Medicare

Believe me, I was certain that I had finally gotten this year's Medical Loss Ratio (MLR) rebate project out of my system. I really was.

However, there was one other MLR-related issue which I've wondered about for years: The ACA requires that carriers who sell policies in the Individual and Small Group markets spend at least 80% of the premium revenue on actual medical claims (limiting them to a 20% gross margin), and 85% on the Large Group market (limiting them to 15% gross).

That accounts for around 165 million people, give or take...roughly 50% of the total U.S. population...but what about the other private (or at least semi-private) insurance markets? I'm referring, of course, to privately-administered Medicare and Medicaid plans...aka Medicare Advantage and Managed Care Organizations (MCOs).

A couple of weeks ago I wrote an extensive piece laying out what seemed, at first glance, to be a bona fide state-level Public Option bill quietly working its way through the Washington State legislature:

Democrats in Olympia push through governor’s 'green' agenda and public healthcare coverage bills

...Another key item on the governor’s agenda is the so-called “public option” socialized health care coverage measure, SB 5526. This bill would create subsidized state-funded public health plans managed by regulated insurance companies. It would require the State Insurance Commissioner and the Health Care Authority to set up the socialized plans by 2021.

,,,These plans would be available through the state’s health care exchange to all residents, but the state would pay subsidies to individuals with incomes of up to five times the poverty level. Premiums would be limited to no more than ten percent of adjusted gross income, and payments to doctors and other health care providers would be restricted to Medicare-level limits.

No, it won't go anywhere with the House held by Democrats, but even so:

President Trump is releasing a $4.7 trillion budget plan Monday that stands as a sharp challenge to Congress and the Democrats trying to unseat him, the first act in a multi-front struggle that could consume Washington for the next 18 months.

The budget proposal dramatically raises the possibility of another government shutdown in October, and Trump used to the budget to notify Congress he is seeking an additional $8.6 billion to build sections of a wall along the U. S.-Mexico border.

Here we go again...

Trump’s “Budget for a Better America” also includes dozens of spending cuts and policy overhauls that frame the early stages of the debate for the 2020 election. For example, Trump for the first time calls for cutting $845 billion from Medicare, the popular health care program for the elderly that in the past he had largely said he would protect.

For as much as I write about healthcare policy, I actually don't write about Medicare itself all that often...at least not Medicare as it's defined today.

However, given all the excitement and confusion about what Medicare is and isn't, here's a handy reminder. Just moments ago the Centers for Medicare & Medicaid published information about 2019 Meciare Parts A & B premiums and deductibles:

CMS announces 2019 Medicare Parts A & B premiums and deductibles

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2019 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B.

There was a bit of confusion on Twitter this morning (shocker!) over a Modern Healthcare story which reported on a new physician payment policy from the Centers for Medicare & Medicaid (CMS) for Medicare enrollees.

At first it looked like CMS was planning on allowing doctors to "balance bill" Medicare patients. Balance billing is already a controversial issue with private insurance; it's the practice of a doctor/hospital charging the patient directly for the difference between what the doctor wants to be paid and what the insurance company agrees to pay them.

Whenever the discussion of what the next Big Move for healthcare policy should be comes up in Democratic/progressive circles, the incredibly difficult path which had to be paved to get the Affordable Care Act passed in 2009-2010 is often brought up as an example of how difficult it is to make even minor changes, much less major ones.

That gets a bit repetitive after awhile, however, so here's another excellent case study from 20 years earlier: The Medicare Catastrophic Coverage Act of 1988.

Thanks to Amy Lotven for this trip down memory lane via the New York Times:

Retreat in Congress; The Catastrophic-Care Debacle - A special report.; How the New Medicare Law Fell on Hard Times in a Hurry

With the benefit of hindsight, legislators and policy makers in both parties now agree that the seeds of disaster for the Medicare Catastrophic Coverage Act were sown well before it became law barely a year ago.

HOORAY! FACE-EATING LEOPARDS FOR EVERYONE!!

I don't write a whole lot about Medicare, since just about all U.S. citizens over 65 are covered by it and therefore don't enroll via the ACA exchanges anyway. However, it does come up on this site from time to time, and a good 55 million or so are enrolled in the program, so this little story might be of some relevance:

I hereby admit that a) I don't know much about Medicare (remember, my major focus is on the ACA exchanges, Medicaid expansion, the individual/small group market and so forth) and b) I'm swamped at the moment so don't have time to do a real analysis/write-up on today's announcement, but it appears to be a Pretty Big Deal, so I'll just present the press release/statement for the moment:

U.S. Department of Health & Human Services • Monday, July 25, 2016 • News Release • 202-690-6343

Important Next Step towards a Better, Smarter, Healthier Medicare:
New Payment Models and Rewards for Better Care at Lower Cost

Today, the Department of Health & Human Services proposed new models that continue the Administration’s progress to shift Medicare payments from quantity to quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.

I very rarely write much about Medicare here, partly because I just don't have time to cover every aspect of the healthcare system, partly because Medicare is only impacted by the ACA indirectly for the most part. However, there's been two recent developments which are worth noting:

First, that "indirect impact" I just mentioned has resulted in the Medicare Hospital Insurance Trust Fund, previously expected to run out of money just 2 years from now, now being expected to be solvent through 2030 thanks to the ACA bending the cost curve:

The slowing growth of healthcare costs has extended Medicare's projected lifespan 13 years beyond projections made in 2009, the last report issued before the passage of the Patient Protection and Affordable Care Act.

The Medicare Hospital Insurance Trust Fund will have "sufficient funds to cover its obligations until 2030," the Medicare Board of Trustees said Wednesday in its annual financial review of the $613 billion program.