As July ended, Congress left town for the entire month of August, just as it does every year. This tradition began when there was no air conditioning, and it was too hot in Washington to conduct their business. Leaving town because of the heat is no longer necessary, but it has become necessary for all of the House of Representatives members and one-third of the Senate who are up for re-election this year.
As has become the norm for the past several years, the work they are supposed to do is not finished. When they finally return in September, they will have less than a month to pass the legislation that must be completed before the government's fiscal year ends. Most importantly, they are supposed to fund the government for the 2025 fiscal year, which begins on October 1.
However, as they have done for many years, they will pass a law that temporarily funds the government and gives them more time to pass the needed legislation. That process could drag on until the end of this year and even into 2025.
Even though Congress is gone from Washington, TSCL is still here, and we're ready to closely watch the actions of Congress when they return in September and ensure the programs that seniors depend on are kept safe from the spending cuts that some in Congress want to make.
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Senate and House Miles Apart when it comes to Funding Health Care
Last month, House Republicans advanced beyond committee a bill to fund the Labor, Education, and Health and Human Services departments.
The $185.8 billion Labor-HHS measure amounts to 11% below current effective funding levels, cutting billions from health care and social programs, as well as from agencies responsible for enforcing worker protection laws.
However, in the Senate, the Departments of Labor, Education, and Health and Human Services would get a $9 billion collective increase in legislation approved by the Senate Appropriations Committee. If this increase remains the same as it goes through the Senate process, the bill would provide $122.8 billion in discretionary funding for Health and Human Services and $13.8 billion to the Labor Department.
Obviously, the vast difference between the House and Senate bills will have to be worked out so they can produce one bill to send to the President for his signature. Getting to that agreement could become very difficult and prolong the funding process in a major way.
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Nursing Homes to Receive 4.2% Medicare Pay Bump In 2025
Medicare rates for skilled nursing facilities will increase by 4.2% in fiscal 2025 under a final rule published by the Centers for Medicare and Medicaid Services (CMS) in July. That is higher than the 4.1% reimbursement increase CMS proposed in March.
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Hospitals get Increased Medicare Payments for Inpatient Care
Medicare payments for inpatient care at acute-care hospitals will increase by 2.9% or roughly $2.9 billion in fiscal 2025.
The new rule, released in July by the CMS, also increases the standard Medicare payment rate to long-term care hospitals by 2%, or $45 million, for inpatient care.
Additionally, the rule requires long-term hospitals to report on the stability of patients' housing, food, and utility needs and their access to transportation. These social factors can affect the resources required for their care.
It also finalizes a separate payment to small independent hospitals to establish and maintain a buffer stock of essential medicines in case of drug shortages.
Long-term care hospitals provide care to beneficiaries who need hospital-level care for relatively extended periods of time. To qualify, they must have an average stay of more than 25 days for certain Medicare patients.
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Federal Aging Programs Receive Funding Boost in Senate Committee
Programs to aid health care for older Americans and provide them meals would receive an almost 5% increase through fiscal 2029 under legislation a Senate committee approved last week.
The Health, Education, Labor and Pensions (HELP) Committee voted 20-1 to reauthorize the Older Americans Act. This 59-year-old law offers grants to state and local organizations that offer training and social programs for older Americans, as well as nutrition services and federal aging programs.
The bill would increase funding for investigating abuse and poor services at long-term care facilities and includes enhanced measures for caregivers, alongside money for items such as senior centers and the Meals On Wheels program.
To get agreement on the package, committee chairman Bernie Sanders (I-Vt.) settled for allowing a 4.62% increase each year, starting at $2.7 billion in the fiscal year starting October 1. The money still needs to be part of the next bill to fund the government.
Susan Collins (Maine), the top Republican on the Senate Appropriations Committee, is a co-sponsor of the bill. Patty Murray (D-Wash.), chair of the Senate Appropriations Committee, voted for it in committee Wednesday. Only Sen. Rand Paul (R-Ky.) voted against the bill.
