1

The Implications of Increasing the Eligibility

Age of Medicare on the Solvency of the
Medicare Insurance Trust Funds
Ashley Lewis
May 15, 2016

TOPIC
This briefing corresponds to the following codes from the Policy Agendas Project:
Major Topic 3: Health
Sub-Topic 300: General (solvency of Medicare)

ACKNOWLEDGEMENTS
Peer review of this briefing was provided by:
Scott Eisenhart
May 16, 2016

HONORS PLEDGE
By including my name here, I submit that the following briefing materials were prepared by me
and me alone. All source material has been properly cited and documented, in accordance with
the Universitys Policy on Academic Honesty.

Ashley Lewis
 2

TABLE OF CONTENTS

TOPIC
ACKNOWLEDGEMENTS
HONORS PLEDGE
TABLE OF CONTENTS
ISSUE SUMMARY
BIBLIOGRAPHY
APPENDIX A- Legislative Actions
1- Bill Information
2- Committee Hearings
3- Congressional Statements
4- Other
APPENDIX B- Executive Actions
1- Presidential Actions
2- Agency Activities
3- Other
APPENDIX C- Judicial Actions
1- U.S. Supreme Court
2- U.S. Court of Appeals
3- U.S. District Court
4- Other
APPENDIX D- Interest Group Activity
1- Organizational Statements (incl. Press Releases, etc.)
2- Hearing Testimony
3- Public Record Submissions
4- Other
APPENDIX E- Media Coverage
 3

ISSUE SUMMARY

Background

Medicare, the nations Federal health insurance plan, provides coverage to more than

53.8 million eligible Americans, which includes individuals over the age of 65, those that are

under the age of 65 and disabled, and people of all ages with end-stage renal disease. The

program was signed into law July 30, 1965 as an amendment to the Social Security Act of 1935.

It has been fifty years since the program was established, and a lot has changed within the

context of our countrys fiscal, demographic, and structural arenas that has demanded

policymakers to place Medicare reform at the forefront of the policy agenda in order to ensure

the permanence of this program, as well as revitalize our nations economy.

Policymakers have been grappling with a huge federal budget deficit for the past two

decades. The Congressional Budget Office projects that the federal budget deficit will reach

$544 billion this year, which amounts to $105 billion more than the nation owed the previous

year. Rising health care costs, the aging of the Baby Boomer generation, and increases in the

average life expectancy have led to substantial increases in federal health care spending. The

Medicare program accounts for a sizable portion of these expenditures and program spending

is continuously rising as a share of the budget and the nations gross domestic product.1 Not

1
Patricia Neuman and Juliette Cubanski, Policy Options to Sustain Medicare for the Future, Kaiser Family
Foundation, January 29, 2013, https://kaiserfamilyfoundation.files.wordpress.com/2013/02/8402-preface-and-
intro.pdf, Preface.
 4

only do rising health care costs pose issues to the countrys economic status, it also challenges

the sustainability of the Medicare program.

The percentage of federal budget outlays designated to the Medicare program has been

increasing annually, yet the sustainability of the Medicare Insurance trust fund has been

projected to be depleted by 2030. The trustees of the fund have also determined that the fund

is not adequately financed over the next 10 years; therefore something must be done to cover

the shortfall of income relative to projected Hospital Insurance Trust Fund expenditures. As

part of comprehensive approaches to reducing the deficit, policymakers have proposed various

acts of legislation that would restructure the financing, delivery and eligibility of Medicare

services in order to reduce program spending and ensure its perpetuity.

This issue summary will provide a brief overview of the history of the Medicare

program, explain current eligibility requirements, how the program is financed and how

spending has changed in an effort to reduce the federal deficit and improve the solvency of the

Medicare trust fund.

A Brief History of Medicare

In 1945, President Harry Truman became the first US president to propose government-

administered health insurance for all Americans, yet his proposal never came close to becoming

a law. The concept of welfare was too premature to have been positively adopted by the

conservative coalition of Republican and Southern Democrats that controlled Congress at that

time. Additionally, the Cold War aroused a stigma towards socialized medicine and the strong
 5

resistance of the American Medical Association further disillusioned his efforts2. Two decades

later, President Lyndon B. Johnson reintroduced President Trumans concept of federal health

insurance in a rather strategic way, and proposed the Medicare program as an amendment to

the Social Security Act (SSA).3 The Johnson administration aimed to leverage the popularity of

old-age social insurance, in order to strategically push forward their agenda and was successful

in doing so.

On July 30, 1965, President Johnson signed the Social Security Amendments of 1965 into

law and Medicare became the nations first form of federal health insurance. All individuals

ages 65 and older that were deemed eligible for retirement under the Social Security Act

became eligible for health insurance under the new program. Congressman Wilbur Mills, chair

of the House Ways and Means Committee, introduced the three-layer-cake structure of the

act, which gave birth to Medicare Parts A and B, and the Medicaid program. Part A provided

insurance for hospitalization, Part B provided supplementary coverage for primary care visits

and Medicaid provided coverage for medical and health-related services to needy and low-

income families.4 Presidents Johnson believed that older adults in America should not be

denied the healing miracle of modern medicine,5 and by year three, the program was

providing coverage to nearly 20 million enrollees. In 1972, amendments were made to the SSA

2
Jonathan Oberlander and Theodore R. Marmor, The Road Not Taken, What Happened to Medicare for All?, in
Medicare and Medicaid at 50, ed. Alan B. Cohen et. al. (Oxford: University of Oxford Press, 2015), 50.
3
Appendix A: Social Security Act of 1935
4
Medicaid was the expansion of the previously implemented Kerr-Mills Act, which was a program that provided
payments to the states to finance care for low-income residents.
5
Oberland and Marmor, 55.
 6

to expand Medicare coverage to people 65 with end-stage renal disease or permanent

disabilities, which welcomed individuals under the age of 65 to the eligibility pool.

Initially, the Medicare program was structured to be funded by a tax on the earnings of

employees, matched by contributions by employers, but the programs costs rapidly outpaced

the actuarial estimated made at the time of its enactment. Legislators labeled the program an

uncontrollable burden on the federal budget,6 and were concerned about the fiscal problems

that would arise as the program continued to expand. The question of how to contain program

spending began to dominate Medicare politics and policymakers have since then proposed a

plethora of ways to improve the programs state of insolvency.

