Advocacy report-describe your state’s (Florida) current Medicaid program including its eligibility criteria, demographics, Medicaid spending and savings since the ACA’s implementation, comprehensive details of current or pending waivers. See instructions - Environmental science
Scenario
You are the director of community affairs for the health lobby organization, Pathways to a Healthy America. In 2010, President Barack Obama signed the Affordable Care Act into law. As a result, millions of Americans who were previously uninsured gained access to the healthcare system. One of the initial provisions of the Act required individual states to expand the eligibility criteria for Medicaid. The program’s costs would be absorbed by the federal government at a rate of 100\% for the first three years of program participation which would decrease to 90\% after 2020, still, considerably higher than previous funding by the federal government. However, in 2012, the Supreme Court ruled the mandate unconstitutional allowing individual states to voluntarily “opt” out of the Medicaid expansion program. As a result of the various states’ decision to “opt” out of the ACA’s Medicaid expansion, millions of adults fell into the critical coverage gap. Your organization represents a state which has decided to forego participation in the ACA expansion program. The decision was met with both praise and criticism.
It has now been a few years since the decision and your organization has gathered information on the impact of the decision in order to advocate for Medicaid reform during the next state legislative session.
You are required to write an advocacy report to state lawmakers in which you advocate for either participating in the original expansion program or participating with conditions (waivers) to address the critical gap in coverage for vulnerable adults in your state. Waivers such as Section 1115 enable for alternative implementation of Medicaid expansion and allow states to impose restrictions which may result in a denial of Medicaid eligibility for individuals who do not meet those restrictions, i.e., work requirements.
Instructions
Research the Medicaid expansion program offered through the Affordable Care Act (ACA) as well as Medicaid reform initiatives using waivers to increase access to Medicaid. Determine, based on your state’s profile, which process (the ACA’s expansion program or the use of waivers) is most beneficial to your state. Include a comprehensive, well-supported recommendation for participation in Medicaid reform using either the ACA’s program or a modified reform process using waivers.
Your advocacy report should describe your state’s current Medicaid program including its eligibility criteria, demographics, Medicaid spending and savings since the ACA’s implementation, and comprehensive details of current or pending waivers. You should also include a discussion (benchmark) on another state’s success with Medicaid reform using your recommended strategy (the ACA’s expansion program or the use of the specific types of waivers for which you propose).
RUBRIC:
Report includes a comprehensive, coherent, well thought out recommendation, for either the ACA’s expansion of Medicaid or a modified expansion process with a justification based on comprehensive research with fully developed, well-supported reasoning.
Report includes a comprehensive description of the state’s Medicaid program including eligibility criteria, demographics, spending, savings and the state’s current or pending waivers.
Report includes a comprehensive assessment of another state’s successful reform efforts and a comprehensive, well-supported discussion on the criteria used in evaluating the implementation of successful Medicaid reform in that state
Report includes a comprehensive discussion with significant and current details on the Medicaid expansion program offered through the Affordable Care Act (ACA). Discussion includes assertions supported by credible research.
Report includes a comprehensive description of waivers (i.e., Section 1115). Discussion includes assertions supported by credible research.
Includes 3 or more credible, scholarly, current (within the past 5 years), and relevant sources. Adequate integration of information included within the report. Appropriate synthesis and analysis included in the report.
Net Federal Spending for
Medicare Parts A and B for
A ected Beneficiaries
Total Payments by
A ected Beneficiaries
Combined Net Federal Spending for
and Total Payments by
A ected Beneficiaries
Premiums Paid by
A ected Beneficiaries
-15\% Second-Lowest-Bid Option
Average-Bid Option
-8\%
-8\%
-5\%
-7\%
-7\%
18\%
35\%
Estimated Difference From Outcomes Under
Current Law, Without Grandfathering, in 2024
CONGRESS OF THE UNITED STATES
CONGRESSIONAL BUDGET OFFICE
CBO
A Premium
Support System
for Medicare:
Updated Analysis
of Illustrative
Options
OCTOBER 2017
Notes
All years referred to in this report are calendar years. The estimates were generated using
the Congressional Budget Office’s March 2016 baseline projections of Medicare spending.
The amounts in the text and tables are in nominal (current year) dollars. Numbers in the
text, tables, and figures may not equal totals because of rounding.
