The SCOTUS has begun a new term, and the most august judicial body is hearing a case involving potential for healthcare consumers (patients), hospitals, or even doctors to sue a state government for what they may see as unjust — or even, unethical — cuts to the state’s Medicaid program. The Obama administration is asking that cuts by proposed to Medi-Cal (of California) in the wake of already massive declines in reimbursements in that state due to its well-know budgetary woes be implemented and shielded from such lawsuits.
The court did not consider the legality of California’s reductions, only whether private citizens could sue to challenge them. No clear majority emerged at Monday’s one-hour hearing. A lawyer for doctors and patients told the court the reductions would be both illegal and cruel.
Barred lawsuits would mean total involment by the federal goverment in policing an already massively bureaucratic Medicaid program — as HHS would have authority over proposing further reductions. A ruling on this case is expected next June — one of many rulings in what appears to be a very interesting pending SCOTUS term. | LINK
The president can take some solace in a new report highlighting a positive aspect of the ACA — the increase in young adults with insurance coverage. According to the Nat’l Center for Health Statistics, approximately 1 million adults between the ages of 19 and 25 obtained coverage in the first three months of 2011 under the new reform law. Amid a continuing faltering economy, young adults appear to be taking advantage of the ACA provision which allows such coverage to continue to the age of 26 under parental policies.
Under- and unemployed adults in this age range could produce results that seem to contrast those above, but, as the report points out, piggybacking on parents’ plans has resulted in a coverage lifeline of sorts, as the unemployment rate of the 18-25 demographic grew by at least 7 percent from 2006-2010. This suggests a direct affect of the ACA’s key coverage provision in the demo. Amid GOP cries and promises for repeal should they take executive control in ’12, why isn’t Obama trumpeting this statistic?
On the campaign trail recently, top GOP candidates have been rolling out the talking points with respect to the debate on healthcare policy and politics. That latter point is made quite clearly in the party’s stance on the “solvency”[1] of the prescription drug benefit under Medicare Part D. Asked whether this rather costly program — arguably one of the most significantly costly from the George W. Bush administration’s passage of MMA in 2003 — should be yanked (as they feel so-called Obamacare should be), you’ll get a resounding “no” on that policy point.
Although the House GOP have led the deficit hawk brigade in response to President Obama’s recent comments on balancing the budget, the party as a whole has been relatively quiet on the Medicare overhaul issue, especially as it pertains to Part D — a program the party structured and passed under Bush eight years ago. It’s no secret politics is in play, especially when monies to support the benefit have to come from the government’s general coffers — competing for earmarks for other priorities, like education funding.
Republicans like to point out that throwing drug coverage under Medicare, in part, to the pharma marketplace has offset initial costs for supporting the program via competition. But, currently, the wide variety (amid the spate of new branded preps) of traditionally cheaper generics probably has to do more with keeping costs low — with respect to beneficiary affordability and the marginal profits on such non-branded offerings by Pharma.
Fast forward to 2011 and the popular Medicare provision is being utilized by over 60 percent of retirees (with the balance coming from former employers’ plans), and it looks safe for now. The big unknown is when the inevitable resurgence in pharma spending increases will occur over the next ten to fifteen years — and how Part D will fare within the reform mix. | LINK
Just whose side is Barack Obama on, anyway? With the passage of the PPACA, Democrats had been assured that — although a complete reform of healthcare delivery was sacrificed at the hands of capitulation to Big Insurance — savings in the form of well-implemented subsidies for exchanges and overall cost shifting from Medicare and Medicaid would be realized over the course of the balance of the 2010s. When he announces his plans for deficit reductions next week, the proposals will carry the tone set forth by the president’s arch-nemesis in the recent debt ceiling debate — House Speaker John Boehner (R-OH). [h/t DailyKos]
[T]he proposal is expected to include the “grand bargain” policies the White House put on the table in the debt ceiling negotiations with Speaker John Boehner: “$150bn extracted from Medicare providers such as doctors and hospitals, $150bn coming from Medicare beneficiaries, and $125bn coming out of reforms to Medicaid,” including “an increase in the eligibility age for Medicare.” Additionally, the administration could propose more flexibility in negotiating drug prices and access to cheaper generic drugs.
Avoiding SS reforms in favor of balancing the federal ledger as it applies to Medicare and Medicaid smells more like a political stunt than a necessary action cloaked in the realm of “reform”, a move that, in the long run, benefits Republicans should they take this ball and run with it in 2012 — ironically negating any real chance of CMS payment reform come 2014.
