For the first time, seniors have a long-time advocate for the elderly heading the key committee that controls funding for Medicare, Medicaid and Social Security. While other Senate Finance Committee chairmen have been strong supporters of seniors and their issues, the elevation of Sen. Ron Wyden, D-Ore., to head the committee, puts in charge a person who has steadfastly supported and advocated for seniors issues over his 30-plus-year Congressional career.

Wyden became the Finance Committee chairman recently when Montana Sen. Max Baucus was nominated to become ambassador to China. The committee is arguably the most powerful committee in the Senate because of its wide jurisdiction including control of all tax policy.

Wyden’s new position instantly vaults him into the ranks of the Senate’s most influential members, giving him a big say over any legislation involving taxes, health care and trade, among other things.

As Finance Chairman, Wyden will face a huge agenda of unfinished business including a big package of expired tax breaks, looming cuts in Medicare payments to doctors, a major highway trust fund projected to run out of money later this year and a trade deal his predecessor worked out with Republicans.

Long Time Senior Advocate   

Wyden has been a senior advocate from before he came to Congress. He was the co-founder and then directed the Oregon chapter of the Grey Panthers, an advocacy group for seniors in the mid-1970s, and served as the director of the Oregon Legal Services Center for the Elderly, a non-profit law service.

He was elected to Congress as a member of the House of Representatives at the age of 31, in 1980 and then moved to the U.S. Senate in 1996 to fill the seat vacated by Bob Packwood, who resigned amid allegations of sexual harassment. Wyden has won re-election twice to the Senate.

The key question will be whether or not he will be able to hold onto his core values in favor of helping seniors, when, as chairman, he must also be pragmatic about what legislation will get through the sharply-divided Congress. You can count on him being tested quickly and often.

Top Priority: Chronic Disease Reform

Everyone should get a sense of how he will balance things based on his first actions as the chairman. But in anticipation of his ascendance to head the committee, Wyden used his newfound clout to focus attention on his latest policy obsession – what he calls “chronic disease reform.” He wants to change Medicare to urge doctors to provide coordinated care and encourage doctors and nurses to pay particular attention and incentivize them to monitor seniors with multiple chronic conditions.

Shortly after Baucus’ nomination for ambassador to China was announced – and almost a month before taking over the Senate Finance Committee, Wyden and an unusually broad coalition of lawmakers – conservative Republican Sen. Johnny Isakson, R-Ga., liberal House member Peter Welch, D-Vt., and conservative Rep. Erik Paulsen, R-Minn., introduced legislation they call the Better Care, Lower Cost Act of 2014. Under the legislation, Medicare would cap payments for the sickest beneficiaries who are in the program, but it would set the cap high enough to fund teams that can focus on strategies that reduce hospital admissions and keep overall costs under the cap.

As Wyden explains it, the lawmakers reject the “false choice” between either cutting services to Medicare recipients or slashing payments to providers – a theme they hear repeatedly from hospitals and doctors all around the country. The four lawmakers see this as a chance to bend the cost curve with its flexibility, alignment of incentives and focus on chronic-care management.

This is a dramatically different approach to how government makes changes in Medicare. The ideas came from the people and the institutions that actually provide health care services to seniors, the lawmakers said.

Normally, this bill would have a limited chance of being noticed and even less chance of becoming law. But with the chairman of the key committee behind the legislation and in complete control of what legislation moves on to the Senate floor, the legislation greatly enhances its chances.

What is inspiring Wyden and his colleagues on the Better Care legislation is the problem that older Medicare beneficiaries often have to deal with two or more chronic conditions. The numbers on chronic care are startling – 14 percent of Medicare patients have six or more chronic conditions and account for a staggering 70 percent of program spending.

This is a familiar problem for families with a senior trying to cope with multiple conditions – doctors don’t talk to each other and sometimes they prescribe drugs that work at cross purposes. Nobody seems to look out for the overall health of the patient.

At a town hall meeting recently in Oregon, Wyden told citizens that Medicare suffers from fragmented and poorly coordinated service delivery and a dependency on a system that pays only for procedures. This causes costs to skyrocket and rarely provides the best care for seniors.

Finally Fixing the Ongoing ‘Doc-Fix’ Issue?

