Insights

The Medicare and SS Trustees Reports – Where Do Things Stand?

The 2024 Reports from the Medicare Trustees and the Social Security Trustees are here.  Let’s dig in to learn where things stand on the perennial question of insolvency and their recommendations. 

The 2024 Medicare Trustees Report showed a positive trend for the Hospital trust fund (Part A), with 5 more years of solvency added.  This moves out the point at which all benefits could be paid at current levels from 2031 to 2036. 

The improvement was due to lower than expected Medicare trust fund expenditures for 2023 (especially for inpatient hospital and home health services), higher payroll tax income, and “a policy change correcting for the way medical education expenses are accounted for in Medicare Advantage rates starting in 2024.”  

In other words, they changed the way the assumptions were calculated.   

The trustees noted 3 factors related to the pandemic: 

  1. Beneficiaries who died from COVID-19 were the sickest with more comorbidities.  Now, the remaining Medicare population is “healthier” as a percentage which leads to lower overall projected spending.  
  1. The expiration of the waiver requiring a 3-day inpatient stay to receive SNF services. Trustees assume that the 3-day inpatient stay requirement will now remain in place, which will increase inpatient spending by 1.9 percentage points and decrease SNF spending growth by 7.5 percentage points in 2024.      
  1. Lower than normal home health spending.  Due to staffing shortages in 2023, home health expenditures were still lower than expected.  But Trustees believe that demand will increase in 2024, and are projecting an increase in the home health spending growth factor by 2.9 percentage points for the next 3 years (2024-2026).   

By contrast, the Social Security Trustees noted a neutral trend from last year.  For Social Security, insolvency is coming in 9 years (CY 2033), which is the same projection as last year.  Funding was projected to decrease due to declining fertility rates but was projected to increase due to increased labor productivity.  So, the two factors equalized the other out.   

Medicare and Social Security Trustees said that Congress and the White House need to act now to be able to create solutions that can be more flexible and gradual.    If the can continues to be kicked down the road, cuts will have to be harsher and more immediate.  Trustees also recommended that Congress and the White House work together to come up with solutions.   

So, is this the year that Congress and the administration address Medicare and Social Security insolvency?  It looks unlikely.  When Speaker Johnson (R-LA) took leadership in January, he announced he would create a bipartisan fiscal commission to address the national debt and necessity of spending cuts.  But news agencies have already reported the Commission is DOA.  Sponsors of a bill to create such a commission in both the House and Senate have said that they have no support to move the bills forward.  A commission faces bipartisan disapproval, with Democrats concerned a commission would cut benefits like Social Security and Medicare and Republicans concerned a commission would be a vehicle for tax increases.    

So, the deadline towards insolvency once again looms, without a path to address it…. 
 

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Navigating Healthcare Transparency: Administration’s Push for Medicare Advantage Clarity

Medicare beneficiaries are often uninformed on prices, supplemental benefits, and the use of prior authorization in their Medicare Advantage (MA) plans.  In a landscape where healthcare decisions can feel opaque, transparency could empower patients in navigating the Medicare Advantage program. New initiatives and regulations by HHS and CMS are working to enhance transparency within Medicare Advantage, creating more informed decision-making and ensuring equitable access.

The Administration’s goal is to provide tools so beneficiaries can make informed choices about their healthcare coverage. By bolstering transparency within the Medicare Advantage program, the Administration aims to address longstanding challenges and equip beneficiaries with the information needed to select plans that align with their healthcare needs and preferences.

At the core of this initiative lies a multifaceted approach designed to enhance transparency across various dimensions of the Medicare Advantage program. Key components of the Administration’s efforts include:

Enhanced Access to Plan Information

The initiative seeks to enable beneficiaries to compare coverage options with greater ease and clarity. By centralizing plan data and making it readily accessible to beneficiaries, the Administration aims to facilitate informed decision-making and empower individuals to select plans that best meet their healthcare needs.