Supplemental information accompanies this report on CBO’s website
(www.cbo.gov/publication/53077).
www.cbo.gov/publication/53077
Figures
1. Estimated Difference From Current Law in Net Federal Spending for and
Total Payments by Affected Medicare Beneficiaries Under Illustrative Premium
Support Options, Without Grandfathering, 2024 7
2. Ratio of Actual and Projected Medicare Advantage Bids to Medicare FFS
Spending per Capita Under Current Law, in Two CBO Studies 13
Table
1. Estimated Change in Net Federal Spending for Medicare Under Illustrative
Premium Support Options, Relative to Spending Under Current Law, 2022 to 2026 6
Contents
Summary 1
What Are CBO’s New Estimates? 1
How Much Did CBO’s Estimates Change and Why? 1
What Is the Current Role of Private Plans in Medicare? 2
What Policy Options Did CBO Analyze? 2
The Federal Contribution 3
Grandfathering 3
Other Features 3
Key Design Decisions for Future Proposals 5
What Were CBO’s Analytical Methods? 5
What Are CBO’s New Estimates? 5
Budgetary Effects Without Grandfathering 6
Budgetary Effects With Grandfathering 8
Other Effects 8
How Much Did CBO’s Estimates of Effects Without Grandfathering Change and Why? 10
Changes in the Estimates 10
Reasons for the Changes in the Estimates 11
BOX 1. THE ROLE OF THE MEDICARE FEE-FOR-SERVICE PROGRAM AND ITS PROVIDER PAYMENT RATES 14
How Much Did CBO’s Estimates of Effects With Grandfathering Change and Why? 15
About This Document 17
A Premium Support System for Medicare:
Updated Analysis of Illustrative Options
Summary
Over the past two decades, policymakers and analysts
have advanced a variety of proposals for converting
Medicare to a premium support system as a way to
reduce federal spending. Under such a system, beneficia-
ries would choose health insurance from a list of compet-
ing plans, and the federal government would share the
cost of their premiums. The proposals have differed in
many respects, notably in the way that the federal con-
tribution would be set and how that contribution might
change over time.
The Congressional Budget Office has in the past ana-
lyzed the budgetary effects of some illustrative options
for a premium support system.1 This report updates
the agency’s work on the topic, presents new estimates
of the budgetary effects of those options, and examines
the reasons for the changes in the estimates, including
changes in law that have affected the Medicare program.
CBO constructed its estimates for this report under
the assumption that the system would be implemented
in 2022. Depending on their details, future cost esti-
mates for legislative proposals that resemble the options
analyzed in this report could differ substantially from the
estimates presented here.
In the options CBO analyzed, the federal government’s
contribution would be determined from insurers’ bids,
and Medicare’s traditional fee-for-service (FFS) program
would be included as a competing plan. CBO examined
two approaches for determining the federal contribu-
tion: One would set the contribution on the basis of
the second-lowest bid in each region; the other would
use the region’s average bid. CBO also examined the
effects of grandfathering, which would keep beneficiaries
in the current Medicare program if they were eligible
for Medicare before the premium support system took
1. See Congressional Budget Office, Options for Reducing the Deficit:
2014 to 2023 (November 2013), pp. 204–210, www.cbo.gov/
content/options-reducing-deficit-2014-2023, and A Premium
Support System for Medicare: Analysis of Illustrative Options
(September 2013), www.cbo.gov/publication/44581.
effect instead of requiring all beneficiaries to enter the
premium support system once it began.
What Are CBO’s New Estimates?
CBO’s new estimates indicate the following:
■ Without grandfathering, the second-lowest-bid
option would reduce net federal spending for
Medicare by $419 billion between 2022 and 2026;
the average-bid option would reduce such spending
by $184 billion.
■ With grandfathering, the second-lowest-bid option
would reduce net federal spending for Medicare by
$50 billion between 2022 and 2026; the average-bid
option would reduce such spending by $21 billion.
Those savings would arise because private insurers’ bids
would generally be lower than FFS costs per capita and
would substantially influence the federal contribution.
Savings would be much smaller if the options included
a grandfathering provision because only a small portion
of the Medicare population would be covered by the
new system initially, and that portion would increase
gradually.
On average, CBO estimates, beneficiaries’ total payments
for Medicare premiums and cost sharing (enrollees’
out-of-pocket spending on copayments, coinsurance,
and deductibles for Medicare-covered benefits) would
be higher under the second-lowest-bid option, but lower
under the average-bid option, than under current law.
Under either option, the total payments made by partic-
ular beneficiaries could differ markedly from the national
average. For example, in many regions, total payments by
beneficiaries who chose to enroll in Medicare’s FFS pro-
gram would be substantially higher than under current
law because of the increases in beneficiaries’ premiums.
How Much Did CBO’s Estimates Change and Why?
