House GOP Looks Ahead to Huge Medicare Overhaul in 2016

The doc fix is done, Obamacare lives, but the GOP still has health policy plans.

Two people walk inside a Medicare Services office on the last day for enrollment in the Medicare Part D program May 15, 2006 in New York City.
National Journal
Dylan Scott
Add to Briefcase
See more stories about...
Dylan Scott
Aug. 10, 2015, 1 a.m.

For years, Re­pub­lic­ans have openly pined for push­ing Medi­care fur­ther in­to the private sec­tor. But they have been re­strained by the prac­tic­al real­it­ies of di­vided gov­ern­ment and the polit­ic­al risks of a plan that Demo­crats have said would turn the pop­u­lar in­sur­ance pro­gram in­to a vouch­er sys­tem.

Con­ser­vat­ives on Cap­it­ol Hill, however, have not sur­rendered the dream and now are plan­ning to un­der­take the dirty work to make it a le­gis­lat­ive real­ity. House Re­pub­lic­ans will start work­ing next year on draft­ing a Medi­care “premi­um-sup­port” bill, ac­cord­ing to Ways and Means Health Sub­com­mit­tee Chair­man Kev­in Brady.

It is the most am­bi­tious item on the up­com­ing le­gis­lat­ive agenda that the Texas Re­pub­lic­an laid out in an in­ter­view with Na­tion­al Journ­al.

Brady said his pan­el wants to start the la­bor­i­ous work of cre­at­ing ac­tu­al le­gis­lat­ive text, likely in pre­par­a­tion for 2017 un­der a new Con­gress and pres­id­ent at the earli­est. This year’s House budget en­dorsed the policy, as it has for sev­er­al years un­der Re­pub­lic­an con­trol.

It would fol­low the first two of Brady’s self-de­scribed steps to sav­ing Medi­care. The first was the “doc fix” deal re­form­ing phys­i­cian pay­ments, passed this spring. He also hopes to ad­vance in the fall a pack­age of re­forms that would, among oth­er things, sim­pli­fy Medi­care hos­pit­al pay­ments and in­tro­duce pay-for-per­form­ance to post-acute care.

Then comes premi­um sup­port.

“Next year, what we hope to turn to is the third and fi­nal step for sav­ing Medi­care in the long term, which is of­fer­ing bet­ter and smarter per­son­al­ized Medi­care op­tions for seni­ors,” Brady said. He spe­cific­ally named com­bin­ing Medi­care’s hos­pit­al and phys­i­cian cov­er­age, with an out-of-pock­et spend­ing cap, and “provid­ing a per­son­al­ized Medi­care op­tion that most call premi­um sup­port.”

The de­tails of how the policy would ac­tu­ally work are what Brady and his staff plan to start craft­ing next year. Premi­um sup­port gen­er­ally means that Medi­care would provide seni­ors with a set amount of money to pur­chase a private health plan. In some it­er­a­tions, the tra­di­tion­al Medi­care pro­gram would con­tin­ue as an op­tion.

“It is do­ing the le­gis­lat­ive work, get­ting the [Con­gres­sion­al Budget Of­fice] scores, mak­ing sure those plan op­tions work both from a budget stand­point and a health care stand­point,” Brady said.

It could be polit­ic­ally fraught: Just 26 per­cent of Amer­ic­ans fa­vor mov­ing to premi­um sup­port, ac­cord­ing to a Ju­ly poll by the Kais­er Fam­ily Found­a­tion. Pres­id­ent Obama re­peatedly at­tacked 2012 Re­pub­lic­an pres­id­en­tial nom­in­ee Mitt Rom­ney over the policy, link­ing him to past House budgets that in­cluded it, which had been pro­duced by then-vice pres­id­en­tial can­did­ate and now-Ways and Means Chair­man Paul Ry­an.

Asked about any polit­ic­al risk in a pres­id­en­tial elec­tion year, Brady em­phas­ized that the bill wouldn’t ne­ces­sar­ily move in 2016, just that the “hard work” of put­ting to­geth­er le­gis­lat­ive lan­guage would be­gin.

“There is an aw­ful lot of ground­work that needs to be done on that,” he said.

The oth­er longer-term pro­ject that Brady plans to un­der­take is com­bin­ing Medi­care’s hos­pit­al and phys­i­cian cov­er­age (known as Part A and Part B). De­tails are still to be de­term­ined, but the concept, which has been floated for some time, would stream­line the pro­gram by hav­ing seni­ors pay one de­duct­ible for both kinds of care. There would also be a cap on out-of-pock­et costs that they would have to pay, Brady said.

Obama re­portedly ex­pressed an open­ness to the idea dur­ing the 2011 budget ne­go­ti­ations. But the pro­pos­al has also been cri­ti­cized by oth­ers who al­lege that, by com­bin­ing the two de­duct­ibles, it would in­crease costs for seni­ors who don’t use hos­pit­al care.

Be­fore the work on those more ex­pans­ive pro­pos­als starts, however, Brady wants to press for­ward with some Medi­care hos­pit­al-pay­ment re­forms that have been in the works for a while. In the lame-duck ses­sion last year, he re­leased a dis­cus­sion draft with a lit­any of pro­pos­als, and his pan­el held a hear­ing last month on the is­sue.

He said he ex­pects a num­ber of smal­ler bills to move this fall in tan­dem, rather than as a lar­ger bill, and for them to earn bi­par­tis­an sup­port. Be­fore Con­gress left for its Au­gust re­cess, four bills were in­tro­duced. But the clock of pres­id­en­tial and con­gres­sion­al polit­ics is tick­ing.

“Be­fore things start to close down next year with the Sen­ate elec­tion and the pres­id­en­tial elec­tions and all that,” Brady said, “we think this fall may be the last real chance to move health policy through both bod­ies.”

What We're Following See More »
North Korea Threatens H-Bomb Test Over Pacific
4 minutes ago

"North Korea said on Friday it might test a hydrogen bomb over the Pacific Ocean after President Donald Trump vowed to destroy the reclusive country, with leader Kim Jong Un promising to make Trump pay dearly for his threats. Kim did not specify what action he would take against the United States or Trump, whom he called a 'mentally deranged U.S. dotard' in the latest bout of insults the two leaders have traded in recent weeks."

Trump Says Facebook Story Is Part of “Russia Hoax”
6 minutes ago
Trump Makes Good on Promise of New North Korea Sanctions
18 hours ago

President Trump this afternoon announced another round of sanctions on North Korea, calling the regime "a continuing threat." The executive order, which Trump relayed to Congress, bans any ship or plane that has visited North Korea from visiting the United States within 180 days. The order also authorizes sanctions on any financial institution doing business with North Korea, and permits the secretaries of State and the Treasury to sanction any person involved in trading with North Korea, operating a port there, or involved in a variety of industries there.

Trump Promises More Sanctions on North Korea
21 hours ago

In response to a reporter's question, President Trump said "he’ll be looking to impose further financial penalties on North Korea over its nuclear and ballistic tests. ... The U.N. has passed two resolutions recently aimed at squeezing the North Korean economy by cutting off oil, labor and exports to the nation." Meanwhile, the Guardian reports that South Korea's unification ministry is sending an $8m aid package aimed at infants and pregnant women in North Korea. The "humanitarian gesture [is] at odds with calls by Japan and the US for unwavering economic and diplomatic pressure on Pyongyang."

FLOTUS to Speak at UN Luncheon
1 days ago

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.