FixHealthCarePolicy

Obamacare in the Senate: Medicare Solvency and Patient Satisfaction

This Monday the Senate voted on two amendments that determined whether savings from Medicare will be used to enhance the solvency of the financially troubled Medicare program or be used to finance new government health programs and additional spending. Once again, the lesson for taxpayers is clear: Pay no attention to Senate rhetoric on health policy. Pay close attention to Senate action.

Gregg Amendment on Medicare Solvency: Senator Judd Gregg (R-NH) offered an amendment that would have required any new spending or revenue reductions stemming from the Senate health care bill to be fully offset by other savings before being enacted. Both the Director of the Office of Management and Budget and the Chief Actuary of the Centers for Medicare and Medicaid Services Office of the Actuary would have to certify savings before spending could begin.

Sen. Gregg’s amendment would ensure that any savings from Medicare or Social Security would have to be applied back to those programs.

Gregg’s amendment highlights the issues raised by Senator Michael Bennett’s (D-CO) amendment, which passed early last week. Sen. Bennett’s amendment required savings from Medicare to increase the solvency of Medicare—it did not, however, require all savings from Medicare to be applied to the solvency of Medicare.

Gregg’s amendment would have clarified the policy that all savings from Medicare would be used to enhance Medicare solvency. Sen. Gregg’s amendment failed by a vote of 43-56.

Pryor Amendment on Patient Feedback in Health Care: Senator Mark Pryor (D-AR) introduced an amendment to create an online enrollee satisfaction survey system as part of the new federally designed health exchange that would exist in the states. This would allow enrollees to evaluate qualified health plans in the exchange, as long as the plan enrolled more than 500 participants. It would make it easy to compare enrollee satisfaction levels between comparable plans. Sen. Pryor’s amendment was agreed to with a vote of 98-0.

It should be noted that health plans that are qualified to compete in the exchange will have to meet extensive requirements both at the state and federal level. This means that most plans will not differ much from one to another. Without a wide variety of choice and competition between health plans, the right to choose the benefits and medical procedures that one wants or needs, “consumer satisfaction” information means less than it would in a free market system, where consumers, not government officials, make all the key decisions in the system.

Kathryn Nix currently is a member of the Young Leaders Program at the Heritage Foundation. For more information on interning at Heritage, please visit: http://www.heritage.org/about/departments/ylp.cfm.

Tags: Amendments, Medicare, patient feedback, senate health care bill

Obamacare in the Senate: Medicare Advantage, Medicare Cuts, Home Health Care and Entitlements

Debate continues on the Senate floor on the Patient Protection and Affordable Care Act of 2009 (H.R.3590), and the focus continues to be on Medicare and Medicare Advantage. While proposing spending cuts in one program to create another, the Senate leadership is claiming that all of these Medicare cuts are possible without cutting benefits or services in current Medicare programs, such as Medicare Advantage and Home Health Care.

Stabenow’s Medicare Advantage Amendment. Senator Debbie Stabenow (D-MI) proposed an amendment which would ensure that spending reductions to the Medicare Advantage program would not result in a reduction or elimination in benefits that enrollees would receive. Sen. Stabenow’s amendment passed 97-1.

This amendment is a curious, as well as popular. Its popularity may reflect the substance of the legislation. The reason: Senate Majority Leader Harry Reid’s (D-NV) bill includes $118.1 billion in cuts to the Medicare Advantage program. It’s hard to imagine how cuts of this magnitude would not affect benefits for enrollees of the program — now more than one in five seniors. Examining similar provisions in the giant House-passed bill, the Chief Actuary of the Centers for Medicare and Medicaid Services said comparable spending cuts to Medicare Advantage would “reduce MA rebates to plans and thereby result in less generous benefit packages.”

The Hatch Amendment on Medicare Advantage Cuts. Senator Orrin Hatch (R-UT) made a motion to commit the bill to the Senate Finance Committee to remove Medicare spending cuts, which would have guaranteed Sen. Stabenow’s promise to protect the Medicare Advantage program. Sen. Hatch’s amendment failed with a vote of 41-57.

The Kerry Amendment on Home Health. Senator John Kerry (D-MA) offered an amendment that the Senate bill would guarantee home health benefits that Medicare enrollees receive under title XVIII of the Social Security Act. The Kerry Amendment to guarantee these benefits was very popular. It passed 96-0.

The Johanns Amendment on Home Health. Senator Mike Johanns (R-NE) then offered a motion to commit the bill to the Senate Finance Committee to remove spending cuts to the same home health benefits that Sen. Kerry’s amendment seeks to preserve. The health care bill currently contains $42.1 billion in cuts to home health benefits over ten years. Sen. Johann’s amendment was defeated by a vote of 41-53.

Whitehouse Amendment to Preserve Social Security. Senator Sheldon Whitehouse (D-RI) offered an amendment to ensure that surpluses created by the health care bill in the Social Security trust fund and savings generated by the CLASS Act would be reserved for Social Security and the CLASS program, respectively. The Senate voted to preserve savings from these programs 98-0.

It is worth noting that the Senate bill delays spending until after revenue collection begins. In examining the CLASS Act provisions, the Congressional Budget Office says, “…the program’s cash flows would show net receipts for a number of years, followed by net outlays in subsequent decades.”

Thune Amendment on Entitlement Spending. Senator John Thune (R-SD) proposed an amendment which would remove the CLASS act altogether in order to eliminate new entitlement spending and limit government control over health care. Thune warned that Congress should not be creating more problems like those inherent in Medicare, which, like the CLASS Act, was also intended to be fiscally self-reliant on premiums and revenues collected by users of the program. Sen. Thune’s amendment was defeated by a vote of 51-47.

Kathryn Nix currently is a member of the Young Leaders Program at the Heritage Foundation. For more information on interning at Heritage, please visit: http://www.heritage.org/about/departments/ylp.cfm.

Tags: Amendments, entitlement spending, Home Health Care, Medicare Advantage, Senate Health Bill