H.R.3006 - To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center. (119th Congress)
Summary
H.R.3006 aims to amend Title XVIII of the Social Security Act, specifically targeting the coinsurance amounts for certain services provided in ambulatory surgical centers. The bill seeks to limit the coinsurance amount a beneficiary pays for facility services related to surgical procedures in these centers. This limit would be capped at the inpatient hospital deductible amount established under section 1813(b) of the Social Security Act for the given year.
If the standard coinsurance calculation exceeds this deductible, the Secretary would reduce the coinsurance to match the deductible. The difference would then be paid to the service provider. The amendments are set to take effect for services furnished on or after January 1, 2026.
Expected Effects
The primary effect of this bill, if enacted, would be to lower out-of-pocket healthcare costs for Medicare beneficiaries undergoing surgical procedures in ambulatory surgical centers. This could lead to increased utilization of these centers, as the financial burden on patients would be reduced.
Ambulatory surgical centers could also see changes in their revenue streams, as they would receive payments from the government to offset the reduced coinsurance amounts paid by patients. The overall impact on the Medicare system's expenditures would depend on the extent to which this change affects utilization rates and the cost of services.
Potential Benefits
- Reduced out-of-pocket healthcare costs for Medicare beneficiaries.
- Increased affordability of surgical procedures performed in ambulatory surgical centers.
- Potentially greater access to necessary medical services for those on fixed incomes.
- Could encourage more patients to seek care in lower-cost ambulatory settings, potentially reducing overall healthcare system costs.
- May improve patient satisfaction with the Medicare program.
Most Benefited Areas:
Potential Disadvantages
- Potential increase in overall Medicare spending if utilization of ambulatory surgical centers rises significantly.
- Possible shift in demand that could strain the capacity of ambulatory surgical centers.
- Administrative burden on the Secretary to manage the coinsurance reduction and payments to suppliers.
- Risk that some providers may increase their charges to offset the coinsurance limit, negating some of the intended cost savings for beneficiaries.
- Potential for unintended consequences if the change in coinsurance affects the types of procedures performed in ambulatory surgical centers.
Constitutional Alignment
This bill appears to align with the general welfare clause of the US Constitution, as it aims to improve access to healthcare for Medicare beneficiaries. The Constitution grants Congress the power to collect taxes and provide for the general welfare of the United States (Article I, Section 8, Clause 1).
By reducing healthcare costs for seniors, the bill can be argued to promote their well-being. However, the specific details of implementation and the potential impact on the federal budget would need to be carefully considered to ensure fiscal responsibility and avoid exceeding constitutional limitations on congressional power.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).