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Opinion: If Nothing Else, the Budget Act Is a Win for Chronic Care

Deficit hawks might not like the recent budget deal, but it brings hope to people living with disabilities and chronic illness

Disability rights advocates gather in the atrium of the Hart Building on July 25, 2017. This year’s bipartisan deal may have alarmed deficit hawks, but it contains provisions that give hope to people living with disabilities and chronic conditions, Hayes writes. (Tom Williams/CQ Roll Call)
Disability rights advocates gather in the atrium of the Hart Building on July 25, 2017. This year’s bipartisan deal may have alarmed deficit hawks, but it contains provisions that give hope to people living with disabilities and chronic conditions, Hayes writes. (Tom Williams/CQ Roll Call)

While the recent passage of the Bipartisan Budget Act of 2018 caused alarm for deficit hawks, one piece of it has given hope to those working to address the needs of people living with disabilities or chronic illness. By reshaping coverage and payment under Medicare, the CHRONIC Care Act could accomplish what decades of federal policy have not.

Now all we have to do is make sure the new law is implemented to create meaningful change.

Over the last year, we’ve seen an acrimonious debate over the future of health care in this country. We have argued about the respective roles of the private sector and government in our health care system, the role of states versus the federal government, and the driver of costs. We have heard as many opinions about how to fix our current system as there are policymakers in Washington.

While this debate will no doubt continue for the foreseeable future, it is important to recognize the significance of the CHRONIC Care Act, which stands for “Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care.”

Nearly three years ago, Senate Finance Committee Chairman Orrin Hatch and ranking member Ron Wyden formed the Chronic Care Working Group, led by Republican Johnny Isakson and Democrat Mark Warner. These leaders and their staffs devoted hundreds of hours to talking with patient groups, health care providers and other experts to develop health policy that would both hold down long-term health care costs and help patients and their families get the care they want and need.

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Sixty percent of adults in this country have at least one chronic condition, and 40 percent have two or more. The federal government and families pay the bulk of these costs at 28 percent each. Private businesses pay 20 percent, and state and local governments 17 percent.

Medicare beneficiaries with four or more chronic conditions account for 90 percent of Medicare hospital readmissions and nearly 75 percent of program spending. Policymakers agree that we could eliminate or delay the onset of these diseases through prevention, but in the near term we must also act to lower the costs and improve quality of care for the most expensive populations.

Many organizations worked for passage of the law, including the Bipartisan Policy Center. The CHRONIC Care Act includes a number of provisions that align with BPC’s Policy Roadmap for Individuals With Complex Care Needs and other reports aimed at improving care for people with chronic illness or disabilities.

The new law:

1) Allows Medicare Advantage plans greater flexibility to help patients and their families by offering coverage of nonmedical services such as grab bars and ramps

2) Provides Medicare beneficiaries with incentives to participate in high-value health care while preserving patients’ choices of health care providers

3) Permanently extends the Medicare Advantage Special Needs Plans (SNPs), to support millions of vulnerable Americans, including those who are eligible for both Medicare and Medicaid and those living with chronic conditions

4) Better aligns regulatory authority for SNPs within the Department of Health and Human Services

5) Unifies the Medicare and Medicaid grievance and appeals process for SNPs to create a single process for Medicare-Medicaid beneficiaries to file complaints or appeal decisions, ensuring that patients continue to receive services during the appeals process

6) Requires SNPs to better integrate care for Medicare-Medicaid beneficiaries by covering all services in a single managed care plan, eliminating confusion for patients who are enrolled in one plan for health services, another for long-term care and a third for behavioral health

7) Extends the successful Independence at Home Demonstration program for two years to help seniors access quality, team-based care at home

8) Expands access to telehealth services under Medicare Advantage, in certain accountable care organizations and for dialysis and stroke patients

We should celebrate the passage of these provisions of the bipartisan budget deal. Yet the story didn’t end with President Donald Trump’s signature; if anything, it has just begun.

As the new law moves toward the regulatory process, we must remain engaged in its implementation to ensure its success.

And we must continue to seek policy solutions that break down the federal, state and local barriers that stand between us and what we need — person- and family-centered coordinated care, support for family caregivers and better private and public financing strategies for the delivery of long-term services and supports.

If we can do that, we can finally shift our focus from temporary Band-Aids to quality care in the long run.

Katherine Hayes is BPC’s director of health policy. She previously served as associate research professor in the department of health policy at the George Washington University School of Public Health and Health Services. Follow her on Twitter @jetthayes.

The Bipartisan Policy Center is a D.C.-based think tank that actively promotes bipartisanship. BPC works to address the key challenges facing the nation through policy solutions that are the product of informed deliberations by former elected and appointed officials, business and labor leaders, and academics and advocates from both ends of the political spectrum. BPC is currently focused on health, energy, national security, the economy, financial regulatory reform, housing, immigration, infrastructure, and governance. Follow BPC on Twitter or Facebook.