Improved Cost Transparency

By providing beneficiaries with clear and comprehensive information regarding plan costs, including premiums, deductibles, and copayments, the initiative aims to empower individuals to assess the financial implications of their healthcare choices and make informed decisions aligned with their budgetary constraints.

Increased Quality Reporting

Quality of care is a fundamental consideration for Medicare Advantage beneficiaries seeking to maximize the value of their healthcare coverage. By changing the way plans are rated and creating more transparency around key quality metrics, such as clinical outcomes and patient satisfaction ratings, the initiative aims to empower beneficiaries to make informed assessments of plan performance and quality of care delivery.

Accessible Tools and Resources

The Administration’s initiative prioritizes the development of accessible online tools and resources designed to support informed decision-making. From online comparison tools to personalized assistance through the Medicare Plan Finder, these resources are intended to empower beneficiaries with the information and support necessary to navigate the complexities of the Medicare Advantage program effectively.

Conclusion

The Administration’s push for increased transparency within the Medicare Advantage should foster transparency across various dimensions of the program.  CMS is laying the groundwork for a more equitable, accessible, and patient-centered healthcare system that prioritizes the needs and preferences of Medicare Advantage beneficiaries. Major health plans and coalitions are objecting to many aspects of these proposals, so we will need to continue watching to see which of these proposals actually become finalized.

If you would like to connect with Chamber Hill Strategies, please do not hesitate to contact us.

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Navigating Healthcare Transparency: Administration's Push for Medicare Advantage Clarity

Not Just Another Election Year Blog Series: The ACA and the 2024 Election

Not Just Another Election Year Blog Series: The ACA and the 2024 Election

This blog post kicks off a series on health care policy and the 2024 election. Unless you are living under a rock, or in a state of denial, you probably realize there will be an election in 2024.  When many people think of election season, they think about endless campaign ads, an increase in contentious social media posts, and debates that seem more like cage matches than thoughtful discourse. This blog series will cut through the noise of partisan bickering and give you real insights into how health care policy is shaping, and being shaped by, this year’s election.

This blog series starts on the eve of the Iowa Caucuses and the same week the open enrollment period for the Affordable Care Act (ACA) ends for most Americans. This blog post focuses on the ACA and the 2024 election. Specifically, this blog post looks at how the law is being talked about, or not talked about, on the campaign trail and what this all means for the status of the law now and in the future.

Repeal Talks Persist

Even though the ACA became law almost 15 years ago, efforts to repeal the law persist. Republicans initially enjoyed success in campaigning against the law but failed to repeal and replace it once they had control of Congress and the White House. Although we saw the repeal and replace conversation pop up a few times in the last year, it never really broken through as a major talking point among the Republicans who want to move into the White House in 2024.

If Only Because of Trump

Recently the ACA and the 2024 election intersected because of comments made by former President Trump. In November 2023, the former president put the debate over the law back in the headlines by saying he would get rid of the ACA and replace it with “much better health care” if he were to be re-elected in 2024. But restarting the repeal and replace efforts is not as popular as it once was among congressional Republicans. Senate Republican Whip John Thune (R-SD) said, “I’m for lowering costs and making our health care system more efficient, but I’m not sure, speaking in response to Trump’s comments, I’d want to know what the proposal is.” Texas Republican Senator John Cornyn stated, “whether we can build a political consensus for something else or not remains to be seen.” Senator Bill Cassidy (R-LA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, also expressed a skeptical view on the prospects of repeal saying, “it’s a narrowly divided Congress. It’s unlikely to happen.” We expect the former President to continue speaking out against the law unless he starts to see negative impacts on his poll numbers.

Biden Bets Big

In sharp contrast to calls to repeal and replace the ACA, President Biden is touting his record of protecting and expanding it. The Biden administration eagerly points to the fact that more than 20 million individuals are enrolled in a plan ahead of the January 16 deadline for open enrollment. Additionally, the Biden campaign argues that the ACA would be threatened if former President Trump were to win the election in 2024.

