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Archive | Reform

Medicare Trustees Release 2011 Report

On May 13, the Medicare Board of Trustees released its 2011 Report on the financial status of Medicare. The Board noted that the financial picture may be understated in the report because certain assumptions are not likely to be carried out. For example, the calculation of Medicare’s solvency is based on the assumption that Congress will not intercede to prevent the Medicare physician payment cuts scheduled to go into effect on January 1, 2012.

The Medicare Trustees issued their sixth “funding warning,” meaning that for Medicare is projected to draw more than 45 percent of its funding from general government revenue. Under the Medicare Modernization Act (MMA), as a result of the warning, the President is required to submit to Congress a legislative proposal to reduce Medicare. However, the White House has not historically issued such a proposal.

The report indicated that the reforms included in the Affordable Care Act (ACA) extend Medicare’s solvency by eight years. The Trustees project that the Medicare Trust Fund will be solvent until 2024.

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NQF Releases Reports on HIT Use

The National Quality Forum (NQF) released two reports this morning related to the effective use of health information technology (HIT).

The report, “Driving Quality—A Health IT Assessment Framework for Measurement,” examines, defines, and organizes the data needed to measure effective health IT use to better understand how health IT tools can improve the efficiency, quality, and safety of healthcare delivery.

NQF’s report on “Driving Quality and Performance Measurement—A Foundation for Clinical Decision Support” details the Forum’s Clinical Decision Support Taxonomy, which is composed of four functional categories that classify and categorize the CDS information necessary for quality improvement: 1) triggers, 2) input data, 3) interventions, and 4) action steps. The NQF CDS Taxonomy provides a foundation for the description of an electronic infrastructure, bridging quality measurement and health IT. Specifically, the taxonomy will enable quality measure developers, clinical system implementers, and vendors to be more effective in developing, sharing, implementing, and evaluating the effectiveness of different approaches to applying CDS aligned with quality measurement.

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MACPAC Releases Report on Medicaid Managed Care

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2011 Report to the Congress: The Evolution of Managed Care in Medicaid. The Commission’s report provides an overview of Medicaid managed care, including information on populations enrolled, plan arrangements, payment policy, access and quality, as well as program accountability, integrity, and data.

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Capital Thinking Podcast

Given recent resignations and a death, House Speaker Nancy Pelosi needs 217 votes to pass the Senate bill. The whip count in the House remains close.  Congressman Joseph Cao, the only Republican who voted in favor of the House health care reform legislation, is not expected to lend his support to passage of the Senate bill. Representative Bart Stupak and other anti-abortion Democrats, who authored the language in the House package to prohibit individuals from using federal subsidies to purchase plans in the exchange that cover elective abortions, have been vocal that they will not support the Senate package. Department of Health and Human Services Secretary Kathleen Sebelius has suggested that the White House may strike a deal with the Congressman to address his concerns in a separate bill in exchange for support on the Senate bill. Although President Obama may be ready to move health care reform forward without Republican support, he must ensure that Congressional Leaders can rally Democrats.

White House Press Secretary Robert Gibbs said that the President wants the House to pass the Senate bill before March 18.  House Energy and Commerce Committee Chairman Henry Waxman, however, suggested that Congress could finish health care reform within the next two months. House and Senate Leadership had hoped to send a reconciliation bill to the Congressional Budget Office to be scored.

Meanwhile, last week, the Senate turned to a jobs package and tax extenders legislation, both which contain short-term fixes or extensions of expiring Medicare provisions. The Senate passed and the President signed into law H.R. 4691, the “Temporary Extension Act of 2010.” The legislation includes an extension of the Medicare physician fee fix as well as an extension of the therapy caps exceptions process through March 31, 2010.

When the Senate convenes today, it will resume consideration of the tax extenders package. The legislation is expected to pass this week with the Baucus substitute amendment, which extends the physician fee fix through the end of the year. The substitute amendment also includes a number of Medicare extenders that were included in the Senate-passed “Patient Protection and Affordable Care Act.”

Representative Charlie Rangel took a temporary leave of absence as the Chairman of House Ways and Means Committee as the House Ethics Committee ruled that he broke ethics rules by accepting trips to the Caribbean. An investigation into claims of tax evasion and failure to report income from rental properties continue.  Michigan Congressman Sandy Levin will serve as Acting Chairman.

