Law, Health Policy & Disability Center Bulletin Board: Benefits (Medicare, Medicaid, Social Security) articles

1) Medicare Physician Payments: Considerations for Reforming the Sustainable Growth Rate System (GAO-05-326T, February 10)

Medicare adjusts the reimbursement rate for physicians based on the Sustainable Growth Rate (SGR). The SGR is used to set spending targets and then adjusts physician’s fees based on the increase in intensity (costliness and complexity of services offered to patients) and volume (number of services offered to patients). Where the volume and intensity exceed the growth in the national economy, the Medicare reimbursement rate for physicians decreases; physicians are paid less for their services. When this happens, physician participation in the Medicare program understandably drops. In 2006, it is projected that an increase in the volume and intensity of services offered to patients combined with the projected cost of the prescription drug benefit passed by congress in 2003 (which raised the cost of the program without adjusting the spending targets), will lead to a reduction in the reimbursement rate that physicians are paid. If the problem is not remedied, it is feared that physicians will no longer accept Medicare.

Read the Highlights of the report at:
http://www.gao.gov/highlights/d05326thigh.pdf

Or read the complete report (GAO-05-326T):
http://www.gao.gov/cgi-bin/getrpt?GAO-05-326T

2) Medicare, Medicaid Challenge Looming

Due to increased focus on Social Security, the more pressing problem of the effect of aging baby boomers and rapidly increasing health care expenses on Medicare and Medicaid has been neglected. At its current rate, Medicare expenditures are expected to surpass Social Security expenditures in less than 20 years, and the Medicare trust fund is expected to run out in the next 15 years. Cuts in these programs could lead to hospitals being forced to pay for indigent care and the denial of the benefits of advances in medicine to the people who need them the most. Thus, advocates argue that both Medicaid and Medicare need to be more efficiently designed. One proposal would be to provide coordinated care for chronically ill patients - a population that makes up less than 20 percent of those in the program but uses 80 percent of Medicare funds.

http://www.baltimoresun.com/news/opinion/oped/bal-pe.medicare13feb13,1,6748188.story?ctrack=3&cset=true

3) The Implications of the Medicare Prescription Drug Benefit for Dual Eligibles

The Kaiser Foundation has just completed a study of the affects of the new Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) on the over six million “dual eligibles:" individuals that qualify for both Medicaid and Medicare. People who fall into the dual eligibility category often are people with disabilities who are either on SSDI, but are poor enough to continue to get Medicaid, or get Medicare as a part of their SSDI, and receive both SSI and SSDI. Under MMA, dual eligibles will be able to sign up for private Medicare prescription drug plans (Part D) as of November 15, 2005, but in order to a avoid disruption in their coverage they must do so by January 1, 2006, when Medicaid drug coverage ceases. The study argues that education and outreach efforts should be used to assist dual eligibles with this transition.

Several reports on the topic and related documents are available at
http://www.kff.org/medicaid/medicaid012405pkg.cfm

4) Reform Talk Passes Disability Program By

While the majority of the focus of the debate on Social Security reform - including President Bush's new plan - has been on the retirement portion of the program, the Social Security Disability Insurance (SSDI) program provides over $70 billion in annual benefits to millions of people. One problem with SSDI is that the federal system for approving payments has known inefficiencies including approximately $1 billion in overpayments and a lengthy appeals process that takes years for resolution. Additionally, state employees are responsible for much of the decision-making regarding claims, which results in admitted disparities between states in claim approval, such as the fact that applicants are twice as likely to be approved in the New England area then other regions. In light of these considerations, President Bush's plan to privatize Social Security may lead to more problems and eventual cuts to the disability program as a way to save money.

http://www.boston.com:80/news/nation/washington/articles/2005/02/14/reform_talk_passes_disability_program_by

5) Social Security Risks for Disabled: Critics Charge that People with AIDS Will Have to Compete to Maintain Incomes

This article primarily focuses on people who have AIDS and receive SSDI, but it offers a good explanation of how that Social Security system currently operates and the possible implications of the Bush administrations proposal to privatize Social Security. Although the administration has insisted that privatization would not lead to a reduction in benefits, this article argues that such a reduction in benefits for SSDI recipients is the inevitable result of privatization.

Read the complete article in the Gay City News:
http://www.gaycitynews.com/gcn_359/socialsecurity.html

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