As health-care costs slow, IPAB’s launch is delayed

With a mandate to drive down Medicare spending, the Independent Payment Advisory Board has always been among the health law’s most-controversial provisions.

Legislators in both parties have attacked the board’s power to dictate Medicare spending cuts without Congress’ seal of approval. While IPAB is specifically barred from changing Medicare’s benefits or increasing cost-sharing, critics worry that cutting  doctors’ payment rates could lead to worse care.

For now, IPAB doomsayers can rest assured: The cost-cutting board has been effectively neutered for 2015, the first year in which it’s spending recommendations could go into effect. It has lost its power to make any of these binding cuts.

via As health-care costs slow, IPAB’s launch is delayed.

If this was a pill, you’d do anything to get it

Medicare is referring to the newly created Center for Medicare and Medicaid Innovation, which gives the program power to create and expand projects without congressional authorization. This authority could also be used to create projects based on HQP’s lessons. It’s not. Instead, Medicare has created a raft of projects and experiments meant to move the system from fee-for-service toward pay-for-quality — with the hope that if they can get the payment incentives right, then the market will have reason to support programs like HQP.

To Health Quality Partners and its defenders, Medicare’s decision is ludicrous. “We’re spending tens of billions of dollars now on Medicare innovation where Medicare already discovered something amazing and now they’re forgetting what they discovered?” Brenner says. “It’s an amazing government moment.”

via If this was a pill, you’d do anything to get it.

Rove: The Return of the Mediscare-mongers – WSJ.com

Medicare Part D has been in operation for eight years, and the results are extraordinary. In 2003, the Congressional Budget Office projected Part D’s cost for its first decade would be $552 billion. The actual cost will be around $358 billion, 35% less than forecast and 64% less than the $1 trillion cost that the CBO estimated for the competing Democratic plan, in which the federal government would decide who got what drugs when and at what price.

The average premium for drug coverage is $30 a month, half what the actuaries estimated it would be this year. A 2011 study in the Journal of the American Medical Association found that the prescription benefit helped reduce hospital stays and delay the need for nursing care, saving Medicare $12 billion a year. The Congressional Budget Office also reported last November that seniors “had fewer hospitalizations and used fewer medical services as a result” of participating in Part D.

via Rove: The Return of the Mediscare-mongers – WSJ.com.

Misperception of Government Benefits Makes Trimming Them Harder – NYTimes.com

To date, Mr. Obama has mostly proposed cuts to payments for health care providers, like hospitals. He has supported reducing benefits or raising costs for higher-income beneficiaries, but has made any broader benefit changes contingent on Republicans’ agreeing to additional tax revenues from wealthy individuals and corporations.Even so, Republican senators said they were heartened by Mr. Obama’s dinner comments on the growing imbalance between Medicare’s benefits and taxes. If they could not yet agree on solutions, agreeing on the problem was a start, said Senator Ron Johnson of Wisconsin who was among the diners.“I suggested it would be immensely helpful to reaching solutions to these problems if he would utilize that bully pulpit and start conveying to the American public the full extent, the full depth, of our problems,” Mr. Johnson said.He added, “I’ll know President Obama is serious about working with us when I start hearing him tell the American people what he told us in private.”

via Misperception of Government Benefits Makes Trimming Them Harder – NYTimes.com.

Health Insurers Prevail in Medicare Fight With Washington – WSJ.com

In February, the federal agency that runs Medicare proposed steep rate cuts to insurers for running these plans, on top of another layer of cuts called for in the federal health overhaul. One key payment metric was set to fall 2.2% under the initial proposal.

That set off the insurance industry’s most intense lobbying campaign in years, according to those involved, and it brought together an unusual coalition of Republican and Democratic lawmakers to push for stopping the cuts.

Lobbyists organized a grassroots effort that recruited 50,000 seniors to contact members of Congress through phone calls, emails or other methods. They warned that cuts would hurt benefits to seniors while driving plans from some parts of the country.

via Health Insurers Prevail in Medicare Fight With Washington – WSJ.com.

Regulators Improve 2014 Rates for Medicare Advantage Plans | Fox Business

Health insurers stand to get significantly more money for running Medicare Advantage plans next year than they expected, according to new government rates announced late Monday.

