Posts Tagged ‘Congress’

« Older Entries

Will the ACA Survive the Supreme Court, 2012 Election?

Wednesday, February 1st, 2012

The 26 states that have challenged President Barack Obamas healthcare law face several dilemmas as they try to convince the Supreme Court to declare the law’s Medicaid expansion unconstitutional   The two lower courts that heard the Medicaid challenge ruled in favor of the Obama administration, even as those judges struck down the healthcare law’s individual mandate. Legal experts on both sides of the mandate debate were surprised that the Supreme Court agreed to also hear the Medicaid piece of the state’  lawsuit.  The healthcare law’s supporters claim that the states erred in their initial brief on the Medicaid expansion, which was filed with the Supreme Court.

According to the states involved in the lawsuit. the ACA’s Medicaid expansion is “coercive.” Although state participation in the program is strictly voluntarily, the brief argues, the healthcare law makes it impossible for states to opt out of Medicaid.  The brief tries hard to link the Medicaid expansion to the individual mandate, arguing that states won’t be able to exercise their legal right to leave Medicaid because it’s the only way for Medicaid-eligible residents to fulfill the mandate.

“While the (Affordable Care Act) purports to leave states’ participation in Medicaid nominally voluntary, multiple aspects of the Act evince Congress’ keen awareness that, in fact, no state will be able to reject its new terms and withdraw from the program,” the brief says. “Most obviously, the ACA’s individual mandate requires Medicaid-eligible individuals to obtain and maintain insurance.”  But most Medicaid-eligible people would be exempt from the mandate, said Timothy Jost, a law professor at Washington and Lee University and a supporter of the health law.

Then there’s the Supreme Court case, which will be heard in the spring and a verdict announced prior to the November presidential election. According to Kurt Mainwaring, a ksl.com contributor, “Far-reaching consequences of the court’s ruling will likely impact both the cost of healthcare and the outcome of the 2012 elections.  If the Supreme Court rules that ACA is constitutional, healthcare costs will likely continue to rise — although at a slower rate than if the law were determined to be unconstitutional.  At present, healthcare costs make up approximately 18 percent of GDP. If expenditures continue on their current trajectory, “the share of GDP devoted to healthcare in the United States is projected to reach 34 percent by 2040.”  Translated to real numbers, the Department of Health and Human Services (HHS) notes that Americans paid approximately $1,000 annually in healthcare costs in 1960; more than $7,000 per year in 2007; and are projected to pay more than $13,000 per year by 2018.  This kind of increase in healthcare costs is not sustainable — and these kinds of projections are part of the reason ACA was enacted in the first place.

Beach Conger, a Vermont internist writing in the Burlington Free Press believes that “Medicare for All” — a possibility that was raised during the lengthy debate over the ACA — should be reconsidered.  According to Conger, “Medicare and I were born in the same year. Professionally speaking, that is. We were raised together, and we have been married to each other for what seems an eternity. As with any long-term relationship, we have had our ups and downs, but we have both matured over the years, and I believe we are both the better for it. Without being too vain, I have to say I have done a better job at providing health care, and I have to admit that Medicare has helped me do it.  At first, it just made sure that those retired people who wished to pay me the fees to which those in my line of work have become so accustomed, could actually do so. But eventually it realized that there was more to the business than just money, and it began to keep an eye over my shoulder, making sure I was not leaving undone those things which ought to be done and not doing those things which I ought not.  So I can’t help but think, why not Medicare for everyone? It would be so simple. And that’s when I realized.  It was too simple.”

Dr. Conge, it should be pointed out, lives in Vermont, to date the only of 50 states to enact a single-payer public option — Green Mountain Care.

Tags: , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems, Hospitals | No Comments »

Some of America’s Doctors Are Going Broke

Wednesday, January 18th, 2012

Many of America’s physicians have an embarrassing secret — they are going broke. This quandary is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Industry insiders are concerned about the trend.  Approximately 50 percent of all doctors operate a private practice. If a cash crunch forces the closure of an independent practice, it robs a community of a vital healthcare resource.  “A lot of independent practices are starting to see serious financial issues,” said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent physician practices about their finances.  Doctors say that smaller insurance reimbursements, changing regulations, soaring business and drug costs take away from their practices’ profitability. Some experts counter that doctors’ lack of business sense shares the blame.

Recent steep 35 percent to 40 percent cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue for cardiologists, as an example.  Federal law requires that Medicare reimbursement rates be adjusted every year based on a formula tied to the economy’s health. That law says rates need to be cut every year to keep Medicare financially sound.

