Medicare – Actuarial News

The federal budget outlook

March 21, 2023March 21, 2023 Mary Pat Campbell

Link: https://www.brookings.edu/research/the-federal-budget-outlook-2/

PDF of report: https://www.brookings.edu/wp-content/uploads/2023/03/20230313_TPC_Gale_FiscalOutlookFINAL.pdf

Graphic:

Excerpt:

The basic story is familiar. Low revenues coupled with rising outlays on health-related programs and Social Security drive permanent, rising primary deficits as a share of the economy. Net interest payments also rise substantially relative to GDP due to high pre-existing debt, rising primary deficits, and gradually increasing interest rates. Unified deficits and public debt rise accordingly.

Under current law for the next 10 years, the CBO’s projections imply that persistent primary deficits will average 3.0% of GDP. Net interest payments will rise from 2.4% of GDP currently to 3.6% in 2033, an all-time high. The unified deficit, and even the cyclically adjusted deficit, will exceed 7% of GDP at the end of decade. Debt will rise from 98% of GDP currently to 118% by 2033, another all-time high.

Over the following two decades, the projected trends are even less auspicious. Primary deficits rise further as spending on Social Security and health-related programs continue to grow faster than GDP and revenue growth remains anemic. The average nominal interest rate on government debt rises to exceed the nominal economic growth rate by 2046, setting off the possibility of explosive debt dynamics. By 2053, relative to GDP, annual net interest payments exceed 7%, the unified deficit exceeds 11%, and the public debt stands at 195%. All these figures would be all-time highs (except for deficits during World War II and in the first two years of the COVID-19 pandemic) and would continue to grow after 2053.

Author(s): Alan J. Auerbach and William G. Gale

Publication Date: 14 Mar 2023

Publication Site: Brookings

Canada’s Health Care Crisis Is in Large Part a Labor Crisis

February 7, 2023February 7, 2023 Mary Pat Campbell

Link: https://jacobin.com/2023/02/canada-health-care-crisis-labor-shortage-wage-cuts-austerity

Excerpt:

Canada’s system of Medicare — a point of national pride — was strained before the COVID-19 pandemic hit. It’s now teetering on the brink, with some Conservative provincial leaders salivating at the prospect of privatization.

For months, provincial premiers have been demanding that the federal government increase health transfer payments. Indeed, the cost-sharing model which sees the federal government currently kick in around 22 percent of health funding should be revised so that Ottawa pays more of the bill. Although a deal to boost federal funding appears to be in sight, Prime Minister Justin Trudeau and the Liberals are failing to ensure that protecting public health care delivery is a part of it.

….

Canada’s health care crisis is in large part a labor crisis. In general, unceasing anguish over a generalized “labor shortage” in Canada has had only the most tenuous relationship to reality. In the health care sector, however, worker burnout and a consequent lack of staff are all too real. While the Canadian Federation of Independent Business, the mouthpiece of Canadian employers, bemoaned a purportedly economy-wide labor shortage that was crippling business, an actual dearth of nurses and other health care professionals snowballed as deteriorating pay and working conditions drove these workers out of their jobs.

Newly released Statistics Canada payroll data helps paint the picture. Overall payroll figures show year-over-year employment across the whole economy virtually unchanged in November 2022, despite the Bank of Canada’s aggressive series of interest rate hikes (how much longer stable employment numbers will persist is debatable). Job vacancies — the bugbear of employers in Canada for most of the past year — declined another 2.4 percent, down to 850,300 from 1,002,200 at their peak, and reached their lowest post-pandemic level since August 2021. Average weekly wage growth, while continuing to lag inflation, ticked upward slightly to 4.2 percent (5.3 percent in goods-production alone).