Although the 1972 Amendments to the SSA expanded the programs reach, it also

introduced the first significant policies aimed at controlling the rate of growth in Medicare

spending.7 The new law established organizations that monitored and reviewed the quality of

hospital care provided to Medicare patients; placed limits on hospital payments made to

providers; and introduced alternative payment methods. Two decades later, another bipartisan

bill8 was signed in an effort to reduce the rate of growth in provider payments while also

promoting private insurer participation in Medicare Advantage plans.9

Over the years, Medicares structure has changed and has become a hybrid of private

and public insurance but one thing that has remained the same is the programs age of

6
Oberlander and Marmor, The Road Not Taken, 62.
7
Ibid.
8
See Appendix A: Balanced Budget Act of 1997
9
Medicare Advantage plans also referred to as Medicare Part C are paid out to providers prior to the
beneficiarys appointment to eliminate the opportunity for providers to abuse the Medicare payment system. This
form of payment is called a capitation payment also aims to minimize health care costs by giving providers a
fixed amount of money per patient, per service. Part C benefits are paid out from the HI and SMI Part B trust fund
accounts.
 7

eligibility. 2015 marked the programs 50th birthday and Medicare has since then provided

coverage to more than 130 million Americans deemed eligible based solely on their age.10

Changes to the programs eligibility age would certainly defy the fidelity of the programs origin,

and would leave millions of Americans uninsured.

Structure of the Current Medicare Program

Medicare Part A provides coverage for hospital care, skilled nursing facility care, home

health services, and hospice care. In order for individuals to be eligible for premium-free Part A

coverage on the basis of their age, individuals must be at least 65 years of age and eligible for

monthly Social Security benefits. Individuals that are already receiving Social Security at least

four months prior to becoming eligible for Medicare are automatically enrolled in both

premium-free Part A and Part B. However, individuals that have not paid payroll taxes under

the Federal Insurance Contributions Act (FICA) over a specified number of quarters of coverage

are required to pay a monthly premium to enroll in Medicare Part A coverage, and may only

enroll during certain enrollment periods.

Medicare Part B provides coverage for preventive care, and services and supplies

deemed medically necessary to manage or treat a disease or condition.11 Since Part A provides

10
Individuals that receive Medicare coverage based on disability or due to a diagnosis of end-stage renal disease
have different requirements for eligibility that are not anticipated to be impacted by an increase in the age of
eligibility, and therefore will not be further explained in this issue summary.
11
John A. Boehner et. al., 2015 Annual Report of the Board of Trustees of the Federal Hospital Insurance and
Federal Supplementary Medical Insurance Trust Funds, July 22, 2016, https://www.cms.gov/research-statistics-
data-and-systems/statistics-trends-and-reports/reportstrustfunds/downloads/tr2015.pdf
 8

the minimum essential (healthcare) coverage required by law,12 all Part B enrollees must pay

a monthly premium for this benefit. About 91% of individuals who participate in Medicare Part

A also enroll in Part B in order to extend their coverage, and this percentage has been steadily

increasing over the last decade as more older adults are living longer with chronic conditions.

Beneficiaries that receive Part A benefits for free are automatically eligible for enrollment in

Part B. Conversely, individuals that pay a premium for Part A benefits are only eligible to enroll

in Part B if they are age 65 or older, and a U.S. resident and citizen or a lawfully admitted alien

that has been residing in the U.S for five continuous years. Once eligible, individuals may only

enroll in Part B during certain enrollment periods.

Medicare Part C offers beneficiaries the option to enroll in coverage under a private

health insurance company that agrees to provide Medicare benefits, and represents the

smallest percentage of program beneficiaries. These Medicare Advantage Plans provide the

same benefits covered by Parts A and B, but under different rules, costs and coverage

restrictions. These differences depend on which plan the beneficiary chooses to enroll in since

this coverage is provided by a private insurer. Individuals are eligible for Part C if they are

enrolled in Medicare Part A and Part B and have not been diagnosed with end-stage renal

disease. All Part C beneficiaries are required to pay the Part B premium and most also pay a

monthly premium for the additional benefits provided by their Medicare Advantage Plan.13

12
Original Medicare (Part A and B) Eligibility and Enrollment, Centers for Medicare & Medicaid Services, last
modified November 3, 2015, https://www.cms.gov/medicare/eligibility-and-
enrollment/origmedicarepartabeligenrol/index.html
13
The Facts on Medicare Spending and Financing, The Henry J. Kaiser Family Foundation, July 24, 2015,
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/
 9

Medicare Financing

Medicare is currently funded through three sources: general revenues, payroll taxes,

and beneficiary premiums paid for coverage under Parts A and B. 14 The Department of the

Treasury manages the programs finances and disperses payments to providers from one of

two trust funds. The Hospital Insurance (HI) Trust Fund pays out Medicare Part A benefits, and

the Supplementary Medical Insurance trust fund (SMI) pays out Medicare Part B benefits. The

1965 Amendment to the SSA established the these trusts to ensure perpetuity of the programs

finances, but the programs original funding structure has proven to be inefficient. A Board of

Trustees manages both Trust Funds.15

The Supplemental Medical Insurance (SMI) Trust Fund is financed by premiums paid by

Medicare Part B beneficiaries, which are intended to cover about 25% of costs, and the general

federal revenue finances the rest. Since beneficiaries will always have to pay a premium to

receive Part B benefits, the SMI trust fund cannot become insolvent. However, Trustees are

concerned about the rapid growth in SMI spending due to increases in provider costs. Most

low-income Medicare beneficiaries receive assistance with paying Part B premiums through

Medicaid funding, which is essentially a shift in the burden of costs from one federal program

to the next. This tax-and-transfer method for healthcare funding contributes to the programs

financing dilemma, but the HI Trust Fund poses the greater concern.

14
Fig. 6
15
The Board of Trustees is comprised of the Commissioner of Social Security, the Secretary of the Treasury, the
Secretary of Labor, and the Secretary of Health and Human Services, all ex officio, and of two members of the
public (both of whom may not be from the same political party), who shall be nominated by the President for a
term of four years and subject to confirmation by the Senate.
 10

The Hospital Insurance (HI) Trust Fund is mainly financed by payroll taxes at a rate of

1.45% for employers and their employees, and 2.9% for individuals that are self-employed.

Since all Medicare beneficiaries must enroll in coverage under Part A in order to participate in

the program, the HI Trust Fund is the primary source of the programs provider payments.

Although the HI is financed through dedicated sources of income,16 the solvency of its reserves

has remained uncertain since the 1970s. This is due to the fact that the HI operates on a pay as

you go basis,17 and its annual revenues are used to cover Part A benefits for todays Medicare

beneficiaries. There has been a significant decrease in the percentage of payroll taxes being

paid into the fund, as millions of older adults near retirement and choose to leave the

workforce. Moreover, program spending on Part A benefits will continue to increase as millions

of individuals from the Baby Boomer generation age into eligibility. The Congressional Budget

Office (CBO) projects that 10,000 people will enroll in Medicare every day for the next 15

years18 - and analysts are calling this shift the silver tsunami.19 Clearly there is more money

going out than coming in and as a result, the Board of Trustees projects the HI to be fully

depleted by year 2030.

