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Old 08-07-2009, 03:21 PM   #1
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Join Date: Apr 2004
Location: South Texas~29N/98W
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What follows is part of an e-mail that I received from MOAA. It appears to be a pretty concise picture of what the future may hold for military retirees over the age of 65 and those who will eventually fall into that category.

Reading 4 bills that each have 1000+ pages is not for me, but this may be a good place to look into the future and appreciate the issues and possibilities for not only retired military folks, but all of the rest of America also.

Perhaps those that have followed this issue more closely can point out any inaccuracies in this information.

What About Medicare and TRICARE For Life?
Now let's take a look at how national health reform legislation would affect Medicare. That's a big issue for military retirees and survivors age 65 and over, for whom TRICARE For Life is a Medicare supplement. It also has the potential to affect beneficiaries under age 65, since TRICARE payment rates are tied to Medicare's.
First things first: Nobody can be certain what the effects will be at this point, because there are already four 1,000-page bills on the table and at least three more still to come.
Three House committees have passed separate versions, and House leaders are now negotiating behind closed doors how to combine those into one. One Senate committee has approved its own bill, and another is working behind closed doors to develop an alternative that could win some bipartisan votes. If and when that happens, Senate leaders will have to find some ground between the two that can win Senate approval.
And then House and Senate leaders will have to work out a further compromise that both the House and Senate can pass and that the President will be willing to sign.
So everything we may think we know now is subject to change tomorrow.
It's also essential to keep in mind that Medicare is nearing an extremely serious fiscal sustainability problem. The coming wave of retiring baby boomers, plus the escalating cost of care, will dictate dramatic benefit cuts and/or tax increases in the not-too-distant future unless something else is done to ease the growing mismatch between benefits and funding. Since the population projection isn't going to change, Congress must find ways to restrain spending growth in the least objectionable way, and that's what every legislator is trying to do, in his or her own way.

Further, the statutory formula for setting Medicare (and TRICARE) payments to doctors is broken. Unless Congress passes some kind of fix, Medicare and TRICARE rates will be cut 21% this coming January - which would be a disaster, as many doctors would stop seeing elderly and military patients.
So what do we know - or think we know (that's a lot of stuff to read and a lot of room for misunderstanding) - about the health reform bills?

They all would at least fix the doctor payment issue for 2010, and some would go beyond that - and that can only be good.
All would invest in primary care and wellness initiatives, raising payments up to 10% for primary care providers and eliminating copays for preventive care. The idea is to reduce long-term costs by encouraging preventive care and healthier lifestyles. Another good thing.
Let's not forget the obvious: constraining cost growth also means constraining future growth in Part B premiums - another good thing, assuming the benefit cost constraints are appropriate.
They all would reduce or eliminate the extra 14% federal subsidy now provided for Medicare Advantage (HMO) programs. (You may recall that managed care programs originally were supposed to cost less, but the opposite proved true. Hill leaders believe alternative plans shouldn't cost the government more per person than regular Medicare does.)
All would extend Medicare therapy cap protections for speech and physical therapy.
All would reduce payments to most hospitals (except rural hospitals), and the associations representing hospitals have agreed to accept the cuts - meaning it shouldn't affect their willingness to accept military/Medicare patients.
All would establish "carrot and stick" incentives to encourage hospitals to use best practices and reduce preventable readmissions.
All contain language explicitly barring benefits for illegal aliens.

H.R.3200, the core bill in the House, also would:
  • Move vaccines (e.g., shingles) from Part D to Part B, a big plus for TFL-eligibles
  • Raise payments 5% for providers of psychiatric services to encourage them to see Medicare (and TRICARE) patients
  • Allow a 12-month Part B enrollment period and waive late enrollment penalties for disabled military retirees under 65 - a major plus for wounded warriors
  • Provide $100 million per year to combat claims fraud and abuse
  • Constrain growth in durable medical equipment, home health and certain other ancillary care through "market basket updates," "productivity adjustments" and other adjustments to payment formulas
The most fiscally austere bill is likely to come from the Senate Finance Committee, where Chairman Max Baucus (D-MT) is striving behind closed doors to reach a bipartisan agreement with fiscally conservative Republicans and Democrats.

Finance staffers have acknowledged that winning that agreement may end up entailing such things as higher copays on lab tests and further means-testing options (e.g., restricting annual inflation adjustments to Part B income thresholds so that more people end up in the higher Part B premium categories).
The Finance plan also calls for a commission to review Medicare spending in 2015-16, and, to the extent that it exceeds some inflation-adjusted baseline, propose a set of payment reductions to restore the funding balance. Under that concept, Congress would have a year to pass alternative legislation to achieve the same savings or let the commission-recommended cuts would go into effect.

Here's MOAA's bottom line:
  • Congress is not going to "kill Medicare" or "kill TFL"
  • Seniors are the most powerful voting bloc in America, and legislators arenít going to flagrantly disregard their interests
  • Many things in the health care reform legislation are positive for Medicare/TRICARE beneficiaries and seek reasonable cost constraints that minimize impact on beneficiaries
  • There also are some things that cause justifiable concern, such as (a) the risk of putting significant power in the hands of a commission or set of administrators who would be empowered to take action that might or might not be draconian at some point in the future, (b) the potential for extending means-tested premiums ever-further down the income scale, and (c) using some Medicare savings to fund universal health care, but applying cost-constraint "hammers" (e.g., a future commission) only to Medicare
  • There's no denying that something has to be done to constrain Medicare cost growth, as the alternative (much higher taxes) wonít fly, and that will almost certainly necessitate some "lesser of the evils" choices
  • There's no free lunch, especially coming into a new decade in which the country faces massive economic challenges and rising deficits. If something isnít done now, the task will only get tougher later
  • Part of the challenge to understanding is that some in both parties and their supporters use rhetoric aimed more at scoring political points than providing factual perspectives
  • MOAA will keep vigilant to protect members' legitimate interests, and MOAA members need to respond with grassroots action when those interests come under attack
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Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. Groucho Marx

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