Skip to content

Add broad Medicare enrollment targets to the healthcare fiscal surface #231

Open

Description

@daphnehanse11

Context

The current healthcare target surface includes Medicare Part B premium income, and #169 tracks a payer-count shortfall for that amount target. It does not yet include broader Medicare enrollment targets.

That leaves several important Medicare surfaces absent from release-over-release healthcare diagnostics: Part A enrollment, Part B enrollment, Medicare Advantage, Part D, dual eligibles, and LIS.

Goal

Add a Medicare enrollment target cluster, or explicitly document which Medicare enrollment surfaces are not yet available to Populace.

Suggested implementation

  • Inventory CMS Medicare enrollment source artifacts available to Ledger/Populace.
  • Add target roles for supported enrollment concepts, especially:
    • Medicare Part A enrollment
    • Medicare Part B enrollment
    • Medicare Advantage enrollment
    • Medicare Part D enrollment
    • dual eligibles
    • LIS recipients
  • Prefer national and state targets where source geography supports them.
  • Keep enrollment targets separate from the existing Part B premium-income target so diagnostics can identify payer-count vs amount-per-payer problems.

Acceptance criteria

  • Release artifacts expose Medicare enrollment targets where source support exists.
  • Metadata names the target role and source concept for each Medicare enrollment surface.
  • Tests cover target mapping and profile coverage for the Medicare enrollment cluster.
  • Diagnose Medicare Part B premium payer-count shortfall #169 can use the new enrollment/payer diagnostics, or links back here if the broader enrollment surface is a prerequisite.

Related:

Activity

  1. MaxGhenis commented on Oct 12, 2026

    @MaxGhenis
    Contributor

    A measured data point for this issue, from the microsim runs behind PolicyEngine/policyengine-us#10107.

    That PR sets the model's Medicare value per enrollee to CMS's NHE Table 17 Medicare spending per enrollee ($20,096 in 2027, $30,129 in 2034). On the default dataset (populace_us_2024.h5@populace-us-2024-spm-20260909), weighted medicare_enrolled is then the only reason modeled Medicare spending differs from CMS's:

    Year Modeled enrollees CMS enrollees (NHE Table 17, Part A and/or B person-years, 50 states and DC) Ratio Modeled medicare_gross_cost NHE Medicare spending Ratio
    2027 58.80M 70.8M 83.1% $1,181.6B $1,422.7B 83.1%
    2034 60.27M 78.1M 77.2% $1,815.8B $2,354.3B 77.1%

    Modeled enrollment grows 2.5% from 2027 to 2034; CMS projects 10.3%. A total Medicare enrollment target (Part A and/or B), with its projected path, would close both gaps.

    Source: NHE projections tables 2025-2034, https://www.cms.gov/files/zip/nhe-projections-tables.zip (Table 17, rows "Medicare" under spending, enrollment and spending per enrollee). Run details are in the PR description.

    🤖 Generated with Claude Code

Sign up for free to join this conversation on GitHub. Already have an account? Sign in to comment

Metadata

Metadata

Assignees

No one assigned

    Labels

    No labels
    No labels

    Type

    No type

    Projects

    No projects

      Milestone

      No milestone

      Relationships

      None yet

      Development

      No branches or pull requests

      Issue actions