It is not surprising that President Biden talks so much about the ACA given the policies his administration has pursued to help people sign up for coverage and to expand eligibility under the law. Almost immediately upon taking office, President Biden signed an executive order allowing the Secretary of Health and Human Services (HHS) to create a special enrollment period so people would have more time to sign up for coverage because of the COVID-19 pandemic. The order also directed federal agencies to review existing regulations and rules to ensure alignment with administration goals to protect and expand the law. The order also repealed two executive orders from the Trump administration which the Biden administration argued undermined the law. President Biden has also tried to use executive action to end what has been referred to as the ACA’s “Family Glitch.” This refers to the fact that the ACA measures eligibility for premium subsidies on an individual basis and not based on the affordability of plans for family members. On the legislative front, President Biden saw the Inflation Reduction Act (IRA) pass Congress and he signed it into law in August of 2022. This legislation extended subsidies, created under the American Rescue Plan Act, to help individuals pay for ACA coverage through 2025. President Biden is calling for these subsidies to be made permanent. We expect President Biden to continue to look for ways to protect and expand the ACA and for opportunities to promote that work to voters.

Looking Beyond November

How do the efforts of President Biden, former President Trump, and others on the campaign trail impact the ACA’s status. As mentioned above, Congressional Republicans have generally not responded to former President Trump’s call to action on the ACA. But of course, that could change, especially if the former president wins re-election. There are no signs that Democratic members of Congress will back down from their support of the law. So, where does that leave us? As is often the case in Washington, especially during an election year, we will need to wait and see. But you can be sure that how the ACA and the 2024 election interact will be something to watch as we start the new year.

If you would like to connect with Chamber Hill Strategies, please do not hesitate to contact us.

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Not Just Another Election Year Blog Series: The ACA and the 2024 Election

How does MedPAC work: A study in physician payments

A recent post came out saying, “How Out Of Touch is MedPAC? – They Are Recommending ONLY a 1.25% Payment Rate Increase for Physicians for 2024” – and it made us think, maybe some folks don’t know how MedPAC works?  We wanted to give a little inside baseball to explain the MedPAC Medicare payment update process.  

Congress created the Medicare Payment Advisory Commission (MedPAC) to recommend Medicare payment updates and strategies to improve the Medicare program. MedPAC is mandated in their charter to submit recommendations on annual payment updates for several fee-for-service payment sectors within Medicare. As MedPAC examines each sector, they must look at that sector only within the context of Medicare; that is to say, they cannot look at nursing home payments from other payers (i.e., private plans, Medicaid, etc.). While MedPAC commissioners examine the financial strength of the overall industry, payment recommendations must also fit within the confines of current law. The Commission is also required to look at the sustainability of the Medicare program – so any payment recommendations must reflect the goal of keeping the Medicare program solvent over time.  

As an example of how this works – let’s look at physician payments.  Reviewing MedPAC’s December 2023 draft physician payment recommendation, MedPAC recommended that physician payments be updated by 50% of the projected increase in the Medicare Economic Index (MEI) in 2025. The MEI is projected to be approximately 2.6% in 2025, so MedPAC’s recommendation is for an update of 1.3% in 2025. Commissioners also recommended a non-budget neutral add-on payment tied to the number of low-income beneficiaries that providers see, as the Commission previously recommended in March 2023. The add-on payment would amount to 15% for primary care physicians and 5% for others.  

Many have commented that the recommended update does not keep up with inflation and that physicians will leave the program based on the lack of updates. So, why didn’t MedPAC recommend a higher update? Because the Commission must work within the confines of data measurements they use as indicators as mandated by Congress – beneficiary access, quality of care, Medicare payment rates, and provider costs. When looking at those indicators for next year’s payment rates, beneficiary access remains at the same levels as past years, quality of care is remaining steady (as much as it could be measured), and private plan payment rates were 136% of fee-for-service rates (which is consistent over time – private plans have been paying more for years).  The only indicator that looked negative within this framework was the Medicare Economic Index (which is a measure of clinicians input costs) – the MEI was projected to be 2.6% in 2025, higher than the pre-COVID rates of 1-2%. So, given those sets of data, MedPAC set as high a rate as they could given those confines. 

