The effects of medicare advantage payment reductions on low income elderly medicare beneficiaries

 描述（由申请人提供）：拟议研究的目的是估计2010年《患者保护和平价医疗法案》（ACA）要求的政府支付医疗保险优势（MA）计划的减少对低收入医疗保险受益人的影响。MA计划每月从医疗保险中为每个参保者收取人头费，并根据参保者的风险进行调整。以前的研究表明，计划通过提供更高的福利和/或更低的自付保费来应对更高的支付率。这在地理上都是正确的（即，支付率较高的县的计划比支付率较低的地区的计划提供更多的福利），并随着时间的推移。ACA大幅减少了MA计划的付款，国会预算办公室（CBO）估计ACA的新付款公式将在十年内减少1320亿美元的MA付款。这将导致千年评估计划减少收益，并将成本从计划转移到受益人身上。政策问题是，高于医疗补助（双重资格）门槛的低收入医疗保险受益人是MA计划的关键选民。低收入受益人难以支付医疗保险按服务收费（FFS）的成本分摊，这使得具有增强福利的MA计划特别有吸引力。如果MA计划像应对1997年平衡预算法案导致的付款削减那样应对付款减少，他们将减少补充福利，增加自付保费，或退出市场，可能导致低收入MA计划参加者的准入问题。拟议的研究的目的是估计ACA规定的减少政府支付给医疗保险优势计划对低收入受益人的影响，并调查可能的政策反应，以“使他们免受”支付削减。在方法上，我们将联合收割机结合一些不同的数据源，以创建一个面板数据集，是全国代表性的医疗保险人口。我们分析了付款削减对受益人保费和受益人自付成本（OOPC）的影响;保费和OOPC变化对受益人选择医疗保险计划的影响;最终对低收入受益人经济福利的影响。这项研究的结果将推动关于保健计划选择的学术文献的发展，并就削减付款对低收入受益人的影响和减轻这种影响的政策解决办法的成本向决策者提供指导。

 DESCRIPTION (provided by applicant): The purpose of the proposed research is to estimate the effects of the reductions in government payments to Medicare Advantage (MA) plans, required by the 2010 Patient Protection and Affordable Care Act (ACA), on low-income Medicare beneficiaries. MA plans receive a monthly capitation payment from Medicare for each enrollee, adjusted for the enrollee's risk. Previous research has shown that plans respond to higher payment rates by offering enhanced benefits and/or lower out-of-pocket premiums. This is true both geographically (i.e., plans in counties with higher payment rates offer more benefits than plans in lower payment areas) and over time. The ACA substantially reduced MA plan payments, with the Congressional Budget Office (CBO) estimating that the new payment formula in the ACA will reduce MA payments by $132 billion over ten years. This will lead MA plans to reduce benefits and shift costs from the plans to beneficiaries. The policy issue is that low-income Medicare beneficiaries who are above the Medicaid (dual- eligible) threshold are a key constituency for MA plans. Low-income beneficiaries struggle to pay Medicare fee-for-service (FFS) cost sharing, which makes MA plans with enhanced benefits particularly appealing. If MA plans respond to reduced payments as they did to the payment cuts resulting from the 1997 Balanced Budget Act, they will reduce their supplementary benefits, increase out-of-pocket premiums, or withdraw from the market, potentially leading to access problems for low-income MA plan enrollees. The purpose of the proposed research is to estimate the effect of the ACA-mandated reductions in government payments to Medicare Advantage plans on low-income beneficiaries and to investigate possible policy responses to "hold them harmless" from the payment cuts. Methodologically, we will combine a number of different data sources to create a panel dataset that is nationally representative of the Medicare population. We analyze the impact of payment cuts on both beneficiary premiums and beneficiary out-of-pocket costs (OOPC); the impact of changes in premiums and OOPC on Medicare plan choice by beneficiaries; and ultimately the impact on the economic welfare of low-income beneficiaries. The results of this study will advance both the academic literature on health plan choice and provide guidance to policy- makers regarding both the impact of payment cuts on low-income beneficiaries and the cost of policy solutions to mitigate the impact.