House GOP eyeing major Medicare overhaul in 2017

[Bill Peckham]

http://thehill.com/policy/healthcare/306540-house-gop-eying-major-medicare-overhaul-in-2017
House GOP eying major Medicare overhaul in 2017


The head of the House Budget Committee said Thursday that lawmakers are eying [sic] an overhaul of Medicare next year.

Budget Committee Chairman Tom Price (R-Ga.) said he expects lawmakers to push forward with an overhaul “within the first six to eight months” of President-elect Donald Trump's administration. He said it would be tackled through the budget tactic in the Senate called “reconciliation,” which allows major spending-related bills to pass the upper chamber without a veto.

“I think that’s probably in the second phase of reconciliation, which would have to be in the fiscal year 2018 budget,” Price added.

It's the first time that a House GOP leader has said officials are planning to fast-track an overhaul of Medicare in 2017.

It's unclear how far House Republicans will go in making changes to Medicare — a process that will especially tricky through reconciliation.

House Republicans have released a range of proposals, from eliminating the ObamaCare cost-cutting panel called the Independent Payment Advisory Board to a major shift that would phase out the publicly run program into private plans.

Overhauling Medicare has been a major goal for Speaker Paul Ryan (R-Wis.) since 2011.

Fiscal conservatives have also been eager for reform of the nation’s entitlement programs, which comprise the bulk of the federal mandatory spending not controlled by Congress.

[Bill Peckham]

I think the idea that replacing Medicare with Private insurers would somehow save money without decreasing service makes no sense.

Our own experience as dialyzors allows us to see why. Right now the allowable reimbursement rate of an incenter dialysis treatment for a Medicare beneficiary is set at about $250 (give or take). Any payer that is smaller than Medicare does not get to pay that rate. If you dilute Medicare's buying power by privatizing the system each treatment will necessarily require more reimbursement. There are no savings to be had.

Our intimate experience with managing a chronic disease as Medicare beneficiaries gives us the standing and experience to speak out about proposed changes to Medicare. We all have 6 to 8 months to connect with our representatives and tell our stories. We have 6 to 8 months to participate in this process and work to ensure our own continuity of care. It is time to dig into the weeds and think through how our care is financed today and how it can continue to be supported tomorrow.

[kickingandscreaming]

Are you aware of any advocacy body that may be organizing a response?  This is the cue for right wingers to shame us as entitled parasites for being interested in prolonging our lives.....

[MooseMom]

Thank you for posting this, Bill.  Yep, Paul Ryan has been eyeing this for years.  He is part of the swamp that the President-Elect's voters wanted to see drained, yet he is still the Speaker of the House.  I heard about this in passing in the media just a few days ago, and I've been on the lookout for more information, but so far, nothing. 

[Bill Peckham]

Josh Marshall has a good analysis here

http://talkingpointsmemo.com/edblog/where-do-we-stand-on-phasing-out-medicare

The thing to worry about is that there is legislation already written to phase out Medicare from 2015 whereas Obamacare repeal legislation doesn't exist. It is a pretty good bet that one lesson thE republicans learned from Obamacare is don't drag the process out. If they want to pass big legislation in the first hundred days you would have to think this would be one of the pieces under consideration.

I think this is a situation we're making a lot of noise would slow the process down and slowing the process down is in the interest of people who believe Medicare should be available in the same form to people in 5 years, 15 years and 25 years. One way to put it is that the government should continue to carry the risk of increasing health care costs.

If you are ready to do something today I would try to start a conversation with your senator or more likely your Senator's office. Ask them about Medicare, ask them: what do they see in Medicare's legislative future? Hopefully you'll get a response and then you can continue the conversation as more information becomes available but it would be good for them to know that they have a constituent who is interested no matter who you voted for or which party your Senator represents.

[nursey66]

That was my biggest fear with Trump , that and social security . He will put all of us on SS and Medicare in the poor house . We are doing just fine now , With me retired and a small 401 k to draw on for extras , my husband who is 64 , I am 70 , he is on SSDI with no 401 k at all . Able to get meds and  other stuff, clinic , Drs , surgery, testing , all for a good affordable cost .  For me , that is why I voted for Hillary , she wouldn't of changed what means the most for us . Trump will have you draining your money, losing your house, unable to make it without going broke, and then what ? This is really adding so much more stress to my life, I can't tell you . At my age I don't need it , especially when my husband is on a new kidney transplant , his second , and has lots of other medical issues to deal with. . I like Medicare the way it is , no changes. Please. ,!!!!

