According to an issue brief recently published by the Heritage Foundation, wealthy seniors should pay more in Medicare premiums. Taxpayers spend an extra $4,897 per Medicare beneficiary beyond what is collected in taxes and premiums. Currently, Medicare beneficiaries pay a basic premium for Part B of $99.90 per month, which covers some costs while the remaining costs are covered by subsidies from the general revenue. The subsidy declines for married seniors with combined income above $170,000. When a senior’s income reaches $428,000, the premium tops out at $319.70 per month, leaving a 20 percent subsidy. According to the report, a retired couple with a $428,000 combined salary would have total financial assets worth more than $7.1 million, excluding the value of their home. In other words, this means that multimillionaire retiree seniors still qualify for a 20 percent Medicare subsidy. The report explores this issue and suggests eliminating premium subsidies for such high income Medicare beneficiaries.

The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors recently amended its January 2012 draft research agenda in response to public comments. The board found 15 major themes that emerged from 474 public comments. The purpose of the National Priorities for Research and Research Agenda is to guide funding for comparative clinical effectiveness research. The agenda amendments address PCORI's focus on patient engagement and transparency, patients with multiple chronic conditions, patients with rare diseases, improvement of health delivery systems, and health literacy. The final version of the agenda and the national research priorities...

The Kaiser Family Foundation recently released an issue brief which compares the expected value of benefits for individuals ages 65 and older under Medicare's fee-for-service program to two "typical" plans offered by large employers: a typical large employer preferred provider organization (PPO) plan and the Blue Cross/Blue Shield Standard Option for enrollees in the Federal Employees Health Benefits Program (FEHBP), also a PPO plan. The analysis updates a 2008 Kaiser Family Foundation report that found...

According to a new Government Accountability Office (GAO) report, Medicare is spending $8 billion on an experimental program that rewards providers of less than stellar health care. The report recommends that the Obama administration cancel the demonstration program, which pays bonuses to health insurance companies caring for millions of Medicare beneficiaries. The administration defended the project, arguing that it could improve care quality for older Americans. The Affordable Care Act (ACA) cut Medicare payments to managed care plans, known as Medicare Advantage (MA), and authorized bonus payments to those that provide high-quality care. However, the GAO letter reports that the majority of the money paid under the demonstration program went to “average-performing plans” rated lower than Congress's benchmarks. GAO reported that the project would cost $8.35 billion over 10 years, with 80 percent of the cost occurring in the first three years. Although the project dwarfs other Medicare demonstrations in its budgetary impact, the GAO report found that the project is so poorly designed that researchers could not determine whether the bonus payments correlated with improved care. As a result, the report argues, the project is unlikely to produce meaningful results. Currently, over 12 million Americans are enrolled in MA plans. About one-third of them are in plans that would receive bonuses under the original ACA. Under the demonstration project, 90 percent are in plans eligible for bonuses. Another report released the same day by...

The Institute of Medicine (IOM) of the National Academy of Sciences (NAS) has released their highly-anticipated essential benefits report. The report, "Essential Benefits: Balancing Coverage and Cost," recommends that the U.S. Department of Health and Human Services (HHS) consider cost of services as factor when determining the specific benefits qualified health plans (QHPs) must include. The Affordable Care Act (ACA) requires the Secretary of HHS to come up with a minimum essential benefits package that all health plans must offer by January 1, 2014, and HHS tasked the IOM with making recommendations on how HHS should determine which benefits to include. For more information on essential benefits, click here.

In their recent publication, "Building Tomorrow's Healthcare System: The Pathway to High Quality, Affordable Care," BlueCross BlueShield Assocation (BCBSA) calls for incentives to reward safety and reinforce primary care. One of the nation's largest insurance companies, BCBSA encourages federal government to adopt "value-based purchasing" and urges individuals eligible for Medicare or Medicaid to enroll in managed care plans. The Association also wants faster implementation of these types of programs in order to show savings more quickly.

The Urban Institute, funded by The Robert Wood Johnson Foundation, recently released the paper, "Improving the Quality and Efficiency of the Medicare Program Through Coverage Policy: Timely Analysis of Immediate Health Policy Issues," which offers several steps to reform Medicare coverage. Medicare coverage determinations can influence the appropriate use of medical technology and the creation of better evidence to support clinical and health policy decision. The paper explores the five following areas in hopes of improving the Medicare coverage process: 1) strengthening evidence-based policies; 2) improving the evidentiary base of coverage policies through improved comparative effectiveness research; 3) using coverage with evidence development more consistently; 4) enabling consideration of costs in making coverage and payment policies; and 5) adopting least costly alternative pricing strategies in particular circumstances.

A new Comparative Effectiveness Research (CER) Board, established by the Affordable Care Act (ACA), is seeking public input as to what kinds of research should be performed. The ACA helped establish the Patient-Centered Outcomes Research Institute (PCORI), which will provide information to consumers to help guide their treatment decisions. PCORI is an independent body, charged with overseeing CER guidelines in the U.S. For more information on CER, click here.