It is important to note that the Commission stated its concerns multiple times about the accuracy of the physician fee schedule, the underpricing of primary care services relative to other services, and the impact of these problems on the pipeline of future primary care physicians.  Commissioners in the December 2023 meeting expressed great concern about the small physician payment update, specifically about the flat fee schedule update and lack of an inflation adjustor.  In addition, over the past 10 years, MedPAC voted on numerous recommendations to change the physician payment system.  

Punchline:  Until Congress fixes the physician payment system, the physician payment hole will continue to get deeper.  

So, is MedPAC out of touch? No, not given the constraints under which they work.

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How MedPAC works physician payment system

Heating Up the Debate: The Latest on Medicare Advantage Plans from Washington, D.C.

Greetings from Washington,  

While temperatures are dropping here in D.C., the Administration and some members of Congress are doing their best to heat it right back up by putting Medicare Advantage (MA) plans on blast. However, the Medicare Payment Advisory Commission (MedPAC) must’ve thought those changes weren’t enough as they thoroughly fanned the flames during their meeting earlier this month. 

MedPAC & MACPAC 

During the second day of its November Meeting, MedPAC held two sessions related to MA. During these sessions, MedPAC staff shared findings that show MA payments being consistently higher than expected because of coding and favorable selection. Specifically, in September, MedPAC estimated that coding differences alone led to more than eight percent higher MA plans than fee-for-service (FFS) plans in 2021, even after accounting for CMS’s 5.9 percent adjustment. In June, MedPAC estimated that favorable selection alone led to eleven percent higher payments than FFS in 2019. MedPAC staff also shared that a large collection of research points to MA plans experiencing favorable selection, both indirectly and directly.  

Furthermore, staff shared updates they made to the analysis from the 2023 MedPAC June Report to Congress. Two of these updates increased the selection effect by less than one percent and one of them decreased the selection effect by two to three percent. The estimated cumulative selection effect in this analysis went from 5.9 percent in 2017 to 12.8 percent in 2021. Based on this analysis, MedPAC staff estimates the combined effects of selection and coding to have caused $50.8 billion in increased payments to MA Plans in 2021. MedPAC plans to continue looking at the effects of selection into MA and will include estimates in the annual March MA status report. When it comes to networks in MA, MedPAC staff has found that choice of provider is important for beneficiaries and that many beneficiaries are willing to trade choice for reduced cost sharing, out-of-pocket spending caps, and additional benefits. When it comes to prior authorization in MA plans, MedPAC has found most MA PA determinations and reconsiderations were eventually approved.  

Commissioners raised many concerns about the Advantage plans including how plans are reimbursed, how the plans use rebates they are issued, and how CMS ensures network directories are accurate. They also expressed concerns about the potential barriers to care and burdens to providers caused by prior authorization requirements. 

Likewise, the November meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC) included a session on the use of State Medicaid agency contracts (SMACs). MACPAC staff concluded that states are using contracted strategies in their SMACs to improve integration with varying frequency. Additionally, they found certain provisions are more widely used while others had relatively limited use. As for next steps, MACPAC will start conducting interviews with state and federal officials and health plans representatives to explore challenges to optimizing SMACs.  

Overall, commissioners were disappointed with the use of SMACs. Chair, Melanie Bella, MBA, underscored a gap exists between what they might see on paper and how these tools are used to ensure everyone who needs it, has access to integrated care. Commissioners expressed a desire to see researchers investigate what prevents states that have D-SNPs and SMACs from effectively using SMACs. MACPAC staff said they could look into this subject.  

On The Hill  

Democratic leaders on the Energy and Commerce Committee have called for increased oversight of the MA program. On the Senate side, Finance Committee Chair Ron Wyden (D-OR) held a hearing on MA marketing and enrollment practices and has commented on the need to address some of those practices.   

