Fiscal cliff healthcare policy fix: good for rural patients and taxpayers

Published: Thursday, March 14, 2013 at 09:32 AM.

Indeed, the Government Accountability Office explicitly warned of "a potential underestimate of the total cost" and said that there were still "questions about payment adequacy beginning in 2014."

If policymakers had proceeded with bundling the oral dialysis medications, patients could have lost access to them. Health care providers serving the Medicare population would have started losing money when dispensing these drugs. Many would have been forced to stop offering them - leaving patients in the lurch.

Patients suffering from end-stage renal failure are some of the most vulnerable in the entire Medicare population. They typically require at least three rounds of treatment every week. Even minor disruptions to their health care regimens can lead to serious deterioration of their already fragile condition.

Those in rural areas would have been hit particularly hard. Many communities outside urban centers depend on just one or two health clinics to meet their medical needs. A single clinic may serve patients coming from 50 miles away or more. These clinics typically run on very thin profit margins and depend heavily on Medicare payments to stay afloat.

Aware of the potential adverse consequences in rural communities, legislators responded by maintaining these oral medicines under the Part D prescription drug benefit. This move helped to maintain the viability of small clinics servicing rural communities.

This was good for patient access but, according to the government budget accountants, also good for the Medicare program and taxpayers because it saves money. The CBO projects that extending the exemption through 2018 would save taxpayers approximately $1.3 billion.

Sens. Max Baucus, D-Mont., and Orrin G. Hatch, R-Utah, played particularly important roles in marshalling support for the extension of the exemption through 2016, as part of the fiscal cliff deal earlier this year. They should be commended for championing the interests of rural Americans.



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