Posts Tagged House Committee
From The Washington Post: A $300 Billion Deception
Posted by Hal Andrews in Healthcare Reform on November 16th, 2009
I think the November 15 Editorial Page at The Washington Post has it exactly right. In the “if you can’t beat’em, join’em” category, I quote:
HAVING PASSED a health reform bill that is, at least theoretically, paid for, the House of Representatives is poised this week to blow a quarter-trillion-dollar hole in the federal budget involving, you guessed it, health care. This is the so-called doc fix, to prevent scheduled cuts in Medicare reimbursements to physicians from taking effect.
Say you are a member of Congress who agrees that the cuts should be rescinded — that physician payments shouldn’t be reduced, that is — but also believes that the payments should not add to the national debt? Under the rule governing the House debate, you won’t be allowed to suggest any offsetting savings. Either you go for the doc fix and add massively to the deficit, or you torpedo the fix and wreak havoc in the Medicare program, with a 21 percent cut set to take effect Jan 1. Nice choice. It puts those who believe in both fiscal responsibility and averting these draconian cuts in an impossible situation.
By the way, don’t be fooled by the incredible shrinking “cost” of the fix. The official Congressional Budget Office estimate used to be $245 billion over 10 years. Now it’s $210 billion. In fact, the real hit to the budget will be closer to $300 billion. The lower CBO numbers stem primarily from the administration’s move to change the rules about which physician payments are subject to the cuts. The administration proposed a regulation to exempt drugs administered in doctor’s offices, such as chemotherapy, from the spending ceiling. That has the effect of making the cost of the fix look smaller, but it doesn’t change the ultimate drain on the treasury: Medicare will end up paying out the same amount of money.
All of this is, to some degree, Medicare kabuki to placate the American Medical Association. The Senate doesn’t have the votes to pass a permanent fix without paying for it — though, of course, it also doesn’t have the votes actually to pay for it. So while the House might pass the unpaid-for fix, it will likely die there. The result will be another year-long, or possible two-year, patch slapped on this mess. Finding the money to pay for the fix and, more to the point, cobbling together the political coalition to support it, is difficult. Which is why Congress and the administration have joined hands in the pretense that the doc fix has nothing whatsoever to do with health reform.
Beltway Math: How To Count Like Nancy Pelosi
Posted by Hal Andrews in Healthcare Policy, Healthcare Reform on October 30th, 2009
Around my house these days, we are working on certain math concepts that have proven irrefutable over the centuries. This week, for example, we have concentrated on multiplication facts, such as 2×3=6. At the parent-teacher conference this week, I was told how important it was to understand these concepts.
Today’s coverage of the House health reform bill makes me think that some members of Congress should take a refresher course in basic math, such as how to add. Today’s Roll Call reports on the real cost of the House bill:
“The House Democrats’ health care plan would cover 36 million more Americans at a cost of $1.055 trillion over the next decade, while slashing the federal deficit overall by $104 billion, according to a preliminary Congressional Budget Office score released late Thursday.
The cost of the bill was a concern to fiscally conservative Blue Dog Democrats, who sent a letter to the CBO asking additional questions about their estimates and what additional measures could be taken to reduce the overall spending on health care.
Speaker Nancy Pelosi (D-Calif.) had touted the bill as costing $894 billion when she released it online earlier in the day, but that number nets out $167 billion in new pay-or-play taxes on individuals and businesses. Pelosi’s office had also said the bill would cut the deficit by $30 billion, but the CBO score came in much better.
The $1.055 trillion cost is offset by $740 billion in new taxes and revenue and a net $426 billion in cuts in spending, largely in Medicare.
The CBO also estimated that the deficit would continue to shrink slightly in the second decade after the bill is adopted, a key issue for many moderate Democrats, although it said that any estimates that far out have considerable uncertainty.
That $1.055 trillion figure only includes the coverage portions of the bill, down from about $1.2 trillion in the original bill.
Other pieces, including the cost of closing the “donut hole” in the bill for seniors under Medicare, come on top of those figures.
The bill also excludes an estimated $245 billion in costs for preventing a 21 percent cut to doctor’s pay under Medicare. Democrats dropped that provision from the bill and plan to move it separately so that they can say the larger bill does not add to the deficit.”
So, $1.055T – $740B – $426B + $245B + ? = $894B. Got it?
Remember, friends, this is courtesy of the same people who are sure that Medicare fraud is $60B per year that Federal agencies cannot seem to stop. What is your prediction when the Federal government adds another $1,000,000,000,000 into the pot?
The Trouble with Massachusetts
Posted by Hal Andrews in For Consumers, Healthcare Policy, Healthcare Reform on July 15th, 2009
My mother lives on Martha’s Vineyard.
My wife and I always chuckle to hear her and others islanders refer to Massachusetts as “America”, as if the island has seceded from the Commonwealth and, incidentally, the United States. As I contrast the “reform” plans in Washington with the reality of the Massachusetts Connector from which key parts of the Senate HELP and House Tri-Committee plans are derived, I wonder if all of the residents of the Commonwealth are wondering what “America” is considering.