16
Patricia A. Davis, Medicare: Insolvency Projections, Congressional Research Service, July 3, 2013,
https://www.fas.org/sgp/crs/misc/RS20946.pdf
17
Davis, Insolvency Projections, 2.; Uwe E. Reinhardt, Medicare Innovations in the War Over the Key to the U.S.
Treasury, in Medicare and Medicaid at 50, ed. Alan B. Cohen et. al. (Oxford: University of Oxford Press, 2015),
182.
18
Dan Diamond, 10,000 People Are Now Enrolling in Medicare Every Day, Forbes.com, July 13, 2015,
http://www.forbes.com/sites/dandiamond/2015/07/13/aging-in-america-10000-people-enroll-in-medicare-every-
day/ - 66d613f75e07
19
Reenita Das, A Silver Tsunami Invades the Health of Nations, Forbes.com, August 11, 2015,
http://www.forbes.com/sites/reenitadas/2015/08/11/a-silver-tsunami-invades-the-health-of-nations/ -
4b1ab2f04c59
 11

Previous legislation has acted to delay the insolvency date of the HI Trust Fund through

changes made to payroll taxes under provisions of the Affordable Care Act, as well as the

incorporation of the HI Fund into larger budget reconciliation laws, yet nothing has had a

significant impact. The federal government is not in a position to allocate an additional funding

stream to the Medicare program since health care spending already amasses a large portion of

the countrys existing deficit. The CBO has concluded that, as the number of beneficiaries and

per capita health care costs continue to grow, total Medicare spending obligations [HI and SMI

spending combined] are expected to place increasing demands on federal budgetary

resources.20

Medicare Spending

Historically, Medicare spending per enrollee grew at an average annual rate of 7.5%

from 1969 2013.21 Yet despite growing health care costs and exponential increases in the

number of individuals eligible for coverage, per capita Medicare spending has been

continuously slowing down, and has averaged 4.1% over the last five years.22 Although a

decrease in per capita spending may signal a positive sign towards the reduction of program

spending, it does not represent the percentage of the total federal budget that Medicare

represents, which remains to be the larger issue in the context of health care reform. In 2014,

Medicare Parts A and B served approximately 34 million people, and provided approximately

20
Lisa Potetz, Juliette Cubanski, and Tricia Neuman, Medicare Spending and Financing: A Primer, The Henry J.
Kaiser Family Foundation, February 2011, https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7731-
03.pdf
21
KFF, Medicare Spending, 1.
22
Ibid.
 12

$350 billion in coverage, totaling $505 billion in net federal Medicare outlays.2324 These

expenditures represented 14% of federal spending that year, and have been expected to

continue increasing. The Office of the Chief Actuary (OACT) projects that Medicares share of

the federal budget will increase to 15.2% by 2024, with more dollars per capita spent per

Medicare enrollee.

Last year, the Trustees of the HI and SMI Trust Funds reported that the projections of

Medicare costs are highly uncertain, especially when looking out more than several decades.25

Scholars have attributed the substantial increases in the cost of providing Medicare coverage to

the following three factors: rising health care costs, aging baby boomers, and increases in the

average life expectancy. None of these factors should be addressed in a vacuum because they

constitute the trifecta of events that are simultaneously restructuring the health policy agenda.

For example, the Congressional Budget Office (CBO) projects that the aging of the population is

expected to account for 60 percent of the growth in federal health spending over the next 25

years,26 which can be attributed to the occurrence of all three factors. In addition, the

development of new scientific advances that aim to serve our aging population will bring forth

new procedures and therapies that will be expected to be covered under Medicare, thus

increasing program costs.

23
Chapter 4: Administration of Grants, Contracts, and Financial and Administrative Management Systems, Office
of Inspector General, U.S. Department of Health & Human Services, 11-15, http://oig.hhs.gov/reports-and-
publications/top-challenges/2015/2015-tmc.pdf
24
Fig. 1
25
Boehner et. al., 2015 Annual Report, 2.
26
Neuman and Cubanski, Policy Options.
 13

The passage of recent legislation, such as The Medicare Access and CHIP

Reauthorization Act of 2015 (MACRA),27 has helped to delay Medicare payment problems that

the Board previously projected yet the long-term implications of these policies remain

uncertain. In addition, the Affordable Care Act28 introduced 165 controversial provisions that

aim to reduce health care costs, but the HIs Board of Trustees feels that many of these

provisions have conversely shifted the costs to other federal programs and will increase the

out-of-pocket expenses incurred by current beneficiaries.

Issue Definition

In a 2015 report, the members of the HI Board of Trustees reported that its funds would

be fully depleted by the year 2030, and that its revenues dedicated to Medicare will be

sufficient to pay only 86 percent of Medicare Part A costs. Although the HI Trust Fund has been

previously projected to become insolvent every year since the 1970 Trustees Report,29 the fund

has never fully hit rock bottom. The date of depletion has continuously been postponed due to

various acts of legislation that attempted to restrain overall health spending. Yet none of the

previously proposed or enacted alternatives have had a notable impact. The Congressional

Budget Office, legislators and additional interested stakeholders have also voiced concern

about the solvency of the fund, and the general consensus is that something must be done to

improve the funding structure of the Medicare program as a whole. As health care costs

27
Appendix A: The Medicare Access and CHIP Reauthorization Act of 2015
28
Appendix A: The Patient Protection and Affordable Care Act of 2010
29
Davis, Insolvency Projections, 4.
 14

continue to rise along with the number of older adults eligible for Medicare, policymakers are

urged to propose solutions that will reduce the overall federal deficit and improve the solvency

of the HI Trust Fund.

Recent discussions concerning the federal deficit included alternatives that would

increase in the age of eligibility for the Medicare program from age 65 to 67. This policy

recommendation first arose in the policy arena in 2011 after the debt ceiling crisis signaled

President Barack Obama to rapidly address the nations growing federal deficit. President

Obama enacted the Budget Control Act30 in an effort to reduce the deficit, which gave birth to a

Super Committee of legislators tasked to develop a plan to cut spending for any program

including funding for Medicare and Medicaid. Rumors began circulating that the legislators

were planning to increase the age of eligibility for the Medicare program, but were halted once

the Committee fell apart since its members could not come to a bipartisan agreement.31 Still

five years later, congressional committees and policymakers have continued to consider this

alleged recommendation as a way to decrease federal health care spending, thus reducing its

impact on the federal deficit.

