Archive for August, 2011

Bundle of Hope?

Wednesday, August 31st, 2011

Last week’s announcement by the Center for Medicare and Medicaid Innovation – a.k.a. The Innovation Center – about the launch of the Bundled Payments for Care Improvement Initiative offers hope in the battle against out-of-control health care costs. Doctors, hospitals, and other health care providers can apply to participate in this new initiative, which will test four different models of paying for services delivered across an “episode of care.”

What’s this all about? Mostly, it’s about shaking up the status quo in the way we pay for health care services. Today, most health care is paid for on a fee-for-service basis. Under this system, doctors, hospitals and clinics are paid “a-la-carte” for care, meaning that they get paid for each individual service they provide — a lab test, an office visit, an MRI – without regard to whether the patient’s health improves. This system gives providers full decision making power, along with the financial incentive to order whatever services they choose regardless of efficacy or expense. The incentive also tends to undervalue lower-paying services such as primary care and important patient supports such as care coordination, home visits, and 24/7 access .

The new initiative seeks to change the status quo by paying providers a fee for all the services a patient receives over the course of an “episode” of care, for example, a hip replacement, rather than paying each provider separately for every service related to the episode (e.g. inpatient stay, lab tests, post-discharge services). The Innovation Center spelled out four models it wants to test. These models vary in terms of episode length, services in the bundle and payment type.

The idea of bundling payments gained traction during the health reform debate primarily based on the experience at Geisinger Health System, a health system out of Pennsylvania (and where it should be noted, the head of The Innovation Center used to work). Years ago, Geisinger launched an episode-based care model for its heart bypass patients. Under this program – called “ProvenCare” – the health system calculated the total cost for all of the preoperative, post-operative and rehabilitation services associated with bypass surgery and paid providers this price. It also created new systems to ensure that doctors were following best clinical practices for the surgery. As a result of implementing this program, there was a 21 percent reduction in all complications from the surgery, a 25 percent reduction in surgical site infections and a 44 percent decrease in hospital readmissions. Geisinger has since expanded this program to other episodes of care such as hip replacement surgery, cataract surgery, obesity surgery, prenatal care for babies and mothers, and heart catheterization.

While the results of this new initiative are still a few years away, bundling payments clearly represents a step toward better care at lower cost. If done well, it will improve the quality of care by encouraging coordination and the use of care management services, such as transition planning, home visits or social service supports. However, if done without strong measures of transparency and accountability for improved quality, it could be a failed experiment. Advocates have a unique role to play in ensuring that the voices of patients and their families are represented in shaping this program, especially in making sure the right quality measures are used.

Given the current pressures in Washington and in the states to reduce health care costs, we hope this bundling program results in lower costs and better care, making it a true bundle of joy.

– Renée Markus Hodin, Project Director

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Check Health Care Off Your Back-to-Campus List

Tuesday, August 30th, 2011

For students heading to college, fall is a season full of the excitement and distraction of a new environment, new friends and new classes. With all of the activity, it can be easy to let signing up for health care slip through the cracks. However, health coverage is critical to keep students healthy and financially secure. Young adults need health care just like everyone else, and preventive care is vital for the long-term health of students. Moreover, 16 percent of young people have a chronic condition, like diabetes or asthma that can require expensive doctors’ visits. There’s also the unexpected – a broken bone or random accident could cause severe economic hardship for a student who’s not insured. In fact, young adults go to the emergency room more than any age group under 75, and can easily rack up thousands of dollars in a visit.

The New England Alliance for Children’s Health, a Community Catalyst initiative, is partnering with Young Invincibles to bring students and their families a free Back-To-School Toolkit breaking down student options for health coverage in every state. The toolkit gives up-to-date information on the costs and benefits of student health plans, walks through how to stay on your parent’s plan, explains what to do if you have a pre-existing condition, and provides relevant updates on the new health care law (like the new rules on birth control and preventive services for women). It also has tips for young women, important information on young adults and cancer, and much more.

Click here to download the Back-To-School Toolkit. With your help, we can make sure that everyone has the information they need to stay healthy this school year.