The bill now goes to the full Senate for a final vote.
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Lower Drug Prices to be Announced by September 1
The Biden administration and the pharmaceutical industry have wrapped up the first round of landmark drug price negotiations after engaging in talks that may lead to lower prices for some of Medicare's most widely used drugs.
For the past six months, the U.S. government and drugmakers bargained largely outside the public's view over the prices of 10 prescription drugs selected for the Medicare Drug Price Negotiation Program. The program is a signature element of President Joe Biden's Inflation Reduction Act that, for the first time, authorizes the government to set the prices for some of the costliest drugs in the Medicare program.
The Centers for Medicare & Medicaid Services is slated to announce the negotiated prices—dubbed the maximum fair prices—by September 1. The prices will go into effect in January 2026.
This is important news for many seniors because the negotiated prices could significantly affect their wallets. Widely used blood thinners from Bristol Myers Squibb Co. and Johnson & Johnson, along with diabetes treatments from AstraZeneca PLC and Merck & Co., were among the drugs selected for price cuts.
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Health Care in the U.S. is Expensive. But does it give Better Results?
According to research by the Kaiser Family Foundation, the U.S. lags behind several other wealthy nations in healthcare quality.
Despite spending more money per capita on healthcare than any similarly large and wealthy nation, the United States has a lower life expectancy than peer nations and has seen worsening health outcomes since the onset of the COVID-19 pandemic.
While inconsistent and imperfect metrics make it difficult to firmly assess system-wide health quality, measures of long-term health outcomes, treatment outcomes, patient safety, and patient experiences suggest the U.S. health system provides lower-quality care than its peers.
In an article reporting on the research, an analyst at WalletHub, an award-winning personal finance company that empowers consumers to lead financially healthy lives, added this comment:
"Health care has two crucial components: cost and quality. The best health care in the nation isn't helpful if it bankrupts the people who try to get it, and cheap health care isn't worth paying for if it provides subpar or ineffective treatment. Therefore, the best states for health care are those that make high-quality care affordable, on top of providing many options for doctors and making insurance easily accessible."
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Some Medicare Advantage Plans to Have Fewer Benefits
Medicare Advantage (M.A.) programs have become very popular among seniors over the last several years. However, recent studies have largely found that Medicare Advantage plans cost the government and taxpayers more than traditional Medicare per beneficiary. In 2023, that additional cost was about 6 percent.
According to the Center for Economic and Policy Research, "Medicare Advantage has never saved taxpayers money as a substitute for Traditional Medicare. In fact, according to the Medicare Payment Advisory Commission (MedPAC), taxpayers have spent more on financing M.A. than they would have if everyone were covered under Traditional Medicare.
Because of that, Congress and CMS have been working to try to stop M.A. companies from gaming the system to steal taxpayer money. A 2023 study by the Physicians for a National Health Program (PNHP) estimates that CMS overpaid M.A. plans between $88-$140 billion in 2022 alone through various practices like pretending patients were sicker than they were along with targeting healthier, less costly seniors to enroll in their plans. Overpayments have also caused all Medicare beneficiaries to pay billions in higher Medicare Part B premiums.
Now, major MA insurers are planning to slash benefits in an attempt to improve profits.
Humana and CVS, two of the largest Medicare Advantage insurers in the country, are poised to seriously downgrade their plan benefits and geographic presence next year as they chase profits in the privately run Medicare program.
As a result, hundreds of thousands of Medicare Advantage seniors — and the billions in revenue they represent — could come up for grabs, representing a significant opportunity for insurers looking to take on more members despite ongoing challenges in M.A.
The size of the turnover depends on a number of factors. Experts say deciding which benefits to cut versus keep is a tough calculus, and there are guardrails from the federal government limiting cutbacks.
TSCL strongly recommends that seniors enrolled in Medicare Advantage programs be on alert for changes to their current M.A. plan and what other M.A. plans offer when the Medicare open enrollment season arrives later this year.
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