A proposed settlement to a nationwide class action suit filed in the U.S. District Court in Vermont could become yet another headache for the world of healthcare. The lawsuit was filed by patient advocacy groups asserting that Medicare eligibility was flawed regarding skilled nursing and home health care. Under current law, Medicare is only required to cover patients if the care is needed to “maintain the patient’s current condition or prevent or slow further deterioration.” The plaintiffs argued that there was no law or regulation that required the improvement and that eligibility should be based on need of care. With the settlement, patients will now be able to qualify for Medicare more easily, especially individuals with chronic conditions or disabilities. This change is all well and good, yet it is adding more people to the already full bill for Medicare, leading to even more costs for the federal program.
Most health reform plans, including the Affordable Care Act (ACA), stress the importance of curbing cost growth in the health entitlement programs. One of the ways the ACA has proposed to cut costs and fund other health programs is through a cut in home health providers’ Medicare reimbursement. The ACA cuts payments by 8%, based on the research that Medicare reimbursement was overpaying the providers for their costs incurred. Over the next ten years, it is projected that this cut will save $40 billion, which will be used on other unpopular ACA provisions. Yet, the settlement being passed increases the number of people using Medicare funded home health. Ironic, huh? We are trying to save money but still adding more to the system, effectively negating any savings that might have been incurred. We are continually finding flaws in the ACA, and this is just another contradiction to add to the list. Given the deep debt our country is already in, we can’t afford to implement ineffective policy like the ACA.