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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

What does cutting Medicare actually mean?

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Today’s edition: Data brokers are selling information on Americans’ mental health data. The challenges to obtaining complete information on hospital prices. But first … 

'All Medicare cuts are not created equal'

Lately, Democrats and Republicans have been accusing each other of “cutting Medicare.”

But what does that even mean?

When Americans hear those words, they may think they’ll automatically lose benefits or pay more out-of-pocket. But cuts to the major federal health insurance program come in different forms — such as changing providers’ pay or increasing the eligibility age — and have different effects on the program, providers and those with Medicare coverage. 

“All Medicare cuts are not created equal,” said Larry Levitt, executive vice president of the Kaiser Family Foundation. “One dollar in reduced Medicare spending can mean very different things depending on how it’s done.” 

That reality is getting lost in the political tradition of “Mediscare,” where lawmakers warn that the other party’s proposals are a threat to care for seniors and those with disabilities.

The Health 202 turned to more than half a dozen experts, and here’s what we learned about Medicare cuts: 

The details

Mediscare isn’t new — and both political parties have participated. 

More than a decade ago, Republicans balked at Obamacare provisions that decreased the growth of payments to Medicare providers, as well as reduced payments to private Medicare plans. And Democrats pounced on former president Donald Trump’s budget, claiming it cut Medicare by more than $800 billion, a figure Washington Post Fact Checker Glenn Kessler called “misleading.” (For more on the political back-and-forth, check out Glenn’s piece from 2019.)

“That’s what the game is supposed to be about — to confuse you,” said Thomas Miller, a senior fellow at the American Enterprise Institute, a conservative-leaning think tank. “You’re not supposed to know exactly what’s going on.”

A “Medicare cut” might simply mean slowing the rate of growth of spending in the program compared to what it would have been. Spending may still be going up, but perhaps not as fast. 

This could come in the form of changes to provider payment, and depending on what that looks like, it can be hard to measure its direct impact on Medicare enrollees. (That’s one reason changes to provider reimbursement are more politically palatable, Miller quipped.)

  • Take the Affordable Care Act: Marc Goldwein, a senior vice president of the Committee for a Responsible Federal Budget, said the effect of the health law’s cuts were pretty “non-noticeable” for those on the program, and that Medicare Advantage plans’ benefits have continued to become more generous over the years.
  • But that doesn’t mean there’s zero impact: “We got to be honest about this: If you cut provider payments, if you cut payments to Medicare Advantage plans, there’s going to be some doctor somewhere that says, you know what, ‘I’d rather go do something else with my life because the money’s not enough.’ Or there’s going to be some hospital that says, ‘we are not going to offer this service,’” Goldwein said.
Other policies

There are other ways of changing Medicare, some of which have a more direct impact on those enrolled in the program. This includes raising the eligibility age, increasing cost-sharing for certain services or raising premiums. 

For instance: The Republican Study Committee, a group of conservative House Republicans, put forward its budget blueprint last year, which included increasing the Medicare eligibility age to 67 and then indexing it to life expectancy. 

That’s one of the proposals the White House bashed last week in a fact sheet released ahead of President Biden’s trip to Florida to portray Republicans as a threat to the program. Other proposals the president has name-checked have a different twist, such as one from Sen. Rick Scott (R-Fla.) who released a plan last year to sunset all federal legislation after five years unless explicitly renewed by Congress, which would include laws relating to entitlement programs. (Scott has pushed back against the argument that he intends to cut Medicare and Social Security.)

Looming insolvency

The political fights notwithstanding, there is a serious financial problem looming for the part of Medicare that pays hospital bills. The program’s hospital trust fund will be unable to pay full benefits starting in 2028. Some experts and lawmakers are sounding alarms — and urging Congress to take a hard look at the program sooner rather than later. 

Sens. Joe Manchin III (D-W.Va.) and Mitt Romney (R-Utah) have proposed a commission to issue recommendations on Medicare and Social Security. But punting the question of how to change Medicare’s fiscal trajectory to a “rescue committee” has also become political. A White House spokesman recently represented the idea as a “death panel” for the programs. 

On the Hill

Covid investigations: Two more Democrats have been named to the House select subcommittee on the coronavirus pandemic. 

