Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999

Great Seal of the United States (obverse)

Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) was a significant piece of legislation passed by the United States Congress in 1999. This act was designed to make adjustments to the Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) as a response to the Balanced Budget Act of 1997, which had implemented substantial cuts to these programs. The BBRA aimed to alleviate some of the financial pressures these cuts had placed on hospitals, other healthcare providers, and beneficiaries.

Background

The Balanced Budget Act of 1997 was enacted with the goal of reducing the federal deficit, and it included measures that significantly reduced spending on Medicare, Medicaid, and SCHIP. However, these reductions led to unintended consequences, including financial strain on healthcare providers and concerns about access to care for beneficiaries. In response, Congress passed the BBRA to correct or mitigate some of these issues.

Provisions

The BBRA contained several key provisions aimed at addressing the concerns raised by the 1997 cuts. These included:

• Increases in payments to hospitals, particularly those serving a high number of low-income patients, known as Disproportionate Share Hospitals.
• Adjustments to the payment rates for Medicare+Choice plans (now known as Medicare Advantage plans) to encourage more health plans to participate in Medicare.
• Restoration of some funding to Medicaid and SCHIP programs to ensure continued coverage for children and low-income individuals.
• Introduction of new protections for beneficiaries, including improvements in the appeals process for Medicare and Medicaid.

Impact

The BBRA had a significant impact on the healthcare system in the United States. It provided financial relief to healthcare providers and ensured that vulnerable populations continued to have access to necessary healthcare services. However, the act also contributed to the increasing cost of Medicare and Medicaid, raising concerns about the long-term sustainability of these programs.

Criticism and Support

The BBRA received both criticism and support from various stakeholders. Supporters argued that the act was necessary to correct the overly harsh provisions of the 1997 Balanced Budget Act and to protect access to healthcare. Critics, however, contended that the BBRA increased federal spending on healthcare at a time when there was a need for fiscal restraint.

Legacy

The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 is seen as a pivotal moment in the history of U.S. healthcare policy. It highlighted the challenges of balancing fiscal responsibility with the need to provide adequate healthcare coverage. The act also set the stage for future debates and legislation regarding healthcare reform, including the Patient Protection and Affordable Care Act.