– Nicole Tambouret, Program Manager
New England Alliance for Children’s Health

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States of Innovation

Tuesday, August 30th, 2011

states of innovation logo

A Team Approach to Care

As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable Americans, restricting critical benefits like prescription drug coverage, imposing premiums on those who can’t afford them, and slashing already-low provider reimbursement rates.

Community Catalyst and Georgetown University Health Policy Institute Center for Children and Families created the States of Innovation blog series to shine a spotlight on states that are trying to find a better way. We will highlight states that are pioneering new approaches to making Medicaid more sustainable without harming – and often by improving – care for the millions of vulnerable seniors, people with disabilities, children and low-income parents that rely on Medicaid.

SOI intro line

Both the Affordable Care Act (ACA) and many state initiatives have sought to encourage new models for health care delivery that simultaneously reduce costs and improve care. Stemming from pioneering work in one of its cities, New Jersey has passed an innovative new law that allows its Medicaid program to replicate a successful trial of team-based care.

Camden, New Jersey is one of the nation’s poorest cities and has one of the highest crime rates in the nation. Homelessness, drug trafficking, high unemployment, and sky rocketing health care costs are a fact of life in this city of just 79,000. Between 2002 and 2008, 978 patients made 3,882 visits to emergency departments in the city – a majority of the visits were for preventable conditions that could be treated by a primary care doctor.

In this dire situation a family practice physician, Dr. Jeffrey Brenner, pioneered a successful approach to reducing hospital readmissions and health care costs of the sickest and most vulnerable populations. A recent episode of PBS’s Frontline highlighted Dr. Brenner and his innovative work and praised his initiative as a new model of care. The work of the Camden Coalition of Healthcare Providers, the practice that Dr. Brenner set up, laid the groundwork for the Garden State to adopt this model, the Medicaid Accountable Care Organization (ACO) Demonstration Project, which was signed into law by Governor Christie earlier this month.

Where it all began
An article by Atul Gwande in The New Yorker features a story about Frank Hendricks, who had multiple health issues, weighed 560 pounds, had a substance abuse problem and lived on welfare. Hendricks spent a majority of his time in the hospital because no one in the health care system was able to effectively manage his care. Dr. Brenner visited him regularly, arranged for a social worker and a nurse practitioner to coordinate his care, and advised him on how to best take care of his health –taking medication on time, healthy eating habits, etc. This team approach to care resulted in a significant improvement in Hendricks’s health.

Hendricks is an example of a “super utilizer” in Camden’s health care system. Through the collection of hospital data, Dr. Brenner found that a core area in the city, where a nursing home and a low-income housing tower are located, accounted for a majority of the hospital visits and millions of dollars in health care costs. Mr. Hendricks’s case and the other super utilizers identified by Dr. Brenner’s work showed that primary and preventive care with a team approach, which takes the whole person into consideration, significantly improves the overall health of the patient. According to Dr. Brenner this team approach has resulted in a 40-50 percent reduction in Camden’s health care costs since he started this work in 2007. The cost saving strategies that Dr. Brenner and his team have used include:

  • – Nurse practitioner-led clinics in high cost buildings
  • – More super utilizer outreach teams
  • – Medical home-based nurse care coordination
  • – More same day appointments (open access scheduling)

What is New Jersey doing?
Despite the great success of Dr. Brenner’s work to improve patient care and bring down overall health care costs, there are a few barriers to replicating this model elsewhere. Many state Medicaid programs do not have a payment system that provides incentives for providers to work together to improve care for patients, and hospitals in many states often lose money if the rate of preventable hospitalizations decreases.

New Jersey passed the Medicaid ACO Demonstration Project to try to remedy those misaligned incentives and help other communities replicate Dr. Brenner’s success. This legislation enables community-based, non-profit coalitions of hospitals and primary care providers to apply for recognition by the state of New Jersey as Medicaid ACOs. Once approved as ACOs, these coalitions would qualify for “shared savings” if they reduce Medicaid costs by providing increased access to primary care and working together to better coordinate patients’ care.