Lawmakers are certain to try and resolve another Medicare issue – a plan to fix Medicare’s system for paying physicians. This has been a problem that lawmakers have annually had to pass in order to hold up fees for the doctors who care for the nation’s seniors. Lawmakers will have to address the so-called “doc-fix” issue, as they have every year since the law was passed in 1997.

While Wyden’s proposal could be added into the doc-fix, which has strong bipartisan support, Republican lawmakers, particularly in the House of Representatives, are likely to seize on any Medicare legislation as a vehicle to take another shot at killing or gutting the President’s health care legislation. So how things end up still has many steps to play out.

Under Wyden’s Better Care proposal, primary care doctors would get one payment for Medicare patients to take care of all of their long-term diagnoses. The idea is loosely modeled on reforms Gov. John Kitzhaber has done to Oregon’s Medicaid system for the poor, through coordinated care organizations. Medicare providers would have more flexibility in delivering care, offering lower copayments for primary care services that could keep patients out of the emergency room.

Since its introduction in January, the proposal has generated serious interest and strong support from doctors and insurance executives who see the chance to save money and at the same time solve one of Medicare’s serious problems.

“Much of the Medicare debate is ‘Are you going to cut people’s benefits? Or are you going to stand pat,” Wyden said recently at a news conference. His chronic care proposal “gets out of that debate.”

Medicare Advantage Fight Coming up

One subject that will also fall squarely into Wyden’s committee’s jurisdiction will be a fight over Medicare Advantage plans. With House Republicans continuing to focus on any opportunity to cast blame on Obamacare, the House leadership is planning to open a new front in that battle. Key Republicans recently wrote to President Obama “to express deep concern about the impact of the cuts imposed by your health care law on the Medicare Advantage (MA) program and the recent action by CMS (the Centers for Medicare and Medicaid Services) to fundamentally dismantle the Medicare prescription drug program.”

“These cuts, in addition to proposed rules issued by CMS will force millions of American seniors to face higher health care costs or lose access to their doctor, health plan, lifesaving drugs, and the benefits they’ve come to rely on,” the letter reads.

The letter is signed by all of the key House Republican leaders -- Speaker John Boehner (R-Ohio), his three top deputies, and the two chairmen with jurisdiction over the health care law — Ways and Means Chairman Dave Camp, R-Mich., and Energy and Commerce Chairman Fred Upton, R-Mich.

New Medicare Advantage rates – which are set by the government –  are slated to be released Feb. 21.  Under the Affordable Care Act (ACA), the Medicare Advantage program would be cut by $200 billion over 10 years because of concerns that the government was overpaying insurance companies. By 2009, Medicare Advantage payments per enrollee were 14 percent higher than traditional Medicare. And the numbers of seniors in the program keep growing. The percentage of Medicare beneficiaries enrolled in private plans has steadily increased over the last decade, according to a Kaiser Family Foundation report, from 13 percent in 2003 to 28 percent in 2013.

When the ACA was passed in 2009, policymakers found it hard to justify paying more for beneficiaries choosing Medicare Advantage than for beneficiaries choosing traditional Medicare. So the Obamacare cuts were intended to translate into plan changes – cutting benefits like eyeglasses and health club memberships that were valued but extra – without impacting beneficiaries’ access to care. Critics of Medicare Advantage see the program as a handout to insurers since its inception in 2003. But instead, doctors and insurers say, those cuts are being passed down to seniors. Now, the issue seems to be whether Congress should pay more for Medicare Advantage plans than for people with traditional Medicare.

Joining the House Republicans in trying to ward off the cuts, is the powerful health insurance industry, which recently announced it is launching a seven-figure advertising, grassroots and lobbying campaign to persuade lawmakers not to cut Medicare Advantage funding next year.

The insurance lobby has had success at this in the past. Last year, the Centers for Medicare and Medicaid Services backed down from a proposed cut of 2.3 percent, replacing it with a 3.3 percent pay increase, after 160 members of Congress joined industry association America's Health Insurance Plans to lobby against the cut. Wyden had not yet taken a public position on the Medicare Advantage issue.

[ Also contributing to this story: Washington Post; AP, Politico, the Lund Report, the Oregonian, Modern Healthcare; the Hill.]

Alan Schlein runs DeadlineOnline.com, an internet training and consulting firm. He is the author of the bestselling “Find It Online” books.

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