Tag Archives: CHIP

Medicare compromise

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Congressional leaders Pelosi, McConnell, Reid, Boehner hold hands after passing bipartisan bill (AP Photo/Susan Walsh)

Sad to say, the optimism in a post I wrote a month ago was misplaced. “Don’t look now, but we’re actually governing!” was quite misleading. While it’s true that the bipartisan legislation passed with overwhelming support from both parties and it solved the “doc fix” dilemma that had been frustrating doctors and legislators for years, it does so at a significant cost (surprise, surprise!).

The physicians were being paid successively less each year, and many were threatening to leave Medicare while others had already left. The new legislation will give them a guaranteed 0.5 percent pay hike for the next five years. While the doctors win, wealthier seniors (earning $133,500 to $214,000 yearly) will pay more for their medical insurance and prescription drug coverage.

Somebody has to pay, not just seniors. Medicare’s budget will be cut by billions of dollars. Spending for long-term care (hospice, home health services, nursing homes) will also be reduced. A reason to cheer, though, is the two-year extension of CHIP, the Children’s Health Care Program.

Pres. Obama is extremely happy to sign the second most significant health care bill after the Affordable Care Act, popularly known as Obamacare. The Tea Party of course isn’t happy. Senators Ted Cruz (R-TX) and Marco Rubio (R-FL) denounced the bill because it will add to the deficit. (These presidential contenders seem to be going out of their way to antagonize significant sectors of the electorate with their stances on immigration, gay marriage, and now seniors.)

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“Don’t look now, but we’re actually governing!”

PelosiBoehnerSo said Rep. Renee Elmers, Republican of North Carolina. She was celebrating the achievement of House Republicans and Democrats, who accomplished the seemingly impossible. Speaker John Boehner (R-OH) and Democratic Leader Nancy Pelosi (D-CA) found a way to reduce Medicare costs while improving medical care and then sold the deal to their caucuses. The parties actually negotiated and came to a bipartisan agreement on how to fix Medicare’s financial woes and other health-related problems. In today’s polarized government, this was nothing short of a miracle.

The sweeping change to Medicare is to reward doctors based on successful outcomes rather than fee-for-service. Until now, doctors were paid for every test and procedure they ordered or performed, regardless of the outcome. “Now,” said Marilyn Moon, a health economist and former trustee of the Medicare program, “doctors get paid more if they do more. In the future, they will be paid more if they do it better — and may be paid more for doing less.”

Some of the cost will be offset by higher premiums for the wealthiest Medicare beneficiaries. Without this bill, physicians with Medicare patients would face a 21-percent reduction in their fees on April 1. Many doctors would consequently feel compelled to drop out of Medicare, leaving seniors scrambling for access to many fewer doctors. Republicans also agreed to extend CHIP, the government-funded health insurance for needy children. Democrats wanted a four-year extension, but settled for two years in the hope of a longer extension in the future.

What remains is for the Senate to vote its approval. Passage of the bill in Senate is all but certain, given the overwhelming majority in the House, which passed the bill by a vote of 392 to 37. Pelosi corralled all but four Democrats to vote in favor, while Boehner lost only 33 of the most conservative Republicans.

Was this an amazing fluke, or are the people we elected to govern actually learning to play well together? Stay tuned.

Photo by KAZ Vorpal

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Filed under Health, Politics