with U.S. Senator Chuck Grassley
Q: As the Affordable Care Act shifts more health care costs to the taxpaying public, how is Medicare stacking up as public entitlements consume a growing share of the economy?
A: Virtually every American has a vested interest in the Medicare program, including current and future enrollees, health care providers and taxpayers. More than 50 million older Americans and younger individuals with disabilities pay monthly premiums and co-pays to receive their health care coverage through Medicare. The nonpartisan Congressional Budget Office forecasts Medicare spending to nearly double from $592 billion in 2013 to $1.1 trillion in 2023. In the last half-century, Medicare has emerged as a cornerstone of the health care sector in the United States, providing insurance security for hospital stays, physician visits, home health, hospice, pharmaceutical benefits and other health care services for its enrollees. And yet, the program faces serious fiscal instability as it nears the 50th anniversary of its passage next year. For eight years in a row, the Medicare board of trustees has issued a “funding warning” to Congress that general revenues are providing an increasing share of Medicare’s revenue stream to pay its bills. Medicare’s fiscal uncertainty is exacerbated by expanding enrollments due to the retirement of the Baby Boom generation; the shrinking ratio of younger workers to enrollees; and, expensive health care services that come with the blessings of longevity. The projected growth of this program will add a substantial burden to American workers, taxpayers and enrollees. And as the labor force participation rate stagnates at historic lows, even more pressure is being shifted to Medicare’s long-term fiscal health, the federal budget and the economy. Policymakers need to find a cure for Medicare’s prognosis, sooner rather than later. Taxpayers are already on the hook for a $17 trillion national debt and hundreds of billions more for the Affordable Care Act’s subsidized insurance exchanges within the next few years. In fact, when the 2010 health care law was passed, it included cuts to Medicare programs to help pay for the new health care subsidies. Supporters of big government always bite off more than they can chew and leave it to the taxpayers to swallow the tab.
Q: Why is it a big deal that the federal government released Medicare payment information?
A: Bridging the widening gap between forecasted Medicare revenues and Medicare payments is a tall order. Reaching a consensus will test policymakers’ willingness to solve problems instead of scoring political points. From the U.S. Senate, I have worked to nail Medicare waste, fraud and abuse through rigorous congressional oversight and advocacy for whistleblower protections and audits conducted by internal independent watchdogs. And I will continue to do so. But not even rooting out every penny of waste would solve Medicare’s long-term sustainability issues. However, there is another powerful tool that has the potential to transform Medicare spending and payment policies. It could help expose payment disparities and foster better value for high-quality care at lower costs. That tool is called transparency. The Centers for Medicare and Medicaid Services in April pulled back a curtain of secrecy that has shielded Medicare payments made to health care providers from the public eye for nearly four decades. The data released by CMS includes $77 billion in Medicare payments made in 2012 through the Medicare Part B fee-for-service program to more than 880,000 health care providers across the United States. As a long-time champion for transparency in government, I consider this is a victory for the taxpaying public and Medicare enrollees. The data offers a rare look at Medicare’s payment and health care delivery system. Policymakers need quality Medicare transparency to analyze how medicine is delivered and paid for in this taxpayer-supported program. No one should be afraid of explaining their payments or defending existing payment structures. And CMS should pull out all the stops to make sure the information is user-friendly. A raw data dump doesn’t raise the bar of transparency if it’s not useful to help flush out fraud or connect the dots to improve high-quality patient care at a better value.
Q: What else is in store for improved Medicare transparency?
A: By the end of September, CMS also will make public on its website data that will show financial relationships between drug and medical device companies with doctors and other health care providers reimbursed by Medicare. As the co-author of the bipartisan 2010 law that required public disclosure of this information, I believe the taxpaying public has a right to know if a financial arrangement exists between the doctors writing the prescriptions and the pharmaceutical company that manufactures the drug. Keeping the public’s business public strengthens accountability and puts the patient in the driver’s seat. Transparency changes behavior for the public good.