The final announcement appeared to significantly improve on a mid-February proposal that featured unexpectedly sharp cuts and prompted a busy lobbying effort from health insurers. Companies such as Humana Inc. (HUM) that sell these plans warned cutting funding too much would hurt benefits for seniors while driving plans out of some markets.

via Regulators Improve 2014 Rates for Medicare Advantage Plans | Fox Business.

Review & Outlook: The Liberal Medicare Advantage Revolt – WSJ.com

A big political story this year is likely to be Democrats turning on their White House minders as the harmful and unpopular parts of the Affordable Care Act ramp up. On the heels of the recent 79-20 Senate uprising against the 2.3% medical device tax, now comes the surge of Democrats pleading on behalf of Medicare Advantage.Liberals have claimed for years to hate this program, but by now Advantage provides private insurance coverage to more than one of four seniors. And those seniors like it.However, the ObamaCare true believers who run the Health and Human Services Department dont answer to voters, and they have written draft regulations that cut Medicare Advantage even more deeply than Congress mandated in the Affordable Care Act. Those cuts will bite hardest in states like Oregon where 42% of Medicare beneficiaries use Advantage, or Florida 37%, New York 33%, California 37% and Arizona 38%.

via Review & Outlook: The Liberal Medicare Advantage Revolt – WSJ.com.

Common Ground in Washington for Medicare Changes – NYTimes.com

As they explore possible fiscal deals, President Obama and Congressional Republicans have quietly raised the idea of broad systemic changes to Medicare that could produce significant savings and end the polarizing debate over Republican plans to privatize the insurance program for older Americans.

via Common Ground in Washington for Medicare Changes – NYTimes.com.

Daring to be cautious?: Bigger steps needed for Medicare cost-sharing reform – Health – AEI

Finding economically feasible and politically safe options for cutting costs in Medicare has proven to be no easy task. A variety of government organizations, including the Congressional Budget Office and Medicare Payment Advisory Commission, and health policy researchers, such as MIT economist Jonathan Gruber, have put forth plans to improve the program, but they often diminish potential savings by playing it too safe. The best option for sustainable reform appears to be a major-risk approach toward restructuring cost-sharing requirements. This involves a higher coinsurance rate and an income-related stop-loss cap on participants’ annual cost-sharing liabilities. An additional key to subsidizing high-income seniors less is by restricting their use of supplemental insurance such as Medigap for early-dollar spending, rather than taxing the coverage itself.

via Daring to be cautious?: Bigger steps needed for Medicare cost-sharing reform – Health – AEI.

Bedside Bureaucrats: Why Medicare Reform Hasn’t Worked by Nicholas Bagley :: SSRN

Notwithstanding its obvious importance, Medicare is almost invisible in the legal literature. Part of the reason is that administrative law scholars typically train their attention on the sources of external control over agencies’ exercise of the vast discretion that Congress so often delegates to them. Medicare’s administrators, however, wield considerably less policy discretion than the agencies that feature prominently in the legal commentary. Traditional administrative law thus yields slim insight into Medicare’s operation.

But questions about external control do not – or at least they should not – exhaust the field. An old and often-disregarded tradition in administrative law focuses not on external constraints, but on the internal control measures that agencies employ to shape the behavior of the bureaucrats who implement government programs on the ground. A robust set of internal controls is necessary whenever central administrators seek to align the actions of line officers with programmatic goals. And they are all the more necessary when, as is so often the case in the modern administrative state, implementation authority is vested in private actors, not government officers.

So it is with Medicare, whose street-level bureaucrats are hundreds of thousands of private physicians with strong professional commitments and no particular allegiance to governmental priorities. Yet Congress’s persistent failure to address weaknesses in Medicare’s administrative structure has stymied a series of major reform efforts that have sought to make the program’s physicians more attentive to the cost and quality of the medical care for which it pays. This dismal history suggests that crafting an effective internal law for Medicare will require Congress to refashion the program around private organizations with the capacity, incentives, and legitimacy to align the practice patterns of private physicians – its bedside bureaucrats – with federal priorities. Measured against that baseline, the set of Medicare reforms included in the Affordable Care Act is a disappointment. A more muscular, thoughtful, and sustained effort is needed.

via Bedside Bureaucrats: Why Medicare Reform Hasn’t Worked by Nicholas Bagley :: SSRN.