WASHINGTON – While the Democrats’ health care bill would represent an unprecedented expansion in access to insurance, the effects on existing government insurance programs are less clear.
At the heart of the Senate debate are reductions in Medicare spending, one of the main ways Democrats have kept the total cost of the bill down. Republicans charge that change will reduce access to care as well as the benefits Medicare provides. Democrats counter that guaranteed benefits are still mandated.
In Washington and Idaho, where providers have long complained Medicare fails to cover their expenses, making them hesitant to take more Medicare patients, the bill’s potential effects are uncertain. Republicans from the states say the bill will make the problem worse. But others argue provisions in the bill that reward efficient care, along with higher reimbursements for primary care physicians, will remedy the problem.
A report released last month by the chief actuary of the Centers for Medicare and Medicaid, which administers the two government insurance programs, predicted that the $500 billion reduction in total Medicare spending in the House bill could result in reduced access to care and benefits. The report states that some of the Medicare savings envisioned by the bill are “unrealistic” and many providers would find it difficult to keep up with the efficiency improvements the bill ties to reimbursements. As a result, some providers could end their participation in Medicare altogether, “possibly jeopardizing access to care for beneficiaries.”
That’s a concern Tom Curry, CEO of the Washington State Medical Association, said is warranted. “There’s no free cut,” he said.
While his group supports the bill, he has concerns about the Medicare cuts. But, he noted, Congress may legislate the cuts away after the overall bill passes.
“Nobody ever got re-elected cutting benefits from an entitlement program,” Curry said.
Patrick Jones, director of Eastern Washington University’s Institute for Public Policy and Economic Analysis, said Congress’ political will to follow through with the cuts is “a significant question.”
Jones directed a study last year for the Spokane County Medical Society that found fewer than a third of primary care doctors in the area were accepting new Medicare patients. Many of those practices are operating at full capacity, he said, but hospitals in the state have room to grow.
Over the next decade, the House and Senate health bills would cut about $280 billion and $200 billion, respectively, from Medicare spending on nonphysician reimbursements. But they add money to increase reimbursements to primary care doctors and train more of them.
Despite anticipating a 6 percent to 7 percent reduction in Medicare revenues over the next three years if the bill passes, John Fletcher, chief executive for Providence Health & Services for Washington and Montana, said he thinks hospitals will ultimately benefit.
“Our hypothesis is that if we have less charity care, we will be able to accept less reimbursement on the government programs and cover more people,” Fletcher said.