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House Action on Health Care Reform Repeal

Last night, the House of Representatives voted 245-189 to pass the the “Repealing the Job-Killing Health Care Law Act” (H.R. 2).  At this time, the Senate has no plans to take up consideration of the bill, which would be unlikely to pass and would almost certainly face a Presidential veto if it were to.

The House will next take up consideration of H.Res. 9, instructing House Committees to recommend measures to replace the reform law. Specifically, the resolution directs Committees to “proposing changes to existing law” that address many of their chief concerns with the health law including: provisions that spur economic growth and create jobs; lower health premiums; preserve patients’ ability to keep their health plan; provide people with pre-existing conditions access to coverage; reform medical malpractice; increase the number of insured; protect the doctor-patient relationship; provide States with more Medicaid flexibility; expand personal responsibility; prohibit taxpayer funding of abortions; eliminate waste; and do not accelerate the insolvency of entitlement programs.

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Tick Tock – Has Time Run Out for Health Reform?

During his State of the Union address, the President did not give any insight into the best path forward for moving comprehensive health care reform. Congress continues to mull over how to pass legislation, and reform advocates are holding out hope that Members can refocus and revive the debate. Meanwhile, it has become clear that creation of new jobs will be the President’s number one priority in 2010.

The New York Times reports that Democrats are considering splitting up the bill and moving smaller pieces separately but Politicoconfirms that option may not be a simple and expeditious process.

The Washington Post reports that Democrats are still contemplating on how to proceed but lawmakers remain steadfast in their commitment to passing legislation and maintain that reconciliation is still on the table.  We anticipate that Democratic leaders will continue to caucus over the next couple of weeks to work on developing a sustainable path forward.

In other health news, while the Democrats still maintain a filibuster proof majority before Republican Senator-elect Scott Brown is seated, the Senate managed to pass a resolution that increases the debt ceiling to $14.3 trillion, which greases the wheels for a potential five-year Medicare physician payment fix that would be exempt from the pay-as-you-go rules.  Congress is still required to pass legislation to stop the 21 percent cuts from going through on March 1, 2010.

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Capital Thinking Radio Show

CT_radio1 Join us this week on Capital Thinking this week as host Kevin O’Neill examines the political impact of the recent House approval of the most sweeping piece of social legislation in decades. John Jonas and Martha Kendrick provide strategic analysis of the bill and what to expect next.

Tune in every Thursday at NOON EST and 9:00 am PST on VoiceAmerica Business

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Still Going for Gold

In hopes of moving health care reform, President Obama has taken a more active role in the debate. Earlier this week, the President released his proposal for reform, which is mostly additive to or revisionist of the Senate bill. The President included several fraud and abuse provisions that were included in H.R. 3970, the “Medical Rights and Reform Act,” or H.R. 3400, the “Empowering Patients First Act.”

On Thursday, President Obama is convening a bipartisan summit with a goal of identifying compromises that will help to move health care reform legislation forward. Senate Republican Leadership has expressed disappointment in the President’s unwillingness to scrap the current health care reform bills and have suggested that an incremental approach to reform is more appropriate than comprehensive reform. The summit does not change the procedural options for moving reform legislation. Congress has two options: either move incremental reform bills or use reconciliation to pass comprehensive reform. President Obama will use the summit to build support for passage of health care reform, even if by reconciliation.

At this point, we expect Congress to move several health care provisions separate from health care reform, including a physician fee fix, repeal of the insurance antitrust exemption, and a package of health extenders and use reconciliation to pass comprehensive reform.

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State of the Union Talking Points from the White House

Rescue, Rebuild, Restore – A New Foundation for Prosperity

The President is going to talk directly to the American people about restoring security for middle class families after a lost decade of declining wages, eroding retirement security and escalating health care and tuition costs. The President will talk to the American people about steps we need to take to build on the work we did this past year to bring the economy back from the brink of a depression. While the worst of the economic crisis has passed, for too many American families and businesses the wreckage remains.

He’ll call on Congress to pass a jobs bill to jumpstart private sector job creation with:

  • Investments in small businesses;
  • Investments in Green Jobs and clean energy;
  • Investments in road, bridge, rail and port projects; and
  • Policies to spur more exports of American manufactured products.

The President will talk to the American people about meeting the challenges that have hurt middle class families, and those who aspire to it, by building a New Foundation of prosperity for American families and businesses.

