A Backdoor for Medicare gutting?

I was reading the summary of the trustees' report and noticed this under the Medicare heading:

The Act requires that an affirmative determination in two consecutive reports be treated as a "funding warning" for Medicare that would, in turn, require a Presidential proposal to respond to the warning and expedited Congressional consideration of such proposal. The 2007 Report projects that the difference will surpass 45 percent in 2013 and therefore makes a determination of excess general revenue funding. Because the 2006 report also made such a determination, a "Medicare funding warning" is hereby triggered that requires the President to propose legislation that responds to this warning within 15 days of the submission of the Fiscal Year 2009 budget and for Congress to consider the proposal on an expedited basis. This requirement will help call additional attention to Medicare's impact on the Federal budget.

Was this a back door to gutting Medicare assuming a Republican congress?  What exactly does the trigger and the 'expedited basis' mean?  It sure doesn't sound good.  I dug into US code as best I could. I've looked through the

MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003

at http://frwebgate.access.gpo.gov/cgi-bin/ getdoc.cgi?dbname=108_cong_public_laws&a mp;docid=f:publ173.108

With the caveat that I have no legal training it looks like it bakes in Senate and House rule changes to facilitate pushing through a proposal for eliminating excess general revenue medicare funding by limiting debate. This is accomplished through overriding House and Senate rules for the purpose of acting on a Presidential proposal to respond to a "Medicare funding warning". The house and the senate can re-override the rule changes, but the existence of the rules in the bill will make it easier for future congresses to force through changes, be they increased taxes or decreased services. I feel this expediting process needs to be removed as soon as possible. 

The 2003 act asks the president to propose a plan to reduce Medicare's excess general revenue funding.  It looks like it can be a pretty sweeping proposal, it doesn't appear to be limited to Part D.

Judging from this:


    (b) Sense of Congress.--It is the sense of Congress that legislation
submitted pursuant to section 1105(h) of title 31, United States Code,
in a year should be designed to eliminate excess general revenue
medicare funding (as defined in section 801(c)) for the 7-fiscal-year
period that begins in such year.

and this:


 (c) Definitions.--For purposes of this section:
            (1) Excess general revenue medicare funding.--The term
        ``excess general revenue medicare funding'' means, with respect
        to a fiscal year, that--
                    (A) general revenue medicare funding (as defined in
                paragraph (2)), expressed as a percentage of total
                medicare outlays (as defined in paragraph (4)) for the
                fiscal year; exceeds
                    (B) 45 percent.
            (2) General revenue medicare funding.--The term ``general
        revenue medicare funding'' means for a year--
                    (A) the total medicare outlays (as defined in
                paragraph (4)) for the year; minus
                    (B) the dedicated medicare financing sources (as
                defined in paragraph (3)) for the year.
            (3) Dedicated medicare financing sources.--The term
        ``dedicated medicare financing sources'' means the following:
                    (A) Hospital insurance tax.--Amounts appropriated to
                the Hospital Insurance Trust Fund under the third
                sentence of section 1817(a) of the Social Security Act
                (42 U.S.C. 1395i(a)) and amounts transferred to such
                Trust Fund under section 7(c)(2) of the Railroad
                Retirement Act of 1974 (45 U.S.C. 231f(c)(2)).
                    (B) Taxation of certain oasdi benefits.--Amounts
                appropriated to the Hospital Insurance Trust Fund under
                section 121(e)(1)(B) of the Social Security Amendments
                of 1983 (Public Law 98-21), as inserted by section
                13215(c) of the Omnibus Budget Reconciliation Act of
                1993 (Public Law 103-66).
                    (C) State transfers.--The State share of amounts
                paid to the Federal Government by a State under section
                1843 of the Social Security Act (42 U.S.C. 1395v) or
                pursuant to section 1935(c) of such Act.

[[Page 117 STAT. 2359]]

