During a House Ways and Means Committee hearing prior to the congressional recess, Rep. Steven Horsford (D-NV) questioned Brookings Institution Fellow, Matthew Fielder, about cuts to healthcare in the Republican reconciliation bill.
00:00Thank you, Chair Schweikert, and to the ranking member. Look, like many of my
00:05colleagues, I support a bipartisan approach to many issues, including
00:10health care. I think the elephant in the room is we just had a partisan exercise
00:15where the result was taking health care away from 17 million Americans, not
00:21creating more access or affordability. And just recently, after the vote of the
00:27big ugly bill, the House Budget Committee Chairman told Bloomberg that
00:31Republicans are planning even deeper cuts to Medicaid and also considering
00:37further spending reductions in Medicare. So on top of the 500 billion in Medicare
00:44cuts, that would be one and a half trillion dollars in total health care
00:50cuts. So help me understand how we're supposed to just come to
00:57the table now and agree without understanding the impacts to our
01:03constituents. Time and again, Congressional Republicans have chosen to go after
01:09beneficiaries rather than to pursue the kinds of systemic reforms that are
01:14needed to increase transparency and accountability across the health care
01:18system. Mr. Fidler, can you outline how the big ugly bill would destabilize the
01:25Medicare system going forward? And where can beneficiaries expect future cuts to
01:31Medicare if they were made? So the the provisions of the bill itself in terms of
01:39its effects on Medicare are comparatively limited. The one important place where I
01:44think the bill will have significant effects on Medicare beneficiaries is it rolled
01:50back policy changes made during the Biden administration to make it easier for
01:53Medicare beneficiaries to get assistance paying their premiums and cost sharing. And those
01:59provisions will will no longer go into effect and so those enrollees will have more
02:05difficulty getting those benefits. In terms of other effects on Medicare, there is an effect on
02:11the sequester that would in principle require reductions in Medicare spending and we'll see what happens.
02:19Thank you. Now Medicare Advantage is now the health care choice for nearly 34 million seniors and
02:27people with disabilities accounting for about 55 percent of the entire Medicare
02:31population. In my district, that number is even higher at 56.2 percent of
02:36beneficiaries who've opted for a Medicare Advantage plan. A key driver of this growing
02:42enrollment is the broad availability of supplemental benefits. In fact, over 99 percent of Medicare Advantage plans
02:49offer at least one supplemental benefit and most enrollees report that these benefits are a major factor in
02:56choosing their coverage. Dr. Jane and Mr. Fidler, two-part question. Can you speak to how the
03:04supplemental benefits available through Medicare Advantage, benefits not currently offered by
03:10traditional Medicare help particularly low-income patients manage out-of-pocket cost? And Mr.
03:18Fidler, from a policy perspective, what steps can we take to enable traditional Medicare to offer similar
03:26supplemental benefits, particularly in the critical areas of hearing, dental, and vision, which we attempted to do when we had the majority?
03:34Supplemental benefits can be the difference between someone accessing health care or not. They can be the difference between someone having a meal at dinner or being hungry.
03:43Supplemental benefits can be the difference between someone actually having a pair of glasses to see clearly or not. So I think these are incredibly impactful and, you know, for lower income, older adults, you know, this is a very, these are very high value benefits. You know, the value of which often gets lost in the
04:04cost in discussions about the Medicare Advantage program and its opportunities to improve it. I will say that there does need to be more transparency around utilization rates because some of our competitors will make benefits available, but then put them far out of reach for the members. And so they have sales value at the point of care, but then many people at the point of sale, but at the point of actually needing a service, they aren't there. And so there's really an opportunity
04:33for, I think, for CMS to take a more forceful posture in terms of regulating supplemental benefits.
04:40So, I mean, I think there are significant gaps in the traditional Medicare benefit. You alluded to coverage of certain specific services. I would highlight the lack of a catastrophic limit on annual out-of-pocket spending. And I think a lot of the conversation we're having is that we're using Medicare Advantage program to fill some of those gaps, but in a rather inefficient way and only for
05:03half of beneficiaries. So ultimately, the traditional Medicare benefit is under Congress's control, and it could fix that gaps. I think that would have benefits for traditional Medicare beneficiaries, but also, frankly, for those who rely on any.
05:14We'll realize the same Uma&a for some of the services that we're having to pay.
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