It had all the trappings of a political football; a blue state’s extremely unpopular Republican governor — looking toward a possible presidential run a year after his term ends — used his partisan hardline to threaten veto of one of the most well-funded social programs for healthcare delivery to the state’s working impoverished, all the while setting the stage for a political attack on his character for all of the nation to see at the hands of the opposing party. The apparent newfound conciliatory stance taken by Minnesota governor and 2012 prez hopeful Tim Pawlenty concerning the threatened veto of GAMC headed this scenario at the pass, however, as the healthcare delivery safety net for thousands of the state’s working poor got a last-minute reprieve to continue being funded, albeit scaled back. Of course the negative PR surrounding a pending lawsuit by three beneficiaries of the program didn’t make eating crow any easier for the chief executive.

Though funding for the program was supposed to end on April Fools Day, the brokered change in funding commitment means that service providers will see less in reimbursements. Also,

[u]nder the agreement, hospitals will receive $71 million from the state’s general fund for the year starting July 1 and $131 million the following year. About 12 to 15 hospitals likely can start serving patients in the new program on June 1. For others not yet ready, $20 million will be set aside to pay for uncompensated care for six months.

The key is in acute care — often the first and only mode by which this underserved patient population will continue to receive care. With a decrease in monies to provide it — even with a grace period of sorts for charity care — the level of participation of acute hospitals is emblematic of both ongoing problems with funding (providing care) and simply surviving as they continue to operate in a program whose demand will only increase until reform is achieved on the national stage. | LINK

• The Wellpoint saga continues…as well as the blame game for significant premium hikes.
• Study: alcohol + energy drinks (like Red Bull) = recipe for disaster.
• Has the H1N1 pandemic peaked?
• The first study of the anti-CSF prototypes for treatment/reversal of Alzheimer dementia is underway.

The trial will measure in the cerebrospinal fluid (CSF) and blood plasma of amnestic mild cognitively impaired (MCI) patients the biochemical changes that are associated with AD and correlate them with the pharmacokinetics of the drug and its metabolites.

• For California, the bleeding never ends. Today, Gov. Schwarzenegger releases his spending plan for 2010-11 which details even deeper cuts to its Dept. of Human Services.

In the Massachusetts healthcare economy, the balance between employer, employee (policyholder, beneficiary), and health plan (insurer) is getting new scrutiny. Its chief executive, Gov. Patrick, filed a bill calling for the broadening of powers of the state’s insurance commissioner in capping rates for care delivery services by hospitals, doctor groups, imaging centers, and insurers. He cites the crippling effect of higher rates on employers and employees of small businesses.

Of course, in a state rocked by lowered reimbursement schedules, a diaspora of primary care physicians to other practice locales with a secondary shortage in those primary care services — the news of capped payments to docs is not generating a lot of support in that camp for Patrick’s plan. And what do the small businesses think? Cautious optimism rules the day. Smaller acute hospitals (who already are at the mercy of government whims with respect to Medicare and Medicaid payments) fear for their bottom lines amid the potential for layoffs and cuts in healthcare delivery services.

Insurance companies have no problem supporting the governor’s proposal, just as long as negotiations of rates with the other parties don’t cut into their bottom lines. | LINK

Twenty-ten is the year for mergers and acquisitions in the healthcare delivery marketplace? A year ago, with President Obama’s massive push for government-enabled reform, a scenario such as this would have been unthinkable in polite (poltical) company. But recent developments in the drive toward reform are really anything but.

Although reform is on shaky ground, major health plans and other third parties are not exactly rushing toward consolidation. A wait-and-see attitude is the gameplan for now. But don’t be surprised to see the market for Medicaid managed care benefit from the weakened stance on reform in Washington. | LINK

Healthcare spending in the United States rose just 4.4 percent in 2008. That’s the lowest rate on record, according to CMS. The recession was cited as the major factor; however, spending’s share of the GDP rose to 16.2 percent in last year. A big chunk of the spending comes from acute hospital healthcare delivery.

Of course, the decline in insurance as a mode of delivery was met by increases in outlays to Medicare (greater spending on care to the elderly and disabled) and Medicaid (shifts of government funds to cash-strapped states to finance their care initiatives). Many are correct in tempering enthusiasm for such belt-tightening as government spending with respect to healthcare expenditures rose last year.

