Policy & Regulation News

Medicare, Affordable Care Act Spending Discussion Continues

By Jacqueline DiChiara

- Medicare and the Affordable Care Act's (ACA) financial future is perhaps nothing more than a cyclone of ever-evolving opinions. A recent RevCycleIntelligence.com article, Will Medicare Part D Prescription Drug Plans Stabilize, has been generating a great deal of buzz among those in the healthcare industry.

affordable care act Medicare spending

The article poses the following primary discussion question: Where is Medicare – the second-largest social insurance program with nearly 54 million beneficiaries and total expenditures topping $610 billion – heading next in terms of projected spending costs?

A riveting conversation including a series of pressing revenue questions, urgent concerns about cost struggles regarding the ACA, and the eloquent ability to agree to disagree, has unfolded within the past week on online healthcare forums, primarily on the LinkedIn page for the Centers for Medicare & Medicaid Services (CMS). As RevCycleIntelligence.com aims to communicate and educate the healthcare industry about revenue cycle matters, such conversation is important to analyze, dissect, (and continue) ongoing revenue cycle concerns, challenges, and triumphs to best determine how to strengthen tomorrow’s bottom line.

Here is a brief collection of reactions to the aforementioned question and article from anonymous members of Xtelligent Media’s online audience:

ACA Expert: CMS may be on the right path

"It appears that CMS is doing a pretty good job in terms of prescription cost control. As long [as] consumers of CMS services are not deprived essential care base on the cost control method, CMS might be on the right path. … [How] do you make Medicare work for everyone? I understand the mandatory part of the ACA regarding health insurance is a little too much, however, one [needs] to shift cost of healthcare. When the government [starts] to pay for everything, taxes might increase and I am sure you won't be pleased. [The ACA] makes healthcare more competitive and health insurance compete for your business."

Multi-Line Producer: premiums low but costs high

"I think the Medicare entry age should be lowered to 60 or 62. The [ACA] client above age 60 has way too high of a monthly premium. … Having one program could make things [simpler]. I have to tell clients that are 60+ all the time. Your [ACA] premium will be high and your RX cost low, but when you turn age 65, your premium will be reduced possibly to as low as $0, but your RX cost will go up. Particularly when speaking with clients [with] high RX needs."

Educational Director: playing the blame game

"[According to the AMA,] 75% of all the money we will spend on healthcare in our lives will be spent in the last 18 months. According to the National Chamber of Commerce, [seniors] control 64% of the disposable wealth in our country. We have an 18 trillion dollar debt in this country. We have 17.8 trillion dollars in organized retirement funds. You don't have to be a mathematician, to add it all up. Our country intends to balance our budget on the backs of our seniors. The only real question is, who can they put the blame on?"

Health Insurance Agent: consumers have less choice

"The government didn't seem to get the fact that the continued yearly increase in premiums by health insurance companies (for reasons they manufacture as a justification) were the main sore point for … people with preexisting conditions being rejected, not with the benefits in their plans. Instead, the government did the opposite as is par for the course and metaled (no pun intended) with the benefits without taking into account the main problem which is the premium cost."

"Their solution was to give money away to people who say they cannot afford the premium and letting the very industry (private health insurance carriers) that created the problem continue [get] away with highway robbery. Is it any wonder how all of a sudden, the likes of Anthem and others can all of a sudden start buying out their competition on a profit of only 3% now giving the consumer lessor of a choice then they had before ACA!" 

Health Plan Representative: ACA is not economical

"The ACA does nothing to lower healthcare costs … Less than one half of one percent of the country is eligible for subsidies and pay less, but … [can] anyone out there who doesn't get subsidies or cost share reduction say that they aren't paying at least twice as much in premiums[,] … anywhere from 4 to 10 times more out of pocket in their plans as compared to before the ACA?"

"The ACA now is stealing over 1/2 a billion more dollars from Medicare to use on ACA costs. The ACA authors claim that Medicare Advantage (MA) Plans cost more than Traditional Medicare and so they are cutting reimbursements that Congress itself set up in [the] first place. Sounds fair, right? Except we see a totally different story if we simply look at how much Medicare spends and the % of the spending that goes to MA Plans compared to % of people covered by MA plans vs. Fee-For-Service Medicare!"

"[If] Medicaid pays about 30 cents on the dollar for care, and Medicare pays about 38 cents on the dollar for care and almost 2/3 of American patients are already on Medicare or Medicaid, that means the other 1/3 of patients that are private pay are paying their entire bill."

Do you have commentary of your own you'd like to share for a future article? Share your voice with the author at jdichiara@xtelligentmedia.com.