As outlined in The New York Times article entitled Massachusetts Takes a Step Back From Health Care for All, the Commonwealth has decided that they cannot provide the coverage that they promised. As a result, 30,000 legal immigrants are set to lose their coverage. Coincidentally, The New York Times reports that the Congressional Budget Office estimates House Tri-Committee bill released yesterday will leave only 17,000,000 people uninsured in 2019, of which nearly half would be illegal immigrants. Similarly, both legislators in the House and in Massachusetts believe that a surcharge on the wealthy, aka a tax increase, is the only way to make the math work.
It was not so long ago, even in 2008, when the federal government was in the habit of actually following the laws passed by Congress, such as the United States Bankruptcy Code. In that bygone era, some might have wondered whether the Constitution or the Declaration of Independence might weigh against the “reform” plans fashioned in the House in which a very small minority was hectored into financing benefits for the majority. Others might have pondered whether a National Institute for Health and Clinical Excellence-like program might constitute an unwarranted invasion of privacy, which many hold dear when applied to Roe v. Wade. In today’s world, however, federal judges will not uphold the United States Code in the GM bankruptcy, so I am skeptical that they will do so in healthcare reform.
What to do in response? As any good lawyer knows, when the law favors your side, argue the law; when the facts favor your side, argue the facts. The facts are that this great country was established by immigrants. It is my view that the enduring legacy of America has resulted from and depends upon the diversity and vibrancy that immigrants bring, whether physicians or scientists or engineers or farmers or laborers or artists. To think that the immigrant, and especially the legal immigrant, will bear the brunt of failed healthcare reform is appalling. To think that the Democratic Party will deliver the blow is, I suppose, their version of Nixon going to China.
True healthcare reform will not disadvantage the wealthy, and it will not break the back of the immigrant, who not so long ago were you and me. Shame on all of us if we allow that to happen.
House Tri-Committee Bill, America’s Affordable Health Choices Act
Posted by Editor in Healthcare News, Healthcare Policy, Healthcare Reform on July 14th, 2009
Viewpoints on Reform – July 10
Posted by Hal Andrews in Healthcare Reform on July 10th, 2009
As pressure continues to build in Washington this week, several prominent voices are beginning to raise crucial questions:
- In today’s edition of The New York Times, David Brooks wonders when Congress and the White House plan to take up the critical issue of health care inflation;
- In today’s edition of The Washington Post, the editorial page ponders How Not To Fix Health Care
- In this morning’s edition of Roll Call, the story Blue Dogs Objections Could Delay Release of Health Care Bill highlights objections to the proposed Medicare-based payment rates under a public option
Meanwhile, many healthcare executives on the provider and payer side wonder when Congress or the White House plan to think about changes to the delivery system itself, as opposed to rearranging the deck chairs on the Titanic. Many with whom I have spoken are especially puzzled given the prominent role of Nancy-Ann DeParle in the reform discussions. Ms. DeParle is very familiar with the provider side of healthcare generally, and one of the first real “medical home” delivery systems was built in her hometown of Rockwood, Tennessee in 1996.
Real reform will only occur with changes to coverage, payment and delivery systems. Any “reform” that does not address all three legs of the stool will not be reform at all.
the provisions of title I of draft legislation called the Affordable Health Choices Act
Posted by Editor in Healthcare News, Healthcare Policy, Healthcare Reform on July 2nd, 2009
CONGRESSIONAL BUDGET OFFICE Douglas W. Elmendorf, Director
U.S. Congress
Washington, DC 20515
July 2, 2009
Honorable Edward M. Kennedy
Chairman Committee on Health, Education, Labor, and Pensions
United States Senate
Washington, DC 20510
Dear Mr. Chairman:
The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary analysis of the provisions of title I of draft legislation called the Affordable Health Choices Act, (labeled BAI09F54.xml)………………………….
Revised HELP Estimate from CONGRESSIONAL BUDGET OFFICE
‘Reconciliation’ to Pass Health Bill Won’t Work
Posted by Editor in Healthcare News, Healthcare Reform on July 1st, 2009
Roll Call Executive Editor
Who Would You Want to Design Your Healthcare Benefits?
Posted by Hal Andrews in For Consumers, Healthcare Policy, Healthcare Reform on June 27th, 2009
Part of the House Tri-Committee plan for the Health Insurance Exchange is the creation of a Health Benefits Advisory Committee (HBAC). The HBAC is slated to be chaired by the Surgeon General – so far, so good.
The others on the HBAC are as follows:
- 9 Presidential appointees who are not Federal employees
- 9 Comptroller General appointees who are not Federal employees
- 8 Presidential appointees who are Federal employees
So, 1/3 of the members of the HBAC are Federal employees (including the Surgeon General), 2/3 are Presidential appointees, and 100% are political appointees.