He’ll call on Congress to pass Education reforms that transform families and strengthen the country;

He’ll call on Congress to pass meaningful Financial Reforms that hold Wall Street accountable, makes sure no bank is ever too big to fail and provide clear rules of the road that give the American consumer the clear information they need to make financial decisions;

He’ll call on Congress to enact Energy Reform that creates the jobs of tomorrow, increases our energy independence and reduces pollution;

He’ll call on Congress to enact fiscal reform that recognizes that the deficits and debt exploded the last decade before the President took office.

He’ll propose measures to deal with the costs of bringing the economy back from the brink of a depression and call on Congress to engage in the bi-partisan work required to address the debt that was accumulated in the last decade.

He’ll ask Congress, Democrats and Republicans, to continue the work on health reform.

He’ll remind all members that premiums will continue to rise; businesses will continue to drop coverage and more families will deal with insurance company abuses if we don’t act.

The President will also speak directly to the American people and to Congress about changing the way business is done in Washington so that the American people know that their interests always come before the special interests.

He’ll call for more transparency so that the public is always aware of what’s being done on their behalf. The President will talk about his efforts to better protect the American people. After inheriting two wars and a growing terrorist threat, he will review the steps that he has taken to increase the pressure on al Qaeda, and refocus on Afghanistan. He will discuss the progress made in carrying out his plan to end the war in Iraq. And he will announce a new plan to protect the American people from bio-terrorism and infectious disease.

The President has renewed America’s alliances and standing in the world. He will preview the progress that we are poised to make as we near completion of a landmark arms control agreement with Russia, and prepare to host a Nuclear Security Summit in April that will rally the world behind the goal of securing all loose nuclear materials. He will also speak about America’s leadership on issues like global economic growth, climate change, and human rights.

For over a decade, American families have been working harder and falling further behind. As college become less affordable; retirement savings become less secure; home values plummet; health insurance premiums and co-pays eat into wages and the cost of living explodes, the standard of living for American families continues to decline.

While they meet their responsibilities and play by the rules, they have seen the special interests and those with political access in Washington get farther and farther ahead. Rather than seeing policies that encourage responsible behavior, American families have too often seen Washington reward irresponsibility while passing on debt to future generations.

The President will talk about the need for change that the American people want and expect. For a decade, American families and businesses have experienced an erosion of the economic security that has been at the core of our prosperity. Tonight the President will lay out his vision on what steps are required to restore that security and how Washington should do its work in a way that reflects the best of our people and our democracy.

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At Last – Long-awaited Health Reform Reconciliation Bill Released

Today House Democratic Leadership released the legislative text of the Reconciliation Act of 2010, sponsored by House Budget Chairman John Spratt.  The bill amends a number of provisions in the Senate-passed “Patient Protection and Affordable Care Act,” including:

  • Provides additional subsidies to improve the affordability of coverage for individuals with incomes up to 400 percent of the federal poverty level;
  • Imposes additional requirements for coverage of non-dependent children up to age 26;
  • Closes the Medicare Part D donut hole by 2020 by offering seniors an immediate $250 rebate and subsequently increasing discounts on brand-name drugs;
  • Strikes the controversial 100-percent federal Medicaid matching rate for Nebraska (known as the “Cornhusker kickback”);
  • Delays the annual cap on contributions to health flexible spending accounts (FSAs) by two years until 2013;
  • Delays the excise tax on high-cost health plans to 2018, increases the dollar thresholds and indexes them to inflation;
  • Delays the industry fee on sales of brand name pharmaceuticals by one year to 2011 but increases revenues raised by $4.8 billion;
  • Delays the medical device tax on manufacturers by two years until 2013 and switches the industry fee to an excise tax on the first sale for use of medical devices at 2.9 percent rate; and
  • Delays the health insurance industry fee by three years to 2014.

House Majority Leader Steny Hoyer announced that the House would convene at 1:00 pm on Sunday, but the final vote on the reconciliation bill would likely not begin until later in the day to comply with the Democratic Leaders’ promise to give Members 72 hours to review the final bill text.  The House is expected to approve the Senate-passed health reform bill using a “deem-and-pass” procedure that Republicans protest as unconstitutional.

Since the bill’s release, several House members have switched their previous ‘no’ vote to a ‘yes’ – including Reps. Bart Gordon (D-TN), Luis Gutierrez (D-IL), Betsy Markey (D-CO), and Mike Arcuri (D-NY).  Additionally, Rep. Dennis Kucinich (D-OH) announced yesterday that he will now vote in favor of the bill.

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