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Healthcare Budget Deficit Calculator

April 6, 2012

From: Center for Economic and Policy Research

Article Excerpt:

The U.S. health care system is possibly the most inefficient in the world: We spend twice as much per person on health care as other advanced countries, but we have worse health outcomes, including a lower life expectancy. The government, through programs like Medicare and Medicaid, pays for approximately half of the country’s health care, almost all of which is actually provided by the private
sector. Thus, the bulk of our projected rising budget deficits are due to skyrocketing private health care costs.

The CEPR Health Care Budget Deficit Calculator shows that if the U.S. can get health care costs under control, our budget deficits will not rise uncontrollably in the future. But if we fail to contain health care costs, then it will be almost impossible to prevent exploding future budget deficits.

The Calculator lets you see what projected U.S. budget debts would be if we had the same per person health care costs as any of the countries listed below, all of which enjoy longer life expectancies than the U.S. (Life expectancies are listed in parentheses.)

Read more… Healthcare Budget Deficit Calculator

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Raising Medicare Age Would Save $148 Billion CBO Says

January 10, 2012

From: National Journal – 1/10/12

Article Excerpt: 

The federal government could save $148 billion over 10 years by increasing Medicare eligibility two years to age 67, the Congressional Budget Office reported on Tuesday. 

The projected savings are lower than CBO’s March estimate of $162 billion, but the earlier calculation did not include the premiums that seniors must pay into the program. A CBO official said that a senator requested the additional analysis of increasing the Medicare and Social Security eligibility ages.

Either way, the savings may not significantly cut the budget deficit but they could pay for a program such as the “doc fix”–a permanent solution to a temporary pay raise Congress must legislate for Medicare doctors every year.

CBO estimated the effects of increasing Medicare eligibility by two months every year beginning in 2014 for people who were born in 1949 until the Medicare eligibility age reached 67 in 2027 for people born in 1960.

Read more…

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Lawmakers urged to weigh cost of extending special Medicare payments

September 21, 2011

Lawmakers urged to weigh cost of extending special Medicare payments

From: the Hill.com Healthcare Blog – 9/21/2011

Article Excerpt:

House members examining whether to renew special Medicare payment bumps for laboratories, patient therapy and rural hospitals heard Wednesday from the usual array of industry groups clamoring for their share of the pie. But one witness, a former member of the nonpartisan Government Accountability Office, said they’re bad policy and should expire.

The so-called extenders, health economist Bruce Steinwald said, are “deceptively costly” when you add them all up — some $2.5 billion a year.

 

 

Read more..

 

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Living Within Our Means and Investing in the Future

September 19, 2011

Living Within Our Means and Investing in the Future

President’s Proposed Budget Cut Plan – September 19, 2011

The White House released their detailed deficit reduction plans in an 80 page document earlier this week.  I have prepared a summary below of the proposed reductions to the Medicare program reimbursements.  In review of the proposed cuts, it is interesting to note the growing influence that MedPAC is having in the discussion as many of the proposals are taken directly from MedPAC’s March 2011 reportto Congress. 

Summary of Proposed Reductions to Medicare Reimbursements

 

 

 

 Type

 

 Proposed Cut

10 Yr Projected  Savings (Billions)

Bad Debts

Reduce Medicare Bad Debt reimbursements from 70% to 25% of bad debt over 3 years starting in 2013 (55%, 40%, 25%).

$20

IME

Reduce IME adjustment by 10% starting in 2013.

$9

Add-on for Hospital/Physicians

Reduce the add-on payment for hospitals & physicians in low-population States starting in 2013.

$2

CAH

Reduce the 101% cost reimbursement for CAHs to 100%;  and eliminate CAH status for hospitals less than 10 miles from nearest hospital (assume start 2013).

$4

Post Acute Care Services LTCH, SNF, IP Rehab, & HH

Based on MedPAC recommendation, will gradually realign payments (Ron Knapp definition “Reduce”) through adjustments to payment rates beginning in 2014 through 2021.

$32

IP Rehab &  SNF Common Services

For common procedures (e.g. hip or knee replacement), will reduce the difference in payment for treatment of specified conditions to encourage care in the most clinically appropriate setting starting 2013.

