Congressional Budget Office: Options for Reducing the Deficit - Report Analysis

[David MHA]

Congressional Budget Office: Options for Reducing the Deficit
Report Analysis Chapter 5
2017-2026
​

This paper, covers an analysis, interpretations and impact issues that are relevant to an Acute Care​

Facility, which focuses on a facility that provides medical care for a significant number of inner city, aged and indigent populations. The conclusive interpretations, are addressing the issues of most impact, in that theater of Patient Care Operations.

Emerging from this “Deficit Reduction Proposal” by the Congressional Budget Office are three broad​

based options:

1. The Imposition of caps on Federal spending for Medicaid
2. A change in the cost-sharing rules for Medicare with restricted allowable Medigap Insurance
3. A new CBO policy of reductions in tax preferences for employment-based health insurance

In addition, are two types of spending limits, and overall limited spending, or pre-enrollee caps on benefits. Pre-enrollee caps are proposed to limit benefits that are prescribed to the projected needs of a specified and categorized Patient population, of the Elderly, the Disabled, Children, Non-Disabled and Non-elderly Adults.

Another explored option is a conversion of Medicare, to a Premium Support System, replacing a full​

service-line benefits package with a fixed spending amount contribution, from the Federal Government Health Plan Budget, despite the actual spending needs of the Patient based on illness. This option, would ultimately require, either more out-of-pocket Patient spending to cover the short-fall, or a resulting neglect of healthcare needs due to a lack of affordability, impacting predominantly Patients within the middle, and lower income sectors, including the poor.

Under a premium support system, the federal government would replace the Medicare beneficiaries’​

guaranteed benefit package, with a fixed dollar amount or “defined contribution”, that beneficiaries would apply toward their health care coverage. The impact on Medicare beneficiaries, when moving to a premium support system are:

• A guaranteed set of Medicare benefits will end

• Medicare Patients will pay more for premiums

• Again, more costs will shift to beneficiaries over time

Lower income Patients will bear the most impact, leading to reduced access to care, and catastrophic​

out-of-pocket medical expenses (Flowers, 2017).

The Congressional Budget Office, also considers that The Patient Protection and Affordable Care Act​

(ACA) will transition into higher penalties for individuals who do not engage in healthcare coverage, essentially “opting-out” of coverage (CBO, 2016). This will take advantage of the loophole that was created when many Patients realized that the fines were less costly than the coverage, ostensibly utilizing the Emergency Room for healthcare services. As in the past, these ER Patients are protected my EMTALA Laws that prohibit facilities from withholding services, due to a Patients inability to pay, which places an additional burden on the facility’s financial resources.

Although the CBO follows current laws, in constructing baseline projections for individual components​

of this form of “discretionary spending”, as required under section 257 of the Balanced Budget and Emergency Deficit Control Act of 1985, its baseline projections of overall spending, will in fact, incorporate these caps and automatic spending reductions, already put in place by the Budget Act.

These caps, either have to be revised, rejected by a new vote on spending as detrimental, replaced with​

alternatives, or rescinded in their entirety, pending new legislation. Large reductions such as these, among the States annual revenue potential and expectations, and ostensibly trickling down cuts within the healthcare industries revenue cycles, will occur, due to spending caps and benefits reductions, in addition, higher healthcare contributions will be forced, and required by the Patient population.

An increase in the ratio of indigent Patients will result from higher Premiums, penalties and the creation​

of stricter and more pervasive caps. In addition, the return to a higher migration of Patients utilizing the ER under EMTALA protections, triggering more losses for Acute Care facilities, where DSH funding, compensation will have been eliminated under the circumstances of these proposed options.

It should be noted, that the original rationale for the Medicare Disproportionate Share (DSH) payment​

adjustment was to compensate hospitals for the higher operating costs they incur in treating a large share of low-income patients. Low-income Medicare patients tend to be sicker and costlier to treat than other Medicare patients with the same diagnosis. Higher costs also result from the need for additional staffing and services, such as translators and social workers, to care for low-income patients (Commins, 2018).

Over time, however, a second justification for the DSH adjustment emerged. Many policy makers now​

view the purpose of DSH payments more broadly. Most agree that DSH funds preserve access to care for Medicare and low-income populations by financially assisting the hospitals they use.

