Policies Affecting Medicare Beneficiaries

Session Submission Type: Panel

Abstract

Medicare serves over 65 million Americans and sits at the center of ongoing debates about how best to organize and regulate healthcare delivery. This panel brings together four papers that examine how public policies, market structure, and provider network regulation shape access to care for Medicare beneficiaries, including some of the program's most vulnerable populations. Overall, the papers show that reforms and structures intended to improve efficiency or expand access can produce unintended consequences that undermine those very goals.

Two papers examine how major Medicare policy reforms reshaped provider markets in ways policymakers did not anticipate. One finds that Medicare Part D's passage was associated with a reduction in pharmacy entry, and that counties experiencing greater losses in pharmacy access saw smaller mortality gains from the program. A second finds that Federally Qualified Health Centers’ participation in Accountable Care Organizations, a centerpiece of value-based care reform, has not improved preventive specialty care access for underserved beneficiaries and may have modestly reduced it. These results raise questions about whether ACO incentive structures are well-suited to safety net providers.

Two additional papers speak directly to federal regulatory debates around network adequacy and behavioral health parity. One provides the first causal evidence that narrow psychiatrist networks in Medicare Advantage restrict enrollees' access to mental health care, with implications for CMS network adequacy standards that critics have long argued are insufficiently enforced. The other examines whether hospital mandates to provide medications for opioid use disorder reduce discharges against medical advice, informing state and federal efforts to expand treatment access.

Taken together, these papers highlight a common tension in Medicare policy: reforms and organizational structures intended to improve efficiency or coordination can inadvertently restrict access, particularly for beneficiaries with behavioral health needs or those relying on safety net and community-based providers. The findings carry direct implications for network adequacy regulation, ACO design, and the structure of Medicare's public and private components.

Policy Area

• Health Policy

Chair

• Lauren Hersch Nicholas, University of Colorado Denver

Discussants

• Amanda R. Kreider, University of Pittsburgh

• Sih-Ting Cai, University of Southern California

Organizer

• Brandyn F Churchill, American University

Individual Presentations

• The Impact of Psychiatrist Network Breadth on Mental Health Care Use in Medicare Advantage - Presenting Author: Mark Katz Meiselbach, Johns Hopkins University

• Health Care Reform and Firm Dynamics: Evidence from Medicare Part D and the Retail Pharmacy Industry - Presenting Author: Brandyn F Churchill, American University

• Safety Net Provider Participation In Medicare Accountable Care Organizations - Presenting Author: Salama S Freed, George Washington University

• Healthcare Patterns Inside and Outside of Health Systems Among Medicare Beneficiaries With Substance Use Disorder - Presenting Author: Kayla Nicole Tormohlen, Cornell University