April 12, 2010
This week's edition of the Chandler Chicco Companies-DC Health Policy Pulse includes:- They're Back
- What Does it All Mean?
- The CMI
- State v. State
- Curing the Doctor Shortage
- Health Policy Politics: You Can’t Go Home Again
- Perspective: The Devil’s in the Details
- Healthcare Playmaker Profile: Sen. Tom Coburn (R-OK)
They're Back
Senators and Representatives return to Washington this week after the Passover/Easter break. Some things have changed since Congress left town. Legislators will find the temperature in the nation's capital much warmer than it was when they left. Cherry blossoms have come and gone. And, for the first time in more than a year, neither the Senate nor the House is scheduled to debate health reform… although a temporary fix to the physician payment is once again on the Senate’ agenda. Members are now focusing on jobs, on financial reform, on climate legislation, and other initiatives both large and small.
While Congress' formal agenda no longer includes health reform, however, many in DC continue to focus on the impact the new law will have on health care, health policy and on legislators' electoral health as we head toward November.
Today we debut a new regular feature, called "Health Policy Politics." This section will focus on how health reform is playing in the 2010 election, with a special focus on key states and House districts as Election Day approaches. Will those electorally vulnerable Democrats who supported health reform be able to explain and defend their votes? Will the GOP face any backlash for its "Just Say No" approach to reform? Which side is winning the support of independent voters so crucial to victory? What are the implications of this debate for the future of health policy in Washington and in state capitals around the nation?
What Does It All Mean?
So now the bill has become law. Lawyers, lobbyists, association executives and leaders of professional and medical societies are working to discover what is in the recently-signed law and what it will mean for them, the clients and their members. But, outside of Washington, hospital leaders, physicians and others on the front line of health care are working to understand what the new law will mean for them, their organizations and the patients they serve. What is becoming clear, of course, is that those actually charged with delivering health care know very little about what the law does and does not do. And they are having a hard time explaining all of that to their patients and their communities. Obviously, it will take time to understand how this is supposed to work... and whether it is working. But that isn't stopping patients and practitioners from wondering what to do now.
http://www.latimes.com/features/health/la-me-health-reform5-2010apr05,0,6777934.story
The CMI
By 2011, the Secretary of Health and Human Services will have a powerful new tool with which to examine new models of care, new methods to spur collaboration and new payment incentives designed to improve quality and save money. The recently signed health reform legislation charges the HHS Secretary with creating the Center for Medicare and Medicaid Innovation (CMI). And the legislation gives the Secretary broad authority to approve and expand experiments that will improve quality and reduce costs. Expect to hear much more about the CMI going forward.
State v. State
One of the more difficult challenges of implementing reform will be keeping every state happy. Each state argues that its hospitals and physicians are efficient and its providers underpaid by Medicare and Medicaid. Some states, like Minnesota, argue that they are delivering high quality care for lower cost. Others, like Massachusetts and New York, argue that health care is more expensive in their states because the costs of goods and services – primarily labor costs – are much higher there than in Minnesota. President Obama wants to pay for “outcomes” not for the quantity of services provided. These fights tend to be less partisan and more regional than most health policy debates, with legislators seeking to deliver higher reimbursement for their provider constituents. And, like Lake Wobegon, every state wants to be above average.
http://www.mndaily.com/2010/04/11/panelists-talk-health-care
Curing the Doctor Shortage
Left undone at the end of the health reform debate was a permanent fix to the formula according to which physicians are reimbursed for caring for Medicare beneficiaries. Senate leaders are hoping to consider a bill this week that would postpone a pending 21% physician payment reduction by 30 days. Sen. Tom Coburn (R-OK), who is a physician himself, is holding up the bill until Democratic leaders demonstrate how it will be paid for. In a perhaps related story, it appears that the physician shortage – especially in primary care – is growing. The shortage will be exacerbated as 32 million people who currently do not have insurance are added to the roles and begin the search for a primary care doctor.
http://www.ama-ssn.org/amednews/2010/04/12/prl10412.htm
Health Policy Politics: You Can’t Go Home Again
The two-week recess from which legislators return today was the first chance since passage of health reform for legislators to get a sense of how much trouble they are in. All members of the House of Representatives must face reelection in November, and a huge majority of them – probably exceeding 80% – face little to no opposition. They are “safe.” The rest – probably between 60 and 90 legislators – will have something of a fight on their hands. Some of the Democrats who supported reform are in real trouble. Perhaps surprisingly, however, some who opposed reform face some angry constituents as well. And those who tried to have it both ways – arguing that they were for it before they were against it – are finding that they have few friends.