Under the legislation, the state is required to share any savings it accrues as a result of improved care coordination with the participating providers in the ACOs. To protect patients from any adverse incentives that might give ACOs a reason to skimp on care, ACOs must demonstrate improved care for their patients in order to qualify for these shared savings. The state will therefore be measuring – and requiring – quality improvement based on benchmarks which include: patient experience, access to primary and behavioral care, and reduction of unnecessary and inefficient medical costs.

Key lessons for other states
Dr. Brenner’s work shows that by providing more primary care and better coordinated care, we can drive down costs and create better outcomes for patients. The key is offering the right incentives to providers so they can work as team to coordinate care for the patient.

While New Jersey offers us one model to accomplish that, the ACA encourages many innovative approaches to improving care while reducing costs. For example, the ACA established the Center for Medicare and Medicaid Innovation (Innovation Center). The Innovation Center has the resources and flexibility to rapidly test innovative care and payment models and encourage widespread adoption of practices that promote better health and deliver better health care at lower cost.

The ACA also created an option for states to qualify for enhanced federal funding to set up health homes to better coordinate the care of Medicaid beneficiaries with chronic physical or mental illness. If we can make this approach work for the sickest and most vulnerable population – then the health care system can work for everyone.

– Leena Sharma, Field Coordinator

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Required Reading: A Gripping Behind-the-Scenes Look at ACA Passage

Wednesday, August 24th, 2011
Inside National Health Reform by John McDonough is out on bookstore shelves. John, a longtime collaborator in efforts to improve health care in Massachusetts, brings his years as an organizer, legislator, professor, and head of Health Care For All (Massachusetts) to this book. Appointed by Senator Kennedy to be to Senior Advisor on National Health Reform to the U.S. Senate Committee on Health, Education, Labor and Pensions, John was the key to bringing the lessons of Massachusetts health reform to Washington.
The first part of the book is an exciting blow-by-blow account of how health reform went from a campaign promise to legislation. The second part is an insider’s account of each of the ten titles of the law. In a straight forward, easy-to-read manner, John provides the story behind many unknown provisions of the law like the Physician Payments Sunshine Act or the Elder Justice Act.
Inside National Health Reform is a must read for anyone interested in health reform and the future of health care in this country.
– Rob Restuccia, Executive Director

Inside National Health Reform by John McDonough is out on bookstore shelves. John, a longtime collaborator in efforts to improve health care in Massachusetts, brings his years as an organizer, legislator, professor, and head of Health Care For All (Massachusetts) to this book. Appointed by Senator Kennedy to be to Senior Advisor on National Health Reform to the U.S. Senate Committee on Health, Education, Labor and Pensions, John was the key to bringing the lessons of Massachusetts health reform to Washington.

The first part of the book is an exciting blow-by-blow account of how health reform went from a campaign promise to legislation. The second part is an insider’s account of each of the ten titles of the law. In a straight forward, easy-to-read manner, John provides the story behind many unknown provisions of the law like the Physician Payments Sunshine Act or the Elder Justice Act.

Inside National Health Reform is a must read for anyone interested in health reform and the future of health care in this country.

– Rob Restuccia, Executive Director

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More Summer Sunshine: New Transparency Rules for Health Plans are a Win for Consumers

Monday, August 22nd, 2011

We got some good news last week from the Administration – new rules for individual and group health plans that require them to disclose critical information about their benefits and out-of-pocket costs. For many of us, this is sort of “ho-hum” news because our employer pretty much makes the decisions about what health plan to buy. And if we get a choice of plans, our employer often provides us with helpful summaries we can use to compare and choose the plan that’s right for us.

But for millions of Americans who don’t have job-based coverage, it is not so easy to make an informed choice. Because of differences in how coverage works, even different ways deductibles work, it is almost impossible to compare health insurance options across plans. Even worse, rarely do two insurers use the same definition for the same terminology, leaving consumers to make decisions in the dark.

Thanks to the proposed rule issued last week, this “Wild West” of an insurance market is going to change. As we shift toward a system in which everyone has both the right and responsibility to have coverage, consumers need access to unbiased, standardized information about benefits, cost-sharing, and any limits or exclusions in the policies available to them. This new information, delivered in a consumer-friendly format, will be available for individuals and families buying their own coverage, people with job-based coverage, and coverage sold through Exchanges starting in 2014.

