CMA Alert – Senate Health Bill, Again; Medicare Trustees Report; HH CoPs; More
Here We Go Again: Senate Health Repeal Bill Released Today, Vote Planned for Next Week
After backing off of plans to vote on its Better Care Reconciliation Act of 2017 (BCRA) before Congress’ July 4th recess, Senate leadership is once again redoubling its efforts to repeal the Affordable Care Act (ACA) and gut Medicaid. Action is planned on the bill next week: after an updated analysis by the Congressional Budget Office (CBO), expected early next week, leadership plans to bring up a procedural vote that will start a shortened debate period, followed by a vote on the bill later in the week.
In an attempt to secure the votes of enough reluctant senators to pass the bill, Senate Leader Mitch McConnell has crafted minor changes to the last version of their bill and has released an updated draft today (also see section-by-section summaries here and here).
These changes cannot fix the Senate’s original bill; they amount to putting band-aids on broken bones.
As noted by the Center on Budget and Policy Priorities, the anticipated changes that are in this latest version of BCRA cannot fix its core flaws. For example:
- Newly added funding to address the opioid crisis would not be enough to off-set the loss of more comprehensive Medicaid coverage,
- Neither the increased funding for “market stability” nor the expansion of tax credits for health savings accounts (HSAs) will do much to mitigate significant cost-increases for moderate income individuals, and
- New provisions allowing the sale of plans that do and do not include certain ACA protections will make plans with adequate coverage unaffordable for people with pre-existing conditions.
Even with the new amendments, the debilitating harm caused by the BCRA remains the same, including:
- Millions of people will lose insurance by next year, and millions more in the coming years
- Medicaid would be decimated – by CBO’s last estimate, in 10 years, it would be cut up to 26% and after 20 years would be cut by 35%
- This will disproportionally affect coverage and care for children, individuals with disabilities, and older adults, including 11 million people who have both Medicare and Medicaid
- Health insurance coverage costs will increase significantly for millions of people, particularly older, low-income adults who are not yet eligible for Medicare
Congress should stop this mission to undermine health care for millions of Americans. Contact your Senators and tell them to protect your care. 1-866-426-2631
Medicare Trustees Project Increase in Solvency of Part A Trust Fund
According to news reports, today, July 13, 2017, the Medicare and Social Security Trustees will issue the 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund.
In short, according to the report, the Part A Trust Fund depletion date is now projected at 2029, a year longer than last year’s estimate. This is twelve years longer than projected before the passage of the Affordable Care Act.
An Important Note on Trust Fund Solvency:
Even if the Part A Trust Fund were to become insolvent, the program will still be able to pay out approximately 87% of its benefits (and, if current projections hold, roughly 80% by 2050). While not ideal, this is far from “bankruptcy.” Further, the date of projected insolvency is an estimate, and could easily change again – as it has many times before.
The Trust Fund largely reflects the health of the economy. At various times since 1970, the trustees have projected Trust Fund insolvency in as few as four years or as many as 28 years. While the Part A Trust Fund is mostly funded by payroll taxes, Medicare Part B is funded by a certain percent of general revenues and premiums, and therefore cannot “go broke.”
In fact, Medicare as a whole is not “going broke.” It could be strengthened with better oversight of private Medicare Advantage plans, smarter prescription drug payment limitations, support for Affordable Care Act provisions, and other cost-effective planning and policies.
Disappointing Delay of New Medicare Home Health Conditions of Participation
On July 7, the Centers for Medicare & Medicaid Services (CMS) delayed implementation of new home health Conditions of Participation (COP) that were slated to take effect on July 13, 2017 by six months – to January 13, 2018. This delay of rules designed to improve quality and patient care is a disservice to Medicare beneficiaries.
Home health agencies currently using industry best practices are already fully prepared for the new COP. Agencies that are not prepared should have used the past 6 months, since the rules were first announced, to prioritize the requirements. Unfortunately, there is already discussion by home health agencies to request another 6 month delay. The Center strenuously objects to further delay.
Home health agencies must abide by the Conditions of Participation in order to participate in Medicare. Delay of the new COP rules, which would improve care coordination, training of staff and administrators, and beneficiary protections, is a step backwards. Indeed, the COP should be expanded to require agencies to serve all Medicare beneficiaries, instead of allowing them to choose only those patients for whom they receive the greatest compensation.
CMS should align all payment, quality measures, and fraud policies to ensure home health agencies serve all who qualify for Medicare and need care. Beneficiaries should not be denied access to Medicare covered home health care, as too many are. The new home health Conditions of Participation were a step in the right direction. They should be implemented as soon as possible.
Advocacy News from the Capitol
This week, the Center was invited to attend #CTintheCapitol, a two-day event hosted by the Connecticut Congressional delegation to inform, and be informed by, constituents. Hosted by Senators Murphy and Blumenthal, the event featured appearances by Representatives Larson, Himes, and Esty. As Senator Blumenthal put it in his introduction, the hope for the event was to “impart rational understanding of a very surreal environment.”
Panels included discussions of infrastructure, manufacturing and business, and very interesting look at the concept of “fake News” hosted by Rep. Himes. Of particular interest to the Center was the health care panel featuring Chris Jennings of Jennings Policy Strategies – and former Deputy Assistant for Health Policy to President Obama – and Sarah Kliff of Vox, one of the country’s leading health policy journalists.
Both Mr. Jennings and Ms. Kliff agreed that the current ACA Repeal proposals were not about controlling health care costs, with Mr. Jennings pointing out that it is actually a cost-shift, from federal government to the states and to beneficiaries. The actual costs of care wouldn’t be reduced at all. Mr. Jennings also noted that the Medicaid program “has a breadth that many people don’t know,” in that it doesn’t just include direct services, but things like school-based health, and that cuts to Medicaid would have to be balanced by states, which would mean less funding to support other efforts.
In conclusion, however, Ms. Kliff urged caution in thinking that efforts to pass the Senate health care repeal bill were stalled, noting that “no politician wants to be seen as the one holding things up.” Health care advocates need to remain equally persistent to safeguard quality health care coverage and care.