CMS Proposed Rule 

The Centers for Medicare and Medicaid Services (CMS) tried to stabilize the climate and keep our lawmakers’ heads cool by publishing a proposed rule to revise the MA program. They outline this ruling in a 2,500-word fact sheet, but we’ll try to give you all an overview in fewer words. Regarding broker/agent compensation, this rule would change the cap so it combines the additional fees at a flat rate (the new cap would be $632/beneficiary instead of $601/beneficiary). The rule would also require plans to provide enrollees with a mid-year notification about supplemental benefits to ensure they are taking advantage of the benefits. CMS also decided to address concerns about the use of prior authorization within MA. To improve the experiences and outcomes for dually eligible individuals the proposed rule would increase the frequency of special enrollment periods for enrollees eligible for both Medicare and Medicaid. And lastly, the ruling would limit out-of-network cost-sharing for dual eligible special needs plans (D-SNP) preferred provider organizations (PPOs) beginning in 2026. 

In accordance with federal law, this proposed rule will be published and subject to a public comment period. To ensure consideration, comments must be submitted by no later than 5 PM on January 5, 2024. 

Between the Administration, Congress, MedPAC, and MACPAC, it seems as though everyone has been trying to cook over the fire that are Medicare Advantage plans. We expect the oversight to continue, and you can be sure we will be watching the thermometer to ensure our clients’ voices are heard in Washington.  

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MedPAC Payment Basics – Our Christmas in October

It’s Christmas in October!  For policy geeks like us, the release of the Medicare Payment Advisory Commission’s (MedPAC) payment basics are like a gift that keeps on giving.

Not familiar with these beauties?  Well, read on, my friend.  MedPAC’s payment basics are a Medicare 101 for every payment system within Medicare.  They cover all players in the Medicare healthcare work from hospitals to physicians to all post-acute care providers.  Want to know how DSH payments for hospitals work? It’s in there.  Want to know about GPCIs for physicians?  In there.  Medicare Donut hole?  Yep.

In addition to the well laid out explanation of each intricate aspect of each payment system, the payment basics also contain excellent graphics that outline the “flow” of each payment system and how one adjustment (for example, a rural payment adjustment) fits into an overall payment rate for each provider.  They are great power point fodder and really help visually explain all of the payment adjustors in the system.  The Basics also cover payments for Accountable Care Organizations (ACOs), Durable Medical Equipment (DME), Federally Quality Healthcare Centers (FQHCs), Medicare Advantage Plans, and Part B and Part D drugs.

The payment basics are not just used by us policy nerds to brush up on our conversion factor calculations, but they are also used to train new Members of Congress and their staff.  And even those of us who have been doing this for far too many years, return to them year after year as the Basics are updated for all new legislative/administrative changes.

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What Happened, What You Missed: October 2-6, 2023

Makers of 10 Drugs Agree to Participate in Medicare Price Negotiations

The manufacturers of all 10 drugs selected for Medicare drug price negotiations have agreed to participate in the program, according to a White House announcement.  The announcement comes as several drugmakers have filed lawsuits against the Biden administration to stop the drug price negotiation program, including one that has already committed to participate in the negotiations.  The administration named its first 10 drugs to participate in the program over a month ago, which includes two diabetes drugs, a blood thinner, and a rheumatoid arthritis treatment.  Initial price offerings on the drugs will be announced on February 1, 2024, although Medicare beneficiaries won’t be able to access drugs with the negotiated prices until 2026.

75K Kaiser Permanente Workers Kick Off Largest Health Care Strike

More than 75,000 unionized employees of Kaiser Permanente, one of the nation’s largest health care providers, started the largest health care strike in US history this week.  Union leaders say they’re hitting the picket lines for outsourcing protections, safe staffing, and better wages to reduce turnover.  The strike comes amid an uptick in organized labor across the country, with unions representing auto workers and actors calling for higher pay.  While Kaiser’s hospitals and emergency departments will stay open during the strike, the company has warned that elective and non-emergency services may be rescheduled.