CBO’s current estimates of the federal savings from the
premium support options without grandfathering are
much higher than its earlier estimates. In a November
https://www.cbo.gov/content/options-reducing-deficit-2014-2023
https://www.cbo.gov/content/options-reducing-deficit-2014-2023
https://www.cbo.gov/publication/44581
2 A Premium SuPPort SyStem for medicAre: uPdAted AnAlySiS of illuStrAtive oPtionS october 2017
2013 report, CBO estimated that if a premium sup-
port system was implemented without grandfathering,
the second-lowest-bid option would reduce net federal
spending for Medicare by $275 billion between 2018
and 2023 and the average-bid option would reduce net
federal spending over that period by $69 billion.2
CBO’s savings estimates increased primarily because the
agency’s current projections of the bids that Medicare
Advantage plans would submit under current law are
lower relative to FFS spending per capita than the pro-
jections used in its earlier analysis. Medicare Advantage
plans submit bids to Medicare for the amount that it
would cost to provide enrollees with Medicare bene-
fits covered under the Hospital Insurance (Part A) and
Medical Insurance (Part B) programs. Medicare pays
plans based on those bids, and then Medicare Advantage
plans assume responsibility for paying providers for
beneficiaries’ care. (In contrast, Medicare’s FFS program
pays providers directly for services covered under Parts A
and B.) CBO used its projections of the bids Medicare
Advantage plans submit under the current program
to estimate the bids of private insurers under the pre-
mium support options. The lower current projections of
Medicare Advantage bids suggest that those insurers’ bids
would be lower than CBO had previously anticipated.
Other factors also affected CBO’s budgetary estimates,
but with smaller net effects.
CBO lowered its projections of Medicare Advantage
bids relative to FFS spending per capita for two reasons.
First, Medicare Advantage bids have declined relative
to FFS spending in recent years. Second, legislation
affecting updates to Medicare’s FFS physician payment
rates caused CBO to revise its projections of how much
Medicare Advantage bids will change relative to FFS
spending.
What Is the Current Role of
Private Plans in Medicare?
In 2016, about 30 percent of Medicare’s 57 million
beneficiaries were enrolled in Medicare Advantage plans.
Almost all other beneficiaries were enrolled in Medicare’s
FFS program. Insurers who wish to participate in
Medicare Advantage submit bids to the government
2. For that estimate, CBO assumed implementation in 2018,
four years earlier than the current estimate. See Congressional
Budget Office, Options for Reducing the Deficit: 2014 to 2023
(November 2013), pp. 204–210, www.cbo.gov/content/
options-reducing-deficit-2014-2023.
indicating the per capita payment they will accept for
providing benefits to enrollees under Medicare Parts A
and B. The resulting federal payments depend in part on
the insurers’ bids and on how those bids compare with
county-level benchmarks, which range from 95 percent
to 115 percent of local spending per capita in Medicare’s
FFS program. Federal payments to insurers are adjusted
to account for the health status of their enrollees, and
plans receive bonus payments if they earn high ratings
for quality of care. (Private insurers also participate in a
separate bidding process that determines payments under
Medicare Part D, the prescription drug program.)
What Policy Options Did CBO Analyze?
In the current analysis, CBO examined two sets of
illustrative options for converting Medicare to a pre-
mium support system. For each, the federal government’s
contribution would be determined from insurers’ bids,
including the “bid” of the Medicare FFS program,
which would be a competing plan. The nation would
be divided into regions within which competing private
insurers would submit bids indicating the amount they
would accept to provide Medicare benefits to a benefi-
ciary in average health.3 Similarly, Medicare’s FFS bid
in each region would be based on the projected cost of
providing benefits in Medicare FFS to an enrollee in
average health.
Insurers would submit bids for a benefit package that
covered the same services as Parts A and B of Medicare
(with a few exceptions, noted below) at the same actuar-
ial value as Parts A and B combined. (That is, each policy
would cover the same benefits and percentage of total
expenses for a given population that would be covered
under current law by Medicare’s FFS program.) As under
current law, Medicare Part D would be administered
separately.
The options CBO examined differ from each other
along two dimensions: the approach used to deter-
mine the federal contribution, and whether the option
included a grandfathering provision so that beneficiaries
who became eligible for Medicare before the premium
support system took effect would remain in the current
3. Throughout this report, the term bid refers to the standardized
bid for a beneficiary in average health. As under current law,
federal payments to plans would be adjusted to account for
differences in their enrollees’ health.
https://www.cbo.gov/content/options-reducing-deficit-2014-2023
https://www.cbo.gov/content/options-reducing-deficit-2014-2023
3october 2017 A Premium SuPPort SyStem for medicAre: uPdAted AnAlySiS of illuStrAtive oPtionS
Medicare system rather than enter the new system. Other
program features would be the same.