Although Congress has blocked those cuts 13 times over the 10 years, most recently on December with a two-month temporary “patch,” this dilemma haunts doctors every year.

Beau Donegan, senior executive with a hospital cancer center in Newport Beach, CA, is well aware of physicians’ financial woes.  “Many are too proud to admit that they are on the verge of bankruptcy,” she said. “These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them.

“This is a very timely and truthful story for doctors and hospitals in America. This is also a 911 call for U.S. healthcare security.  More importantly, when a doctor is ‘$3.2 million in debt’ or has to force 6,000 cancer patients to look for a new doctor”, as reported by CNN Money, “our healthcare system infrastructure earthquake is coming,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.  This 2012 CNN Money report is consistent with an AMA report on March 4, 2011 that 51 percent of doctors in Texas are going broke: “51 percent of Texas doctors dug into personal funds to keep practices afloat in 2010,” Dr. Zhou said.

Writing in Forbes, Rick Ungar counters that “While there is considerable truth to be found in the CNN Money piece, a deeper analysis is in order given the knee-jerk reaction by the many who are too quick to place the problem and the blame at the feet of the federal government.  First off, it is important to recognize that not all physicians in the healthcare system are facing financial crisis. About 50 percent of the nation’s doctors are employed, typically by hospitals, and receive a salary in exchange for their service. So far, these practitioners do not appear to be in any significant financial danger.”

The financial problems are typically experienced by a portion of the remaining 50 percent who wish to operate their own private practices and, as a result, find themselves suffering from the financial stresses faced by so many small businesses in these difficult times.  Yet, even among this 50 percent, not all private practices areas are in trouble. For example, surgeons and dermatologists seem to be doing just fine while cardiologists and oncologists, whose business models necessarily make them more susceptible to trouble, are feeling the pain.

Why oncology and cardiology?

Part of the blame does rest with changes in Medicare and Medicaid payment policies. Certainly, cardiologists and oncologists, whose practices naturally bring them into contact with more senior citizens, are the most likely to feel the pain when it comes to reduced government payments. Last year, the Centers for Medicare & Medicaid Services (CMS) took a hatchet to what is paid to cardiologists for performing important tests such as echocardiograms, stress tests and other “machine” based testing. But what you may not know is that these reductions were based on a survey conducted by the American Medical Association, at the request of the CMS, that seemed to go out of its way to omit cardiologists in private practice from the survey participants. Why? Because private practice cardiologists have, by and large, dropped out of the AMA and the AMA’s interest was in getting more money set aside for those medical practitioners in other areas of medicine who remain members.

Tags: , , , , , , , , , ,
Posted in Healthcare, Hospital Systems, Hospitals | No Comments »

Medicare Times Are a Changing

Monday, January 16th, 2012

Baby boomers may not like it — and whoever wins the White House this year — but the Medicare that our parents knew and love is destined to change. And it’ll be like it or lump it.

With more than 1.5 million baby boomers enrolling in Medicare every year, the program’s future is one of the most crucial economic issues for anyone who currently is 50 or older. Healthcare costs are the most erratic part of retirement expenses, and Medicare remains a great deal for retirees, who often get benefits worth significantly more than the payroll taxes they paid while working.  “People would like to have what they used to have.  What they don’t seem to understand is that it’s already changed,” said Gail Wilensky, a former Medicare administrator. “Medicare as we have known it is not part of our future.”

Consider these numbers.  Medicare’s giant trust fund for inpatient care is expected to run out of money in 2024.  When that happens, the program will collect only enough payroll taxes to pay 90 percent of benefits.  Additionally, researchers estimate that as much as one-fifth and even two-thirds of the more than $500 billion that Medicare now spends every year is spent on treatments and procedures of little or no benefit to patients.

Representative Paul Ryan (R-WI), chairman of the House Finance Committee, is leading the charge on changing Medicare.  Ryan’s current proposals will not impact people now 55 or older would not have to make any changes.  But how would it work?  Would it save taxpayers’ dollars?  Would it shift costs to retirees, who are least able to afford it?   Will Congress ultimately end traditional Medicare?  These questions are still waiting for answers.  “I’m not sure anybody has come up with a formula on this that makes people comfortable,” said health economist Marilyn Moon, who formerly served as a trustee overseeing Medicare finances.

The White House’s preference is to keep the existing structure of Medicare while “twisting the dials” to control spending, said Medicare trustee, economist Robert Reischauer of the Urban Institute think tank.

Ryan’s original approach would have put 100 percent of future retirees into private insurance.  His most recent plan, written with Senator Ron Wyden (D-OR), would keep traditional Medicare as an option, competing with private plans.

