House Ways and Means Health Subcommittee Discusses Restructuring Medicare
Weighs Proposals to Combine Medicare Deductibles, Restructure Copays and Limit Medigap Insurance
March 17, 2016 11:30 AM
On March 16, 2016, the U.S. House of Representatives Ways and Means Health Subcommittee held a hearing titled, “Preserving and Strengthening Medicare.” During the hearing, Subcommittee Chairman Pat Tiberi (R-OH-12) and others indicated potential support for a number of proposals to restructure Medicare cost sharing, including combining deductibles under Part A and Part B of Medicare, restructuring copays, and limiting Medigap insurance.
Chairman Tiberi called for “long overdue reforms to the outdated Medicare benefit” such as those put forward bythe National Commission on Fiscal Responsibility and Reform (“Bowles-Simpson”), which recommended a uniform 20 percent copay for all Medicare services including home health and hospice. He said such reforms would result in “largely stable copayments.” Chairman Tiberi also called for “combining the deductibles under Part A and Part B of Medicare.”
The hearing included discussion about limiting Medigap insurance, and Chairman Tiberi noted that all of the witnesses appeared to support such a proposal. The witnesses includedKatherine Baicker, who is a professor at Harvard School of Public Health and serves on the Medicare Payment Advisory Commission; Stuart Guterman, a senior scholar at AcademyHealth; and Robert E. Moffit, a Senior Fellow at The Heritage Foundation.
The use of uniform cost sharing may have surface appeal, but it can act as a barrier to care that is less costly and clinically better than care in other settings. Over the years, Congress intentionally excluded home health services from cost sharing and allowed only very limited hospice cost sharing because it wanted to encourage the use of these services as better alternatives than costly institutional care or curative care at the end-of-life.
In its Legislative Blueprint for Action, the National Association for Home Care & Hospice (NAHC) stated that Congress should preserve the principle operative in Medicare that encourages the use of cost effective care alternatives such as home health services and hospice care in any restructuring of Medicare. Any proposals to revise the current cost sharing approaches through combined deductibles and copayments (or their equivalents) should be rejected. Cost sharing standards should incentivize high value services such as home health and hospice. Medicare beneficiaries should be able to purchase supplemental insurance to cover co-pays and deductibles without any limitation.
Along these lines, during the hearing Rep. Diane Black (R-TN-6) expressed support for providing high value services at low or no cost to incentivize the use of such services, encourage high quality care, and “save dollars down the line.”
Members and witnesses also expressed support for improving chronic care, providing increased telehealth to people in their homes and in rural areas, and allowing people to receive the care they need in their communities in order to keep them out of hospitals.
The Subcommittee’s focus on restructuring Medicare is yet another example of why it is so important for home care and hospice advocates to attend this year’s March on Washington Conference. You will have the opportunity to meet with Congress regarding specific issues, such as rejecting efforts to impose a copay on Medicare home health or additional copays on Medicare hospice services (for more information on opposing a copay on home health click here and for opposing additional copays on hospice click here). Additional resources to assist advocates during their meetings with Congress are available here. The 2016 March on Washington Conference is taking place April 3 – April 5 in Washington, D.C.
If you have not yet done so, make sure to register for the March on Washington Conference here.