S.1776 - Medicare Beneficiary Co-Pay Fairness Act (119th Congress)
Summary
S.1776, the Medicare Beneficiary Co-Pay Fairness Act, aims to amend Title XVIII of the Social Security Act. The bill seeks to limit the coinsurance amount for certain services furnished in an ambulatory surgical center (ASC). It ensures that the coinsurance amount does not exceed the inpatient hospital deductible under section 1813(b) of the Social Security Act.
Expected Effects
The bill would reduce the financial burden on Medicare beneficiaries who require surgical procedures in ASCs. It mandates that the Secretary of Health and Human Services reduce the coinsurance amount to match the inpatient hospital deductible. The change applies to services furnished on or after January 1, 2026.
Potential Benefits
- Reduced Out-of-Pocket Costs: Medicare beneficiaries will pay less for certain surgical procedures performed in ambulatory surgical centers.
- Increased Access to Care: Lower costs may encourage more beneficiaries to seek necessary medical care.
- Financial Relief: Limits coinsurance to the inpatient hospital deductible amount.
- Fairness: Addresses potential inequities in coinsurance amounts for similar services.
- Improved Affordability: Makes healthcare more affordable for seniors and individuals with disabilities.
Most Benefited Areas:
Potential Disadvantages
- Increased Government Spending: The government will need to cover the difference between the original coinsurance amount and the reduced amount.
- Potential for Increased Premiums: To offset increased spending, Medicare premiums could potentially rise in the future.
- Administrative Burden: The Secretary of Health and Human Services will need to implement and manage the new coinsurance limitations.
- Unintended Consequences: May incentivize more procedures in ASCs, potentially straining resources.
- Limited Scope: Only applies to certain services in ambulatory surgical centers, not all healthcare services.
Most Disadvantaged Areas:
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution, as it aims to improve healthcare affordability for Medicare beneficiaries. Specifically, the preamble states the Constitution is intended to "promote the general Welfare". Article I, Section 8 grants Congress the power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States.
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).