Author(s): Adam D.K. King

Publication Date: 1 Feb 2023

Publication Site: Jacobin

Fight to Rename ‘Medicare Advantage’ Gets New Push

February 2, 2023 Mary Pat Campbell

Link: https://www.thinkadvisor.com/2023/02/01/fight-to-rename-medicare-advantage-gets-new-push/

Excerpt:

Rep. Mark Pocan and two colleagues are reviving a fight to take “Medicare” out of the name of the Medicare Advantage program — and, this time, they have a YouTube that looks like a parody of a Medicare Advantage TV ad.

The Wisconsin Democrat introduced the new version of the Save Medicare Act bill today, together with Reps. Ro Khanna, D-Calif., and Jan Schakowsky, D-Il..

The sponsors are promoting the position that “only Medicare is Medicare,” and that a Medicare Advantage plan may fail to provide the care that an older Medicare enrollee might need.

….

The bill would rename the Medicare Advantage program and prohibit Medicare Advantage plans from using the word “Medicare” in plan titles or ads.

The Pocan-Khanna-Schakowsky bill is a new version of H.R. 9187, a bill that Pocan and Khanna introduced in the 117th Congress. That bill had a total of four co-sponsors, all Democrats.

H.R. 9187 died in the House Energy and Commerce Committee and the House Ways and Means Committee at a time when Democrats controlled the House.

Author(s): Allison Bell

Publication Date: 1 Feb 2023

Publication Site: Think Advisor

How Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers by Millions

December 20, 2022December 20, 2022 Mary Pat Campbell

Link: https://khn.org/news/article/medicare-advantage-auditors-overcharged-taxpayers/

Excerpt:

A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.

The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013.

As KHN reported late last month, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.

Author(s): Fred Schulte and Holly K. Hacker

Publication Date: 13 Dec 2022

Publication Site: Kaiser Health News

Will Democrats Try Cutting Social Security and Medicare After a Disastrous Midterms?

June 20, 2022June 20, 2022 Mary Pat Campbell

Link: https://jacobin.com/2022/06/austerity-entitlement-reform-social-security-democrats-gop

Excerpt:

Days after Obama lamented Democrats’ 2010 electoral “shellacking,” his commission released a plan to slash Social Security benefits and raise the program’s eligibility age. Economist Paul Krugman noted at the time that the commission also suggested using newly gained revenue to finance “sharp reductions in both the top marginal tax rate and in the corporate tax rate.”
The plan ultimately did not receive the fourteen commission votes it needed to move forward, and a few years later in 2012, the House voted down a version of the proposal. That didn’t stop the Obama-Biden administration’s push: right after winning reelection — and after cementing much of the George W. Bush tax cuts — they tried to limit cost-of-living increases for Social Security, to the applause of Republican lawmakers.
…..
Like Obama, Biden campaigned on a promise to protect Medicare and Social Security. But as we have reported, Biden is already affirming big Medicare premium increases and accelerating the privatization of that health care program. Biden also has not pushed to fulfill his promise to expand Social Security, even though there is new Democratic legislation that would do so.
And now with Graham’s comments, Republicans are banking on him becoming the old Joe Biden on Social Security if they win in November.
It’s not an insane political bet. After all, Biden for decades proposed cuts and freezes to Social Security and publicly boasted about it. Indeed, Biden spent most of his career depicting himself as an allegedly rare and courageous Democrat who was willing to push off his party’s base and tout austerity.

Author(s): David Sirota

Publication Date: 16 Jun 2022

Publication Site: Jacobin

As our entitlements crisis gets closer, a solution moved farther away

June 11, 2022June 13, 2022 Mary Pat Campbell

Link: https://www.washingtonpost.com/opinions/2022/06/09/social-security-medicare-crisis-approaching/

Excerpt:

The annual Social Security trustees report is once again upon us, and this year it actually bears some good news: The projections give us an extra year before the trust fund is exhausted in 2035.
At least, this sounded like good news when I first heard it. Then I remembered that I have been writing about these trustees reports for more than 15 years. When I started, all these projections sounded comfortably far off — we had decades to fix the problem! Now we have 13 years. And in all that time, we have done nothing at all, except watch the date of insolvency advance.
In 2008, it was 2040, and the people likely to be worst affected — those who would be eligible to retire just as the trust fund was exhausted — were 35. Now, the people facing the most disruption are 54, much closer to retirement than to their college graduation.
In the meantime, the politics of fixing America’s old-age entitlements has gotten considerably worse.

