Washington state has cut its healthcare costs by more than $40 million annually by limiting insurance coverage, but policy experts say the Medicare program is unlikely to adopt a similar strategy, according to a Kaiser Health News report.
Since its inception in 2006, Washington's Health Technology Assessment has cut coverage for 21 medical procedures and devices under the state's public employee insurance, worker's compensation and Medicaid. In deciding to eliminate coverage of treatments such as the high-cost spinal surgery vertebroplasty, the Washington committee decided there wasn't enough evidence that the procedures were safe, effective or worth their cost, according to the report.
However, health policy expert Robert Berenson of the Urban Institute told Kaiser Health News the federal Medicare program is unlikely to follow Washington state's path, partly due to congressional lawmakers' fears that they will be accused of rationing care.
Additionally, the Patient Protection and Affordable Care Act forbids Medicare from using cost-effectiveness to make coverage decisions, according to the report. Other factors including the influence of drug manufacturers, medical device companies and physicians also make it difficult for Medicare to make coverage decisions in the same manner that Washington does, according to the report.
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