[Opinion] How to Fix Our Enormous, Inefficient Health Care System
"[C]hange will require new structures and institutions, not tweaks to the current system. That's the only way to disrupt the wasteful habits of the status quo. [The author offers] two specific proposals for new frameworks. The first ["Create Special Heath Care Courts"] is now broadly accepted by health care thought and political leaders of both sides ... but has been stymied so far by a powerful special interest. The second [" Replace Public Health Care with Comprehensive Providers"] is radical, and would be considered politically suicidal. It would also solve much of the problem of misaligned incentives." (The Atlantic)
[Opinion] Text of Comments by Consumer-Purchaser Disclosure Project to CMS on Health IT Meaningful Use Program (PDF)
"Stage 2 of Meaningful Use marks a significant step toward national commitment to effective management of health information to improve health outcomes. [The Project urges] CMS to finalize the progressive strides it makes in the proposed rule, especially those that enhance patient and family engagement. However, the proposed rule does not do enough to: (1) drive providers to share information with each other and (2) build the capability to report on quality measures that indicate whether providers are improving their ability to deliver high-value, coordinated care. [This letter elaborates and offers] recommendations on these points[.]" (Consumer-Purchaser Disclosure Project)
Nearly Half of Soon-to-Be-Retired, High-Net-Worth Americans 'Terrified' of Health Care Costs in Retirement
"While 45 percent expect health care to be their biggest expense throughout retirement, when asked to estimate how much they anticipate spending each year on health care, they said, on average, $5,621. This represents a drastic underestimation based on a 2010 study that estimates out-of-pocket health care expenses for a 65-year-old couple retiring today and living for 20 years to range from $250,000 to $430,000. That could mean as much as $10,750 a year per person in out-of-pocket health care expenses." (Nationwide Financial)
'Accountable Care Organizations' Could Have Medicare Muscle to Transform the Health System
"The drawbacks of fee-for-service reimbursement are hardly secret. In 1909, the playwright George Bernard Shaw wondered why 'any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg.' A century later, McKinsey Global Institute identified 'payment for more care rather than more value' as one reason U.S. medical spending is more than 25 percent higher per person than even in other industrialized nations." (Kaiser Health News)
How Much Do Private Industry Employers Pay for Government Employee Benefits Such as Social Security? (PDF)
"The legally required benefits covered in this issue of Program Perspectives are Social Security, Medicare, federal and state unemployment insurance, and workers' compensation. The focus here is on the employer's portion of the cost of these benefits." (Bureau of Labor Statistics)
Deloitte Health Care Reform Memo, April 30, 2012
Describes recent developments in various health plan and health insurance matters at the federal and state levels. This issue includes a discussion of health policy and costs. (Deloitte)
[Guidance Overview] CMS Issues Medicare Part D Benefit Parameters for 2013
"These parameters will be used by group health plan sponsors to determine whether their plans' prescription drug coverage is creditable for 2013. The information is needed for the disclosures that must be made annually and at other specified times to Part D eligible individuals and to CMS." (Thomson Reuters/EBIA)
Medicare Finances: Findings of the 2012 Trustees Report (PDF)
"According to the 2012 Trustees Report, expenditures from Medicare's HI Trust Fund exceeded revenues by $27.7 billion in 2011. Without a policy change that would increase revenues or reduce expenditures, the accumulated surplus in the HI Trust Fund will be depleted by 2024, the same as last year's projection; after that, the HI Trust Fund would rely on the annual revenues from Medicare payroll taxes, which are projected to cover 87 percent of annual expenditures." (National Academy of Social Insurance)
Trustees Issue Warnings on Medicare, But Make No Changes to Solvency Projections
"Overall, the outlook for the Medicare program which covers nearly 50 million elderly and disabled people was only slightly worse than findings from last year. Once again, trustees forecast that Medicare's hospital fund would begin to run out of money beginning in 2024, but many experts place little importance on the trustees' projection since the program's insolvency has been forecast from as little as two years away to as many as 28 years since 1970." (Kaiser Health News)
