Over the weekend, Minority Leader Pelosi (D-CA) made the false claim that there is not a single area where Congress can find savings to reduce the deficit, “Because the cupboard is bare. There’s no more cuts to make,” Pelosi said on CNN’s “State of the Union.”   She added, “It’s really important that people understand that.”

Really?  Not a single area of spending Congress can reform or find savings from curbing waste, fraud and abuse?  

It seems that Minority Leader Pelosi and President Obama might want to compare notes. While Pelosi claims the cupboard is bare, Obama’s FY2014 Budget proposed over $540 billion in spending cuts to Medicare and Social Security alone:

Medicare

• Cutting payments to post-acute providers, including long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and home health agencies (HHAs), from 2014 through 2023 ($79 billion);
• Further cutting IRF payments for certain patients whom the HHS Secretary feels could be treated in a SNF and increasing the percentage of IRF patients that must meet certain classification criteria beginning in 2014 ($4.5 billion);
• Cutting payments to SNFs with a high rate of preventable hospital readmissions beginning in 2017 ($2.2 billion);
• Establishing post-acute care bundles for 50 percent of all post-acute services beginning in 2018 ($8.2 billion);
• Cutting Medicare “bad debt” payments, beginning in 2014 ($25.5 billion);
• Cutting medical education payments to hospitals beginning in 2014 ($10.9 billion);
• Cutting reimbursements to Critical Access Hospitals (CAHs) beginning in 2014 ($2.1 billion total);
• Reducing payment to physicians for cancer and other drugs administered in office ($4.5 billion);
• Reducing payment to clinical laboratories for tests paid under the laboratory fee schedule ($9.5 billion);
• Restricting physician ability to furnish in-office radiation therapy, physical and other therapy services, and advanced imaging without violating the Stark self-referral law ($6.1 billion);
• Increasing Medicare Advantage coding intensity adjustment ($15.3 billion);
• Reducing payments to employer group waiver plan payments (4.1 billion);
• Applying Medicaid drug rebates to Part D plans ($123.2 billion);
• Accelerating and increasing manufacturer rebates inside the Medicare Part D donut hole ($11.2 billion);
• Reducing the biologics market exclusivity period from 12 to 7 years ($3.3 billion);
  
• Giving new authority to the Federal Trade Commission to end “pay-for-delay” agreements ($11 billion);
• Beginning in 2017, increasing Medicare Part B and D monthly premiums for high-income beneficiaries by increasing the income-related premiums by 15 percent and freezing the current income brackets until one-in-four beneficiaries are paying the higher premiums ($50 billion);
• Increasing the Part B annual deductible by $25 for new beneficiaries in 2017, 2019, and 2021 ($3.3 billion);
• Implementing a new premium surcharge for new Medicare beneficiaries that purchase near-first dollar Medigap coverage, beginning in 2017 ($2.9 billion);
• Charging all new beneficiaries a $100 per episode co-payment for home health services that are not preceded by an inpatient hospital stay beginning in 2017 ($350 million); and
  
• Encouraging the use of generic drugs by low-income seniors when therapeutic equivalents exist ($6.7 billion).

Social Security

• Use the more accurate Chained Consumer Price Index to measure inflation while including protections for long-time Social Security beneficiaries.  This provision would only apply to non-means tested programs and the tax code ($230 billion);
• Offset Disability Insurance benefits by the amount of Unemployment Insurance benefits received ($1 billion);
• Prevent the improper use of Social Security death records ($1.3 billion); and
• Strengthen enforcement of benefit offset provisions for certain state and local government workers ($3.7 billion).

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