Romney's Budget Promises on Medicare Cannot Be True
The political jiu-jitsu on Medicare since the selection of Paul Ryan as the GOP Vice Presidential candidate has been amazing to watch. Democrats shriek Romney/Ryan will "end Medicare as we know it." Romney/Ryan countered by charging that health reform was funded by $716 Billion in Medicare cuts -- it's Obama who is the threat to the program. At the moment they're fighting to a draw in the polls on the issue. But the fact is that Romney's budget would restore the ACA cuts to Medicare -- and require everything else the Federal government does except Social Security and defense to be cut by a catastrophic 40% as a result. Which means Romney's budget proposal isn't worth the paper it's on.
As he prepared to keynote the Republican Convention Romney issued a statement: "A Romney-Ryan Administration will restore the funding to Medicare, ensure that no changes are made to the program for those 55 or older, and implement the reforms that they have proposed to strengthen it for future generations." Avik Roy, a health-care policy adviser to Romney, doubled down. "Whatever you think of Obamacare's cuts to Medicare, the fact is that a Romney administration would repeal them," he writes.
Restoring the ACA's Medicare cuts -- which Ryan's own budget proposals don't dare do -- means that if Romney is elected, by his third year in office, every federal program that is not Medicare, Social Security, or defense, will be cut, on average, by 40 percent. That means everything -- roads and bridges, farm aid, foreign aid, food stamps, the works. EVERYTHING. It means cuts far deeper than even what his running-mate has proposed. Mushroom cloud on the American economy.
One of my all-time favorite bloggers, Ezra Klen at the Washington Post, summed it up best:
"Consider what Romney has promised. By 2016, he says federal spending will be below 20 percent of GDP, and at least 4 percent of that will be defense spending. At that point, he will cap federal spending at 20 percent of GDP, meaning it can never rise above that level.
"All that's hard enough. Romney will have to cut federal spending by between $6 and $7 trillion over the next decade to hit those targets. As my colleague Suzy Khimm has detailed, those budget promises already require cuts far in excess of what even Paul Ryan's budget proposes.
"But Ryan's budget includes more than $700 billion in Medicare cuts over the next decade, Romney's budget won't. And Romney promises that there will be no other changes to Social Security or Medicare for those over 55, which means neither program can be cut for the next 10 years. But once you add up Medicare, Social Security and defense and you've got more than half of the federal budget. So Romney is going to make the largest spending cuts in history while protecting or increasing spending on more than half of the budget.
"The Center on Budget and Policy Priorities indulged this idea back in May. If Social Security and Medicare are spared from cuts, then to get federal spending under 20 percent of GDP while holding defense spending at 4 percent of GDP, "all other programs — including Medicaid, veterans' benefits, education, environmental protection, transportation, and SSI — would have to be cut by an average of 40 percent in 2016 and 57 percent in 2022."
"That's not even remotely plausible. The consequences would be catastrophic. The outcry would be deafening. And Romney has shown no stomach for selling such severe cuts.
"Consider that, even as we speak, Romney is running away from the unpopular bits of the Ryan budget, which delivers far less devastating cuts than what Romney is promising. Does anyone really believe that he will take office and cut education by 40 percent? That he will take office and, after running away from specifics during the campaign, propose what would surely be the most unpopular budget in American history?
"And does anyone believe that the real Romney is the guy who made these outlandish budget promises in order to win a Republican primary, rather than the guy who is disavowing Ryan's Medicare cuts mere days after naming him to the ticket?
"This is simply not a credible budget plan, and Romney's fast retreat from Ryan's most unpopular cuts makes it even less credible. And yet Romney, who has never released the specific cuts that would make his numbers add up, repeatedly touts it on the campaign trail, and the media dutifully reports his promises to cut federal spending by more than $500 billion in 2016, and in fact to balance the budget by the end of his second term, which would require far larger cuts than what I've outlined here, despite the fact that everyone basically knows these cuts aren't credible and will never happen.