If there were any reason Republicans wanted the reform bill’s negotiating and reconciliation sessions transparent, it certainly is that last one. | LINK

Using the “slippery slope” argument, a vocal minority of Republican lawmakers and constitutional scholars who lean that way are making some noise on Capitol Hill this week, and they are poised to fight the pending reform bill’s conversion into law. These critics of the reform bill are attacking the mandate that individuals (as opposed to employees and recipients of Medicare and Medicaid) must obtain some coverage as part of reform. The coverage mandate aspect of the reform bill has gotten much ink over the past six months, as national sentiment began to turn against the Obama plan. Ultimately, this wave of dissent among lawmakers infected the entire Republican party, leading to a compromise many believe Obama privately anticipated all along — practical dissolution of the public option.

For those on the Right opposing the constitutionality of the reform bill, squelching the public option is not enough. They contend

…that an individual’s inactivity — in this case, the failure to buy health insurance — does not qualify as interstate commerce, and thus Congress does not have the power to regulate it under the Commerce Clause. [Also] … the financial penalty the law would impose goes beyond Congress’s ability to lay and collect taxes.

Naysayers in response quickly point out that Congress has every right to impose a tax that promotes the general welfare of the citizen and that the Supreme Court has ruled “that Congress may regulate activities that ’substantially affect’ interstate commerce”. That the constitutionality of this bill as being seriously challenged at this point is a telling postlude to just how polarizing this issue has become — something many political pundits and even Barack Obama never quite envisioned when it comes to something so intimate to every body as healthcare. | LINK

The great state of Tennessee, where I’m originally from, gives us this latest nugget of news from the health reform front.

State Reps. Debra Maggart, R-Hendersonville, and Susan Lynn, R-Mt. Juliet, are asking the state’s attorney general to take legal action to stop the federal healthcare reform bill because it would expand Medicaid.

The two state Republicans sent a letter to Tennessee’s attorney general asking him to file suit against the federal government on the eve of the reform bill’s passage. Citing the familiar GOP refrain of state’s rights, they fear for the “sovereignty” of the state against the “unconstitutional” action of the federal government in expanding Medicaid as a result of reform. Is secession from the U.S. based upon health reform next? | LINK

In many ways, state governments offer political solutions and conform to the same methods in getting similar results when presented with problems like those the federal government faces in times of economic crisis. The nation’s current budgetary issues with respect to financing healthcare reform are no exception.

In Minnesota, just as in the U.S. Senate, the effort is on for the majority lawmaking party — the Democrats — to work with the fiscal constraints imposed by the state’s Republican governor, Tim Pawlenty. GAMC^[1] coffers will be exhausted by next spring, and the safety net for the working poor in Minnesota will shift to a system partially dependent on federal matching funds — as Pawlenty has proposed shifting coverage to MinnesotaCare, a jointly funded federal-state program that puts pressure on the state to come up with its own funds to administer the program.

Problem is, many lawmakers are scrambling to fix that program out of concern of the unsustainability of the governor’s proposal. One state GOP lawmaker is taking a cue from U.S. Senators who want a reform bill passed, and is trying to garner broader support to do so — before there are no sustainable options for Minnesota’s eligible poor. Reacting to the Dems’ kneejerk responses to the governor’s plans, state Representative Matt Dean (Republican leader on the MN House Health Care and Human Services Finance Division) is gathering census data to obtain more accurate demographics on the state’s most eligible beneficiary population, taking a very fiscally responsible strategy whose goal is to streamline this safety net mode of care in the most economically feasible manner possible. | LINK

1. General Assistance Medical Care (GAMC) is a state-funded program for low-income adults, ages 21-64, who have no dependent children and who do not qualify for federally funded health care programs. [↩]

A report issued by the White House Office of Management and Budget found that Medicare, Medicaid and Medicare Advantage programs spent $54 billion in improper payments for healthcare in fiscal year 2009.

The Nov. 17 report concluded that Medicare fee for service improperly spent $24 billion in fiscal 2009, a rate equivalent to 7.8% of total outlays, and Medicaid improperly spent $18 billion, a rate of 9.6%. Medicare Advantage improperly spent $12 billion in 2009, a rate of 15.4% of total outlays on the private plans.

