Report: Many Californians Support Changes to Medicare Program

The majority of California residents who participated in a project on how to improve Medicare said they would do so by reducing low-value coverage, using a defined physician network and increasing premiums for out-patient care among higher-income beneficiaries, according to a report by the not-for-profit Center for Healthcare Decisions, the Sacramento Business Journal  reports (Robertson, Sacramento Business Journal, 9/11).

Details of Project

For the project, 810 California residents in the past year played a three-hour computer simulation game, called MedCHAT. Participants included:

• Community leaders;
• Elderly individuals;
• Health care professionals;
• Senior services workers; and
• Young adults.

In the simulation, participants had to make choices individually and as a group about how to keep Medicare solvent.

A qualitative analysis of the results was conducted by the Sutter Institute for Medical Research (Center for Healthcare Decisions report, September 2014).

Findings

According to the report:

• 88% of participants supported reducing low-value care and requiring beneficiaries to pay for at least half the cost of treatments that provide a small benefit or those that are more expensive than comparable treatments;
• 82% supported using a defined physician network, but the majority of those also supported out-of-network referrals by primary care doctors;
• 79% supported increasing Medicare Part B premiums for outpatient care for beneficiaries with high annual incomes; and
• 48% supported using penalties and rewards to prompt beneficiaries to comply with chronic disease management methods, while 36% supported using just penalties to do so.

In addition, many participants were in favor of adding benefits to the program. For example:

• 85% supported including some dental, hearing and vision coverage;
• 81% supported coverage for transportation to medical appointments;
• 77% supported including one year or more of coverage for nursing home stays, supportive housing stays or in-home care; and
• 69% supported increased mental health care coverage.

Meanwhile, 85% of participants supported reducing Medicare spending to keep the program solvent for at least 50 more years.

Reaction

Marge Ginsburg, executive director of the Center for Healthcare Decisions, said, "One of the things that surprised me was that only 3% [of participants] wanted to keep the current level" of coverage.

However, Ginsburg noted that the California study "may not reflect the views of everybody in the U.S."

To that end, the American Enterprise Institute and the Brookings Institution will co-host a briefing on the issue in Washington, D.C., on Sept. 19 (Sacramento Business Journal, 9/11).