Author(s): Megan McArdle

Publication Date: 9 June 2022

Publication Site: Washington Post

Top 10 Medicare Bills Introduced in 2022

June 10, 2022June 10, 2022 Mary Pat Campbell

Link: https://www.thinkadvisor.com/2022/04/28/top-10-medicare-bills-introduced-in-2022/

Excerpt:

Here’s a look at the top-performing Medicare bills introduced since Jan. 1.
We searched Congress.gov for new Medicare bills, then ranked the bills based on co-sponsorship bipartisanship and numbers.
Some of these bills could pass on their own. Others could surface as provisions in much larger bills, such as a Ukraine aid bill or a COVID-19 pandemic response funding bill.
What It Means
These measures seem to have the legislative mojo to go places.
Each sponsor has managed to overcome the current hostility between Republicans and Democrats and persuade at least one member of the opposite party to sign on as a co-sponsor.

Author(s): Allison Bell

Publication Date: 28 April 2022

Publication Site: Think Advisor

Despite a First-Ever ‘Right-to-Repair’ Law, There’s No Easy Fix for Wheelchair Users

June 5, 2022June 5, 2022 Mary Pat Campbell

Link: https://khn.org/news/article/power-wheelchair-users-right-to-repair-law-no-easy-fix/

Excerpt:

The multibillion-dollar power-wheelchair market is dominated by two national suppliers, Numotion and National Seating and Mobility. Both are owned by private equity firms that seek to increase profits and cut spending. One way they do that is by limiting what they spend on technicians and repairs, which, when combined with insurance and regulatory obstacles, frustrates wheelchair users seeking timely fixes.
The $70 billion durable medical equipment market has been an attractive target for private equity investment because of the aging U.S. population, the increasing prevalence of chronic conditions, and a growing preference for older adults to be treated at home, according to the investment banking firm Provident Healthcare Partners. Medicare’s use of competitive bidding favors large companies that can achieve economies of scale in manufacturing and administrative costs, often at the price of quality and customer service.
Regulations set by Medicare and adopted by most Medicaid and commercial health plans have led to lower-quality products, no coverage for preventive maintenance, and enough red tape to bring wheelchairs to a halt.
Power wheelchair users have long been fighting for the right to repair their wheelchairs themselves or through independent repair shops. Medicare and most insurance companies will replace complex wheelchairs only every five years. The wheelchair suppliers that have contracts with public and private health insurance plans restrict access to parts, tools, and service manuals. They usually keep a limited inventory of parts on hand and wait until health plans approve repair claims before ordering parts.
Some chairs require a software passcode or a physical key for any repairs. Wheelchair users who make fixes themselves may void their warranty or lose out on insurance payments for repairs.

Author(s): Markian Hawryluk

Publication Date: 2 June 2022

Publication Site: Kaiser Health News

On Social Spending, the Question Isn’t “Can We Afford It?” but “Who Will Pay?”

