December 8, 2016

Posts on medicare

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Monday, January 10, 2011 - 11:16 AM

Urban Institute scholar Gene Steuerle has run the numbers and found that for Medicare, retirees are getting a really good deal.

In a fascinating set of calculations, Steuerle and colleague Stephanie Rennane, looked at both Social Security and Medicare and estimated the levels of benefits relative to taxes (and premiums for Medicare) paid for many different levels of income and years of retirement.

For Social Security, prior generations received substantially more benefits than taxes paid, while current retirees and those in the future who earn average and above-average wages are scheduled to receive slightly less cash benefits than taxes paid. The lowest income workers are scheduled to still get more in benefits than taxes paid. 

For Medicare, however, their conclusion is that, "Past and current retirees, and most working age adults, will never pay for all of their benefits."

The basic reason is that Medicare payroll taxes, which only go towards Medicare Part A (hospital insurance), combined with premiums (which are set at levels to pay for about 25 percent of Medicare Part B costs), only cover 51 to 58 percent of total Medicare ...

Monday, December 6, 2010 - 10:54 AM

By now we've seen a number of proposals for fiscal sustainability from groups with very different perspectives. Some of the harshest critics of the bipartisan deficit-reduction panels are liberal-leaning groups that argue that the recommendations of the President's commission, as well as those of the Bipartisan Policy Center and the MacGuineas-Galston plan, leaned too heavily toward the conservative side and proposed packages that were too heavy on spending cuts and too insistent on keeping taxes (too) low. (I may agree that I would have preferred more revenue increases in the overall mix than the President's commission proposed, but I don't think that should lead me to declare the overall proposal "dead on arrival" or to reject the the individual policies contained within it.)

I've looked at two...

Monday, September 13, 2010 - 1:56 PM

The Center for Medicare and Medicaid Services recently updated its estimate of National Health Spending. This unusual mid-year update, delivered in an article in Health Affairs, reflects changes due to the passage of the health care reform law in March, along with a few smaller legislative changes since then.

The overall picture is that within the 2009-2019 time period, projected total national health care spending will slightly increase relative to where it would have been without passage of reform. Annual spending growth will average 0.2 percent higher over the projection period. As a nation, we will go from spending 17.3 percent of GDP on health care in 2009 to 19.3 percent of GDP in 2019, a figure 0.3 percent of GDP higher than it would have been without health care reform.

Within these small overall changes, however, there will be major differences in the number of insured and the payers for health insurance. By 2019, approximately 32.5 million more individuals will have health insurance, which will mean coverage of 92.7 percent of the population (compared to 83 percent prior to passage of the legislation). Within that, Medicaid and the Children’s Health Insurance Program (CHIP) enrollment will be one-third...

Tuesday, August 10, 2010 - 1:45 PM

Good news comes and goes rather quickly in the 2010 Medicare Trustees’ Report. It begins with the optimistic news that Medicare’s finances have improved substantially as a result of this year’s health care reform bill, the Affordable Care Act (ACA). However, the report then goes on to explain in great detail why this apparently good news is probably not as good as it sounds.

According to the trustees, “actual future Medicare expenditures are likely to exceed the intermediate projections  shown in this report, possibly by quite large amounts.” A separate memo prepared by the Center for Medicare and Medicaid Services (CMS) Office of the Actuary bluntly states that “the projections in the report do not represent the ‘best estimate’ of actual future Medicare expenditures.”

For those seeking solutions to our nation’s long-term structural deficit, understanding the complex message of the trustees’ report is crucial. Despite the buoyant headlines, the trustees warn, “The financial projections in this report indicate a need for additional steps to address Medicare’s remaining financial challenges.”

On paper, Medicare’s finances have indeed improved. The ACA reduced future non-physician Medicare provider reimbursements and added dedicated...

Wednesday, June 16, 2010 - 12:23 PM

Debate on the so-called “extenders” bill has focused on the size and duration of unemployment benefits, health insurance assistance for those who recently lost their jobs, Medicare physician payments, state aid for health care and various offsets to mitigate the overall effect on the deficit.

Conspicuously missing from the debate is any scrutiny of the extenders themselves. It’s a missed opportunity to raise needed revenue while simplifying the tax code and broadening the tax base -- goals that economists of all ideological stripes have long advocated. 

Both the House and Senate versions of the extenders bill contain more than 60 narrowly targeted tax breaks that expired last year. Extending them just through this year will cost about $32 billion. The long-term cost runs to over $350 billion. That cost will add to the debt unless it is offset by corresponding tax increases or spending cuts that may prove more harmful to the economy than failing to renew some, or all, of the extenders. 

