditional Medicare program since it doesn't concern them anymore. And
efforts to reduce Medicare Advantage funding to the same levels as
traditional Medicare are met with loud protests orchestrated by AHIP.
Those in the traditional Medicare program usually have supplemental
retiree or Medigap plans with which they are satisfied, and thus they
are not advocates for change either.

It is really difficult to explain to people that what is a good deal for
them is a bad deal for all of us together since it perpetuates high
costs and extraordinary administrative waste. If their programs seem to
be working for them, they don't want change.

We need to improve the traditional Medicare program so that it is more
comprehensive and provides greater value, and then use it to cover
everyone. Our task is made much more difficult by the powerful forces
that support corporate control of our health care system. After all,
they are the ones with the money. And Tavenner and Slavitt will be there
as their agents, working inside and outside of the government. And most
people won't care.