Medicare Trustees May Sound New Alarm

Medicare Trustees May Sound New Alarm

By KEVIN FREKING

WASHINGTON - The upcoming report on Medicare's financial health is likely to contain a first-of-its-kind warning that will require President Bush to find ways to make the entitlement program more self-reliant.

House Republicans came up with the idea for the warning when drawing up the Medicare drug benefit in 2003. Lawmakers say they were concerned the program's future growth would crowd out essential spending for defense, education and other purposes.

"It's just one way of throwing some water in our faces so we look at this problem" said Rep. Paul Ryan, R-Wis.

The drug bill required that trustees issue a "Medicare funding warning" when they project in consecutive years that Medicare will rely on general revenues for 45 percent of its money.

Last year's report contained such a projection for 2012. So this year's report, scheduled to be released Monday, could be the one that triggers the warning if the trend line holds for 2013.

The warning could lead to such changes as payment cuts for health care providers or higher premiums for beneficiaries. Congress also could choose to ignore it.

Some advocacy groups and congressional aides are expecting such a warning. Medicare's long-term financing trends have not changed dramatically over the course of the year. One part of Medicare, the drug benefit, is coming in under budget.

"We are going to hit the 45 percent," Mark Hayes, chief health care adviser to Iowa GOP Sen. Charles Grassley, said late last year. "And the official sounding of that trigger, I think, will at least trigger its own discussion about entitlements and where we're going in this country with spending."

Already, many analysts believe the wake-up call will be greatly ignored. They say the trigger has nothing to do with the program's solvency, which refers to how long surpluses in the hospital insurance trust fund will last.

"There's not a great enthusiasm on the Hill to make arbitrary cuts based on an arbitrary number," said Kirsten Sloan, the AARP's national coordinator for health.

In fact, Rep. Pete Stark, D-Calif., chairman of the health subcommittee for the House Ways and Means Committee, said he will work this year to pass legislation that does away with the 45 percent rule. In any event, he does not intend to pay it much attention.

Absent legislation, Bush will be required to propose ways to reduce Medicare's reliance on the general treasury to below 45 percent. Bush's most recent budget has recommended an across-the-board cut of 0.4 percent for every Medicare provider when general funds pay for more than 45 percent of the program.

Congress also will have to consider the president's recommendations next year on an expedited basis, but it can reject them. Several advocacy groups will encourage them to do so.

More than 43 million elderly and disabled people will rely on Medicare this year for their health insurance coverage. The program will cost an estimated $436 billion. It is paid for through a mix of payroll taxes, general revenue, premiums and state payments.

Medicare costs are growing at a rate of about 6.5 percent. The growth stems from enrollment increases as well as health care inflation, which tends to outpace overall inflation.

The AARP's Sloan said that a more prudent course for Congress to take when it comes to controlling growth would be to look at each piece of Medicare. Then, they can determine where it is overpaying and how that problem can be best fixed.

But Ryan believes that a Democrat-led Congress is not inclined to take that approach, either.

"In and of itself, the trigger has nothing to do with the long-term solvency," Ryan said. "But it serves as a wake-up call to Congress that it better get serious about reforming and saving these programs.

"If we do what the Democratic budget proposes, which is nothing for five years on entitlements, then we're guaranteeing that these programs go bankrupt."

Stark said capping general revenue for Medicare makes as much sense as capping it for defense.

One way Democrats will look to control Medicare costs is through lowering the payment rates for some private insurers, he said.

"I've heard the trustees tell me that the Medicare trust fund has a one-year survival up to as high as a 26-year survival," he said. "It changes every year. It's sort of like my kids who tell me that if they don't get dessert, they're going to hold their breath and die. Well, they're still kicking."
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