June 24, 2017

Posts on medicare

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Wednesday, June 7, 2017 - 12:21 AM

The federal government’s financial problems are so large that all parts of the budget -- from entitlements to defense spending to tax breaks -- should be considered “on the table” for fiscal reform discussions.

Comprehensive, lasting reform will require substantial public sacrifice. As responsible elected officials in both parties have long recognized, this burden will need to be widely shared. Proposals that fail to spread the burden lack both mathematical and political credibility.

On that score President Trump’s proposed budget for the coming fiscal year falls short. Many of his fellow Republicans in Congress, to their credit, quickly recognized this and vowed to do better.

Trump gets some credit for specificity in terms of where he would like to reduce spending. But he has proposed extremely deep cuts in some parts of the budget while leaving other parts alone -- and is also calling for tax cuts that are unlikely to “pay for themselves.”

As Concord Coalition Executive Director Robert L. Bixby discussed in...

Tuesday, May 30, 2017 - 12:20 PM

In presenting President Trump’s first budget to the House Budget Committee last week, Office of Management and Budget Director Mick Mulvaney said that it “keeps the president’s promise to balance the budget within the next decade and reduce our debt without affecting beneficiaries of Social Security and Medicare retirement programs, and without raising taxes.”

Unfortunately, the budget relies on improbable assertions of higher economic growth and unrealistic assumptions about future spending cuts to achieve its goal. However, even taking the budget at face value, one little-noticed effect of the president’s budget is the extent to which his pledge to leave Social Security and Medicare largely alone, while imposing deep cuts elsewhere in the budget, results in those two programs consuming an escalating share of the budget.

To be sure, Social Security and Medicare would consume a growing share of the budget even without Trump’s policies. An aging population means that the number of beneficiaries for these programs will grow substantially in the coming years and they will be using more health care services, which tend to grow faster than the economy.

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Tuesday, February 21, 2017 - 12:20 PM

In the release of their annual projections for National Health Expenditures (NHE), the federal government's chief health care actuaries see the sector growing to represent one-fifth of the entire economy by 2025 (up from 18 percent in 2016). Understanding this growth and how to moderate it should be front-and-center for newly confirmed Secretary of Health and Human Services Tom Price.

Over the period of 2016-2025, the actuaries expect NHE to grow by an average of 5.6 percent a year, about 1.2 percent faster than the expected growth of the economy over the same time period.

The year 2016 itself actually saw a slight decline in the growth rate. Its 4.8 percent growth was the result of a slowdown relative to the prior two years, when new coverage under the Affordable Care Act (ACA) was phased in and there was a related increase in the usage and intensity of health care services.

However, the actuaries expect the growth rate to pick up over the projection period as the population ages, making more people eligible for Medicare and Medicaid, and as health care prices rise faster than prices in the overall economy. The two pieces of health care spending that will grow the fastest...

Friday, February 17, 2017 - 12:45 PM

President Trump and many lawmakers in both parties have promised to attack waste and substantially improve government efficiency. The Government Accountability Office (GAO) has just handed them a long list of opportunities to do so in its latest “High Risk List.”

With a large and growing federal debt, elected officials should vigorously pursue these opportunities to reduce unnecessary spending and collect hundreds of billions of dollars in unpaid taxes. In addition, Congress and the president should heed the GAO’s renewed warnings about the long-term fiscal challenges facing important but costly entitlement programs.

The High Risk List, which GAO updates at the start of each new Congress, spotlights 34 government activities or areas that the agency considers “vulnerable to waste, fraud, abuse and mismanagement or needing broad-based transformation.”

GAO, a nonpartisan investigative arm of Congress, reports that the government made “considerable progress” on problems highlighted in the 2015 list. The agency removed one area from the High Risk List: the sharing and managing of information related to terrorism, which U.S. Comptroller General Gene Dodaro called “a particularly...

Tuesday, December 6, 2016 - 10:20 AM

How the incoming Trump administration handles health care policy is perhaps the most consequential question hanging over the nation’s budgetary outlook.

That’s why policy analysts are scrambling to read the tea leaves on health care amid conflicting signals. Republicans seem to have one foot on the gas pedal and one foot on the brakes.

For example, recent developments have led to intense speculation on whether the new administration will rapidly work to reform Medicare. On the campaign trail, candidate Trump was adamant that he would not touch the program other than by cutting waste, fraud and abuse. However, his selection of a strong Medicare reform advocate, House Budget Committee Chairman Tom Price (R-Ga.), to become secretary of Health and Human Services raises the prospect that something more might be contemplated.

House Speaker Paul Ryan, another strong advocate of Medicare reform, has indicated that he is still planning to push the issue soon, even as senior Senate Republicans have voiced caution. 

So it is understandable if some confusion has arisen as to the direction and pace of Medicare reform.

But the tension between speed and deliberation is best exemplified by the congressional Republicans’ developing strategy for delivering on their campaign promise to “repeal and...

Monday, December 5, 2016 - 2:44 PM

National health expenditures grew by 5.8 percent in 2015, pushing health care spending to 17.8 percent of the economy, up from 17.4 percent in 2014. This marks the second year in a row spending has grown more quickly than the economy, following a stable period from 2009 to 2013. 