December 13, 2021December 13, 2021 Mary Pat Campbell

Link:https://jacobinmag.com/2021/11/social-spending-biden-reconciliation-bill-build-back-better

Excerpt:

There are three possible answers to the question of who pays for social expenses. First, governments can pay by taxing their citizens to fund social programs. Second, employers can pay by using corporate revenues to provide employment-related benefits. Third, individuals and families can pay out of pocket, rely on unpaid labor from friends and relatives, or make do without.
For much of the twentieth century, the United States had a workable answer to the “Who pays?” question that drew on a mix of all three sources. Government provided certain social benefits like Social Security, Medicare, and public education. Aided by government tax incentives, many employers offered a wide range of benefits like health insurance and pensions, creating what political scientist Jacob Hacker refers to as a “public-private welfare regime.” And with one-third of the labor force unionized, and even nonunion employers pressured to match union-scale wages and benefits, many workers earned enough to support their families and handle the social expenses not covered by government- and employer-based programs.
….
For its part, government social spending has been uneven. Large universal programs like Medicare and Social Security have proven resistant to most retrenchment efforts, and Obamacare included a major expansion of Medicaid — though this was blocked in some Republican-dominated states. Meanwhile, more means-tested programs targeting low-income Americans have proven more vulnerable. In a context where employers have sharply cut back their commitment to providing social benefits, and individuals and their families are faced with stagnating wages, government’s response has proven inadequate.

Author(s):Barry Eidlin

Publication Date:28 Nov 2021

Publication Site: Jacobin

How Will The Biden Medicare Dental Plan Affect The Trust Fund Solvency?

September 24, 2021September 24, 2021 Mary Pat Campbell

Link:https://www.forbes.com/sites/ebauer/2021/09/20/how-will-the-biden-medicare-dental-plan-affect-the-trust-fund-solvency/

Excerpt:

Among the changes coming if the Democrats succeed in their $3.5 trillion reconciliation bill would be the inclusion of dental, vision, and hearing coverage through Medicare, possibly in 3 – 5 years due to implementation challenges, and with suggestions of a voucher/cash payout in the meantime. There is not yet an official cost estimate as the details are still being negotiated, but a similar proposal in 2019 would have cost $358 billion over 10 years.
At the same time, late last month, the latest Trustees’ Report for Medicare determined that the Medicare Part A Trust Fund will be exhausted in the year 2026, which, if you do the math, is a mere five years from now. At that point, Medicare would have to cut reimbursement rates for doctors by 9%, increasing to 20% in 2045, or even more if the report’s assumptions don’t pan out.
How will the new dental benefits — assuming they remain in the bill — affect Medicare Part A and its trust fund? Strictly speaking, not at all. The new benefits would be a part of Part B of the program, that is, doctors’ charges, rather than Part A, which covers hospital charges. In one respect, it would be its own benefit structure entirely, since, unlike “regular Part B” Medicare, the proposal would have the federal government pay 100% of the benefit’s costs, rather than requiring participants to pay a 25% cost-share premium. It would, in a way, become Medicare Part E.

Author(s): Elizabeth Bauer

Publication Date: 20 Sept 2021

Publication Site: Forbes

Nursing homes warn vaccine mandate could lead to staff shortages

September 5, 2021September 5, 2021 Mary Pat Campbell

Link: https://thehill.com/policy/healthcare/570807-nursing-homes-warn-vaccine-mandate-could-lead-to-staff-shortages

Excerpt:

The Biden administration’s vaccination requirement is putting a squeeze on nursing homes as they try to balance protecting residents and retaining low-wage staff that have been reluctant to get the shot.
Later this month, the administration will outline a policy that requires all staff working at nursing homes to be vaccinated or risk the facilities losing federal funding.
The specifics of the policy are sparse so far, but it would effectively be a mandate for an industry that relies heavily on Medicare and Medicaid funding.https://aef67baff698e02f95a8ec2b0d53753d.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
Only about 62 percent of nursing home and long term care facility staff are fully or partially vaccinated nationally, according to federal data compiled by the Centers for Medicare and Medicaid Services (CMS).
…..
“The biggest group of unvaccinated staff are certified nurse aides. They’re making close to minimum wage. They can make that, maybe even more, plus maybe even better benefits out in retail jobs, restaurant jobs. The vast majority of those employers are not imposing mandates,” Grabowski said.

Author(s): NATHANIEL WEIXEL

Publication Date: 4 September 2021

Publication Site: The Hill