Congress Overrides Bush Veto of Medicare Bill (HR 6331)

Wednesday, July 16, 2008

JC Jones MA RN

Both the Senate and House of Representatives passed HR 6331 which President Bush vetoed on July 15, 2008 but the House voted to override him. Interestingly, neither presidential candidate for the Democratic or Republican party this issue. HR 6331 now becomes law. What's at stake? Cuts to Medicare payments (10.6%) to providers as a way to fund private Medicare Advantage (MA) Plans. Doctors threatened to stop seeing Medicare patients if the cuts were made law.

HR 6331 is a victory for those with mental illness, and may represent the beginning of a shift in policy changes. Parity for mental illness with physical illness shifts cost sharing from 50% to 20%. Part D will now offer broad coverage of antidepressants, antipsychotics, and anticonvulsants and the ban on coverage of benzodiazepines, used for treatment of mania and anxiety disorders. There are also changes to the Low Income Subsidy (LIS) eligibility requirements which lowers premiums, drug cost sharing and eliminates the nasty donut hole coverage gap for beneficiaries.

What's all the fuss about? Most (80%) of the 44 million elderly and disabled opt for Medicare's traditional fee-for-service payment plan. The other twenty percent (about 10 million people) are enrolled in a Medicare Advantage Plan which include HMOs, PPOs, MSAs and even private fee-for-service PFFS plans. The Medicare Advantage Plans offer Medicare Part A, B and sometimes D through coordinated network services. MA payments are higher than traditional Medicare payments, which raises questions about equity of distribution of benefits for the Medicare population. Apparently the government has subsidized these plans with billions of dollars to finance low premiums and extra benefits for the privileged few who enroll - who are generally in good health. Now $14 billion will be cut from these programs over the next five years and the majority of Medicare beneficiaries will continue to receive care.




Thank you eliz.avery for use of hilarious image My Doctor Often Walks Me to the Door and Waves Goodbye
...in my dreams.

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