Will 2013 Be Year of the Compact?

We don't usually go out of our way to quote journalists advocating aggressive implementation of the Patient Protection and Affordable Care Act (ACA). But economist and Boston University professor Austin Frackt has written a piece for the Journal of the American Medical Association's JAMA Forum on Medicare's immediate future that contains some credible insights.

First, Frackt predicts the Supreme Court will uphold the Medicare provisions in the ACA even if it throws out the mandate.

Second, he believes that even if Republicans win the presidency and control of the Senate, they won't have the 60-vote majority needed to implement the Ryan Plan or something similar.

Third, the election will be followed by a "perfect storm" of events that could leave Medicare open to reconstruction. Here's Frackt's set up on the new year:

[T]here's one more big event -- or confluence of events -- on the calendar in the next year. On January 1, 2013, the 2-year extension of the Bush tax cuts is scheduled to expire. If it does, income tax rates will increase for nearly all taxpayers.

On the same day, the current patch to Medicare's Sustainable Growth Rate (SGR) expires, threatening to decrease payments to physicians by about 30%.

Furthermore, as agreed on during last summer's showdown over the U.S. debt ceiling, $1.2 billion in cuts to defense and other domestic spending, including a 2% cut to Medicare, are scheduled to commence at the turn of the year.

As if that's not enough, the current debt ceiling will probably be reached this fall or early winter, forcing another potentially contentious vote to raise it.

In the gridlock that ensues, Frackt sees "an opportunity for a grand bipartisan bargain, one that includes a major overhaul of Medicare."

At the Health Care Compact Alliance, we see it, too. If the Supreme Court strikes down the ACA, Congress will need to find a new plan in a hurry. The health care compact is poised to be that solution. Whether Republicans or Democrats win the White House or Congress in the fall, health care policy is going to have to be fixed. A partisan plan has little chance of survival. A policy-neutral plan, such as the health care compact, may be the only compromise possible.

Frackt sees what's headed our way at the end of this year and believes the best response is to support the reforms to Medicare in the ACA. We see the same touchpoints but recognize the opportunity for a grand bipartisan bargain in the form of an interstate health care compact.

Source: "Medicare and the Year Ahead: Opportunities for Reform," JAMA Forum, May 9, 2012.
Image courtesy of Wonderlane used under its Creative Commons license.

Steve O'Keefe is a freelance writer, author and book editor.