Moderna’s Combination COVID-Flu Shot Shows Promise

Moderna is moving on to late-stage clinical trials for its combination COVID-19 and influenza vaccine after early-stage trials found the shot to be effective against both viruses.  The combined vaccine has been shown to have a similar safety profile to existing mRNA COVID-19 vaccines, and no new safety concerns have been reported.  The company’s efforts to create a two-in-one COVID-19 and flu shot mirror similar efforts at Pfizer and Novavax.  Health experts say a combination vaccine has many logistical benefits, such as a reduced need for storage space and fewer injections for patients.  Known as mRNA-1083, Moderna’s experimental vaccine could become available to the public in time for the 2025 flu season.

Study: “Good” Cholesterol Linked to Dementia

“Good” cholesterol may not be as good as previously thought, according to a new study.  The researchers found a correlation between high-density lipoprotein (HDL) cholesterol and dementia in older adults, although they did not conclude if high or low levels can directly cause dementia.  The study, which was supported by the National Institutes of Health (NIH), included more than 180,000 California residents who now have an average age of 70 years old.  The average HDL cholesterol level in the study was 53.7 mg/dL, which is within the recommended range of 40 mg/dL in men and 50 mg/dL in women.  People whose cholesterol levels deviated too far from these numbers were more likely to develop dementia, according to the study.  Too much HDL cholesterol in the brain can cause inflammation that causes the production of amyloid plaques, which are attributed to dementia.

ICYMI: Biting Incidents Prompt Ouster of Biden’s Dog

Commander, President Joe Biden and First Lady Jill Biden’s German shepherd, has been removed from the White House following a string of biting incidents involving White House residence staff and Secret Service personnel.  Commander’s departure from DC is similar to Major, the Bidens’ other German shepherd, who was sent to live with family friends in Delaware in 2021 after biting people at the White House.  According to emails published by Judicial Watch, Commander bit several Secret Service agents a total of 10 times.

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What Happened, What You Missed: May 1-5, 2023

Study: 340B Suppresses Uptake of Biosimilars

Hospitals that participate in the 340B Drug Pricing Program see lower adoption of biosimilar drugs, according to a new study from Health Affairs. Roughly a third of the nation’s hospitals participate in the 340B program, which requires manufacturers to provide discounts on most drugs administered in the outpatient setting to help safety-net hospitals, although the discounted drugs are reimbursed by Medicare at the same rate as they are in non-340B hospitals. Researchers also found that 340B hospitals were associated with an overall increase in the use of increased use of pricier biologic medications. To conduct the study, researchers examined 340B hospitals’ 2017-2019 Medicare claims data for two commonly used biosimilars.

Vaccine Mandate for Employees at CMS-Certified Facilities Drops on May 11

The requirement for federal government employees to be vaccinated for COVID-19 will end on May 11, the same day the COVID-19 public health emergency (PHE) is set to expire. President Biden is expected to issue an executive order in the coming days to rescind the mandate, which applies to federal employees, contractors, international visitors, and people working at Centers for Medicare and Medicaid Services (CMS)-certified facilities. Originally put in place in September 2021, the vaccine mandate was blocked by a federal appeals court in March 2023 after initially being upheld by a federal court in January 2023. According to the Biden administration, nearly 98% of federal employees have been vaccinated against COVID-19.

CBO Posts Estimate on TANF Work Requirements in Debt Ceiling Bill

Congressional Budget Office (CBO) released an estimate that the work requirement provision in the recently passed House debt ceiling bill would lower federal expenditures, but increase the number of people without health insurance without increasing hours spent in employment. H.R. 2811, the Limit, Save, Grow Act of 2023 raises work requirements for certain Medicaid recipients up to 80 hours per month and increases the age through which those persons must continue working. CBO estimated that while this provision would save the federal government $109 billion over 10 years, it would increase costs to states $65 billion.

FDA Clears First RSV Vaccine for Seniors

On Wednesday, the Food and Drug Administration (FDA) approved Arexvy as the first vaccine for respiratory syncytial virus (RSV). Manufactured by GlaxoSmithKline, the vaccine is administered as a single shot, and it approved only for adults ages 60 and older. Assuming a Centers for Disease Control and Prevention (CDC) independent advisory committee votes to recommend the vaccine in June, Arexvy could be available to older adults as soon as this fall. Although RSV is mostly associated with babies and young children, an estimated 159,000 American adults 65 and older are hospitalized each year with RSV, and an estimated 10,000-13,000 die as a result of their infection. RSV vaccines for younger populations are currently under review and could made available by the end of the year.

