Happy Anniversary, Health Care Reform

Health Care Reform

Deficit Reduction Proposals

Repeal of Health Care Reform

Deficit Reduction

Reduces deficit by $1.2 trillion over twenty years. [4]

Do not address the issue of sharply rising health care costs in the private sector, which are reflected in the costs to the federal government.[5]

Adds $230 billion to the deficit[6]

Medicare Solvency

Extends Medicare Part A Trust Fund solvency by 12 years to 2029. [7]

Do nothing to promote Medicare solvency. 

Eliminates cost-savings, including development of new delivery systems, that promote Part A Trust Fund solvency.

Protects Medicare's Guaranteed Benefits

"Nothing in the provisions of, or amendments made by, this Act shall result in a reduction of guaranteed benefits under title XVIII of the Social Security Act [the Medicare title]" Additionally, "Nothing in this Act shall result in the reduction or elimination of any benefits guaranteed by law to participants in Medicare Advantage plans."[8]

Eliminate Medicare as we know it by turning Medicare into a voucher program. There would be no guaranteed benefit package, and beneficiaries would face less extensive coverage or pay higher premiums than under the current system.[9]

Increases the vulnerability of the Medicare Trust Fund, leading to a corresponding threat to beneficiaries' guaranteed benefits.

Medicare Eligibility

Medicare eligibility is not changed.  Most people are eligible at age 65.

Increase the age of Medicare eligibility to 67. [10]

If Health Care Reform is repealed and the age of eligibility is increased, people between ages 65 and 67 who would otherwise have had Medicare coverage would be uninsured.[11]

Medicare Cost-Sharing

Reduces cost-sharing by:

1) Eliminating co-insurance and deductibles for most preventive services;

2) Closing the Part D prescription drug donut hole; and

3) Prohibiting Medicare Advantage plans from charging more than traditional Medicare for costly services.[12]

Increase cost-sharing by:

1) Increasing deductibles and coinsurance for Parts A and B through a combined deductible and 20% coinsurance for all further costs; [13]

2) Adding a co-payment for home health services;[14]

3) Changing Medigap (Medicare supplemental) insurance so that beneficiaries would have to pay a co-payment for all services.[15]

These proposed increases in cost-sharing would most affect poor and sick beneficiaries, leaving them with higher costs and less access to the care they need.[16]

Reinstates cost-sharing for preventive services and reopen the "Donut Hole," ensuring higher out-of-pocket costs.  Some beneficiaries would forego preventive care and stop taking their medicine.

Medicare Premiums

Freezes the income level at which beneficiaries with higher incomes pay more for Part B; requires beneficiaries with higher incomes to pay more for Part D.[17]

Requires ALL Medicare beneficiaries to pay higher Part B premiums, in addition to the extra premiums that people with higher incomes pay for Part B and Part D. Some proposals would increase Part B and D premiums by 30% by 2021.[18]

Rescinds freeze on income levels for increased premiums.

Fraud, Waste, and Abuse

Targets fraud, waste, and abuse in Medicare by:

1) Eliminating overpayments to Medicare Advantage plans.[19]

2) Implementing stricter screening procedures and billing procedures on Medicare providers and suppliers;

3) Appropriating additional funds[20]

Do not address fraud, waste, and abuse.

Eliminates programs that target fraud and abuse, and reinstates wasteful Medicare Advantage overpayments.[21]

Coordination of Care and Improved Quality

Adds specific programs to improve quality of care.  For example: payment reforms; auditing unnecessary hospital admissions and hospital acquired conditions; promoting programs to improve care coordination, particularly for beneficiaries with complex health conditions; improving quality measures and quality reporting.[22]

Apply across-the-board payment cuts and do not seek to reduce costs by improving care coordination or quality of care. 

Eliminate programs that seek to coordinate care and improve quality for beneficiaries.

Promotion of Health Care Delivery System Reforms

Creates the Center for Medicare & Medicaid Innovations (CMMI) to promote delivery systems that improve care and reduce costs, creates Medical Home and Accountable Care Organization models to improve care for people with multiple chronic conditions.[23]

Eliminate funding for CMMI and for innovative delivery system models without alternative delivery system reforms to address high costs.

Eliminates authority and funding for delivery system innovations, including for CMMI, thereby eliminating opportunities to find solutions to the growth in health care costs.

Protection for People Dually Eligible for Medicare and Medicaid (Dual Eligibles)

Creates the Federal Office of Coordinated Health Care to improve access to care for dual eligibles;[24] improves access to benchmark Part D drug plans for people eligible for the Part D low-income subsidy.[25]

Turn Medicaid into a block grant program, thereby providing less or no assistance to people with limited incomes and resources, including people who need long-term care.[26]

Reverses the creation of critical initiatives to improve access and navigation through the health system for vulnerable dual eligibles.