WASHINGTON — The Trump administration is signaling it will pursue significant changes to Medicare that could put beneficiaries on the hook for higher costs.
In an informal proposal on Wednesday, federal health officials hinted at several new pilot programs it may implement in the months ahead. One idea would give doctors more latitude to enter into so-called private contracts to charge Medicare beneficiaries more for certain services, if the patients were willing to pay. Elsewhere in the document, officials indicated they might offer more incentives to encourage beneficiaries to join private Medicare plans, known as Medicare Advantage plans. Democrats and other experts said the language suggested interest in the controversial “premium support” model long favored by Republican policymakers.
For now, the proposals are only hints of what the Trump administration hopes to pursue in its Medicare and, potentially, its Medicaid policy making. There are no formal rules for the new ideas, nor is there any clear timeline for when they might be detailed. The suggestions came as part of a broader request, asking doctors, hospitals, and other parties to weigh in on ways that the administration could use an Obama-era policy center to make it easier for the industry to work with Medicare.
The policy center, known as the Centers for Medicare and Medicaid Innovation, or CMMI, has sweeping authority to steer about $1 billion annually toward almost any new program or initiative that agency officials believe will help reduce costs in Medicare and improve the quality of its services. The Obama administration deployed it for a wide array of pilot programs touching everything from hip surgery payments to cardiovascular care improvements.
Until now, the Health and Human Services Department under Secretary Tom Price has mostly made changes to Medicare by unwinding Obama-era initiatives. It has canceled pilot programs that would have penalized some doctors and hospitals and made others voluntary, among other changes.
Wednesday’s request includes, for the first time since Trump’s inauguration, clear signals about the conservative policies that the Republican officials want to achieve in the Medicare and Medicaid programs. Many of the changes reflect policies outlined by Speaker Paul Ryan and other Republicans in the “A Better Way” plan that, unlike efforts to repeal the Affordable Care Act, can be achieved without legislation. And Democrats caution that the proposals could have serious ramifications for patients.
“Beginning down this treacherous path is a clear sign that Secretary Price is betraying Donald Trump’s campaign promise not to touch Medicare or Medicaid and instead pursue his ideological goals at the expense of vulnerable Americans,” said Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee, which has jurisdiction over Medicare.
One of the policies most clearly outlined in the document is a longstanding favorite of Price’s: so-called private contracting. Price, who introduced legislation on the topic when he was a Georgia congressman, wants to let doctors who feel Medicare’s prices are too low contract directly with beneficiaries to charge them more. Now Price may be able to achieve something similar via regulation.
The practice is actually legal right now, but any doctor who engages in it is barred from accepting some Medicare payments for two years. And beneficiaries must pay the whole price for any service a doctor provides through private contracting — Medicare doesn’t pick up its part of the tab. About 96 percent of physicians who work with Medicare avoid private contracts.
But Price might be able to use the CMMI authority to waive the current rules, making it more attractive for doctors to try private contracting. It could also allow the doctors to start “balance billing” patients — essentially, putting them on the hook for any price they want to charge beyond what Medicare is willing to pay.