Beginning as early as next year, this information will help consumers make “apples-to-apples” comparisons about what is covered, what is not, and out-of-pocket expenses. Plans must disclose, up front, any limits or exclusions to the plan. All insurers will be required to use the same standard set of definitions, and provide new “coverage examples” that will help consumers assess the relative generosity of each plan’s benefits in common medical scenarios, like pregnancy, breast cancer, or diabetes.

However, the proposed rule also raises questions, and it will be important to see them resolved so that these new disclosure rules truly benefit consumers. For example, the final version of the rules should clearly state that insurers and group health plans must make available the summary of coverage on their webpages, healthcare.gov, and on current and future Exchange sites. Consumers should not have to make special requests or provide personal information to get this information. The Massachusetts Exchange makes this kind of comparative information available on its website – and Congress intended all Americans to have access to similar shopping tools.

The proposed rule also requests comments on whether larger employers should be allowed to embed the new coverage summary in their “summary plan description” (SPD), which is a detailed description of the plan’s coverage and how it operates. But those SPDs are often highly technical and complex. Most likely, embedding the short, consumer-friendly summary of benefits form in the lengthy SPD means it will never be seen by the vast majority of employees.

The Administration is asking for comments on these issues before they finalize the rules. Insurance companies and employers are already complaining loudly – it will be important for consumer groups to weigh in too.

– Sabrina Corlette, Research Professor
Health Policy Institute, Georgetown University

Note from Community Catalyst: Contact Christine Barber (cbarber@communitycatalyst.org) if you are interested in commenting to HHS and are looking for assistance.

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How the Affordable Care Act Helps Youth Aging Out of Foster Care

Wednesday, August 17th, 2011

Mandatory Medicaid coverage for former foster care youth who have aged out of the foster care system but are in care as of their eighteenth birthday—an important provision in the Affordable Care Act (ACA) that isn’t as widely known as it should be—is finally getting some traction thanks to a recent paper in the Michigan Journal of Social Work and Social Welfare.

Finding quality, affordable health insurance can often be difficult for youth transitioning out of the foster care system, and providing Medicaid coverage as a bridge during this pivotal time up to age 26 is an incredibly significant step forward. According to the paper’s author, Aisha Hunter (having herself aged out of the foster care system), “the 2014 foster youth health care expansion plan represents the most comprehensive and profound legislation for this population in decades.” Here at Community Catalyst’s New England Alliance for Children’s Health program, we couldn’t have said it better ourselves.

The foster youth expansion provision goes into effect beginning in 2014. It builds  upon the Foster Care Independence Act of 1999, which, among other things, gave states the option of extending Medicaid coverage to foster youth up to age 21 through the John Chafee Foster Care Independence Program (otherwise known as the “Chafee option”).

The paper also helpfully points out that, despite the difference  this ACA provision will make in the lives of youth aging out of the foster care system, there are important implementation issues that need to be addressed to make it as effective as possible. For instance, because all foster youth aging out of Medicaid will qualify for the program up to age 26, individual applications for enrollment are an unnecessary burden for the youth themselves as well as for parents and child welfare workers. Instead, an automatic enrollment process should be put into place to ensure these youth can easily take advantage of this important ACA benefit. Additionally, in order to ensure continuous health insurance coverage during this transitional period for youth, states should not be permitted to deny youth’s access to Medicaid simply because they have another potential source of coverage.

The extension of Medicaid coverage to youth aging out of the foster care system is another example of how the ACA is full of commonsense reforms that enhance access to care for those who need it most. When we hear overblown rhetoric about this historic law, it’s worth remembering that it’s already helping real people every day, and will help even more as time goes on.

