Reform advocates challenge gov't. report on Medicare impacts of health-care bill
By Lori Montgomery
A plan to slice $500 billion from Medicare over the next decade -- one of the most significant sources of funding for President Obama's health care overhaul -- would not jeopardize services for Medicare patients, reform advocates argued Monday, challenging a government report suggesting that the cuts could prompt hospitals and other providers to stop participating in the program.
"A memorandum recently issued by the CMS Actuary analyzing the effects of 'America's Affordable Health Choices Act of 2009' (H.R. 3962) concludes that some providers may end their participation in the Medicare program. Hospitals always will stand by senior citizens," Charles "Chip" Kahn, president of the Federation of American Hospitals, said in a statement.
Added Sister Carol Keehan, president of the Catholic Health Association of the United States: "Clearly, the Catholic Health Association thinks the possibility that hospitals might pull out of Medicare because of the deal that was struck to be very, very unfounded.... Catholic hospitals would never give up on Medicare patients."
The comments came in reaction to the release over the weekend of a 31-page report by Richard Foster, chief actuary for the Centers for Medicare and Medicaid, the federal agency that administers both programs. In an analysis of the House bill requested by GOP lawmakers, Foster, who serves as an independent technical adviser to the administration and Congress, questioned the sustainability of about $282 billion Medicare cuts, which would sharply lower projected payments to institutional providers. He also noted that an additional $200 billion in proposed cuts to the Medicare Advantage program is likely to reduce enrollment in the program by 64 percent in 2014, causing more than 8 million seniors to lose access to the program's more generous benefits packages.
Overall, the cuts would require spending per beneficiary to grow at roughly half the rate of the past two decades, according to the Congressional Budget Office, a dramatic reduction many budget and health care experts consider unrealistic. In his report, Foster said the cuts could prompt some providers to stop accepting Medicare patients, potentially jeopardizing access to care for millions of patients. Alternatively, Foster wrote, the providers could implore Congress to restore some of the funds, blowing a hole in the financing for House's $1.05 trillion expansion of health coverage.
Democrats and hospital officials on Monday disputed that assertion, arguing that providers had agreed to the cuts in exchange for legislation that would bring them millions of newly-insured customers. Moreover, they said, hospitals, nursing homes and other institutional providers -- unlike doctors -- are heavily dependent on public health recipients and would never pull out of the programs.
In an interview, Foster said it's possible that the deal could hold through 2019, but said that at some point, providers are unlikely to be able to absorb the cuts. "The question is at what point would it become unworkable," he said. "If it's within the 10 years, then some portion of those savings would not be realized."
Democrats also challenged another of Foster's points: That adding more than 34 million people to the rolls of the insured, as the House bill is projected to do, would overwhelm the existing health care system, causing providers to raise fees or take privately-insured patients over the newly-expanded pool of Medicaid patients that would be created under the legislation. A House Democratic aide said Foster had not taken into account an entire section of the House bill that calls for new investments in community health centers and incentives to expand the supply of physicians and other providers.
Foster acknowledged that he had not estimated the impact of those provisions. But, he said, "The key issue is, if you add 34 million people with insurance, can the supply of providers expand quickly enough? And that's not obvious. Even if the well-intentioned and well-designed" provisions in the House bill were enacted, Foster said, he remains convinced that the system's ability to rapidly absorb the increased demand for services "is worth worrying about."
Web Politics Editor
November 16, 2009; 5:57 PM ET
Categories: 44 Native , Health Care
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