The Federal Contribution
CBO analyzed two approaches to determining the
benchmarks for setting the federal contribution:
■ A second-lowest-bid approach would set the
regional benchmark at the lower of a pair of bids:
either Medicare’s FFS bid or the second-lowest bid
submitted by a private insurer.
■ An average-bid approach would set the regional
benchmark at the weighted average of all bids,
including the FFS bid, with weights equal to the
proportion of beneficiaries enrolled in that plan in
the preceding year.
For each enrollee, the federal government would pay
insurers an amount equal to the benchmark for the
region minus the standard premium paid by enroll-
ees (discussed below). Insurers would receive larger or
smaller payments for beneficiaries whose health was
worse or better than average. Neither the amount nor the
growth rate of the federal payment would be capped.
Beneficiaries who enrolled in a plan with a bid that
equaled the benchmark would pay a standard premium
directly to the insurer. That premium would be the same
everywhere and would be set to cover approximately
one-fourth of the total cost, excluding cost sharing, for
services covered in Part B (physicians’ services, hospital
outpatient care, durable medical equipment, and other
services, including some home health care)—a formula
that is similar to that under current law for Part B premi-
ums. Beneficiaries who chose a plan with a bid above the
benchmark would pay the insurer the standard premium
plus the difference between the bid and the benchmark.
Those who chose a plan with a bid below the benchmark
would pay the standard premium minus the difference
between the benchmark and the bid. Income-related
Part B premiums for higher-income beneficiaries would
continue as under current law.
Grandfathering
For each approach to determining the benchmark, CBO
analyzed options with and without grandfathering.
(Grandfathering would keep current beneficiaries from
having to adjust to a new system.) Under grandfathering,
only a small portion of the Medicare population would
participate in the premium support system initially, but
that portion would increase gradually over the long term.
Other Features
The other features of a premium support system were
common to all options. Some illustrate the potential for
savings from a premium support framework; others were
chosen for feasibility of implementation or to simplify
the modeling approach. Many other variations are pos-
sible, and none of the options presented in this report
should be considered a recommendation by CBO.
Under each option, beneficiaries would choose a plan
when they first entered the premium support system.
Beneficiaries who did not select a plan at that time
would be assigned (with equal probability) to a plan that
had submitted a bid at or below the regional bench-
mark, including the FFS program if it met that criterion.
Beneficiaries would remain in the plan they chose (or
were assigned to) in subsequent years, unless they chose a
different plan during an annual enrollment period.
To clarify the choices for beneficiaries (and thereby
heighten competition based on differences in premiums),
private insurers would be allowed to submit bids for the
basic Medicare package for just one or two plans in each
region. If they chose to submit bids for two plans, each
could have different features—offering a larger or smaller
provider network, for example—but both would need to
have the same actuarial value. Insurers also could offer a
package of enhanced benefits (with a single, fixed, higher
actuarial value that would be the same for all insurers) to
accompany each basic package offered. Enrollees would
pay the full additional cost of the enhanced packages
through higher premiums.
CBO assumed that there would be no changes to the
current FFS program, either in the mechanisms for
setting the rates paid to providers or in the tools avail-
able to contain costs. As under current law, beneficia-
ries who remained in the FFS program could purchase
supplemental coverage (known as medigap coverage)
from private insurers. Such policies cover some or all
of Medicare’s cost sharing and may also cover certain
services that are not covered by Medicare.
To simplify the analysis, CBO assumed that the pre-
mium support system would not affect certain types of
federal spending for Medicare. Specifically, the agency
assumed that dual-eligible beneficiaries—people who are
4 A Premium SuPPort SyStem for medicAre: uPdAted AnAlySiS of illuStrAtive oPtionS october 2017
simultaneously enrolled in Medicare and Medicaid—
would be excluded from the premium support system
and that federal spending for their health care would
continue as it would under current law. CBO made
that assumption because of the additional complexity
of structuring a premium support system to include
dual-eligible beneficiaries, although a system could be
devised to include them.
In a change from past analyses, CBO assumed that ben-
eficiaries with coverage only for Medicare Part A would
be excluded from the premium support system and
that federal spending for their benefits would continue
as it would under current law. CBO chose that feature
because most such beneficiaries have primary coverage
through employment-based insurance and have second-
ary coverage through Medicare.4
CBO also assumed that Medicare’s spending for Part D
would continue as projected under current law, as would
spending for items and services that are not included in
the calculation of the benchmarks or bids for current-
law Medicare Advantage plans—such as Medicare’s
additional payments to hospitals for medical education,
hospice benefits, and certain benefits for patients with
end-stage renal disease.