"I'm not sure what alternative there is, exactly, except to say, as clearly as possible, Romney's budget plan is a fantasy, and it will never happen. I would revise that opinion if Romney released a list of specific cuts that achieved his spending goals and showed himself willing and able to take the heat for them. But I don't think that's going to happen."
Woo. And Amen. It certainly seems as if the Emperor-Aspirant wears no clothes on the centerpiece of his campaign.
I'm a Ryan Fan on Medicare, But He Dropped Some Whoppers at the Convention
As we've said here before, we're fans of Rep. Paul Ryan's Medicare reform plans with Senator Ron Wyden (D-OR). Ryan's the first Gen-Xer on a major party ticket, and he's just so freakin' earnest he's hard not to admire. He did a nice job of rallying the faithful in his speech to the Republican National Convention. But man, he dropped some whoppers you just gotta call him out on, because they undermine his credibility as a brave standard-bearer for big ideas, especially on Medicare.
Ryan made his reputation in large part by advancing an unpopular plan to dramatically cut and restructure Medicare two years ago. While he didn't mention his own plan once on Wednesday, he included it in his last two budgets, both of which preserved the Affordable Care Act's cuts to Medicare — taken mostly from health plans and and hospitals. Instead, Ryan once again accused President Obama of being the true threat to Medicare.
"You see, even with all the hidden taxes to pay for the health care takeover, even with new taxes on nearly a million small businesses, the planners in Washington still didn't have enough money. They needed more. They needed hundreds of billions more. So, they just took it all away from Medicare. Seven hundred and sixteen billion dollars, funneled out of Medicare by President Obama. An obligation we have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn't even ask for. The greatest threat to Medicare is Obamacare, and we're going to stop it."
Obama did use those Medicare savings — in the form of targeted cuts in payments to providers, not in benefits to seniors — to pay for the health care law. Ryan's budget calls for using them to finance tax cuts for wealthy Americans, and deficit reduction. But by now calling to restore that spending commitment to Medicare, Ryan and Romney would accelerate Medicare's insolvency by several years.
Ryan also criticized the president as failing to act on the recommendations of the bipartisan debt commission that Obama had created. "They came back with an urgent report," Ryan said in his speech. "He thanked them, sent them on their way, and then did exactly nothing." He was referring to the Simpson-Bowles commission — which Ryan served on, but whose plan he ultimately opposed, saying it would raise taxes and not cut enough from health programs. Ryan's opposition put Simpson-Bowles in the ground, since it soured other House Republicans on the proposal.
And in an extended critique of the president's stimulus plan, Ryan said: "What did taxpayers get out of the Obama stimulus? More debt." He didn't mention that a third of the stimulus was in the form of tax cuts, and that he sought stimulus funding for his own district.
Near the end of his speech, Ryan claimed the campaign's top priority is protecting the poor. "We have responsibilities, one to another — we do not each face the world alone," he said. "And the greatest of all responsibilities is that of the strong to protect the weak." But just under two-thirds of the cuts in Ryan's budget target programs that benefit low-income people, while calling for large tax breaks for the wealthy.
I know it's delusional to think we'd get straight talk in an election year. I just hate to see an effective advocate for Medicare reform like Ryan diminish himself for applause lines no one will remember in 30 days -- when the big fight on Medicare is coming in 2013. The country needs this guy to keep his facts straight and distortions narrow.
Obama, Ryan, and the Myth of Competition
Both the exchanges at the heart of ObamaCare, and the competing plans in the Ryan Medicare reform proposal rely on competition among health insurance plans to reduce the upward trend in the costs of health care. But health insurance isn't health care.