Sen. Ben Cardin to Retire

Sen. Ben Cardin (D-MD) announced on Monday that he won’t seek a fourth term in the US Senate in 2024. A longtime fixture in Maryland politics, Cardin was first elected to the Maryland House of Delegates while he was still a student at the University of Maryland Carey School of Law. He went on to become the chamber’s youngest speaker in 1979, and in 1986, he was elected to represent Maryland’s Third Congressional District in the US House of Representatives, where he served until 2007. That same year, Cardin became Maryland’s junior senator in the US Senate, where he would serve on the powerful Finance Committee. During his tenure in the Senate, Cardin has been a strong proponent of oral health, and he frequently sponsored legislation to make dental care a covered benefit under Medicare. Cardin’s announcement has set off what’s expected to be a competitive Democratic primary to succeed him. While no formal announcements have been made, Reps. Jamie Raskin (D-MD) and David Trone (D-MD) are seen as possible candidates, as well as Prince George’s County Executive Angela Alsobrooks.

ICYMI: Freshman Lawmakers Launch Congressional Sneaker Caucus

Freshman Rep. Jared Moskowitz (D-FL) launched the Congressional Sneaker Caucus last week with fellow freshman Rep. Lori Chavez-DeRemer (R-OR). Moskowitz and Chavez-DeRemer are among a small but growing number of lawmakers and staff who are opting to wear sneakers over more traditional dress shoes on Capitol Hill. Both members of Congress say they intended to use the caucus as a way for sneaker fans on both sides of the aisle to find common ground. They also hope to host meetings and partner with manufacturers on philanthropic activities.

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The Calculations Change – But the Insolvency Dilemma for Medicare and Social Security Remains the Same

The 2023 Medicare Trustees Report showed a positive trend for the Hospital trust fund (Part A) but the Social Security Trustees noted a worsening trend for in their report.  For Social Security, insolvency is coming 1 year earlier than last year (in CY 2032, rather than CY 2033), due to inflation, lowering of the GDP, and labor productivity.

For Medicare, the Hospital trust fund added 3 more years of solvency, moving the point at which all benefits could be paid at current levels from 2028 to 2031.  This improvement was due to “lower projected health-care spending stemming from updated analysis that uses more recent data” or, in other words, they changed the way the assumptions were calculated.

Three other factors helped push out the timeline for the Hospital trust fund:

  1. Those beneficiaries that died from COVID-19 were the sickest with more comorbidities – so the remaining Medicare population is “healthier” as a percentage – which leads to lower overall projected spending.
  1. More dual eligible beneficiaries have been moving into Medicare Advantage plans in the past few years and. as duals are more expensive, this shift has resulted in savings.  The report highlighted that the additional dual-eligible enrollments [in Medicare Advantage] have decreased the average fee-for-service per capita cost– affecting, in turn, the trends for inpatient hospital, SNF, and home health spending..
  1. The Comprehensive Care for Joint Replacement program (CJR) in Medicare has led to a larger than expected shift of knee and hip replacements from inpatient to outpatient care which resulted in savings.

Trustees reiterated that the Medicare pay rates for physicians are not keeping up with inflation and costs, which could affect beneficiaries’ access to care.  American Medical Association President Jack Resneck said, “MedPAC and the Trustees have provided lawmakers with a legislative agenda for this year. Congress should adopt a 2024 Medicare payment update that recognizes the full inflationary growth in health care costs…to ignore this would be malpractice.”

To improve the solvency of the Medicare trust fund, the Trustees urged Congress to act on President Biden’s ideas of increasing taxes for those making over $400,000 and allowing Medicare to negotiate rates on an expanded list of prescription drugs.  House Speaker Kevin McCarthy has said that Biden’s tax proposals are “completely unserious” and that, “Washington has a spending problem, NOT a revenue problem.”

