The senior member of the Oregon congressional delegation U.S. Senator Ron Wyden, also is a senior member of Congress when it comes to health care policy.
He's been active in efforts to protect seniors from the deceptive marketing of privatized Medicare Advantage plans. He’s also spearheaded legislation to regulate the companies hired by insurers to manage their prescription drug coverage — known as pharmacy benefit managers, or PBMs — that critics blame for policies harming patients and independent pharmacies.
More recently, Wyden has taken an interest in federal policies that give hospital systems an incentive to absorb independent providers, thus helping fuel an unprecedented consolidation of health care that many experts and industry leaders — and Wyden himself — call alarming. But reforms in that area recently stalled after rural hospitals complained they would be hurt.
The Lund Report recently spoke with Wyden about happenings in Congress, as well as his efforts as chair of the Senate Finance Committee to conduct investigations into Medicare and related areas. This interview has been edited for clarity and brevity.
The Lund Report: Where do things stand with Medicare Advantage reform?
Sen. Ron Wyden: The finance committee has jurisdiction over Medicare Advantage, and we have jurisdiction over all the programs where their federal health dollars involve Medicare and Medicaid and CHIP (the federal Children's Health Insurance Program). Health care has always been an issue I thought was the most important. I've tried to specialize in, and MA is kind of front and center.
We have a long history of choice-oriented policies, and it's made for a competitive market. And a lot of seniors like what they have.
And the reality is, that is not the case everywhere in the United States. And there has been a real drive to clean that up, particularly the marketing. Deceptive and fraudulent advertising for MA plans cost taxpayers $6 billion in 2022 alone. It's outrageous. They call until they get somebody's number and then they sell it to people and these kinds of things. So, I've tried to focus on the proposition that there really needs to be consumer protection guardrails. And we're starting to see CMS rein in some of these abuses. I’m just going to be watchdogging it every single enrollment season and the reality is pouring billions of dollars in high-pressure marketing campaigns and marketing middlemen buying and selling seniors' information to brokers and plans is a prescription for trouble.
I’m going to stay on it in terms of rooting it out until we get it done. Some plans seem to be sending profits to Wall Street, rather than on what consumers need.
I've also been taking on these ghost networks in the mental health field. So that's kind of what we're spending our time on. There are providers that are speaking out much more now saying that they're getting too much red tape and not enough help in terms of actually delivering health.
TLR: St. Charles Health is one of those.
Wyden: Right, Exhibit A for Oregon.
TLR: Is there any legislation that's in the works on that?
Wyden: Well, we may need to have some legislation. But right now I'm focused on getting CMS to step up and really lock in these kinds of changes. MA plans and providers use scare tactics for all kinds of things — for contracts, for example. So, these are the kinds of things I'm gonna push that we get them resolved. And it's faster to get an agency in this kind of area where it's quite technical, you know, when you're putting words into blackletter rules. You always try to get it done that way if you can.
"Some plans seem to be sending profits to Wall Street, rather than on what consumers need,"
TLR: I was talking to a SHIBA (Senior Health Insurance Benefits Assistance) volunteer last year and what you hear from them often is that the —
Wyden: They’re great, and they’re furious about these marketing abuses that I talked to you about.
TLR: They talk about how these wonderful sounding benefits that are the basis on which seniors are selecting their plans, often prove to be much less than they appear in terms of what they actually get when they need it. What can be done?
Wyden: I've said to my colleagues in the Congress, in hearings, I'm going to stay at it until these marketing abuses get cleaned up. I mean, the idea of $6 billion spent in all of these policies that just have abuse written all over them — they pry the information out of one senior, and then they start selling it to everybody in town.
And as I say, you try to use administrative remedies to the greatest extent possible. I mean, new laws are often necessary. I'm all about trying to get real solutions in the real world, and administrative fixes are less time-consuming, less likely to have all the litigation because you try to work through some of those issues in advance. And if you can't do it, you'll have to have legislation.
TLR: One SHIBA volunteer told me a solution to Medicare Advantage’s marketing tactics might be for traditional Medicare to become more creative, to where it is actually able to offer solid, specialized benefits to people that meet their perceived needs.
Wyden: I've been very heavily involved in beefing up traditional Medicare. Before he retired, I persuaded Utah Sen. Orrin Hatch to join me in a major piece of legislation to basically upgrade the Medicare guarantee using chronic care. I was stunned at the number of cases that presented with two or three people having chronic conditions with cancer, diabetes, heart strokes, COPD (chronic obstructive pulmonary disease) — all of that kind of thing. Medicare is today about chronic illness. I've got staff working right now trying to beef up traditional Medicare because they want to have some of the extra things — care coordination, chronic care, looking at the social aspects of health care and the like.
"Medicare is today about chronic illness,"
TLR: What is on your front burner right now in terms of health care reform?
Wyden: Well, a couple of things. On PBM legislation, we got a 26 to nothing vote in the finance committee. PBMs are another key piece of holding down the cost of pharma issues.
I already mentioned dealing with the $6 billion in consumer abuses in Medicare Advantage.
In terms of telemedicine and school-based clinics, we have gotten a lot more one-on-one aid for school clinics in terms of mental health. And then there’s this ghost network fight.
Those would probably be four really big battles that we're in right now.
I'm holding a hearing next week on cybersecurity because hospitals and health plans look like they are really, really unprepared. And it touches upon the size issue, with so many (companies) merging. We’ve got two systems in Oregon, OHSU and Legacy Health, talking about merging and I’d like to see what their plan is before everybody just signs off on it.
TLR: The new state merger oversight office has been working overtime, as you know. Sachin Jain, the SCAN Health Plan CEO was very vocal about his desire to build up into a nonprofit competitor to some of these private Medicare Advantage giants. Are you concerned about the consolidation in the Medicare Advantage industry and, if so, what can be done?
Wyden: I am very concerned about consolidation in health care generally .... (With (OHSU-Legacy) they basically said that they were going to be talking about a merger months ago, but nobody's ever seen anything.
At the last minute, (applicants can) bring it to the regulators and say, “See, look, we're gonna collapse if we're not allowed to merge.”
So, we're taking a very extensive look at mergers, generally, and inefficiencies. Look at what we're dealing with with PBMs — a handful of big guys push aside all these small pharmacies in rural Oregon, where I just came from.
"I'm holding a hearing next week on cybersecurity because hospitals and health plans look like they are really, really unprepared,"
TLR: One of the issues that's come up is these “site neutral policies.” You were one of the people who’d raised questions about how hospitals essentially receive preferential reimbursements by obtaining independent outpatient clinics.
Wyden: We're now taking a special look at how rural facilities would be affected by site neutral. We’ve got so many challenges in rural Oregon. I just want to make sure that people walk through what site neutral means for rural facilities.
TLR: Can you spell that out?
Wyden: Rural people are already worried that their dollars are shrinking in a variety of different ways, like St. Alphonsus in Baker City, where they've been for 100 years. And they're just worried about making sure that reforms really work for them. And I got asked by a bunch of people who are in rural areas about site neutral, and I said we're gonna look at it.
The Lund Report: People talk about reimbursements on the federal level are lagging behind real-life cost increases. And you've got Medicare physician reimbursements actually being cut, and that is part of the stress on rural hospitals and other providers. What is the solution? Does Medicare need higher reimbursements?
Wyden: Medicare definitely needs to reimburse more for quality. Oregon has made such a push to deliver more quality, and we've kind of baked it into our kind of Senate ethic to spend for value. There's got to be more in the reimbursement system to reward that.