Alzheimer dementia continues to be among the most heavily researched and funded chronic diseases in medical science today. The increased awareness, brought into the spotlight and “modernized” more than 20 years ago following the high profile revelations of celebrites and politicians afflicted with the disorder, has led to increased patient education, public policy initiatives, and, of course, greater research monies in the effort to not only treat symptoms, but also to find a cure.
An international advocacy group is now asking municipalities to take awareness a notch higher with the commitment to even greater awareness of the disorder — addressing what it calls a “treatment gap”, hampering any gains on detection of the disorder at its earlier stages. Here in the U.S., the Obama admin is apparently hard at work in developing the country’s first-ever national anti-Alzheimer strategy aimed at sharply cutting the enormous healthcare costs associated with ancillary treatment .
The National Alzheimer’s Project: From Act to Action is an effort to support a committed and effective implementation of the National Alzheimer’s Project Act (NAPA). Information collected from individuals living with the disease, caregivers, providers and other stakeholders will be shared with the U.S. Department of Health and Human Services, which is responsible for creating a national strategy to address the crisis and coordinate across government agencies. This project is facilitated and supported by the Alzheimer’s Association.
Consider this effort an amalgam of citizen awareness and discussion (townhalls) and legislation (congressional passage of the National Alzheimer Project Act) garnering bipartisan[1] support to fight a scourge that can leave heavy financial tolls on caregivers, families, and the healthcare delivery system itself.[2] A daunting task, to be sure — but one that is sorely needed. Here’s looking forward to December — the date when the president makes his plans for these initiatives very public. | LINK
If one assumes that news of cuts in reimbursements of the two major healthcare entitlements (which probably will not happen) is never really good news for providers when accompanied by news of overall decreases in government spending on Medicare and Medicaid — then news of OMB-projected reductions in entitlement spending over the next decade essentially confirms this postulate. Under current fiscal policy, the government is expected to spend about $4 billion less this year on Medicare, matched with another $4 billion reduction over the next decade compared to the administration’s previous estimates, according to those revised projections.
When coupled with a virtually stagnant U.S. economy, a subsequent decline in payroll tax means finding alternatives to fund not only Medicare, but also Social Security. FY 2012 mandatory spending (which now includes funds spent on TARP funding) on Medicare will top north of $450 billion. If more than half of the budget goes toward entitlement spending, it’s difficult to realize other options when it comes to managing discretionary expenses — even with President Obama’s push for healthcare reform. Choosing between raising taxes, decreasing SS payouts to retirees, or inflating the budget as a percentage of GDP — just to maintain fiscal gov’t solvency — is enough to give any healthcare policy wonk a massive headache.
Will this story “have legs”, as they say? The media-anointed GOP frontrunner of the moment has a brewing scandal on his hands — one that involves dealmaking, wagering, and the creation of tax shelters for the purpose of profiting from life insurance premiums. Although the scheme was essentially thwarted, Team Perry (the Texas governor and associated conspirators, at the time, in 2003) decided that betting on the length of life insurance policies on Texas teacher retirees for the purposes of generating profits for a Swiss bank was not as risky (and stupid) as it sure as heck sounds today.
All they had to do was convince retirees to let UBS buy life insurance policies on them. When the retirees died, those policies would pay out benefits to Wall Street speculators, and the state, supposedly, would get paid for arranging the bets. The families of the deceased former teachers would get nothing. The meeting notes offer the most direct evidence that the Perry administration was not only intimately involved with the insurance scheme, but a leading driver of the plan.
Investors, of course, would have not been taxed for those profits. The state’s retired teachers fortunately said no, effectively ending the deal. On its surface, corporate tax shelters are a rather common affair instituted by corporate entities — so this essentially falls in line pleasing speculation among investors in the marketplace. Tea Partiers will probably look the other way on this one, but the president has another salvo at his disposal if he decides to take it to the next level. Anyone care to speculate on the cost of healthcare delivery on the taxpayers’ dime once reform kicks in? | LINK
The recent vote by Congress to end the debt ceiling debacle is forcing lawmakers to take a hard look at federal spending in some of the most sacred and protected programs, chiefly the defense budget, Social Security, and Medicare. The next big front on this news cycle will be who will be serving on the so-called Deficit Super Committee — the body whose task it will be to “reduce entitlement spending” and create savings in those programs. President Obama has often called for a balanced approach to this problem, by increasing taxation on the nation’s wealthiest while combining savings from entitlements collectively.