—Patrick M. Tigue, Senior Policy Analyst

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ACA Opponents Grab a (Partial) 11th Circuit Win

Tuesday, August 16th, 2011

In a 2-1 decision this past Friday, the 11th Circuit U.S. Court of Appeals in Atlanta handed ACA opponents a partial victory and dealt a partial blow to the Obama Administration and ACA supporters. While the ruling is frustrating to those working tirelessly on ACA implementation, the good news is that the entire law wasn’t ruled unconstitutional. The individual mandate provision – or the requirement that everyone who can afford insurance must obtain it – was struck down, raising doubts about the long-term sustainability of the ACA. However, let us grab the bits of good news that are sprinkled (lightly) throughout this ruling.

Medicaid is no bully.

 Medicaid expansion is at the heart of expanding coverage to millions of uninsured Americans in the coming decade. The appeals panel confirmed that the Medicaid program is a legitimate federal mechanism to expand coverage to the uninsured. It is not a coercive tool, as charged by the plaintiffs; rather, Medicaid is a longstanding federal-state partnership to address the uninsured in states. The panel writes “If states bear little of the cost of expansion, the idea that states are being coerced into spending money in an ever-growing program seems to us to be ‘more rhetoric than fact.’”

The individual mandate is one provision of many…

It is worth noting that the panel declined to uphold Judge Vinson’s lower court ruling that the entire law be thrown out. Therefore, it raises the possibility that the individual mandate could be severed from the ACA, leaving the law intact. This does raise concerns for ACA supporters and insurers alike because the mandate is a way to include everyone – healthy and sick – and is used as a tool for calibrating risk.

Politics aside…or front and center?

Pam Bondi, the Florida AG leading the 26 state lawsuit against the ACA, commented that due to the bipartisan nature of the 11th Circuit ruling, “politics are out of this now.” (Judge Hull of the majority opinion is a Clinton appointee; however, she is also cited as a compromise candidate during a fierce partisan nomination battle for judges during the mid-nineties). Did Bondi really say that? If that were the case, the 6th Circuit ruling where Republican appointed Judge Sutton upheld the individual mandate would have marked the beginning of the end of ‘politics.’ Saying ‘this is the end of politics’ surrounding these ACA legal challenges is merely politics. Yes, it is confusing. What is clear, however, is that the individual mandate provision of the ACA is bound for the Supreme Court. All pundits agree that the Justices cannot avoid taking an ACA case– as to when the Justices take the case may depend on, well, politics.

Therefore, perhaps you feel a tinge of pity for the Supreme Court as everyone waits to see what ruling they will choose to hear. Will it be the 4th Circuit where we are still awaiting an appeals decision? Will it be the 6th Circuit that has already petitioned the Supremes? Or will it be the 11th Circuit where we are awaiting the Administration’s decision as to whether or not to appeal (they have 90 days)? You can hear the chorus now – “Pick me! Pick me!” Most believe the Obama Administration will win this leg of the race (rare to turn down an Administration petition). Who will reach the finish line first? Well, that is the topic of another blog.

- Eva Stahl, Policy Analyst

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It’s Time to Reauthorize Funding to Train Pediatricians (and Use Funding to Train Other Physicians More Effectively)

Wednesday, August 10th, 2011

It’s hard to imagine how children can stay healthy if there aren’t enough pediatricians to take care of them. And this is precisely the issue at stake as Congress decides whether to reauthorize the Children’s Hospitals Graduate Medical Education Payment Program (CHGME) over the coming weeks. The House Energy and Commerce Committee recently passed CHGME reauthorization legislation (H.R. 1852), and its companion bill (S. 958) is due to be considered by the Senate Health, Education, Labor, and Pensions Committee in early September. However, CHGME’s current authorization expires on September 30 of this year, and the ultimate fate of the reauthorization effort remains very much in doubt at this point.

Putting the debate in context
There was a real concern about the nation’s pediatric workforce in the late 1990s after the American Board of Pediatrics noted that the number of pediatric residents had seen a decline of more than 13 percent, and the Pediatric Education Task Force concluded that the lack of adequate federal funding for graduate medical education at independent children’s hospitals was a significant threat to maintaining an adequate number of pediatricians going forward.

To address this issue, Congress created CHGME 1999 so that independent children’s hospitals could receive federal support to train resident pediatricians and pediatric specialists similar to the support provided to adult hospitals through the Graduate Medical Education Program (GME) through Medicare. Prior to the enactment of CHGME, independent children’s hospitals were receiving only half of a percent of the federal funding provided to adult hospitals for GME as well as unstable and varying support from Medicaid.

