MedPAC, the Medicare Payment Advisory Commission, is advising Congress to consider imposing a new charge — or copay — for seniors who receive home healthcare-based services. Until this point, home visits for a variety of conditions from nursing and other providers was free of charge. A payment of at least $150 would constitute the amount the commission is advising Congress to implement. It’s all a part of the effort to continue to streamline Medicare and attack waste.[1] So-called dually eligible patients (those on Medicaid, as well) would obviously not be affected.
More than 3M beneficiaries utilize home healthcare services, and, as expected, some lobbies (including the AARP) pushed hard against the imposition of such additional fees required of many patients with low-to-modest incomes. The charge would be collected for each home health agency admission, not for every visit by a nurse or provider. All of this news comes on the heels of a recommendation by MedPAC to increase the levels of Medicare reimbursement to providers by 1 percent in 2012.
The three gubernatorial candidates have engaged in multiple debates and will continue to do so here in Minnesota until election day. The GOP, Democratic, and Independent party nominees for the state’s highest office are in a race which is anyone’s to lose. Although Minnesota’s healthcare fortunes have withered in the past 4 years as have other economic sectors in the state, its general coffers and the general state of its economic health amid a looming budget deficit of approximately $6B are the main focus of the race in which all three candidates are jockeying for differentiation.
The AARP today released a watchdog analysis (using Medicare claims data) depicting the general increase in the price of the most popular prescription medications relative to prevailing inflationary trends. And, surprise! The lobbying group notes an almost 10 percent increase in the price of branded preparations straight from the manufacturer for 2009. Apparently, all but 6 of the over 200 brands studied showed any increase over the rates of inflation for that period. Pharma is quick to dispute the group’s findings as they do not include more precise reporting of actual point of purchase data to the consumer, forgoing mentions of rebates and plan discounts. | PDF LINK of AARP’s report
Perhaps the most salient aspect to the hubbub surrounding the reform bill (politics aside) is the tremendous amount of myth surrounding its individual provisions. Of course, no single lobby or advocacy group (mainstream media included) has the desire to read the entire thing — only the portions that benefit their needs, for whatever reason.[1] However, groups under the radar, such as those which lobby for the needs of the Alzheimer patient population, stand to benefit from the recently passed legislation. According to the VP of the Alzheimer’s Association’s Public Policy and Advocacy Division, Obama’s reform legislation would
[Establish] a Medicare pilot program to provide transitional care to seniors at a high risk, including those with cognitive impairment, of re-entering a hospital. Cognitive impairment due to Alzheimer’s and other causes increases the complexity of care transitions and post-acute care, resulting in increased risk for medication errors and hospital readmissions. Alzheimer families need assistance with planning and managing discharge and post-acute care, including arranging and monitoring in-home medical treatment and supportive services.
It is easy to see the mixture of hope, advocacy, and idealism in this organization’s comments on the possibilities inherent in the reform bill. It’s also apparent how difficult it will be to apply them in the face of other lobbies desirous of the same possibilities and resources Obama’s reform will bring. | LINK
Sen. John McCain’s move to include an amendment in the health reform bill was overturned by a 58-42 vote. Recall that his provision would have thrown out the possibility for women’s preventive services (chiefly, screening mammograms) and also would have eliminated cuts in Medicare spending. Joining in the Democrats’ fight against McCain’s proposals is the (new) political lobby, the AARP.
The leading seniors’ group, AARP, said in a statement that the McCain amendment would “do nothing to improve Medicare benefits and essentially stop health reform in its tracks.”
That’s probably a little grandiose; after all, the Republicans want to save Medicare, right? As for the Senate Democrats, their caucus is still hanging on, albeit somewhat precariously. | LINK
As the Senate mulls a timetable on initiating debate on the reform bill, the AARP is holding firm on its political backing of the Democrats’ House formulations. The GOP, ironically the party that is telling its constituents that it wants to “save Medicare”, is warning that providers will essentially stop seeing Medicare patients. This is all based upon a CMS report that forecasts cuts to the program based upon President Obama’s plan to use some of those monies to fund a public option provision — threatening public-private partnerships (Medicare Advantage plans). What amounts to posturing by the Republicans in advance of Senate debate is summed up in a letter [PDF] addressed to the influential seniors’ lobby.
HR 4038, otherwise known as the “Republican alternative” to the House reform bill recently passed, argues against a public option. It soundly went to defeat earlier this month as the Democrats’ historic version passed. The GOP appears to be making a public posture to put the pressure on Senate Republicans to vote against any version with a public option provision. The controversial Stupak amendment just may give them that “out”.