One major reported issue with increasing the age of eligibility for the Medicare program

is that policymakers are not certain that this policy change would substantially decrease federal

health care spending, nor will it generate enough savings to ensure the solvency of the HI trust

fund. In a 2013 report published by The Kaiser Family Foundation (KFF),32 experts in the field of

30
Appendix A: Budget Control Act of 2011
31
Ted Barrett, Kate Bolduan, and Deidre Walsh, Super Committee Fails to Reach Agreement, CNN, November
21, 2011, http://www.cnn.com/2011/11/21/politics/super-committee/
32
Neuman and Cubanski, Policy Options.
 15

Medicare reform and health policy estimated that if this policy change had been fully phased

out in 2014, it would have generated an estimated $5.7 billion in net savings, but also result in

an estimated net increase of $3.7 billion in out-of-pocket costs for 65- and 66-year-olds, along

with an additional $4.5 billion in employer retiree health-care costs. Many other think tanks

and research institutions have also reported similar projections of the financial impact this

recommendation would have on the federal deficit and the HI trust fund, as well as implications

for its stakeholders.

The CBO projects that raising the eligibility age would decrease the number of

individuals eligible for enrollment in Medicare,33 and would reduce federal budget deficits by

$19 billion between 2016 and 2023.34 In addition, the CBO projects that if this program were

phased-in to the health care system between now and 2023, following a plan similar to the one

implemented to increase the age of Social Security eligibility, a shift in federal spending from

the Medicare program to Medicaid would occur. Moreover, increasing the eligibility age for the

Medicare program will decrease the number of individuals eligible for enrollment in Medicare,

which will increase the cost of coverage for millions of American citizens and leave millions

more uninsured. Of the 5.5 million people projected to be affected by this option by the year

2023, roughly:

50% would obtain insurance from their employer or their spouses employer, or
former employer;

33
Total Number of Medicare Beneficiaries, The Henry J. Kaiser Family Foundation, March 2016,
http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/
34
Paul Jacobs, Raising the Age of Eligibility for Medicare to 67: An Updated Estimate of the Budgetary Effects,
Congressional Budget Office, October 24, 2013, https://www.cbo.gov/sites/default/files/113th-congress-2013-
2014/reports/44661-EligibilityAgeforMedicare.pdf
 16

15% would continue to qualify for Medicare on the basis of their eligibility for
disability benefits;
15% would buy insurance through the exchanges or in the nongroup market;
10% would receive coverage through Medicaid
10% would become uninsured.35

Stakeholders and their Interests

Current Medicare beneficiaries have primarily expressed concern that increasing the age

of eligibility would drive up their premium costs. As more relatively healthy, low-cost

individuals defer enrollment in the optional Part B plan, premiums will rise for its remaining

beneficiaries. Medicare beneficiaries have described the program as a valuable insurance

policy that provides peace of mind as well as financial protection,36 and increasing the age of

eligibility for Medicare benefits makes the young elderly, individuals ages 65- and 66-years

old a major stakeholder in this issue. Individuals under the age of 65 would also bear some of

the burden of these shifts in cost. Premiums in the health care exchange would increase

roughly $141 for individuals under the age of 65 due to the shift of older adults from Medicare

into the risk pool of individuals covered by the exchange. Individuals that would have been

dually eligible for Medicare and Medicaid could still receive Medicaid assistance, but those that

earn higher incomes will not qualify for Medicaid, and will have larger health care expenses

than those eligible to receive subsidies.

Insurance premiums are expected to increase as more older adults enter the risk pools

in the private insurance market. The ACA brought forth provisions that provide subsidies to

35
Ibid.
36
Rashi Fein, The Early Days of Medicare and Medicaid: A Personal Reflection, in Medicare and Medicaid at 50,
ed. Alan B. Cohen et. al. (Oxford: University of Oxford Press, 2015), 53.
 17

low-income individuals to offset the cost of health care premiums in the marketplace. However

the risk pool that was once filled with young and middle-aged adults that did not receive

coverage under an employer, will continuously experience an influx of individuals ages 65 and

66 who are more likely to have chronic illnesses and higher percentages of insurance claims.

Although a study published by The Urban Institute revealed that the young elderly population is

the least costly group of Medicare beneficiaries,37 they are still considered to pose a greater risk

amongst other individuals in the private marketplace. Insurance companies will not hesitate to

capitalize on the opportunity to charge its enrollees higher rates. Although the ACA contains

provisions to keep private insurance rates affordable, the market is still monopolistically

competitive, and they have some control over their pricing.

Organizations that advocate for the rights and benefits of older adults and all Americans

are also large stakeholders in this issue. This policy option aims to revoke the benefits of the

Medicare program from this group of American taxpayers for two years, which would be

disheartening and unethical. Principally, any changes made to federal entitlement programs

challenges the rights and the values of our government. Changes to the eligibility age has been

described as a renege on a promise to workers who contributed payroll taxes to Medicare

throughout their working lives with the expectation that they would be covered when they

reach age 65.38 It has been argued that this benefit is owed to them, regardless of the federal

governments ability to pay. The American Association of Retired Persons (AARP) explains that,

Social insurance programs are the financial foundation for all families across America, but

37
Amy J. Davidoff and Richard W. Johnson, Raising the Medicare Eligibility Age: Effects on the Young Elderly,
Health Affairs 22 (2003): 201, accessed May 14, 2016, doi: 10.1377/hlthaff.22.4.198.
38
Neuman and Cubanski, Policy Options.
 18

particularly for the middle class and those at are near poverty.39 Moreover, Black and Hispanic

adults, and others with low-incomes in this age group would be disproportionately affected.

The existing structure of the Medicare program requires all Americans to pay a

percentage of their income their entire working lives to ensure that their healthcare costs

would be covered when they retire or reach age 65. Most Americans believe that these taxes

are saved to pre-fund their health care coverage, but are not aware that the sum of their

taxes paid would not merely cover the total cost of their care for the rest of their life after age

65. Thus, increasing the age of eligibility would create a larger pool of uninsured individuals

since older adults ages 65 and 66 would have to find alternative sources of coverage.