Writing for AARP, Ricardo Alonzo Zaldiver says that, “This could mean more Medicare recipients joining private insurance plans (currently, only about 25 percent of Medicare recipients are in private ‘Medicare Advantage” plans, while the other three-quarters participate in the traditional, government-run Medicare program).  A new voucher-for-private-Medicare plan would be available to anyone currently under 55.

“It could also mean keeping the existing Medicare structure but making certain tweaks to control spending.  Under President Obama’s healthcare overhaul, the Independent Payment Advisory Board could force Medicare cuts to service providers if costs rise above certain levels and Congress fails to act.  Obama has said he’ll veto any plan to cut Medicare benefits without raising taxes on the wealthy.  During failed budget negotiations last summer, he indicated a willingness to gradually raise the Medicare eligibility age to 67, revamp co-payments and deductibles in ways that would raise costs for retirees, and cut payments to drug makers.  ‘For the 76 million baby boomers signing up over the next couple of decades, it will pay to be watching.’”  President Obama has promised that he will veto any plan to cut Medicare benefits without raising taxes on the wealthy.

The Chicago Sun-Times offers this sage advice: “Fix Medicare, ignore scare talk.”  According to writer Steve Huntley, “I’ve contributed to Medicare every year of its existence. Yet, it’s a myth that seniors have paid the costs of their Medicare services, as demonstrated by the research of economists Eugene Steuerle and Stephanie Rennane of the Urban Institute think tank.  Their study showed that a two-income couple earning $89,000 a year would pay $114,000 in Medicare taxes during their careers but could expect to receive $355,000 in medical care in retirement. They could get prescriptions, doctor visits and hospital services valued at three times their contribution to Medicare.

“Medicare combined with Medicaid and Social Security add up to an entitlement time bomb –  they’ll consume all tax revenues by 2052, according to a Heritage Foundation analysis –  for the people who’ll be stuck with the bill: working Americans.  In 1950, there were 16 taxpaying workers for each retiree; by the time the baby boomers all retire, there will be two workers for each retiree. Entitlement reform has to happen.”

Tags: , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems, Hospitals | No Comments »

Time to Resolve the “Doc Fix”

Wednesday, December 21st, 2011

Congress’ end of year to-do list inevitably includes the “doc fix” – billions of dollars to avoid deep rate cuts for physicians who treat Medicare’s 48 million patients.  Congressmen and Senators always defer the cuts demanded by a 1997 reimbursement formula — known as the sustainable growth rate (SGR) – and which most believe needs to be entirely rewritten.  The deferrals are temporary, and the doc fix has become increasingly difficult to pass through a divided and deficit-wary Congress.  In 2010, Congress put off scheduled cuts five times, with the longest delay lasting one year.

The story is the same heading into 2012.  If lawmakers are unable to agree before returning home for the holidays, 500,000 physicians will face a stiff 27 percent cut beginning January 1.  Although Congressional leaders have vowed to prevent that, they disagree over how to pay for the fix.  There is little doubt some agreement will be reached, but that deal could be delayed until early next year.

The cost of congressional intervention, not surprisingly, has grown: Delaying the cuts — the solution Congress has chosen since 2003 — will cost $21 billion for a one-year delay and $38.6 billion for two years.  Repealing the formula would add approximately $300 billion to the deficit, according to the Congressional Budget Office.

No one imagined that the SGR would cause so much trouble when it was passed as a minor element of the Balanced Budget Act of 1997.  Nearly 15 years ago, Medicare physician spending, which accounts for a small share of the program’s overall outlay, was growing slowly.  The law included other restraints that have since been repealed.  Analysts predicted that, at most, the SGR formula would curb physician payments minimally.  “It wasn’t viewed as a big deal at the time,” said Paul Van de Water, an economist specializing in Medicare with the research group Center on Budget and Policy Priorities.  “They needed a few more billion dollars in savings (for the Balanced Budget Act), so they just tacked on the SGR arrangement.”

Kaiser Health News wonders why Congress doesn’t just scrap the SGR formula.  “Money is the biggest problem.  It would cost about $300 billion to stop the doc fix cuts over the next decade and Congress can’t agree on where to find that kind of cash.  Some lawmakers, including Senator Jon Kyl (R-AZ), have proposed using money saved from winding down the wars in Iraq and Afghanistan to finance a permanent fix.  While the idea has found favor among some Democrats, other Republicans oppose it.  For physicians, the prospect of facing big payment cuts is a source of mounting frustration.  Some say the uncertainty led them to quit the program, while others are threatening to do so.  Still, defections have not been significant to date, according to MedPAC.  Physician groups continue to lobby Congress to enact a permanent payment fix.”