Minority Leader Hakeem Jeffries (D-N.Y.) announced Saturday that he’d appointed Reps. Ami Bera (Calif.), a doctor, and Jill Tokuda (Hawaii) to serve on the chamber’s special investigative panel, which Republicans have charged with probing the origins of the pandemic, the federal government’s response and more. Jeffries has already tapped five Democrats to serve on the subcommittee, including Rep. Raul Ruiz (Calif.) as its top Democrat.

Mental health

Now for sale: Data on your mental health

The pandemic-era rise of telehealth and therapy apps has created a lucrative new product for data brokers: Americans’ mental health information, The Post’s Drew Harwell reports. 

A study out today from Duke University’s Sanford School of Public Policy outlines how expansive the market has become for the companies, which collect and resell Americans’ personal information for government or commercial use, such as targeted ads.

Researchers identified at least 11 companies that were willing to sell bundles of data that included information on what antidepressants people were taking, whether they struggled with insomnia or attention issues, and details on other illnesses such as Alzheimer’s disease. 

Some of the data was offered in an aggregate form that would have allowed a buyer to know, for instance, a rough estimate of how many people in an individual Zip code might be depressed. But other brokers offered personally identifiable data featuring names, addresses and incomes. 

The practice is legal in the United States, even without the person’s knowledge or consent. That’s because the Health Insurance Portability and Accountability Act (HIPAA) — which restricts hospitals, doctors’ offices and other “covered health entities” from sharing patient data — doesn’t protect the same information when it’s sent anywhere else. 

  • As a result, app makers and other companies are permitted to share or sell the data however they’d like, and many people are unaware that brokers had collected their information in the first place. 

In other news …

Suicides in the United States rose in 2021 after a two-year decline, according to a report released Friday by the Centers for Disease Control and Prevention that found that rates among American Indian and Alaska Natives, Black and Hispanic people climbed in the wake of the pandemic. In 2021, more than 48,100 people died by suicide compared to about 46,000 in 2020.

Industry Rx

The challenges with price transparency

Since January 2021, hospitals have been required to post the rates they negotiate with insurers and standard charge information for an array of services. But some of the data hospitals are sharing is “ambiguous, missing, or difficult to find,” according to an analysis from the Kaiser Family Foundation. 

That’s partly because of the way the rule is crafted, researchers wrote, saying the regulation lacked specificity and uniformity about what should be included with each charge and how the information should be presented.

The analysis included some policy recommendations, such as requiring the inclusion of whether the charge is a facility or professional charge, if it originated from an inpatient or outpatient setting, the type of health plan the rate is negotiated with, and more.

In other health news

  • The Centers for Medicare and Medicaid Services said arbitrators of surprise medical billing disputes should stop issuing new payment determinations while federal departments evaluate guidance after a court ruling last week.
  • Sheila Garrity will serve as director of the federal health department’s Office of Research Integrity, the agency announced Friday. Garrity, an associate vice president for research integrity and research integrity officer at George Washington University, will start the week of March 26. 
  • Dozens of Republican and Democratic attorneys general filed competing arguments on Friday in a heated Texas lawsuit that seeks to reverse the Food and Drug Administration’s approval of abortion pills, threatening access nationwide, our colleague Anumita Kaur writes. 
  • Republican lawmakers from several states with abortion bans have introduced bills that would allow state officials to either bypass local prosecutors or kick them out of office if their abortion-related enforcement is deemed too lenient, Politico’s Alice Miranda Ollstein and Megan Messerly report.


📅 The Senate is in this week, and the House is out for the next two weeks. Here’s what we’re watching over the next few days: 

Wednesday: Top federal officials will testify before the Senate Foreign Relations Committee on countering fentanyl trafficking. Washington Post Live is hosting a conversation about ending the stigma on issues affecting women’s health, including fertility, menstruation and menopause.  

Thursday: The Senate HELP Committee will discuss health-care workforce shortages, a top bipartisan issue for the committee; the Senate Commerce, Science and Transportation Committee will hold a hearing on bringing transparency and accountability to pharmacy benefit managers.

Health reads

Hugh Auchincloss was Anthony Fauci’s longtime deputy. Now he’s taking his job as House Republicans probe the pandemic (By Jim Puzzanghera l Boston Globe)

‘Tranq,’ a Veterinary Drug, Is Worsening the Fentanyl Crisis (By Jon Kamp and Julie Wernau | The Wall Street Journal)

Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds (By Claire Cain Miller, Sarah Kliff and Larry Buchanan | The New York Times)

Sugar rush

Thanks for reading! See y'all tomorrow.