The Medicare Access and CHIP Reauthorization Act (MACRA) is a reform measure that scraps an old, outdated system for reimbursing doctors and keeps them happy because it spares them from a looming pay cut. It was enacted in April 2015 with overwhelming support from Democrats and Republicans alike.
At the same time, MACRA is likely to raise some costs for Medicare users — particularly higher-income seniors. And, in the near term, it is projected to raise the deficit.
But even with those caveats, MACRA is a reform that conservatives should learn to love, according to Ryan Ellis of Americans for Tax Reform, which champions small government and low taxes.
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Ellis wrote in the conservative National Review that "this bill will reduce the unfunded liabilities of Medicare without raising taxes" and "is a good down payment on even more entitlement reforms."
It also keeps the peace with the nation's doctors, who, under the old reimbursement formula, were confronted every year with a large cut in their reimbursements — and Congress always averted the cuts at the last minute.
This reform puts an end to that routine and brings predictability to reimbursements — at least for the first four years.
Later on, doctor payments will be tied to quality scores based on patient health, and when these kick in, starting in 2019, fights could erupt over how to measure patient health in a way that all parties consider fair and credible.
Vox reported: "widespread concern that the new way Medicare is going to pay doctors forces the government to do something it's not very good at: measure how good — or bad — doctors are at their jobs.
At first, these issues may not register in any meaningful way for patients. Medicare beneficiaries are more likely to be focused on any changes in their premiums and shared costs such as co-payments and deductibles.
The American Association of Retired Persons has given the Medicare reform package a thumbs up, saying it "moves Medicare in the right direction toward better quality health care and greater transparency for patients."
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Major medical organizations including the American Medical Association and the American College of Physicians are also on board.
But one seniors' organization, the National Committee to Preserve Social Security and Medicare, opposed it because it cuts costs by means-testing beneficiaries based on their income, and adds a deductible to so-called "Medigap" insurance policies that seniors use to fill holes in
Medicare coverage, according to Daily Kos.
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