Here’s a convenient talking point for the Obama campaign as it begins to coalesce its message surrounding healthcare reform spending under the ACA: enrollment in Medicare Advantage is up since the beginning of the current decade, while premiums have been on the decline. HHS Sec’y Sebelius attributes this to the core provisions within the ACA allowing stipulations of bonus payments based upon quality, changes to enrollment periods, new medical loss ratio requirements and penalties, and the power for CMS to reject plan bids.
According to Humana’s last quarterly report, it bought two Medicare Advantage contractors in the third quarter of last year and enrollment increased over the past 12 months. Wellpoint also acquired an Advantage contractor in 2011 and saw increased enrollment.
While it may be a little premature to trumpet reform to this sector of Medicare spending by the government as being a permanent fixture of ACA implementation, it does highlight the need to revisit the drama surrounding payments to providers in FFS plans. Will the doc-fix ever be truly fixed? Bipartisan Senate and House members tasked with establishing a permanent end to reimbursement cuts to physicians will have their work cut out for them starting today — apparently considering everything from repeal of the SGR in its current form for Medicare spending to the use of war funds to finance such a permanent patch. Should be interesting.
For Don Berwick, MD, the path to greatness as head of the Centers for Medicaid and Medicare Svcs was essentially doomed from the start. President Obama’s choice to head the federal agency was one made via his executive powers, bypassing congressional confirmation and giving Berwick a scarlet letter on the forehead ever since. Sure, there were the efforts at priming the PR pump in the first year since the reform bill was signed into law — his efforts to eliminate the quality chasm in hospitals and other care settings, bringing new light and interest into so-called comparative effectiveness research to improve healthcare, and most recently, his support of a citizen-led innovation care advisory panel, of sorts, to create models of reform in cutting Medicare spending on the run-up to reform. But it was all for naught. Senate Republicans, miffed at the recess appointment at the outset, never were willing to give the new CMS head a chance. Rather than face an uphill battle with pending confirmation hearings amid a hellish re-election campaign, Obama decided to drop him in favor of a less controversial pick:
President Obama said on Wednesday he plans to nominate Marilyn Tavenner as administrator of the Centers for Medicare & Medicaid Services to replace Dr. Donald Berwick, who has never won the support of Congress. [...] Tavenner, Berwick’s principal deputy, was the Virginia secretary of health and human resources. She has served as a board member of the American Hospital Association and as president of the Virginia Hospital Association. Ms. Tavenner holds a B.S. in nursing and an M.A. in health administration, both from the Virginia Commonwealth University.
You can bet that this nominee will be a safer one — an administrator who can hold steady on policies of Medicare spending without being seen as a “rationer” of healthcare delivery whose ideas on cutting federal costs of healthcare will not be perceived as coming from a wealth redistribution model.
Okay, here’s what we do know about the current state of solvency of Medicaid post-stimulus funding: states are grappling with a larger share of Medicaid liabilities than before, and they are immediately reacting with a combination of cuts to providers/hospitals and pulling in the reins on certain services.
Although states are bearing a bigger share of the Medicaid burden this year than they have in the recent past, overall Medicaid spending (state and federal dollars) is projected to grow by only 2.2 percent, the lowest amount since 2006, [a] Kaiser report [shows]. That is because the stimulus funding ended, and program costs are stabilizing as the national economy shows tentative signs of recovery and enrollment growth slows.
The article is a lengthy one, but worth a read. The Kaiser-funded survey trial of states with respect to this question suggests many states are implementing myriad Medicaid spending stopgaps in the short term. All this is on the table as the bipartisan so-called congressional supercommittee gets ready to release its report on trimming the current budgetary deficit.
The news Wednesday morning of a 3.6 percent increase in Social Security COLA payments for 2012 is somewhat of a mixed blessing for Medicare beneficiaries, many of whom have had to shoulder stagnant SS income over the last couple of years due to negligible inflation. The increase — set to take place in January — could be offset by higher Medicare B premiums, which are deducted from SS payments.
