Summary
Medicare
The highly anticipated and long overdue 2021 Medicare Trustees Report is expected to be released tomorrow, August 31. With Medicare reform a major component of Democrats’ $3.5 trillion budget reconciliation package – in terms of both generating savings through drug pricing reform and spending for vision, hearing, and dental benefits – the projected insolvency date of the Hospital Insurance (HI) Trust Fund and total spending growth of the Medicare program, among other findings, will shape the legislative debate.
Most notably, the 2021 report will account for the potential effect of the COVID-19 pandemic, a key factor that was not reflected in the 2020 report. Last year, the Medicare Trustees estimated that the HI trust Fund will no longer be able to pay scheduled benefits beginning in 2026. In a February 2021 report, the Congressional Budget Office (CBO) projected that the HI fund will become insolvent in 2026, expecting a faster economy recovery and lower spending on hospital services. It remains to be seen how the surge of COVID-19 cases due to the Delta variant will affect the Trustees’ projections.
The Medicare Payment Advisory Commission (MedPAC) spoke to the impending insolvency concerns in its June 2020 Report to Congress – published in the midst of the COVID-19 pandemic – and recommended Medicare would need to rapidly expand the use of value-based care to control program spending. As for the SMI Trust Fund (Parts B and D), the Trustees found it to be “adequately financed” for the next 10 years and beyond (i.e., “indefinitely”).
This morning, Sen. Bob Casey (D-PA), Chairman of the Special Committee on Aging, is convening a hearing in Pennsylvania to discuss expanding Medicare to include vision, hearing, and dental benefits. As a point of reference, the Congressional Budget Office (CBO) previously estimated that providing dental, vision, and hearing coverage under the Medicare program, as proposed by House Democrats’ H.R. 3 (116th Congress), would cost roughly $358 billion over a decade – $238 billion for dental care, $30 billion for vision care, and $89 billion for hearing services.
Later this week, MedPAC will convene to discuss Medicare’s financial outlook and the effects of the COVID-19 public health emergency on Medicare payment adequacy. Commissioners will also discuss:
- Potential reforms to Part D’s low-income subsidy (LIS), such as automatic enrollment of LIS enrollees in prescription drug plans and modifying the method for setting the benchmark to promote competition and reduce Medicare spending;
- A value-based payment program for all post-acute care (PAC) providers; and
- The impact of two statutory changes to home health payments implemented in 2020 (a 30-day unit of payment and elimination of therapy visits provided during an episode as a payment factor).
COVID-19 Vaccine
Today, the Advisory Committee on Immunization Practices (ACIP) will meet to vote on updating its recommendation for the Pfizer-BioNTech (COMIRNATY) COVID-19 Vaccine for individuals 16 years and older. It is the first COVID-19 vaccine to be approved by the Food and Drug Administration (FDA).
ACIP will also discuss a “framework for COVID-19 booster doses.” In a speech on August 18, President Biden had announced that individuals would be eligible for boosters eight months after receiving the second dose of the Pfizer or Moderna mRNA vaccines. “Pending approval from the Food and Drug Administration and the CDC’s Committee of outside experts, we’ll be ready to start these booster — this booster program during the week of September 20, in which time anyone fully vaccinated on or before January 20 will be eligible to get a booster shot,” Biden said.