Dr. Florence C. Barnett recently decided to quit seeing Medicare patients.  She said the plan covered approximately 33 percent of what it cost her to see patients — and found herself facing a growing Medicare patient population after other local neurosurgeons left the program in 2010.  “This is the way the government will ration healthcare,” Barnett said.  “The people who can afford it will have healthcare, and the people who are only on government support — they will not be able to find a doctor or they will have a very long wait.  It’s happening now.”

A survey conducted by the Medicare Payment Advisory Commission found that among patients looking for a new primary-care physician in 2010, 79 percent experienced no problems finding one.  According to the American Medical Association (AMA), which generally resists limits in reimbursements, nearly 33 percent of primary-care physicians already restrict how many Medicare patients they accept in their practices.

Physicians are once again relying on Congress to put off the impending cut.  It’s a scenario that Glen Stream, M.D. and president of the American Academy of Family Physicians, calls a “Lucy and Charlie Brown and the football thing.”  In other words, physicians have become numb to the whole situation.  This year, that numbness could be risky.  “Doctors are sort of numb from this,” Stream said.  “It’s concerning because I think there’s a very serious chance that this cut could go into place and yet many practicing physicians have heard this years and years in a row and it always seems to get averted at the last minute.  I think that they may not understand the gravity of the situation this time.”

Writing on the MDNews.com website, Maggie Behringer says that “Last year the battle to fund the Medicare deficit — $19 billion for the fiscal year — ended in a one-year measure.  The summer saw a hands-off stance from the Center for Medicare and Medicaid Services when the administration instructed providers to temporarily cease filing claims until Congress resolved a standstill over stimulus spending and unemployment benefits.  The cut projected for January, 2012, should Congress fail to enact the customary doc-fix, totals to 27.4 percent.  The core conflict for legislators — 19 of whom are physicians, themselves — emerges in the inability of the SGR to adapt in today’s economic environment.  The formula was originally developed to bind spending to the economy’s growth.  Despite initial success, the exponential climb in healthcare costs quickly surpassed the overall market.  The subsequent deficits to fund Medicare were further compounded by the recent depression and ongoing recession.  Even if Congress is able to act in time with a temporary doc-fix over the holidays, the fundamental dilemma will remain a question of funding just as the patient population eligible for Medicare benefits enters a major boom.”

Tags: , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

Super Committee’s Failure Raises Questions About Healthcare Funding

Wednesday, December 7th, 2011

Now that the Super Committee has failed to identify $1.2 trillion in cuts from the federal budget, automatic cuts totaling billions for everything from Medicare to biomedical research, start in 2013.  Some healthcare sectors will fare better than others.  The primary health entitlement programs, Medicare and Medicaid, are protected under the law that created the Super Committee.  Automatic cuts will not impact Medicaid, the joint federal-state health program for the poor.  Medicare would be cut by two percent – all from payments to hospitals and other providers.

The bad news is that unless Congress reworks the legislation mandating the automatic cuts, a series of across-the-board reductions will begin in 2013.  The House and Senate appropriations committees must decide how to spread the cuts among various programs.  And some of the larger, better-financed lobbies may be able to influence what is cut and what is kept.

Even though the Medicare cuts are limited to hospitals and other medical providers and would not exceed two percent, they argue that is too much and that they sacrificed plenty in the Patient Protection and Affordable Care Act (ACA).  Rich Umbdenstock, president and CEO of the American Hospital Association, said sweeping cuts would hurt Medicare beneficiaries and their families and “also have an impact on the ability of hospitals to provide essential public services to the communities they serve given the impact that Medicare has on the entire healthcare system.”

Officially known as the Joint Select Committee on Deficit Reduction, the Super Committee was unable to meet its deadline to come up with $1.2 trillion of deficit reduction required by the law that created it, much less the $4 trillion that deficit hawks said was necessary to stabilize the finances of the U.S. government, whose debt has topped $15 trillion.  The failure ensures that the fiscal debate between Democrats who want to protect social programs and increase revenue by raising taxes on the wealthy; and Republicans who want smaller government and have pledged to reject tax increases will be a fundamental choice confronting voters in 2012.

“After months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee’s deadline,” Representative Jeb Hensarling,(R-TX), and Senator Patty Murray, (D-WA) said.  The co-chairs thanked committee members, staffers and “the American people for sharing thoughts and ideas and for providing support and good will as we worked to accomplish this difficult task.”

