The wrangling back and forth in the US legislature concerning the upcoming vote on the payroll tax cut extension (which includes a provision giving providers a two-year break on Medicare payment cuts) continues to raise the ire of acute hospitals, which would shoulder part of the financing for such an action. The amount to be financed, at the literal expense of hospitals, approaches $17 billion. Essentially, the proposed offsets to direct provider payments would come from reduced payments to hospital administrative and evaluatory functions.
House GOP leaders are in the hospitals’ crosshairs, as the hospitals complain that, under the proposal, there is little incentive for them to continue to collect other payments (copays, deductibles) in the face of such financing, compromising care delivery in the process. Republicans are quick to point out, however, hospitals did agree to major cuts in Medicare as part of reform and that overall Medicare spending would fall by less than 1 percent over the next 10 years. | LINK
A physician advocacy group has released a report detailing the costs to Massachusetts in the wake of its healthcare reform. The goal is to shed light on the potential costs to the country as a whole once reform begins in earnest. The single-payer advocacy group mainly cites that cost shifting of taxpayer subsidies to fund the private insurance marketplace is creating an access burden for the state’s impoverished and lower middle class by pricing them out.
Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care.
Read the PDF of the entire report. The report appears to yearn for a less-than-market-based approach to solving this financial crisis as a way in which access to care can remain intact amid long-term reform sustainability. This report was released jointly among this group and via the state chapter of Physicians For a National Health Program.
The news Wednesday morning of a 3.6 percent increase in Social Security COLA payments for 2012 is somewhat of a mixed blessing for Medicare beneficiaries, many of whom have had to shoulder stagnant SS income over the last couple of years due to negligible inflation. The increase — set to take place in January — could be offset by higher Medicare B premiums, which are deducted from SS payments.
Typically, and unsurprisingly, Medicare B premiums increase at rates higher than inflation — but those increases cannot exceed COLA, by law. Dually eligible recipients over the last couple of years, as well as higher income senior beneficiaries, were not protected from rate increases over 2010 because of Medicaid payments incurred by the former and Part B surcharges paid by the latter group.
The majority of Medicare beneficiaries, however, paint a variable picture with respect to SS income and Part B liability; and the degree of variability has to due with the amount of the monthly SS benefit paid to seniors. All of this is a stark reminder of the degree of the increasing costs of healthcare delivery on Medicare and how it compares and impacts SS entitlements year-in and year-out.
With all of the hubbub surrounding Herman Cain’s 9-9-9 taxation plan, it got me to thinking about what this really means for the financing of healthcare now that reform is upon us. Answer? I should just keep on wondering. The Soundbite Candidate really offers nothing substantial at this point — though, that could change if his polling continues to rise among GOP and Tea Party faithful.
Cain, who should employ the KISS mnemonic to all of his policy decisions, doesn’t stray from this credo with respect to healthcare. In fact, he cites a late-1960s era promo campaign to healthcare delivery and its skyrocketing costs: creating an ad campaign in order to change peoples’ behaviors and attitudes toward healthcare in this country. Via MOJO:
Cain got a chance to lay out what he would have done if he’d been in charge of the country and needed to deal with health care. His alternative? Lady Bird Johnson’s “Keep America Beautiful” campaign. Cain writes in his [1997 book, "Leadership Is Common Sense"] that the main problem the United States has with health care is one of attitude, and the former first lady’s anti-littering campaign was a stellar example of how an advertising campaign to change national attitudes can have a significant impact on behavior.
Who needs robust policy on healthcare when a potential president says it all comes down to simply not getting sick in the first place? Certainly, not Mr. Cain, whose recent cancer scare would have been much moreso had he not had his wealth to rely on for timely access to appropriate care. | LINK
While California struggles to make some headway in reconciling its budgetary woes amidst an outcry from patients, hospitals, and physicians with respect to Medicaid funding, the funding of Medicare — specifically via auterity measures to ensure its short term viability within reform — is a top concern among the same factions. Only this time, the ire is directed towards the commission charged with implementing payment scales.
The [sustainable growth rate] calls for annual, automatic cuts in Medicare payments to doctors, which Congress always delays, allowing the cuts to accumulate. MedPAC is considering a 10-year replacement that would be offset by cuts to most medical specialties. But the American Hospital Association said health care providers shouldn’t have to foot the bill for a new formula.
