Posts Tagged ‘Obama administration’
Wednesday, August 3rd, 2011
Attorneys representing 26 states – with Florida taking the lead – locked horns with the Obama administration in the U.S. Court of Appeals for the 11th Circuit over the constitutionality of the Patient Protection and Affordable Care Act (ACA).Florida, 25 other states and the National Federation of Independent Business claim that the “individual mandate” violates the Constitution’s Commerce Clause by requiring that Americans buy healthcare insurance or pay a penalty.
Arguing for the Obama administration was acting Solicitor General, Neal Katyal, who said “People are seeking this good already in untold numbers. The good of healthcare. It’s purely financing. It’s about failure to pay. Not about failure to buy.” Katyal pointed out that the 50 million Americans who currently lack healthcare insurance too often end up in emergency rooms for medical treatment, driving up costs. Defending the law, Katyal emphasized the special nature of healthcare and the insurance market today. He said billions of dollars incurred by people without insurance are passed on to people who carry insurance. Arguing for the states, attorney Paul Clement conceded that the government can enact laws that people acquire healthcare insurance, but not until they need medical care. Prior to that, “they’re not engaged in commerce. They’re sitting in their living rooms,” Clement said.
The three-judge panel seemed to be skeptical about the government’s position. “I can’t find any case like this,” Chief Judge Joel Dubina said. “If we uphold this, are there any limits” to the federal government’s power? Judge Stanley Marcus said “I can’t find any case” in the past where the courts upheld “telling a private person they are compelled to purchase a product in the open market…Is there anything that suggests Congress can do this?”
So far, three federal district judges have upheld the ACA while two have ruled it is unconstitutional. Three cases were heard by appeals courts, with a fourth appellate panel planning to hold a hearing in September. The current case has attracted the most attention because it involves 26 state attorneys general who jointly challenged the law. Additionally the Atlanta-based 11th Circuit is considered one of the nation’s most conservative federal appellate courts.
If any appeals courts declare the law unconstitutional, the case likely would be heard by the Supreme Court — perhaps during the election year. Legal experts believe the 11th Circuit is more likely to rule against the administration.
The hearing was a government appeal of a decision by Florida-based U.S. District Judge Roger Vinson that ruled against the insurance mandate and voided the healthcare law. According to Vinson, the mandate exceeded Congress’ power to regulate commerce because, instead of involving the usual “economic activity,” it targeted “inactivity,” in other words, someone’s decision not to purchase insurance. This case is high profile because it was brought by more than half of the states; additionally, it tests an unprecedented lower-court ruling that invalidated the entire law.
One of the appellate judges asked Katyal if there are there any limits on Congress’s power to compel people to act. “Absolutely,” Katyal replied. “We are not saying that Congress can force somebody to buy something and that failure to do so is economic activity. People are seeking that good already,” he said. Katyal said $43 billion is spent annually on care for the uninsured. “That’s quintessentially economic,” he said. Clement argued that the crux of the issue is whether the federal government can regulate individuals. “For 220 years, Congress never saw fit to exercise that power,” he said. “The whole reason we do this is to protect individual liberty.” According to Clement, the Commerce Clause regulates people engaged in commercial activity and does not force them to engage.
Writing in The New Republic, Jonathan Cohn is reluctant to say how he thinks the court will rule. “I didn’t hear the entire oral argument, which C-Span helpfully broadcast. (Note to the federal judiciary: There’s this thing called the internet and it can transmit audio files.) But I, too, came away genuinely uncertain how the court will rule. The judges seemed a lot more ornery during the questioning of Katyal than they did during the questioning of Paul Clement, the former solicitor general arguing on behalf of the states filing the lawsuit. But the actual substance of those questions – and some side comments that the judges made – suggested they were ready to reject essential pieces of the legal challenge. Particularly striking were a series of comments from Frank Hull, in which she (yes, Frank is a ‘she’) stated repeatedly that she did not agree with the ‘activity-inactivity’ distinction opponents of the law have made. As those of you following this case know, that’s really the heart of their argument: They say the decision not to buy insurance is a form of ‘inactivity,’ which means the government may not regulate it. Supporters of the law, including the government, disagree. And Hull seemed to side with them, saying (roughly, given my sketchy notes): ‘When I decide I would rather spend my money differently…that I would rather buy this product than pay for health insurance…that’s an economic decision…How can that be anything other than an economic decision?’”
