• each Commission member will choose one task force for primary membership
• all Commission members will be free and encouraged to participate informally in all task forces
• all task force information (e.g., staff reports, scheduled meetings and testimony, etc.) will be shared with all Commission members through web pages, faxes, etc.
• task forces will use existing analyses from credible sources whenever possible, rather than "reinventing the wheel"
• task forces may meet more frequently than the full Commission and may meet with experts, recipients, providers, etc.
• task forces will gather facts, generate policy options, prepare detailed agendas, and make presentations to full Commission for its review
• task forces will establish open and regular process to interact with, experts, providers, advocates, recipients, legislative staff, etc.
• specific topics considered by task forces will be developed throughout the year, and the following lists are examples only
• task forces will provide an interim progress report 90 days after creation so that full Commission can evaluate progress
• the Chairmen will be members of each task force

I. Modeling

This task force will analyze Medicare's place in the overall health care system and economy, the program's past and current successes and challenges, and the impact of changing certain assumptions external to the health care system. Its main goal is to define the problem and then help the Commission members educate the public about issues confronting the Medicare program. The focus will be on presenting a range of data with explicit conditions rather than making controversial assumptions.

Topics to be covered (examples only):

1. Eligibility

• current and future health and economic status of elderly
• potential carve-outs
• status of dual eligibles, QMBs, SLMBs, etc.
• other

2. Benefits

• impact of chronic disease and acute disability trends
• skilled nursing facility demand
• changing health care needs
• other

3. Structure

• interaction of Medicare with rest of health care market, Medicaid, economy, etc.
• comparison with changes in private plans, historical perspective
• performance of risk contracts
• impact of Medicare changes on rural and inner city providers, non-recipients, etc.
• non-delivery functions of Medicare (e.g., provider certification)
• status of current demonstration projects
• other

4. Financing and Cost

• Medicare's role in graduate medical education
• cost and financing scenarios
• impact of balanced budget act
• variations in regional utilization and cost
• generational distribution of costs and financial contributions
• accuracy of inflation factors, risk contract rates
• overall social dependency ratio
• other

5. Other

• international comparisons
• public attitudes and education on current program's accomplishments, issues, etc.
• impact of future changes in technology, health market, demographics, etc.
• impact on program's outlook of changing external variables/assumptions (e.g., retirement patterns, economic growth, immigration, health costs, technology, labor policies, etc.)
• other

II. Reform

This task force will review options to strengthen the current Medicare program and prepare it for future changes in demographics, technology, health care needs, etc. The program has had many successes to date, and adopting incremental reforms may allow Medicare to continue preserving the elderly's health and financial well-being. This task force will organize its work around four topics: (1) eligibility, (2) benefits, (3) structure, and (4) financing and cost. Topics to be covered (examples only):

1. Eligibility

• means-testing
• age and income adjustments
• buy-ins
• other

2. Benefits

• preventive care, health education
• catastrophic versus first-dollar coverage
• long-term care and outpatient drugs
• new technology, experimental procedures
• other

3. Structure

• competitive purchasing
• outcomes-based contracting
• utilization review, profiling, selective contracting
• Medigap policies, Medicaid, third party payers
• risk contract enrollment
• regulation of private sector involvement in Medicare
• ongoing flexibility to respond to external changes, adjust performance, etc.
• other

4. Financing and Cost

• premiums, cost sharing, deductibles
• balance of payroll taxes, general revenues, beneficiary contributions, etc.
• fraud and abuse
• rate adjustments, risk contracts
• Medigap policies
• out of pocket spending
• trust funds
• tobacco taxes, budget surpluses, other revenues
• private sector role in financing medical education
• other

III. Fundamental Restructuring

This task force will approach the Medicare program from a "blank sheet of paper" perspective. Health care has changed dramatically since Medicare's creation, and it may thus be useful to review new program options to secure services more efficiently for future recipients. This task force will organize its work around four topics: (1) eligibility, (2) benefits, (3) structure, and (4) financing and cost.

Topics covered (examples):

• Part C risk plans
• premium support
• merging trust funds
• Federal Employee Benefit Health Plan model
• combination of defined contribution and defined benefit models
• multiple sponsors, administrators
• greater integration with Social Security
• private investment model
• other