$4

IP Rehab

Modify current compliance threshold of 60% (IP Rehab must demonstrate a compliance threshold which specifies a minimum % of patients with designated medical conditions that require intensive Rehab services) to previous threshold of 75% beginning in 2013.

$3

SNF

To reduce the incidence of preventable readmissions, proposing to reduce payments by up to 3% beginning in 2015 for SNFs with high rates of care-sensitive, preventable hospital readmissions.

$2

Part D Drugs

Will allow Medicare to benefit from the same rebates that Medicaid receives for brand name and generic drugs provided to beneficiaries who receive the Medicare Low-Income Subsidy beginning in 2013.

$135

Fraud & Abuse Medicare Advantage

Recover payments made to Medicare Advantage plans that reflect mistaken overpayments made for beneficiaries.  Recovery to be based on extrapolation of CMS audits.

$2.3

Fraud & Abuse   Improper Payments

A series of enforcements are proposed to reduce the level of improper Medicare payments.  This includes increased scrutiny of providers using high-risk banking arrangements, civil monetary penalties for providers who do not update enrollment information, creation of a Medicare claims ordering system to validate physician orders for certain high risk services, etc.

$1

EHR

Proposes to use the penalties imposed for hospitals & physicians who do not implement electronic health records systems (penalties begin in 2015) for deficit reduction beginning in 2021.

$0.5

Imaging Services

Spending for imaging services has grown dramatically in recent years.  This proposal will implement in 2013 a payment adjustment (reduction) for advanced imaging equipment to account for higher levels of utilization of certain types of equipment. 

$0.4

Imaging Services Prior Authorization

Proposes to adopt prior authorization for the most expensive imaging services beginning in 2013.

$0.9

Part B & D Premiums

Proposes to increase income-related premiums starting in 2017 under Medicare Part B & D by 15% and maintain the income thresholds associated with income-related premiums until 25% of beneficiaries under Parts B & D are subject to these premiums.

$20

Part B Deductibles

For new beneficiaries, proposed increase in Part B deductible of $25 to be applied to 2017, 2019, & 2021.  Existing beneficiaries will not subject to this change.

$1

Home Health Co-Pay

For new beneficiaries, proposed implementation of a $100 co-pay per episode (minimum 5 visits in episode) beginning in 2017.  Existing beneficiaries will not be subject to this change.

$0.4

Part B Premium Medigap Coverge

For new beneficiaries starting in 2017, proposes a Part B premium surcharge equivalent to about 15% of the average Medigap premium (or about 30% of Part B premium) for those that purchase Medigap policies with particularly low cost-sharing requirements.

$2.5

Independent Payment Advisory Board (IPAB)

Proposes to provide IPAB with additional tools like the ability to consider value-based benefit design and enforcement mechanisms such as automatic sequester as a backstop for IPAB, the Congress, and the Secretary of HHS.  Reduces the target rate growth from GDP plus 1% to GDP plus .5%

 

  Total Projected Medicare Savings

$240B

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Living Within Our Means and Investing in the Future

September 19, 2011

Living Within Our Means and Investing in the Future

President’s Proposed Budget Cut Plan – September 19, 2011

Last week we highlighted the White House proposed cuts related to the Medicare program.  Click here to view this summary of the proposed Medicare cuts.  This week we are highlighting from the same report, the proposed cuts that will impacting the Medicaid program.

Summary of Proposed Reductions to Medicaid Reimbursements 

  

 

Type

  

 

Proposed Cut

10 Yr Projected  Savings (Billions)

Reduce Provider Tax

Beginning in 2015, begin to phase down the provider tax threshold from the current 6% in 2014, to 4.5% in 2015, 4% in 2016, and 3.5% in 2017 and beyond

$23.0

Single FMAP Match Mcaid & CHIP

Beginning in 2017, created a single matching rate (FMAP) specific to each State, replacing current complex formula that utilize that applies more differing FMAPs and eFMAP federal matching rates.

14.9

DME Reimbursements

Starting in 2013, limits Medicaid DME spending on certain services to what Medicare would have paid in the same State for the same service.

4.2

3rd Party Liability for Mcaid Claims

Starting in 2013, affirm Medicaid’s position as payer of last resort by allowing States to avoid costs for prenatal & preventative pediatric claims when 3rd parties are responsible.  This provision allows Medicaid to recover costs from beneficiary liability settlements.