Writing for Politico, David Nather speculates on whether the Super Committee’s failure has harmed efforts to reform Medicare and Medicaid.  It would be easy to conclude that the Super Committee’s failure means the big, expensive health care entitlement programs — Medicare and Medicaid — are untouchable.  It also would be wrong.  The timing was off, coming too close to a presidential election.  The co-chairs weren’t powerful enough.  The work came too soon after a summer debt deal that Democrats hated.  Republicans couldn’t give the kind of concessions on taxes that Democrats needed.  And the alternative to a Super Committee deal on healthcare entitlements — the two percent automatic cuts in healthcare payments and defense funding that will now take place in 2013 — wasn’t harsh enough to force a deal on Medicare and Medicaid. In fact, it might even have been the easier way out.  All of which means Medicare and Medicaid are not off the table forever.”

The Hill’s Sam Baker offers a different perspective. “The Super Committee’s demise is a mixed bag for the American Medical Association and other groups that wanted the 12-member panel to tackle Medicare’s payment formula, known as the sustainable growth rate (SGR).  The AMA — with bipartisan support in Congress — pushed hard for the supercommittee to include in its deficit-cutting package a long-term fix to the SGR.  The formula calls for automatic annual cuts in doctors’ payments, which add up as Congress consistently delays each cut from taking effect.  Aspirations of a long-term SGR patch should be put to rest, healthcare lobbyists said. But they questioned whether the supercommittee push was ever realistic, because an SGR fix would add to the deficit.”

“I never once believed that the Joint Select Committee would be the one to do that,” said Julius Hobson, a senior adviser at the Washington, D.C.-based law firm Polsinelli Shughart and a former AMA official.

Tags: , , , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

Can Marilyn Tavenner Save Medicare?

Monday, December 5th, 2011

President Barack Obama’s choice of Marilyn Tavenner as administrator of the Centers for Medicare and Medicaid Services – to replace Dr. Donald Berwick, whose recess appointment was set to expire at the end of the year – is more likely to survive the Senate confirmation process relatively unscathed.

A Harvard-educated pediatrician, Berwick won praise and the backing of major healthcare groups for his academic work, which focused on cutting the cost of care while improving quality and patient experience.  Republicans took exception to his praise of Britain’s National Health Service as an “example” for the United States to emulate.  Others accused him of supporting “rationing” healthcare services, a claim Berwick rejects.  “Every bone in my body, as a physician, even as a person, is to get everything (patients) want and need and to help them at every step,” he said.  “I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia…and they are telling me I’m rationing?  They haven’t met me.”

White House officials said, “Before entering government services, Tavenner spent nearly 35 years working with health care providers in significantly increasing levels of responsibility, including almost 20 years in nursing, three years as a hospital CEO, and 10 years in various senior executive-level positions for Hospital Corporation of America.”

According to Ezra Klein, “Tavenner’s healthcare experience lies much more in management than policy.  Former colleagues describe her as a patient-centered manager, a hands-on medical professional equally comfortable in the board room and the emergency room.  And in contrast to Berwick, Tavenner isn’t associated with a grand vision for health reform, or a particular policy agenda for Medicare and Medicaid.  ‘With Marilyn, you present the information, then she makes a decision, and you move on,’ said Patrick Finnerty, who served as Virginia’s Medicaid director under Tavenner.  ‘She doesn’t make promises she can’t keep.  There are differences of opinions, and she would try to work through those.  She’s straight with folks but always respectful.’”

Tavenner started her career as a nurse at Virginia hospitals owned by the Hospital Corporation of America (HCA).  Tavenner met with success, rising from chief nursing officer to CEO.  In 2004, she was again promoted to HCA’s president of outpatient services, her first national position with the firm.  She resigned two years later, when then-Virginia Governor Tim Kaine tapped her to head the state’s Health and Human Resources department.

Tavenner has already won the American Medical Association’s (AMA) backing. “We have worked extensively with her in her role as deputy administrator, and she has been fair, knowledgeable and open to dialogue,” AMA President Peter Carmel said.  “With all the changes and challenges facing the Medicare and Medicaid programs, CMS needs stable leadership, and Marilyn Tavenner has the skills and experience to provide it.”

Senator Orrin Hatch (R-UT), the ranking Republican on the Senate Finance Committee, said that the panel would thoroughly scrutinize Tavenner, but did not say he opposes her nomination.  Despite Hatch’s mild comment, Tavenner is expected to face some difficult questioning because Senate Republicans have not overtly endorsed her.  According to a Republican healthcare lobbyist, “I can’t imagine a lot of support for her,” noting that the high-profile CMS role “always gets sucked into the controversy of the day.”  Ultimately, Tavenner is likely to be confirmed for the CMS post.