With the consolidation of health care providers that is happening throughout the US, more and more health care is being purchased in non-competitive markets. Health insurers are faced with large systems that must be included in the carriers' networks if they, the insurers, are to offer a competitive product in the market. Consumers expect access to the big systems, and insurers must include them. That is the description of an oligopolistic market for health care. Nothing that happens in the exchanges or among the Ryan-esque Medicare plans will change that dynamic. Eighty to eighty-five percent of the cost of health insurance is driven by the cost of health care. Costs determined by the health care oligopolists will inexorably drive up the costs of health insurance.
A 2011 RAND study found that "hospital markets are much less competitive than health plan markets nationally and, importantly for consumers, that hospitals operating with little competition are able to charge health plans much higher prices, which are passed on to consumers in the form of higher insurance premiums."
Anna Wilde Mathews, writing in the August 27, 2012 Wall Street Journal cites hospital acquisition of physician practices as another cost driver that is immune to health insurance competition. She notes that prices for procedures can double after an acquisition, sometimes even when the procedure is performed by the same people in the same facility with the same equipment.
The Health Care Cost Institute published a study of health care costs in May of 2012, based on an analysis of commercial insurance claims from over 33 million beneficiaries of several large carriers. The Institute found that "the increase in per capita health care expenditures from 2009 to 2010 was primarily driven by higher unit prices and not by the utilization (amount) or intensity (mix) of services." This was in the wake of the Great Recession, when competitive pressure should have been driving prices down, as in other markets. But competition among the major carriers who provided the data for this study had no apparent effect on prices charged for care.
In this study, increases in the cost of care determine increases in the cost of health insurance, in a way that competition, even among major insurance carriers, could not alter.
The policies of both parties regarding affordability of health care are built on a myth. Expecting competition among health insurers to control the cost of health care is akin to expecting competition among auto manufacturers to control the price of gasoline.
Politics Distort Similarities Between RomneyCare, ObamaCare and RyanCare
I was quoted in Monday's New York Times story on the success private plans are having in Medicare, pointing out the similarities between RomneyCare, ObamaCare, and RyanCare -- Paul Ryan's proposal for Medicare reform, now receiving unprecedented scrutiny following his selection as Vice Presidential candidate. When you remove the distortion of election-year politics, it's easy to see the three approaches share the same DNA.
Only in an election year could you see a conservative advance a proposal for Medicare reform with a liberal pedigree and get demagogued for it. The same could be said for Obama -- a liberal advancing health reform with conservative concepts. Consider:
- RyanCare's premium support or vouchers resemble the subsidies of Romney's Massachusetts' health reform and Obama's Affordable Care Act. All three proposals have roots extending to President Clinton's and subsequent bipartisan entitlement reform commissions, as well as to conservative think tanks like the American Enterprise Institute and the Heritage Foundation.
- All three feature a government-regulated insurance exchange, modeled after Medicare Advantage and Part D, as the central marketplace where consumers will choose the coverage that fits best.
- All three feature critical insurance reforms and foster regulated competition among payers and providers at their core. To be clear, Ryan's second Medicare proposal with Senator Ron Wyden (D-OR) features much stronger consumer protections.
Medicare really wasn't a leading issue in the election; now it is with Ryan's selection, especially in senior-heavy swing states like Florida and Pennsylvania. Both camps are jockeying to define the other, with Ryan the Democrat's poster boy for "Medi-Scare" or "Medagoguery" tactics. An honest debate over Medicare is delusional in an election year -- but will be unavoidable in 2013 as the "fiscal cliff" looms and the deficit debate comes to the fore again.
My concern is that Democrats and Republicans will stake out positions during the election cycle that prevent them from having the thoughtful discussion the country needs about Medicare's future next year. We must first agree that Medicare in its current form is unsustainable. The most recent Medicare Trustee's report stated the Part A Trust Fund will be bankrupt in 2024 under a rosy outlook, and we know the program is a major contributor to deficit projections. We can't go on this way.