Employers are concerned that increasing the age of eligibility for the Medicare program

would increase their costs. Since most companies offer retiree health benefits, increasing the

age of eligibility would lead more retirees to continue relying on employer plans for primary

coverage. It would also place a burden on those with physically demanding jobs that may be

unable to work an additional two years, creating incentives to remain employed if that is the

only option for retaining health insurance. Currently, the law requires employers to continue

offering health insurance to those who stay on the job past 65, even though they would be

eligible for Medicare. Employers premiums for these workers are much higher than for young

workers, which means employers may have a logical reason to want anyone past 65 off the

payroll and make older job-seekers less marketable.

39
The Priorities Book: Building a Better Future 2015 2016, AARP, accessed April 29, 2016.
http://www.aarp.org/content/dam/aarp/about_aarp/aarp_policies/2015-05/AARP-Priorities-Book-2015-2016.pdf
 19

Supporters of increasing the age of Medicare eligibility to 67 believe that eligibility

should coincide with the average age of retirement in order to keep capable older adults

productively engaged in the workforce. Due to modern medicine and the advent of new

technologies that enables us to live longer, healthier lives, it is argued that there is a less urgent

need for these subsidized health benefits that were first created when the average life

expectancy was 72 years. Proponents also observe that increasing the Medicare eligibility age

to 67 would reflect improvements in the average life expectancy among Americans, as this

policy would conform the program to the full retirement age eligible for Social Security. Some

supporters lay claim that individuals begin receiving Medicare benefits as soon as they turn 65,

and retire soon after primarily because they expect to be supported by the government.

Raising the age of eligibility would also encourage workers to delay retirement if they
are physically able to work beyond age 65, which ultimately would increase both
general revenue and payroll tax contributions, thereby strengthening the Medicare and
Social Security trust funds and alleviate pressure on the federal budget.40

Stuart Butler, Director of the Heritage Foundations Center for Policy Innovation,

supports the option to raise the Medicare eligibility age and claims, It must be done carefully,

to make sure that older workers still have health insurance.41 Similar to the argument used to

support the increase in age for Social Security eligibility, policymakers that believe that

increasing the age of Medicare eligibility is a way to align the entitlement to government

40
Neuman and Cubanski, Policy Options.
41
Stuart Butler and Henry J. Aaron, Reforming Medicare, Option: Raise the Medicare Eligibility Age, AARP Public
Policy Institute, June 1, 2012,
http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/option-raise-the-medicare-
eligibility-age-AARP-ppi-health.pdf
 20

benefits with the average age of retirement. AARP released a statement in their Medicare

Principles and Policy publication that read:

All Medicare participants [beneficiaries, providers, suppliers, and plans] should

contribute to its viability. Shared accountability will differ for providers, beneficiaries,
and the program itself, but each should be responsible for ensuring the prudent use of
Medicare resources.42

While the organization is traditionally known for its advocacy work relative to the lives of

retired persons, this statement is encouraging all individuals to work to ensure the

sustainability of the program.

Current Status of the Issue

The number of people age 65 and older in the U.S. will almost double between 2012 and

2050, increasing from 43.1 million in 2012 to 83.7 million, a proportion equal to 1 in every 5

Americans.43 At the same time this large demographic shift is occurring, we are also in the

midst of great health care system change, as payments become value-based, and systems focus

more on population health. The health care priorities of the nation are changing, especially

among Medicare recipients ages 65+. Our current health care system is not structured to

adequately address this new context for older adults, and scholars are encouraging

policymakers to consider Medicare as the primary insurer for older adults in the United States

42
Medicare Principles and Policy, AARP, accessed May 10, 2016, http://policybook.aarp.org/the-policy-
book/chapter-7/p094-1.2034604
43
Julie Bynum, A New Understanding of Health System Performance for Older Adults, Health Affairs (blog),
March 14, 2016, http://healthaffairs.org/blog/2016/03/14/a-new-understanding-of-health-system-performance-
for-older-adults/
 21

in order to address the unique needs of our aging population.44 Medicare has influenced the

social identity and expectations of its beneficiaries since the programs inception,45 and

increasing the programs age of eligibility has sparked discussion among a wide range of

stakeholders.

Advocacy organizations such as AARP, employers, current program beneficiaries and the

young elderly are among those in opposition. It has been argued that increasing the age of

eligibility will not decrease program spending, nor will it have a large impact on the nations

deficits. Opponents of this alternative also argue that increasing the age of eligibility would

increase the rates of uninsured minorities, low-income individuals and unemployed and/or

displaced workers. Moreover, the absence of alternative sources of coverage and subsidies for

those with modest incomes would shift costs and risk onto retirees and delay retirement for

millions of Americans.

However, supporters of the increase in the age of eligibility claim that the adjective

old no longer represents this age cohort, and that this alternative would make the program

more current and still provide coverage to older adults when they need it the most. There

has not been a lot of recent legislative action on this issue since 2013, but it would behoove the

incoming president to address the depleting Hospital Insurance Trust Fund and the federal

deficit that has resulted from increases in health care spending.

44
Ibid.
45
Mark Schlesinger, Medicare and the Social Transformations of American Elders, in Medicare and Medicaid at
50, ed. Alan B. Cohen et. al. (Oxford: University of Oxford Press, 2015), 138.
 1

BIBLIOGRAPHY
AARP. The Priorities Book: Building a Better Future 2015 2016. Accessed April 29, 2016.
http://www.aarp.org/content/dam/aarp/about_aarp/aarp_policies/2015-05/AARP-
Priorities-Book-2015-2016.pdf

AARP. Medicare Principles and Policy. Accessed May 10, 2016.

http://policybook.aarp.org/the-policy-book/chapter-7/p094-1.2034604

Barrett, Ted, Kate Bolduan, and Deidre Walsh. Super Committee Fails to Reach Agreement.
CNN, November 21, 2011. http://www.cnn.com/2011/11/21/politics/super-committee/

Boehner, John A., Joseph R. Biden, Jacob J. Lew, Thomas E. Perez, Sylvia M. Burwell, Carolyn W.
Colvin, Charles P. Blahous III, Robert D. Reischauer, and Mandy Cohen. 2015 Annual
Report of the Board of Trustees of the Federal Hospital Insurance and Federal
Supplementary Medical Insurance Trust Funds. July 22, 2016.
https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-
reports/reportstrustfunds/downloads/tr2015.pdf

Butler, Stuart and Henry J. Aaron. Reforming Medicare, Option: Raise the Medicare Eligibility
Age. AARP Public Policy Institute. June 1, 2012.
http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/optio
n-raise-the-medicare-eligibility-age-AARP-ppi-health.pdf

Bynum, Julie. A New Understanding of Health System Performance for Older Adults. Health
Affairs (blog), March 14, 2016. http://healthaffairs.org/blog/2016/03/14/a-new-
understanding-of-health-system-performance-for-older-adults/

