New Medicare pilot program launching in Arizona sparks debate

A new Medicare pilot program is making its way to Arizona and six other states. Right now, Medicare enrollees have two choices: pay more for traditional Medicare, or opt for a plan offered by a private insurer and risk drawn-out fights over coverage. Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare.

This practice, known as prior authorization, has drawn public scrutiny, which intensified after the murder of a UnitedHealthcare executive last December. Now, the Centers for Medicare and Medicaid Services plans to begin a pilot program that would involve a similar review process for traditional Medicare, the federal insurance program for people 65 and older as well as for many younger people with disabilities.

The program, called the Wasteful and Inappropriate Service Reduction Model, is already drawing opposition from Democratic lawmakers, former Medicare officials, physician groups and others saying “it’s the back door into privatizing traditional Medicare.” People enrolled in traditional Medicare who live in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington State will be included in the experiment, which is expected to start in January and last for six years.

Swapna Reddy who is a JD, DrPH, MPH at the ASU College of Health Solutions joined “Arizona Horizon” to discuss the new pilot program

“So six dates have been chosen by the Senators of Medicare and Medicaid services, and those six dates include Arizona,” Reddy said, “…we are one of the states that have been chosen for a six year pilot program.”