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11) What would the plan actually do to fix health care and why doesn’t it do more?

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Though much of the “low hanging fruit” for health care cost control was included in the Patient Protection and Affordable Care Act (PPACA), the Commission proposed over $400 billion in health savings with the goal of further bending the health care cost curve. For example, the Commission proposed reforming cost sharing rules to offer Medicare beneficiaries better catastrophic coverage but make them more price sensitive to routine health services.

In addition, the Commission called for medical malpractice liability reform, changes to physician payments which encourage coordinated care, the acceleration and expansion of the payment reform pilots and other demonstration projects in PPACA that show potential to achieve cost savings, and the elimination of provider carve outs under the Independent Payment Advisory Board (IPAB). It also recommended “piloting” premium support through the FEHB program and increasing state Medicaid waivers to allow them to experiment with other cost control measures.

On top of this, the commission reduced federal health spending in a number of ways – including reducing payments for graduate (and indirect) medical education, limiting the ability of States to manipulate their federal Medicaid matches by taxing providers, expanding Medicaid drug rebates to low-income Medicare recipients, and reducing fraudulent payments. 

Furthermore, the commission’s tax reform plan would limit or eliminate the tax benefits for employer provider health insurance – a change which economists and health care experts of all stripes agree would slow health care cost growth.

And finally, the Commission recommended replacing the government’s open-ended commitment to health care with a budget for all federal budgetary commitments to health care (on the tax and spending side) that grows at GDP+1. Should the reforms from PPACA and the Commission proposal be insufficient to meet this cap, the Commission recommended considering a wide range of options, including premium support, Medicaid block granting, increasing the retirement age, instituting a public option, strengthening IPAB, strengthening CMS to be a more active purchaser of health care services to promote high value care, or moving to an all-payer system.