Centers for Medicare & Medicaid Services. Original Medicare (Part A and B) Eligibility and
Enrollment. Last modified November 3, 2015.
https://www.cms.gov/medicare/eligibility-and
enrollment/origmedicarepartabeligenrol/index.html

Das, Reenita. A Silver Tsunami Invades the Health of Nations. Forbes, August 11, 2015.
http://www.forbes.com/sites/reenitadas/2015/08/11/a-silver-tsunami-invades-the-
health-of-nations/ - 4b1ab2f04c59
 2

Davidoff, Amy J. and Richard W. Johnson. Raising the Medicare Eligibility Age: Effects on the
Young Elderly. Health Affairs 22 (2003): 198-209. Accessed May 14, 2016
doi: 10.1377/hlthaff.22.4.198

Diamond, Dan. 10,000 People Are Now Enrolling in Medicare Every Day. Forbes, July
13, 2015. http://www.forbes.com/sites/dandiamond/2015/07/13/aging-in-america-
10000-people-enroll-in-medicare-every-day/ - 66d613f75e07

Fein, Rashi. The Early Days of Medicare and Medicaid: A Personal Reflection, in Medicare and
Medicaid at 50, edited by Alan B. Cohen, David C. Colby, Keith A. Wailoo, and Julian E.
Zelizer, 39-54. Oxford: University of Oxford Press, 2015.

The Henry J. Kaiser Family Foundation. The Facts on Medicare Spending and Financing. July
24, 2015. http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-
sheet/

The Henry J. Kaiser Family Foundation. Total Number of Medicare Beneficiaries. March 2016.
http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/

Jacobs, Paul. Raising the Age of Eligibility for Medicare to 67: An Updated Estimate of the
Budgetary Effects. Congressional Budget Office. October 24, 2013.
https://www.cbo.gov/sites/default/files/113th-congress-2013-2014/reports/44661-
EligibilityAgeforMedicare.pdf

Leonard, Kimberly. For the First Time, Health Care Spending is Higher than Social Security.
U.S. News and World Report. January 25, 2016.
http://www.usnews.com/news/articles/2016-01-25/health-care-programs-contribute-
to-increasing-federal-deficit

Neuman, Patricia and Juliette Cubanski. Policy Options to Sustain Medicare for the Future.
The Henry J. Kaiser Family Foundation, January 29, 2013.
https://kaiserfamilyfoundation.files.wordpress.com/2013/02/8402-preface-and-
intro.pdf

Oberlander, Jonathan and Theodore R. Marmor. The Road Not Taken, What Happened to
 3

Medicare for All? In Medicare and Medicaid at 50, edited by Alan B. Cohen, David C.
Colby, Keith A. Wailoo, and Julian E. Zelizer, 55-74. Oxford: University of Oxford Press,
2015.

Office of Inspector General, U.S. Department of Health & Human Services. Chapter 4:
Administration of Grants, Contracts, and Financial and Administrative Management
Systems. In 2015 Top Management and Performance Challenges Facing the
Department of Health and Human Services, 11-15. http://oig.hhs.gov/reports-and-
publications/top-challenges/2015/2015-tmc.pdf

Ortman, Jennifer M. and Victoria K. Velkoff. An Aging Nation: The Older Population in the
United States. United States Census Bureau, May 2014.
https://www.census.gov/prod/2014pubs/p25-1140.pdf

Potetz, Lisa, Juliette Cubanski, and Tricia Neuman. Medicare Spending and Financing: A
Primer. The Henry J. Kaiser Family Foundation. February 2011.
https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7731-03.pdf

Reinhardt, Uwe E. Medicare Innovations in the War Over the Key to the U.S. Treasury. In
Medicare and Medicaid at 50, edited by Alan B. Cohen, David C. Colby, Keith A. Wailoo,
and Julian E. Zelizer, 169-189. Oxford: University of Oxford Press, 2015.

Schlesinger, Mark. Medicare and the Social Transformations of American Elders. In Medicare
and Medicaid at 50, edited by Alan B. Cohen, David C. Colby, Keith A. Wailoo, and Julian
E. Zelizer, 119-144. Oxford: University of Oxford Press, 2015.
 1

APPENDIX A- Legislative Actions

1- Bill Information
1. Social Security Act of 1935
Signed into law by President Franklin D. Roosevelt on August 14, 1935

The Social Security Act of 1935 awarded retirees with paid benefits after they reached
the age of 65 in the form of a one-time lump-sum payment. This Act was the nations
first form of social insurance, and future amendments expanded the Act into a piece of
legislation that encompasses a multitude of services

2. H.R. 3708: Older Americans Act (1965)

Introduced January 27, 1965.
Signed into law by President Lyndon Johnson on July 14, 1965.

The Older Americans Act (OAA) was enacted in 1965 by the 89th United States Congress as a
component of President Lyndon B. Johnsons Great Society reform, which aimed to eliminate
poverty and racial injustice through the development of social services and community welfare
programs. The OAA established the Administration on Aging (AOA) as an agency within the
Department of Health and Human Services (DHHS) to carry out the provisions of the Act, and
remains the principle federal organization that caters to the needs of older adults in America.

The AOAs mission statement includes:

The OAA is considered to be the major vehicle for the (Administration on Aging) and
delivery of social and nutrition services to this group and their caregivers. It authorizes a
wide array of service programs maintaining the dignity and welfare of older individuals
and created the primary vehicle for organizing, coordinating and providing community-
based services and opportunities for older Americans and their families.

3. S.365 - Budget Control Act of 2011

Introduced February 16, 2011.
Signed into law by President Barack Obama on August 2, 2011.
 2

Significance: The Budget Control Act of 2011 lowered Medicare spending through
sequestration that reduced payments to providers and plans by 2% beginning in 2013.46

In 2011, the nation was experiencing a debt-ceiling crisis and the members of Congress
had long been struggling to develop a bipartisan plan that would decrease the federal
debt and deficit. President Barack Obama signed the Budget Control Act (BCA) of 2011
into law as an act to provide for budget control, which gave birth to the Joint Select
Committee on Deficit Reduction. President Obama developed this Super Committee
under a provision of the BCA in order to bring policymakers together to negotiate a plan
that would decrease the federal deficit by at least $1.2 trillion over a 10-year period. In
order to encourage the twelve-committee members to reach a consensus, the BCA
contained provisions that would result in automatic, across-the-board budget cuts if a
plan was not established by the end of the year. Unfortunately, the committee
members were not able to come to an agreement by the deadline, and the sequester
was enacted. Although most social welfare programs were exempt from budget cuts,
Medicare and Medicaid programs accounted for a large portion of federal spending, and
were growing faster than the overall economy,47 so in order to reduce the overall
deficit, Congress enacted a plan to reduce payments to Medicare providers and plans by
2%.48 However, this provision did not significantly reduce federal health care spending
as anticipated, nor did it improve the solvency of the Medicare program. Yet it adversely
increased out-of-pocket expenses for Medicare beneficiaries and decreased payment to
providers.