[kickingandscreaming]

I second your fear, Nursey. 

I'm 75, a widow and I'm on dialysis with no prospect for Tx.  I have always been self-employed, but with my change in health circumstances, I don't have the same drive to push my business as before and I'm not really earning anything.  I had a second business that I've had to give up entirely.   I'm quite scared to have Medicare and SS "reformed" (that's republican-speak for FUBAR and privatized, discontinued or worse).  I think even Trump supporters will be unhappy to learn that the Medicare/SS gravy train has crashed, especially since The Oranged One promised to leave them alone.  So much for promises.

I'm in MA (a relaively enlightened state) and I know my Senators are  already on my side in this.  But they're on the "wrong" side of the aisle.

[Rerun]

Speculation.  You guys are wearing yourselves out for nothing. 

[kickingandscreaming]

Speculation.  You guys are wearing yourselves out for nothing.

And you are in deep denial.

[Simon Dog]

I think even Trump supporters will be unhappy to learn that the Medicare/SS gravy train has crashed, especially since The Oranged One promised to leave them alone.  So much for promises.

Reminds me of "If you like your doctor, you can keep your doctor".

[MooseMom]

Speculation.  You guys are wearing yourselves out for nothing.

What is not "speculation" is that Paul Ryan has been gunning for Medicare for a long time.  What IS speculation is whether or not Trump will agree with Ryan and will sign legislation, assuming said legislation gets through Congress.  He has already backtracked about repealing all of the ACA in that he doesn't want those with pre-exisiting conditions to be uninsurable, so it is not definite that he will side with Paul Ryan on Medicare.

It is no secret that the two men do not get along, so it will be interesting to see if Trump squashes Ryan's dream just because he can.

It is true that Ryan is going to try to get legislation passed in the early days of Trump's presidency because he is counting on the nation's attention being elsewhere.  The media is fascinated by the idea of Trump, so what Paul Ryan is doing on the side probably won't be revealed through our mainstream media.  In Ryan's view, that's just good politics.

What I don't understand is why Ryan would turn on the "forgotten people" who voted for Trump and take away their Medicare and replace it with something that will benefit corporations and the elites who will profit from the privatization of Medicare.  This is exactly the kind of thing these voters voted against.  Paul Ryan is about as "elite" as it gets, and he is backed by powerful lobbyists who reside in the swamp that is DC. 

[Bill Peckham]

Judging by the 2015 plan that message will be if you're over 55 nothing will change and if your under fifty-five you'll have the option of opting in to the current system.

They are pushing the idea that the Affordable Care Act did something to harm the long-term viability of Medicare. In fact the Affordable Care Act  has strengthened Medicare, but if people believe otherwise  then Affordable Care Act reform can include "privatization" of Medicare. This Administration's approach to governance is to turn as much as it can, as many functions of government as possible, over to contractors. That will be their approach on infrastructure, private Public Partnerships, with the emphasis on private.

This approach to governing may directly  impact  the way dialysis is provided. There was legislation in the last  Congress  that would have set up  corporations to manage  all Medicare  funded care for individuals with ESRD. Basically it would be single payor, with a corporation being the payor, an LDO coughcoughDaVitacough, for instance.

It's S 3090, the name of the act is the "Dialysis patient demonstration Act of 2016" or the "Patient access to integrated care, empowerment, nephrologists and treatment demonstration Act of 2016" ... I know it sounds great but you read it and what they are setting up is to make an LDO the fiscal intermediary for Medicare beneficiaries who rely on dialysis.

That's the direction I think this Administration will try to steer Medicare, basically transferring the risk of increasing costs to either the  private sector or  the beneficiaries. The risk here is that they will take existing legislation and quickly push it through before any sort of advocacy can happen.

[Simon Dog]

This Administration's approach to governance is to turn as much as it can, as many functions of government as possible, over to contractors.

Sometimes this deceases costs; sometimes not.  A big question is "would contractors pay the same cost controlled medicare rates?".

[Rerun]

I think it is good Trump is flexible.  Insurance should have to cover preexisting conditions.  You all are cutting your nose off to spite your face...

 

[MooseMom]

I think it is good Trump is flexible.  Insurance should have to cover preexisting conditions.  You all are cutting your nose off to spite your face...

 

But if you go back and looks at these posts, you'll notice that we aren't talking so much about Trump as we are about Paul Ryan.  The irony is that we all may need Trump to save us from Paul Ryan.

