“During the debate over the health care law, it was often argued that the added federal cost of the coverage provisions would be more than offset by other tax hikes and spending cuts. Indeed, it was suggested that the new law would actually reduce the longterm budget deficit. But this perspective rests critically on how one accounts for the Medicare taxes
and cuts that were enacted in the law, and specifically the taxes and cuts that were assigned to the Medicare Hospital Insurance (HI) trust fund.”
“The fact that premiums fell this year in no way disputes that this will be the future of Medicare Advantage under Obamacare, since the health law’s payment reductions won’t even be fully enacted until years down the road. Indeed, cuts were scheduled to begin this year, but the White House eased their blow in an election year. As part of a temporary demonstration program, Obamacare had allocated approximately $7 billion in funding for bonuses for the highest-performing MA plans. HHS used the funds to award bonuses to hundreds of plans, which, as health policy expert Robert Laszewski describes, led to “a ‘Lake Wobegon’ moment,” effectively cancelling out the impact of lower payments.”
“Obamacare’s tinkering with the current program will essentially end Medicare as we know it by replacing the existing fee-for-service (FFS) payment system, the heart of traditional Medicare, with top-down payment and delivery schemes independent of the consumer choice and competition that would enable them to prove their value. Worse, new layers of bureaucracy and compliance will discourage physicians who are already wrestling with reams of paperwork and will undermine their professional independence in the practice of medicine.”
“Programs designed to cut Medicare spending and improve the quality of healthcare have mostly failed, according to the Congressional Budget Office.
The findings are a blow to existing Medicare projects as well as a key goal of the healthcare reform law.”
Make Part D cost-sharing for full-benefit dual eligible beneficiaries receiving home and community-based care services equal to the cost-sharing for those who receive institutional care.
Allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.
Reduce Medicare payments that would otherwise be made to hospitals by specified percentages to account for excess (preventable) hospital readmissions.
Create the Medicare Independence at Home demonstration program.
Establish a hospital value-based purchasing program in Medicare and develop plans to implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers.
Provide bonus payments to high quality Medicare Advantage plans.