Update for Week Ending July 17, 2021

Update for Week Ending July 17, 2021

The parameters of whatever new health care legislation is passed by Congress this year have now been laid out by the Democratic majorities in both Houses.  We cover these Democratic proposals because they hold the – extremely narrow – majorities in Congress and therefore they set the agenda just as Republicans did when they held the majorities.

Health Care Legislation for Seniors Unveiled in the Senate

Last week Senate Democrats reached an agreement on a $3.5 trillion legislative package that would, among other things:

  • Create dental, vision and hearing benefits in the Medicare program.
  • Expand long-term care benefits to help people getting home- and community-based services.
  • Reduce the cost of prescription drugs.

Senate Democratic leaders plan to pass their agenda using a process known as reconciliation, a move that only requires only 51 votes to pass as opposed to the 60 votes needed to pass controversial legislation in the Senate because of its filibuster rule.

That means Democrats will need all 50 of their members to vote for a final bill because total Republican opposition to the bill is expected.  If that is the case it would require a tie-breaking vote by Vice President Kamila Harris to pass the bill.

One of the big sticking points is paying for the program but Sen. Mark Warner (D-Va.), one of the centrist lawmakers involved in the crafting of the package said the budget measure would be fully financed.

Democrats previously have said they planned to pay for much of their package using tax increases on wealthy Americans and corporations. Otherwise, the plan will not raise taxes on people making less than $400,000 per year, nor small businesses, in keeping with Biden’s prior commitments.

How the bill is paid for will be critical because one of the obstacles in passing the legislation will be its price tag.  With inflation having raised its ugly head the past few weeks there is real concern mounting among Congressional lawmakers over how much more spending the federal government can afford.  That fear could force major changes in whatever bill might finally be passed.

* * * *

Democrats in House of Representatives have Similar Legislation

The Democratic majority in the House of Representatives has previously introduced its own legislative package that would include vision, dental and hearing coverage in Medicare.  The legislation would initially add preventive dental, hearing and vision care to Medicare’s “Part B” program and later expand the benefits to cover basic impairments.

The House bill would reduce what seniors would need to pay out of pocket to access the new services. It treats dental, vision and hearing care the same as existing services covered by Medicare, with no co-pays for preventive care and no more than a 20 percent co-pay for other services — an approach that would lead to higher costs for the government.

The bill would also expand the Medicare eligibility age to those between 60 and 65.  However, that part of the bill will be the hardest to pass because of its cost and given the growing concerns about inflation most observers are very skeptical that proposal will be part of the final bill.

* * * *

Biden Administration Indicates Support for Whatever Health Care Bill Congress Can Pass

In a recent interview with Kaiser Health News, Health and Human Services Secretary Xavier Becerra was asked what health care measures the Biden Administration would like to see passed.  His response was very simple: “Our preference is to get it done. What’s the ‘it’? We’ll take everything we can get.”

However, he urged Congress to pass legislation to bring down drug prices, including allowing importation from such countries as Canada that have lower prices and giving Medicare the ability to negotiate prices.

Since the health care legislation in the House and Senate contain provisions for coverage of dental, hearing and vision by Medicare that TSCL has long championed, we are pleased that these have been included in the proposals.  However, unlike the Biden Administration, we will carefully track the legislation as it works its way through both Houses and reserve judgement until we see the final result.

Pay Freeze for Health Care Providers Proposed

Last week the Center for Medicare and Medicaid Services (CMS) proposed a payment rule for 2022 that does not include pay raises for doctors, physician assistants, nurse practitioners and others.

That means there will be a rerun of the battle over this year’s physicians fee schedule, which originally financed a pay increase for primary care providers by cutting payments to specialists.  That battle resulted in Congressional intervention that culminated in an across-the-board 3.75% pay raise for the 2021 calendar year, at a cost of $3 billion to taxpayers.

The payment increase this year enabled Medicare to pay more for office visits and avoid larger cuts for specialists. But they were only possible because Congress decided to increase Medicare spending rather than adhering to the program's budget neutrality requirement.

Now that the short-term boost is due to expire, CMS has proposed a 3.75% reduction in the physician fee schedule's conversion factor, which is used to calculate physician payments, for next year. As a result, total provider payments will not increase in 2022 unless Congress allocates additional money.

Specialists are particularly upset about the pay freeze since they would bear the brunt of the costs.

In addition, physicians and other providers could face additional cutbacks unless Congress puts a stop to Medicare sequestration and other budget rules that require spending reductions.

According to one medical industry expert, health care providers have long complained that Medicare payment rates have not kept pace with inflation. But many experts say that is intentional because their rates were already too high.

* * * *

As we continue recovering from the Covid 19 pandemic, TSCL remains constant in our 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 our website at www.SeniorsLeague.org, follow TSCL on Twitter or Facebook.