With a toxic mix of expiring tax breaks and automatic spending reductions set to begin in January, expectations are high for 
President Barack Obama and House Speaker John Boehner, R-Ohio, who claim they want to avert the fiscal cliff.
If republicans make concessions on taxes, Democrats and the president say they?ll move on entitlements, like Medicare and Medicaid, to reduce the federal deficit. Lawmakers are wrestling to find a balance between asking beneficiaries to pay more for Medicare services and reducing payments to Medicare providers, such as hospitals or nursing homes.
Either decision could have sweeping effects on the program. ?You don?t just get to turn a dial and have it not resonate, We need to think about our risk pool, we need to think about how the program works,? said a Democratic staffer on the Senate Finance Committee.
Tricia Neuman, director of the Kaiser Family Foundation?s Program on Medicare Policy believes it is hard to imagine a deal without Medicare savings.
The Supreme Court?s ruling made the health law?s Medicaid expansion optional for states, so there?s concern that any additional reductions in federal Medicaid spending might make governors even more reluctant to expand the federal-state program. And as the nation continues to recover from the recession, some Democrats are reluctant to cut the program, which serves more than 60 million low-income Americans.
Below are some of the Medicare changes that may take place:
CAP FEDERAL HEALTH CARE SPENDING: Advanced by Obama?s bipartisan commission, chaired by former Clinton chief of staff Erskine Bowles and former GOP Sen. Alan Simpson, the panel proposed a cap on federal health care spending that, starting in 2020, would require the growth in per capita spending on Medicare, Medicaid, and other federal health care programs not exceed the increase in gross domestic product plus one percent.
If spending grew beyond that target, the president would have to submit and Congress would have to consider ways to lower spending, such as creating a ?premium support? system for Medicare.
REDUCE PAYMENTS TO PROVIDERS: Hospitals, physicians and other health care providers ? many who are now facing payment cuts either in the 2010 health care law or from the upcoming ?sequestration? reductions (or both) ? may take another hit in a deficit deal. Another option mentioned is limiting the amount of ?bad debt? that hospitals and other providers can write off their taxes, reducing federal funding for medical education and requiring more prior authorization for some medical services, such as imaging, to help reduce unnecessary care. Lawmakers looking for political cover from angry providers could cite the many deficit-reduction proposals that have advanced provider cuts: Obama?s 2011 deficit reduction proposal, the Simpson-Bowles plan and the Medicare Payment Advisory Commission, or MedPAC, which advises Congress on Medicare payment policy.
RAISING MEDICARE?S ELIGIBILITY AGE: The age for full Social Security benefits will reach 67 in 2027 and some analysts argue that it makes sense to slowly raise the Medicare eligibility age from 65 to 67. Obama backed increasing the Medicare eligibility age as part of his negotiations last year with Boehner, according to documents obtained by Washington Post reporter Bob Woodward. According to a March 2011 analysis by the Congressional Budget Office, gradually increasing the Medicare eligibility age would save the federal government $125 billion over the next decade.
Proponents say that with implementation of the health law moving forward, people under 67 without job-related insurance could buy coverage ? even if they are sick ? on the new exchanges being set up under the health law and may qualify for subsidies to help. Or, if they are lower income, they might be eligible for Medicaid.
?MORE SKIN IN THE GAME?: Members of each political parties and some health care analysts have long believed that spending could be slowed if patients, including Medicare beneficiaries, used more of their own money for health services. Others have suggested raising seniors? share of the Medicare Part B premium (which covers doctor visits and other outpatient services) from 25 percent to 35 percent and imposing co-payments for home health services or the first 20 days of a skilled nursing facility stay.
The home health co-payment would save $40 billion over the next decade for the federal government; the skilled nursing co-pay would save $21.3 billion, according ?to the CBO?s 2011 estimates. Increasing the beneficiary?s share of Part B would save $241 billion over 10 years.
CHANGING MEDICARE?S DEDUCTIBLE AND MEDIGAP COVERAGE: In addition to paying premiums for Part B, Medicare beneficiaries also have separate deductibles for their hospital care (Part A) and for Part B. Nearly one in five beneficiaries in Medicare?s fee-for-service program have supplemental insurance known as Medigap coverage to help with those costs and others get such coverage from their Medicare Advantage plans, retiree health plans or other sources.
Some proposals have suggested combining the Part A and B deductibles into one $550 yearly deductible. That could reduce beneficiaries? costs for hospital care but be more expensive for seniors who mostly use Part B. In addition, some proposals suggest a 10 to 20 percent co-payment for all services until beneficiaries reach a catastrophic limit of $7,500. Others argue for making that $550 deductible ineligible for Medigap coverage so that beneficiaries are responsible for covering the cost of those initial services.
Read more:
http://www.kaiserhealthnews.org/Stories/2012/November/14/fiscal-cliff-medicare.aspx#.UKYRWXpfHUA.twitter
Attorney Christopher J. Berry is a Metro Detroit estate planning and elder law lawyer who helps families, seniors, veterans and business owners with their important legal needs. Oakland County estate planning lawyer, Christopher Berry is a partner in the Bloomfield Hills law firm of Witzke Berry PLLC. Mr. Berry practices in the areas ofestate planning, business, probate, veterans benefits & Medicaid planning. Follow Christopher on Twitter@chrisberryesq.
Source: http://michiganelderlawcenter.com/avoiding-fiscal-cliff-likely-means-changes-medicare/
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