Saturday, 7 Dec 2019

Opinion | Medicare and the Trump Budget: Differing Views

To the Editor:

Re “Not All Medicare Cuts Are Bad” (editorial, March 26):

While your editorial board and the Trump administration may not always see eye to eye, this editorial finds important areas of agreement.

The president’s 2020 budget takes thoughtful steps to strengthen and protect the Medicare program for America’s seniors. In fact, the budget does not harm beneficiaries. It does not cut their benefits, nor does it increase aggregate out-of-pocket spending.

Instead, the budget eliminates waste and inefficiencies in the Medicare program, in line with the president’s campaign promise. One prominent example cited in the editorial is our push toward site-neutral payment. Why should taxpayers or seniors pay higher rates for a service at an outpatient hospital clinic than for the same service at a doctor’s office?

For example, seniors pay about $34 for a clinic visit at an outpatient hospital and about $15 for the same services at a physician’s office. This push is not a one-off occurrence; rather, it is something we have worked to embed in the system through the yearly payment process over the last two years.

We also publicly laid out the president’s philosophy on site neutrality in the December report, prepared by several federal departments, on “Reforming America’s Healthcare System Through Choice and Competition.”

As you noted, policymakers in both parties have failed to focus on managing the cost of care, and on reducing or eliminating bad incentives and inefficiencies in our system. Rather than take partisan shots at serious reforms intended to manage costs while protecting our seniors, we invite Democrats and Republicans to come together to work on common-sense reforms.

Senators Kamala Harris, Elizabeth Warren and Brian Schatz, who, as you note, oppose our plan, should know that our doors are always open if they wish to partner on reforms to protect American seniors and taxpayers.

Joe Grogan
The writer is director of the White House Domestic Policy Council.

To the Editor:

Our organizations agree that conserving Medicare resources to preserve the program for generations to come is an important goal. But we cannot support a budget that impedes access to care, and the president’s budget would do just that.

Among the problematic Medicare provisions are those that would make it harder for beneficiaries to obtain care by curtailing appeal rights, increasing out-of-pocket costs and expanding prior authorization.

Additionally, provider cuts of the magnitude proposed would likely be impossible to carry out without negatively affecting beneficiaries. And unlike the Affordable Care Act’s reimbursement changes, the resulting savings would not be reinvested in efforts to expand and improve coverage.

Notably, these Medicare spending reductions tell only part of the story. Older adults and people with disabilities look to a constellation of programs to stay healthy, many of which — in particular Medicaid and the health care law — would see steep cuts under the administration’s budget.

People with Medicare and their families deserve better. Working together, we can find ways to reduce health care costs without jeopardizing Americans’ health and economic security.

Joe Baker
Judith Stein
Mr. Baker is president of the Medicare Rights Center, and Ms. Stein is executive director of the Center for Medicare Advocacy.

To the Editor:

You call for slashing the “bonus payment” that hospitals receive for the outpatient services they provide.

Hospital-based outpatient services are reimbursed at a higher rate than physician offices because of the vast overhead costs associated with hospitals staying open 24/7 and never turning away patients.

Given those major cost drivers, the notion that the level of reimbursement for hospital-based outpatient services constitutes an unnecessary bonus payment is befuddling.

Many financially struggling inner-city and rural hospitals can barely sustain their outpatient services right now. Cutting their Medicare reimbursement for those essential services will severely compromise access to care for the vulnerable communities they serve, many of which have no other outpatient health care options.

Kenneth E. Raske
New York
The writer is president of the Greater New York Hospital Association.

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