Official Summary of the 2012 Annual Reports of the Social Security and Medicare Boards of Trustees
"The long-run actuarial deficits of the Social Security and Medicare programs worsened in 2012, though in each case for different reasons. The actuarial deficit in the Medicare Hospital Insurance program increased primarily because the Trustees incorporated recommendations of the 2010-11 Medicare Technical Panel that long-run health cost growth rate assumptions be somewhat increased. The actuarial deficit in Social Security increased largely because of the incorporation of updated economic data and assumptions. Both Medicare and Social Security cannot sustain projected long-run program costs under currently scheduled financing, and legislative modifications are necessary to avoid disruptive consequences for beneficiaries and taxpayers." (Social Security Administration)
Official Report on Medicare: Text of the 2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds (PDF)
"The financial outlook for Medicare is ... uncertain because some provisions of current law that are designed to reduce costs may not be sustained. The clearest example of this issue is the sustainable growth rate ... formula for physician fee schedule payment levels. The projections in this report assume that, as required by current law, CMS will implement a reduction in Medicare payment rates for physician services of more than 30 percent at the start of 2013. However, it is a virtual certainty that lawmakers, cognizant of the disruptive consequences of such a sudden, sharp reduction in payments, will override this reduction just as they have every year since 2003." (The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds)
Social Security and Medicare Annual Trustee Reports Expected April 23, 2012
"Experts said they expect the trustees' conclusions to be similar to their findings last year.... [when] the trustees projected Social Security could pay promised benefits in full through 2036, after which the program could only afford to pay 77% of them." (CNN Money)
[Guidance Overview] Health Plan Sponsors Assessing Effect of 2013 Medicare Part D Indexed Amounts
"[This publication provides] charts comparing the 2013 [Medicare Part D standard defined benefit and Retiree Drug Subsidy (RDS) amounts] to the 2012 numbers. It also reviews changes to the Part D benefit, which were made by the Affordable Care Act, and illustrates the impact of those changes on the 2013 benefit.... Plan sponsors should note the new benefit amounts for planning purposes for 2013 � both with respect to expected RDS income and to the design of any Medicare Part D prescription drug plan that is offered to retirees." (Segal)
[Opinion] 'Double-Counting' Canard Quacks Again on Issue of Cost of Health Care Reform Law
"[Former Bush Administration official Charles Blahous] claims the Congressional Budget Office's cost estimate for the health reform law 'double-counts' a considerable portion of the law's Medicare savings. By subtracting these savings, Blahous asserts that -- contrary to CBO -- health reform increases the deficit. But there's no double-counting involved in recognizing that Medicare savings improve the status of both the federal budget and the Medicare trust funds." (Center on Budget and Policy Priorities)
Health Care Budget Deficit Calculator Shows Budget Deficits Will Explode
"The government, through programs like Medicare and Medicaid, pays for approximately half of the country's health care, almost all of which is actually provided by the private sector. Thus, the bulk of our projected rising budget deficits are due to skyrocketing private health care costs." (Center for Economic and Policy Research)
Medicare Coverage Less Generous Than Coverage in Large Employer Plans, When Available
"Medicare requires multiple deductibles and coinsurance based on service type, whereas a typical large employer plan requires a single deductible for all medical services ... In 2011, for an inpatient hospital stay Medicare required a $1,132 deductible and no coinsurance for the first 60 days whereas the typical large employer plan required 20 percent coinsurance beginning from the first day." (Wolters Kluwer Law & Business / Health Reform Talk Blog)
SCOTUS Affordable Care Act Arguments: Day 3 Part Two: Does Medicaid Expansion Coerce the States?