The numbers come from a new report by actuaries at the Centers for Medicare and Medicaid Services (CMS). Increased spending had been widely expected, given expanded insurance coverage through the Affordable Care Act (ACA). The insured population rose from 86 percent of the country in 2013 to 90.9 percent in 2015. 

The actuaries said that in addition to spending on the newly insured, faster growth was driven by increased use and intensity of health care services and rapidly increasing spending on prescription drugs -- which grew by 9 percent after even more dramatic growth of 12.4 percent in 2014.

Slow growth in Medicare spending stands out as a bright spot in the report. While overall Medicare spending grew by 4.5 percent, on a per-enrollee basis spending only grew by 1.7 percent because the number of beneficiaries increased by 1.5 million. 

Even with moderate cost growth, more clearly needs to be done to slow health...

Saturday, June 28, 2014 - 9:58 AM

Short-term improvements in the federal government’s finances have led to widespread complacency in Washington about fiscal reform.

But a panel discussion this week highlighted the continuing need for such reform, with former members of Congress lamenting the sharp political divisions within the two major parties as well as between them that hinder constructive change.

“We have a fiscal challenge which is really a political challenge which really is a societal challenge. . . .the two parties are more polarized than ever before,” said Evan Bayh, a former senator (D-Ind.). “The Democratic Party has moved further left, the Republican Party has moved even further right.”

Mike Castle, a former congressman (R-Del.), sounded a similar theme, noting the pressures faced by moderates in both parties. “The Congress of the United States today,” he said, “is a difficult place.”

The panel discussion took place in Washington on Wednesday night, when The Concord Coalition honored Senators Dick Durbin and Tom Coburn with the 2014 Paul E. Tsongas Economic Patriot Award.

Joining Bayh and Castle for the panel discussion were former senator Judd Gregg (R-N.H.), former House member John Tanner (D-Tenn.) and Concord Coalition Executive Director Robert L. Bixby.

Castle and Tanner are Concord’s co-...

Tuesday, June 24, 2014 - 10:00 AM

Following last year’s bipartisan budget agreement, this was supposed to be the year of a harmless fiscal ceasefire on Capitol Hill. Unfortunately, the ceasefire is becoming a retreat for fiscal responsibility.

On issues ranging from tax and entitlement reform to highways and veterans health, Congress has backtracked, ducked and gimmicked its way around hard choices. This pattern does not bode well for any attempt to put the budget on a sustainable track after the fall elections.

Backing away from military retirement reforms. The first sound of retreat came in February with overwhelming votes in the House and Senate to repeal a provision included as part of their budget agreement just a month earlier that limited cost-of-living adjustments for working-age military retirees.

The minor change supported by the Pentagon would not have saved a huge amount of money (roughly $7 billion over 10 years) but represented the type of difficult choice necessary to reduce defense spending. However, in the face of complaints from veterans groups, Congress quickly backed down. To save face, lawmakers replaced the savings on paper with unspecified automatic cuts 10 years from now, but it was still a clear case of kicking the can down the road.

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Monday, May 5, 2014 - 4:00 PM

A book titled “Dead Men Ruling” is not the place you would expect to find an optimistic message about our nation’s future. That is the case, however, with a new book from budget expert Eugene Steuerle of the Urban Institute. The critical connection he draws between renewed fiscal freedom and generational fairness casts the budget debate in a far more important context than deficit reduction for its own sake. This larger theme is one that The Concord Coalition has long embraced.

Despite the dismal fiscal outlook, which portends rising deficits and debt in perpetuity, Steuerle argues that “we no more live in an age of austerity than did Americans at the turn of the twentieth century.... Conditions are ripe to advance opportunity in ways never before possible, including doing for the young in this century what the twentieth did for senior citizens, yet without abandoning those earlier gains.”

The key to realizing these opportunities, he says, is “breaking the political logjam that…was created largely by now dead (and retired) men.”

As Steuerle puts it, “both parties have conspired to create and expand a series of public programs that automatically grow so fast...

Tuesday, April 8, 2014 - 9:39 PM

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released the 2015 government payment levels for the Medicare Advantage private insurance plans that are offered to seniors as an alternative to traditional Fee-for-Service (FFS) Medicare. In a bit of a surprise, CMS projects that total payments will increase by about 0.4 percent despite earlier CMS guidance suggesting payments would be cut by 1.9 percent.

The change follows months of lobbying by the private insurance industry -- fearful of lost profits -- along with members of Congress from both parties who are fearful of being attacked for cutting benefits to seniors.

Medicare Advantage plans have seen annual cuts to their payments from the government through a process set in motion by the Affordable Care Act (ACA), and cuts are scheduled to continue (despite the slight increase for next year). The payment reductions were intended to fix a fundamental financing disparity between FFS Medicare and the Medicare Advantage program; insurers are paid more per beneficiary than it would cost the government if the beneficiaries remained in FFS. 

The negative reaction from politicians and interest groups to these continual cuts...