OVERNIGHT HEALTH: Clash over Medicaid looms

By Julian Pecquet - 05/31/11 07:10 PM ET

Saving Medicaid: A Democratic briefing for several dozen Medicaid advocates on Republican plans to cut the program by close to $750 billion resulted in what one participant called a "clarion call" to action.

The advocates filing out of the darkened Senate building were under strict orders to keep tight-lipped, but a few participants indicated that no firm decisions were made during the meeting. Rather, they said, the public can expect to increasingly hear that the magnitude of cuts contemplated by Republicans would not be achievable without hard budget caps; that approach would hurt beneficiaries and would shift costs to the states, participants said, since the growth in Medicaid spending is expected to remain below that of the private sector, according to the latest CBO projections.

Here's the invitation:

"The Health Democratic staff from the House Energy and Commerce Committee, the Senate Finance Committee, leadership staff in the House and Senate, and Democratic Governors' offices invite you to a meeting on Tuesday, May 31 […] to discuss threatened changes to the Medicaid program, including global spending caps, a block grant, the loss of the maintenance of effort requirement (the Medicaid MOE), and other cuts to the Medicaid program that may be contemplated during budget negotiations."

By the numbers: The meeting comes as Avalere Health released a state-by-state breakdown of the effects of House Republicans' proposal to turn Medicaid into a block grant for states. The report found wide variations in how states would cope: Texas and Virginia, for example, would likely experience a funding decline in excess of 30 percent over 10 years; other states, like Massachusetts and New York, meanwhile, would have a drop in funding of less than 10 percent.

"With Washington focused on Medicare, policymakers also need to consider the dramatic impact on Medicaid," Avalere Health CEO and founder Dan Mendelson said in a statement. "As governors struggle to control Medicaid costs, it's hard to see how they can accommodate further constraints in federal spending."

Budget battles: House appropriators were on track Tuesday evening to adopt a budget that slashes the Food and Drug Administration's budget by 11.5 percent, or roughly $285 million. Republicans on the panel also want to revisit new school meal regulations that would limit starchy foods such as potatoes.

Funny money: Hours before the vote, the public interest group Food & Watch Watch released an analysis of campaign contributions showing that meatpacker and poultry industry PACs gave $615,305 to House Appropriations Committee members between the 2000 and 2010 election cycles. The 2012 appropriations bill slashes the U.S. Department of Agriculture's Food Safety and Inspection Service by 3.6 percent, the group points out, while expanding self-regulation favored by industry.

Come enjoy our pool: The Health and Human Services Department (HHS) announced new steps Tuesday to bolster enrollment in insurance pools for sick people, which have come under fire from Republicans after falling short of their enrollment goals.

The department announced that it is cutting premiums and easing eligibility criteria for the high-risk pools. HHS administers the high-risk pools in 23 states; the rest are state-run. The department plans to lower premiums in 18 of those 23 states — some by as much as 40 percent. Healthwatch's Sam Baker has the story.

Comments closed: Tuesday was the deadline for stakeholders to comment on a joint proposal by the Antitrust Division of the Department of Justice regarding antitrust enforcement of the accountable care organizations created by the healthcare reform law. Predictably, the Federation of American Hospitals decried regulatory overreach. Stakeholders that stand to lose from further consolidation — medical device manufacturers, for example — are singing a different tune.

Patient rights: Patients would be able to find out who has looked at their electronic medical records under a proposed rule opened up for public comment on Tuesday.

Patients would obtain the information by requesting an access report, which would document who electronically accessed and viewed their protected health information. Although providers are currently required to track access to such information, they don't have to tell patients. Read the Healthwatch story.

Medical imaging: The top Republican and Democrat on the Energy and Commerce Health panel are pushing back against proposals to curb medical imaging tests paid by Medicare, arguing that they could restrict access to "life-saving medical tools."

In a letter to the chairman of the Medicare Payment Advisory Commission (MedPAC), Reps. Joe Pitts (R-Pa.) and Frank Pallone (D-N.J.) request that scheduled imaging payment cuts be allowed to go into effect before new restrictions are considered. In April MedPAC voted to submit clinicians who order large numbers of such tests to prior authorization, a recommendation that's expected to be included in the commission's June report to Congress. Healthwatch's Julian Pecquet has the story.

New faces: The comptroller general on Tuesday announced the appointment of two new MedPAC members and the reappointment of three others. Their terms expire in 2014.

The newly appointed members are Willis Gradison, a scholar in residence in the Health Sector Management Program at Duke University's Fuqua School of Business; and William Hall, a geriatrician and professor of medicine at the University of Rochester School of Medicine. Reappointed were Rush University Medical Center COO Peter Butler; Harvard Medical School professor Michael Chernew; and First Diversity Management Group COO George Miller.

Wednesday's agenda:

Geographic disparities: The Institute of Medicine will release a long-awaited report on geographic variation in healthcare spending that 50 Democrats from the Midwest and Pacific Northwest demanded in exchange for their support of the House healthcare bill back in 2009. The report assesses the methodology and data used to calculate Medicare geographic payment adjustments and recommends ways to improve their accuracy.

Oral arguments: The healthcare reform court saga continues as the 6th Circuit Court of Appeals hears arguments in the case of four members of the Thomas More Law Center who say the law's individual mandate violates their freedom. The Cincinnati court is the second court of appeals to hear oral arguments in a healthcare reform case, after the 4th Circuit in Richmond gave the law’s critics a frosty reception earlier this month.

The three-judge panel in Cincinnati, Ohio, is expected to be more divided: One was appointed by President George H.W. Bush and two by President Clinton, one of whom is a Republican. In a novel twist, the Obama administration argued Friday that the plaintiffs don't have standing, especially since it turns out one of them had employer-sponsored coverage the whole time and presumably wouldn't be penalized under the law’s mandate.

Budget call: Center for American Progress COO Neera Tanden and others hold a briefing in the morning to discuss the Republican budget plan and what the numbers mean for the ongoing debate over the Affordable Care Act.

Lobbying registrations:

Association of Schools of Public Health (self-registration)

Mr. Eric Lachica / US Medicare PH (Medicare overseas portability)

Missy Edwards Strategies / Georgia Health Services University

Rasky Baerlein Strategic Communications / Massachusetts Eye and Ear (specialty hospital)

Venn Strategies / Medical Information Working Group

Reading list:

High-deductible insurance plans are gaining popularity, reports USA Today.

California's crackdown on hospital-acquired conditions is faltering, writes The Sacramento Bee.

The World Health Organization suggests cell phones should be labeled as "possibly carcinogenic," Reuters reports.

What you might have missed on Healthwatch:

House Republicans aren't backing away from Rep. Paul Ryan's Medicare proposal.