So, is this the year that Congress and the administration address Medicare and Social Security insolvency?  The dilemma remains the same – they can ignore the warnings, or they can increase taxes and/or cut government spending.  We also have the looming debt ceiling to address.  For now, both sides are playing politics.  The Biden Administration has repeatedly said it only wants a “clean” debt ceiling increase knowing full well that they need to work with Congress to make any significant changes to impact the trust funds or raise the debt ceiling.  House Republicans want cuts to spending, and to require these cuts be part of any agreement to raise the debt ceiling.  Although they say Medicare and Social Security are off the table, news agencies have reported that multiple proposals to cut Medicaid are circulating.  House Republicans can’t agree among themselves on what they want, and that 7-vote margin doesn’t make things easy for them.  So, we wait.  And we are pretty sure you’ll have enough time to read the reports before any of these problems are solved.

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What Happened, What You Missed: April 3-7, 2023

Final Rule Prohibits Deceptive Marketing of MA Plans

Medicare Advantage (MA) plans and Medicare prescription drug plans will face tougher requirements on marketing plans, according to a rule finalized by the Centers for Medicare and Medicaid Services (CMS) on Wednesday.  The final rule is part of an overarching effort by the administration to crack down on deceptive and misleading marketing of MA plans, which have been growing in popularity.  Nearly half of Medicare beneficiaries are enrolled in MA plans, which are operated by private insurers.  According to the rule, MA plans can no longer run advertisements that use the Medicare name or mention the federal government deceptively. Ads are also prohibited from running without mentioning a specific plan name.  Aside from addressing deceptive marketing, the final rule streamlines prior authorization requirements by requiring prior authorization approval for care to remain valid for as long as “medically necessary” to avoid disruptions in care.

ACA Premiums Up 3.4% Thanks to Inflation, Higher Spending

Affordable Care Act (ACA) premiums rose in 2022-2023 due to inflation and higher health care spending, according to a recent analysis by the Robert Wood Johnson Foundation (RWJF).  The higher premiums mark the reversal of a trend towards gradually lower premiums over the past few years.  The analysis notes that inflation will continue to put upward pressure on premiums, particularly due to high labor costs.  Another reason for higher premiums cited in the report was uncertainty over whether the ACA’s enhanced premium tax credits would be extended.  Over 16 million Americans enrolled in marketplace plans in 2023.

NCI Releases National Cancer Action Plan

To help achieve the administration’s goal of “ending cancer as we know it,” the National Cancer Institute (NCI) released its National Cancer Plan on Tuesday.  The plan is centered around eight goals: preventing cancer, detecting cancer early, developing effective treatments, eliminating inequities, delivering optimal care, engaging every person, maximizing data utility, and optimizing the workforce.  According to NCI, the framework is intended to engage all stakeholders involved in treating cancer, including health care providers and researchers.  The Biden administration has notably laid out a goal of reducing the cancer death rate by 50% over the next 25 years.

Gallup: More Americans Concerned about Health Affordability, Drug Use 

A growing number of Americans are concerned about drug use and affordable health care, according to a new Gallup survey.  While inflation and the economy were the top two key issues the respondents were worried about, health care affordability and drug use saw a respective 5% and 8% increase in concern compared to a 2022 poll.  The poll results come amid growing fears over high health care costs and a near-record high in drug overdose deaths.  Gallup conducted the survey in March 2023 and polled over 1,000 US adults.

ICYMI: The Library of Congress Reading Room Will Soon Be Open to Visitors

Currently, only individuals with a photo ID library card are allowed to visit the main reading room of the Library of Congress.  However, starting next Tuesday, the Library of Congress will kick off a new pilot program that will allow visitors to access the ornate reading room during two hour-long periods on Tuesday through Friday.  The main reading room sits below a 160-foot-high dome that’s painted with imagines representing human understanding and intellectual progress.  Additionally, the library is changing its rules to allow non-flash photography in the reading room.  Visitors are still required to reserve timed passes to access the Library of Congress.

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