An HHS Spin Job on Medicare Premiums?

On Thursday, officials from the  Health and Human Services department announced the premiums and deductibles that Medicare beneficiaries will pay in 2012. There were two main messages from those officials: that beneficiaries are paying less because utilization was down last year, and that the Affordable Care Act has had a role in bringing the costs down.

Courtesy Wikimedia Commons/jaqian/Creative Commons License

“The Affordable Care Act is helping to keep Medicare strong and affordable,” HHS Secretary Kathleen Sebelius said in a statement. “People with Medicare are seeing higher quality benefits, better health care choices, and lower costs. Health reform is also strengthening the Medicare Hospital Insurance Trust Fund and cracking down on Medicare fraud.”

“Thanks in part to the Affordable Care Act, people with Medicare are going to have more money in their pockets next year,” said Dr. Donald Berwick, administrator of Centers for Medicare and Medicaid Services, in the same statement. “With new tools provided by the Affordable Care Act, we are improving how we pay providers, helping patients get the care they need, and spending our health care dollars more wisely.”

These were a lot of bold statements that didn’t really seem to be backed up by any of the fact sheets put out by the agencies or in a briefing with reporters. Dr. Berwick said on the call that Medicare recipients had used less services in 2011 (the basis for 2012 premiums), but never gave a good explanation for why seniors had used less health services.

Even if a reporter had wanted to probe the point, he or she first had to hack through the thicket of numbers in the HHS press releases. The conference call itself was incredibly brief, leaving very little leeway to get at the root of the complicated issues that drive Medicare premiums and deductibles.

Officially, according to CMS, the hospital premium (Part A) will rise only $1 per month in 2012; the hospital deductible will rise $24 to $1,156.  Those coinsurances are shouldered by only about 1% of Medicare enrollees, though. Most have more than 40 quarters of pay in the system, and thus don’t pay Part A premiums.

The numbers on premiums for physician services were more confusing. According to CMS, the standard Part B monthly premium will be $99.90 in 2012, a $15.50 decrease from this year’s $115.40.  The majority of beneficiaries, however, for various reasons, paid only $96.40 per month in 2011. Thus, they’ll see a $3.50 increase.

But wait. The Part B premium, though, is based on annual income, so it’s hard to really give an average figure.

Part B premiums are calculated to cover one-fourth the cost of physician services, plus a contingency margin that is essentially equivalent to an insurer’s reserve.

This has nothing to do with health reform; it’s been a statutory requirement since, well, for a long time. And the contingency margin is always dependent on what happens with the Sustainable Growth Rate formula.

CMS assumes every year that the SGR will be overturned, so that calculation also has nothing to do with health reform.

For an administration that prides itself on transparency, it seems to have done little today to pull back the curtain on Medicare spending — even as Dr. Berwick said that transparency itself had led to lower costs.

— Alicia Ault (on Twitter @aliciaault)

Funding More Primary Care: The Policy & Practice Podcast

The Obama Administration made good on its promise last week to help fund more primary care, as it released some $320 million in grants designed to train more doctors, nurses, dentists, and mental health providers.  This is especially important as health reform comes on line and more people have access to health care.

Photo via Seattle Municipal Archives flickr stream

But even as HHS Secretary Kathleen Sebelius announced this boost, a Kaiser Family Foundation study showed that some states have begun cutting their Medicaid payments to physicians.  The move is a response to the recession and states’ inability to meet budget demands.

Take two minutes out of your day to hear our synopsis:

– Alicia Ault (on Twitter @aliciaault)

Outreach or Propaganda?

When it comes to the overheated rhetoric of the health reform debate, a brochure is never just a brochure. Officials at the Centers for Medicare and Medicaid Services recently sent a four-page mailing to seniors called “Medicare and the New Health Care Law—What It Means for You.” Almost immediately, Republicans in Congress blasted the communication as government-funded propaganda and demanded that the Government Accountability Office investigate the claims made in the brochure.

 

The GOP lawmakers have a long list of complaints about the brochure, starting with the fact that even though it is being sent to Medicare beneficiaries, it includes information about how the new health reform law benefits children with preexisting conditions and early retirees under age 65 years.

 

HHS Secretary Kathleen Sebelius. Photo courtesy of HHS.

But Republicans say the brochure also leaves out plenty of information. For example, they take issue with the claim that seniors will still have a choice of physicians. Instead, GOP lawmakers counter that, because Democrats didn’t provide a fix to the Medicare physician fee formula in health reform, doctors may choose not to see Medicare patients.

The Obama administration is proud of their brochure and Health and Human Services Secretary Kathleen Sebelius defended it at a press briefing earlier today. She said the brochure will set the record straight on what changes health reform will bring to the Medicare program as well as what will stay the same. And she said seniors need correct information to protect them from criminals who have been using the law as a pretext for scams.

 Take a look at the brochure and let us know, is it fact or fiction? 

— Mary Ellen Schneider (on Twitter @MaryEllenNY) 

 

The War at Home: The Policy & Practice Podcast

From press briefings and goings-on around Washington, D.C.

Lawmakers returned to their districts last week for their month-long break and health reform was pretty much at the top of the agenda for meetings with constituents.  Right away, it was clear that this was not going to be an ordinary summer recess, however.  Many representatives and Senators were met by angry mobs demanding to stop what they said was a “government takeover” of health care.

Courtesy of Flickr Creative Commons user Robert Couse-Baker

Hmmm, anyone remember way back in 1988 when disgruntled senior citizens chased then-Ways & Means Committee Chairman Dan Rostenkowski down a Chicago street like they were paparazzi after Britney Spears on a Beverly Hills shopping spree?  Some say that action derailed the Medicare Catastrophic Coverage program that was in play on the Hill at that time.  Could lightning strike twice? Such thoughts are ricocheting around the blogosphere (see here and here ) now that the debate’s shifted to Congress’ home turf.

For the latest on the war of words over health reform, take a listen to this week’s podcast.  Two, short-but-sweet, minutes.

Policy & Practice Podcast, August 10, 2009

–Alicia Ault (on Twitter @aliciaault)