Ryan-Wyden lays out a carefully considered approach shown to be successful in Medicare Advantage and Part D. Without Ryan-Wyden's kind of structural reform, we have no hope of getting our debt under control. Ryan-Wyden was a significant improvement over "Ryan 1" -- his first, draconian Medicare reform proposal two years ago -- and it shows Wyden's liberal, former Gray Panthers fingerprints. It keeps traditional Medicare as an option, with heavily-regulated competition at its core. Ryan-Wyden is adequately funded whereas Ryan 1 pegged subsidy growth to inflation, which would result in a huge cost shift to beneficiaries. Ryan-Wyden's subsidies are pegged to the second-lowest bid or traditional Medicare, whichever is cheaper. Seniors who choose a plan above the benchmark would pay the difference, just like in Part D. It calls for the formation of a Medicare exchange modeled after www.Medicare.gov, and even adds a new catastrophic benefit, also like in Part D. It is inextricably related to both RomneyCare and ObamaCare.
The fundamental difference between the parties is what we'd do with the savings, and that's what elections are for. My hope is that it doesn't get so nasty that battle lines harden and Ryan-Wyden doesn't get its moment.
GOP Piling-on Begins on the Medicare Advantage Star Ratings Demo
House Republican Committee chairmen began to pile onto rising controversy around the $8.3 billion Medicare Advantage Star Ratings Demonstration this week, first brought to attention by the Government Accountability Office's study of the program commissioned by Senator Orrin Hatch (R-UT) in April.
In May, the American Action Forum — an influential conservative think tank here in DC — released a report authored by former Congressional Budget Office Chief Douglas Holtz-Eakin blasting the Stars Demo. "The system rewards beneficiaries for choosing those plans favored by the selected CMS criteria, rather than the plans that best meet their needs," said the report. It went on to say the program will actually serve to limit choice — and since counties with higher incomes will end up having higher-rated plans, it will have an adverse effect on low-income beneficiaries. "The goal of incentivizing quality health plans is legitimate and admirable; that goal will not be achieved by the rating structure currently being put into place," Holtz-Eakin wrote.
Last Friday House Ways and Means Committee Chairman Dave Camp (R-MI) weighed in with a nasty-gram to HHS Secretary Kathleen Sebelius demanding extensive additional information on the development of the Stars Demo. Camp wrote, "With its most recent report, GAO has determined HHS exceeded its legal authority to implement this demonstration, which calls into question all activities surrounding the development of the (Stars Demo)". Camp requested that Secretary Sebelius detail all communications with the "CMS Actuaries' office, the Office of Management and Budget, the White House, the Democratic National Committee, the Democratic Congressional Campaign Committee, the Democratic Senatorial Campaign Committee and" — wait for it — "Obama for America, which led the agency to take action related to the (Stars Demo)". Wait, wait — did he just say that? The Obama campaign directed CMS to launch this demo? Having worked in the agency I can tell you these guys are smoking something excluded from Part D coverage.
Join us Thursday for First in New Webinar series: Risk adjustment in the exchanges
On Thursday July 26th at 1pm ET we'll kick off our new webinar series, "Lessons from Medicare Advantage and Part D", a monthly webinar series around what we've learned in Medicare that can be applied to the exchanges and other aspects of health reform. We'll begin with a deep dive on risk adjustment in the exchanges.