If you are a little worried that political patronage will enter into the deliberations, rest assured that the HBAC membership ” shall at least reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, individuals knowledgeable about disparities relating to race, ethnicity, and disabilities, representatives of relevant governmental agencies and at least one practicing physician or other health professional (my emphasis) and an expert on children’s health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee.”
So, a ratio of 18 Presidential appointees to at least 1 practicing physician or other health professional (who could be the Surgeon General) to decide what benefits should be provided to Americans. Hmmm…
Is It Worth It®: The Prevention and Wellness Trust
Posted by Hal Andrews in Healthcare Policy, Healthcare Reform on June 27th, 2009
As evidenced by the volume of posts on the House Tri-Committee plan for health reform, Chairmen Rangel, Waxman, and Miller delivered a broad and comprehensive plan for reforming health insurance coverage and services. Even so, one proposal screamed for an installment of “Is It Worth It®”.
The House proposes the creation of the “Prevention and Wellness Trust”. This sounds like something straight out of England’s National Health Service, but it’s not – just Google “Doris Matsui” to find out the champion of the concept.
The House plan reserves $15,200,000,000 over 5 years for prevention task forces, prevention and wellness research, delivery of community-based prevention and wellness services, and public health infrastructure. The Secretary of HHS is instructed to submit a national strategy every two years for improving America’s health through evidenced-based clinical and community-based prevention and wellness activities, including core public health infrastructure improvement activities.
Is It Worth It®? Only if you think all Americans are morons. Let’s be serious – as posted previously, behavior is the Number 1 factor in our health status. For free, I will suggest the national strategy here: exercise more, eat less fat and sugar, quit smoking, make sure your kids get vaccinated on time, and get a physical every 2-3 years. Could we use more resources for community health clinics and vaccines? Sure. However, we don’t need comparative effectiveness studies or strategic committees or infrastructure improvement to improve our wellness. A little pain in the pocketbook from taxing employer-sponsored healthcare benefits will work wonders in this regard.
Value-Based Purchasing and the House Tri-Committee Bill
Posted by Hal Andrews in Healthcare Policy, Healthcare Reform on June 27th, 2009
Unlike the Senate Finance Committee, whose ideas on Value-Based Purchasing (VBP) are very clear and consistently focused on payment incentives to providers, the House Tri-Committee takes a more roundabout way to integrating value concepts into healthcare reform. The House Tri-Committee draft broadly implements VBP concepts in three initiatives: health insurance, quality-based reductions in payment, and additional provider quality reporting initiatives.
VBP and Health Insurance Option. The House plan authorizes the Secretary of HHS to “utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value-based purchasing, bundling of services, differential payment rates, performance or utilization based payments, partial capitation, and direct contracting with providers.”
In addition, the Secretary is required to “design and implement the payment mechanisms and policies under this section in a manner that…promotes care that is integrated, patient centered, quality, and efficient.” In the Data Advantage Hospital Value Index™, we evaluate care on the axes of quality, affordability, efficiency, and patient satisfaction.
The House plan also introduces the concept of value and quality based payments for Medicare Advantage (MA) plans. By ranking MA plans based on the quality and value that the MA plans deliver on behalf of their members, MA plans will effectively be forced to be more selective in establishing provider networks, which will in turn reinforce other value-based purchasing reforms.
Finally, the House plan explicitly encourages the public health insurance option to use “high value services” through the implementation of “cost sharing and payment rates to encourage the use of services that promote health and value.”
Quality-Based Reductions in Payment. The House plan contains provisions to adjust payments to hospitals for excess readmissions beginning October 1, 2010. In addition, the House plan contemplates comprehensive payment reform, i.e. bundling, for post-acute care service providers (SNF, LTAC, IRF, hospital-based outpatient rehabilitation facilities and home health)
Additional Provider Quality Initiatives. The House plan contains numerous initiatives to increase quality measurement and reporting, including:
- Integration of physician quality reporting and EHR reporting
- New requirements for ASCs to submit cost reports and data on quality and health care associated infections
- Establishment of National Priorities for Performance Improvement – goal is to develop national consensus standard for measuring the performance and improvement of population health or of institutional providers of services, physicians and other practitioners
Under the National Priorities for Performance Improvement, the AHRQ is instructed to enter into agreements with “qualified entities” to develop quality measures for delivery of health care services. Among other things, the quality measures must be designed to assess patient experience and patient engagement, the safety, effectiveness and timeliness of care, and efficiency and resource use. In other words, what the Hospital Value Index™ measures.
Another proposal is to establish the Center for Quality Improvement headed by the Director of AHRQ. Until the Center is fully operational, the Director of the AHRQ is instructed to focus in on healthcare-associated infections, including nursing homes and outpatient settings; hospital and outpatient perioperative safety; improved quality in hospital ED, especially in identification of sepsis.
Finally, the House plan proposes the establishment of an Assistant Secretary for Health Information to collect, report and publish statistics on key health indicators.
In summary, the House Tri-Committee plan proposes to introduce VBP concepts in both health insurance coverage and healthcare services. While not as obvious as the Senate Finance Committee initiatives, the House initiatives may effectively be more far-reaching.
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