Yesterday, Bart Stupak, a Democratic congressman from Michigan, warned that if the Senate version was stripped of his abortion restrictions (his amendment which got the bill passed in the House), there would be no reform bill with a sound public option. Potentially, women with employer-based insurance plans which cover the range of women’s health and reproductive services will be at risk.
Are progressives throwing the pro-choice movement under the bus to get Obamacare passed? Or, will a woman’s civil liberties essentially be up for debate in the Senate, as some Republicans suggest? AARP support or not, it should be interesting to see what really motivates Republicans (and more importantly, moderate Democrats) in the Senate to modify the breadth of what ultimately passes as a public option. | LINK
Rep. Michelle Bachmann and her cadre of “tea-baggers“, AARP, the AMA. What do these three disparate groups have in common? They have all made appearances in one way or another on the Hill to make their feelings known on pending healthcare legislation — which is now set to begin debate this weekend on the House side.
AARP has always publicly stated that it does not support one political candidate or ideology over an opponent. The lobby, which boasts over 40 million members, appears to be balking on that notion, at least in terms of its body language. The AARP, which was solidly pro-Bush with respect to the issues that were central to the passage of the MMA[1] in 2003, appears to be benefiting from the Democrats’ policymaking ideals with Obama at the helm.
Last week, the group expressed concern over the Senate-blocked attempt to avert Medicare (and, by extension, Medicare Advantage [MA]) payment cuts to physicians. The AARP had hoped to influence Democratic senators to prevent such a move because so much of its constituency stands to benefit from programs — many of them AARP endorsed — covered by Medicare and MA.
Calling such maneuvers “backroom deals”, top Republican House leaders are demanding regulation of the lobby — much in the mold of recent moves by Democrats to regulate bona fide insurance companies as part of the health reform overhaul. This statement by the Republicans appears to be supporting a tone of collusion with the Democrats — something which the AARP denies, of course. The irony of this entire scenario is, perhaps, its most interesting quality: Republicans want to use the lobby’s majority membership (the elderly Medicare beneficiary) essentially to counter that very organization. A pretty bold divide-and-conquer move, don’t you think? | LINK
It’s just something that makes healthcare policy observers want to ask, “how public is this public option going to be after the merger of House and Senate versions of the reform bill occurs”? Now that the Baucus bill has been released and is being met favorably by fiscally conservative Democrats (as expected) and the more progressive wing of the party (somewhat surprising), criticisms are beginning to emerge in advance of Baucus’s committee’s vote on it next week. Most notably, a current report by the RWJ finds that older Americans under the Senate Finance Cmte. version will be paying more in premiums than much younger adults; this would only apply to those patients finding coverage on the open healthcare market or are uninsured.
This pits the actions of two groups of observers/lobbyists, the AARP and the AHIP, as a potential source of political friction once the Senate Finance version passes. Insurance plans would stand to gain in a plan in which the government would have to subsidize the inclusion of younger patients in a given pool of beneficiaries to offset the high risks incurred by covering, say, those over 65 who lack affordable insurance coverage. The AARP, needless to say, will be watching the merging process very closely in the run up to the final reform bill. They obviously have much to gain if uninsured seniors are not forced to pay premiums which may be as much as 5 times higher than what a younger adult under the Baucus-led bill would pay. | LINK
Democrats are starting to feel the heat. Okay, they’ve felt this way for a long time — almost an eternity as far as getting a health reform bill passed is concerned. But the urgency is upon the party to think about financing that reform, especially if some anemic form of public option makes its way through to final legislation.
Republicans have capitalized on the effort of the Democrats to save costs by creating the buzz that Medicare, the nation’s largest public option with regard to healthcare coverage, is under danger and could fundamentally disappear as they know it. According to the GOP, the government entitlement program for healthcare consumers is under the cost-cutting knife with President Obama salivating at the chance to slash spending to keep it solvent.
Of course, this scenario is a rather fantastic notion — as are many of the fallacies which have worked their way into the national consciousness of the healthcare reform debate (remember healthcare townhalls?), but it is the sole PR issue the Dems want to swing to their advantage. With polls showing that the 65-and-over demographic as having the most negative perception of Obama’s health reform plans, the party is looking to the AARP to change the tide of negativity by framing reform as a mandate to ensure continued and improved healthcare access for senior citizens. And, although the organization staunchly defends its nonpartisanism, some of its core ideals run squarely counter to Republican talking points on the issue of healthcare reform — namely eliminating Medicare’s gaps in paying for seniors’ preventive care. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