"In the afternoon, the Justices listened to arguments from both sides on whether the Medicaid expansion part of the Affordable Care Act is coercion because it forces the states to either accept the expansion to the program or risk revocation of all federal funding for Medicaid." (Miller Johnson)
Justices Wrestle with Whether Health Care Overhaul Should Be All or Nothing
"The law imposes new taxes on medical-device makers, calls for the establishment of insurance exchanges, permits parents to carry adult children on their health policies until the age of 26, and even requires restaurants to post the calorie content of menu items. It also greatly expands Medicaid, the joint program of the federal and state governments, to provide health insurance to individuals and families who currently earn too much to qualify for the program but not enough to afford health insurance. The Obama administration contends many of these programs can stand on their own, without the insurance mandate, and has urged the court to keep them in place." (philly.com)
Supreme Court Hears Argument on Severability of Individual Mandate and State Sovereignty
"[T]he U.S. Supreme Court heard oral argument on the two remaining issues involving the ACA. The morning session concerned the issue of severability -- if the Court determines that the individual mandate is unconstitutional, can the mandate be severed from the rest of the ACA, or does it drag down part or all of the ACA with it? The afternoon session concerned the issue of state sovereignty -- did the federal government improperly coerce the States into acquiescing in the ACA's expansion of the Medicaid program in violation of the Spending Clause?" (Faegre Baker Daniels)
Explaining the Lack of Non-Public Actors in the U.S. Public Social Insurance System
"[T]he paradox of the American social insurance system is that while disclaiming any desire for socialist-type programs, most Americans today believe that only the government should be responsible for providing the social insurance safety net.... [M]ost Americans are not yet ready to place their faith in these private actors, even if more efficiency, cost-savings, and activation could be achieved by doing so." (Marquette University Law School)
Chart: Employer Costs for Legally Required Benefits in December 2011
"The average cost for legally required benefits was $2.33 per hour worked in private industry (8.1 percent of total compensation) in December 2011. Social Security comprises the largest legally required benefit cost component at $1.34 per hour or 4.7 percent of total compensation. Legally required benefits such as Social Security and Medicare are often directly linked to wages; therefore, higher paid occupations or industries will typically show higher cost estimates for this compensation component." (Bureau of Labor Statistics)
Judge Puts Hold on Kodak Cuts to Retiree Health Benefits
"Kodak in February filed a motion seeking court approval to eliminate the Medicare enhancement it provides for employees 65 and older who retired after 1991. According to Kodak, currently going through a Chapter 11 bankruptcy reorganization, such a move would save the company about $20 million a year starting in 2013." (DemocratandChronicle.com)
Video/Audio: Health Care Is a Necessary Reform
"As the two-year anniversary of the Affordable Care Act approaches, Alice Rivlin speaks with Campaign 2012 Director Benjamin Wittes about the health care reform law, the Supreme Court's upcoming oral arguments, and Medicare's impact on the federal budget." (Brookings)
GOP Plans for Medicare, Health Reform Repeal Draw Scrutiny
"Political observers are noting challenges for Republican lawmakers in upcoming budget, health law and Medicare debates. And some Democrats in the Senate are being pressured on the issue of keeping one of the health law's safeguards for slowing Medicare's costs." (Kaiser Health News)
How Long Does a Retiree Health Benefits Transition Take: Implementation Milestones
"If you are planning to move your retirees to coincide with the change to the RDS taxable status, this article will help you understand what you need to do to make the transition before the change takes place on January 1, 2013." (The Extend Health Blog)
Deficits Push N.Y. Cities and Counties to Desperation
"Even as there are glimmers of a national economic recovery, cities and counties increasingly find themselves in the middle of a financial crisis. The problems are spreading as municipalities face a toxic mix of stresses that has been brewing for years, including soaring pension, Medicaid and retiree health care costs." (The New York Times; free registration required)
Taking Advantage of Off-Cycle Retiree Transitions
"If you are considering a move to a Medicare Exchange for your retirees, now is the time to start thinking about an off-cycle transition. Because the Retiree Drug Subsidy loses its tax-deductible status starting in 2013, many corporate employers are timing a new retiree strategy to coincide with this pivotal legislative change." (The Extend Health Blog)
The Influence of Public Policy on Health, Wealth and Mortality
"In this project we extend an augmented lifecycle model, incorporating a Grossman-style model of health capital, to enhance understanding of factors influencing consumption, wealth and health. We develop three primary results when using the model to explore the effects of stylized versions of Medicare and Social Security on wealth and longevity." (University of Michigan Retirement Research Center)
Low Premiums, Zero-Dollar Deductibles and Preferred Pharmacy Networks Winning Strategies for Medicare Part D Sponsors Last Open-Enrollment Period
"Both the Humana Walmart-Preferred Rx Plan and Coventry Health Care, Inc.'s First Health Part D Value Plus succeeded at netting new enrollees. And UnitedHealth Group's AARP MedicareRx Preferred plan lost 12% of its members, although it still remained the market leader." (AISHealth)
[Guidance Overview] Creditable Drug Coverage Disclosure Due to CMS, but Website Problems May Hamper Filing
