The Truth About the Trickle Effect

The Medicare Competitive Bidding Program for home medical equipment (HME) is setting a dangerous precedent for other insurance companies. This makes it harder for Americans to get the equipment they need, regardless of their insurance.

The faulty and failing program cut funding for necessary HME, services, and supplies. This is creating widespread access issues for Medicare beneficiaries across America. The pricing from this program is having a trickle-down effect to other insurers, such as Medicaid, BlueCross BlueShield, Care Centrix, Anthem, and TRICARE.

While many people believe that HME access isn’t relevant to them, but the bidding program affects more people than one would think—including younger populations. For example, about 22 million people in the U.S. have obstructive sleep apnea (OSA). Although it can affect anyone at any age, it’s particularly common in overweight men over the age of 40. These people are often working age with insurance through work or Medicaid. Continuous positive airway pressure (CPAP) machines offer a way to manage sleep apnea.

Diagnosing and treating sleep apnea is critical to prevent serious health problems. Some of the effects of sleep apnea are surprising. The American Academy for Sleep Medicine revealed the economic impact of untreated OSA. For instance, OSA causes problems in the workforce, such as lost productivity and increased absenteeism. In contrast, productivity on the job increased by an average of 17.3 percent for those treating their OSA.

People with OSA also have higher motor vehicle accident rates. There was a 73 percent decrease in preventable driving accidents among employees treated with CPAP. For drivers diagnosed with OSA and treated with CPAP, an average of $550 was saved per driver per month. Hospital readmissions decreased by almost 25 percent. Overall health care dollars were cut in half.

The costs of diagnosis and treatment are much lower than the costs of leaving OSA untreated. An important part of treating sleep apnea is the role of HME companies who provide the CPAP equipment and supplies. Staff guide patients through product options and provide essential educational support. This increases compliance.

Federal Medicare policies are negatively impacting individuals with other insurance who need CPAPs or other HME. Medicare funding for CPAP dropped 62.6 percent in the last three years, and other companies are following Medicare's lead. Some companies have to follow Medicare rates. Others don't see the damaging effects on patient access. More than one in three HME-providing companies has closed in the past few years. This makes it harder for people to find a supplier to provide essential equipment regardless of which insurance company they have.

Have you suffered from these trickle effects? Advocate for change! Help make sure that everyone has access to the HME, services, and supplies they need to stay safe at home. Speak out and share your story.

Click here to send a letter to your member of Congress asking for their help. Call us at 800-404-8702 to share your story and have your voice heard.