The new year is less than a month away and with it will come a Republican-led House of Representatives and a divided Congress. People hoping for improvements to Medicare should not be holding their breadth. Allison Bell reports for Think Advisor on Medicare issues policymakers might take up in the next Congress.
It’s more than likely that the Republican-controlled House of Representatives will do its best to push reforms that cut Medicare spending. Of course, House Republicans will only succeed if they can find Democrats who buy into their agenda. But, that is very possible.
Republicans in the Senate, for example, might find support from Senators Joe Manchin of West Virginia and Kyrsten Sinema of Arizona. Though they have been Democrats in name, they often do not support Democratic health care reform proposals. Indeed, Sinema has just announced that she is switching parts and will be an independent hereon in. Among the Medicare proposals with bi-partisan appeal are:
- Direct payments to physicians: It is currently illegal for physicians who are Medicare “participating providers” to charge patients privately out-of-pocket for their services on top of Medicare’s approved rate. “Non-participating providers” who see Medicare patients can charge no more than 15 percent above Medicare’s approved rate and the limit is less in some states. Only physicians who opt out of Medicare (who are few and far between) and have their patients sign waivers acknowledging that they must pay totally out of pocket for their services can charge patients what they please. For good reason. If it were legal for all physicians to charge Medicare patients whatever they pleased, people with Medicare would have no protection from large and unaffordable out-of-pocket costs. People in traditional Medicare would have to think twice before going to the doctor. As it is, people in Medicare Advantage often skip care because of out-of-pocket costs. People in traditional Medicare without supplemental coverage do as well. But, with supplemental coverage, they generally have no financial barriers to care.
- Health savings accounts: Some Republicans love the idea of giving people with Medicare cash to cover their medical costs, through health savings accounts. But, that is a recipe for discriminating against the sick, for whom the cash will never be enough to cover their care needs. It would likely keep people from getting needed care.
- Health care and prescription drug price transparency: It’s hard to find fault with this proposal. People should know what they are paying. But, the proposal sounds a lot better in theory than in practice. Prices fluctuate and depend on the services you receive, which you usually cannot predict in advance. Moreover, if you want to rely on referrals from your physicians, you have little choice as to who you see. For emergency care, transparency offers few if any benefits in keeping costs down.
- Physician assistants and nurse practitioners practicing without direct physician supervision: No question, there’s a shortage of primary care physicians. Many conservatives support expanding “scope of practice laws” to allow physician assistants and nurse practitioners to step in and care for patients without direct physician supervision. For a variety of basic needs, such as treating a cold or a wound, it makes sense. But, primary care physicians have far more training than these other providers and, at least in some cases, are better able to identify and address bigger issues. So, the devil is in the details.
- Expanding telehealth coverage: There’s some bi-partisan support for Medicare continuing its extended coverage of telehealth services. That could make a lot of sense, depending upon how the coverage is designed.
All this said, Congress won’t be doing the Medicare work it should be doing. None of these proposals will bring down Medicare costs or address overpayments and barriers to care in Medicare Advantage.
Here’s more from Just Care:
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