Medicaid

Rep. Linda Sanchez (D-Calif.) on Wednesday introduced legislation to expand overtime and minimum wage protections to home care workers, who don’t currently have those rights.

Sanchez, a member of the Ways and Means Committee, says the exclusion represents a case of discrimination against hundreds of thousands of workers who tend the sick and elderly, allowing them the freedom to stay at home in lieu of entering nursing homes and other institutional facilities.

“All work in this country has dignity,” Sanchez said during the bill’s unveiling on Capitol Hill. “There isn’t a reason why these workers should be excluded.”

Although Congress 35 years ago extended the Fair Labor Standards Act (FLSA) to provide minimum wage and overtime protections to many in-home direct care workers — including certified nursing assistants and home health aides — the law cut out an exemption for those performing so-called “companionship services,” a category into which the Labor Department has placed home care workers.

The result, critics say, is a home care workforce that gets paid less, works longer hours and suffers more turnover than most other professions. Indeed, home care workers perennially make it onto Forbes’ list of the lowest-paying jobs in the country, earning less than parking lot attendants, housecleaners and bartenders, in one recent survey.

For 35 years, home care workers have been excluded from the minimum wage and overtime protections granted to the rest of the nation's workforce. This week, a House Democrat will take a step toward eliminating that discrepancy, which many in the party consider discriminatory.

Rep. Linda Sanchez will introduce legislation Wednesday to expand the wage protections of the Fair Labor Standards Act (FLSA) to home care workers, who provide health and other domestic services to the sick and elderly. The California Democrat says the change is needed to entice more home care workers into the field in the face of an ever-increasing demand for their services.

"It's one of the worst-paid jobs in the country," Sanchez told The Hill on Tuesday. "In this day and age," she added, the current FLSA exemption "is shocking."

Senior advocates agree. AARP spokesman Jordan McNerney said Tuesday the group has yet to see the Sanchez bill, but supports the concept. 

“As older Americans continue to choose home and community-based care over more costly nursing homes," he said in an e-mail, "the home health workers who care for them should be fairly compensated."

Calling for new stimulus legislation, a group of local government groups and liberal lawmakers will gather Tuesday afternoon on Capitol Hill to warn that local economies have hit a "crisis point" that threatens the nation's rebound from the recession.

Officials from the National League of Cities, the U.S. Conference of Mayors and the National Association of Counties will unveil a new report outlining the layoffs and cuts to safety-net programs if Congress doesn't pass a new jobs bill.

Joining the groups will be a number of liberal Democrats, including Reps. Barbara Lee (Calif.), Phil Hare (Ill.), Lynn Woolsey (Calif.) and Keith Ellison (Minn.).

Sen. Sherrod Brown (D-Ohio) and House Labor Committee Chairman George Miller (D-Calif.) have also been invited.

The Senate this week is expected to consider legislation providing $30 billion to encourage community banks to increase their lending to small businesses. The upper chamber already ended debate on the measure last week, clearing the way for final passage.

The House passed a similar bill on June 17.

The Obama administration on Monday announced $2.25 billion in federal grants designed to help severely disabled Americans move from hospitals and nursing facilities to their own homes.

The funding — included in the Democrats’ new healthcare reform law — will enhance Medicaid’s five-year-old “money-follows-the-person” (MFP) demonstration, which helps states shift patients with chronic illnesses from institutional facilities to community-based settings. The program is intended to save Medicaid money while also lending greater independence to the disabled.

Currently, 29 states and the District of Columbia have adopted MFP programs, according to the Centers for Medicare and Medicaid Services (CMS). The new reform law encourages states not already enrolled to apply for grants, while allowing current participants to expand their programs.   

The law provides $450 million for each of the five years, beginning with 2012, for a total of $2.25 billion.

On Aug. 11, CMS will host a call for interested applicants.

The announcement arrives on the 20th anniversary of the Americans with Disabilities Act, which extended certain anti-discrimination protections contained in civil rights laws to folks with disabilities. 

A bill that would have the federal government cover medical malpractice costs for physicians who volunteer at community health centers cleared the Energy and Commerce panel's health subcommittee on Thursday.

The sponsors of the bipartisan Family Health Care Accessibility Act, Reps. Tim Murphy (R-Pa.) and Gene Green (D-Texas), say the bill would enable underserved communities to have access to care at minimal cost to the government. The bill extends to volunteers the medical liability protections currently offered by the Federal Tort Claims Act to physicians employed at community health centers.