Tavenner is widely seen as a pragmatic administrator who will not rock the CMS boat. “The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs,” she said.  Tavenner also said she opposed Republican efforts to turn Medicaid into a block grant that would limit the amount of federal funding states can receive for the program.  “That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above,” she said.  Tavenner “brings continuity in terms of implementing the mission,” said Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics.

Tags: , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

Showdown As Opposing Medicare Ads Debut

Wednesday, November 30th, 2011

A coalition of advocacy groups such as the Americans United for Change, Service Employees International Union, American Federation of State, County, the Municipal Employees and Service Employees International Union and Moveon.org recently started running a series of ads telling lawmakers not to cut Medicare benefits.  In particular, the ads target Representative Denny Rehberg (R-MT), Senator Dean Heller (R-NV) and Senator Scott Brown (R-MA).

“If you vote to cut Medicare, Representative Rehberg, I will remember it every time I visit my doctor.  I’ll remember you cut Medicare and Medicaid every time I fill my prescription,” says an elderly woman narrator in one of the ads.  “I’ll remember you cut Medicare every time I fall or get hurt. I’ll remember you protected millionaires over protecting my health. My friends will remember it, too — all of them.  Call Senator Heller.  Tell him to protect Medicare and Medicaid.”

Brian Walsh, the National Republican Senatorial Committee communications director, made light of the Democratic message, arguing that the half-trillion dollars they shifted out of Medicare to pay for healthcare reform makes their argument hollow.  “The irony of this pathetic attack ad is that in each of these three races, it’s actually the Democrat candidates who are all firmly on record supporting the $500 billion in Medicare cuts that were included in their massive healthcare overhaul,” said Walsh.  “The big labor unions funding this ad know that, but yet they are doing everything they can to mislead voters in Montana, Nevada and Massachusetts.”

In the meantime, the United States Chamber of Commerce is running commercials attacking Senators Sherrod Brown (D-OH) and Jon Tester (D-MT).  Friends of the U.S. Chamber criticize Tester for supporting “government-run healthcare” and challenges Brown on energy taxes.  The business community has been under unprecedented threat,” Rob Engstrom, part of a two-man team running the chamber’s political operation, said.  The trade group plans to break its previous political spending record — $50 million — to try to elect a more business-friendly Congress.  The Montana ad reminds viewers about Tester’s votes for “government-run healthcare” then urges voters to “call Senator Tester and tell him to stop supporting big government and start fighting for Montana’s families.”

Americans United for Change explains why it is running ads about protecting Medicare and Medicaid.  “For decades, seniors have relied on Medicare being a guaranteed benefit and those less fortunate have depended on Medicaid to provide long-term care and coverage for children.  These programs need to be strengthened to ensure they remain available for future generations, which means not gutting and decimating benefits, leaving low-income children, seniors, and people with disabilities out in the cold.  The key to making Medicare sustainable is reining in costs, not dumping more expenses onto seniors.  We are working to set the right priorities for an economically secure future while continuing to protect healthcare coverage for those who can least afford it.”

Writing for the Huffington Post, Sam Stein describes the Democratic ads as “Not exactly the most visually stimulating videos, the ads warn lawmakers that they will pay a political price for cutting Medicare or Medicaid.  That may prove to be popular politics — certainly, polls show that voters want the two healthcare programs protected — but the notion that cuts won’t ultimately be pursued is highly unlikely.  Aides on the Hill from both political parties have long agreed that there is room to trim down Medicare’s provider-side components.  Reforms to Medicaid, whether in the form of decreased help to the states or something more structural, have also been discussed.”

Tags: , , , , , , , , , ,
Posted in General, Healthcare, Hospital Systems | No Comments »

Half of Americans Support Obamacare Repeal

Monday, November 28th, 2011

A recent Gallup poll found that 47 percent of Americans support the repeal of the Patient Protection and Affordable Care Act (ACA), compared with the 42 percent who want the law kept in place.  The remaining 11 percent offered no opinion.  In an ironic twist, the survey also determined that half of Americans believe the federal government has a responsibility to make certain that all citizens have healthcare coverage, compared with 46 percent who do not.

“Views on this issue are highly partisan, with Republicans strongly in favor of repeal and the large majority of Democrats wanting the law kept in place,” according to Gallup.

Republicans claim that the healthcare law is unconstitutional because of the individual mandate that requires all Americans to purchase health insurance.  Approximately eight in 10 Republicans think Congress should repeal the healthcare law, including 54 percent who want the entire law thrown out.  Democrats have an opposing view: 60 percent support keeping the healthcare law as is.  Independents are split.