Welcome news from HHS Sec’y Kathleen Sebelius, but necessary. The White House realizes that to make its case for financing a portion of health reform with appropriate cuts in Medicare spending, it has to have data to back up the argument that responsible reaction to Medicare & Medicaid fraud and abuse does not equal rationing of services. If anything, more funding is available for what CMS is supposed to provide — a reliable form of healthcare coverage for the elderly in the spirit of its formation more than 40 years ago. | LINK

Recall the lawsuit brought against Minnesota Governor Tim Pawlenty because of his unallotting of state funds that previously went to nutritional support for its plaintiffs’ terminal illnesses? Today, his attorney does all the talking — saying that the MN House “mischaracterized” economic factors which led to his decision to take away those previously earmarked funds.

Six people who received assistance through the program filed suit against Pawlenty and other state officials last month, saying the governor wrongly used his emergency budget-cutting powers. On Friday, the House filed a friend-of-the-court brief supporting the plaintiffs, who seek a temporary injunction to get the money reinstated.

Mischaracterization of budgetary priorities or misuse of a state’s chief executive’s powers? | LINK | Previous DP Post – LINK

The process of unallotment^[1] chosen by the governor of Minnesota — as is his right by law — has raised the ire of lawmakers in the Democratic-controlled legislative branch. Through this action, Governor Tim Pawlenty, who is widely believed to have designs on a presidential run in 2012, has unilaterally made cuts into many programs overseen by the state’s Department of Human Services.

Many of those of programs are Medicaid-funded and, most notably, include Minnesota’s General Assistance Medical Care.^[2] While proposed cuts to programs such as this have made the headlines, it is a lawsuit by six indigent patients against the governor that is shining a spotlight on a state program that covers special diets for terminally ill patients. The program’s entire $5M budget is slashed because of Pawlenty’s unallotments, leaving the nearly 5100 elegible patients for the program vulnerable. | LINK

1. The Governor has the authority to reduce the amount of state spending to prevent a deficit. Minnesota’s Constitution requires a balanced budget. Total: $2.76B, $236M from the Dept. of Human Svcs. [↩]
2. Human Services expenditures make up almost 30% of the state general fund and are largely responsible for dramatically increasing state government costs. In an effort to limit direct impacts to individuals, as well as avoid further reductions to hospitals and nursing facilities, targeted reductions include ending General Assistance Medical Care (GAMC) coverage on March 1, 2010 [↩]

Tuesday night, House Republicans unveiled their version of reform in a bill proposal that would be aimed primarily at small businesses. The bill’s finer points will probably preclude ultimate passage, but leaders hope that it will be offered as an alternative when debate begins later this week or early next. Echoing the party’s talking points on reining in increased costs due to Medicare expansion, Medicare cuts, tax increases, or an “eventual taking over by the government of the physician-patient relationship”, the proposal should make for expected, yet interesting, banter during floor debate on the reform bill.

The Republican plan, which will be offered as an amendment to the Democratic bill when it is brought to the floor, also would authorize subsidies to states that reduce the annual per person premium for health insurance coverage or develop new programs that cover more of their residents over a 10-year period. The bill leaves out a number of important provisions of the Democrats’ 1,990-page bill, including new mandates for many employers to provide insurance for their employees or pay a penalty and for nearly all Americans to purchase insurance.

Perhaps what is even more absurd than the introduction of this measure at this time by the Republicans is the necessity of the Democrats (whose majority in the House has completely endorsed an infinitely more progressive version of reform) to debate it at all, amid yawns and rolled eyes. | LINK | GOP bill summary here [PDF]

Medicaid funds, particularly those from matching state coffers, often take the lion’s share of taxpayer subsidized healthcare costs of coverage for individual states’ poor, disabled, young, and pregnant citizens. With the explosion in “alternative”^[1] arenas of care for many in those populations, the ability for states to oversee the potential for fraudulent billing and waste is stretched to unassailable limits — often resulting in a mode of “catchup” to stop Medicaid fraud’s ever-expansive reach throughout states’ already fragile healthcare economies. Truly, Medicaid’s characterization as a mechanism for social protection — rather than public insurance — is explicit and is easily manipulated by unscrupulous and unregulated (non-state) third parties which can easily exploit limited state resources (safety nets). At least Louisiana appears to be applying some much needed influence by cracking down on many unregulated “care entities” after noting an almost 25% overbill rate (!) from various home care agencies. | LINK

1. Non-traditional scenarios for the care of patients with chronic disability, often operating under limited or no certification from licensing authorities [↩]