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Archive | Legislation

Sen. Coburn Proposes Deficit Reduction Plan

Yesterday, Sen. Tom Coburn (R-OK) proposed a deficit reduction plan, “Back in Black,” which would achieve $106.7 billion/10 years in savings from the Department of Health and Human Services (HHS).  His proposal:

  • Reduces Medicare and Medicaid fraud, waste, and abuse
  • Repeals the Affordable Care Act
  • Repeals the Independent Payment Advisory Board (IPAB)
  • Repeals the Community Living Assistance Services and Supports program (CLASS)
  • Repeals policies that increase the cost of health care insurance for individuals – the medical device and pharmaceutical drugs fees and the health insurance excise tax
  • Repeals Medicaid expansion
  • Repeals individual mandate
  • Eliminates Children’s Hospital GME
  • Reduces improper payments, modernizes HHS’ systems, controls unnecessary costs, and improves management of resources
  • Cuts administrative budget
  • Allows American to purchase health insurance across state lines
  • Adopts medical malpractice reform

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Gang of Six Presents Deficit Reduction Plan to Senate

This morning, the Gang of Six, which, again, includes Sen. Tom Coburn (R-OK) presented its deficit reduction plan to the Senate. According to Sen. Coburn, the deal gaining momentum in the Senate includes $116 billion in Medicare and Medicaid cuts, although the committees of jurisdiction would have to shape the specifics.  He also reported that the proposal fully pays for a SGR fix “with no gimmicks.”  Of note, the plan proposes to:

  •  Adopt statutory discretionary spending caps through 2015
  • Repeal the CLASS Act
  • Require the Senate Finance Committee to report legislation within 6 months that would permanently reform or replace the Medicare SGR formula and fully offset the cost with health savings; find an additional “$202 billion/$85 billion” /10 years in health savings; and maintain the essential health services that the poor and elderly rely upon
  • Require the Senate Health, Education, Labor and Pensions (HELP) Committee to report legislation within 6 months that would find an additional $70 billion/10 years in savings
  • Require the Senate Judiciary Committee to report legislation within 6 months that would advance medical malpractice reform
  • Require the Senate Finance Committee to report tax reform within 6 months that would include reforming – not eliminating tax expenditures for health
  • Require the Budget Committee to report legislation within 6 months that would: extend discretionary caps and enforcement mechanisms through 2021; ensure Congressional action to reduce the deficit if the debt-to-GDP ratio after 2015 has not stabilized; review total federal health care spending starting in 2020 with a goal of holding growth the GDP + 1% per beneficiary and require action by Congress and the President if exceeded; achieve program integrity savings of $26 billion in entitlement programs to curb fraud, abuse, and other wasteful spending government-wide; and create a working group to provide updated budget concepts for CBO and OMB
  • Provide that if any Committee fails to report entitlement program savings, the Senate would considered on an expedited basis across the board cuts to programs in the Committee’s jurisdiction

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Gang of Six Presents Deficit Reduction Plan to Senate

This morning, the Gang of Six, which, again, includes Sen. Tom Coburn (R-OK) presented its deficit reduction plan to the Senate. According to Sen. Coburn, the deal gaining momentum in the Senate includes $116 billion in Medicare and Medicaid cuts, although the committees of jurisdiction would have to shape the specifics.  He also reported that the proposal fully pays for a SGR fix “with no gimmicks.”  Of note, the plan proposes to:

  •  Adopt statutory discretionary spending caps through 2015
  • Repeal the CLASS Act
  • Require the Senate Finance Committee to report legislation within 6 months that would permanently reform or replace the Medicare SGR formula and fully offset the cost with health savings; find an additional “$202 billion/$85 billion” /10 years in health savings; and maintain the essential health services that the poor and elderly rely upon
  • Require the Senate Health, Education, Labor and Pensions (HELP) Committee to report legislation within 6 months that would find an additional $70 billion/10 years in savings
  • Require the Senate Judiciary Committee to report legislation within 6 months that would advance medical malpractice reform
  • Require the Senate Finance Committee to report tax reform within 6 months that would include reforming – not eliminating tax expenditures for health
  • Require the Budget Committee to report legislation within 6 months that would: extend discretionary caps and enforcement mechanisms through 2021; ensure Congressional action to reduce the deficit if the debt-to-GDP ratio after 2015 has not stabilized; review total federal health care spending starting in 2020 with a goal of holding growth the GDP + 1% per beneficiary and require action by Congress and the President if exceeded; achieve program integrity savings of $26 billion in entitlement programs to curb fraud, abuse, and other wasteful spending government-wide; and create a working group to provide updated budget concepts for CBO and OMB
  • Provide that if any Committee fails to report entitlement program savings, the Senate would considered on an expedited basis across the board cuts to programs in the Committee’s jurisdiction

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HHS Releases Draft Regulations to Implement CO-OP Program

Today, the Department of Health and Human Services (HHS) issued draft regulations that would implement the Consumer Operated and Oriented Plan (CO-OP) program.  The program would provide loans to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the state health insurance exchanges. The purpose of this program is to create a new CO-OP in every state in order to expand the number of health plans available in the exchanges with a focus on integrated care and greater plan accountability.