                   (D) Premiums.--The following premiums:
                          (i) Part a.--Premiums paid by non-Federal
                      sources under sections 1818 and section 1818A (42
                      U.S.C. 1395i-2 and 1395i-2a) of such Act.
                          (ii) Part b.--Premiums paid by non-Federal
                      sources under section 1839 of such Act (42 U.S.C.
                      1395r), including any adjustments in premiums
                      under such section.
                          (iii) Part d.--Monthly beneficiary premiums
                      paid under part D of title XVIII of such Act, as
                      added by section 101, and MA monthly prescription
                      drug beneficiary premiums paid under part C of
                      such title insofar as they are attributable to
                      basic prescription drug coverage.
        Premiums under clauses (ii) and (iii) shall be determined
        without regard to any reduction in such premiums attributable to
        a beneficiary rebate under section 1854(b)(1)(C) of such title,
        as amended by section 222(b)(1), and premiums under clause (iii)
        are deemed to include any amounts paid under section 1860D-13(b)
        of such title, as added by section 101.
                    (E) Gifts.--Amounts received by the medicare trust
                funds under section 201(i) of the Social Security Act
                (42 U.S.C. 401(i)).
            (4) Total medicare outlays.--The term ``total medicare
        outlays'' means total outlays from the medicare trust funds and
        shall--
                    (A) include payments made to plans under part C of
                title XVIII of the Social Security Act that are
                attributable to any rebates under section 1854(b)(1)(C)
                of such Act (42 U.S.C. 1395w-24(b)(1)(C)), as amended by
                section 222(b)(1);
                    (B) include administrative expenditures made in
                carrying out title XVIII of such Act and Federal outlays
                under section 1935(b) of such Act, as added by section
                103(a)(2); and
                    (C) offset outlays by the amount of fraud and abuse
                collections insofar as they are applied or deposited
                into a medicare trust fund.
            (5) Medicare trust fund.--The term ``medicare trust fund''
        means--
                    (A) the Federal Hospital Insurance Trust Fund
                established under section 1817 of the Social Security
                Act (42 U.S.C. 1395i); and
                    (B) the Federal Supplementary Medical Insurance
                Trust Fund established under section 1841 of such Act
                (42 U.S.C. 1395t), including the Medicare Prescription
                Drug Account under such Trust Fund.

The President is required to submit a plan to stop the excess general fund revenue of all of Medicare.  

This is also neat, maybe its standard, but still its interesting.  In specifying that the legislation that the President proposes needs to be expedited it mentions that any bill with the same required name, "A bill to respond to a medicare funding warning.", qualifies on this section.  I don't know if that means it's granted all the expedite provisions or not.  That's for the house parliamentarian I guess.


            (2) Medicare funding legislation.--For purposes of this
        section, the term ``medicare funding legislation'' means--
                    (A) legislation introduced pursuant to subsection

               (a)(1), but only if the legislative proposal upon which
                the legislation is based was submitted within the 15-day
                period referred to in such subsection; or
                    (B) any bill the title of which is as follows: ``A

               bill to respond to a medicare funding warning.''.

This part deals with the fact that the expediting process is based on rules of the house and senate:


(g) Rulemaking Power.--The provisions of this section are enacted by the Congress--

[[Page 117 STAT. 2363]]

           (1) as an exercise of the rulemaking power of the House ofRepresentatives and, as such, shall be considered as part of the

       rules of that House and shall supersede other rules only to the
        extent that they are inconsistent therewith; and
            (2) with full recognition of the constitutional right of
        that House to change the rules (so far as they relate to the

       procedures of that House) at any time, in the same manner, and
        to the same extent as in the case of any other rule of that
        House.


and

   (f) Rules of the Senate.--This section is enacted by the Senate--
            (1) as an exercise of the rulemaking power of the Senate and
        as such it is deemed a part of the rules of the Senate, but

       applicable only with respect to the procedure to be followed in
        the Senate in the case of a bill described in this paragraph,
        and it supersedes other rules only to the extent that it is

       inconsistent with such rules; and
            (2) with full recognition of the constitutional right of the
        Senate to change the rules (so far as relating to the procedure
        of the Senate) at any time, in the same manner, and to the same

       extent as in the case of any other rule of the Senate.

So it looks like the Senate and House can override the rules, but if ever one of them isn't inclined to it looks like debate is severly limited.  The part dealing with the limits on debate is a little beyond me.  There is the standard waiving of points of order, and a five minute rule in the house and 2 hours debate in the Senate.  I think a US code reader would be required to get a full read on what all this entails.

Anyway, looks like an end run around debate on gutting Medicare to me.  I hope I'm wrong.  If not this needs to be acted on and these provisions removed.

Tags: Medicare, Medicare Part D (all tags)

Comments

2 Comments

Re: A Backdoor for Medicare gutting?

Pipe:

Consider this.  The Social Security Trust Fund is a multi billion dollar cash drawer.  Our Nations insurance industries collectively hold more assests than any other idustries combined.  What if they could gain primary and control access to this fund and have to do nothing more than assume the role of denying claims submitted by providers.  In effect, they would gain access to the assets, provide no services, and if they are really clever, make the appeals process so cumbersome for providers as to run many, if not most, small providers out of the business.

Check in to the changes made, via the "M'Care Rx Drug and Reform Act of 2003", in the claims review process and appeals processes.  The insurance companies bid for and become the gate keepers for payments.  They are paid, and bonused, for denials.  Denial percentages are consideration points for contract renewals.  

What a neat way to breach entitlements and make sure the economic values are diverted to those who already hold the lions share of our national assets.

Good Luck!

by pointwithaview 2007-04-29 07:34AM | 0 recs
Re: A Backdoor for Medicare gutting?

There really is nothing good about Part D.  The worst part is everything I consider a deficiency is an intentional choice.  They aren't bugs, they are features.

by pipe 2007-05-02 10:40AM | 0 recs

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