Most of the CBO options presented in Chapter 5 of the Budget Report, would either decrease spending​

by the Government, to stabilize healthcare coverage, or increase taxes to meet projected spending needs. The CBO also suggests that States can further subsidize healthcare spending to cover the shortfall. Conversely, that would increase State taxation needs. However, the Federal Government matches State Medicaid spending on healthcare, which would (in effect) impact State contributions to a smaller amount by virtue of strategic financial balance. Under current law, the Federal and State Governments, share in the financing and administration of Medicaid.

Finally, some provider options could shift the sources, or types of health insurance coverage, or cause​

different types of healthcare to be sought and delivered, i.e., budget changes that will inevitably trigger a shift in traditional providers, from conventional vendors, to alternative providers that will deliver similar medical services at lower costs.

References​

CBO (2016, December) Congressional Budget Office: Options for Reducing the Deficit

COMMINS, J. ( 2018, FEBRUARY 12) Safety Nets Cheer DSH Cuts Delay

Flowers, L., Komisar, H., Lind, K., Noel-Miller, C., and Purvis, L., (2017, JANUARY 9) Premium Support and the

Impact on Medicare Beneficiaries​

 

[Penelope]

I so expected this to come, decrease in Medicare benefits and cost sharing of 50/50. After all the elites needed their tax cuts and what good are old people or disabled if they are not able to fend for themselves.

They want to get rid of all FDR's new deal.

 

[frigidweirdo]

Congressional Budget Office: Options for Reducing the Deficit
Report Analysis Chapter 5
2017-2026
​

This paper, covers an analysis, interpretations and impact issues that are relevant to an Acute Care​

Facility, which focuses on a facility that provides medical care for a significant number of inner city, aged and indigent populations. The conclusive interpretations, are addressing the issues of most impact, in that theater of Patient Care Operations.

Emerging from this “Deficit Reduction Proposal” by the Congressional Budget Office are three broad​

based options:

1. The Imposition of caps on Federal spending for Medicaid
2. A change in the cost-sharing rules for Medicare with restricted allowable Medigap Insurance
3. A new CBO policy of reductions in tax preferences for employment-based health insurance

In addition, are two types of spending limits, and overall limited spending, or pre-enrollee caps on benefits. Pre-enrollee caps are proposed to limit benefits that are prescribed to the projected needs of a specified and categorized Patient population, of the Elderly, the Disabled, Children, Non-Disabled and Non-elderly Adults.

Another explored option is a conversion of Medicare, to a Premium Support System, replacing a full​

service-line benefits package with a fixed spending amount contribution, from the Federal Government Health Plan Budget, despite the actual spending needs of the Patient based on illness. This option, would ultimately require, either more out-of-pocket Patient spending to cover the short-fall, or a resulting neglect of healthcare needs due to a lack of affordability, impacting predominantly Patients within the middle, and lower income sectors, including the poor.

Under a premium support system, the federal government would replace the Medicare beneficiaries’​

guaranteed benefit package, with a fixed dollar amount or “defined contribution”, that beneficiaries would apply toward their health care coverage. The impact on Medicare beneficiaries, when moving to a premium support system are:

• A guaranteed set of Medicare benefits will end

• Medicare Patients will pay more for premiums

• Again, more costs will shift to beneficiaries over time

Lower income Patients will bear the most impact, leading to reduced access to care, and catastrophic​

out-of-pocket medical expenses (Flowers, 2017).

The Congressional Budget Office, also considers that The Patient Protection and Affordable Care Act​

(ACA) will transition into higher penalties for individuals who do not engage in healthcare coverage, essentially “opting-out” of coverage (CBO, 2016). This will take advantage of the loophole that was created when many Patients realized that the fines were less costly than the coverage, ostensibly utilizing the Emergency Room for healthcare services. As in the past, these ER Patients are protected my EMTALA Laws that prohibit facilities from withholding services, due to a Patients inability to pay, which places an additional burden on the facility’s financial resources.

Although the CBO follows current laws, in constructing baseline projections for individual components​

of this form of “discretionary spending”, as required under section 257 of the Balanced Budget and Emergency Deficit Control Act of 1985, its baseline projections of overall spending, will in fact, incorporate these caps and automatic spending reductions, already put in place by the Budget Act.

