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On Monday, group of 25,000 physicians and health professionals sent a LETTER to Health and Human Services (HHS) Secretary Xavier Becerra, demanding that he reject proposed changes to the controversial Direct Contracting (DC) pilot program and instead end it immediately.
The doctors, members of Physicians for a National Health Program (PNHP), were joined by leaders from Pubic Citizen, Social Security Works, and Just Care USA in calling on Sec. Becerra to end the program.
“Direct Contracting Entities (DCEs) and their Wall Street investors hoped they could fly under the radar of seniors, health care advocates, and members of Congress,” said Dr. Susan Rogers, president of PNHP, an organization of 25,000 physicians who support Medicare for All and oppose Direct Contracting. “Now that HHS is feeling pressure to end this backdoor privatization of Medicare, the industry thinks they can save it with minor tweaks and cosmetic fixes. But we won’t back down until Direct Contracting is shut down, for good.”
On Monday night, members of the DCE industry sent a letter to Sec. Becerra, asking him not to cancel the DC program but to “improve” it by, among other things, implementing unspecified “guardrails.”
In response to the industry’s letter, PNHP reminded Sec. Becerra that DC has tarnished the reputation of HHS, and ending the program would demonstrate a commitment to improved integrity and the best interests of beneficiaries. The letter points to the conflicts of interest present at the program’s inception: DC was developed in 2019 by Adam Boehler, who, prior to leading the CMS Innovation Center (the agency responsible for the DC program), was founder and CEO of Landmark Health, which later won a DC contract. After leaving the administration, Boehler was co-founder of Rubicon Partners, which is now partnering with physician practices to join DC or Medicare Advantage (MA) programs.
PNHP also explained that as long as the program provides a profit motive for DCE middlemen, they will find a way around proposed “guardrails” on abuse. “Our experience from Medicare Advantage (MA) shows that when regulators install new guardrails that threaten profits, the industry will simply build a bigger truck to run them over,” the letter said, noting that despite government efforts to rein in fraud, it overpaid MA insurers by more than $106 billion from 2010 through 2019.
Several other advocacy groups called on Sec. Becerra to end, not tweak, the DC program.
“Direct contracting is nothing more than privatizing Medicare,” said Alex Lawson, Executive Director of Social Security Works. “It inserts a corporate bureaucrat between a patient and their doctor in order to deny care and make Wall Street money. The Biden administration must completely eliminate Direct Contracting — nothing less than that is acceptable.”
“We can’t afford even more for-profit middlemen getting between America’s seniors and the care they need, especially seniors that chose to avoid Medicare Advantage for a variety of reasons,” added Eagan Kemp, the Health Policy Advocate for Public Citizen. “HHS should be working to strengthen Medicare, not pushing seniors into an untested program where for-profit companies can benefit by denying care. There are much more savings to be had by cracking down on Medicare Advantage than through pushing seniors into Direct Contracting.”
Diane Archer, President of Just Care USA, which advocates for seniors and caregivers, said, “Medicare Advantage data show that putting insurers between patients and their doctors threatens patients’ health and drives up costs,” “Direct Contracting is another version of Medicare Advantage, but worse, because it overrides people’s choice of Traditional Medicare. We need to end it now, before it destroys Medicare.”
PNHP’s letter to Sec. Becerra is available HERE.
Physicians for a National Health Program (pnhp.org) is a nonprofit research and education organization whose more than 25,000 members support single-payer Medicare for All reform.