Healthcare Reform in the U.S. Must Be Driven by Policy and Data, Not Politics and Idealogy

Background U.S. healthcare spending will reach 20% of GDP by 2026. Despite this spending, almost 14% of our under-65 population still lacks health insurance and out-of-pocket healthcare spending is high. To date, much of the healthcare reform debate has focused on who pays—the government, employers or individuals. Objective To review current healthcare reform issues and evidence. Method We address the questions of how much we pay, how we pay and what we receive for the money as a potential foundation for constructive dialogue. Results U.S. healthcare spending continues to exceed that of other countries, without offering universal coverage. Notwithstanding coverage expansions implemented under the Affordable Care Act, uninsurance rates have been rising. Rapid growth of high deductible plans has also significantly increased rates of underinsurance. There is very little evidence that specific policies or interventions employed to date will significantly reduce cost, especially under a fee for service system, where volume makes up for cuts. Global risk payments hold the greatest promise for real cost containment because they can drive true delivery system reform. Conclusion Meaningful, long-term healthcare reform cannot be successful until comprehensive, evidence-based policies that address healthcare costs are fully embraced and implemented

Federal Employees’ Retirement System: Budget and Trust Fund Issues

[Excerpt] Pensions for civilian federal employees are provided through two programs, the Civil Service Retirement System (CSRS) and the Federal Employees Retirement System (FERS). CSRS was authorized by the Civil Service Retirement Act of 1920 (P.L. 66-215) and FERS was established by the Federal Employees’ Retirement System Act of 1986 (P.L. 99-335). Under both CSRS and FERS, employees and their employing agencies make contributions to the Civil Service Retirement and Disability Fund (CSRDF), from which pension benefits are paid to retirees and their surviving dependents. Retirement and disability benefits under FERS are fully funded by employee and employer contributions and interest earned by the bonds in which the contributions are invested. The cost of the retirement and disability benefits earned by employees covered by CSRS, on the other hand, are not fully funded by agency and employee contributions and interest income. The federal government therefore makes supplemental payments each year into the civil service trust fund on behalf of employees covered by CSRS. Even with these additional payments into the trust fund, however, CSRS pensions are not fully pre-funded. Prior to 1984, federal employees did not pay Social Security payroll taxes and did not earn Social Security benefits. The Social Security Amendments of 1983 (P.L. 98-21) mandated Social Security coverage for civilian federal employees hired on or after January 1, 1984. This change was made in part because the Social Security system needed additional cash contributions to remain solvent. Enrolling federal workers in both CSRS and Social Security, however, would have resulted in duplication of some benefits and would have required employee contributions equal to more than 13% of workers’ salaries. Consequently, Congress directed the development of the FERS, with Social Security as the cornerstone. The FERS is composed of three elements: (1) Social Security, (2) the FERS basic retirement annuity and the FERS supplement, and (3) the Thrift Savings Plan (TSP). Most permanent federal employees initially hired on or after January 1, 1984, are enrolled in the FERS, as are employees who voluntarily switched from CSRS to FERS during “open seasons” held in 1987 and 1998

Federal Employees’ Retirement System: Budget and Trust Fund Issues

[Excerpt] Pensions for civilian federal employees are provided through two programs, the Civil Service Retirement System (CSRS) and the Federal Employees’ Retirement System (FERS). CSRS was authorized by the Civil Service Retirement Act of 1920 (P.L. 66-215) and FERS was established by the Federal Employees’ Retirement System Act of 1986 (P.L. 99-335). Under both CSRS and FERS, employees and their employing agencies make contributions to the Civil Service Retirement and Disability Fund (CSRDF), from which pension benefits are paid to retirees and their surviving dependents. Retirement and disability benefits under FERS are fully funded by employee and employer contributions and interest earned by the bonds in which the contributions are invested. The cost of the retirement and disability benefits earned by employees covered by CSRS, on the other hand, are not fully funded by agency and employee contributions and interest income. The federal government therefore makes supplemental payments each year into the civil service trust fund on behalf of employees covered by CSRS. Even with these additional payments into the trust fund, however, CSRS pensions are not fully pre-funded. Prior to 1984, federal employees did not pay Social Security payroll taxes and did not earn Social Security benefits. The Social Security Amendments of 1983 (P.L. 98-21) mandated Social Security coverage for civilian federal employees hired on or after January 1, 1984. This change was made in part because the Social Security system needed additional cash contributions to remain solvent. Enrolling federal workers in both CSRS and Social Security, however, would have resulted in duplication of some benefits and would have required employee contributions equal to more than 13% of workers’ salaries. Consequently, Congress directed the development of the FERS, with Social Security as the cornerstone. The FERS is composed of three elements: (1) Social Security, (2) the FERS basic retirement annuity and the FERS supplement, and (3) the Thrift Savings Plan (TSP). Most permanent federal employees initially hired on or after January 1, 1984, are enrolled in the FERS, as are employees who voluntarily switched from CSRS to FERS during “open seasons” held in 1987 and 1998