The categories of spending that CBO assumed would
be unaffected by the premium support system—which
include spending for dual-eligible beneficiaries and bene-
ficiaries enrolled in Part A only, all spending on Medicare
Part D, and the other categories of spending discussed
above—made up about 40 percent of net federal spend-
ing for Medicare in 2016. (Net spending consists of total
Medicare spending minus beneficiaries’ premiums and
other offsetting receipts.)
CBO made many other detailed assumptions concerning
the options that have been described previously.5 With
the following three exceptions, the specifications used in
this analysis were the same as those that applied in 2013.
4. Under current law, beneficiaries must be enrolled in both Part A
and Part B of Medicare to be eligible to enroll in a Medicare
Advantage plan.
5. See Congressional Budget Office, A Premium Support System
for Medicare: Analysis of Illustrative Options (September 2013),
pp. 7–15, www.cbo.gov/publication/44581.
First, CBO assumed that beneficiaries who had Part A–
only coverage would be excluded from the premium
support system. That analytical choice resulted in mod-
estly smaller budgetary savings, relative to CBO’s prior
estimate, because Medicare is the secondary payer for
most such beneficiaries and thus typically spends much
less to cover them.6
Second, CBO assumed that the federal government
would apply a greater reduction in the risk scores of
private-plan enrollees under the premium support
options than it would under the current Medicare
Advantage program. Risk scores are computed for all
Medicare beneficiaries on the basis of their diagnoses
and other characteristics, and the government uses those
scores to adjust payments to plans. (CBO assumed that
a comparable risk-adjustment system would be used
for the premium support options.) Research pub-
lished in the past few years has shown that, on average,
Medicare Advantage enrollees have higher risk scores
than FFS beneficiaries in similar health and that the
difference has increased recently.7 The difference between
risk scores for the two groups of enrollees appears to
arise more from the intensive diagnostic coding used by
Medicare Advantage plans than from actual differences
in health among the two groups.8 In the current analysis,
CBO assumed that the federal government would take
steps to ensure that the risk scores of private-plan enroll-
ees would be no more than 5 percent higher, on average,
than the risk scores of Medicare FFS beneficiaries with
6. In certain situations—such as when a Medicare-eligible
beneficiary has health insurance coverage through a current
employer or a spouse’s employer—Medicare acts as the secondary
payer. That is, Medicare only pays for covered benefits after the
primary payer has met its responsibility for the beneficiary’s costs
of care.
7. For example, see Medicare Payment Advisory Commission,
“MA Risk Adjustment and Coding Intensity Adjustment,” in
Report to the Congress: Medicare Payment Policy (March 2016),
pp. 344–346, www.medpac.gov/-documents-/reports; and
Richard Kronick and W. Pete Welch, “Measuring Coding
Intensity in the Medicare Advantage Program,” Medicare &
Medicaid Research Review, vol. 4, no. 2 (2014), pp. E1–E19,
https://go.usa.gov/xN5DU.
8. Because they receive larger payments for covering enrollees with
higher risk scores, Medicare Advantage plans have an incentive
to code all diagnoses that are included in the risk-adjustment
mechanism. Many providers (particularly physicians) have no
such incentive to code every diagnosis for their Medicare FFS
patients; they are paid on the basis of the services furnished, not
the diagnoses reported.
https://www.cbo.gov/publication/44581
http://www.medpac.gov/-documents-/reports
https://go.usa.gov/xN5DU
5october 2017 A Premium SuPPort SyStem for medicAre: uPdAted AnAlySiS of illuStrAtive oPtionS
similar health status.9 That difference is smaller than the
published estimates of the difference under current law.
Third, for this analysis, CBO assumed that legislation to
establish a premium support system would be enacted
late in 2017. To allow time for the federal government to
develop the necessary administrative structures and for
beneficiaries and insurers to prepare for the new system,
CBO assumed that the system would not be imple-
mented until 2022.
Key Design Decisions for Future Proposals
Options considered by the Congress, and the result-
ing costs or savings, could differ significantly from the
options analyzed in this report. Policymakers who wished
to develop such proposals would need to make many
complex decisions about the design of a premium sup-
port system, with important implications for Medicare
spending. In its earlier report, CBO discussed several
such decisions that would be specific to a system with
grandfathering.10
Some more broadly applicable design questions include
the following:
■ Would dual-eligible beneficiaries be included in the
premium support system, and if so, how would the
system accommodate them?
■ Would enrollment in Part B remain voluntary, and if
so, how would beneficiaries who are enrolled only in
Part A be treated by the new system?