4. H.R.2 The Medicare Access and CHIP Reauthorization Act of 2015

Introduced by Rep. Michael C. Burgess on March 24, 2015
Signed into law by President Barack Obama on April 16, 2015

Significance: The Medicare Access and CHIP Reauthorization Act of 2015 restructured
Medicares payment systems to slow down program spending and improve the quality
of care provided to Medicare beneficiaries.

Medicare has traditionally followed a cost-based, fee-for-service (FFS) payment system

that paid health care providers based on the number of services they delivered, without

46
The Facts on Medicare Spending and Financing, The Kaiser Family Foundation, July 24, 2015,
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/
47
http://khn.org/news/debt-deal-faq/
48
The Facts on Medicare Spending and Financing, The Kaiser Family Foundation, July 24, 2015,
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/
 3

much regard to the quality of the services being provided. However, FFS payment
systems have evolved over time, providers are now being offered prospective and
bundled payments for their services as an attempt to constrain the growth in program
spending.49 On April 14, 2015, the Medicare Access and CHIP Reauthorization Act of
2015, known as MACRA, was passed with bi-partisan support and was signed into law by
President Obama on April 16, 2015. MACRA is expected to accelerate paying for and
rewarding the value of services providers give to their patients, thus incentivizing
providers to provide quality care and reduce program spending.

(Sec. 211) Makes permanent the qualifying individual (QI) program under which states
pay Medicare Part B premiums for low-income Medicare beneficiaries with income
between 120% and 135% of the federal poverty level. Extends funding for the QI
program through FY2016, with a formula for increasing subsequent allocations.

(Sec. 402) Adjusts income thresholds for Medicare part B (Supplementary Medical
Insurance) premiums for years beginning with 2018.

5. The Patient Protection and Affordable Care Act

Introduced by Rep. Charles Rangel on September 17, 2009 as the Service Members
Home Ownership Tax Act of 2009.
Signed into law by President Barack Obama on March 23, 2010.

(ACA, P.L. 111-148 and P.L. 111-152) Independent Payment Advisory Board
An amendment to the ACA established the Independent Payment Advisory Board as a
team of 15 experts tasked to make policy recommendations about Medicare spending
reductions to Congress; to reduce the per capita rate of growth in Medicare spending if
projected spending growth exceeds target levels.50 Since this has not happened, the
IPAB has yet to be constituted and no members have yet to be nominated. The board is
prohibited from recommending changes in premiums, benefits, eligibility, taxes, or
other changes that would result in rationing.51 However, if the age of Medicare eligibility
were to increase, this would trigger the IPAB to act. In 2015, there were a lot of

49
Patrick H. Conway et al., MACRA: New Opportunities For Medicare Providers Through Innovative Payment
Systems (Updated). Health Affairs (blog), http://healthaffairs.org/blog/2015/09/28/macra-new-opportunities-for-
medicare-providers-through-innovative-payment-systems-3/
50
https://www.fas.org/sgp/crs/misc/R44075.pdf
51
Section 5: Medicare Program Administration of Policy Options to Sustain Medicare for the Future, Kaiser
Family Foundation, January 29, 2013, https://kaiserfamilyfoundation.files.wordpress.com/2013/02/8402-section-
five.pdf
 4

proposed pieces of legislation that aimed to repeal the IPAB board, however none of the
provisions were passed.

2- Committee Hearings
The following committees have held hundreds of hearings concerning the solvency of
the HI Trust Fund and federal health care spending. All of the transcripts for these
hearings can be found at:
Joint Select Committee on Deficit Reduction
House Committee on Ways & Means
House Committee on Energy & Commerce
House Committee on Education & the Workforce
Senate Finance Committee
Senate Committee on Health, Education, Labor, & Pensions (HELP)

Significance: The House and Senate each have a Budget Committee and an
Appropriations Committee, which oversee the federal budget and federal spending,
respectively. These committees are also important, because the federal budget includes
spending on health care programs.

3- Congressional Statements
NONE

4- Other
NONE

APPENDIX B- Executive Actions

1- Presidential Actions
NONE
 5

2- Agency Activities
The following agencies and sub-agencies have published thousands of documents about
Medicare reform, the status of the solvency of the HI Trust Fund, and health care
spending and the federal deficit:

Department of Health and Human Services (HHS)

Sub-Agencies:
Agency for Healthcare Research and Quality
Aging Administration
Centers for Medicare & Medicaid Services
(formerly known as the Health Care Finance Administration)
Reform of Requirements from Long-Term Care Facilities
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0ahUKE
wiM49fToMTLAhXBJx4KHaogCKwQFggkMAE&url=https%3A%2F%2Fwww.cms.gov%2FM
edicare%2FProvider-Enrollment-and-
Certification%2FSurveyCertificationGenInfo%2FDownloads%2FSurvey-and-Cert-Letter-
15-46.pdf&usg=AFQjCNFryrFT3kJv9UfJCCDloCS2bfYcMg&cad=rja
Health Resources and Services Administration
National Institutes of Health
Office of Inspector General
10-28-2015: Final Waivers in Connection with the Shared Savings Program
04-07-2011: Medicare Program; Waiver Designs in Connection With the Medicare Shared
Savings Program and the Innovation Center
o http://oig.hhs.gov/authorities/docs/2011/fr_04072011.pdf
o Health Care Fraud and Abuse Control Program Report, Fiscal Years 1997-2015
http://oig.hhs.gov/reports-and-publications/hcfac/index.asp
FY2015 (p.42: The Medicare claims processing systems did not have
sufficient prepayment edits in place to prevent all overpayments.)
o Semiannual Report to Congress Archive
o OIG Annual Work Plan Archive
o OIG Compendium of Unimplemented Recommendations

3- Other
 6

APPENDIX C- Judicial Actions

1- U.S. Supreme Court

NONE

2- U.S. Court of Appeals

NONE

3- U.S. District Court

NONE

4- Other
 7

APPENDIX D- Interest Group Activity

1- Organizational Statements (incl. Press Releases, etc.)

