Entitlement Reform: Possible Changes to Medicare & Medicaid

With all the talk in Washington about deficit reduction and efforts to craft a “grand bargain,” entitlement “reform” or changes to entitlement programs, such as Medicare and Medicaid, are on the table.  Taken together, Medicare, Medicaid, and the Children’s Health Insurance Programs are an estimated 21% of the federal budget while Social Security is approximately 20%.[i]  According to the Pew Research Center, beginning January 2011 and for the next 19 years, 10,000 people a day are turning 65 – making them eligible for entitlement programs, such as Medicare and Social Security.[ii]  In turn, this demographic reality will cause those slices of the federal budget pie to grow at break-neck speed, unless the Congress does something to stem the tide.  Hence, the growing bipartisan interest in discussing entitlement reform.

So, what does that really mean?  One usual favorite for reducing entitlement spending being touted is cracking down on “fraud, waste, and abuse,” which supporters say could potentially save billions each year (though the independent Congressional Budget Office (CBO) tends to think otherwise).  In addition to that old stand-by, here is a sampling of some of the other changes to Medicare and Medicaid currently under consideration:

–     Reforming Medicare cost-sharing rules

–     Restricting first-dollar coverage in Medicare supplemental insurance (Medigap)

–     Extending Medicaid drug rebates to dual eligibles in Medicare Part D

–     Cutting Medicare payments to hospitals for bad debts

–     Accelerating Medicare home health savings in health reform

–     Eliminating state Medicaid provider tax (a mechanism used by a majority of states to increase their federal Medicaid matching funds)

–     Placing dual eligibles in Medicaid managed care

–     Block granting the Medicaid program

–     Moving some or all of Medicare into a “Premium Support” program

–     Combining Medicare Part A&B deductibles

–     Expanding use of competitive bidding under Medicare

–     Bundling Medicare payments (e.g., moving away from fee-for-service)

–     Increasing the eligibility age for Medicare

–     Increasing means-testing for high-income Medicare beneficiaries

This entry was posted in Fiscal Cliff, Medicaid, Medicare, Outlook by Ilisa Halpern Paul. Bookmark the permalink.
Ilisa Halpern Paul

About Ilisa Halpern Paul

Ilisa Halpern Paul leads the District Policy Group and has more than 20 years of experience in government relations, advocacy, and policymaking in non-profit, academic, federally-funded, and government settings. Ilisa’s practice centers on advising clients with respect to advancing their federal legislative, regulatory and programmatic policy agendas. Ilisa works with clients to establish and strengthen relationships with elected officials and federal agencies, develop and implement government relations and advocacy programs, craft effective grassroots campaigns, establish coalitions and third-party stakeholder partnerships, and affect the outcomes of appropriations measures, authorizing legislation and federal regulatory actions. Ilisa is particularly skilled in creating innovative messaging, tactics, and materials in support of her clients’ policy goals. She helps her clients by bringing traditional and nontraditional partners to the table in support of common goals, fostering relationships with members of Congress and their staff, and collaborating with the administration and federal agencies. Ilisa frequently speaks at meetings and briefings providing political insight and analysis to help clients navigate the current policy environment. Ilisa previously served as director of federal government relations for the American Cancer Society and as director of federal affairs with the American Public Health Association. Ilisa worked on the legislative staff for U.S. Senator Dianne Feinstein (D-CA). She earned a bachelor’s degree in English at UCLA and a master's of public policy degree from Georgetown University's Public Policy Institute. Originally from California, Ilisa planned to become a doctor, but found her health care niche after doing a policy internship in D.C. Ilisa lives with her husband, Scott, and their twin boys in Silver Spring, Maryland, where she is currently learning to play the drums.

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