[Simon Dog]

I think it is good Trump is flexible.  Insurance should have to cover preexisting conditions.

As a person with such a condition, I agree this is in my best interest.  This means an insurer will have to sell me a policy guaranteed to lose money - so they question becomes who makes up the difference between what I would pay and actuarially sound rate?

[Shaks24]

Here is an advocacy group that is very interested in preserving SS and Medicare as it is.  http://www.ncpssm.org/  You can get updates here and join to make your voice heard. Ryan is not pushing this agenda to benefit us. He is doing it to cut government spending on medicare which means we will pay more for less. Whats scary is that Trumps transition website changed to include the term "modernize medicare". What does that mean? Ryan seems to indicate they are on the same page in some interviews I saw. We need to make our voices heard on this issue. I am shocked that there has been no major backlash from the AARP to this point.

[CW]

This Administration's approach to governance is to turn as much as it can, as many functions of government as possible, over to contractors...

There was legislation in the last  Congress  that would have set up  corporations to manage  all Medicare  funded care for individuals with ESRD...

That's the direction I think this Administration will try to steer Medicare, basically transferring the risk of increasing costs to either the  private sector or  the beneficiaries...

My real takeaway from all the GOP and the Trump camp has put forth so far is what I pulled out of Peck's post above. The reason this scares me is that almost any time private industry is made steward to anything that is not profitable and biggest benefit is the public good (especially for a group ad small as ours) the long term outlook is not good for the ppl made subject to their choices.

Case in point (with all of its good intentions) the private exchanges created by the ACA have been a challenge for people shopping for health care. Prices have been violatile, access is a challenge and sometime just sketchy. The patchwork of rules and varying participation in different jurisdictions have made the overarching plan of "make everyone buy in and we will all be better off" not manifest. So what we are left with now is more providers pulling out because keeping shareholders happy and making the most profits possible is their ultimate goal.I'm certain I do not want the quality of my care wholly determined by the board of a private company. The government is not much better but at least I have some say and access (or I believe I do, lol).

I will be praying and will be attempting to establish a relationship with my lawmakers to be certain they know someone is paying attention to this issue; often that is the only thing that makes a difference.

[Michael Murphy]

The biggest drain on the Medicare fund is the Republican created Plan D drug plan added to Medicare during the Bush two  administration.  It is the only expense that Medicare by law is required to pay full list price for.one of the Medes I take used to cost my Insurance company pre Medicare 40 a month now Medicare is paying 200 dollars a month.  If the republicans trulely wanted to reduce Medicare costs allow Medicare to set prices like it ,does for every thing else it pays for.  But then who who  would republican congressmen hit up for large donations.  All they care about is Big Pharma's bottom line.

[Simon Dog]

Not only that, but Medicare prohibits patients from using the copay assistance cards (like the $5 copay card for Sensipar).     Medicare cannot "set" a price but it can "negotiate" one.   Providers are not required to accept Medicare if the price is not worthwhile to them (something many primary care providers are doing when the refuse new Medicare patients).  It would be interesting to see what price Medicare could negotiate for Harvoni if it was allowed to do so.

The one place drug price negotiation happens with Medicare is ESAs for dialysis patients.  The clinics are paid based on "the bundle" which included the ESAs (epo, micera, aranasep), so Freseius and DaVita in turn negotiate the prices for these drugs.

Privatization works when it keeps workers off the state nipple.   For example, here in MA school districts use private school bus companies.  You would think this would be more expensive, but it saves a bundle since the bus companies can do it cheaper.  The reason?  The school bus companies pay "market rates" and "market benefits" for school bus drivers (I would guess around $15/hour, no pension, no post-employment medical).  If they were state employees they would get a package like the Boston Transit system bus drivers - salary of $75K/year, defined benefit pension (retire at 55 with about 80% of your salary for life) and lifetime medical benefits.   Until they automated tolls in MA, toll taker was a $75k/year pensioned lifetime medical job....where you had to know someone powerful to get in.

[Shaks24]

The bundle payment also includes Calcitriol and Gentamicin cream for PD patients. I used to have to buy them but now they come from Fresenius by mail with no separate billing to me. Saved me about 60 bucks a month.

[Simon Dog]

The bundle payment also includes Calcitriol and Gentamicin cream for PD patients. I used to have to buy them but now they come from Fresenius by mail with no separate billing to me. Saved me about 60 bucks a month.

FMC will only give Paracalcitrol under the bundle if numbers are not met with Calcitrol.  The Para form is slightly more effective, but much more expen$ive.