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U.S. lawmakers said to seek $200 billion in Medicare fee changes

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(Bloomberg) — The doctors who treat Medicare patients would avoid a cut in their government reimbursements under a proposal to be presented to U.S. House members next week, according to Republican and Democratic aides.

The bipartisan $200 billion framework to replace Medicare’s cost-containment formula for doctor reimbursement was negotiated by House leaders of both parties and members of the committees with jurisdiction over Medicare.

Some of the cost would be offset with $35 billion worth of Medicare savings from beneficiaries over 10 years. Another $35 billion over a decade would come from reducing or delaying higher payments to hospitals and other Medicare service providers over time, the aides said.

The rest would be offset with $130 billion worth of adjustments in the budget resolution that would include government health programs, said a Republican aide who spoke on condition of anonymity because the proposal hasn’t been presented to members.

There’s pressure on Congress to act by March 31 to prevent a more than 20 percent cut in payments to doctors for treating Medicare patients.

Congress has avoided such payment cuts 17 times by passing what has become known as “doc-fix” legislation, or a change to the “sustainable growth rate” (SGR) Medicare provider reimbursement formula.

Medigap plans

The $35 billion worth of Medicare beneficiary savings would be achieved in two ways. Private insurance companies that offer Medicare supplement (Medigap) policies—policies that supplement Medicare’s basic coverage—would be required to start paying benefits only after recipients pay $250 in out-of-pocket expenses for doctor visits, aides said.

See also: Why Medigap sellers’ ears are burning

Such a requirement would give Medicare recipients an incentive to make fewer doctor visits, thereby saving some costs to the government program.

The plan also would expand means testing for use of the Medicare program’s Part B, for doctor visits, and Part D, which covers prescription drugs. Single recipients with annual incomes of more than $85,000 and married couples with incomes of more than $170,000 already pay higher premiums for these programs, the aides said.

Child health

The package also is to include a $5 billion, two-year extension of the Children’s Health Insurance Program (CHIP) past its current Sept. 30 expiration, said aides in both parties. That program provides health insurance to low-income children through state agencies and services.

In a joint statement, Ways and Means Committee Chairman Paul Ryan of Wisconsin and Energy and Commerce Chairman Fred Upton of Michigan said they were “engaging in active discussions on a bipartisan basis.” The statement also was signed by the ranking Democrats on the two panels, Sander Levin of Michigan and Frank Pallone of New Jersey.

See also: House uses Medicare changes to pay for special needs account bill


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