March 12, 2019
Dive
Brief:
- President Donald Trump proposed
slashing Medicare funding by $845 billion over the next decade in a budget
blueprint by increasing audits of Medicare Advantage payments, changing hospital
reimbursement rates and reducing "fraud and abuse" in the
system.
- The annual White House budget,
released Monday, also seeks to move more than $1 trillion in Medicaid
spending to a system of block grants allowing states more control in
allocating the funds, in addition to cutting another $1.5 trillion
over the next 10 years. The 2020 plan also calls for a nationwide Medicaid
work requirement for low-income adults to be eligible for coverage.
- The budget is sure to go nowhere
in Congress, as Democrats control the House and the document includes
politically toxic ideas in cutting Medicare, a largely popular program
among its users. It will however, give Democrats fodder during the next
election cycle, with top 2020 contenders already bashing it.
Dive
Insight:
The
plan to winnow funding away from Medicare and Medicaid contradicts campaign
promises Trump made in 2016. They could also alienate a big part of his
base — the elderly — in a White House budget eerily similar to the
failed Republican repeal and replace efforts of 2017.
But
some of the Medicare cuts have received bipartisan support in the
past, including halting hospitals from bumping up their Medicare payments
by acquiring doctors' practices (a method CMS has tried to crack down in the
past with its site-neutral payment proposals) and
lowering spend on prescription drugs.
The
budget would also require everyone with a plan from the Affordable Care Act
exchanges pay some amount of premium. Currently, subsidies allow some people to
qualify for plans without paying any monthly premium.
A
more traditional conservative proposal is block grants for Medicaid, part
of an ongoing effort to move healthcare decisions to the states. CMS has
already been busy approving Section 1115 demonstration waivers giving states
more wiggle room in structuring Medicaid, including highly-controversial work
requirements.
The
White House's plan stipulates all "able-bodied" and
"working-age" Medicaid beneficiaries would have to go to work, train
for work or volunteer to quality for Medicaid. The Kaiser Family Foundation
estimates that 1.4 million to 4 million impoverished Americans could lose
Medicaid coverage if work requirements were scaled nationwide. The Trump
administration predicts a savings of $130 billion over the next decade if
Congress enacts the proposal.
Currently,
seven states have approved waivers from the government for work requirements,
and an additional eight have applied, according to KFF. Oral arguments in
lawsuits against the programs in Arkansas and Kentucky begin later this week.
More than 18,000 Americans lost health insurance in the first four months of
Arkansas' program alone.
Under
the new budget, $1.5 trillion would be cut from Medicaid over the next decade
and $1.2 trillion would be added for a new "Market Based Health Care
Grant" to start in 2021. It would also eliminate Medicaid expansion
funding.
The
proposal comes amid the fierce political debate around expanding public health
programs. Multiple Democrats running for president in 2020 espouse some version
of an expansion, lumped in popular discourse under the umbrella term of Medicare for all.
Even
with little likelihood of coming law, pushback from provider groups was swift.
The
Federation of American Hospitals called the proposed cuts "arbitrary and
blunt" and the American Hospital Association warned they raise
"serious concerns about how hospitals and health systems can ensure they
serve as the safety net for their patients."
"Hospitals
are less and less able to cover the cost of care for Medicare
patients," FAH president and CEO Chip Kahn said in a statement.
"It is no time to gut Medicare."
The
White House budget also includes provisions meant to lower prescription drug
spending and allocates $4.8 billion to stem the tide of the opioid epidemic,
along with $291 million next year to fight HIV/AIDS. The National Institutes of
Health, which conducts and supports medical research, would lose $4.5 billion
in funding, another politically unpopular idea, though the Department of
Veteran's Affairs would gain an additional $6.5 billion from the year before.
HHS
secretary Alex Azar will appear in front of three separate Congressional
committees this week to defend the budget: Tuesday, the House Energy and
Commerce subcommittee on Health; Wednesday, the House Appropriations
subcommittee; and Thursday the Senate Finance Committee.
https://www.healthcaredive.com/news/trump-admin-proposes-massive-cuts-to-medicaid-medicare/550224/
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