Ryan: Do your projections assume providers will accept Medicare patients at the same rate now under the traditional program? Because let’s remember, Medicare already pays providers 80 percent of what they will receive in the private market. By 2030 [under Obamacare], this will fall to about 40 percent. Do your projections assume providers will continue to accept Medicare patients at the same rate they do now under the traditional program and does your analysis assume – despite the additional provider cuts coming in current law – that this will have no effect on the quality or access of care?Elmendorf: The way I would put it Mr. Chairman, is we don’t model the behavior of physicians. We don’t model the access to care or quality of care.Ryan: So you assume it stays on as is?Elmendorf: That is the point we noted in the letter analyzing your proposal. That is a gap in our tool kit and a gap we are trying to fill. But under the current circumstances, we don’t model either on the regular base line projections or in our analysis of last year’s health legislation or your proposal, the effects that might happen under current law or alternatives.Ryan: Therein lies the issue here. Your analysis effective assumes that no matter how much the government pays providers for health care services, providers will continue to provide the same quality care and access. That is the gap you talk about.
Ryan: When analyzing projected costs under the House-passed budget, did you take into account the effect choice and competition would have on the growth rate of health care costs and do you assume people will continue to utilize health services at the same rate as they do now? Meaning, what I got out of what you just said is that you’re not really gleaning those kinds of lessons from the experience we have from the Part D results.Elmendorf: We are not applying any additional effects of competition on this growth rate over time in our analysis of your proposal. And again, we don’t have the tools, the analysis we would need to do a quantitative evaluation of the importance of those factors.