At a time when the President is commendably urging all federal agencies to identify their lowest priority and least effective items, Congress should devote the same level of scrutiny to the tax code. The extenders would be a good place to...

Monday, June 7, 2010 - 3:45 PM

How large is the federal debt? That's something of a trick question in economic circles, and some analysts believe it may have already tripped up the President's fiscal commission.

Some commission members think the panel, charged with recommending solutions to the nation’s fiscal problems, should focus on the total federal debt. That figure, which just hit $13 trillion, is most familiar to the general public because it is widely cited by the news media and politicians.

Many budget experts and economists, however, say the real number to watch is “publicly held debt,” meaning what the government owes to investors. This figure, now approaching $8.6 trillion, does not include money that the government owes to various trust funds, notably for Social Security.

Beyond this issue is the question of how much more debt the government can safely take on. Fiscal commission members tussled over that at their second full meeting late last month on Capitol Hill, with some arguing that the economy was still too weak for the government to start focusing on deficit reduction.

“It’s very important that we don’t in our zeal focus on deficit reduction right now,” said Rep. Jan Schakowsky, an Illinois Democrat.

Regardless of which figure the commission focuses on, federal debt is...

Monday, June 7, 2010 - 3:34 PM

Public concern about the nation’s rising debt burden is beginning to have an impact on the legislative agenda.  

That much was evident as the House passed a scaled back “extenders” bill (H.R. 4213) on May 28 by a slim margin. Originally estimated to have a gross cost of $192 billion and a net deficit increase of $134 billion, the final bill carried a gross cost of $114 billion and a net deficit increase of $54 billion.

While this cost reduction was a victory for House Democrats -- mainly Blue Dogs -- who objected to the deficit impact of the original bill, much of it was accomplished by timing shifts rather than a change in policy. For example, shortening the extension period of certain unemployment benefits “saved” about $8 billion and sunsetting an increase in the Medicare physician reimbursement rate (the “doc fix”) after 19 months “saved” almost $40 billion. 

It remains to be seen whether concerns about the immediate deficit, which is largely driven by economic conditions, will be translated into hard choices on the long-term structural deficit. 

In that regard, it is worth noting that the policies extended in the extenders bill carry large long-term costs whether they become visible now or in the...

Monday, May 24, 2010 - 4:25 PM

The extenders bill that the House will consider this week is a timely reminder of why it is important for Congress to complete action on a budget resolution.  A budget resolution continues to elude Congress, but there has been considerably less trouble reaching agreement on a bill that the Congressional Budget Office estimates will add a staggering $167 billion to the deficit over 2010-2014 and a net increase of $134 billion over 2010-2020. 


Last Thursday, leaders of the Senate...

Friday, March 19, 2010 - 1:25 PM

It looks like we might be entering the final week(s) of (at least) this year's legislative push on health care reform.

Thursday brought us legislative text of the amendments to the Senate bill that the House will take up through the reconciliation process as well as an updated CBO score of the whole package. It is likely the House will vote on the bill package Sunday. If they do so, the Senate bill will become the law of the land, and the reconciliation amendments will then have to make it though the Senate before those become law.

The main fiscal takeaway from this week is that there really has not been any substantial change in what heath care reform is attempting to accomplish and whether it will ultimately be fiscally responsible legislation. Today we released a series of video discussions (see above) between Bob Bixby and I explaining the big picture and how the reconciliation tweaks effect that. One of the issues discussed is that clearly the most consequential fiscal change through reconciliation is the delay in implementation of the excise tax on cost insurance plans.

For a more complete view, our December Issue Brief, created as the Senate bill neared passage,...

Tuesday, March 2, 2010 - 9:47 AM

The end game for health care reform may finally have arrived. Some in Congress are suggesting that a decision should be made by the Easter break, which begins on March 26. Time is running short.

If we learned anything from last week’s health care summit, it is that the final end game negotiations will not take place between Democrats and Republicans but among various factions of Democrats.

Republicans now sense big gains coming in the November elections and thus have no motivation to move in Obama’s direction. Any attempt to draw them into a negotiation –- including the “start from scratch” option Republicans themselves are pushing -- will likely fail.

Democrats are split, with some fearing for their jobs if they support an unpopular bill while others believe that passing even a flawed bill will leave them better off in November.

One casualty of the situation may be cost containment. Democrats are mostly united around coverage expansion. That’s the easy part. Their biggest difference is on the more difficult question of aggressive cost containment. The two most promising cost-containment strategies still on the table are the tax on high-cost health care plans and the...