Jul

15
2008-07-15
Medicare Legislation


The Medicare Improvements for Patients and Providers Act of 2008, HR-6331, was introduced in the House of Representatives on June 20.  It passed the House 355-59 on June 24.  On June 26, the Senate failed to vote to close debate on this legislation by a vote of 58-40.  [60 votes are needed for a cloture vote.]  Thus, the legislation is in limbo while Congress is on their July 4 recess.  It will probably be taken up again in the Senate [probably with some modifications] after the July 4 recess.  [Modifications are probably be necessary to get the 60 votes needed to close debate and actually vote on the legislation in the Senate.]  The Administration has stated that the legislation will be vetoed if it is passed.
 
HR-6331 includes several important provisions.  The media coverage has centered on the reversal of the 10.6% cut in provider reimbursement rates which took effect on July 1.  This legislation would also reverse two other Medicare changes which occurred on July 1--the elimination of the "exception process" for the caps on Medicare coverage of outpatient therapy; and the elimination of the QI program for low income beneficiaries.  The legislation includes some enhancements for the Medicare program, including additional coverage for preventative services and less stringent qualifications for the Part D Low Income Subsidy.  Another important provision included in this legislation is to create parity in Part B for mental health services.  [Currently, there is a 50% copayment for Part B mental health services while there is a 20% copayment for other Part B services.]
 
One might wonder why there is any opposition to this legislation.  Should physicians receive a 10.6% cut in their reimbursement rate??  Obviously physicians would not favor this.  If physicians stop seeing Medicare patients because their reimbursement rates has been lowered, Medicare patients would not be able to obtain the medical care they need.  This doesn't seem to be a wise political move!!
 
Congress works on a "pay go" policy.  There must be a savings to offset any additional costs included in legislation.  Each of the changes cited above will add costs to Medicare.  HR-6331 does include provisions which will offset these costs.  Opposition to this legislation is based on these provisions.  HR-6331 would lower the reimbursement rate for "Medicare Advantage" [Medicare Part C"] plans.  About 10 years ago when the first "Medicare Part C" plans were introduced, there were several plan options available in most geographic areas.  When the insurance companies which offered these "Medicare part C" plans realized that they would not be financially profitable, the insurance companies stopped issuing "Medicare Part C" plans.  Gradually most geographic areas had few or no "Medicare part C" options.  In order to entice these insurance companies to return to the Medicare marketplace, the reimbursement rate for "Medicare Advantage" [Medicare Part C"] plans were set at a rate greater than the rate for "traditional Medicare" coverage.  HR-6331 attempts to level the playing field for reimbursement for all Medicare beneficiaries.  Obviously, this is not popular with the companies which issue "Medicare Advantage" plans.
 
It's important that everyone understand the issues involved with this legislation.  An informed electorate is essential if we want our legislators to enact legislation consistent with our interests.

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Posted by: Becky  on  12/28/2016
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