Typically, and unsurprisingly, Medicare B premiums increase at rates higher than inflation — but those increases cannot exceed COLA, by law. Dually eligible recipients over the last couple of years, as well as higher income senior beneficiaries, were not protected from rate increases over 2010 because of Medicaid payments incurred by the former and Part B surcharges paid by the latter group.
The majority of Medicare beneficiaries, however, paint a variable picture with respect to SS income and Part B liability; and the degree of variability has to due with the amount of the monthly SS benefit paid to seniors. All of this is a stark reminder of the degree of the increasing costs of healthcare delivery on Medicare and how it compares and impacts SS entitlements year-in and year-out.
The reining in of costs associated with spiraling Medicare coverage amidst the proposed so-called “doc-fixes” addressing incessant threats of congressionally mandated cuts has many on the Hill wondering what will the Super Committee do to remedy the situation? FYI, the Super Committee is the bipartisan congressional panel made up of 6 Dems and 6 GOPers tasked with putting the brakes on deficit spending to the tune of $1.5T over the next ten years. Issues of Medicaid and Medicare spending are high on the panel’s agenda.
Specifically, futher tightening of Medicare eligibility rules and block-grant funding of Medicaid are mong the most rancorous of discussions — so much so, that at least one Republican moderate senator has chosen to distance herself from the Super Committee recommendations forthcoming. Sen Olympia Snowe (R-ME) also cites her support of branded pharma rebates (something her GOP colleagues really aren’t enthusiastic about) as another mechanism to trim costs.
The ramped-up schedule endorsed by the panel has states, insurance companies, and policywatchers of reform on the edge of their collective seats as issues of funding of the Medicare hospice benefit funding and possible elimination of the SGR formula for determining Medicare reimbursements to phsyicians and hospitals are discussed along with Medicaid funding. | LINK
While California struggles to make some headway in reconciling its budgetary woes amidst an outcry from patients, hospitals, and physicians with respect to Medicaid funding, the funding of Medicare — specifically via auterity measures to ensure its short term viability within reform — is a top concern among the same factions. Only this time, the ire is directed towards the commission charged with implementing payment scales.
The [sustainable growth rate] calls for annual, automatic cuts in Medicare payments to doctors, which Congress always delays, allowing the cuts to accumulate. MedPAC is considering a 10-year replacement that would be offset by cuts to most medical specialties. But the American Hospital Association said health care providers shouldn’t have to foot the bill for a new formula.
MedPAC knows that this is an issue which legislators are echoing, as well. It is becoming a rather common — and exasperating — rite of passage: automatic SGR cuts in Medicare reimbursements which are usually stalled by Congress; the inevitable revisiting of definitive methods to decrease healthcare costs due to Medicare next on the agenda. Most parties agree on that point, just as long as that agenda does not include massive industry cuts (read: providers) within healthcare delivery. | LINK
Say it isn’t so. Healthcare activists and state insurance commissioners are unlikely bedfellows in the fight to keep Medigap coverage plans static, avoiding the wide swath of projected cuts under the banner of entitlement reform in this term of Congress. House Speaker Boehner has made no secret of his plans for so-called entitlement reform, and Medicare programs are vulnerable, it is assumed.
Medigap plans are insurance supplementals which beneficiaries receive in paying for services not covered under traditional Medicare. The average Medigap beneficiary is more ill and older, and it is perceived by many lawmakers in favor of reform that massive savings within Medicare could be realized over the near term with cost shifting of the most popular (and usually more expensive) gap renewable policies.
Some state commissioners are crying foul and that implementation of such a move in the name of reform may be illegal — as beneficiaries are entitled to renewable Medigap benefits under fed law. Since 2003, when George W. Bush signed the MMA into law, much focus has been on Medicare Advantage plans and structure. In this Wild West scenario of budgetary slashing in Congress, the “sanctity” of Medigap legislation is at risk; some states have created working groups to inform beneficiaries and the general voting public of the issues. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
