First, Trump’s plan takes two hefty pieces of Medicare — extra payments to hospitals that serve a lot of uninsured patients and funds for teaching hospitals — and moves them out of Medicare and into the regular general fund budget. Hospitals still get paid, but the money doesn’t come from the main Medicare trust fund. Spending does fall a bit, but not nearly by as much as the Medicare line items suggest.
“In general, these proposals are in areas where there is evidence we pay providers too much,” Matthew Fiedler, at the Brookings Institution Center for Health Policy, told us recently. “One big proposal is to make payments site-neutral. Currently, we often pay more for the same service when it’s delivered in a hospital rather than in a doctor’s office, even when there’s no evidence the site of service makes a difference.” Read More