Newly installed Sec’y of Defense Leon Panetta has put out the call for raising taxes on SS and Medicare before even thinking about any cuts to defense spending, citing a risk to national security. Within defense appropriations, the military’s health coverage for retirees and dependents, the costs to fund this program have risen over two and half times to a current level of spending approaching $55 billion. The venerable Tricare program has come under the scrutiny of the Obama administration — not for any impropriety — but as a source for possible changes to federal spending on this portion of the defense budget. Look for a commission to be formed to deal with possible changes to this program and tackle the contentious issue of healthcare spending within the defense budget on the cusp of healthcare reform. | LINK
The initial spin on the recently squared away budget deal preventing a national default relates a necessary evil that not only carries the partisan rift seen in advance of the legislation, but also becomes a harbinger for a financial outlook that, in some ways, looks as bleak as the presumptive default did. Still retaining its triple-A rating, the credit outlook for the United States will be reflected in a “negative” forecast — likely resulting in a downgraded credit status within the next couple of years. Of course, all of this big-picture wrangling really doesn’t mean much to the millions of people whose salaries are paid — in part — by the federal government. A harsh reality at the forefront of this thinking, given the current jobless rate and achingly persistent unemployment levels is the specter of the loss of unemployment insurance for those currently receiving benefits. Minnesota is just one of many states bracing for such an apocalypse which appears to be sparing future cuts in another enormous federal subsidy — Medicaid.
Department of Human Services Commissioner Lucinda Jesson said she was relieved that Medicaid, known as Medical Assistance in Minnesota, is exempted from the initial cut. That doesn’t mean the new bipartisan commission charged with driving down the deficit won’t come after it once the panel breaks out the budget knife. “We are going to track it very closely,” Jesson said Tuesday. She said her department will also keep a close watch on child protection, food support and other assistance for seniors.
What about cuts to the service side of the equation? Since Social Security and Medicaid are specifically exempted from the ravages of the debt ceiling bill, physicians could see an additional 2 percent pay cut on top of double-digit Medicare reductions already slated for 2012 under the debt ceiling deal. Perhaps more concerning is the strong likelihood for major Medicare cuts and overhauls in long term care payments as a by product of a commission[1] created as part of the deal agreed to on Sunday. Nursing homes would be hit extremely hard in this scenario — potentially affecting care delivery to the most medically complex beneficiaries in the LTC sector. Understandably, the deal reached by a less than jubilant Hill on Sunday has many folks extremely wary about the nation’s prospects on an already shaky economy. Its effects on federally subsidized healthcare delivery ups the ante for lobbyists, providers, and most importantly — patients. | LINK
Many states have already agreed to federal funds to kickstart the path toward healthcare cooperatives and exchanges upon the cusp of reform. Funds appropriated by state legislatures will be used to create options for those who would have been denied traditional insurance coverage to be able to enter the competitive healthcare marketplace to obatin that coverage. Since the PPACA was signed into law, over 50 percent of states have begun crafting ways to set up exchanges.
Florida is not one of those states. Citing the burden on taxpayers, Florida’s republican governor is flying in the face of mandates required by the law to create affordable coverage via many mechanisms — chief among them — subsidies for low income healthcare consumers to enter the coverage marketplace. Florida says unless mandated by the courts to accept funds for the creation of exchanges, it’ll stay out of it. What the state is in the thick of at present, however, is its stance (upheld by a federal judge) that the ACA coverage mandate, itself, is unconstitutional. | LINK
Democrats don’t want them. House Minority Leader Pelosi reminded Obama about them. The GOP wants them “on the table”. What will drive Obama’s conscience with regard to possible cuts to Medicare and Social Security entitlements as part of the debt ceiling talks — due to last all weekend?
Democrats, too, have a point beyond which they will not go – cuts to Social Security and Medicare benefits – and want the president to keep it in mind as he prepares for a new round of negotiations at the White House on Sunday. … For that reason, a closed caucus meeting on Friday was a last chance for many Democrats to signal the White House and their own leaders what it will take to win their votes, once a deal comes to the floor.
Dems essentially do not want benefits, per se, redefined or recalculated. The Dem legislative caucus is open, however, to changes in which potential increases in spending due to waste or fraud are identified. The GOP will not vote for anything that will raise the debt ceiling, since many of those frosh legislators ran on such campaign promises. Dems seem to have the advantage here, however slight, as most Americans, in recent polling, have looked negatively on any perceived absolute cuts to Medicare as a way of balancing the budget. But, if the WH and the president agree to bipartisan means that rely, in part, upon Medicare changes, the issue could be a costly one for the Dems in the next election. Should be an interesting 48 hours for the president and Congress. | LINK
The Medicare boilerplate is going nowhere soon. The Ryan fiasco was just the latest iteration in the political football that is government spending on Medicare. Left somewhat scrambling after the recent voter mandate that pushed a little known Democrat into one of New York state’s most heavily conservative U.S. congressional districts into office, the GOP is trying to get its message straight on Medicare spending and what it means as reform begins to take hold in less than three years.