The American Federation of State, County and Municipal Employees (AFSCME) Union
Significance: AFSCME is the largest public services employees union that has more than 1.6
million working and retired members, whose mission is to fight for fairness in our
communities and in the halls of government to strengthen and protect Medicare and
Social Security for this and the next generation. The organization consistently publishes
statements, letters, fact sheets and issue briefs on Medicare reform.

Site map of AFSCME publications: http://www.afscme.org/issues/medicare-social-security

Relevant Publications:
Fact Sheet: GOP House Budget Threatens Medicare
http://www.afscme.org/issues/medicare-social-security/resources/document/GOP-
Budget-Threatens-Medicare-Fact-Sheet.pdf
Statement for the Record by AFSCME for the Hearing on the Future of Medicare
Advantage Health Plans
http://www.afscme.org/issues/medicare-social-security/letters-statements/f/AFSCME-
Statement-on-Medicare-Advantage-7-24-14.pdf
AFSCME urges Congress to Protect Medicare from legal waste, fraud and abuse
http://www.afscme.org/issues/medicare-social-security/letters-
statements/document/AFSCME-statement-on-protecting-Medicare-from-Waste-Fraud-
and-Abuse.pdf
AFSCME urges Senators to Co-Sponsor the Medicare Protection Act (S. 2087)
http://www.afscme.org/issues/medicare-social-security/letters-
statements/document/AFSCME_cosponsor_S2087-1.pdf
AFSCME Opposes Overcharging Medicare Beneficiaries
http://www.afscme.org/issues/medicare-social-security/letters-
statements/document/AFSCME-Letter-Opposing-the-Elimination-of-Medicare-
Protections-from-Balance-Billing.PDF
AFSCME Opposes Increasing Beneficiary Cost-Sharing to Reduce the Deficit
http://www.afscme.org/issues/medicare-social-security/letters-
statements/document/AFSCME-Statement-Medicare-Benefit-Design-2-26-13-Final-
WEB-wcover.pdf
 8

AFSCME, SEIU and NEA Launch Ad Campaign to Protect Social Security, Medicare,
Medicaid and Education
http://www.afscme.org/news/press-room/press-releases/2012/afscme-seiu-and-nea-
launch-ad-campaign-to-protect-social-security-medicare-medicaid-and-education
Affordable Care Act Cracks Down on Medicare Fraud
http://www.afscme.org/issues/medicare-social-security/letters-
statements/document/AFSCME-Statement-for-the-Record-on-the-Hearing-for-
Medicare-Contractors-Efforts-to-Fight-Fraud-06.08.12.PDF
Statement of AFSCME Pres. Lee Saunders on President Obamas Remarks
http://www.afscme.org/news/press-room/press-releases/2012/statement-of-afscme-
pres-lee-saunders-on-president-obamas-remarks
A Stealth Attack on Social Security, Medicare and Medicaid
http://www.afscme.org/news/press-room/press-releases/2011/statement-of-afscme-
pres-mcentee-in-response-to-house-republicans-passing-their-cut-cap-and-kill-
medicare-bill
AFSCME Statement for the House Ways and Means Committee on Medicare Trustees
Report
http://www.afscme.org/issues/medicare-social-security/letters-
statements/document/AFSCME_testimony_to_Ways_and_Means_on_Medicare_Truste
es_Report.pdf

Leadership Council of Aging Organizations (LCAO)

Significance: The LCAO is comprised of 72 advocacy groups that collaborate to publish

letters and position papers concerning the interest of senior citizens.

Relevant Publications:
Letter to President Obama Recommendations for Fiscal Year 2017 Budget
http://www.lcao.org/letter-to-president-obama-recommendations-for-fiscal-year-2017-
budget/
Letters to House and Senate Responding to President Obamas Fiscal Year 2017
Budget
http://www.lcao.org/letters-to-house-and-senate-responding-to-president-obamas-
fiscal-year-2017-budget/
Letter LCAO FY 2016 Appropriations
http://www.lcao.org/letter-lcao-fy-2016-appropriations/
 9

Chairs Letter Opposing Increases in Medicare Part B Premiums and Deductible in 2016
(House)
http://www.lcao.org/letter-opposing-increases-in-medicare-part-b-premiums-and-
deductible-in-2016-house/
Chairs Letter Opposing Increases in Medicare Part B Premiums and Deductible in 2016
(Senate)
http://www.lcao.org/chairs-letter-opposing-increases-in-medicare-part-b-premiums-
and-deductible-in-2016/
Letter to House on Older Americans Act Reauthorization Act of 2015
http://www.lcao.org/letter-to-house-on-older-americans-act-reauthorization-act-of-
2015/
Letter Medicare Observation
http://www.lcao.org/letter-medicare-observation-status/
Letter Medicare Balance Billings
http://www.lcao.org/letter-medicare-balance-billings/

Medicare Rights Center

Comments in Response to Senate Finance Committee Chronic Care Working Group
Proposals
2014 Medicare Trends and Recommendations
Comments on Medicare-Medicaid Plan Quality Ratings Strategy
Sign-on Letter for Notice of Benefit and Payment Parameters for 2017
Comments on Alternative Payment Model (APM) Framework, Draft White Paper
Comments on Notice of Benefit and Payment Parameters for 2017
Comments on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
2013 Medicare Trends and Recommendations
Health Reform and Medicare: The Doughnut Hole in 2015

Medicare Payment Advisory Commission (MedPAC)

Actor: Dr. Francis, J. Crosson, MedPAC Chairman
Relevant Publications:
Comments on CMSs proposed rule on the Medicare shared saving program
http://www.medpac.gov/documents/comment-letters/medpac-comment-on-cms's-
draft-quality-measure-development-plan.pdf?sfvrsn=0
 10

Supporting the Transition to MIPS and APMs

http://www.medpac.gov/documents/comment-letters/medpac-comment-on-cms's-
draft-quality-measure-development-plan.pdf?sfvrsn=0
Report to the Congress, March 2016
http://www.medpac.gov/documents/fact-sheets/fact-sheet-on-medpac's-march-2016-
report-to-the-congress-medicare-payment-policy.pdf?sfvrsn=0

2- Hearing Testimony
NONE

3- Public Record Submissions

NONE

4- Other
 11

APPENDIX E- Media Coverage

CNN
Health care reform: Issues roundup
http://www.cnn.com/2012/06/14/health/heath-care-roundup/
Medicare: Seniors saved $3.7 billion on medicine
http://money.cnn.com/2012/06/25/pf/health-reform-medicare/index.htm
 12

Fig. 1: Medicare as a Share of the Federal Budget, 2014, The Henry J. Kaiser Family Foundation

Fig. 6: Sources of Medicare Revenue, 2014, The Henry J. Kaiser Family Foundation