Tags: Atlanta, C-Span, Commerce Clause of the Constitution, conservative, Election year, emergency rooms, Florida, Individual mandate, Jonathan Cohn, National Federation of Independent Business, Neal Katyal, Obama administration, Patient Protection and Affordable Care Act, Paul Clement, President Barack Obama, Solicitor General, Supreme Court, U.S. Court of Appeals for the 11th Circuit
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Wednesday, July 13th, 2011
The Obama administration has fine-tuned rules that give patients greater clout in disputes with health insurers, changing the standards in ways that disappointed leading advocates for healthcare consumers. The rules are designed to guarantee patients the same rights to appeal if their insurers do not cover care that is considered necessary. The federal standards, part of the Patient Protection and Affordable Care Act (ACA), replace a patchwork of varying state policies. The rules allow patients to protest to their health plans; if they do not succeed, they can take their complaints to an outside arbiter. Department of Health and Human Services (HHS) officials issued the rules 11 months ago, but they have revised them. Insurers and employers have long wanted limited appeal rights; conversely, consumer groups have argued for stronger patient protections. In the new version, the grounds to protest an insurer’s decision are narrower than consumer groups prefer.
Writing on the Becker’s Hospital Review website, Rachel Field says that “The earlier rules governed consumers’ right to appeal denials by health plans. The overhaul gave members in group and individual health plans the right to appeal the denial of coverage to an independent review panel. The administration’s new rules give beneficiaries less time to prepare an appeal, less information about the reason for the denial and limitations on which denials can be appealed. According to the report, patients can still appeal if their coverage is cancelled by an insurer, and decisions by external review panels are still binding. Employer-sponsored plans that are self-insured will have to use at least two independent review organizations to make sure decisions remain unbiased.”
Because states lack the authority to regulate self-insured health plans, there has been no requirement allowing beneficiaries to appeal denials to an independent panel. The health law extends that right to more than 44 million Americans covered by self-insured plans that will lose their exempt status this year. “The right to an external appeal is considered one of the most important consumer protections that you can have,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the HHS. “Consumers do not want insurance companies making medical decisions for them or for their families.” According to Larsen, states will have extra time to revise local external appeals rules so that they can conform to the federal standards. Insurers won’t have to comply with new state rules that incorporate federal requirements until January 1, 2012.
The revised rules come at an appropriate time. Although few people want to a fight with their health insurer, it may be worthwhile. A recent Government Accountability Office report found that more claims problems resulted from annoying but often clear-cut billing and eligibility issues than from disagreements over whether care was medically necessary. Plus, the odds are about 50/50 that if a patient appeals an insurer’s decision, the patient will win.
Not everyone agrees with the action. “The Obama administration gave in to the insurance industry and large employer lobby on rules that would, for the first time, give rights to patients with certain employer-paid health plans to challenge a healthcare denial. These consumers need the protection of independent reviews the most because they usually have no legal remedy for a wrongful decision to deny care under an errant 1987 Supreme Court ruling. Health reform was intended to strengthen the public’s ability to make insurers provide the coverage patients are promised. The administration should reverse the changes in this regulation that undermine that promise,” said Carmen Balber, Washington director for Consumer Watchdog.
Tags: Becker’s Hospital Review, Center for Consumer Information and Insurance Oversight, Consumer Watchdog, Denial of coverage, Department of Health and Human Services, Government Accountability Office, Health insurers, Kaiser Health News, Obama administration, Patient Protection and Affordable Care Act, Self-insured health plans
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Wednesday, July 6th, 2011
Despite strong opposition from some member doctors, the American Medical Association (AMA) supports a key element of the Patient Protection and Affordable Care Act (ACA) that requires Americans to buy health insurance. By a 2 — 1 margin, the AMA’s policy-making House of Delegates voted to continue its support of the individual mandate, saying such responsibility for Americans who can afford to buy coverage was the best option to expand benefits to people who are currently uninsured. The results of the vote were 326 in favor and 165 opposed. Without an individual mandate, people will not purchase health insurance until they are sick; that would lead to a spike in premiums for all.
“The AMA’s policy supporting individual responsibility has bipartisan roots, helps Americans get the care they need when they need it and ends cost shifting from those who are uninsured to those who are insured,” said AMA president Dr. Cecil Wilson, a Winter Park, FL. internist. “Important insurance market reforms, such as an end to denials based on pre-existing conditions, are only possible by having broad participation in the health insurance market. The AMA reviewed alternatives and concluded that any approach to covering the uninsured that is in line with AMA policy cannot be fully successful in covering the uninsured without individual responsibility for health insurance,” Wilson noted.