9. Recent trends informed CBO’s expectation that, under current
law, the unadjusted difference between the risk scores of Medicare
Advantage enrollees and FFS beneficiaries would be greater
than it anticipated in 2013 and substantially above 5 percent.
For the premium support options, CBO assumed that coding
differences would be limited to 5 percent. That limit is illustrative
and arbitrary. Pressure to have a low limit would stem from
concerns that a greater divergence between risk scores under
premium support would allow private plans to reduce their
bids. Reductions in those bids would tend to lower the federal
contribution but would not affect the FFS bid. Thus, premiums
would increase for beneficiaries who chose to remain in the FFS
program.
10. See Congressional Budget Office, A Premium Support System
for Medicare: Analysis of Illustrative Options (September 2013),
pp. 32–33, www.cbo.gov/publication/44581.
■ What rules would be established for beneficiaries who
receive retiree coverage from a former employer or
union?
■ How would the federal government change risk
adjustment to account for differences in the health
status of enrollees in various plans (including
Medicare FFS)?
What Were CBO’s Analytical Methods?
CBO’s estimates of the effects of the premium support
options on federal spending and beneficiaries’ total pay-
ments were based on detailed modeling of the behavior
of buyers and sellers of health insurance policies. That
modeling was similar for both sets of options.11
First, the agency projected the amounts of the bids that
would be submitted by plans in the Medicare Advantage
program under current law. Then, the agency adjusted
those projected bids, given the downward and upward
pressures that would be a likely result of a premium sup-
port system. CBO used that information (and data about
past enrollment for the average-bid option) to estimate
regional benchmarks and premiums for each plan.
CBO then simulated the enrollment choices of a large
sample of beneficiaries in different plans on the basis of
premiums and previous patterns of enrollment, calcu-
lated federal spending as the sum of the risk-adjusted
federal contribution for each beneficiary, and compared
that estimate of total federal spending with its baseline
projection of federal spending under current law. To
project beneficiaries’ total payments, CBO used claims
data to estimate cost-sharing payments by each benefi-
ciary for the services covered by Medicare and combined
those estimates with estimates of the plans’ premiums.
What Are CBO’s New Estimates?
CBO estimates that the options considered in this
analysis would reduce net federal spending for Medicare
but that the savings would be substantially greater for
the second-lowest-bid option than for the average-bid
option. Beneficiaries’ total payments, on average, would
be higher under the second-lowest-bid option but lower
under the average-bid option than under current law. For
11. For additional information, see Congressional Budget Office,
A Premium Support System for Medicare: Analysis of Illustrative
Options (September 2013), Appendix A, www.cbo.gov/
publication/44581.
https://www.cbo.gov/publication/44581
http://www.cbo.gov/publication/44581
http://www.cbo.gov/publication/44581
6 A Premium SuPPort SyStem for medicAre: uPdAted AnAlySiS of illuStrAtive oPtionS october 2017
this analysis, CBO considered total payments to consist of
premiums plus cost sharing for Part A and Part B benefits.
Under either option, a particular beneficiary’s total pay-
ments could differ markedly from the national average.
For example, in many regions, premiums would be much
higher for Medicare’s FFS program, which would result
in substantially higher total payments by FFS beneficia-
ries than would be the case under current law. Moreover,
under either option, the savings over the next decade
would be substantially lower if a grandfathering provi-
sion was included.
Budgetary Effects Without Grandfathering
If the premium support system covered currently eligible
and future beneficiaries (but excluded dual-eligible
beneficiaries and those with coverage under Part A only),
the second-lowest-bid option would reduce net federal
spending for Medicare by $419 billion between 2022
and 2026, CBO estimates (see Table 1). The average-
bid option would reduce net federal spending over
that period by $184 billion. Compared with projected
spending under current law, by 2024 (an illustrative
year shortly after implementation of the new system)
the second-lowest-bid option would reduce net federal
spending for Medicare by 9 percent, and the average-bid
option would reduce that spending by 4 percent.
Another way to measure the options’ effects is to exam-
ine their impact on net federal spending just for affected
beneficiaries for benefits that would be included in the
premium support system—rather than for the Medicare
program as a whole. That group would include every-
one (other than dual-eligible beneficiaries and those
with Part A–only coverage) who would have enrolled in
Medicare under current law. (The measure of spending
included in that calculation consists of federal spending
for those beneficiaries for Part A and Part B benefits,
excluding spending for items and services not covered by
Medicare Advantage bids, minus beneficiaries’ premi-
ums and other offsetting receipts.) Without a grand-
fathering provision, the second-lowest-bid option would
reduce net federal spending for affected beneficiaries in
2024 by 15 percent, and the average-bid option would
reduce such spending by 8 percent, CBO estimates (see
Figure 1). Those percentages are larger than the percent-
age reductions in total Medicare spending because the
savings are measured relative to the portion of Medicare
spending that would be covered under the premium
Table 1 .
