Bill Overview
Title: Achieving Equity in the Treatment of Dual Eligible Beneficiaries Act
Description: This bill temporarily establishes geographic adjustments for certain Medicare Advantage payment formulations, and specifies that a certain percentage of corresponding payment increases must be directed toward payments for basic benefits. It also requires U.S. territories to establish Medicare Savings Programs (currently optional in the territories).
Sponsors: Resident Commissioner González-Colón, Jenniffer [R-PR-At Large]
Target Audience
Population: Dual eligible beneficiaries (Medicare and Medicaid) and citizens in U.S. territories
Estimated Size: 12000000
- The bill affects Medicare Advantage payments, which are part of the Medicare program serving those aged 65 and over and people with disabilities.
- It impacts 'dual eligible beneficiaries,' which are individuals eligible for both Medicare and Medicaid benefits.
- Medicare Savings Programs help low-income individuals pay Medicare premiums and out-of-pocket costs.
- There are millions of dual eligible beneficiaries globally residing in the U.S, predominantly as it concerns U.S law.
- The bill mentions U.S. territories, which include jurisdictions like Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands.
- All U.S. territories combined have a population of around 4 million people, although not all may be dual eligible beneficiaries.
- Globally, outside the USA, relatively few people might be impacted directly by this, as Medicare is primarily a U.S.-based program.
Reasoning
- The policy predominantly affects older adults (65+ years) who are dual eligible beneficiaries, as it changes payment structures in the Medicare Advantage program. This group is mainly made up of disabled individuals and those who have lower incomes, often residing in specific U.S. territories and areas with low Medicare spending adjustments.
- U.S. territories are crucial as the bill mandates territories establish Medicare Savings Programs, impacting not just older residents but also the governance of the programs in these regions.
- In the simulation, people outside this target group, such as younger individuals and those not dual eligible, should see no direct impact from the policy.
- The $3 billion budget for the first year and $34.8 billion over ten years suggests wide-scale program implementation but limited drastic financial transformations per person due to the scale of the affected population.
Simulated Interviews
Retired teacher (Puerto Rico)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- I hope this policy brings more funds for healthcare and reduces out-of-pocket expenses.
- It’s encouraging that territories are getting more support.
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 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Part-time Uber driver (Florida)
Age: 68 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- Increased funding in the Advantage plan could mean more coverage for my medications.
- It’s necessary for those of us struggling with basic expenses.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Retired nurse (California)
Age: 85 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- I'm wary of changes in policies but hope it improves my healthcare.
- Ensuring equitable payment means more doctors accepting my insurance plan.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Community worker (Guam)
Age: 60 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 3/20
Statement of Opinion:
- These changes are crucial for increasing local healthcare funding.
- Figuring out how funds flow should eventually improve care quality.
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 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Retired firefighter (New York)
Age: 78 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 15/20
Statement of Opinion:
- Balancing funds geographically can entice more doctors back to less-funded regions.
- Stability in the healthcare system leads to better outcomes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 4 |
Social worker (Kentucky)
Age: 50 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 7/20
Statement of Opinion:
- Implementation may take time but could gradually reduce healthcare barriers.
- Equity in funding is critical, but it needs to be transparent.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 6 | 7 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 5 | 5 |
Self-employed consultant (Texas)
Age: 45 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 20/20
Statement of Opinion:
- Unlikely to see a direct impact personally but foresee regional economic health improvements.
- Could indirectly affect business if local economies strengthen.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Retired artist (American Samoa)
Age: 82 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 2/20
Statement of Opinion:
- Relocation of funds toward territories is long overdue.
- Hoping for better preventative care and drug assistance.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Retired farmer (Michigan)
Age: 74 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- Important to have funds reach remote areas.
- Ambivalence on effect due to prior unmet promises in rural areas.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 5 |
Retired government worker (U.S. Virgin Islands)
Age: 67 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- Potentially boosts territory healthcare general budget.
- Skeptical on how much will trickle to actual service and care quality improvements.
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 | 7 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
Cost Estimates
Year 1: $3000000000 (Low: $2500000000, High: $3500000000)
Year 2: $3100000000 (Low: $2600000000, High: $3600000000)
Year 3: $3200000000 (Low: $2700000000, High: $3700000000)
Year 5: $3400000000 (Low: $2900000000, High: $3900000000)
Year 10: $4000000000 (Low: $3300000000, High: $4500000000)
Year 100: $10000000000 (Low: $8500000000, High: $11500000000)
Key Considerations
- The complexity of adjusting geographic payments can lead to varying levels of effectiveness.
- Improvements in care quality might reduce long-term Medicare and Medicaid expenditure.
- U.S. territories may require assistance to effectively manage new Medicare programs.