After the civil, one-hour individual mandate debate, Wilson said an “overwhelming” majority of physicians voted to continue the position the association has maintained 2006. Some delegates raised the issue because the constitutionality of that portion of healthcare reform legislation is being challenged. “Our concern is that if we are not able to have a requirement that people have an individual responsibility to purchase insurance, we’re not aware of another solution, except something that would say that the government would make a requirement and tax the individuals for that,” Wilson said. “From our perspective, the concern would be raised that would take us down a path toward a government run system.”
Wilson criticized people who can afford health insurance but refuse to purchase it, “who then arrive in the emergency room having fallen off of their motorcycle – and they did not wear a helmet – and they end up with major life-threatening injuries, the treatment for which very few people could afford. And the result of that is that all of pay for that, private as well as taxpayers.” Those are the people who cause those who have health coverage to pay premiums that are “$1,000 a year more than they otherwise would be.” The reaffirmation vote stipulates that for individuals and families who cannot afford health coverage, there would be government tax subsidies or credits inversely proportional to income. When asked if the AMA might file an amicus brief to support the Obama administration’s fight to block challenges, Wilson said that is unlikely.
According to Wilson, the delegates’ vote emphasized that “We cannot walk away from the fact that some 32 million more Americans would be able to have insurance and who do not have it now, and that as a result of not having insurance, would live sicker and die sooner.”
Several physicians strongly opposed the mandate, referring to constitutionality challenges, freedom issues, and the opposition of physicians and numerous medical organizations. The AMA admits to having lost 12,000 members since 2009, many because of their endorsement of ACA. “The AMA has turned 180 degrees since the 1950s, when it held that ‘the voluntary way is the American way,’” said Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). “Now it has adopted the ‘progressive’ left-wing stance of calling for compulsory purchase of government-prescribed insurance.” People will no longer be able to choose how to pay their medical bills. Many might opt for the most affordable way: self-payment of most bills, with low-cost, high-deductible insurance for the rare catastrophe. “But that choice would deprive the government’s favored plans of some fat premiums,” Dr. Orient said.
With 250,000 of the nation’s physicians comprising its membership, the influential AMA has historically been opposed to a bigger government role in healthcare. Physicians who oppose the ACA attempted to convince colleagues that the AMA should change its position. Some delegates have blamed the Association’s support of the individual mandate for a loss of membership in the AMA in their states. “I believe that each state, working with the population it has and the specific problems it has, can craft a solution that works better for that state than perhaps the one next door,” said Michael Greene, M.D., a delegate with the Medical Association of Georgia. Dr. Greene, a family physician, supported the amendment.
Tags: American Medical Association, Amicus brief, Association of American Physicians and Surgeons, health insurance, Health insurance markets, Individual mandate, Medical Association of Georgia, Obama administration, Patient Protection and Affordable Care Act, pre-existing conditions
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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.
Tags: Block grants, Center for Medicare and Medicaid Services, Department of Health and Human Services, Disabled, Dr Donald Berwick, Ezra Klein, Governor Chris Christie, Institute for Healthcare Improvement, Kaiser Family Foundation, Kathleen Sebelius, Medicaid, Medicare, National Governors Association, Obama administration, Partnership for Patients, Patient Protection and Affordable Care Act, poor, President Bill Clinton, Representative Eric Cantor, Representative Michele Bachmann, Representative Paul Ryan, senior citizens
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Monday, June 20th, 2011
Premiums and eligibility standards for many federally run state-based pre-existing insurance pools will be cut, according to the Department of Health and Human Services (HHS). The changes will impact some- of the state-based insurance programs, which have attracted fewer enrollees than the Obama administration originally estimated. The plan will reduce Pre-Existing Condition Insurance Plan (PCIP) premiums between two percent and 40 percent in Washington, D.C., and in 17 of the 23 states where the federal government runs the program. Another 27 states run their programs by using federal funding through the Patient Protection and Affordable Care Act (ACA).
