December 19, 2020

December 19, 2020

Barring any unexpected news relating to seniors this will be our last update for this year.  It has been an incredibly tough year.  We hope that despite all the challenges we all face, the health risks and the distancing from our loved ones, that you have the best holiday season possible.  We wish you a Merry Christmas, Happy Hanukkah, Happy Holidays, and a very Happy New Year.


Congress Finally Gets its Job Done

The flurry of activity in Congress has shared the top of the news this week with the continuing Covid-19 crisis and the beginning of the vaccine distribution program.  We try not to repeat news here that is available to everyone who gets their news from TV, radio, newspapers or online, but there are two things that occurred in all the activity that are especially important to seniors.

As we foresaw last week, Congress was not able to finish its work by the end of the day last Friday and had to pass two continuing resolutions (CR) in order to give themselves more time.  The current CR runs through next Monday, the 28th.

The extra time was needed because although both houses of Congress were finally able to pass the needed legislation, the bill was nearly 5,600 pages in length.  It is probable that no member of Congress actually read the entire bill and likely very few Congressional staff members read it either.

After a bill passes Congress there is a certain process that must be followed when it is transmitted to the President for his signature.  That is why the extra time is needed at this point.

Unless something totally extraordinary happens, the President is expected to sign the bill prior to midnight on the 28th and at long last the federal government will be fully funded through the remainder of fiscal year 2021 and much needed economic stimulus and rescue money will be sent to taxpayers and businesses alike.

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Surprise Billing Coming to an End for Patients

One of the issues high on TSCL’s agenda this year was putting an end to the practice of “surprise billing.”

Surprise billing is when patients incur “surprise” medical bills when they unexpectedly receive out-of-network services in an emergency, or for services such as anesthesia and radiology that were provided by doctors or others who do not accept the patient’s insurance plan. Out-of-network care is usually more expensive than in-network care with higher coinsurance rates or no coverage at all.

As a result, patients have ended up with thousands of dollars in medical bills they thought were covered by their health insurance.

Because of the new legislation, patients will no longer have to worry about those surprise bills.  Instead, doctors are going to have to fight it out with insurance companies about how much to pay.

(It should be noted that transportation of a patient by a ground ambulance is not covered by the legislation and patients will still be liable for the cost if their insurance does not cover it.)

In an article in Politico, it was pointed out that doctor groups have spent millions of dollars fighting to stop legislation that would end surprise billing.  And it turns out their investment paid off.

According to Politico, “Powerful hospital and physician groups that tied up Congress for nearly two years on how to end “surprise” medical bills saw their efforts pay off with the compromise lawmakers inserted in the giant year-end spending package.

“The health care providers — including private-equity backed physician staffing groups — chipped away at leading legislative proposals through high-profile lobbying and tens of millions of dollars’ worth of attack ads while promoting a solution that would submit their payment feuds with insurers to independent mediators.”

The article continued with this: “Elizabeth Mitchell, president of the Pacific Business Group on Health, which represents large employers including Walmart and major tech companies, predicted the legislation will yield an ‘opaque, expensive bureaucratic process’ favoring ‘those with the resources to navigate that most effectively.’

“’These bills will still end up driving up premiums overall,’ Mitchell said.”

And then there is this: “One insurance lobbyist said the outcome showed how private equity-backed physician groups and hospitals dictate policy, adding, ‘For consumers, this will mean higher and higher costs, year over year, forever.’”

So, while patients will no longer receive surprise bills, in the long run insurance companies may increase premiums on everyone to cover the costs.  That, at least, is the opinion of insurance companies and large employers.

Nonetheless, we are pleased that individual patients will no longer face these unexpected and costly medical bills.

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Medicare Pay Cuts to Doctors Stopped for Now

Every year since the late 1990’s, Congress has ‘balanced’ the budget by declaring a pay cut to doctors’ Medicare services.  Every year, after the budget for the next year is revealed, this cut is rescinded.

Again, next year, a number of physicians and medical specialists were facing sharp Medicare pay cuts.  This was to come, of course, in the face of the worst pandemic in our lifetimes and one which has worn so many physicians and nurses to the point of exhaustion.

Medicare’s 2021 physician fee schedule would’ve cut payments for radiology by 10%; physical/occupational therapy by 9%; anesthesiology and cardiac surgery by 8%; critical care by 7%; general surgery by 6%, and infectious disease by 4%.

As part of the economic stimulus bill just passed by Congress those sharp cuts have been put on pause.

According to the president and CEO of the Federation of American Hospitals, “The bill throws a lifeline to caregivers by continuing the pause in the 2% Medicare sequester, and making adjustments to buffer the impact of an ill-conceived change in physician payments during a pandemic.”

The legislation now calls for a “one-time, one-year increase in the Medicare physician fee schedule of 3.75 percent” in 2021 “to provide relief during the COVID-19 public health emergency.”

This is good news.  While we have disagreements with some doctors over things like surprise medical billings, this year has taught us how critical and valuable to us all are our medical personnel.  This certainly was no time to try to balance the budget on the backs of those who have borne the weight of so many of us this year.

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Despite the coronavirus emergency, TSCL is continuing its fight for you to protect your Social Security, Medicare, and Medicaid benefits.  We have had to make some adjustments in the way we carry on our work, but we have not, and will not stop our work on your behalf.

For progress updates or for more information about these and other bills that would strengthen Social Security and Medicare programs, visit the Bill Tracking section of our website or follow TSCL on Twitter.