Estimated Change in Net Federal Spending for Medicare Under Illustrative Premium Support Options,
Relative to Spending Under Current Law, 2022 to 2026
Billions of …
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ach
e. Embedded Entrepreneurship
f. Three Social Entrepreneurship Models
g. Social-Founder Identity
h. Micros-enterprise Development
Outcomes
Subset 2. Indigenous Entrepreneurship Approaches (Outside of Canada)
a. Indigenous Australian Entrepreneurs Exami
Calculus
(people influence of
others) processes that you perceived occurs in this specific Institution Select one of the forms of stratification highlighted (focus on inter the intersectionalities
of these three) to reflect and analyze the potential ways these (
American history
Pharmacology
Ancient history
. Also
Numerical analysis
Environmental science
Electrical Engineering
Precalculus
Physiology
Civil Engineering
Electronic Engineering
ness Horizons
Algebra
Geology
Physical chemistry
nt
When considering both O
lassrooms
Civil
Probability
ions
Identify a specific consumer product that you or your family have used for quite some time. This might be a branded smartphone (if you have used several versions over the years)
or the court to consider in its deliberations. Locard’s exchange principle argues that during the commission of a crime
Chemical Engineering
Ecology
aragraphs (meaning 25 sentences or more). Your assignment may be more than 5 paragraphs but not less.
INSTRUCTIONS:
To access the FNU Online Library for journals and articles you can go the FNU library link here:
https://www.fnu.edu/library/
In order to
n that draws upon the theoretical reading to explain and contextualize the design choices. Be sure to directly quote or paraphrase the reading
ce to the vaccine. Your campaign must educate and inform the audience on the benefits but also create for safe and open dialogue. A key metric of your campaign will be the direct increase in numbers.
Key outcomes: The approach that you take must be clear
Mechanical Engineering
Organic chemistry
Geometry
nment
Topic
You will need to pick one topic for your project (5 pts)
Literature search
You will need to perform a literature search for your topic
Geophysics
you been involved with a company doing a redesign of business processes
Communication on Customer Relations. Discuss how two-way communication on social media channels impacts businesses both positively and negatively. Provide any personal examples from your experience
od pressure and hypertension via a community-wide intervention that targets the problem across the lifespan (i.e. includes all ages).
Develop a community-wide intervention to reduce elevated blood pressure and hypertension in the State of Alabama that in
in body of the report
Conclusions
References (8 References Minimum)
*** Words count = 2000 words.
*** In-Text Citations and References using Harvard style.
*** In Task section I’ve chose (Economic issues in overseas contracting)"
Electromagnetism
w or quality improvement; it was just all part of good nursing care. The goal for quality improvement is to monitor patient outcomes using statistics for comparison to standards of care for different diseases
e a 1 to 2 slide Microsoft PowerPoint presentation on the different models of case management. Include speaker notes... .....Describe three different models of case management.
visual representations of information. They can include numbers
SSAY
ame workbook for all 3 milestones. You do not need to download a new copy for Milestones 2 or 3. When you submit Milestone 3
pages):
Provide a description of an existing intervention in Canada
making the appropriate buying decisions in an ethical and professional manner.
Topic: Purchasing and Technology
You read about blockchain ledger technology. Now do some additional research out on the Internet and share your URL with the rest of the class
be aware of which features their competitors are opting to include so the product development teams can design similar or enhanced features to attract more of the market. The more unique
low (The Top Health Industry Trends to Watch in 2015) to assist you with this discussion.
https://youtu.be/fRym_jyuBc0
Next year the $2.8 trillion U.S. healthcare industry will finally begin to look and feel more like the rest of the business wo
evidence-based primary care curriculum. Throughout your nurse practitioner program
Vignette
Understanding Gender Fluidity
Providing Inclusive Quality Care
Affirming Clinical Encounters
Conclusion
References
Nurse Practitioner Knowledge
Mechanics
and word limit is unit as a guide only.
