The enormous cost of providing long-term care represents a major challenge for America's health system, and a major funding challenge for Medicaid, the public program that covers much of the cost of long-term care. To identify a solution to this challenging problem, the Bipartisan Policy Center (BPC) recently launched a Long-Term Care Initiative (LTCI) to find a politically and fiscally viable path forward to improve the financing and delivery of long-term services and supports (LTSS).
Budget Committee Chairman Paul Ryan’s (R-WI) FY 2015 budget achieves $3 trillion of its $5.1 trillion in deficit reduction over the next ten years from health care programs, predominantly from repealing the coverage expansions passed in the Affordable Care Act (ACA). Repealing those coverage expansions alone would reduce spending by $2.1 trillion through 2024. Notably, though, Ryan’s budget leaves the ACA’s Medicare reforms in place (although also creates a reserve fund to make it easier for Congress to replace those reforms with other cuts).
The Senate voted 64-35 today to approve a 12-month temporary “doc fix” to push back the impending nearly 25 percent cut to Medicare physician payments dictated by the Sustainable Growth Rate (SGR) formula.
Congress is considering another 12-month doc fix, averting a 24 percent cut in Medicare physician payments scheduled for April 1. While the SGR patch contains several serious reforms that would reduce future health care costs, it contains one big accounting gimmick that accounts for about one-fifth of the bill's savings.
(Updated to incorporate new information from the Congressional Budget Office's score of the doc fix bill)
In lieu of a permanent agreement and with the deadline approaching in five days, new legislation has emerged in the House to extend the "doc fix" and other health extenders for a year. This legislation would avert a 24 percent cut in Medicare physician payments due in April from the Sustainable Growth Rate (SGR) formula, instead freezing physician payments through March 2015.
The end goal remains a permanent replacement of the SGR formula, but with no agreement reached on pay-fors and three of the four proposals either offsetting the costs with gimmicks or simply ignoring its costs altogether, lawmakers appear ready to move a host of smaller Medicare reforms to pay for another temporary patch.
Proposals to "pay for" (or not pay for) a repeal of the Sustainable Growth Rate (SGR) formula have come out this week, and the verdict has been mostly not good.
To bolster their case against offsetting the high cost of SGR reform, many have claimed that the Medicare Sustainable Growth Rate (SGR) is “budget fakery” and represents “savings that aren’t going to be realized.” Yet while it’s true most SGR cuts have not gone into effect as scheduled, that doesn’t mean the SGR hasn’t helped to control health care costs.