These caps, either have to be revised, rejected by a new vote on spending as detrimental, replaced with​

alternatives, or rescinded in their entirety, pending new legislation. Large reductions such as these, among the States annual revenue potential and expectations, and ostensibly trickling down cuts within the healthcare industries revenue cycles, will occur, due to spending caps and benefits reductions, in addition, higher healthcare contributions will be forced, and required by the Patient population.

An increase in the ratio of indigent Patients will result from higher Premiums, penalties and the creation​

of stricter and more pervasive caps. In addition, the return to a higher migration of Patients utilizing the ER under EMTALA protections, triggering more losses for Acute Care facilities, where DSH funding, compensation will have been eliminated under the circumstances of these proposed options.

It should be noted, that the original rationale for the Medicare Disproportionate Share (DSH) payment​

adjustment was to compensate hospitals for the higher operating costs they incur in treating a large share of low-income patients. Low-income Medicare patients tend to be sicker and costlier to treat than other Medicare patients with the same diagnosis. Higher costs also result from the need for additional staffing and services, such as translators and social workers, to care for low-income patients (Commins, 2018).

Over time, however, a second justification for the DSH adjustment emerged. Many policy makers now​

view the purpose of DSH payments more broadly. Most agree that DSH funds preserve access to care for Medicare and low-income populations by financially assisting the hospitals they use.

Most of the CBO options presented in Chapter 5 of the Budget Report, would either decrease spending​

by the Government, to stabilize healthcare coverage, or increase taxes to meet projected spending needs. The CBO also suggests that States can further subsidize healthcare spending to cover the shortfall. Conversely, that would increase State taxation needs. However, the Federal Government matches State Medicaid spending on healthcare, which would (in effect) impact State contributions to a smaller amount by virtue of strategic financial balance. Under current law, the Federal and State Governments, share in the financing and administration of Medicaid.

Finally, some provider options could shift the sources, or types of health insurance coverage, or cause​

different types of healthcare to be sought and delivered, i.e., budget changes that will inevitably trigger a shift in traditional providers, from conventional vendors, to alternative providers that will deliver similar medical services at lower costs.

References​

CBO (2016, December) Congressional Budget Office: Options for Reducing the Deficit

COMMINS, J. ( 2018, FEBRUARY 12) Safety Nets Cheer DSH Cuts Delay

Flowers, L., Komisar, H., Lind, K., Noel-Miller, C., and Purvis, L., (2017, JANUARY 9) Premium Support and the

Impact on Medicare Beneficiaries​

Lovely, so, tax breaks for the rich increase the deficit, so we need to take away healthcare in order to get the deficit down again.

And Trump said he was for who?

 

[Penelope]

This all started under Reagan who tripled the debt and decreased the top bracket from 70% to 38.5%, and has the nerve to delete the 11% (lowest) tax bracket. Then we had Bush Jr who lead us into the greatest recession since the great depression, and now we have

TRUMP. who wants the trickle down to turn us into slave labor and their taxes to cover the US expenditures, and not the elites.

 

[dblack]

1. The Imposition of caps on Federal spending for Medicaid
2. A change in the cost-sharing rules for Medicare with restricted allowable Medigap Insurance
3. A new CBO policy of reductions in tax preferences for employment-based health insurance.

Number three is certainly a step in the right direction. It was a mistake to try to turn our employers into our health care providers.

...

The Congressional Budget Office, also considers that The Patient Protection and Affordable Care Act​

(ACA) will transition into higher penalties for individuals who do not engage in healthcare coverage, essentially “opting-out” of coverage (CBO, 2016). This will take advantage of the loophole that was created when many Patients realized that the fines were less costly than the coverage, ostensibly utilizing the Emergency Room for healthcare services. As in the past, these ER Patients are protected my EMTALA Laws that prohibit facilities from withholding services, due to a Patients inability to pay, which places an additional burden on the facility’s financial resources.

Saw that coming. This is what Republicans don't want to admit. ACA is still law. So is the mandate. The penalty has just been temporarily dialed back. They'll dial it right back up when resistance wanes.

 

[there4eyeM]

uh, the 'defense' rat hole?

 

[petro]

What penalty?
I successfully filed my taxes 8 years claiming a self exemption for no coverage. Never paid a single fine. There were about 8 exemptions listed. I know of no one who paid the fine. The options under the mandate were simply unaffordable.

 

[Dont Taz Me Bro]

Closed. Opening posts require original commentary