And CHGME has worked exactly as Congress intended by increasing the number of pediatric residents and pediatric resident specialists training at independent children’s hospitals, meeting pediatric workforce development needs in geographic regions across the country, and ensuring that even children living in states without independent children’s hospitals have some access to well-trained pediatricians and pediatric specialists.

Success begets success
Given CHGME’s track record of success, advocates must remain vigilant to ensure that the program is reauthorized before it expires at the end of September. This becomes even more important given the shortage of pediatric specialists in many areas of the countrydespite the impressive progress made as a result of CHGME. Advocates can play an important role in the coming weeks by weighing in with their Congressional delegation.

For more information on CHGME, check out the new paper from our New England Alliance for Children’s Health program that outlines in greater detail the past success of CHGME, makes the case for why it is still needed, and offers some ideas about how to improve the program.

Training for docs for grown-ups needs help too…
It’s also worth noting that, unlike CHGME, the GME Program (aimed at training physicians who serve adults) receives a majority of its funding from Medicare to train medical residents. Currently, GME does not produce enough primary care providers to meet the country’s needs. Primary care is critical to fixing the health care system, and GME is one untapped tool for primary care workforce expansion, as outlined in another new paper we recently released. More can be done to redesign GME so that it is more nimble in its response to regional and national workforce needs. Policy makers have an opportunity to develop a framework of accountability that preserves our tradition of excellent medical education while tying it directly to the needs of consumers.

—Eva Marie Stahl, Policy Analyst
—Patrick M. Tigue, Senior Policy Analyst

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Debt-Ceiling Compromise Kicks Medicaid Fight Down The Road

Wednesday, August 3rd, 2011

Yesterday, the president signed a bill that ended months of intense negotiations over lifting the country’s debt-ceiling. But for the fate of Medicaid – and the millions of seniors, people living with disabilities, and low-income children who rely on the program – the negotiations are just beginning.

What’s the deal?
In short, the final compromise lifts the debt ceiling enough to last until after the 2012 election and puts in place two stages of cuts in government spending.

In the first stage, caps are immediately placed on discretionary spending, saving $917 billion over 10 years.

In the second stage, a bipartisan joint committee is tasked with developing legislation to reduce the deficit by another $1.2 – $1.5 trillion over 10 years. Failure by the committee to produce an agreement by Thanksgiving or by Congress to enact their plan by December 23 would trigger automatic across-the-board cuts in federal spending to achieve $1.2 trillion in savings. If the Committee agrees on – and Congress enacts – less than $1.2 trillion in deficit-reduction, the across-the-board cuts will be triggered to make up the difference.

Let’s start with some good news
Medicaid and Medicare were spared any immediate cuts in the first stage. That said, the first stage cuts include significant short-run spending reductions; any serious economist will tell you that cutting federal spending in the midst of an economic downturn will only worsen the nation’s employment outlook. These larger economic forces certainly have implications for state budgets and Medicaid, but that’s a blog for another day.

The picture is murkier in the second stage. While Medicaid and Medicare are very much at risk for major cuts in a compromise that the joint committee might broker (more on that below), Medicaid is completely exempt from the automatic across-the-board cuts that would be triggered if the committee fails to achieve $1.2 trillion in deficit-reduction. Medicare benefits are also largely protected: across-the-board cuts to Medicare are limited to 2 percent of the programs’ costs and can only come from cuts to providers and insurers.

This is an important victory. Inside reports suggest that Republican negotiators demanded that Medicaid be added to the mix of programs that could face cuts in the event of the trigger, but the Obama administration refused to budge on this point. Consumer advocates deserve credit: they worked tirelessly over the past few months to send a strong message to Congress and to the White House that Medicaid matters. It’s clear that Obama took that message to heart.

Now the bad news – we’re not even close to out of the woods
Relief that Medicaid will escape unscathed should across-the-board cuts be triggered must be tempered by the understanding that the trigger may not be pulled, and that committee members will consider deep cuts to Medicaid in their efforts to broker a deal.

