CBO: Baucus bill would cost $829b over next decade, leave 25 million uninsured

[jackalope]

It was confusing to me at first as well, but I believe the two groups are different. The AMA was promised $200b in increased doctor payments under Medicare. This money is not in exchange for treating more people, but rather to offset what would otherwise be cuts in their reimbursement rates. This bill does not include that promised $200b.

The second portion of that quote is referring to the Federation of American Hospitals when it says "trade group." The White House apparently struck a deal with them whereby they would accept a $155b reduction in payments if the bill covered 94% of people. Since the bill doesn't, they will presumably refuse to accept that $155b reduction.



The plan claims to be revenue neutral (although that's doubtful, based on the above info), but even so, it's revenue neutral for two reasons: The massive cuts in reimbursements and the huge tax on healthcare plans, much of which will fall on those making under - you guessed it - $250k.

Okay, the trade group is the Federation group. So, the hospitals are getting less payments in the Baucus bill, but the doctors are saying they were promised higher payments? What were the doctors promised higher payments in exchange for?

I know there was talk of blowing up a pharmaceutical deal the White House made, too, but I don't see that referenced in the articles either. The taxes part, I don't know which scheme will end up in the final bill. The other bills have different tax schemes.

 

[RightinNYC]

Okay, the trade group is the Federation group. So, the hospitals are getting less payments in the Baucus bill, but the doctors are saying they were promised higher payments? What were the doctors promised higher payments in exchange for?

The doctors were promised more money in exchange for continuing to treat Medicare patients. To put it another way:

Say a procedure costs a doctor $20 to perform. He likes to perform it for people on private insurance, because they pay him $30, but doesn't like to perform it for people on Medicare, because the government only pays him $25. If a doctor lives in an area where there are enough people with private insurance demanding the procedure, he will probably refuse to take Medicare at all. However, if his day is only 60 or 80% full with private patients, he may take on Medicare patients to fill that gap. Even though he's not making much, the private patients help subsidize the Medicare people.

Over time, the cost of performing the procedure increases to $22. At the same time, the government is trying to save money by cutting the reimbursement down to $23. The doctor will refuse to do this, as the profit margin is too slim. In order to prevent doctors from dropping out of the Medicare system, the government has promised them an additional $200b to be used to prevent those rate cuts or to increase payments for some expensive services.

I'm not sure what they're referring to with the hospital payments, or if it's another facet of the same thing.

 

[jackalope]

The doctors were promised more money in exchange for continuing to treat Medicare patients. To put it another way:

Say a procedure costs a doctor $20 to perform. He likes to perform it for people on private insurance, because they pay him $30, but doesn't like to perform it for people on Medicare, because the government only pays him $25. If a doctor lives in an area where there are enough people with private insurance demanding the procedure, he will probably refuse to take Medicare at all. However, if his day is only 60 or 80% full with private patients, he may take on Medicare patients to fill that gap. Even though he's not making much, the private patients help subsidize the Medicare people.

Over time, the cost of performing the procedure increases to $22. At the same time, the government is trying to save money by cutting the reimbursement down to $23. The doctor will refuse to do this, as the profit margin is too slim. In order to prevent doctors from dropping out of the Medicare system, the government has promised them an additional $200b to be used to prevent those rate cuts or to increase payments for some expensive services.

I'm not sure what they're referring to with the hospital payments, or if it's another facet of the same thing.

Ahhh, I see. Doctors refusing new Medicare patients has been a problem.

 

[jackalope]

The doctors were promised more money in exchange for continuing to treat Medicare patients. To put it another way:

Say a procedure costs a doctor $20 to perform. He likes to perform it for people on private insurance, because they pay him $30, but doesn't like to perform it for people on Medicare, because the government only pays him $25. If a doctor lives in an area where there are enough people with private insurance demanding the procedure, he will probably refuse to take Medicare at all. However, if his day is only 60 or 80% full with private patients, he may take on Medicare patients to fill that gap. Even though he's not making much, the private patients help subsidize the Medicare people.

Over time, the cost of performing the procedure increases to $22. At the same time, the government is trying to save money by cutting the reimbursement down to $23. The doctor will refuse to do this, as the profit margin is too slim. In order to prevent doctors from dropping out of the Medicare system, the government has promised them an additional $200b to be used to prevent those rate cuts or to increase payments for some expensive services.

I'm not sure what they're referring to with the hospital payments, or if it's another facet of the same thing.

I just came across an article about this provision, Right. I thought you might be interested. The AMA may withdraw support for reform, if the deal cut in '97 to lower Medicare payments to doctors isn't eliminated permanently (the Congress has been waiving it year by year):

Influential AMA's Support for Reform Is Far From Certain
Medicare Fee Cuts Are Crux of Issue, Policy Analysts Say

By Amy Goldstein
Washington Post Staff Writer
Friday, October 16, 2009


(snip ... ) But according to health-care policy specialists on Capitol Hill and beyond, the real linchpin of the AMA's support involves its controversial -- and expensive -- goal to persuade Congress to eliminate reductions in physicians' pay through Medicare that lawmakers tried to set in motion a dozen years ago. Those reimbursement rates carry enormous stakes: Medicare, the federal program for people 65 and older, accounts, on average, for nearly one-third of doctors' income, and its rates often influence how much private insurers will pay.

The reductions in Medicare fees were part of a 1997 law intended to eliminate the budget deficit. Since then, Congress has relented repeatedly. Each year's deferral translates into deeper cuts the following year, so that Medicare is now scheduled to lower physicians' payments by 21 percent in January.

In their health-care bills, House committees have devoted $228 billion to keeping doctors' payments from falling for a decade. It is the only provision for which House members have not found a way to pay. In the Senate Finance Committee version, however, the reductions would be deferred just one year, as Congress has done before, at a cost of about $10 billion. A senior Senate aide said that Finance Chairman Max Baucus (D-Mont.) would like to eliminate the pay cuts in theory but found "it's hard to get [everything] into the shopping cart."

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