Fully 80 percent of Republicans support repeal, while a mere 10 percent support the law.  Democrats, not surprisingly support the healthcare law by 64 – 21 percent.  The intensity of the issue on both sides is also striking.  Among those who favor repeal of the so-called Obamacare, 66 percent say it is a “very important” issue.  Fully 60 percent of the ACA’s supporters described it is a “very important” issue.

Another finding of the survey is that 56 percent of respondents prefer an insurance system run by private companies; while 39 percent prefer a government-run system.

Writing for CBS News, Jennifer De Pinto says that “Even though overall support for the healthcare law is mixed, majorities have favored some individual elements of the law, including requiring health insurance companies to cover people with pre-existing conditions and allowing children to stay on their parents’ healthcare plan until age 26.  However, the provision that requires all Americans get health insurance is not as popular.  A CNN/ORC Poll conducted this past summer found 54 percent of Americans oppose that provision.”

In a poll taken by the Kaiser Foundation, 34 percent said they view the law either “very” (12 percent) or “somewhat” (22 percent) favorably while 51 percent saw it in either as “somewhat” (20 percent) or “very” (31 percent) unfavorably.  In April 2010, the favorable view of the law was 50 percent only one time (July 2010).  With the exception of the October dip, support has generally been between 39 and 43 percent since the start of this year.  Even as the overall bill remains consistently unpopular, parts of it — including the individual mandate, which would require all Americans to carry health insurance — are viewed more positively.

Even if the Supreme Court overturns the ACA or it is repealed, President Barack Obama said that the healthcare law he signed in 2010 represents “a reform that will finally make sure that nobody goes bankrupt in America just because they get sick.”  Obama said the law assures coverage for people with preexisting medical conditions and is the kind of change he promised during the 2008 presidential campaign.  “Everything we fought for in the last election is now at stake in the next election,” Obama said.  “The very core of what this country stands for is on the line.”

Tags: , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

Supreme Court to Decide Healthcare Reform

Wednesday, November 23rd, 2011

The Supreme Court has agreed to rule on the fate of President Barack Obama’s Patient Protection and Affordable Care Act (ACA) healthcare law, with an election-year ruling due by July on the most comprehensive overhaul in nearly a half century.  The decision had been widely expected because the Obama administration asked the nation’s highest court to uphold the landmark legislation and 26 states asked that the law be ruled unconstitutional.

President Obama expressed confidence that the court would uphold the law when the decision is handed down, just four months prior to the 2012 election.  “Thanks to the Affordable Care Act, one million more young Americans have health insurance, women are getting mammograms and preventive services without paying an extra penny out of their own pocket and insurance companies have to spend more of your premiums on healthcare instead of advertising and bonuses,” said Dan Pfeiffer, the White House communications director.  “We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree,” Pfeiffer said.  The administration pointed out that other landmark legislation, such as the Social Security Act, the Civil Rights Act and the Voting Rights Act, all faced similar legal challenges that failed.

Republicans have vowed to repeal “Obamacare,” but that promise will have to be modified if the high court undercuts the law as written.  A Supreme Court victory would make President Obama even more confident that the law is the major accomplishment of his first term.

Senate Minority Leader Mitch McConnell, (R-KY) said “this misguided law represents an unprecedented and unconstitutional expansion of the federal government into the daily lives of every American.”  The majority of Americans agree,” McConnell said.  “In both public surveys and at the ballot box, Americans have rejected the law’s mandate that they must buy government-approved health insurance, and I hope the Supreme Court will do the same.”

Despite Republicans’ insistence that the ACA is unconstitutional, only one of the four federal appeals courts that have heard cases on healthcare reform has struck down even a part of the law.

One of the ACA’s most vocal opponents is Karen Harned of the National Federation of Independent Business, who said: “We are confident in the strength of our case and hopeful that we will ultimately prevail.  Our nation’s job-creators depend on a decision being reached before the harmful effects of this new law become irreversible.”

Legal experts believe that the healthcare vote will be close on the nine-member court, which is comprised of five conservatives and four liberals.  Moderate conservative Justice Anthony Kennedy, who often is the swing vote, and could well cast the decisive vote.  Paul Heldman, senior analyst at Potomac Research Group, which provides Washington policy research for the investment community, said he still leaned toward the view that the law’s requirement that individuals buy insurance will be upheld.  “We continue to have a high level of conviction that the Supreme Court will leave much of the health reform law standing, even if finds unconstitutional the requirement that individuals buy coverage,” he wrote.

