Health Reform Hub Issues

Issues :: Medicare, Medicaid and SCHIP

Medicaid's Ticking Bomb Could Wipe Out State Budgets
Blaire Briody
The Fiscal Times, 06/23/10

A new study claims the costs of Medicaid's long-term care services could cripple states' already-fragile budgets. The Deloitte Center for Health Solutions study, "Medicaid Long-Term Care: The Ticking Time Bomb," runs through worst and best-case scenarios: the best being that Medicaid costs as a percentage of state budgets will nearly double by 2030, from the current 20 percent to 35 percent in some states. The worst? These costs will nearly triple, rising to 50 percent of the operating budget in one state — with long-term care accounting for 25 percent of that. "Obviously, this is not sustainable," write the authors. Read more...

The Myth of the "Doc Fix"
John R. Graham
National Center for Policy Analysis, 06/22/10


In order to prevent a one-fifth drop in the fees physicians receive under Medicare, Congress is proposing another in a series of temporary fixes. The American Medical Association (AMA) engaged in an expensive lobbying campaign to implement the so-called "doc fix" for Medicare Part B, but Congress is unlikely to permanently solve the problem...Physicians, of course, would like a permanent "fix" - allowing their fees to grow in line with the Medicare Economic Index, a measure of medical cost inflation. This is unlikely to happen. Having the government reimburse physicians on a "cost-plus" basis - like defense contractors - would create more incentives to drive up costs. Read more...

Temporary Medicare Fix Passed, but Doctors Get Pay Cut
Peter Lipson
Forbes, 06/22/10

The unending problem of Medicare payments to doctors continues.  This weekend, a 6-month fix averted a 21% pay cut to physicians, but the checks are already in the mail.  The payments will eventually be reprocessed, but the cash-flow problems are very real.  Every time Congress has to redress the payment problem, they put a temporary hold on payments.  In this case there was both a temporary hold, and then a reduced payment. This is probably the primary reason fewer and fewer primary care physicians are taking Medicare patients.  In general, Medicare is easy to deal with.  They do not tend to clutter my desk with paperwork for prior authorizations or referrals.  But my expenses are fixed.  My landlord doesn't care why I don't pay him on time.  My suppliers won't deliver gloves or urine test strips if I can't pay them, no matter the reason.  Primary care medicine is a narrow-margin business, and these frequent interruptions in payments threaten to drive doctors out of business.  This isn't a matter of doctors expecting extravagant reimbursement, but one of keeping the doors open. Read more...

You can lead a doctor to government insurance, but you can’t make him treat you
Mark Hemingway
Washington Examiner, 06/21/10

Despite the fact that Obamacare greatly expands Medicaid, we’ve known for while now that doctors are refusing to see patients when government dictates the price of the treatment. I discussed this problem in a column I wrote back in December: The policy outcome is Econ 101: Price controls always result in scarcity. Over half of all specialists in many major metropolitan areas are refusing to take on new Medicaid patients, according to a 2009 survey by Merritt Hawkins and Associates on physician wait times. “Medicaid is not widely accepted in most markets surveyed, in at least some of the medical specialties reviewed, and, in some cases, all of them,” according to the survey. Read more...

How Is the Senate’s ‘Doc Fix’ Paid For?
John R. Graham
National Review Online: Critical Condition, 06/21/10

The editors of National Review and NRO have consistently called for the repeal of Obamacare, and established Republican politicians claim to be onside. But when push comes to shove, those Republicans have been unwilling to expose the entire political-medical complex to sunshine, which is a prerequisite for repeal. Witness last Friday’s unanimous passage in the U.S. Senate of a standalone so-called “doc fix” for Medicare Part B. This “doc fix” kicks the can down the road until the end of November. But, hey, it doesn’t increase the deficit! Big deal. Read more...

Confirmation Fight on Health Chief
Robert Pear
New York Times, 06/21/10

President Obama’s nominee to run Medicare and Medicaid, Dr. Donald M. Berwick, is a man with a mission, a preacher and a teacher who has been showing hospitals how they can save lives and money by zealously adhering to clinical protocols for the treatment of patients. Hospital executives who have worked with Dr. Berwick describe him as a visionary, inspiring leader. But a battle has erupted over his nomination, suggesting that Dr. Berwick faces a long uphill struggle to win Senate confirmation. Republicans are using the nomination to revive their arguments against the new health care law, which they see as a potent issue in this fall’s elections, and Dr. Berwick has given them plenty of ammunition. Read more...

Doctors limit new Medicare patients
Richard Wolf
USA Today, 06/21/10

The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program. Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill. Read more...

Obamacare and its Impact on Doctors
Robert Moffit
Wall Street Journal, 06/19/10

Don't expect doctors to give the Patient Protection and Affordable Care Act a clean bill of health. The act will reinforce the worst features of existing third-party payment arrangements in both the private and public sectors — arrangements that already compromise the professional independence and integrity of the medical profession. Doctors will find themselves subject to more, not less, government regulation and oversight. Moreover, they will become increasingly dependent on unreliable government reimbursement for medical services. Medicare and Medicaid payment, including irrational government payment updates, are preserved (though shaved) and expanded to larger portions of the population. Read more...

Senate 'doc fix' comes too late to avoid physicians' rancor
Julian Pecquet
The Hill, 06/19/10

Senators patted themselves on the back and the White House sought political cover Friday as a 21.3 percent cut to Medicare physician payments went into effect, raising the ire of doctors and seniors across the country. The Senate passed by unanimous consent a six-month, 2.2 percent pay increase for physicians following a late-night deal between Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa), but with the House having already recessed for the week the deal came too late to avert the pay cut. "After years of band-aid patches and short-term fixes, doctors caring for the millions of seniors in Medicare are now reckoning with an unprecedented 21 percent cut to their reimbursement rates," AARP Executive Vice President Nancy LeaMond said in a statement. "This cut creates a dangerous atmosphere for seniors and their doctors, and will contribute to more doctors making the decision already made by some physicians to stop taking Medicare patients." Read more...

Conservatives and the 'Doc Fix'
Stephen Spruiell
National Review Online: The Corner, 06/17/10

Jonathan Chait is upset that conservatives are clinging to a "myth" about the role that the "doc fix" played in the broader debate over Obamacare. Chait is right that some conservatives have incorrectly claimed that Democrats partially offset the spending in Obamacare by pretending that they would not enact the doc fix, even though everyone knew that they would do it eventually. But that doesn't mean that conservatives don't have legitimate gripes with the way the Democrats used a generous version of the doc fix to build support for Obamacare and then, when an early draft came in over-budget, pulled it from the bill, but promised doctors they would pass it later. I wrote a post shortly after Obamacare passed that attempted to explain what really happened. Read more...

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