According to HHS, the changes will bring the premiums closer to the individual insurance market rates in each state. The change will not affect premiums in states where they are “well-aligned” with the individual insurance market premiums. “That means real savings for people across the country,” HHS Secretary Kathleen Sebelius said. “The Pre-Existing Condition Insurance Plan changes lives, and in many cases, literally saves lives. These changes will decrease costs and help insure more Americans.”
Changes include allowing adults — beginning July 1 — to qualify for the program if a physician, physician assistant or nurse practitioner provides a letter from the last year stating that the individual has had “a medical condition, disability or illness.” The change no longer requires that applicants provide an insurance company denial letter, although the programs will still require citizenship or legal residency and no health insurance coverage for the previous six months. PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care. It limits yearly out-of-pocket spending and does not carve out benefits the people need. Eligibility is not based on income and people who enroll are not charged a higher premium because of their medical condition.
According to the MyHealthCafe.com blog, the move is a good one. “Based on PCIP enrollment so far, it may not be an issue. California may have a budget to provide health insurance coverage for 20,000 in its PCIP, but so far only 513 Californians have enrolled in its PCIP. That is still more than the paltry 101 residents of Missouri who have enrolled for health insurance coverage in that state’s PCIP. In contrast, Pennsylvania, which is running its own PCIP and is limiting health insurance premiums to a comparably affordable $283 a month, has enrolled 1,657 in its PCIP, 1,000 more than any other PCIP in the nation. Overall, only 8,000 Americans have enrolled in a PCIP so far. Although Americans with pre-existing conditions were expected to stampede into the newly-formed PCIPs, applications for most of the PCIPs have only trickled in so far. It is astonishing to many who predicted that the PCIPs would be flooded with applications from Americans with pre-existing conditions who have been long-denied health insurance. Experts questioned whether the $5 billion dollars would be enough to cover the 375,000 expected to enroll until 2014,when all health insurers will be required to offer insurance regardless of pre-existing conditions.”
As an example, HHS said that a 50-year-old Floridian can now get comprehensive health coverage for as low as $270 per month. “This option became available to children under age 19 in February, and we are extending this pathway to all applicants regardless of age,” Sebelius said. “Applicants will no longer have to wait on an insurance company to send them a denial letter.”
“These changes will get more people covered,” said Steven Larsen, the director of the Center for Consumer Information and Insurance Oversight. “We’re encouraged by recent increases in enrollment and we’re excited to build on these efforts and reach even more people.”
Tags: Center for Consumer Information and Insurance Oversight, Department of Health and Human Services, insurance premiums, Kathleen Sebelius, MyHealthCafe.com, Obama administration, Patient Protection and Affordable Care Act, pre-existing medical conditions
Posted in Hospital Systems, Hospitals | 1 Comment »
Wednesday, June 15th, 2011
Americans will be given a tool that helps them keep their personal information private if a proposed Department of Health and Human Services (HHS) rule is adopted. The change in federal healthcare privacy laws proposed by HHS would give patients the right to see the name of any person who accessed their electronic health records, and what he or she did with them. The “access reports” would be available from some healthcare providers as soon as January 1, 2013. It would be similar to a free credit report — consumers would have the ability to request one report for free every year. The move is the latest in an effort by the Obama administration to update and streamline the nation’s medical records system.
The proposed “access report” right has its roots in a provision of the 2009 stimulus package passed by Congress to start the economy moving and which contained $30 billion to encourage development of electronic healthcare records, called the Health Information Technology for Economic and Clinical Health (HITECH). To ease concerns about the security of online health records, Congress told the HHS’ Office of Civil Rights (OCR) to strengthen consumer disclosure rights included in the Health Information Portability and Accountability Act (HIPAA).
“This proposed rule represents an important step in our continued efforts to promote accountability across the healthcare system, ensuring that providers properly safeguard private health information,” OCR Director Georgina Verdugo said. “We need to protect peoples’ rights so that they know how their health information has been used or disclosed.”
In the proposed rule, HHS said the majority of providers oppose the change, because they believe it would be costly to implement and provide minimal consumer benefit. Tena Friery, a HIPAA expert with the Privacy Rights Clearinghouse advocacy organization, disagrees, noting that the potential to identify who accessed a health record would be a significant disincentive to potential snoops.
Disclosure reports would summarize medical information transfers to entities such as law enforcement, judicial hearing or public health investigations, but would not explain the reason for the transaction. Under the proposed rule, exchanges of medical information made via an electronic health records systems would not be included in a disclosure report. “After careful consideration of this option, we concluded that accounting for such disclosures at this time would be overly burdensome when compared to the potential benefit to individuals,” the proposed rule states.
