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d-31783House OversightOther

Medicare & Medicaid payment ratios and private payor subsidies

The passage is a generic policy analysis slide showing payment ratios and cost trends. It contains no specific names, transactions, dates, or allegations linking powerful individuals or agencies to mi Private insurers have historically paid higher rates than Medicare/Medicaid. Payment-to-cost ratios for private payors hovered around 140% in the 1990s‑2000s. Differential payment rates may pressure

Date
November 11, 2025
Source
House Oversight
Reference
House Oversight #020990
Pages
1
Persons
1
Integrity
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Summary

The passage is a generic policy analysis slide showing payment ratios and cost trends. It contains no specific names, transactions, dates, or allegations linking powerful individuals or agencies to mi Private insurers have historically paid higher rates than Medicare/Medicaid. Payment-to-cost ratios for private payors hovered around 140% in the 1990s‑2000s. Differential payment rates may pressure

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healthcare-policypayment-ratiosmedicareprivate-insurancemedicaidhouse-oversight

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Text extracted via OCR from the original document. May contain errors from the scanning process.
Restructure Medicare & Medicaid: Economic Factors— Rising Healthcare Costs Disproportionately Borne by Employers and Individuals Over the last few decades, private payors (employer-sponsored health insurance plans) have consistently paid more than government payors (Medicare / Medicaid) and have, in effect, subsidized government reimbursement. Healthcare Service Payment to Cost Ratio, 1990 - 2006 0, 140% — Private Payor — ~~ Medicare — Medicaid 120% 110% 100% 90% Payment to Cost Ratio 80% 70% 60% | T T T T T T T T T T T T T T T T 1 1990 1992 1994 1996 1998 2000 2002 2004 2006 KP Source: Avalere Health Analysis of American Hospital Association Annual Survey data, 2006, for community hospitals. www.kpcb.com USA Inc. | What Might a Turnaround Expert Consider? 297 Restructure Medicare & Medicaid: Differential Payment Rates Can Create a Negative Cycle Leading to Erosion of Private Healthcare Coverage and Higher Entitlement Spending 5. Employers/ easing Use of 2. Cost Shi a ernment the Private ursement nment Lowers ursement Rate to Providers Private Marke Government Mar. KP ource: Doug Simpson, Morgan Stanley Healthcare Research. (@E) www.kpcb.com USA Inc. | What Might a Turnaround Expert Consider? 298

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