"By Feb. 29, employers with calendar-year plans providing prescription drug benefits to Medicare-covered people must disclose whether their plans' coverage is 'creditable' to [CMS]. Plan sponsors must make this disclosure even if a plan covers only active employees or is fully insured. Sponsors must use CMS' web-based disclosure form and provide information about themselves and the coverage options they offer. Because the CMS website is frequently unavailable, sponsors may submit their information later; no penalties apply for late filing." (Mercer)
AARP Health Law Guide
"This guide will help you find resources tailored to your needs, whether it's about Medicare, health insurance coverage for you or your family, or public programs that may work for you. [The guide is also available in Spanish.]" (AARP)
[Guidance Overview] Employees Cannot Opt Out of Medicare Part A Without Also Rejecting Social Security Benefits
"Several employees, who were receiving Social Security benefits, sued on the grounds that they suffered harm due to the Medicare Part A coverage because private insurers reduce the benefits they can receive once they become covered by Medicare Part A. They said they wanted to receive the benefits they would be entitled to under their employer's group health plan." (HighRoads)
[Guidance Overview] Circuit Court Says Individuals Cannot Disclaim Entitlement to Medicare Part A
"To be sure, no one has to take the Medicare Part A benefits. But the benefits are available if you want them. There is no statutory avenue for those who are 65 or older and receiving Social Security benefits to disclaim their legal entitlement to Medicare Part A benefits." (Physicians for a National Health Program)
Employer Retiree Groups Will Move To Medicare Advantage, but How Soon Is the Question
"Employer groups stand to become a much bigger contributor to Medicare Advantage growth than they are now, but any big move probably won't occur until 2013 and beyond." (AISHealth)
Annual Statistical Supplement, 2011, Published by the U.S. Social Security Administration
"The Supplement is a major resource for data on our nation's social insurance and welfare programs. The majority of the statistical tables present information about programs administered by the Social Security Administration -- the Old-Age, Survivors, and Disability Insurance program, known collectively as Social Security, and the Supplemental Security Income program. In addition, data are presented on the major health care programs -- Medicare and Medicaid -- and social insurance programs, including workers' compensation, unemployment insurance, temporary disability insurance, Black Lung benefits, and veterans' benefits. The Supplement also includes program summaries and legislative histories that help users of the data understand these programs." (U.S. Social Security Administration)
Congressional Budget Office Expects Health Spending to Double in Ten Years
"CBO's economic outlook predicts that federal spending on Medicare, Medicaid and other healthcare programs will climb to $1.8 trillion -- or about 7 percent of the entire economy -- by 2022." (The Hill)
Government Health Spending Seen Hitting $1.8 Trillion
"[R]esearchers warned that the longer term prospects for rising healthcare spending could have dire consequences for the U.S. deficit when combined with the cost of Social Security, if current revenue levels remain unchanged." (Reuters)
[Opinion] Aging Groups Argue That Most Health Reform Law Provisions Affecting Seniors Should Not Be Tied To Supreme Court's Ruling on Individual Mandate (PDF)
"The [recently filed amicus] brief . . . highlights the parts of the ACA that greatly benefit people aged 65 and older that should not be affected should the Court decide to invalidate the minimum coverage provision, including: Reduced cost-sharing for Medicare beneficiaries for prescription drugs by substantially reducing the coverage gap or so-called donut hole; Elimination of cost-sharing for annual wellness visits and other screening services; Medicare Advantage plans are prevented from charging higher cost-sharing for chemotherapy and dialysis than permitted under traditional Medicare . . . ." (National Senior Citizens Law Center)
Downgrades in Ratings Loom for G20 Nations on Health Costs, S&P Warns
"Ratings agency Standard & Poor's warned it may downgrade 'a number of highly rated' Group of 20 countries from 2015 if their governments fail to enact reforms to curb rising healthcare spending and other costs related to ageing populations." (Reuters)
Increasing Retirement Ages Would Reduce Spending and Limit Benefits
"The Congressional Budget Office released on Jan. 11 an issue brief describing the effect of increases in the eligibility ages for Social Security and Medicare. The CBO found that raising the Medicare eligibility age or the early or full eligibility age for Social Security would reduce federal spending and limit the number of people with access to health insurance." (AdvisorOne)
[Opinion] Fitness Memberships and Favorable Selection in Medicare Advantage Plans
"This study further confirms what we have known all along - that private insurers selectively market to the healthy, further cushioning their profits by being paid at rates for those with only average health." (Physicians for a National Health Program)
[Official Guidance] HHS Final Rule: Payments to Sponsors of Retiree Prescription Drug Plans (PDF)
"This final rule implements and finalizes provisions regarding thereporting of gross covered retiree plan-related prescription drug costs (gross retiree costs) and retained rebates by Retiree Drug Subsidy (RDS) sponsors; and the scope of our waiver authority under the Social Security Act . . . . DATES: Effective Date: These regulationsare effective on March 12, 2012." (U.S. Department of Health & Human Services)
CBO Issue Brief: Raising the Ages of Eligibility for Medicare and Social Security
"This issue brief reviews how ages of eligibility affect beneficiaries under current law and how delaying eligibility would affect beneficiaries, the federal budget, and the economy." (U.S. Congressional Budget Office)
New York City's New Ad Campaign Attacks Big Food Portions
"About 57% of adult New Yorkers and two out of every five elementary school children remain overweight, while nearly 10% of New Yorkers have been diagnosed with type 2 Diabetes, according to the agency." (Crain Communications, Inc.)
