Medicare "Scare" Campaign
May 27, 1998
Are you being bombarded with scare tactics about your
right to privately contract with doctors? You may be,
if you are a Medicare beneficiary. Many seniors around
the country are being flooded with conflicting information
about their right to privately contract with physicians.
It's working this way: Conservative groups are telling
seniors that due to the new Medicare law, Section 4507,
they now have less medical freedom than their British
counterparts do under socialized medicine.
Liberal groups, on the other hand, are countering that
by saying that the conservatives, and some newspapers
who repeat the line, are scaring seniors unnecessarily.
What's the Truth?
The truth is that Congress wrote an ambiguous Medicare
law. And now they are leaving it up to the Health Care
Financing Administration (HCFA) to interpret it.
When a conservative group or newspaper points out how
Section 4507 could restrict seniors' freedom, HCFA comes
along behind and interprets the law in a way that discredits
Case in point: The Heritage Foundation, a conservative
think tank based in Washington, D.C., was the first public
policy group to interpret Section 4507. The Foundation
concluded that this section of the Medicare law could
restrict seniors' choice of doctors.
Last November, Heritage Foundation's Bob Moffit published
a policy paper for United Seniors Association. In it,
he noted that "Under Section 4507 (3)(B)(ii), the physician
who enters a private contract with a Medicare beneficiary
must sign an affidavit that he will not submit any claim
for `any item or service' provided to `any Medicare beneficiary'
during a two-year period. Presumably, one would submit
a claim to Medicare for a covered service only and would
not submit a claim to Medicare for a non-covered service.
But still the language itself is ambiguous," writes
Still Not Clear
Not long after Moffit raised that concern, HCFA presented
its interpretation of Section 4507. It sent a memo to
insurance carries (private companies that process Medicare
bills). In the memo, HCFA stated that Section 4507 applies
only to Medicare-covered services. That means that seniors
can continue to pay privately for services that Medicare
does not cover. That seems clear enough.
But wait. Nancy-Ann de Parle, the head of HCFA, recently
told Congress that "Medicare Part B rules do not apply
to individuals or disabled persons who are eligible for
Medicare, but not enrolled in Part B. Therefore, a private
contract is not necessary for a physician to provide services
to an individual who is Medicare-eligible, but who is
not enrolled in Part B of the program," said de Parle.
Wait Again. The actual law passed by Congress states
otherwise. In fact, Section 4507 could apply to nearly
all seniors, because it defines a Medicare beneficiary
The term `Medicare beneficiary' means
an individual who is entitled to benefits under Part
A, or enrolled under Part B.
That means that, down the road HCFA could interpret Section
4507 to encompass nearly all seniors, since most are entitled
to Medicare Part A.
Pete Hutchison of the Landmark Legal Foundation warns,
"Bureaucrats excel at changing the rules in the middle
of the game. "By manipulating the administrative rules,
HCFA regulators can change the meaning and enforcement
of Medicare regulations with little regard for congressional
intent. It is an alarming practice that not only is dangerous
for America's seniors, but also mocks the Constitution's
delegation of legislative authority to the Congress,"
Pulling the Alarm
Conservative groups have pulled the Medicare freedom
alarm, and with good cause. As a result of their public
outcry, HCFA is now interpreting the new Medicare law
in a manner that gives seniors as many choices as possible.
That probably would not have happened without the conservatives'
Let's hope the alarm continues to sound until Congress
and the courts guarantee that seniors are free to choose
and pay privately for their health care.
This article appeared in the May/June issue of Health