Straying a little from the privatization rhetoric that gained momentum before faltering as a result of the Senate vote on the matter, House Republicans are taking a different strategy to limiting spending on government-run insured care by focusing on that other perennial election year boilerplate: the economy. Buoyed by the recent lackluster jobs report out just a couple of days ago, the party sees an opening on economic reform — as well as Medicare reform — once again. In fact, the field of candidates for the GOP ’12 nomination have already seized upon the opportunity to rip Obama on this issue. Mitt Romney — hampered by the institution of universal care now in full force in his state — has the most to gain (or to lose) on the issue of healthcare spending and is hitting the ground running in trying to clarify his position.
The next arena of battle in the ongoing war over the budget is the debt ceiling. A vote is expected in a couple of months (possibly sooner — if the House speaker has his way), and the Democrats appear to be using the entitlement as a central argument in its support of the Obama admin’s handling of things. Dem leadership in the House support raising the ceiling as a job creator and protector of Medicare solvency. Look for Obama to use health reform as an explanation for his administration to resist cuts to Medicare as a means of balancing the budget. It should be an interesting summer on the Hill as healthcare reform inserts itself into the wrangling. Whatever the outcome on the budget vote in July or August, both sides will continue to apply the result to most potent use of the economy as a wedge issue since the 1992 vote.
Open season on ACOs? Not only are hospitals and healthcare organizations seizing upon the Obama admin’s goals for federal oversight of such programs, they are doing it in an unusually vociferous and uncharacteristically uncivil way. If you recall, the use of ACO oversight by CMS with respect to the care of Medicare patients seemed to be a solution to challenge rising Medicare costs of care delivery. Unfortunately, under the nascent reform law, it really never gained traction outside of the Obama admin’s ivory tower.
The five-year test enlisted 10 leading health systems around the country and offered financial bonuses if they could save enough by treating older patients more efficiently while providing high-quality care. … In 2010, the final year, just four of the 10 sites, all long-established groups run by doctors, slowed their Medicare spending enough to qualify for a bonus, according to an official evaluation not yet made public. Two sites saved enough to get bonuses in all five years, the evaluation shows, but three did not succeed even once.
The goals of the Obama administration may be laudable here, but many simply think the degree of ACO regulatory oversight by the federal government in this sense is downright lofty, if not impossible, as a Medicare cost-cutting measure.
The Cleveland Clinic’s chief executive, in a letter to the head of the CMS, called Medicare’s plans for accountable care organizations prescriptive, burdensome and discouraging. Dr. Delos Cosgrove, president and CEO of the 11-hospital system, said its officials finished a review “disappointed generally” with the proposals released two months ago to create Medicare ACOs.
Other orgs (Mayo Clinic [MN], Geisinger [PA]) have lobbed similar criticisms against CMS, HHS, and President Obama — citing startup costs for the future participation of theirs and other systems without guarantees of fiscal rewards for accountable care, all while being mired in massive regulatory oversight. Looks like the line has been drawn in the sand. Either further risk the alienation of hospitals and healthcare systems integral to making reform work by their future participation, or scale back and make major changes to the already controversial porposals CMS is mandating for ACOs with respect to Medicare reform and healthcare reform, overall. | 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.
2011 National Forum On Health Information Exchange
rufuspolk: RT @Ziggy_Daddy: Hunger Growing Problem Among Seniors | Crooks & Liars http://t.co/FRRGv4d4 But hey #GOP, let's turn #Medicare into a voucher system, right?
Paul_Sonnier: The First Wearable Computer Was Used For What? http://t.co/fEb902GA #WearableComputing #DigitalHealth #mHealth (Spoiler alert: #Gambling)
CiscoHealth: RT @FierceHealthIT: #FCC expands wireless spectrum for mobile medical monitoring http://t.co/UdFc8aAa #HealthIT
KezNoo: On my way to the airport for Your Death Your Choice Community Forum! #YDYC http://t.co/GyBMh8kw #hpm #eol #palliativecare
ribbonsnbowsRN: RT @ScrubsMagazine: "Knock knock"..."Who's there?"..."#HIPAA"..."HIPAA who?"..."Sorry, I can't tell you that!" What's your favorite #nursing joke?!
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.
