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Wednesday, Oct 28 2015

Full Issue

Budget Deal Stops Medicare Premium Increases For Most Seniors

The measure also prevents a deep cut in Social Security disability benefits. However, some hospital Medicare payments will be reduced.

The budget agreement reached by congressional leaders and the White House this week will prevent a sharp increase in Medicare premiums for more than 15 million older Americans and a deep cut in Social Security benefits for nine million disabled workers, but it will not alter the long-term financial outlook for either program, lawmakers and budget experts said Tuesday. (Pear, 10/27)

The budget deal hammered out between the White House and congressional leaders Monday would stave off an unprecedented increase in 2016 Medicare premiums for millions of seniors and prevent a Social Security program for the disabled from becoming insolvent next year. Both are issues that have vexed Congress in recent months. Legislators had wanted to shore up the disability fund before its expected depletion at the end of next year, given the difficulty of addressing entitlements in an election year. The White House achieved its goal of keeping the program solvent and House Republicans won sought-after reforms. (Armour, 10/27)

The two-year budget deal that congressional leaders negotiated with the White House may not be the kind of sweeping accord that House Speaker John A. Boehner and President Obama once tried to hammer out, but its provisions will directly affect the lives of millions of Americans. Senior citizens will be spared a 52% increase in Medicare premiums that would otherwise have taken effect next year. ... And rather than being cut once again, spending will increase at the Pentagon and on domestic programs, including medical research and Head Start preschool programs. That last point, in particular, represents a setback for congressional Republicans, who have campaigned for a steady shrinking of most government functions. (Mascaro, 10/27)

The tentative budget agreement forged by congressional leaders and the Obama administration will ward off a historic spike in Medicare premiums for the coming year, but it will nevertheless require nearly one in three older Americans to pay 17 percent more in monthly premiums for doctors’ visits and other outpatient care. (Goldstein, 10/27)

Without intervention by Congress, roughly 15 million seniors and chronically ill people currently claiming both Medicare and Medicaid coverage would have seen their premiums increase from $104.90 per month to $159.30 for individuals, according to Medicare actuaries. The actuaries also predicted an increase in the annual deductible for Part B of Medicare, from $147 in 2015 to $223 next year. (Pianin, 10/27)

Hospitals could see some Medicare payments reduced as part of a U.S. budget agreement, a change that may reduce the incentive for hospitals to buy more outpatient facilities. The deal, brokered with the Obama administration by outgoing Republican House Speaker John Boehner, lowers payments for care delivered at hospital-owned outpatient centers, but only at newly opened or acquired ones. Hospitals would have to bill for that care under the fee schedule for doctors’ offices or outpatient sites, rather than at the higher levels allowed for care delivered in the hospitals themselves. (Tracer and Lauerman, 10/27)

The pending budget deal would clamp down on a strategy that hospitals have used in recent years to expand their Medicare payments -- physicians' practices newly acquired by hospitals would not quality for higher reimbursements than independent physicians. Many lawmakers and Congress’ advisers on the Medicare program have been concerned about the trend of hospitals acquiring doctors’ practices with an aim of securing higher federal payments. The purchased practices can bill Medicare for routine services through the program's hospital outpatient system, which generally receives more generous rates than independent practices. A routine 15-minute office visit for an elderly person, for example, cost about $72.50 at an independent doctors’ office in 2013, but $123.38 if billed through the hospital outpatient system, according to the Medicare Payment Advisory Commission. (Young, 10/27)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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