Risk adjustment is the defining health care finance issue of the decade, and MA and Part D represent the largest experiments in risk adjustment on the planet. MA and Part D's risk adjustment system is the blueprint for ACOs, the exchanges, and a growing number of state Medicaid programs as well. We'll explore the risk adjustment provisions in the ACA and the final regulation, and apply what we've learned in the last 7 years to the future of health plan payment, with our partner Dr. Jack McCallum, CEO of GHG sister firm CenseoHealth. Bring your CFO, Chief Strategy Officer, CMO,Chief Marketing Officer, and your actuaries for a geektastic discussion on how to follow the money post-2013. In the coming months we'll examine other reform topics where the Medicare, Part D and Medicaid Dual Eligible experience shines a light: In early September: Distribution In and Around the Exchanges: Lessons from MA and Part D. We'll explore how individuals with subsidies and small groups will be sold the "metal" plans, especially in the Exchanges through Navigators and other impartial facilitators, to the deployment of brokers and sales management. Our focus will be on the Federally-Facilitated Exchange, which could operate in as many as 40 states, with updates on specific states as applicable. In late September: we'll explore the Nuts and Bolts of the Federal Exchange: Lessons from MA and Part D. We'll focus on how the Federal Exchange will function from a 10,000-foot level perspective, where the plan interfaces are and the broad strokes of anticipated reporting requirements. In late October: Product Strategy in the Exchanges: Lessons from MA and Part D. How subsidies will work based on income determinations; a landscape view of where states are on accepting ACA Medicaid expansion dollars in the wake of the SCOTUS ruling. For Red States: what the new "near-Medicaid coverage gap" means in those states that refuse the ACA funds. We'll examine how to segment the market for Platinum, Gold, Silver, and Bronze plans, and the allowability of supplemental insurance products (like dental) in the exchanges. What existing commercial and government programs provider networks mean to product pricing and strategy. The imperative for a database of local individual claims to wargame product designs on. More to come. The scars on our collective backsides in Medicare the last 16 years provide some great "teachable moments" for the new world post-ACA. We look forward to the discussion.
Rising Chorus Urges CMS to Slow Down on Dual Eligibles
CMS and at least 20 states are moving hell-bent-for-leather toward enrolling as many as 3 million of the 9 million Dual Eligibles into health plans in the next two years, creating one of the biggest opportunities for payers in history. Now a rising chorus including the Medicare Payment Advisory Commission, the American Medical Association, some policy analysts and now at least one key Senator are urging CMS to hit the brakes. I tend to think the movement of duals into plans is like the movement of water: it can be slowed but not stopped.
Most agree that something has to change for the 9 million Americans who receive both Medicare and Medicaid. Duals typically have multiple chronic conditions, much higher prevalence of mental and behavioral health problems, polypharmacy issues, and much higher rates of institutionalization. They represent about 15% of Medicaid enrollees but account for almost 70% of program costs. Duals are the most vulnerable patients in the entire US health system, and they need the best of what health plans have to offer: better coordination, access to broader networks of providers, and better deployment of home and community-based services. 15 states are working with CMS on a pilot program to transition these folks to health plans in the next couple years, and at least another half-dozen states are moving forward on the same timetable but without CMS assistance.
But resistance to the effort is escalating:
- MedPAC recently raised a number of concerns over the size, scope and rapid pace of the program. "If all the state proposals are approved, then roughly 3 million dual eligible beneficiaries will be enrolled," MedPAC Chairman Glenn Hackbarth stated in an 11-page letter to CMS. "This would mean that approximately 40 percent of all full-benefit duals will be enrolled in the demonstration."
- Provider and advocacy groups warn that the size of the pilot programs under consideration represent the equivalent of a waiver or Medicaid program change. Last month, the AMA called for a delay of the program to give providers and patients more time to understand how it would run. Among the AMA concerns were disruption of established doctor-patient relationships, auto-enrollment of duals, and that pilots don't slash physician fees.
- Sen. Jay Rockefeller (D-W.Va.), who helped shape the effort in the Affordable Care Act (ACA), has called for its immediate suspension. In a letter released late last week, Rockefeller torched the pilot, asserting its design is more about savings for states and less about improving care. Rockefeller created the CMS Federal Coordinated Health Care Office in the ACA -- so this episode is a bit like Daddy taking his son to the woodshed.
