John Aloysius Cogan, Jr. writes for Scotus blog on a new Supreme Court decision that defers to the Biden administration regarding Medicare payments. In Becerra v. Empire Health Foundation, the Supreme Court opted not to undo the Chevron doctrine, which gives executive agencies significant power over interpreting statutes. In this case, the court let a regulation regarding Medicare payments to hospitals serving low-income populations remain in place.
For years, Medicare has paid hospitals serving low-income populations a higher rate than other hospitals because people with low-incomes tend to be in a worse health than other people and have higher health care costs. The special rate is based on the hospital’s share of Medicare and Medicaid patients.
The Supreme Court, in a 5-4 decision written by Elena Kagan, reversed a 9th Circuit decision that rejected the department of Health and Human Services’ (HHS) interpretation of how to calculate payments to hospitals serving low-income populations. I won’t go into the details, but the takeaway is that HHS’ decision to count every hospital patient entitled to Medicare Part A in its calculation of its DSH (disproportionate share hospital) payment to a hospital made sense.
Unfortunately, the result of the decision is that HHS can cut its payments to hospitals serving low-income populations based on a 2005 regulation, and these hospitals could lose billions of dollars a year. In all likelihood, many of them will not be able to stay in business and will close down.
What’s noteworthy is that Medicare is throwing away billions of dollars a year to corporate health insurers offering Medicare Advantage plans (corporate health plans covering Medicare benefits)–more than $600 billion in overpayments to Medicare Advantage plans in the next nine years. At the same time, Medicare is doing precious little to strengthen traditional Medicare and improve benefits for low-income vulnerable older adults.
Has anyone in Congress considered that millions of older adults and people with disabilities–particularly people with low literacy levels, people with cognitive and physical impairments and people of color–are hard-pressed to navigate the myriad administrative and financial obstacles to care in Medicare Advantage?
Here’s more from Just Care:
