Posts Tagged ‘National Governors Association’

What’s at Stake? Medicaid, Not Medicare

Monday, June 27th, 2011

Seventy percent of Americans oppose cuts to Medicare and 57 percent are against cutting Medicaid, even when they are aware that the programs constitute an outsized weight in the federal deficit.  Of the two wildly popular programs, Medicaid is the most vulnerable.

Writing in the Washington Post about a report from the Kaiser Family Foundation about the health of Medicare and Medicaid, Ezra Klein says “It doesn’t matter whether Eric Cantor says he’s bargaining for the Ryan budget or not.  The GOP cannot privatize and voucherize Medicare.  They can’t even get close.  It’s too easy an issue for Democrats, too dangerous an issue with seniors, and too slipshod a policy even for Michele Bachmann.  The attack on Medicaid, however, is another story.  That one might actually work.  And if it does, it’ll actually be worse.  ‘in-the-know political circles,’ says Chris Jennings, who ran President Bill Clinton’s healthcare reform efforts, ‘it’s just assumed Medicaid is going to be hit.  No one is going to want to touch Medicare.  Medicare is where the political juice is.  But we’re going to need savings.  So that leads to Medicaid.’  There are two reasons Medicaid is more vulnerable than Medicare.  The first is who it serves.  Medicaid goes to two groups of people: the poor and the disabled. Most of the program’s enrollees are kids from poor families, though most of the program’s money is spent on the small fraction of beneficiaries who are disabled and/or elderly.  These groups have one thing in common: They’re politically powerless.”

It’s a little-known fact that Medicaid covers more people than Medicare. In 2010, according to the Department of Health and Human Services, Medicaid covered 53.9 million people, compared with Medicare’s 47.3 million.  Additionally, Medicaid patients are also among society’s most vulnerable.  “Kids (and) pregnant women are the vast majority,” according to Health and Human Services Secretary Kathleen Sebelius.  “But then older seniors, many of whom are in nursing homes…and very disabled individuals” are also covered by Medicaid.

Although states and the federal government share the cost of Medicaid, what grates on some governors is the rules that come with the money.  “Governors just want flexibility to run our states,” said Republican New Jersey Governor Chris Christie at the annual National Governors Association meeting in February. “We don’t want to pay 50 percent of the cost of Medicaid and have zero percent of the authority.  And I don’t think that’s an unreasonable thing to be asking for.”  Governor Haley Barbour of Mississippi agrees.  “If I could get total flexibility, I would take a two percent cap in a heartbeat,” he said.  Barbour’s preference is to receive a lump sum – what it gets now from the federal government, plus two percent to fund Medicaid.

Dr. Donald Berwick, administrator of the Center for Medicare and Medicaid Services, (CMS) said “There’s a right way to reform Medicare and a wrong way,”  Berwick believes that the direction he is taking — modeled on his successful patient safety campaigns at the Institute for Healthcare Improvement – will bring about needed healthcare change.  The Obama administration’s efforts to improve patient safety are more or less bipartisan.  There is little cause to dispute CMS’ data: the agency spent $4.4 billion in 2009 caring for patients harmed in hospitals and an additional $26 billion on patients who were readmitted within 30 days.  The Partnership for Patients, funded through the Patient Protection and Affordable Care Act (ACA), seeks to reduce preventable injuries by 40 percent and cut hospital readmissions by 20 percent in just two years.  According to CMS, achieving the Partnership’s goals will result in 1.8 million fewer patient injuries, allow more than 1.6 million patients to recover complication-free and save up to $35 billion in health costs.

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius described contentious portions of the ACA as the inaugural steps toward entitlement reform.  Sebelius criticized proposals to transform federal Medicaid funding into block grants for states.  When some lawmakers asked her to speak about the Obama administration’s alternative proposal to rein in entitlement spending, Sebelius pointed to two provisions of the new law.  The ACA created a new board of independent experts that will recommend Medicare payment cuts.  Its recommendations will take effect automatically unless Congress blocks them — and proposes equivalent savings.  According to Sebelius, the panel represents “a big step in terms of entitlement reform that actually doesn’t potentially cause harm to our seniors.”  She also pointed to an HHS effort to create new methods of dealing with people who are eligible for both Medicare and Medicaid because those patients represent a lopsided share of the programs’ costs.

Obama Calls the States’ Bluff on Healthcare Law Implementation

Tuesday, March 8th, 2011

President Barack Obama is calling the states’ bluff on implementing the Patient Protection and Affordable Care Act (ACA) by allowing them to opt out of its most onerous requirements three years earlier than currently permitted. Speaking at a meeting of the National Governors Association, Obama specifically pointed to a proposal from Senators Ron Wyden (D-OR) and Scott Brown (R-MA) which he endorsed as a flexible approach.  “If you can come up with a better system for your state to provide coverage of the same quality and affordability as the Affordable Care Act, you can take that route instead,” Obama said, noting that, “If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act does, without increasing the deficit, you can implement that plan and we’ll work with you to do it.”

The president endorsed the proposal to allow states to apply for “innovation waivers” beginning in 2014, three years earlier than originally scheduled. Under the terms of these waivers, states would be exempt from several of the law’s requirements if they set up their own method of adequately expanding coverage.  The “individual mandate” is the focus of multiple state lawsuits by states that contend it is unconstitutional.

The Obama administration has posted a detailed fact sheet on the proposal on the White House website. Additionally, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has blogged about it.

Despite lingering opposition to the healthcare reform law, the Obama administration is moving ahead with its implementation.  Over the last 10 months, HHS has made $2.8 billion available to states to help them start reforming their healthcare systems.  These funds let the states invest in improvements.  These investments are showing signs of progress thanks to more comprehensive oversight of insurance premium increases, new rights and protections for consumers, additional choices for people living with medical conditions, and the elimination of some of the worst insurance industry practices.

The bipartisan proposal’s future is uncertain, with both Democrats and Republicans casting wary eyes at it. Representative Eric Cantor (R-VA), the House majority leader, said the healthcare law is “an impediment to job growth” and that he is still committed to repealing the ACA.  “I was disappointed,” said Governor Rick Perry (R-TX) and chairman of the Republican Governors Association.  “Pretty much all he did was to reset the clock on what many of us consider a ticking time bomb that is absolutely going to crash our state budgets.  The states need more than that.”  Even some Democrats are cautious because they believe that it is impossible to expand healthcare coverage and reduce the deficit without the federal mandate.  Senator Max Baucus (D-MT) said “We want to give states as much flexibility as possible, but that flexibility shouldn’t fail to ensure that Americans in every state have access to quality, affordable healthcare.”

Writing in the Washington Monthly, Steve Benen asks “So, how big a deal is this?  It marks a fairly significant departure from the administration’s status quo, but at its root, what we’re seeing is the White House call Republicans’ bluff.  The GOP is convinced it can offer comparable coverage at comparable prices using Republican-friendly policies.  Today, in effect, the president said, ‘Be my guest.’  Why?  Because Obama knows it’ll take more than tort reform and HSAs to make the system work, and he sees a political upside to watching GOP officials scramble to actually craft their own plans, rather than bash his.”

President Obama also made it clear that the federal government is moving forward with healthcare reform. “I am not open to refighting the battles of the past two years or undoing the progress that we have made, but I am willing to work with anyone, governors or members of Congress, to make this law better…and fix what needs fixing,” Obama said.