The assessment may be re-attempted on two further occasions (maximum three attempts in total). All assessments must be resubmitted 3 days within receiving your unsatisfactory grade. You must clearly indicate “Re-su
Trigonometry
Article writing
Other
5. June 29
After the components sending to the manufacturing house
1. In 1972 the Furman v. Georgia case resulted in a decision that would put action into motion. Furman was originally sentenced to death because of a murder he committed in Georgia but the court debated whether or not this was a violation of his 8th amend
One of the first conflicts that would need to be investigated would be whether the human service professional followed the responsibility to client ethical standard. While developing a relationship with client it is important to clarify that if danger or
Ethical behavior is a critical topic in the workplace because the impact of it can make or break a business
No matter which type of health care organization
With a direct sale
During the pandemic
Computers are being used to monitor the spread of outbreaks in different areas of the world and with this record
3. Furman v. Georgia is a U.S Supreme Court case that resolves around the Eighth Amendments ban on cruel and unsual punishment in death penalty cases. The Furman v. Georgia case was based on Furman being convicted of murder in Georgia. Furman was caught i
One major ethical conflict that may arise in my investigation is the Responsibility to Client in both Standard 3 and Standard 4 of the Ethical Standards for Human Service Professionals (2015). Making sure we do not disclose information without consent ev
4. Identify two examples of real world problems that you have observed in your personal
Summary & Evaluation: Reference & 188. Academic Search Ultimate
Ethics
We can mention at least one example of how the violation of ethical standards can be prevented. Many organizations promote ethical self-regulation by creating moral codes to help direct their business activities
*DDB is used for the first three years
For example
The inbound logistics for William Instrument refer to purchase components from various electronic firms. During the purchase process William need to consider the quality and price of the components. In this case
4. A U.S. Supreme Court case known as Furman v. Georgia (1972) is a landmark case that involved Eighth Amendment’s ban of unusual and cruel punishment in death penalty cases (Furman v. Georgia (1972)
With covid coming into place
In my opinion
with
Not necessarily all home buyers are the same! When you choose to work with we buy ugly houses Baltimore & nationwide USA
The ability to view ourselves from an unbiased perspective allows us to critically assess our personal strengths and weaknesses. This is an important step in the process of finding the right resources for our personal learning style. Ego and pride can be
· By Day 1 of this week
While you must form your answers to the questions below from our assigned reading material
CliftonLarsonAllen LLP (2013)
5 The family dynamic is awkward at first since the most outgoing and straight forward person in the family in Linda
Urien
The most important benefit of my statistical analysis would be the accuracy with which I interpret the data. The greatest obstacle
From a similar but larger point of view
4 In order to get the entire family to come back for another session I would suggest coming in on a day the restaurant is not open
When seeking to identify a patient’s health condition
After viewing the you tube videos on prayer
Your paper must be at least two pages in length (not counting the title and reference pages)
The word assimilate is negative to me. I believe everyone should learn about a country that they are going to live in. It doesnt mean that they have to believe that everything in America is better than where they came from. It means that they care enough
Data collection
Single Subject Chris is a social worker in a geriatric case management program located in a midsize Northeastern town. She has an MSW and is part of a team of case managers that likes to continuously improve on its practice. The team is currently using an
I would start off with Linda on repeating her options for the child and going over what she is feeling with each option. I would want to find out what she is afraid of. I would avoid asking her any “why” questions because I want her to be in the here an
Summarize the advantages and disadvantages of using an Internet site as means of collecting data for psychological research (Comp 2.1) 25.0\% Summarization of the advantages and disadvantages of using an Internet site as means of collecting data for psych
Identify the type of research used in a chosen study
Compose a 1
Optics
effect relationship becomes more difficult—as the researcher cannot enact total control of another person even in an experimental environment. Social workers serve clients in highly complex real-world environments. Clients often implement recommended inte
I think knowing more about you will allow you to be able to choose the right resources
Be 4 pages in length
soft MB-920 dumps review and documentation and high-quality listing pdf MB-920 braindumps also recommended and approved by Microsoft experts. The practical test
g
One thing you will need to do in college is learn how to find and use references. References support your ideas. College-level work must be supported by research. You are expected to do that for this paper. You will research
Elaborate on any potential confounds or ethical concerns while participating in the psychological study 20.0\% Elaboration on any potential confounds or ethical concerns while participating in the psychological study is missing. Elaboration on any potenti
3 The first thing I would do in the family’s first session is develop a genogram of the family to get an idea of all the individuals who play a major role in Linda’s life. After establishing where each member is in relation to the family
A Health in All Policies approach
Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum
Chen
Read Connecting Communities and Complexity: A Case Study in Creating the Conditions for Transformational Change
Read Reflections on Cultural Humility
Read A Basic Guide to ABCD Community Organizing
Use the bolded black section and sub-section titles below to organize your paper. For each section
Losinski forwarded the article on a priority basis to Mary Scott
Losinksi wanted details on use of the ED at CGH. He asked the administrative resident