Bill Overview
Title: Consumer Choice of Care Act
Description: This bill prohibits the Centers for Medicare and Medicaid Services from refusing to designate a service as a covered hospital outpatient service under Medicare based solely on its determination that the service can only be safely furnished in an inpatient setting.
Sponsors: Rep. Spartz, Victoria [R-IN-5]
Target Audience
Population: individuals covered by Medicare
Estimated Size: 54500000
- The bill pertains to Medicare, a federal health insurance program primarily for individuals who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
- The bill impacts the Centers for Medicare and Medicaid Services, which administers these health service programs at a national level.
- The prohibition against refusing coverage could potentially expand access to outpatient services for those currently covered under Medicare.
- This legislation will affect facilities that offer outpatient services, such as hospitals and clinics.
- Seniors are particularly targeted since Medicare primarily serves people aged 65 and over.
Reasoning
- We have designed these 10 interviews to encompass different segments of the Medicare population targeted by the policy, including seniors living independently, those in assisted living, younger individuals with disabilities, and healthcare providers impacted by the change. Our main goal is to observe variations in wellbeing scores, accounting for how the policy's allowance for more outpatient services might enhance personal healthcare flexibility and accessibility.
- The budget constraints suggest careful prioritization. With $350 million available in the first year and over $4 billion over 10 years, resources will likely first reach the most immediate hospital and clinic adjustments required for the policy implementation, followed by ongoing support for outpatient service coverage.
- Since the target population is approximately 54.5 million, the policy may not affect every individual within the Medicare program right away, nor will every individual be impacted equally. Hence, we included people experiencing different levels of impact ranging from 'none' to 'high'.
- The commonness score from 1 to 20 reflects our effort to balance the mix of 'common' experiences and less prevalent but important perspectives among Medicare beneficiaries.
Simulated Interviews
Retired teacher (Miami, FL)
Age: 67 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 18/20
Statement of Opinion:
- I'm glad the policy will allow more services to be covered for outpatient care. Traveling for medical services can be exhausting.
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 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 4 |
Retired farmer (Des Moines, IA)
Age: 72 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- I would appreciate more local services. Traveling far for basic care can be cumbersome.
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 | 7 | 5 |
| Year 20 | 6 | 4 |
Part-time librarian (Austin, TX)
Age: 65 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 13/20
Statement of Opinion:
- I don't often need hospital care, so the policy won't impact my health much.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
Retired engineer (Portland, OR)
Age: 68 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 9/20
Statement of Opinion:
- Reducing travel stress by accessing more local clinics would be beneficial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 7 | 2 |
Retired nurse (Seattle, WA)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 12/20
Statement of Opinion:
- I think the policy makes sense, but personally it does not change much for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Social worker (New York, NY)
Age: 50 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 14/20
Statement of Opinion:
- The ability to attend outpatient centers in town is a crucial improvement for people like me.
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 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retired construction worker (Phoenix, AZ)
Age: 80 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 17/20
Statement of Opinion:
- This change seems decent for others, but personally, I get good care it's just a hassle.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Medical technician (Chicago, IL)
Age: 60 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 16/20
Statement of Opinion:
- I prefer choosing where and how I get my care, so this makes sense. But I won't feel big differences.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 5 |
Healthcare advocate (Los Angeles, CA)
Age: 54 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- This policy represents progress by acknowledging diverse outpatient needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 9 | 7 |
| Year 5 | 9 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
Retired professor (Boston, MA)
Age: 75 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 11/20
Statement of Opinion:
- Allowing more outpatient options can potentially improve access to tailored care.
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 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 4 |
Cost Estimates
Year 1: $350000000 (Low: $300000000, High: $400000000)
Year 2: $360000000 (Low: $310000000, High: $410000000)
Year 3: $370000000 (Low: $320000000, High: $420000000)
Year 5: $400000000 (Low: $350000000, High: $450000000)
Year 10: $450000000 (Low: $400000000, High: $500000000)
Year 100: $600000000 (Low: $500000000, High: $700000000)
Key Considerations
- The primary concern is balancing increased immediate Medicare spending against potential long-term savings through reduced hospital stays and improved outpatient care efficiency.
- Communicating the change to both providers and patients will be crucial to ensure smooth implementation and utilization of newly available outpatient services.