Starting on the Path to a High Performance Health System: Analysis of Health System Reform Provisions of Reform Bills in the House of Representatives and Senate

Compares the reform bills' reform provisions, with a focus on closing the coverage gap by creating an insurance exchange of public and private plans, strengthening Medicare, and expanding Medicaid. Examines implications for the budget and coverage rates

Improving Health Care Access for Older Alaskans: What Are the Options?

This report focuses on the problem older Alaskans who rely on Medicare face getting access to primary care, and discusses some of the options policymakers are considering to resolve the problem. But older Americans across the country also report difficulty getting the primary care they need. The discussion here sheds light on the problem and potential solutions nationwide. Most Americans 65 and older use Medicare as their primary health insurance. Medicare is federal health insurance for people 65 and older, people under 65 with certain disabilities, and people of any age with end-stage renal disease—but this report looks only at access issues for Medicare beneficiaries 65 and older. Doctors don’t have to participate in the Medicare program. But those who do participate have to accept, as full payment, what Medicare pays for specific services. Many primary-care doctors say Medicare doesn’t pay them enough to cover their costs—so growing numbers are declining to see new Medicare patients. Among primary-care doctors nationwide, 61% accept new Medicare patients.1 National surveys sponsored by the Medicare Payment Advisory Commission have found that 17% of Medicare patients in the U.S. had “a big problem” finding family doctors in 2007—up from 13% in 2005.2 In Alaska, a 2008 survey by the Institute of Social and Economic Research (ISER) found that just over half of Alaska’s primary-care doctors were willing to treat new Medicare patients.3 The situation was worse in Anchorage, where 40% of all older Alaskans live. Only 17% of primary-care doctors in Anchorage were willing to treat new Medicare patients as of 2008 (Figure 1).4The Harold E. Pomeroy Public Policy Research EndowmentIntroduction / How Medicare Works / Closed Doors / Older Anchorage Residents and Primary Care / Options for Changing Access to Primary Care: What is Alaska Considering? / Conclusions / Appendi

Bending the Curve: Options for Achieving Savings and Improving Value in Health Spending

Analyzes the potential of fifteen federal health policy options to lower spending over the next ten years and yield higher value on investments in health care

Finding Resources for Health Reform and Bending the Health Care Cost Curve

Examines policy options for slowing healthcare spending growth, improving outcomes, and financing comprehensive reform, including changes to Medicare Advantage and hospital pay-for-performance. Compares their estimated budget impact over ten years

How Health Reform Legislation Will Affect Medicare Beneficiaries

Analyzes how provisions in the House and Senate healthcare reform bills and President Barack Obama's proposal would improve Medicare benefits, strengthen the fiscal solvency of the Medicare Hospital Insurance Trust Fund, and reduce spending growth

Competitive Bidding in Medicare Advantage

Outlines a proposed plan to cut healthcare spending through a competitive bidding system for Medicare Advantage plans that pays insurers the average of their submitted bids. Considers multiple estimates, arguments for and against, and implications

Health Care Costs: A Primer 2012: Key Information on Health Care Costs and Their Impact

Examines changes in U.S. healthcare spending, compared with other countries and per capita; what it pays for; who pays; and how healthcare costs affect families and employers. Examines why healthcare costs outpace economic growth and how to slow growth