The Prism of Ethics: Quiet Plans to Change MEDIGAP Insurance

I remember Dan Rostenkowski's expressions of disbelief, when he joined our meeting of the executive committee of the National Health Lawyers Association in Chicago about 20 years ago.  A couple of days earlier, he had been physically attacked with canes and umbrellas by little old men and women whom had represented in Congress for years.  Their concern that legislation he supported would raise their costs of prescription drugs made them furious. Twenty+ years later, other Chicago based political figures have chosen not to learn from Rostenkowski's experiences

The following vaguely-written section of the Affordable Care Act buried at page 342,  seems to predict significant MediGap change (you will have to refer to your own MediGap insurance brochures to determine how it might affect you). I have underlined the words which I consider most problematic.The approach appears to be double-barreled: (1) reduce Medicare beneficiaries access by raising the cost of plans which might give their purchasers more extensive (or appropriate for their needs?) physician Part B services and (2)  directly or indirectly create barriers to physicians' services to reduce high users (i.e., the sick elderly) access. Since my experience is that older Americans choose their MediGap insurance very carefully and pay the increasing premiums out of hard-earned dwindling financial reserves, I am concerned about the implications of this section for seniors.

SEC. 3210. DEVELOPMENT OF NEW STANDARDS FOR CERTAIN MEDIGAP PLANS.
(a) IN GENERAL.—Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is amended by adding at the end the following new subsection:
‘‘(y) DEVELOPMENT OF NEW STANDARDS FOR CERTAIN MEDICARE SUPPLEMENTAL POLICIES.—
‘‘(1) IN GENERAL.—The Secretary shall request the National Association of Insurance Commissioners to review and revise the standards for benefit packages described in paragraph (2) under subsection (p)(1), to otherwise update standards to include requirements for nominal cost sharing to encourage the use of appropriate physicians’ services under part B. Such revisions shall be based on evidence published in peer-reviewed journals or current examples used by integrated delivery systems and made consistent with the rules applicable under subsection (p)(1)(E) with the reference to the ‘1991 NAIC Model Regulation’ deemed a reference to the NAIC Model Regulation as published in the Federal Register on December 4, 1998,
and as subsequently updated by the National Association of Insurance Commissioners to reflect previous changes in law and the reference to ‘date of enactment of this subsection’ deemed a reference to the date of enactment of the Patient Protection and Affordable Care Act. To the extent practicable, such revision shall provide for the implementation of revised standards for benefit packages as of January 1, 2015.
‘‘(2) BENEFIT PACKAGES DESCRIBED.—The benefit packages described in this paragraph are benefit packages classified as ‘C’ and ‘F’.’’.
(b) CONFORMING AMENDMENT.—Section 1882(o)(1) of the Social Security Act (42 U.S.C. 1395ss(o)(1)) is amended by striking ‘‘, and (w)’’ and inserting ‘‘(w), and (y)’’.