So just how prevalent are unauthorized views of Americans’ healthcare records? The New York Times reports that the personal medical records of at least 7.8 million people have been improperly accessed in the past two years. The Office of Civil Rights has a website dubbed the “wall of shame“ which lists 300 hospitals, doctors and insurance companies who have reported significant breaches of medical privacy. The list reveals that major HMOs such as Kaiser Permanente Medical Care Program, New York Presbyterian Hospital and Columbia University Medical Center have experienced medical records security breaches. These can occur when a laptop or other portable electronic device is lost or stolen. An employee of Massachusetts General Hospital left the paper records of 192 patients on a Boston subway train. Other reasons may be improper record disposal; hacking; and the unauthorized accessing of computer records.
Tags: Credit report, Department of Health and Human Services, Electronic health records, Federal healthcare privacy laws, Hacking, Health and Human Services Office of Civil Rights, Health Information Technology for Economic and Clinical Health, healthcare providers, HIPAA, Obama administration, Privacy Rights Clearinghouse, “Wall of shame”
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Tuesday, June 7th, 2011
The Patient Protection and Affordable Care Act will save Medicare $120 billion over the next five years as a result of lower payments to insurers and hospitals. According to the Obama administration additional steps to cut fraud and abuse are providing promising results. Medicare Deputy Administrator Jonathan Blum said that the healthcare overhaul is working, resulting in real savings and making program more efficient. Payment reforms are improving quality, performance and slashing costs. When President Barak Obama signed the healthcare bill, one major goal was to cut spending on Medicare.
“Just a year after passage, we are seeing savings in Medicare begin to materialize from provisions in the Affordable Care Act,” said Donald Berwick, M.D., administrator for the Centers for Medicare and Medicaid Services (CMS). “This work is laying the groundwork for a larger transformation of Medicare and our healthcare delivery system, from simply paying for the volume of services provided to rewarding the quality of care delivered. We remain committed to achieving a healthcare system that pursues better care, better health, and lower cost through improvement.”
In addition to the projected savings, Medicare is on track to improve the quality of care members receive. CMS has implemented quality improvements and delivery system efficiencies including providing new preventive benefits, tying payment to quality standards, investing in patient safety and offering new incentives to providers who deliver high-quality, coordinated care. “These actions will produce savings, create incentives for greater efficiency in care delivery and lay the groundwork for a long-term transformation of our healthcare system as well to make it safer and prevent injuries and unnecessary readmissions to hospitals which not only harm patients but increase overall healthcare costs,” according to a CMS analysis.
Cutting Medicare spending was a priority of the healthcare overhaul that President Barack Obama signed into law in March 2010. The law is projected by the Congressional Budget Office to reduce deficits by $143 billion, partly through almost $500 billion in cuts and savings from the Medicare program over a 10-year period. Blum said the savings are in line with expectations by the Obama administration. “We’re very much consistent with where we thought we would be,” he said.
The savings come at a cost, of course. Cuts in physician reimbursement represent a 31 percent reduction. If the cuts are adjusted for practice-cost inflation, the American Medical Association says Medicare payment rates to physicians in 2013 will total less than half of what they were in 1991. “If we can’t fix this, the impact on physicians and physician practices is going to be devastating,” said Alan C. Woodward, M.D., Massachusetts Medical Society president. “Many practices are barely surviving now. Coupled with the ongoing problem of soaring professional liability costs, Medicare reimbursement is a critical issue for physician-practice viability,” Dr. Woodward said. “Failure to solve the Medicare problem will only further endanger older patients’ access to needed healthcare services.”
Writing on the White House Blog, Deputy Chief of Staff and healthcare czar Nancy-Ann DeParle says that “Many of these reforms were made possible by the Affordable Care Act. The new law rewards doctors and hospitals for providing high-quality care and offers new tools to help law enforcement and the Medicare program crack down on waste, fraud and abuse. Other steps like improving care for patients with disabilities and bringing down the cost of durable medical equipment build on initiatives undertaken at CMS that will also reduce costs. And we recently announced the launch of the Partnership for Patients, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. Already, more than 3,000 organizations, including 1,500 hospitals, have signed a pledge to become part of the Partnership for Patients. This has the potential to save up to $10 billion for Medicare through 2013.”
