If Congress is ever going to overhaul Medicare, it will almost certainly have to happen this way. Sen. Ron Wyden, the Oregon Democrat widely expected to be the next Senate Finance Committee chairman, last week led a bipartisan group of lawmakers, health care experts and seniors’ advocates backing a plan to better coordinate care given to Medicare beneficiaries.
The proposal is part of the ongoing health policy conversation over shifting Medicare away from paying per service provided to paying for the quality of that care. Sponsors say their measure would modify existing law to make it easier for providers to seek out those patients who have multiple chronic conditions like high blood pressure, high cholesterol, heart disease and diabetes and tailor care to their needs.
Health insurers and providers who want to specialize in chronic care would receive a set amount of money to care for patients and would be responsible for the cost, care and outcomes of their enrolled patients. Doctors and nurses would lead those care teams.
According to the Centers for Medicare and Medicaid Services, 68 percent of Medicare enrollees in 2010 suffered from two or more chronic conditions and accounted for 93 percent of program spending, which was about $487 billion.
Reaching across the aisle on health care is a path Wyden has taken before. In 2009 he co-sponsored health care overhaul legislation with former Sen. Robert Bennett, R-Utah. In 2011 he joined forces with Rep. Paul Ryan, D-Wis. — who later became the GOP vice-presidential nominee in the 2012 presidential race — on a plan to give Medicare beneficiaries more choices for their medical care. Neither effort prevailed and the partisan battles over the health care law have made bipartisan compromise unlikely on anything — let alone something as politically difficult as overhauling Medicare, a program that now covers 50 million people.
There’s no official “score” yet from the Congressional Budget Office for Wyden’s newest plan, but the bill’s sponsors predict that if it works as envisioned the legislation would reduce federal spending on Medicare by $25 billion annually. That’s barely a dent in the annual Medicare tab but it’s something all sides could agree on. Republicans and Democrats alike have long sung the praises of coordinated care as a way to reduce costs and improve medical outcomes.
“This is where you have to go if you are serious about Medicare reform,” Wyden said at a news conference where the legislation was unveiled.
Conversations between Wyden and his co-sponsors, fellow Finance member Johnny Isakson, R-Ga., Rep. Peter Welch, D-Vt., and Rep. Eric Paulsen, R-Minn., began before President Barack Obama announced his intention to nominate Finance chairman Baucus to be the country’s next ambassador to China.
“Please don’t be confused. We’ve been working on this a long time,” said Isakson. “The coincidence of Max Baucus becoming the ambassador to China and Ron Wyden ascending to the chairmanship of the committee is irrelevant,” said Isakson, who also noted that “it’s fortunate” for the legislation’s prospects that Wyden is poised to chair the Finance panel, which has jurisdiction over Medicare and other health care matters.
It’s unclear what happens next. Elements of the bill may be included in legislation to repeal and replace Medicare’s “sustainable growth rate,” the formula used to pay Medicare physicians. Maybe the legislation will be attached to another bill or pass on its own. Even if it goes nowhere, it may well be the pathway to Congress finding consensus on Medicare changes in the future.
“We think this kind of approach is looking to really change the tenor of the debate to how do we actually reduce the cost of health care and at the same time provide better quality and better value,” said David Certner, legislative counsel and legislative policy director for government affairs at AARP .
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.