Commentary: How bureaucrats are limiting Texas’ access to health care


Texans have a harder time finding affordable health care than folks in any other state. Our state also has one of the worst ratings for overall medical care, according to a recent Commonwealth Fund study.

Unfortunately, Washington could soon make our state’s health care problems even worse. Many know that Medicaid, the state-federal health partnership for low-income people, is in major discussions, but few realize the potential sweeping changes to Medicare, the federal program that subsidizes health care for more than 3.6 million senior citizens and Texans with disabilities. Today, we’ll focus on Medicare and how lawmakers must help rein in the initiative to protect these beneficiaries.

The Center for Medicare and Medicaid Innovation (CMMI) has two objectives: identify how to cut Medicare costs without decreasing the quality of care, or identify how to improve care without raising costs. After eight years in existence, it has neither cut costs nor improved care. The last administration instead used CMMI to propose sweeping changes to Medicare that would have significant impact on Texans.

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CMMI initiatives are supposed to test ideas by conducting small experiments.

But recently, these experiments haven’t been small at all. Last year, CMMI proposed changing how Medicare reimburses doctors for medicines, such as chemotherapy, that must be administered under physician supervision. Doctors pay for these treatments up front. Medicare then reimburses them for the cost of the drug plus a 6 percent add-on fee to cover expenses like storage and administrative costs.

CMMI wanted to slash the add-on reimbursement to 2.5 percent. The mandatory change was far from a small experiment – it would have affected 75 percent of Medicare providers.

Many physicians wouldn’t have broken even due to the lowered reimbursement rates. They wouldn’t have been able to afford to prescribe and administer the most advanced treatments to patients.

Some doctors would have gone out of business entirely. Many clinics operate under razor-thin margins. More than half of our state’s oncology clinics have closed or reported financial struggles in recent years. That would’ve been a significant impact to Texans.

Thankfully, widespread public backlash convinced CMMI to abandon the planned cuts, no doubt saving many clinics that provide lifesaving care to Texans. But CMMI still has the power to implement other changes to Medicare.

For example, CMMI proposed to change how it reimburses hospitals for caring for heart attack victims. CMMI planned to pay hospitals different amounts based on the quality of services provided.

There’s nothing wrong with this sort of experiment, in theory; the problem is the scale. CMMI planned to implement the change in over 1,100 hospitals in nearly 100 cities, including in Austin, Abilene, Beaumont and Port Arthur. More than 400,000 Texas seniors suffer from heart disease. Thanks to serious questions raised by lawmakers, including U.S. Rep. Kevin Brady of Houston, CMMI is now proposing to cancel the test.

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Right now, Congress can’t do much to stop overreaching tests like this. The initiative is provided a guaranteed funding stream of $10 billion every decade, and it can choose how to spend the money.

Large regions of the country should never be forced to participate in “experiments.” Fortunately, the Centers for Medicare and Medicaid Services, which monitors CMMI, is poised to reform the initiative so that it stops implementing large-scale experiments. This is a step in the right direction – one that the Trump administration should acknowledge by requiring CMMI to abide by such rules when implementing any new experiments.

CMMI was created to improve Medicare while reducing costs. But the initiative’s lack of accountability enables federal bureaucrats to make major changes to Medicare that impact millions of seniors and individuals in the disability community. With modest reforms, CMMI could fulfill its mission and improve Americans’ access to health care.

We urge members of Congress to reassert control over CMMI funding. As chairman of the House Ways and Means Committee, Rep. Kevin Brady is uniquely positioned to continue to play a key role in reining in CMMI. We urge him to continue his efforts for the sake of Medicare beneficiaries across Texas and the country.

Borel is the executive director of the Coalition of Texans with Disabilities.



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