ObamaCare quietly leaves mark on Medicare despite repeal push

(This story originally appeared in The Hill Extra)

Republican efforts to repeal ObamaCare will likely leave Medicare untouched, meaning former President Obama will leave his mark on the popular health program for more than 58 million elderly and disabled

Some in the GOP, like House Speaker Paul Ryan (R-Wis.), were believed to want to tie efforts to repeal the law and overhaul Medicare financing. But President Trump and others pushed back, calling the repeal bill the wrong vehicle.

Experts say it’s unlikely Congress will now tackle Medicare issues anytime soon.

“There are changes to Medicare that are in the ACA that have taken effect that people are benefiting from today,” Juliette Cubanski, Kaiser Family Foundation Medicare policy program associate director, told The Hill Extra. “Medicare, the way it is now, is really popular.

“It’s not entirely clear that there is a lot of appetite for Medicare reform proposals outside of some Republican leaders in Washington,” Cubanski added.

Despite Republican control of both houses, Congress has struggled to coalesce around a plan to overhaul the Affordable Care Act (ACA).

Tension over a replacement plan and a timeline for implementation has stalled the process, while the White House has chimed in demanding a quick timeline for Congress to move legislation.

“Trying to repeal and replace the Affordable Care is turning out to be more complicated and controversial than some had anticipated and that may impact whether they do something on Medicare,” Howard Bedlin, vice president of public policy for the National Council on Aging, told The Hill Extra. “It could be a factor later.”

ObamaCare provisions.

Medicare provisions in ObamaCare, while not sweeping, did establish new benefits for seniors along with protections from high drug prices. It also set income-based taxes for hospital coverage, which helps finance the program. 

“Everywhere else people are not quite as focused on Medicare reform ideas.” Cubanski added.

On the agency side, the law gave the Centers for Medicare and Medicaid Services new power to toy with payments through the Center for Medicare and Medicaid Innovation (CMMI) — a power Republicans criticized as too broad — and which reduced industry payments for Medicare Advantage plans.

The ACA also tied provider payments to patient outcomes and created the controversial and never used Independent Payment Advisory Board (IPAB), a task force that would recommend savings measures if per-beneficiary spending spiked to certain rates.

None of these are specifically targeted by the leading GOP plans to overhaul ObamaCare. Bedlin said CMMI and IPAB are still potential targets for smaller scale changes to the program down the road.

“[IPAB] probably will be repealed sometime this year but a lot of provisions will remain intact that should remain intact,” he said.

Too big of a bite.

Anything on a larger scale is unlikely in the near term.

Newly minted Health and Human Services Secretary Tom Price told the Senate health committee in January that changes to Medicare would not be a priority for his department.

“The challenges we have to address immediately are those in the individual market and Medicaid market,” Price told Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.).

Republicans have walked back from detailed Medicare repeal and reform ideas backed by many conservatives as recently as last summer. Medicare changes were most clearly laid out in Ryan’s “A Better Way” plan. 

Ryan’s plan called for scrapping “the most damaging Medicare provisions contained in ObamaCare,” including CMMI, IPAB and a moratorium on physician-owned hospitals.

“House leadership is anxious to move that agenda. I don’t think the Senate is anxious and I don’t think the White House is supportive,” Bedlin said, noting the 2018 reconciliation bill has been floated as a vehicle for some Medicare repeal changes.

Still there could be some room for changes to Medicare outside of the ObamaCare repeal efforts.

“They would have to scale it back significantly but I would be very surprised if we don’t see some Medicare reforms this year,” he added. “They will be incremental and hopefully noncontroversial and bipartisan.”

Despite the Republican promise to leave Medicare mostly untouched, their current plans could still have some impact on the program.

Impact of repeal.

The Medicaid program could also be largely reshaped by repeal and replace legislation, which could affect some poor seniors enrolled in the Qualified Medicare Beneficiary Program and the Specified Low-Income Medicare Beneficiary Program.

“People oftentimes don’t understand that there are two very important Medicaid laws that help Medicare beneficiaries,” Bedlin said. “They are paid for by Medicaid … These Medicaid proposals have us very concerned about how they might impact these Medicare beneficiaries.”

Glenn Giese, a Medicare Advantage actuarial consultant for firm Oliver Wyman, told The Hill Extra that if there are no changes to that program it could benefit Medicare Advantage plans.

“The stability of not changing anything after we’ve been through a six-year period of reduced funding each year is important for the plans. The stability will cause plans to be able to adjust to the six-years of payment reductions,” Giese said.

But just because there are no provisions targeting aspects of Medicare doesn’t mean a line won’t be slipped in during the legislative process, Cubanski said.

“Even if people on Medicare and people who focus on the Medicare program might not be paying as much attention to the ACA repeal debate because they think it doesn’t have anything to do with Medicare, depending on the details, it could have something to do with Medicare,” Cubanski said. “It’s important to pay attention.”

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