1.3

DSH Allotments

Proposes to compute the 2021 State DSH allotments based on States’ actual 2020 DSH allotments, to better align future Medicaid supplemental payments to hospitals given the anticipated reduction in uncompensated care from ACA.

4.1

Modified Adjusted Gross Income(MAGI) for Health Insurance Assistance

Beginning in 2014, proposes to amend the MAGI to include Social Security benefits rather than just the taxable portion when determining eligibility for the Exchange Tax credit programs. This will better target those individuals in need of this type of assistance.

14.6

Fraud & Abuse Reductions

Several proposals are included to increase enforcement and oversight of the prescription of drugs to individuals and for drug manufacturers.

.110

 

Total Projected Medicaid Savings

$62.21

 

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The Grand Plan Brought to you by the “Gang of Six”

July 21, 2011

From: The Disciplined Investor Blog – 7/21/11

Blog Excerpt

Here is the executive summary of the plan that is being offered by the Gang of Six. What it means is anyone’s guess. Why did it take so long for them to come up with something?  Already there is a major pushback from both sides on this as the “Right” does not want tax increases and the “Left” does not want cuts to entitlements. Back to the drawing board?

Executive Summary

This bipartisan, comprehensive, and balanced plan consistent with the recommendations of the Bowles-Simpson fiscal commission that will:

  • Slash our nation’s deficits by $3.7 trillion/$3.6 trillion over ten years under CBO’s March 2011 baseline, or $4.65 trillion/$4.5 trillion under the original fiscal commission baseline (which used the President’s 2011 budget request as the starting point for discretionary spending). 
  • Stabilize our publicly-held debt by 2014.
  • Reduce our publicly-held debt to roughly 70% of our economy by 2021.
  • Impose unprecedented budget enforcement

Click here to read the rest of the executive summary provisions.

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Obama and Boehner in Push for High Stakes Deal

July 21, 2011

From: Financial Times 7/21/11

 

Article Excerpt

President Barack Obama and John Boehner, the top Republican in the House of Representatives, are engaged in a final high-stakes push to secure an ambitious budget deal, less than two weeks before the US runs out of cash to pay its bills.

Both the White House and Mr. Boehner’s office denied they were close to an agreement, amid rising anxiety in both the Republican and Democratic camps that elements of the deal could provoke a backlash from their respective bases.

Click here to read article.

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Looking for debt deal, Obama outlines cuts

July 14, 2011

From: USA Today – 7/14/11

 

Excerpt:

President Obama implored congressional leaders Thursday to reach a deal on raising the nation’s $14.3 trillion borrowing limit by this weekend to reassure jittery world financial markets, and he suggested he could settle for a smaller deficit-reduction package than he originally sought.

Rather than continue to push for $4 trillion in savings over the next decade, Obama outlined a plan that would achieve roughly $2 trillion, almost entirely from spending reductions. That marks a major concession — one the president is likely to address at a news conference scheduled for 11 a.m. ET this morning.

At the same time, Senate Republican leader Mitch McConnell and Democratic leader Harry Reid forged ahead with an even smaller deal of their own, one that represents a second fallback plan. It would allow Obama to raise the debt limit and create a process by which Congress would vote in the future on spending reductions.

Click here to view full article.

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Cantor outlines $353B in Medicare, Medicaid savings during debt talks

July 12, 2011

From: the Hill’s Healthcare Blog – 7/12/11

Here is an article outlining changes to Medicare and Medicaid that were outlined by House Majority Leader Eric Cantor (R-Va.) on Monday.  The savings are estimated to save $353 billion over ten years.  Given the current state of negotiations, it is hard to say what if any of these provisions will actually be agreed to.

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Advocacy Group Messages, Concerns Emerge As Deficit Talks Continue

July 8, 2011

From:Kaiser Health News – July 8, 2011

Article Excerpt:

The drug industry and teaching hospitals are among the health industry sectors that are bracing for hits from the budget deal. Meanwhile, other health care providers are watching and waiting — trying to figure out what might become of their interests as the negotiations go forward. And Democrats and liberal advocates, the staunchest supporters of the health law, fear President Barack Obama could give up too much in the ultimate agreement.

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