President Donald Trump is sending well over 20 million Medicare enrollees $90 apiece, and plenty of recipients will understandably welcome the money. With the standard Medicare Part B premium at $202.90 a month this year, $90 isn't pocket change for someone living on Social Security.
From the White House:
- Payments will be made from the Medicare Improvement Fund, which has been given $2 billion by Congress for the purposes of making improvements to the Medicare fee-for-service program, but has never before been utilized.
- Most eligible seniors will receive the payment in the form a direct deposit of $90 in early October. Those without direct deposit will receive a check, also sent in early October, to the mailing address they have registered with Medicare.
The interesting question comes before the checks arrive. Congress created something called the Medicare Improvement Fund, and the law describing what the money can be used for doesn't specifically say anything about mailing cash directly to beneficiaries.
The statute gives the secretary of Health and Human Services authority to use the fund to make "improvements" to original Medicare Parts A and B. It then specifically mentions adjustments to payments for medical items and services that doctors, hospitals, and other suppliers provide.
The language is broad enough to give HHS room to argue that helping beneficiaries pay Part B premiums qualifies as an improvement, but direct cash payments aren't specifically identified.
Congress currently has $2.062 billion sitting in the fund. Sending $90 to slightly more than 20 million people will consume roughly $1.8 billion of it. The money ultimately comes from the Medical Hospital Insurance and Supplementary Medical Insurance trust funds in proportions determined by the HHS secretary, so this isn't an unused pile of general Treasury cash somebody discovered behind a filing cabinet.
The statute also contains a safeguard worth noticing. HHS may obligate the use of the money only after the secretary determines that sufficient funds exist, and the CMS chief actuary and appropriate budget officer certify that enough money is available to cover the obligations.
Maybe all of that paperwork has been completed. The White House announcement doesn't provide the certifications, an HHS legal analysis, or an explanation of how a direct beneficiary payment fits within the statutory purpose. With nearly $2 billion moving from Medicare trust funds into bank accounts and mailboxes, publishing those documents would answer a reasonable question.
The White House calls the $90 payment a Medicare premium rebate, and says this is the first time any administration has used the Medicare Improvement Fund to directly lower beneficiaries' costs. Most eligible recipients will receive direct deposits in early October, while others will receive checks. People whose premiums are already paid by Medicaid and those paying income-related premium surcharges aren't eligible.
None of this proves the payments are unlawful. Congress wrote an unusually broad phrase when it authorized HHS to "make improvements" to Medicare, and an administration lawyer can make a serious argument that reducing a beneficiary's effective premium cost qualifies.
Still, a novel reading involving almost $2 billion deserves more than a celebratory fact sheet. Show the legal interpretation. Show the actuarial certification. Show Congress and taxpayers exactly how HHS concluded that a fund historically discussed in terms of Medicare services and provider payments can now finance direct checks.
Trump may have found a perfectly lawful use for a fund Washington spent years moving money into and out of without ever spending it. If so, releasing the documents should make the case stronger.
For $90, beneficiaries get a check. For $1.8 billion, taxpayers deserve the paperwork.