Last year, the town meetings and in-district forums held during the August Congressional Recess defined the health reform debate for the rest of 2009 and into January, 2010. So how do legislators feel as they return to Washington following the April recess? How is health reform playing back home?
http://www.latimes.com/features/health/la-na-healthcare-profiles12-2010apr12,0,3986361,print.story
Perspective: The Devil’s in the Details By Al Jackson, CCC Washington
Now that the bill has become a law, the process of realizing the policy objectives and implementing the legislation falls to the bureaucracy. Very few people know the names of those who will develop the rules by which insurers, hospitals, physicians, device manufacturers, drug makers, PBMs, patients and others will live by for the foreseeable future. These people work in relative anonymity at the Department of Health and Human Services, for the Food and Drug Administration (FDA) and, mostly, for the Centers for Medicare and Medicaid Services (CMS).
Many of the “big” reforms are postponed until much later, such as the requirement that all citizens and legal residents have insurance (2014), the creation of state-based insurance co-ops (2013) and tying Medicare reimbursement to outcomes by reducing payment for preventable hospital readmissions (2012).
But some of the reforms start right now. Already, CMS is putting in place a process to establish a temporary national high-risk pool to provide health insurance coverage to individuals with pre-existing medical conditions (insurers are not precluded from denying coverage to such individuals until 2014). There are other reforms that begin in 2010, including allowing parents to keep their kids on their insurance plans until they reach age 26; tax credits for Medicare beneficiaries who end up in the “donut hole” under Medicare Part D; and payment reductions for hospitals, home health agencies and skilled nursing facilities, along with “productivity adjustments.”
In short, the process is just beginning. Health reform provided direction, and defined a destination. The regulators will decide how we get there.
Healthcare Playmaker Profile
Sen. Tom Coburn (R-OK)
Sen. Tom Coburn, M.D., became the first Republican to represent Oklahoma’s 2nd Congressional District when he was elected to the U.S. House of Representatives in 1994. A decade later and after a brief return to private medical practice where he specialized in family medicine, obstetrics and the treatment of allergies, Coburn re-emerged in Washington to run for the open Senate seat. He took office in January 2005 and was selected to serve as a non-attorney on the Senate Judiciary Committee. Coburn also serves on the Homeland Security and Governmental Affairs Committee, Intelligence Committee, the Indian Affairs Committee and the Committee on Health, Education, Labor and Pensions. Coburn is widely known for his fiscal conservatism, and has often been referred to as a “political maverick.” In recent months, Coburn was referred to as “Dr. No” for his strong opposition to health reform.
Tom “Dr. No” Coburn is still making headlines for his obstinacy. The fiscally conservative Republican recently withheld his support for the nomination of Donald Berwick as the head of the Centers for Medicare and Medicaid Services. Coburn told reporters that he disagreed with Berwick’s use of cost comparative effectiveness, saying “I want to do what's best for the patient, not necessarily what's cheapest.” And now, Coburn is blocking Congress from a “fix” to the Medicare physician payment formula. Without a fix, a 21 percent cut in Medicare physician rates will take effect. His grounds? Coburn said he wants to know where the $10 billion to pay for the “fix” is coming from. In a recent New York Times article, he referred to the idea of using the federal budget to provide extended benefits to the nation’s jobless as “theft.” Senate rules give Coburn significant power to block the doctor fix. His physician colleagues are hoping he will relent.
http://www.ama-assn.org/amednews/2010/04/05/gvl20405.htm
For more information or to subscribe directly to the CCC-DC Health Policy Pulse, please email healthpolicypulse@chandlerchiccocompanies.com or call CCC-DC Health Policy Pulse Editor Al Jackson at 202-609-6002 or contributor Katherine Lea at 202-609-6021.
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