Bill Overview
Title: RAMP Act
Description: This bill repeals the private right of action against insurance plans that do not provide appropriate primary payment in cases in which Medicare is a secondary payer.
Sponsors: Rep. Schneider, Bradley Scott [D-IL-10]
Target Audience
Population: People relying on Medicare as a secondary payer whose primary insurance fails to pay
Estimated Size: 63000000
- Currently, the private right of action allows individuals or representatives to take legal action against insurance providers who fail to fulfill their obligation as a primary payer when Medicare is secondary.
- Removing this right might impact individuals who rely on the legal system to ensure they receive the appropriate payment from their insurance providers.
- The number of people impacted is determined by the number of Medicare beneficiaries who may have claims against their primary insurance providers for non-payment issues.
- In 2021, there were about 63 million Medicare beneficiaries in the U.S.
- A proportion of these beneficiaries may find themselves in situations where their primary insurance does not pay, but historically, not all of these instances would lead to legal action being sought individually.
Reasoning
- The RAMP Act impacts a subset of the 63 million Medicare beneficiaries, specifically those dealing with primary insurance non-payment issues.
- Legal action due to payment issues is rare, so direct impacts will be limited.
- The policy’s budget constrains outreach and assistance, limiting the population that can be effectively managed by the policy.
- Many people are unaware of their rights concerning Medicare or insurance payment structures, implying that even with the act, awareness and potential impacts are limited to a subgroup with prior legal inclinations.
Simulated Interviews
Retired (Florida)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 1.0 years
Commonness: 10/20
Statement of Opinion:
- I rely on Medicare and sometimes dealings with insurance companies can be frustrating.
- I haven't needed to pursue legal action yet, and I'm unsure if I would even if it was an option.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 6 | 7 |
| Year 3 | 6 | 7 |
| Year 5 | 6 | 7 |
| Year 10 | 7 | 8 |
| Year 20 | 8 | 9 |
Retired Engineer (California)
Age: 82 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 3/20
Statement of Opinion:
- Without the ability to take legal action, I feel vulnerable to insurance companies.
- I've relied on this option in the past.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 5 | 6 |
| Year 3 | 5 | 6 |
| Year 5 | 5 | 6 |
| Year 10 | 6 | 7 |
| Year 20 | 7 | 8 |
Part-time Worker (New York)
Age: 60 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 5/20
Statement of Opinion:
- I haven't faced issues directly yet, but I worry about medical bills going unpaid.
- Losing legal recourse is concerning.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 5 | 6 |
| Year 3 | 5 | 6 |
| Year 5 | 6 | 7 |
| Year 10 | 6 | 8 |
| Year 20 | 7 | 9 |
Retired Teacher (Texas)
Age: 75 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 8/20
Statement of Opinion:
- I prefer to avoid legal battles if possible, so it's not a large concern for me.
- The experience with insurance claims is a hassle.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Freelancer (Illinois)
Age: 55 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- The option for legal action gives me peace of mind, even though I haven't needed it.
- Without it, I feel like I lose protection.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 5 | 6 |
| Year 3 | 5 | 6 |
| Year 5 | 5 | 6 |
| Year 10 | 6 | 7 |
| Year 20 | 7 | 8 |
Retired Marketing Specialist (North Carolina)
Age: 66 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 6/20
Statement of Opinion:
- I haven't had to deal with insurance non-payment yet, so I'm not very worried.
- If it came up, I'd want to keep my legal options open.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 6 | 7 |
| Year 3 | 6 | 7 |
| Year 5 | 6 | 7 |
| Year 10 | 7 | 8 |
| Year 20 | 8 | 9 |
Retired Firefighter (Ohio)
Age: 68 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 2/20
Statement of Opinion:
- I've dealt with non-payment before and knowing I could sue was reassuring.
- This change makes me uneasy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 5 | 6 |
| Year 3 | 5 | 6 |
| Year 5 | 5 | 6 |
| Year 10 | 6 | 7 |
| Year 20 | 7 | 8 |
Retired Nurse (Pennsylvania)
Age: 72 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 9/20
Statement of Opinion:
- I've had smooth experiences so far and avoid legal entanglements.
- Removing the legal option doesn't seem to affect me currently.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Retired (Georgia)
Age: 69 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 4.0 years
Commonness: 7/20
Statement of Opinion:
- I had to switch insurers because of non-payment issues in the past.
- Losing the right to sue puts me in a vulnerable position.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 6 | 7 |
| Year 3 | 6 | 7 |
| Year 5 | 6 | 7 |
| Year 10 | 7 | 8 |
| Year 20 | 8 | 9 |
Retired Factory Worker (Arizona)
Age: 78 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 1.0 years
Commonness: 15/20
Statement of Opinion:
- Honestly, I don’t even understand all this legal stuff.
- I'm just worried about making ends meet and getting my treatments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 5 |
| Year 2 | 4 | 5 |
| Year 3 | 4 | 5 |
| Year 5 | 5 | 6 |
| Year 10 | 5 | 7 |
| Year 20 | 6 | 8 |
Cost Estimates
Year 1: $25000000 (Low: $20000000, High: $30000000)
Year 2: $25000000 (Low: $20000000, High: $30000000)
Year 3: $25000000 (Low: $20000000, High: $30000000)
Year 5: $25000000 (Low: $20000000, High: $30000000)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Impact on Medicare beneficiaries who rely on the private right of action.
- Potential shifts in how insurance companies manage secondary payer responsibilities.
- Legal and administrative cost changes for insurance providers.
- Long-term effects on Medicare payment structures or incentives.