Understanding the Three Main Pillars That Create the Foundation for Retirement in the U.S.
"The Three Pillars: In our opinion, those pillars consist of Medicare, Social Security and Retirement Plans. Each of these pillars is complex in its own right." (Seeking Alpha)
[Guidance Overview] 2012 Payroll Tax Rates and Limits (PDF)
"The maximum [Social Security Employee] withholding for the period January 1, 2012, to February 29, 2012, is $770.70 (calculated at 4.2% ofmaximum wage base). The maximum withholding for the period March 1, 2012, to December 31, 2012, if the payroll tax holiday is not extended, is $5,688.50 (calculated at 6.2% of maximum wage base). The sum of $770.70 and $5,688.50 is $6,459.20." (Lindquist LLP)
The Independent Payment Advisory Board: In 2013, this Entity Will Have Authority to Curb Medicare Spending If Growth Exceeds Targets
"Arguments for and against IPAB hinge on several key issues -- including the degree to which decisions about saving money in Medicare are so political that they should be made outside the context of the day-to-day operations of Congress. The arguments don't necessarily correspond with divisions between the political parties, because Democrats are divided on their support for IPAB. The brief concludes that IPAB's unclear fate will likely be determined by the Supreme Court's decision on the ACA or the outcome of the 2012 elections." (Robert Wood Johnson Foundation)
Lawmakers Offer Bipartisan Plan to Overhaul Medicare
"A Democratic senator, Ron Wyden of Oregon, and a Republican member of the House, Paul D. Ryan of Wisconsin, unveiled a bipartisan plan on Wednesday to revamp Medicare and make a fixed federal contribution to the cost of coverage for each beneficiary." (The New York Times; free registration required)
[Official Guidance] Text of IRS Final Regs and Removal of Temporary Regs for Employer's Annual Federal Tax Return and Modifications to Deposit Rules (PDF)
"This document contains final regulations relating to the Employers'Annual Federal Tax Program (the Form 944 Program) and the requirements fordepositing social security, Medicare, and withheld Federal income taxes(collectively ''employment taxes'')." (U.S. Internal Revenue Service)
GOP Alternative Proposal: Wealthy Pay Full Price for Medicare to Cover Payroll Tax Extension
"The Senate Republican plan would instead pay for the costs by making spending cuts elsewhere in the federal budget and requiring the rich to do without government aid." (Los Angeles Times)
[Guidance Overview] ADEA Exemption for Coordination of Health Benefits with Medicare Does Not Permit Employer To Terminate Current Employees' Benefits
"The ADEA provisions notwithstanding, Medicare law requires that employers who are subject to the Medicare as secondary payer (MSP) rules provide the same group health plan coverage to workers and their dependents who have Medicare coverage as they provide for other workers and their dependents who are not Medicare-covered." (Wolters Kluwer Law & Business / CCH)
Social Security Applications in Spanish Now Available on Website
"To make the process easier for Spanish speakers with limited English skills, the Social Security Administration has translated the applications for the following benefits: Retirement benefits . . . . Medicare benefits . . . . Prescription drugs benefits . . . ." (PLANSPONSOR.COM)
Restructuring Medicare's Benefit Design: Implications for Beneficiaries and Spending
"Several deficit-reduction plans have proposed combining Medicare's separate deductibles for hospital and physician services, standardizing cost sharing across types of benefits, and establishing a new limit on annual out-of-pocket costs for beneficiaries. A new Kaiser Family Foundation study examines the potential implications of proposals to revamp Medicare's cost-sharing requirements as a way of reducing federal spending." (The Henry J. Kaiser Family Foundation)
Medicare Savings by Raising Eligibility Age Could Be a Mirage
"In addition, health care reform -- assuming that it is not repealed and is implemented smoothly in 2014 -- adds a new element to the argument about eligibility age. Without reform, many people ages 65 to 67 would have trouble finding affordable insurance -- or any insurance at all." (POLITICO LLC)
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