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New Paragon research on Medicare clinician payments, Medicaid expansion, long-term care, and the CDC

Paragon Newsletter
President at Paragon Health Institute
Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and serves as its CEO.

As Congress and state legislators around the country get back to work, Paragon has produced several recent analyses to inform health policy debates. Below, I highlight our work related to Medicare’s payment of doctors, Medicaid expansion, long-term care policy, and the Centers for Disease Control and Prevention (CDC).  

Research on Medicare Payments to Clinicians

As a result of government’s outsized role in our health care sector, largely because of Medicare, clinicians are one of the most prominent and powerful lobbying groups. This has led to intense interest in how Medicare modifies payment rates each year. Joe Albanese has done several reports on Medicare’s payments to clinicians, including testifying twice before the House Committee on Energy and Commerce last year.

Clinician groups have put tremendous pressure on Congress to address recent Medicare payment cuts, including a 3.4 percent reduction that went into effect for 2024. Many argue that inadequate pay will cause providers to drop out of Medicare entirely. But the unsustainable fiscal trajectory of the program and seniors’ out-of-pocket expenses are also important factors to consider. In his most recent report and testimony, Joe argues for permanent reforms that take a balanced approach: any increases in clinician pay should be fully offset by other savings in Medicare and coupled with other policy changes such as the incorporation of market-based pricing data.

As the figure below shows, one key fact to keep in mind during the debate is that clinicians’ participation rates in Medicare have never been higher as 98% of Medicare-billing clinicians agree to accept Medicare payments as payment in full. Given that seniors’ overall access to care is exceptionally high, Congress must avoid Medicare changes that increase costs for patients or taxpayers.  



Research on Medicaid Expansion

Rumblings suggest that Medicaid expansion could be an issue in several states this year that have not yet adopted the Affordable Care Act’s dramatic expansion of the program to able-bodied, working-age adults. Paragon has produced the most up-to-date research looking at the effect of Medicaid expansion. In December, we released a report, Resisting the Wave of Medicaid Expansion: Why Florida Was Right. The Wall Street Journal ran an op-ed that summarized the findings.

While the first half of our report reviewed new enrollment, private coverage loss, and expenditure estimates specific to Florida, the second half of the report focused on key takeaways from states that have previously adopted the expansion. These takeaways include: actual enrollment much higher than expected, actual spending much higher than expected, emergency room use for non-emergent services soaring, improper payments soaring, crowding out of services from traditional recipients, a significant decline in private coverage, and no improvement in population health.

Research and Event on Long-Term Care

Paragon has published two papers from long-term care financing expert Steve Moses: Long-Term Care: The Problem and Long-Term Care: The Solution. Yesterday, Steve was joined by several other long-term care experts for a discussion of the issues. Here is a video of that event, as well as a copy of the presentation.

Steve’s research indicates that the main problem is caused by well-intentioned but misguided policy that makes it too easy for people who have sizeable assets to qualify for Medicaid, effectively preserving larger inheritances for their heirs with taxpayers picking up the tab for long-term care expenses. The solution therefore centers on making it more difficult to access Medicaid for long-term care, but easier to plan ahead and pay privately when care is needed. Doing so would unleash the private financing needed to improve the quality of long-term care services, improve staffing, and enable more people to receive home-and-community based services. For a summary of the key issues, The Washington Times has published an op-ed from Steve and me.

Reforming the CDC

Last fall, Paragon published an important paper from Drew Keyes and Paragon’s Public Health and American Well-being Initiative director Dr. Joel Zinberg: Unauthorized and Unprepared: Refocusing the CDC after COVID-19. On December 19, Dr. Zinberg participated in a virtual briefing hosted by the Competitive Enterprise Institute with Iowa Congresswoman Mariannette Miller-Meeks on the ways that the CDC failed during COVID and how policymakers must learn from those failures, including its recommendation of widespread lockdowns, to reform the CDC moving forward.

In conclusion, please let me know if there are any other issue areas where Paragon research and analysis would be useful.

All the best,

Brian Blase President Paragon Health Institute

Recent Newsletters

Resisting the Wave of Medicaid Expansion
Medicare Advantage, Obamacare Enrollment, and DeSantis on Medicaid Expansion


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