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Another Health Crisis Is Looming

Expert Witness: Vipul Kella, M.D., MBA. FACEP
As the pandemic comes to an end, Americans are faced with another major health crisis.

Medicare 101. Part of FICA payroll tax for every American employee includes a 1.45% tax to pay for Medicare Part A. Anything that is left over goes to the Hospital Insurance Trust Fund, which pays for additional Medicare Part A expenses.

In 2019 a Medicare report found that HITF will be insolvent by 2026. That is, only hospital expenses equal to HITF revenues will be able to be paid out. Why is this? Pre-pandemic, sluggish economic growth and an increasing number of retiring baby boomers were projected to drastically cut tax revenues. There is an additional spending problem, as the booming baby boomer population
will require a higher intensity of services with their more complex medical conditions.

Now we need to add in the COVID-19 effect. We are seeing unemployment skyrocket, and payroll tax revenues decline. Despite the CARES stimulus bill, the 2026 insolvency trust fund projection is now expected to be accelerated by 3 years. So by 2023, Medicare Part A will cover less than 90% of hospitalization and hospice costs for beneficiaries, dropping to 70% by 2040. As COVID continues to spiral, these projections could even worsen. There is also the long-term effect on patients who canceled elective surgeries and procedures and the health consequences of delayed medical care.

The post-COVID Medicare outlook is troubling. At least $1.5 trillion in costs will need to be cut over the next decade. Without higher spending and dwindling revenues, Medicare will only be left with two options: increase the share the beneficiaries pay by increasing taxes, or by reducing the number that is eligible by raising the retirement age. Neither option is palatable as they involve accepting a new, more austere type of health care.

But these don’t have to be the only two options. Focusing efforts on ensuring “right care” and reducing unnecessary utilization of services will lower costs without compromising quality. Innovation in digital technology, wearables, and big data analytics that focus on cost control will need to be accelerated faster, especially in areas of chronic disease management. Hospitals will be needed more aggressive incentives to invest in technologies through value-based programs and shared savings models. Decisions about how we allocate resources in end-of-life care will finally need to be confronted as well.

As the pandemic is now in our rearview mirror, we must now refocus our attention an another health crisis that may be far more troubling.

Dr. Kella is a board-certified emergency physician, executive and medical expert. He has practiced for over 18 years in the DC area and has served as a medical expert for 10 years. He has reviewed over 100 cases in areas of medical malpractice, emergency room standards of care, hospital administration and health policy, medical device and product liability, and nursing home negligence.

Copyright Vipul Kella, M.D., MBA. FACEP

Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.For specific technical or legal advice on the information provided and related topics, please contact the author.

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