Elizabeth Lippincott

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.