MedPAC knows that this is an issue which legislators are echoing, as well. It is becoming a rather common — and exasperating — rite of passage: automatic SGR cuts in Medicare reimbursements which are usually stalled by Congress; the inevitable revisiting of definitive methods to decrease healthcare costs due to Medicare next on the agenda. Most parties agree on that point, just as long as that agenda does not include massive industry cuts (read: providers) within healthcare delivery. | LINK
Ever wonder how the preparations for healthcare exchanges are proceeding? The Kaiser foundation has constructed a brief [PDF] which allows one to reasearch states’ plans in progress. To review, the establishment of healthcare exchanges by the feds under reform is meant to enable consumers to compare a selection of qualified health insurance options in order to find the plan that best meets their needs and budget — with a significant amount in taxpayer subsidies devoted to this purpose.
Among the highlights in the brief report: (1) discussion of governance of exchanges, with some states granting significant control over governance matters at the hands of the excutive branch; (2) plans by states to address conflict-of-interest issues regarding insurance plan representation within governing boards of exchanges; (3) the total amounts paid to states so far in the funding of exchange formations in their individual healthcare marketplaces; and (4) the effect of legal challenges brought forth in some states regarding the constitutionality of the insurance mandate provision of the ACA (most recently, the striking down of the state of Virginia’s challenge filed by its atty. gen.) on the formation of exchanges.
As we move closer to 2014 — the real enaction of reform — HHS is offering almost $4B under reform to create consumer-focused healthcare co-ops. Healthcare cooperatives are meant to offer a ready consumer alternative to traditional plans for coverage. Additionally, CMS[1] will be making available $600 million in loans to help start the plans along with another $3.2 billion to help keep them solvent.
As stipulated by the reform law, cooperatives must be nonprofit entities that reinvest extra revenues into either lowering premiums or improving the quality of care. Although they were originally advertized as an alternative to the public option provision (which never materialized), co-ops cannot be run by a government entity. This proviso, in effect, quells consideration that co-op funding will lead to a single-payer necessity based upon funding source.
There seems to be a neverending chorus on how Medicaid, as a payment system, fails on so many levels. Administrative hassles for short term gain multiplied many times during the average workweek for primary care physicians mired in all of the paperwork, all with no end in sight — unless the provider wishes to end the relationship, of course. Some states have made working with Medicaid beneficiaries more problematic, by lowering matching funding of the program on many levels. It seems like practically every state in the nation, except here in Minnesota, has taken a route in cutting their respective HHS budgets as a primary strategy to meet budgetary shortfalls head-on en route to a balanced result.
To curb rising Medicaid costs, about a dozen states are starting a new budget year by reducing payments to doctors, hospitals and other health care providers that treat the poor. Some health care experts say the cuts, most of which went into effect July 1 or will later this month, could add to a shortage of physicians and other providers participating in Medicaid.
With government projections of huge increases in Medicaid rolls by mid decade on the cusp of reform, insurers, policymakers, lawmakers, and healthcare systems are faced with the reality that numbers of beneficiaries will continue to add to the cost of care delivery in spite of reform. With the federal government planning to supplement spending to offset some of those costs, sky’s the limit on the share the feds will pay — increasing GOP fears of even more spending. With states’ assistance from stimulus (approx $100B) funds practically gone, it’s no surprise that of the 49 states with a budget, around half of those have met the deadline with Medicaid cuts to providers. HHS budgetary issues are on the table in Minnesota today as part of our state’s effort to balance the budget and end its government shutdown.
Consider this: With a rate approaching 30 percent, the state of Texas has the highest degree of uninsured in the country. Now consider this: It has always been known in healthcare policy circles that, if given the chance, conservative lawmakers in the state would choose to opt out of Medicaid because of what they see as a wild “unsustainability” in the federal-state program for the short term.
One of the state’s lawmakers, a Senate republican, is introducing a bill whose end result would create administrative partnerships (as presumptive methods to control healthcare costs) among health systems — a compact — that would allow the state opt-out as a feasible way of reining in the cost of healthcare delivery to the poor and uninsured in Texas. The price tag: almost half a billion dollars. While consolidating administrative redundancies to reduce costs, the bill would also have some undesirable provisions, according to healthcare advocates for Texas’s poor:
This law is more designed to set up the legal structures that will allow doctors and clinics and labs and hospitals and health plans to work together to restructure themselves in a way that they can share information and savings if they really not just keep costs down but actually improve people health outcomes. [...] The bill allows Texas to ask the federal government for permission to take its share of funding and join other states in creating a compact, a healthcare program free of federal requirements.
It’s obvious that a federal opt-out is an impossiblity in the Obama administration, but it does open up the possibility for upping the ante in the reform debate via the anti-spending advocacy of the state’s current governor — who just happens to be considering seriously a run for the White House in 2012. | 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.
