By Thomas Goldsmith
With additional reporting by Rose Hoban
Medicare, the federal health care system for people 65 and older, presents a complex maze of decisions for those who sign up for its plans.
And this week’s federal budget talks could bring cuts, or even elimination, to a program designed to help people make Medicare choices that will provide them the best care at optimum prices.
North Carolina’s version of the program, the Seniors Health Insurance Information Program, or SHIIP, provides counseling annually to more than 105,000 Medicare beneficiaries, according to the North Carolina Medical Society.
“SHIIP is critical to the financial health and well-being of older Americans enrolled in Medicare,” U.S. Rep. David Price, a Chapel Hill Democrat, said Monday through his office. He called it “a flagship example of how healthcare programs can be innovative, efficient, and cost-effective.”
Republicans who control Congress take a different view of the program, calling it unnecessary and duplicative of other efforts. Last summer’s draft federal budget, containing the cut to SHIIP, allowed legislators to cut lower-priority spending, Rodney Frelinghuysen, a New Jersey Republican and the House Appropriations Chairman, said when the budget was announced.
The proposed House 2018 budget cuts all funding for the SHIIP programs across the country, while the Senate version preserves flat funding of $47 million.
“This bill reflects Republican priorities to cut spending and focus investments in programs our people need the most – public health and medical research, biodefense, fundamental education, and proven programs that increase job growth, for example,” Frelinghuysen said. “It also includes important provisions to stop government overreach.”
Big Medicare savings ahead
The program is largely staffed by volunteers such as B.J. Boyarsky, who took part in training last fall in Durham at the SHIIP-affiliated agency Senior PharmAssist.
“Medicare is so complicated, absolutely so complicated; we get trained up to here, and I love, love, love to be able to kind of understand it,” said Boyarsky, who’s been volunteering with Senior PharmAssist for more than seven years.[sponsor]
“I can help someone else understand what the options are because they are complicated,” she said. “They are interrelated — there is no right answer, there is no one best way for any of this.”
Volunteers’ chief goal is “to unpack the confusion around Medicare,” Boyarsky added.
SHIIP can also help recipients save money on their plans, according to supporters.
“In North Carolina alone, the SHIIP program saved seniors more than $60 million on Medicare coverage and prescription drugs in 2017, $13 million more than what’s appropriated for all SHIIP programs nationwide each year,” Price said.
Origins in the “Great Society”
The original Medicare program will observe its 53rd anniversary on June 30, the date in 1965 on which President Lyndon Johnson signed the health care act into law as part of his “Great Society” social services initiative. Very basically, Medicare covers people over 65 and others with limited resources through three prongs:
- Part A, which covers hospital inpatient care, hospice care, some home health care and some skilled nursing care — though not for long terms. Most people have paid for Part A throughout their lives with payroll deductions.
- Part B, which covers doctor’s office care, outpatient care, physical and occupational therapy and some other services. Part B is available through a variety of insurance company offerings, which vary greatly in price, but by statute must cover the same services.
- Part D, added during the presidency of George W Bush, covers prescription drug costs for Medicare beneficiaries. It’s also available through many different companies, which offer varying formularies, or lists of drugs, at a wide range of prices.
In addition, Medicare Advantage programs offered by private companies offer a range of choices that can combine elements of other Medicare plans. “Enrollment in Medicare Advantage is at an all-time high as approximately one-third of all Medicare beneficiaries are enrolled in a plan,” the Centers for Medicare and Medicaid Services announced last month.
Just as with Medicare B and D, Medicare Advantage plans, sometimes called Medicare C, require careful scrutiny before enrollment to see which services are covered and which are not.
Faced with a welter of choices for Medicare plans, recipients can turn to SHIIP volunteers in every North Carolina county who enter personal data into a computer to match the recipient with a few best options. The price tag: about $1.2 million, the roughly 105,000 North Carolinians who receive help from SHIIP cost a little more than $10 apiece.
Though a tiny sliver of the federal budget, SHIIP has more than once received attention from budget-cutters on Capitol Hill.
- assisted over 102,000 Medicare recipients
- saved more than $60 million in health care costs for Medicare recipients
- saved consumers in North Carolina more than the total amount Congress awards to all SHIPs nationwide;
- served almost 17,000 Medicare beneficiaries with disabilities
- counseled more than 28,000 beneficiaries with incomes below 150 percent of the federal poverty line
“The fiscal year 2017 Labor-HHS bill eliminates more than a dozen duplicitous or unnecessary federal programs in addition to the 18 from last year’s bill, and is $270 million less than last year,” U.S. Sen. Roy Blunt, a Missouri Republican and chair of the corresponding Senate committee, said in June 2016.
But advocates disagree that SHIIP would be easily replaced.
“It funds a network of organizations that provide very in-depth, personalized counseling to Medicare beneficiaries,” Marci Phillips, director of public policy and advocacy at the National Council on Aging, said Monday. “It’s very important to us — we’ve been following it very closely.”
Will Congress sink SHIIP?
SHIIP programs survived the 2017 budget debate but took a $5 million cut.
In July, the U.S. House Labor, Health and Human Services committee followed the White House’s lead in suggesting the entire $47 million SHIIP appropriation be eliminated in 2018 as a part of myriad health and human services cuts. The entire allocation for those sectors is $156 billion.
Early this week, conferees were resolving countless differences on funding government services as Congress worked to beat a Friday deadline for completing the 2018 federal omnibus budget. Established under federal law in 1990, SHIIP-styled programs have retained a wide following among seniors and advocacy groups for older people.
In Durham, SHIIP had made an apparent convert of Byeori Kim, a Campbell University pharmacy student training to become a volunteer. The intricacies of Medicare coverage weren’t part of her pharmacy classes, said Kim, a Chapel Hill resident.
“It’s really really basic, you don’t go into all this details about different plans,” she said. “We knew about the Part D program as opposed to A and B. It’s very customized in all the plans. My goal is to learn as much as I can.”