Elizabeth Lippincott

If you, like us here at SHL, have been waiting for insights into the Biden Administration’s vision and agenda for the Medicare Advantage and Part D programs, the wait is over. On Thursday, January 6, CMS proposed Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, [CMS-4192-P].  Comments on the proposed rule are due March 7, 2022. We encourage health care companies to comment individually on their highest priority issues in addition to contributing to comment letters submitted by industry associations.

The answer to that question is not as straightforward as you might think. Chiquita Brooks-Lasure is the nominee to serve as the next CMS Administrator, but she has yet to assume the role. The previous CMS Administrator, Seema Verna, resigned effective January 20, 2021, as is customary in an administration transition. Elizabeth Richter then became Acting Administrator of CMS, after having served at CMS since 1990, and continues in that interim role due to the holdup of the confirmation of President Biden’s appointee.

As a health plan lawyer for over two decades, I have seen the intricacies—and curiosities—of our healthcare financing and regulatory system up close. Before I studied political science, law, and theology, I learned from my history teacher father that knowledge of the past is critical to making sense the present. My dad taught me to try to place what I observe in historical perspective to understand it better.

In 2004, when I started focusing on Medicare plans in preparation for the 2006 implementation of Medicare Part D prescription drug benefits, only a small percentage of Medicare beneficiaries—just 13 percent or roughly 5.3 million people—were enrolled in what were then called Medicare+Choice plans.[1]  Fast-forward 16 years, now 39 percent of all Medicare beneficiaries, or 24.1 million people out of roughly 62 million Medicare beneficiaries overall, are enrolled in Medicare Advantage (MA) plans.[2]  The Congressional Budget Office projects the share of beneficiaries enrolled in MA plans will rise to over 50 percent by 2030.[3]

Medicare Advantage (MA) organizations have a unique relationship with the federal government.  Like all healthcare companies, they interact with the government as a regulator, the industry’s rule-maker and watchdog.  This is a familiar aspect of the industry-government relationship, consistent with insurers’ experience with state and federal agencies in commercial lines of business. The most successful MA plans, however, adopt a broader picture of their relationship with the government.  The Centers for Medicare & Medicaid Services (CMS) is also their customer, a valuable and demanding public group health plan, responsible for safeguarding the benefits of tens of millions of Medicare beneficiaries administered by private insurers.