A Better Approach for End of Life Planning

The need to ensure that individual autonomy is considered and respected near the end of life is rapidly increasing. Every single day, over 10,000 baby boomers turn 65 years old and gain Medicare eligibility. Between 2010 and 2050 the number of Americans on Medicare will double to 84 million, octogenarians will quadruple to 8 million, and the ratio of potential caregivers to Americans over 80 years old will dive from 7-to-1 in 2010, to 4-to-1 in 2030 Though we are fortunate that medical science has been able to extend the number of years a Medicare beneficiary is expected to live by about 300 percent, Americans have not changed how they talk about and plan the final stages of life.

The Commonwealth Fund Report on Medicaid Falls Short

The coverage expansion under the Affordable Care Act relies heavily on expanding eligibility for Medicaid, which raises important questions on the efficacy of the program. Proponents of the law applaud the expansion as a windfall for low-income households, while critics maintain that Medicaid provides poor access relative to private coverage and does not measurably improve the health of beneficiaries. In an attempt to answer these questions, the Commonwealth Fund has weighed in, suggesting that Medicaid beneficiaries are, in many respects, just as well off or better in Medicaid as in private coverage. The report has led some proponents of Medicaid expansion to exaggerate the findings.

A Responsible Fantasy Budget

I've been puzzling over the recent assertion by Committee for a Responsible Federal Budget (CRFB) that the proposed Sustainable Growth Rate (SGR) fix would blow a $400 billion hole in the budget. One part was clear. They estimate $210 billion in costs during the first 10 years. This requires they assume that – in the absence of the proposed fix – Congress would stand idly by and permit savage, double-digit cuts to doctors totaling $140 billion.

The Affordable Care Act after Five Years: Wasted Money and Broken Promises

The main promise that we heard repeated over and over again was that the ACA would provide universal access to affordable coverage of high-quality health care. In these remarks I will discuss (1) coverage, (2) affordability, (3) quality, and (4) access to care under the ACA. The ACA has been riddled with wasted money and broken promises. It has proven to be poor growth policy, red-ink budget policy, flawed insurance policy, and poor health care policy. Instead of growth, it has contributed to a mediocre recovery. Instead of fiscal responsibility, it has exacerbated the red ink that plagues the government. Instead of universal coverage for the uninsured, the retention of valued policies and lower premiums, it has produced spotty, uneven coverage expansions, the forcible loss of valued polices and higher premiums for all. And instead of bending the cost curve and raising quality, it has delivered limited access to doctors and the loss of preferred providers.

Merits of the Proposed SGR Repeal

Congress has the chance to eliminate an annual legislative nightmare, fix the reimbursement of doctors under Medicare, introduce substantive, structural changes to an entitlement program, and ensure the continued insurance coverage of needy children – all without raising a dime of taxes. Reports indicate that there is a bipartisan, bicameral leadership agreement for Congress to repeal the Sustainable Growth Rate (SGR) mechanism, as well as extend for two years the Children’s Health Insurance Program (CHIP) and numerous other health provisions. The legislation isn’t perfect – more on that below – but it is an important step forward.

The ACA’s Risk Spreading Mechanisms: A Primer on Reinsurance, Risk Corridors and Risk Adjustment

The 2010 Affordable Care Act (ACA) health reform law established state-based health insurance exchanges to provide an individual market for qualified health insurance plans. The state exchanges sell insurance plans to any citizen, regardless of health status. Enrollees who purchase plans through an exchange can receive federal premium subsidies if their household income falls between 100 and 400 percent of the federal poverty level. This primer provides an overview of the ACA’s risk mitigation provisions that apply to individual and/or small group market plans: reinsurance, risk corridors, and risk adjustment.

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