I tend to think these concerns will result in CMS raising the bar on states and other stakeholders -- there will be plenty of strings attached to these pilots, especially for the plans -- but they won't stop the movement of duals into health plans. The state fiscal crisis is so severe that Governors and Legislatures need these initiatives to move forward just to balance their budgets -- duals are the #1 or #2 item in every state budget now. And the Feds are eager to help states with the right approach, especially in light of the drama on Medicaid expansion arising from the recent Supreme Court decision. So it may get noisy around the duals' transition to health plans, but it won't get slower.
GOP's "Reform Repeal Theatre" Costs Taxpayers $48 Million. WTF?
The House of Representatives again voted to repeal the Accountable Care Act (ACA) last Wednesday, marking the 33rd time Republicans have tried. All 32 previous attempts died in the Senate, as this one will. But the GOP's "Repeal Theatre" comes with a sick price tag: about $48 million and counting, according to a report by CBS News.
CBS reported last Wednesday that Republicans' many futile, utterly symbolic attempts at repealing the ACA have eaten up at least 80 hours of time on the House floor since 2010, amounting to two full work weeks. As the House, according to the Congressional Research Service, costs taxpayers $24 million a week to operate, those two weeks amounted to a total cost of approximately $48 million. I just threw up in my mouth a little.
And while all this drama and silliness is going on and a pile of taxpayer dough gets flushed, have the Republicans gotten it together enough to propose an alternative? The promise when the new House majority took over in 2011 was "Repeal and Replace." We've now seen 33 acts of repeal at a cost of almost $50 million, and not a word of dialogue on replace. Know why? There isn't one. The ACA was it.
Remember, this law's policy framework -- the individual mandate, subsidies, and exchanges -- was developed at the conservative Heritage Foundation, advanced by a conservative (Speaker Newt Gingrich, mid-90s), implemented by a conservative (MA Governor Mitt Romney), upheld by a conservative (Chief Justice John Roberts), and now denounced by conservatives. Most of what the GOP had in the "health reform toolbox" ended up in the ACA. All that's left is the same warmed-over stuff we've heard for years that still don't have the votes: selling insurance across state lines, tort reform, Medicaid block grants. They got nothin'. And 50 million uninsured Americans and the providers who would care for them need better than "Repeal Theatre".
Medicaid Mattered Most in the SCOTUS Decision
In all of the drama around the recent Supreme Court ruling on the Accountable Care Act (ACA) and the individual mandate, it was the Medicaid eligibility expansion ruling that mattered most. Hands-down, Medicaid was WAY more important: $1 TRILLION and 17 million Americans' access to health insurance is now at stake, potentially millions more when Medicaid maintenance of effort rules on states expire in 2014, and it's all red meat for Red State governors who will devour it at their own peril.
Red State governors will make a spectacle of throwing a middle finger at President Obama -- but it's the most vulnerable Americans and the most hardcore uninsured they're giving the shaft. Not to mention hospitals and other powerful provider organizations who would prefer Medicaid to bad debt. I'll say it here: the RedGovs' are bluffing for political gain and most of these jerks will fold before the election, ultimately taking the ACA expansion money in the face of an onslaught of local lobbying.
Why Medicaid mattered: SCOTUS essentially made it optional for a state to participate in ACA's $1 TRILLION Medicaid eligibility expansion to 133% of the poverty limit. The federal government is funding 100% of the expansion for the first three years, and will eventually scale back to match $9 to every $1 spent by states. According to the Center on Budget and Policy Priorities, the Feds would pay $931 billion of the cost of the Medicaid expansion through 2022 — while the states would be asked to chip in $73 billion, or about 7%. It's a great deal for cash-strapped Red States. If a state declines to participate in the coverage expansion, it will create a huge gap in coverage among the poor and near-poor, and will subject safety-net providers to more bad debt where there was supposed to be coverage.
The Republican governors of 5 states — Florida, Texas, Louisiana, Mississippi, and South Carolina — have declared they want nothing to do with the expansion. "The bottom line here is that Medicaid is a failed program," Texas Governor Rick Perry -- who claims 1.3 million long-term uninsured in his state -- said Monday on Fox News. "To expand this program is not unlike adding a thousand people to the Titanic."
