Update for April 17, 2021

Update for April 17, 2021

President Biden Signs Bill to Delay Medicare Payment Cuts

Last Wednesday President Biden signed legislation temporarily halting cuts to Medicare providers that would likely have had a negative impact on seniors who rely on Medicare for their health care coverage.

The cuts are part of the Budget Control Act that was passed into law in 2011 and were supposed to have reduced the cost of Medicare by reducing payments made to doctors and other health care providers.

In March of 2020, Congress temporarily stopped the 2% Medicare cuts until the end of last year as part of the Coronavirus Aid Relief and Economic Security (CARES) Act. It extended them again until March 31.

However, this only delays the cuts until 2022 when they will again become part of a larger debate over federal spending.  That means Congress will be faced with more than $36 billion in spending reductions to Medicare in 2022.

The original law mandating the cuts requires anything that adds to the federal deficit to be offset by spending reductions.

Although the cuts were to reduce the payments made to health care providers, TSCL believes it is foolish to believe they wouldn’t affect the health care received by the millions of seniors who are enrolled in Medicare.  It could even mean that many doctors would refuse to see new Medicare patients, leading to a worse health care crisis for seniors, especially those who live in the less populated areas of the nation.

Simply delaying the cuts year after year is no solution to the long-term issues facing Medicare.  Congress needs to address this as part of an effort to shore up the viability of Medicare for the future.

Fighting to fix both the long-term viability of both Medicare and Social Security are at the top of TSCL’s legislative agenda this year.

* * * *

Biden Proposes Major Changes to Government Health Care Programs

Also last week, President Biden unveiled his proposal to create a $6.5 billion medical research agency with a bold new goal: quickly developing cures for diseases including cancer, Alzheimer’s, and diabetes.

If the agency is established, it could mark a fundamental shift in how the U.S. government funds research, steering the emphasis from basic science to higher-risk projects more directly aimed at major medical breakthroughs.

He also has proposed to spend $400 billion over eight years on home and community-based services, a major part of his $2 trillion infrastructure plan.  The goal here is to help older adults and people with disabilities remain independent as long as possible.

Republicans have said his proposal costs too much and argue that much of what the proposed American Jobs Plan contains, including the emphasis on home-based care, isn’t really about infrastructure.

According to Kaiser Health News, “Even advocates acknowledge the proposal doesn’t address the full extent of care needed by the nation’s rapidly growing older population. In particular, middle-income seniors won’t qualify directly for programs that would be expanded. They would, however, benefit from a larger, better paid, better trained workforce of aides that help people in their homes — one of the plan’s objectives.

“At some point, 70% of older adults will require help with dressing, hygiene, moving around, managing finances, taking medications, cooking, housekeeping and other daily needs, usually for two to four years. As the nation’s aging population expands to 74 million in 2030 (the year all baby boomers will have entered older age), that need will expand exponentially.

“This reflects a sobering reality: Long-term care services are simply too expensive for most individuals and families. According to a survey last year by Genworth, a financial services firm, the hourly cost for a home health aide averages $24. Annually, assisted living centers charge an average $51,600, while a semiprivate room in a nursing home goes for $93,075.”

Many seniors and their families probably think that Medicare will pay for long-term care if it is needed.  But that’s simply not the case.  The fact is, Medicare coverage is very limited.

Again, according to Kaiser Health Care News, “In the community, Medicare covers home health only for older adults and people with severe disabilities who are homebound and need skilled services from nurses and therapists. It does not pay for 24-hour care or homemakers or routinely cover care from personal aides. In 2018, about 3.4 million Medicare members received home health services.

“In nursing homes, Medicare pays only for rehabilitation services for a maximum of 100 days. It does not provide support for long-term stays in nursing homes or assisted living facilities.”

There are lots of questions still to be answered about the President’s plans.  TSLC will be watching carefully to see what the President’s final proposal contains and we will keep you updated as more information becomes available.

* * * *

Hospitals Told to Stop Hiding Their Prices from Patients

There are new federal rules that require hospitals to post their pricing information online in order to give patients the information they need to make decisions about their health care.  But it turns out that some large hospital systems have been using codes that prevent that information from appearing in online search results.

Advocates for less government involvement in health care and instead letting the free market have a stronger role base their arguments on the idea that just like groceries or cars or clothes, consumers should be able to shop around and look for the best value in health care.

But among other things, if consumers can’t find the cost of health care, the idea of the free market is impossible.

Now the Centers for Medicare & Medicaid Services (CMS) has told hospitals they can't hide their prices from web searches.

While that may solve one problem in trying to find the most affordable health care, it’s not clear it will solve many others that still exist.

* * * *

New Report Reveals Drug Companies Trick to Keep Prices High

A new report suggests that “product hopping”—a practice by drug companies to extend their patents on profitable drugs—costs American consumers and the U.S. health care system billions of dollars each year.

The report looked at five prescription drugs and found that drug companies slightly alter the formulas in those drugs, allowing them to extend their patents on the new formulations, and delay the move to the generic drug marketplace.

This, of course, keeps the costs of those drugs much higher than if a generic version were available.

That is only one of the issues involved with high drug prices, and the drug companies aren’t the only issue.

According to the lobbying arm of the major drug companies, in 2018, nearly half of the money spent on brand medicines went to some business other than the research companies that discover and manufacture medicines.

Those include pharmacy benefit managers, insurers, hospitals and others in the biopharmaceutical supply chain. Meanwhile, a greater share of the cost of medicine has shifted onto patients.

As with Social Security and Medicare long-term viability, reducing the high costs of drugs is also at the top on TSCL’s agenda this year.  These are complicated problems but Congress must find a way to deal with them and TSCL will be fighting for you as these debates continue.

* * * *

In spite of the coronavirus emergency, TSCL is continuing its fight for you to protect your Social Security, Medicare, and Medicaid benefits.  We’ve 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 our website at www.SeniorsLeague.org, follow TSCL on Twitter or Facebook.