It is difficult to predict whether the committee will succeed. On the one hand, the terms of the process were constructed specifically to put immense pressure on both parties to avoid the across-the-board cuts. If committee fails to reach a compromise, all $1.2 trillion in deficit-reduction would come from program cuts – violating Democrats’ vows to ensure revenue increases are part of any deficit-reduction package. And 50 percent of the triggered across-the-board cuts must come from the defense budget – a painful prospect for Republicans.

On the other hand, competing pressures may prevent the committee from reaching a compromise. Republicans may prefer cuts in military spending to a compromise that includes tax-increases. And if they can’t broker a deal that includes tax-increases, Democrats may prefer to allow the across-the-board cuts to be triggered since at least Medicaid and Medicare benefits are protected from those cuts.

While there is considerable debate about the likelihood that the committee will succeed, the prospects for Medicaid are grim if a deal is brokered. Having already slashed discretionary spending by nearly a trillion dollars in the first stage, it will be difficult for the committee to find more savings in those programs. That leaves revenue increases and entitlement spending as the only real options for significant deficit-reduction.

Both parties have already drawn lines in the sand around revenue increases, with Democrats insisting on including them as part of a final deal, and Republicans vowing to vote against any package that includes them. But if significant revenue increases are not part of the solution, for the committee to succeed the cuts required to Medicaid and Medicare would absolutely devastate these programs. According to a statement by Robert Greenstein, president of the Center on Budget and Policy Priorities: “The deal that President Obama and Speaker Boehner were negotiating several weeks ago would have raised Medicare’s eligibility age, raised Medicare cost-sharing charges, shifted significant Medicaid costs to states, modified cost-of-living adjustments in Social Security and other benefit programs (and in the tax code), and instituted other entitlement savings. Those steps would have saved $650 billion to $700 billion over ten years. The joint committee would have to produce cuts twice as deep.”

And even if Democrats succeed at ensuring revenues are part of a deal, Medicaid would still likely sustain very significant cuts, such as the ones that were already on the table during earlier negotiations. Those cuts would jeopardize the health and financial security of millions of seniors, people living with disabilities, and low-income children who rely on Medicaid, and they would shift new cost burdens onto already-strained state budgets.

Making a dark picture worse, Congress needs to act this December to avert an automatic cut in Medicare doctor reimbursement rates (the “doc-fix”). While this is unrelated to the debt-ceiling negotiations, Congress will need to offset the costs of the doc-fix – about $300 billion for a 10-year fix – and they will likely look to find these savings in Medicaid and Medicare. These savings would be in addition to whatever cuts the deficit-reduction committee enacts.

Where does that leave us?
Medicaid lives to fight another day, and we should celebrate this success. But let’s celebrate while we roll up our sleeves. The fight starts anew today, and it’s not going to be easy.

– Katherine Howitt, Senior Policy Analyst

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Another Historic Announcement Brought to You by the ACA

Monday, August 1st, 2011

Today, the Department of Health and Human Services (HHS) released new guidelines about women’s preventive health, and announced the services for women that insurance plans must cover without co-payments under the Affordable Care Act (ACA). We first discussed this in a blog following the release of the Institute of Medicine report which outlined eight recommendations for HHS.

The recommendations HHS adopted in its guidelines include:

  • – well-woman visits
  • – screening for gestational diabetes
  • – human papillomavirus (HPV) DNA testing for women 30 years and older
  • – sexually-transmitted infection counseling
  • – human immunodeficiency virus (HIV) screening and counseling
  • – FDA-approved contraception methods and contraceptive counseling
  • – breastfeeding support, supplies, and counseling
  • – domestic violence screening and counseling

As with the rest of the ACA, the political cup runneth over when it comes to women’s health issues and what insurance should cover. In an attempt to handle objections to the inclusion of contraception, HHS included in its announcement today an exemption for religious institutions.

This is a historic day for women’s health. The regulations ensure that women across the country will be able to access the important services they need without a co-payment – removing a significant barrier to women living healthier lives.

– Reena Singh, Associate Director of State Consumer Health Advocacy

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