An impressive 5 ½ hours of oral arguments will be held in late February or March. The primary issue is whether the “individual mandate” section – which requires virtually all Americans to buy health insurance by 2014 or face fines — is an improper exercise of federal authority.  According to the states, if that linchpin provision is unconstitutional, the entire law must be also be overturned.  Joining Florida in the challenge are Alabama, Alaska, Arizona, Colorado, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.  Virginia and Oklahoma have filed their own challenges, along with other groups and individuals opposed to the law.

According to USA Today’s Joan Biskupic, “The leading question before the justices is whether in requiring most Americans to buy insurance, Congress exceeded its power to regulate interstate commerce.  The case is on track to be heard by March, and a ruling would come by the end of June, just before the Republican and Democratic conventions for the 2012 presidential election. The law known as the Affordable Care Act, intended to extend medical care nationwide, is the centerpiece of the Obama domestic agenda, and all major GOP presidential candidates oppose it.  The legal challengers, including a group of 26 states, say the law went beyond federal power and, if allowed to stand, would hurt small businesses and compromise individual choices on medical care.”

Writing in The Hill, Sam Baker says that “As they weigh the mandate, the justices will have to consider how it affects other parts of the law.  If they find the coverage requirement unconstitutional, they will have to decide whether to strike it down on its own or instead strike down the entire law.  The justices also will determine whether a separate federal law bars them from reaching a decision on the mandate before it takes effect.  People can’t challenge a tax before they have to pay it, and the Obama administration has defended the mandate by invoking Congress’s taxing power.  But it has also said the court should bypass procedural issues and rule directly on the mandate.”

Tags: , , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

Obama to Sign Executive Order Releasing $1 Billion to Cut Medical Fraud

Wednesday, November 23rd, 2011

President Barack Obama will once again sidestep a fractious Congress and sign an executive order designed to cut fraud from Medicare and Medicaid.  The Department of Health and Human Services (HHS) will administer the changes, such as testing changes to obsolete hospital billing systems to prevent overbilling, administration officials said.

The billion-dollar initiative will reward the “most compelling new ideas” for cutting costs and improving care of Medicare and Medicaid patients with rewarding federal grants.  Called the Health Care Innovation Challenge, the initiative will provide between $1 million and $30 million over three years to individual organizations or coalitions that develop sustainable, new approaches to improving healthcare quality and efficiency.  “We’ve taken incredible steps to reduce healthcare costs and improve care, but we can’t wait to do more,” said HHS Secretary Kathleen Sebelius.  “Both public and private community organizations around the country are finding innovative solutions to improve our healthcare system, and the Health Care Innovation Challenge will help jump-start these efforts.”

Centers for Medicare and Medicaid Services (CMS) administrator Dr. Donald M. Berwick, M.D. said, “When I visit communities across the country, I continually see innovative solutions at the very ground.  By putting more programs like this in place and more ‘boots on the ground,’ these types of programs can truly transform our healthcare system.”

This program is part of the Obama Administration’s “We Can’t Wait” initiative, which is a series of legal Executive Branch steps designed to move America forward while Congressional Republicans block critical and necessary legislation.

To demonstrate that its campaign to cut government waste is working, the White House said the administration cut improper payments by nearly $18 billion in 2011, largely in such programs as Medicare, Medicaid, Pell Grants and food stamps.  Budget chief Jack Lew ordered federal agencies to tighten their oversight of contractors and grant recipients to reduce the potential for taxpayer waste.

Not surprisingly, there was some immediate opposition to the initiative, with Republican critics calling it a “$1 billion experiment.”  “On the day the Supreme Court decided to review the constitutionality of ‘Obamacare,’ the president is asking for another $1 billion in taxpayer dollars to pay for another healthcare experiment that will continue taking us in the wrong direction,” said RNC spokeswoman Kirsten Kukowski.  “We already spent $2.6 trillion on his job-killing health care bill.  Another $1 billion Executive Order is just more words for a president more interested in campaign talking points than creating jobs.”

With the Supreme Court preparing to hear arguments for and against the Patient Protection and Affordable Care Act (ACA) next March, it is important to note that even the 26 states suing to have the law overturned are hedging their bets.  Only four states have refused all federal money to plan for the changes that are scheduled to take place.

Several healthcare industry leaders expressed their support for the ACA. “The system is transforming itself,” said Charles N. Kahn III, president of the Federation of American Hospitals.  “But the success of these changes depends a lot on whether there is sufficient funding.”  Nationally, hospital systems are anticipating an influx of federal funds and patients as the law goes into full effect.  “If the law is struck down, healthcare reform will have to continue one way or another,” said Patricia Brown, president of Johns Hopkins HealthCare.

Tags: , , , , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

« Older Entries