In an interview with “Good Morning America” on Wednesday, House Speaker Paul Ryan (R-WI) cast doubt on the prospect for comprehensive Medicare reform on the congressional agenda in 2018: “There are some provider issues that we may be addressing as you know. Some providers in the Medicare field in some cases are getting overpaid. We want to make sure that’s being dealt with. But as far as you’re talking about beneficiaries, we’re not focused on that.”
Unfortunately, however, if Congress fails to address comprehensive Medicare reform, beneficiaries will miss out on significant savings in their pocketbooks, and taxpayers will miss out on the opportunity to slow the growth of the program’s expenses. This “win-win” proposition—seniors save money, as do taxpayers—could help the federal government solve its growing entitlement shortfalls, but only if Congress has the courage to act.
How Medicare Reform Would Work
Lost in the cacophony of debate surrounding Obamacare “repeal-and-replace” legislation, the Congressional Budget Office (CBO) in October released an updated analysis of illustrative proposals to create a premium support program for Medicare. The report explained how and why premium support could save even more money than CBO had estimated just a few years ago.
To the uninitiated, premium support would transform Medicare into a program roughly akin to the federal employee health benefit plan, or the Obamacare exchanges established in 2014. Insurers, including traditional government-run Medicare, would bid against each other to offer the usual complement of Medicare services.
In each bidding area, whether a county, state, or region, officials would determine a “benchmark” bid—based on, for instance, the average of all plan bids, or the second-lowest plan bid. (Obamacare exchanges use the second-lowest plan bid.) Beneficiaries would receive a sum from the federal government to cover the cost of a benchmark plan in their area. If a senior selected a plan costing less than the benchmark amount, he or she would receive the difference in savings; conversely, if a senior selected a plan costing more than the benchmark, he or she would pay the difference in higher premiums.
New Report Shows Increased Savings
Compared to an earlier CBO report released in September 2013, the updated analysis shows greater savings from implementing premium support. In ten-year budget terms, the second-lowest bid option would save $419 billion, while the average bid option would save $184 billion—up from $275 billion and $69 billion, respectively, four years ago.
The savings grow more when expressed in percentage terms: Whereas CBO thought the average bid option, once fully implemented, would reduce federal spending by between 1 and 7 percent in its 2013 analysis, now the budget office believes that option would reduce federal spending by 8 percent.
The October report cited several factors that put both upward and downward pressure on the amount of federal savings. In general, however, two factors stood out. First, Congress passed a law repealing the Medicare sustainable growth rate mechanism in 2015. That law increased projected spending in traditional fee-for-service Medicare, making it less financially competitive when compared to private Medicare Advantage plans.
Second, the Medicare Advantage plans have become more efficient, reducing their bids when compared to traditional Medicare. With plans already operating in a more competitive environment, the federal government could achieve greater savings by altering the bidding structure to harness that competitive environment.
Let’s Compare the Two Options
In general, while the second-lowest bid option would achieve greater savings for the federal government, the average bid option seems the likeliest to achieve the political consensus necessary to ensure its enactment. Setting a lower benchmark, as the second-lowest bid option would do in most if not all markets, would require more seniors to pay additional premiums, as more plans would exceed the benchmark.
The CBO analysis puts the difference between the two options in stark relief. Whereas the second-lowest bid option would raise average seniors’ average premiums by 35 percent—with much higher spikes in costly areas of the country—the average bid option would lower—yes, lower—seniors’ Medicare premiums by an average of 7 percent. The average bid option would also reduce overall out-of-pocket spending (i.e., including deductibles and co-payments) for seniors by an average of 5 percent, compared to an 18 percent increase under the second-lowest bid option.
To this conservative, the average bid option seems much more politically palatable. While any plan will result in confusion and controversy, one that will save both taxpayers and seniors money provides a strong incentive to transition to a new system. Congress can adjust the formula over time as needed, to reflect any difficulties in implementation and changes in our fiscal outlook. But the transition should happen—sooner rather than later.
Republicans Need to Combat ‘Mediscare’ Tactics
Of course, enacting Medicare reform involves overcoming partisan attacks and demagoguery—as the ads depicting Republicans throwing granny off a cliff so vividly illustrate. Democrats ran those ads against Ryan in the past, and no doubt will do so again the minute conservatives contemplate a serious effort to reform Medicare.
But conservatives—and Congress as a whole—have no choice but to reform entitlements. As previously noted, Medicare would already be financially insolvent but for Obamacare’s fiscal gimmickry—the accounting scheme that allows Medicare savings simultaneously to make Medicare solvent and fund Obamacare.
With the federal government more than $20 trillion in debt, the fiscal crisis grows closer by the day. CBO has laid out the pathway to a more sustainable fiscal future, one that would help save Medicare for future generations, while saving this generation of seniors money. All our country requires is a group of political leaders willing to lead, and put the plan into place.
Mr. Jacobs is founder and CEO of Juniper Research Group, a policy consulting firm based in Washington. He is on Twitter: @chrisjacobsHC.