Medicare Program Changes in the Senate Amendment in the Nature of a Substitute to H.R. 3590

Medicare is a federal program that pays for covered health services for most persons 65 years and older and for most permanently disabled individuals under the age of 65 years. The rising cost of health care, the impact of the aging baby boomer generation, and declining revenues in a

weakened economy continue to challenge the program’s ability to provide quality and effective health services to its 45 million beneficiaries in a financially sustainable manner.

On November 21, 2009, the Senate Amendment in the nature of a substitute to H.R. 3590, the Patient Protection and Affordable Care Act was offered. This report, one of a series of CRS products on this Senate Amendment, examines the Medicare related provisions in this Amendment. Estimates from CBO on the Senate Amendment indicate that net reductions in Medicare direct spending may approach $400 billion from FY2010 to 2019. Major savings are expected from constraining Medicare’s annual payment increases for certain providers, basing payment rates in the Medicare Advantage program on average bids, reducing payments to hospitals that serve a large number of low-income patients, creating an independent Medicare

Advisory Board to make changes in Medicare payment rates, and modifying the high-income threshold adjustment for Part B premiums. A new Hospital Insurance tax for high wage earners would also raise approximately $54 billion over 10 years.

Other provisions in the Amendment address more systemic issues such as increasing the efficiency and quality of Medicare services, and strengthening program integrity. For example, the Amendment would establish a national, voluntary pilot program that would bundle payments for physician, hospital and post-acute care services with the goal of improving patient care and reducing spending. Another provision would adjust payments to hospitals for readmissions related to certain potentially preventable conditions. Additionally, the Amendment would increase funding for anti-fraud activities, and subject providers and suppliers to enhanced screening before allowing them to participate in the Medicare program.

The Senate Amendment would also improve some benefits provided to Medicare beneficiaries. For instance, Medicare prescription drug program enrollees would receive a 50% discount off the price of brand name drugs during the coverage gap (the “doughnut hole”) and the coverage gap would be reduced by $500 in 2010. Other provisions would expand assistance for some low-income beneficiaries enrolled in the Medicare drug program, and eliminate beneficiary copayments for certain preventive care services.

Date of Report: December 8, 2009
Number of Pages: 69
Order Number: R40970
Price: $29.95
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