The Medicare trust fund will be insolvent by 2029, the
program's trustees reported today.
The prediction is a year later than
the 2028 date the Obama administration
outlined in last
year's report. The Congressional Budget Office in January 2016 estimated the
program would be solvent only until 2026.
Based on the new findings, the
feared Independent Payment Advisory Board, which was created by the Affordable
Care Act to reign in Medicare costs if they grew faster than a set rate, will
not be activated.
That's likely good news as the board, called the death
panel by ACA opponents, has not yet been created. There hasn't been the need,
and some say, the willingness to expend the political capital. With mid-term
elections coming and possible fall out likely if Republicans repeal the ACA,
this is one less possible political headache to worry about. Also of note, 2029
is 12 years longer than projected estimates before the Affordable Care Act
become law.
However, trustees are worried doctors will exit the program
anyway. The report contained new concerns about access to physicians in the
coming years due to Medicare Access and CHIP Reauthorization Act
(MACRA).
MACRA replaced the physician payment updates under the
sustainable growth rate, which clinicians were paid under for
years.
Under MACRA the annual physician payment update for 2017 through
2019 will be 0.5%. For 2020 through 2025, there will be no payment update, which
alarmed the trustees.
"These amounts do not vary based on underlying
economic conditions, nor are they expected to keep pace with the average rate of
physician cost increases," the report said. "Absent a change in the delivery
system or level of update by subsequent legislation, access to
Medicare-participating physicians may become a significant issue in the long
term under current law."
The new insolvency date does incorporate
modest savings from the agency's move to value-based care, including accountable
care organizations. However, exact figures were not broken out.
"The
innovations being tested under the ACA, such as bundled payments or accountable
care organizations, could reduce incentives to adopt new cost-increasing
technologies and could contribute to greater efforts to avoid services of
limited or no value within the service bundle," the report says.
Medicare
Part D expenditures per enrollee are estimated to increase by an average of 6.4%
annually over the next five years, which is higher than the projected average
annual rate of growth for the U.S. economy is 5.2 % during this
period.
The report found that these costs are trending higher than
previously predicted, particularly for specialty drugs.
In 2016,
Medicare covered 56.8 million people and expenditures were $678.7 billion up
from $647.6 billion and 55.3 million beneficiaries in 2015.