In the October 3 order, Trump mentioned the proposed Medicare for All Act of 2019, which would significantly alter the program.
“America’s seniors are overwhelmingly satisfied with their Medicare coverage,” states the order. “‘Medicare for All’ would take away the choices currently available with Medicare and centralize even more power in Washington, harming seniors and other Medicare beneficiaries.”
Creating New Options
Trump’s order calls for expanding alternative payment methodologies, such as Medicare Advantage (MA), that “link payment to value, increase choice, and lower regulatory burdens imposed on providers.”
The Secretary of Health and Human Services (HHS) will have one year to propose a regulation and implement ways to expand plan choices. These could include a “Medicare Medical Savings Account” usable to pay for extra benefits and telehealth. Beneficiaries might even be eligible for rebates if they choose more cost-effective plans and services.
The current fee for service (FFS) model will remain, but the order gives HHS 180 days to issue a report on modifying FFS payments to more closely align with prices in MA or plans in the commercial insurance market. In addition, recognizing that “network adequacy,” or provider competition in individual markets, has a big effect on the success of MA plans, the order gives HHS one year to propose a regulation adjusting MA plan requirements to take into account anticompetitive government restrictions such as certificate-of-need laws, which impede service expansion in 35 states.
Putting Beneficiaries First
Beneficiaries should experience some improvements in the time they spend with providers as a result of the changes. The order calls for new regulations eliminating “burdensome billing requirements” and rewarding providers for time spent with patients. This includes a review within one year by HHS of policies that “create disparities in reimbursement” for care and service from nonphysician care providers such as nurse practitioners.
The order also addresses a frustration for seniors who do not want to participate in Medicare but have pay for Part A through automatic deductions from their Social Security checks. The order calls for a change in this rule within 180 days.
It is a welcome move, not just to current seniors but for future generations, says Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons and a policy advisor to The Heartland Institute, which publishes Health Care News.
“Young people might not care now but might change their mind as rationing becomes more extreme,” said Orient. “If those who can opt out do, better alternatives might develop.”
AnneMarie Schieber ([email protected]) is managing editor of Health Care News.
“Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors,” October 3, 2019: https://www.whitehouse.gov/presidential-actions/executive-order-protecting-improving-medicare-nations-seniors/