Bill Overview
Title: GOLD CARD Act of 2022
Description: This bill exempts physicians from prior authorization requirements under Medicare Advantage plans with respect to specific items and services if at least 90% of the physician's requests for such items and services were approved during the previous plan year.
Sponsors: Rep. Burgess, Michael C. [R-TX-26]
Target Audience
Population: Medicare Advantage beneficiaries and physicians under Medicare Advantage plans
Estimated Size: 29000000
- The bill targets physicians who frequently seek prior authorizations under Medicare Advantage plans.
- Medicare Advantage plans are popular among Medicare beneficiaries, hence changes can affect both physicians and patients using these plans.
- The exemption from prior authorization may streamline processes for physicians, particularly those with high approval rates (>90%).
- Simplifying the authorization process could lead to quicker patient access to necessary medical services.
- Medicare Advantage is utilized by a significant number of elderly Americans, suggesting that changes here can impact a large demographic.
Reasoning
- The policy primarily benefits physicians who often request prior authorizations, and their patients, by reducing administrative overhead and potentially speeding up access to care.
- Given that nearly 29 million Americans use Medicare Advantage, those affected first are likely to be the elderly and patients with chronic conditions who require frequent care and thus frequent authorization.
- The policy budget is intended to ease the financial burden of managing authorizations, potentially reducing costs associated with delays in service delivery.
- A broad range of perspectives is included to reflect the diversity in the U.S. population's interaction with this policy.
Simulated Interviews
Retired Teacher (Florida)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- The bureaucracy involved in getting medical tests approved is frustrating.
- Hoping this policy means less waiting around for approvals so I can get my treatments on time.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 4 |
| Year 20 | 8 | 3 |
Retired Engineer (Arizona)
Age: 75 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- Prior authorizations are a hassle and delay my care.
- I'm optimistic about faster service with this new policy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 5 | 3 |
Primary Care Physician (Texas)
Age: 62 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- The policy is a great relief, less paperwork means I can focus more on patient care.
- I hope to see faster turnaround times for my patients.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 9 | 7 |
| Year 3 | 9 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
Retired Businessman (California)
Age: 70 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 7/20
Statement of Opinion:
- I'm worried about delays in getting treatments without this policy.
- Immediate access to services is crucial for my heart condition.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 3 |
Retired (Pennsylvania)
Age: 85 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- Anything that reduces delays in my healthcare is welcome.
- This policy seems beneficial but I worry about how quickly it can be realized.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Cardiologist (New York)
Age: 45 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- I'm hoping this cuts down on administrative tasks so I can see more patients.
- The policy could help streamline our clinic operations significantly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Retired Nurse (Ohio)
Age: 66 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I just want my treatments to be timely without jumping through hoops.
- If this policy works, it will be a blessing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
Retired from Construction (Illinois)
Age: 78 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 9/20
Statement of Opinion:
- I've spent too much time waiting for approvals in my condition.
- I'd like to see this policy make a difference soon.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Healthcare Administrator (Massachusetts)
Age: 64 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- This should ease the approval process strain on our staff.
- It might lead to better patient outcomes and satisfaction if expedited.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Geriatric Specialist (Washington)
Age: 60 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 4/20
Statement of Opinion:
- I'm concerned about the operational delays I've seen before this policy.
- Expecting to provide faster, quality care with less red tape.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Cost Estimates
Year 1: $65000000 (Low: $50000000, High: $80000000)
Year 2: $67000000 (Low: $52000000, High: $82000000)
Year 3: $69000000 (Low: $54000000, High: $85000000)
Year 5: $73000000 (Low: $57000000, High: $88000000)
Year 10: $80000000 (Low: $65000000, High: $95000000)
Year 100: $1000000000 (Low: $800000000, High: $1200000000)
Key Considerations
- The policy primarily impacts Medicare Advantage plans, a major component of Medicare offerings which can disturb existing budgetary allocations.
- Savings in administrative cost might be partially offset by increased volume in service delivery when barriers to care are reduced.