CMA Health Policy Blog

Pants on Fire!

October 28, 2010 at 9:51 pm Judith Stein Leave a comment

HEALTH CARE REFORM DOES NOT CUT MEDICARE BENEFITS

Health care reform does not cut Medicare benefits. In fact, health care reform expands Medicare coverage, by eliminating cost-sharing for preventive services, adding a yearly wellness visit, limiting some cost-sharing in private Medicare plans, and closing the Part D “Donut Hole.” It also improves the solvency of the Medicare program itself.

Health care reform changes some wasteful Medicare payment policies. Some misstated reports of these changes have resulted in exaggerating public fear of cuts to Medicare benefits.

The Affordable Care Act, aka health care reform, achieves savings in the Medicare program through a series of payment reforms, service delivery innovations, and increased efforts to reduce fraud, waste, and abuse. The actual projected reduction in Medicare spending is $428 billion over 10 years, after $105 billion in new Medicare spending is taken into consideration. These projections actually extend the life of the Medicare trust fund by about a decade. None of the payment reforms affect Medicare’s guaranteed benefit packages. Indeed, the law specifically states that the guaranteed benefits in Medicare Part A and Part B will not be reduced or eliminated as a result of changes to the Medicare program.

Health Care Reform Rolls Back The Privatization of Medicare.

Most of the new law’s Medicare “cuts” are actually reductions in subsidies to private Medicare plans, which were begun in 2003 during the Bush Administration. These overpayments to private insurance companies, (known as “Medicare Advnatage” plans) will account for about $130 billion in Medicare savings over 10 years. Medicare Advantage plans are offered by private insurance companies that contract with the government to provide Medicare for people who choose to enroll in a private plan. By law these plans must provide all of the guaranteed benefits under Part A and Part B.

Under the funding mechanism in effect before enactment of the Affordable Care Act, Medicare Advantage plans were paid, on average, about 13% more than the traditional Medicare program to provide the same coverage. These extra payments resulted in Medicare Part B premiums being $3.35 higher per month for all beneficiaries in 2009, and resulted in the federal government (and taxpayers) spending $14 billion more than would have been necessary, if Medicare Advantage enrollees had remained in the traditional Medicare program.

The Affordable Care Act will end these wasteful overpayments by phasing in reductions in Medicare Advantage payments, starting with a payment freeze in 2011. Medicare Advantage payments will be based on national county benchmarks, with plans being paid a fixed percentage of traditional Medicare costs. As a result of this payment formula, plans in some lower-paid counties, generally rural and suburban areas, will continue to receive payments that exceed the traditional Medicare amount, while plans in higher paid counties, many of them large cities, may see substantial reductions. Rebates (an amount plans receive if they bid less than the county benchmark) will also be reduced. The new payment structure also provides for an increase in payments by up to 5% for plans that receive four or more stars for high quality on the CMS star rating system.

Health care reform cuts wasteful payments put in place to encourage private Medicare. Health care reform increases benefits for all people with Medicare, decreases Medicare costs for beneficiaries and taxpayers, and extends the life of the Medicare program.

Health care reform is good for Medicare. Pass it on!

Entry filed under: Health Care Reform, Judith Stein, Medicare. Tags: Medicare.