Tags: American Medical Association, Centers for Medicare and Medicaid Services, Congressional Budget Office, deficit, Dr Donald Berwick, Healthcare czar, Medicare, Nancy-Ann DeParle, Obama administration, Partnership for Patients, Patient Protection and Affordable Care Act, White House blog
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Tuesday, May 24th, 2011
America’s senior citizens can breathe a sigh of relief. Even as the majority Republicans in the House of Representatives wield a surgeon’s scalpel to slash spending from the federal budget, they are unlikely to succeed at making significant changes to the extremely popular Medicare program. The Democratic-controlled Senate rejected serious cuts in the proposed legislation, which also included an attempt to block implementation of the Patient Protection and Affordable Care Act. Congressional Democrats and the Obama Administration pointed out that the Republican budget measure’s block on implementation funding would endanger short-term funding for Medicare.
The legislation would create “significant disruptions in services” to Medicare recipients, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius wrote to Senator Max Baucus (D-MT). The payment delays, Sebelius wrote, would halt the need to undertake a lengthy process to issue new regulations governing Medicare Advantage payment rates since the Patient Protection and Affordable Care Act (ACA) put in place its own set of payment rate rules. The Congressional Budget Office’s (CBO) analysis questioned that claim because it believes that the Republican bill will reduce spending by $1.6 billion through the rest of 2011. Democrats maintain that the CBO’s review of Medicare spending is a separate issue from HHS’s lawful authority to fund the program.
Despite the Senate Democrats’ united front, House Budget Committee Chairman Paul Ryan (R-WI) is “ready to take on health programs” as legislators on both sides of the aisle struggle with long-term spending concerns. Lawmakers continue talks regarding the current year spending measure still under consideration. A new continuing resolution that would fund government operations until April 8 has emerged. Though it includes deeper spending cuts, it is free of controversial riders such as language to restrict ACA implementation funds. Meanwhile, the CBO issued a report that legislation designed to further the defunding goal would add $5.7 billion to the deficit.
Democratic leaders insisted that some form of compromise by the House GOP members is now needed. “We’re looking for some give on the Republican side,” said Sen. Charles Schumer (D-NY). Speaker of the House John Boehner (R-OH), he said, “needs something to bring his freshmen into the real world.” Boehner, referencing the Democrats and the White House, said “I hope the talks are going to continue, but we are not going to get very far if they don’t get serious about doing what the American people expect of us. “This is not going to be easy. Our goal, as I’ve said many times, is to cut spending and keep the government open.”
Tags: Congressional Budget Office, deficit, Democrats, Department of Health and Human Services, Federal budget, GOP, House Budget Committee, House of Representatives, Kathleen Sebelius, Medicare, Obama administration, Patient Protection and Affordable Care Act, Representative John Boehner, Representative Paul Ryan, Senate, Senator Charles Schumer, Senator Max Baucus, senior citizens
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Wednesday, May 11th, 2011
Mississippi Governor – and possible presidential hopeful — Haley Barbour and other Republican governors recently demanded that Medicaid, the state-federal health program that covers 50 million poor and disabled, be transformed into block grants. House Republicans have vowed to tackle expensive programs like Medicaid to cut federal spending. Any attempt to turn Medicaid into block grants – federal lump-sum payments to states – raises many questions. Democrats argue that a move of this type could result in loss of healthcare coverage for millions who are poor, sick and old.
Representative Fred Upton (R-MI), chairman of the House Energy and Commerce Health Subcommittee said to expect House bills on the Medicaid program’s maintenance-of-effort requirement and block grant funding to states. Because Medicaid is an entitlement program, all Americans who are eligible are guaranteed coverage. The federal government, which foots the bill for approximately 60 percent of Medicaid’s cost, is committed to helping the states cover costs; in return, it requires them to cover certain groups of people and provide specific benefits. For example, children, pregnant women who meet explicit income criteria and parents with dependent children must be given coverage.
“The governors have requested flexibility in the way they serve Medicaid patients,” Representative Joseph Pitts (R-PA), the Health Subcommittee’s chairman said. “They maintain they can provide the service better and cheaper, so we’re looking to give them that flexibility and change this maintenance-of-effort provision. I won’t be specific on the block grants, but we’re having discussions with governors.” Pitts’ comments followed a Health Subcommittee hearing in which HHS Secretary Kathleen Sebelius answered extensive questions about the Obama administration’s fiscal 2012 budget and the Patient Protection and Affordable Care Act.
