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A Questionable Way to Change Medicare

With so many significant changes to the Medicare program being discussed right now, I thought it would be a good idea to take a step back and examine the way changes in Medicare policy get made. It would be good to understand, for example, what tools are used to make it possible for any president’s administration to unilaterally change the program.

As you know, there is a defined process that allows our government to spend money and to change programs that have been legislated into law. A tool that presidents are using more frequently to get around these conventional processes involves the Center for Medicare and Medicaid Innovation (CMMI).

CMMI was created within the Affordable Care Act (Obamacare) as a testing ground for new ways to implement and pay for healthcare in our country. It was a great idea, have providers or payers or academia propose new ways to increase the efficiency and lower the cost of healthcare. Let them get a small number of representative healthcare providers signed up and test a new concept outside of current regulations and restrictions. If there is a positive result from the small test, then the changes to the existing laws can be proposed and the normal legislative processes are followed to implement the changes. What a great idea, test ideas to find the best way to administer healthcare before you change the existing laws. Unfortunately, this great idea began to be used instead as a way to circumvent the usual process and change Medicare policy, by both the Obama and the Trump administrations.

This misuse began with the administration proposing ideas directly to the CMMI that were so large in scale they were similar to an actual policy change. These proposed tests were not limited; they were designed to include virtually all the providers in America. And the test mandated participation, no provider could opt out. There is no legislative input and no judicial review. This is not how the CMMI has usually done business, it ignores the checks and balances that historically have been part of the CMMI process. Whether you believe the changes proposed by a president are good or not, this is not the way we should be changing programs that have been voted into law by the legislative process.

Misusing designed testing programs is not limited to the CMMI. The $200 card that the President proposed to send to 33 million Medicare beneficiaries to help pay for prescription drugs uses a program in the Social Security Act that allows Medicare to test out new money saving programs. These tests are usually proposed by state governments, Congress or the private sector and go through a rigorous, methodical approval process. Again, it isn’t for implementing a payment to 33 million Americans within a few weeks. This program is primarily for saving money so it must be at least budget neutral. The proposed source of funds to offset the cost of this $6.6 billion program is the savings from the “most favored nation” Executive Order, a program that hasn’t been implemented and any proposed savings are suspect. This onetime payment does nothing to lower the long-term costs of our healthcare. A yearly cap on the out-of-pocket payments on Medicare Part D would be a much more effective long-term solution to those who really need help with the tens of thousands they pay each year for their prescription drugs.

Somehow, we must put safeguards around these various testing programs. They should be transparent, have continued congressional oversight, have clear goals and published updates, be available to testify at congressional hearings, and have committee hearings before a rule is finalized. Unilaterally changing Medicare is not the way we should be operating. The checks and balances inherent in our government have worked for over 200 years. As you communicate with those who represent you, either directly or through your vote, remember how important it is to make sure that any changes to Medicare go through the same approval process that brought us this great benefit.

Get your flu shot and stay healthy, Thair