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House Majority Leader’s Proposal for Health Care Savings

Politico published the proposal for health-care savings ($334-353 billion over 10 years) that House Majority Leader Eric Cantor (R-VA) presented at the White House yesterday.

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Shared Sacrifice in Resolving the Budget Deficit

This evening, the Senate voted 69-27 to proceed to a cloture vote on S.1323, a bill to express the sense of the Senate on shared sacrifice in resolving the budget deficit. Senate Majority Leader Reid indicated that he would fill the amendment tree and file for cloture on the bill.

 

UPDATE:  On July 13, the Senate voted on a procedural motion to the “Senate of the Senate on Shared Sacrifice,” which that states that taxpayers who earn $1 million or more annually should “make a more meaningful contribution to the deficit-reduction effort.”  The Senate did not have the 60 votes necessary to close debate and consider the legislation.

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Senate Democratic Budget Framework

Today, Chairman Conrad made a floor speech in which he outlined the Senate Democratic budget framework.  The plan would:

  • Lower the corporate rate from 35 percent to 29 percent
  • Extend the Bush tax cuts for singles earning up to $500,000 a year and for couples earning up to $1 million a year
  • Provide for alternative minimum tax relief
  • Reform the estate tax, going back to the 2009 levels which are $3.5 million a person and $7 million a couple
  • Assume net $2 trillion of additional funds over 10 years from closing tax loopholes, cutting tax subsidies, promoting tax fairness – specific policies to be determined by the Finance Committee
  • Extend all of the middle-class tax cuts
  • Broaden the middle-class tax cuts so that nobody is affected by a rate increase unless they are a couple earning over $1 million a year
  • Achieve the same savings out of security as the fiscal commission did — $886 billion out of the security category (including defense, but not veteran spending)
  • Advance government-wide savings by: (1) freezing the pay of Members of Congress for 3 years; (2) freezing the legislative branch and White House budgets for 3 years; (3) freezing civilian pay for 2 years, which has already been adopted; (4) reducing the Federal vehicle fleet by 20 percent; (5) reducing travel costs of Federal agencies by 20 percent; (6) reducing Federal printing costs by $1 billion by 2015; and (7) reducing the number of contractors.

In his floor speech, he noted that health care reform is already expected to reduce the deficit, suggesting that Medicare will not be targeted for significant cuts. The Chairman summarized that the budget would cut spending by $2 trillion while raising approximately $2 trillion in revenue. Text of the Chairman’s speech is online.

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Senators Offer Health Amendments To Trade Agreements

The Senate Finance Committee is marking up a number of trade agreements at 3pm this afternoon. The following health-related amendments have been filed to the United States-Korea Free Trade Agreement:

Rockefeller #2 – GAO study of health coverage tax credit

Hatch #19 – To ensure health care premiums are reduced by $2,500 for American families

Hatch #20 – To ensure greater health care choices for American families

Hatch #21 – To repeal the job-killing employer mandate

Hatch #22 – To repeal the job-killing medical device tax to ensure continued access to life-saving medical technologies to Americans

Hatch #23 – To restore the longstanding partnership between the States and the federal government in managing the Medicaid program (Saves $2.1 billion over 10 years, which shall be allocated to a deficit reduction trust fund.)

Hatch #24 – To ensure that taxpayer dollars are effectively used in demonstration programs implemented by the Centers for Medicare and Medicaid Services (CMS)

Hatch #25 – To close the loophole that sends taxpayer dollars to fund operational costs for abortions

Hatch #26 -To repeal the burdensome restrictions on taxpayers’ purchase of over- the counter medications

Grassley #1 – Sunsetting the Independent Payment Advisory Board (CBO informally suggested to Senator Grassley’s office that this amendment is budget neutral, having no impact within the 10 year budget window)

Kyl #4 -TAA/health care/tax- related reform

Kyl #5 -TAA/health care/tax- related reform

Kyl #6 – TAA/health care/tax- related reform

Kyl #7 – TAA/health care/tax- related reform

Kyl #8 -TAA/health care/tax- related reform

Kyl #9 -TAA/health care/tax- related reform

Crapo #1 – Ambulatory Surgical Center Update

Crapo #2 – Equalizing Radio Surgery Reimbursment (CBO scored language at a 300 million savings over 10 years)

Crapo #3 – Accountable Care Organizations Regulatory Repeal (Cost neutral)

Crapo #4 – Ensuring Access to Ambulatory Surgery Centers Same Day Services

Crapo #5 – Medicare Advantage Payment Rate Update

Roberts #4 -To prevent seniors requiring in home health care from being forced out of their homes and into institutional care