Why are the block grants important? When the new healthcare law goes into full effect in 2014, approximately 16 million additional people will become eligible for Medicaid. The debate, which cuts to the heart of the social contract between the government and its citizens, has implications for the other large entitlement programs — Social Security and Medicare. In 2010, the federal government spent $1.5 trillion on those programs, or approximately 43 percent of the federal budget, according to the Congressional Budget Office. Speaker of the House John Boehner (R-OH) said House Republicans’ upcoming budget proposal would cut Social Security and Medicare, despite the political risk of taking on such popular programs. Democrats are skeptical. Changing Medicaid into a block grant means “you have no guarantee that people who are now covered will continue to be covered, or whether (the states) will simply cut back on their Medicaid program,” said Representative Henry Waxman, (D-CA), who is a primary defender of the program.
Tags: Block-grant funding, Centers for Medicare and Medicaid Services, Community-based attendant services, Congressional Budget Office, Democrats, Department of Health and Human Services, Dr Donald Berwick, Governor Haley Barbour, House Energy and Commerce Committee, House of Representatives, Kathleen Sebelius, Maintenance of effort requirement, Medicaid, Medicare, Obama administration, Patient Protection and Affordable Care Act, Representative Fred Upton, Representative Henry Waxman, Representative John Boehner, Representative Joseph Pitts, Republicans, Social contract, social security
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Tuesday, April 26th, 2011
Is the healthcare insurance industry the scapegoat for rising premiums? In the inaugural episode of the Chuck Lauer Show, presented by Alter+Care, the former publisher of Modern Healthcare Magazine talked about the insurance industry’s take on healthcare reform with Ben Cutler, Chairman and CEO of USHEALTH Group, Inc., who previously led Fortis Healthcare. Cutler currently serves on AHIP’s Executive Committee, serves on AHIP’s Board and is also the Chairman of AHIP’s Membership Committee. The Chuck Lauer Show is an ongoing conversation about the future of healthcare with the leaders and thinkers who are shaping a new direction for healthcare in the United States.
Cutler, who has spent more than 30 years in the healthcare insurance industry, recalled the ongoing national debate that began nearly 20 years over HillaryCare with the objective of how to provide universal coverage for the more than 50 million uninsured Americans. Cutler believes that the Obama administration has chosen to focus on access and doesn’t sufficiently address affordability issues. Healthcare industry groups recognized that the day would come when reform would be a top-line issue and that we would not be well served by just saying “no”. Cutler says “We’ve worked hard on positioning the industry to accommodate reforms and tried to be very accommodating because getting more people covered is a laudable objective.”
As the healthcare reform bill was drafted, it soon became clear that the insurance industry would have a problem with some of the issues. Unfortunately, according to Cutler, the politicians decided they needed an enemy and “that turned out to be us. We continue to be vilified as an industry”, a situation that could – and should — have been avoided. The Patient Protection and Affordable Care Act will have some unintended consequences in terms of how the legislation will affect the behavior of various stakeholders who comprise the healthcare economy – consumers, providers, insurers, regulators, etc. It is inevitable that the insurance industry will have to raise rates if they are to comply with the healthcare law, which essentially constitutes a new tax on the American people.
Cutler cites the example of the $5 billion set aside to subsidize people in high-risk pools. The government estimated that by this time, upwards of 500,000 individuals would be enrolled in these pools. So far, just 8,000 people have signed up, an example of where government expectations were totally unrealistic. Additionally, there is the issue of pre-existing conditions, which the government has characterized as an industry-abusive position, and one which relates to affordability of coverage. According to Cutler, if people buy homeowners’ insurance only after their house catches fire, the premium obviously would be higher.
Ben Cutler: An Insurance Industry CEO Responds to Healthcare Reform:
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Tags: Affordability, American Hospital Association, American Medical Association, Ben Cutler, Chuck Lauer, Congress, Fortis Healthcare, healthcare industry, healthcare reform, high-risk pools, Hillarycare, House of Representatives, Inc, insurance companies, Kathleen Sebelius, Lasik surgery, Modern Healthcare Magazine, Nancy-Ann De Parle, Obama administration, Patient Protection and Affordable Care Act, Perfect storm, pre-existing conditions, Senate, universal coverage, USHEALTH Group
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