Are we talking about the same Medicaid program? You know, the one that is the largest source of health insurance in Texas and the nation? Leaders of 6 other states are considering the same kamikaze mission. As of today, the scorecard looks like this:
Hell, No (5) -- FL, TX, LA, MS, SC
Probably Not (5) -- IA,MO, NE, NV, NJ, WI
Leaning Yes (3) -- AR, OR, RI
All-In (10) -- CA,CT, DE, DC, HI, IL, MD, MA, MN, VT, WA
Undecided (26) -- AL, AK, AZ, CO, GA, ID, IN, KS, KY, ME, MI, MT, NH, NM, NY, NC, ND, OH, OK, PA, SD, TN,
UT, VA, WV, WY
Publicly-traded health plans and hospitals and Wall Street itself are betting the RedGov's are chest-thumping too. WellPoint announced Monday it will spend almost $5 billion to purchase Amerigroup to buy a bigger stake in Medicaid expansion. "When you step back from all this, there are billions of dollars of federal money that are going to flow into the states. We think the states are going to need to take it," Amerigroup CEO James Carlson said following the announcement. Stocks for Amerigroup, Molina and Centene all jumped following the SCOTUS ruling, posting gains of 20+% this week.
Stocks for the largest chains of private, for-profit hospitals also shot up following SCOTUS, and the RedGovs' threats to withdraw from Medicaid have done little to drive them down. Hospitals expected to be another beneficiary of the Medicaid expansion -- in 2010, they paid out $39.3 billion — 5.8 percent of their total expenses — in uncompensated care.
I get the RedGovs' posturing but still hate them for it: rejecting the Medicaid expansion fits with their crusade to cut government, and a slam on Obama is catnip for their base. But the ringleader of the RedGovs, Florida Governor Rick Scott, is the former CEO of HCA, one of the biggest publicly-traded hospital chains in the nation. Texas' massive hospital districts and Louisiana's charity hospital system make for noisy, well-funded lobbying campaigns with intense turnout on the ground. The RedGovs will face the fury of a local lobbying campaign never before seen at the state level. Hospitals will say they're doomed to bad debt if RedGovs reject the coverage expansion. They'll remind the RedGovs that hospitals are among the biggest employers in most communities and will say that once-rock-solid jobs in their communities are now in peril. They will point out that without Medicaid expansion, many small safety-net and traditional providers of care to the underserved will cease to exist.
The Kaiser Family Foundation released a poll this week following the SCOTUS ruling, and it found 56% of Americans now say they would like to see the GOP stop their efforts to block the ACA's implementation and move on to other national problems. Solid majorities of voters of every political stripe say the decision won't impact whether or not they vote this November. That shows the RedGovs' politics on Medicaid expansion for what they are: opportunistic, fiscally irresponsible, cynical, and heartless. And they'll pay for it in November.
Medicare ACO's: Tool for Reducing Medicare costs or something more?
The June 18th blog by my colleague and friend William MacBain posed a valid question when he asked whether Medicare ACO's are a revolution in healthcare or a side show. My view--it's that and more. To the point that Medicare ACO's will probably have only a minor impact on overall Medicare expenditures, I totally agree but would argue that significantly reducing Medicare expenses is not the overriding goal of the CMS sponsored shared savings program. I believe the overriding goal is to stimulate provider change in how healhcare is priced, delivered and made accessible to those who need it.
To the question of whether Medicare ACO's are a sideshow, I would respond with yes but in a good way--meaning that ACO's, Medicare sponsored or not, have helped ramp up the level of dialogue and drawn attention to the reality that change is coming to the healthcare industry, that it will come in many forms and that ACO's are one model for implementing such change. ACo's are not the magic cure for what ails the healthcare industry but ACO's do begin to address some of the symptoms -- that is a good thing.