The just released 2011 Medicare trustees report does not contain any big surprises. Much of what the trustees say in this report they have said before: Medicare poses enormous challenges for patients and taxpayers alike, and its financial condition continues a downward slide. Some key findings:
- Medicare’s unfunded obligations increased by $2 trillion. A key indicator of the true cost of the program is the cost of the promised benefits that are not financed by dedicated revenues. Using their standard 75-year projection (2011–2085), the trustees estimate this year that Medicare benefits promised that are not paid for amount to $24.6 trillion, compared to their projection of $22.5 trillion last year. These and other projections in the report are based on current law, including the official assumption that the estimated $575 billion in savings from Medicare provider cuts under Obamacare will be sustained, as well as the 29 percent reduction in Medicare physician payments in 2012. The Medicare trustees concede the point: “Although the long-term viability of some of these provisions is debatable, the annual report to Congress on the financial status of Medicare must be based on current law” (emphasis added). Different assessment and different accounting techniques, of course, can yield different estimates of these long-term costs. Based on an alternative scenario of projected costs and spending that many analysts considered more realistic, the Medicare actuary in 2010 estimated the long-term Medicare debt at $34.8 trillion. The Medicare actuary has yet to offer his alternative assessment for 2011.
- The financial condition of the Medicare Part A trust fund is worse. The Hospitalization Trust Fund—the part of the program that pays seniors’ hospital bills—is in worse shape than reported last year. The Hospital Insurance (HI) Trust Fund is going to be exhausted in 2024 rather than 2029. While the fund has started running big annual deficits ($32 billion in 2010 and $34 billion in 2011), the five-year acceleration of the fund’s exhaustion has been aggravated by a combination of higher hospital spending and the consequent reduction in the payroll tax receipts resulting from the economic downturn. When the HI fund is exhausted, obviously it cannot pay benefits. Congress would have to replenish it with higher taxes. One more point: It should be noted that the most recent Congressional Budget Office assessment of the trust fund (March 2011) is more pessimistic and projects an exhaustion in 2020.
- The “Medicare Funding Warning” has been issued again. Under current law, the Medicare trustees are required to issue a Medicare Funding Warning. This means that general revenues will account for more than 45 percent of Medicare’s total outlays. The 45 percent threshold for such funding, in contrast to dedicated revenues, is officially “excessive” under current law. In this year’s report, the statutory threshold has been reached again this year, as it was last year, and the President is required to develop a proposal to transmit to Congress to deal with the problem.
This year’s trustees report only confirms the seriousness of the financial challenge posed by an unreformed Medicare program. Over the full 75-year budget window for the entitlements, about 90 percent of the growth of Medicare and Social Security is going to occur by 2035. The baby boom generation, to be supported by a relatively smaller workforce, will drive costs to new levels. That is indeed why The Heritage Foundation’s comprehensive reform proposal, Saving the American Dream, takes on an even greater urgency.