Roberts #5 -To ensure continued access to care for those of the most vulnerable populations and to enusre equitable treatment of all hospitals

Roberts #6 -To ensure valuable stakeholder comment on regulations implementing the Patient Protection and Affordable Care Act

Roberts #7 -To ensure the integrity of the Medicare program and avoid undue burden on rural home health and hospice providers

Roberts #8 -To ensure access to over-the-counter medications

Enzi #4 -An amendment to eliminate Medicaid and insurance subsidy eligiblity for early retirees

Enzi #5 -Making helath care more affordable for consumers and reducing burdens on physicians and pharmacists

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Deficit Reduction Debate Quick Links

The Kaiser Family Foundation prepared a comparison chart of Medicare changes that have been recommended in various deficit reduction proposals.

As the bipartisan, bicameral negotiations lead by Vice President Biden continue, the Committee for a Responsible Federal Budget has identified areas of agreement among the deficit reduction plans, which amount to $1 trillion in savings.

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President Obama’s Deficit Reduction Commission Recommendations

As we await the release of a deficit reduction plan from the Senate – either the Gang of Six or Sen. Kent Conrad (D-ND), it is worth reviewing the recommendations made by the President’s National Commission on Fiscal Responsibility and Reform.

On November 10, the co-chairs of President Obama’s Commission on Fiscal Responsibility and Reform released draft recommendations for deficit reduction. The Commission’s report to Congress is due by December 1; however, any recommendations must be approved by 14 of the 18 Commissioners. The draft presentation includes significant changes to reduce Medicare and health care costs, as well as Social Security and tax policies. While it is unclear whether the Commission can muster the votes needed to approve recommendations, these proposals could be considered in the Congressional debate on spending offsets and deficit reduction.

Among the guiding principles outlined in the draft document, co-chairmen Erskine Bowles and Alan Simpson urged:  (1) instituting cuts gradually and beginning in Fiscal Year (FY) 2012 so as not to disrupt the economy; (2) considering all budget items for possible cuts; (3) protecting the disadvantaged by focusing benefits on those truly in need and ensuring an affordable and sustainable safety net; and (4) reducing the long-term growth of health care costs.  The co-chairmen made five overarching draft recommendations:

1.   Enact tough discretionary spending caps and provide $200 billion in illustrative domestic and defense savings in 2015.

2.   Pass tax reform that dramatically reduces rates, simplifies the code, broadens the base, and reduces the deficit.

3.   Address the “Doc Fix” not through deficit spending but through savings from payment reforms, cost-sharing, and malpractice reform, and long-term measures to control health care cost growth.

4.   Achieve mandatory savings from farm subsidies, military and civil service retirement.

5.   Ensure Social Security solvency for the next 75 years while reducing poverty among seniors.

The draft proposal acknowledges the need to address the Sustainable Growth Rate (SGR) problem and proposes that the physician fee fix be fully offset “by asking doctors and other health providers, lawyers, and individuals to take responsibility for slowing health care cost growth.” The proposal calls for SGR cuts through 2015 with modest reductions while directing the Centers for Medicare and Medicaid Services (CMS) to establish a new payment system, beginning in 2015, to reduce costs and improve quality.  The co-chairmen explain that potential offsets and savings could include the following: (1) paying doctors and other providers less, improving efficiency, and rewarding quality by speeding up payment reforms and increasing drug rebates; (2) paying lawyers less and reducing the cost of defensive medicine by adopting comprehensive tort reform; (3) expanding cost-sharing in Medicare to promote informed consumer health choices and spending; (4) expanding successful cost containment demonstrations; and (5) strengthening the Independent Payment Advisory Board (IPAB).

The proposal also makes reference to additional ways to reduce health spending, such as:(1) placing dual-eligible beneficiaries in Medicaid managed care; (2) cutting Medicare payments for bad debt; (3) expanding ACOs, payment bundling, and other payment reform; (4) cutting federal spending on graduate and indirect medical education; (5) reducing federal spending on Medicaid administrative costs; (6) increasing nominal Medicaid copayments; (7) accelerating the phase-in of DSH payment cuts, Medicare Advantage (MA) cuts, and home health cuts included in the Affordable Care Act (ACA); (8) reforming Tricare to increase cost sharing for military retirees; (9) reforming Federal Employees Health Benefits (FEHB) retiree plans to increase cost sharing for federal civilian retirees; (10) establishing national standards for regulating and administering health insurance; and (11) converting the federal share of Medicaid payments for long-term care into a capped allotment.

In the long-term, the co-chairmen call for containing the total health care spending to gross domestic product (GDP) + 1 percent after 2020 by establishing a process by which to regularly evaluate cost growth and institute a means by which additional savings could be derived if projected savings are not realized. The draft proposal suggests evaluating a “robust public option and/or all-payer system in the exchange,” overhauling the fee-for-service system, and expanding the authority of the IPAB if health care costs grow faster than targets.

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