"Extending medical liability protections to volunteer physicians would result in more doctors and more patients being served at a lower cost to these centers," Murphy said. "And the cost to do this is pennies on the dollar. It is estimated that extension of FTCA protection would cost the federal government just $1.5 million a year, but it would serve millions more new patients."

Murphy and Green say physicians who currently want to volunteer have to pay as much as $100,000 a year in medical malpractice insurance, making it too costly for them to do so. At the same time, the new healthcare reform law increased funding for community health centers by $11 billion and requires them to cover as many as 40 million patients — twice the current number — by 2015 because of the law's Medicaid expansion.

"This is the third time we’ve moved the bill out of committee, and I’m hoping that the Senate will be able to get behind the bill," Green said. "It is extremely important to the community health centers in my area and across the country to be able to bring on licensed medical practitioners willing to volunteer their time with the support of federal liability coverage."

The health panel unanimously passed the bill with a recommendation for passage by the full committee.

Medicaid is wasting hundreds of millions of dollars each year purchasing name-brand drugs in cases where a cheaper generic is also available, according to a report released Wednesday by the American Enterprise Institute (AEI), a conservative think-tank. 

After examining two-thirds of the $21.8 billion Medicaid spent on pharmaceuticals last year, AEI researchers identified 20 branded drugs commonly purchased by the program for which a generic option exists. The savings if Medicaid had purchased the generics instead of the branded drugs? $271 million, AEI estimates.  

Drilling down, researchers found that 12 of those 20 drugs made up 94 percent of the waste. Purchases for just two branded drugs — Lamictal (generic: lamotrigine) and Risperdal (generic: risperidone) — accounted for $95 million of the overspending, AEI found. 

Furthermore, AEI reports, roughly three-quarters of the waste surrounded drugs whose generic counterparts hit the market most recently, in 2008 or 2009.

The findings raised the eyebrows of the National Coalition on Health Care (NCHC), a nonprofit health reform advocate, which said the report “provides a solid basis for starting a much-needed national dialogue about how best to address increasing drug costs not only in Medicaid but also in other parts of our health system.”

“Rising pharmaceutical costs, the aging population, and increased use of costly specialty drugs makes containing drug-related spending an urgent health system priority closely linked to expanding access to care and improving quality,” Ralph Neas, who heads NCHC, said in a statement. 

“All stakeholders need to be engaged in developing policies and practices to help contain prescription drug related without negatively impacting clinical decisions or therapeutic outcomes.”

AARP, the monolithic 50-and-older lobbying group, is throwing its weight behind states' push for more federal Medicaid dollars. 

In a letter sent to every member of Congress last Friday, the group warned a failure to provide the additional funding next year "will harm millions of Americans" — particularly low-income seniors for whom Medicaid is often the only coverage option.

"Medicaid is an important economic driver, not only providing essential health care services to individuals in need but also adding money to the state economy by paying local providers who then spend locally," wrote David Sloane, an AARP vice president.

"With the economic downturn, the number of Medicaid beneficiaries has understandably swelled, with many people unable to pay for health care. Unfortunately, these swelling ranks come at a time when states can least afford the additional costs."

Congress had increased the federal share of Medicaid funding as part of last year's economic stimulus bill, but that money expires at the end of this year — halfway through the budget year of most states. 

Many governors have warned the looming expiration, if realized, will force them to cut state programs, including education. Hoping to prevent that from happening, Democrats have pushed for an extension of the enhanced federal rate through the end of the state budget year next July. But GOP concerns over deficit spending have forced supporters of that crusade to scale back their proposal. 

The Republicans — notably Sen. Susan Collins (R-Maine) — want the enhanced rate to decrease incrementally over the first six months of 2011.

Sen. Chuck Grassley (R-Iowa), ranking member on the Senate Finance Committee, pressed the Obama administration to release a congressionally mandated report on the status of the Medicaid program. The report, due Jan. 1, is required to cover the “financial status of, enrollment in, and spending trends for” Medicaid.

“The report might contain bad news, but we all need to see it,” Grassley said in a statement. “The new health care reform law expands Medicaid by the greatest amount in the program’s history, yet states are already struggling to afford their existing Medicaid responsibilities. A true picture of Medicaid’s financial state is necessary to ensure that services are funded adequately for the millions of people who rely on the program.”

Grassley made the request in a letter sent Thursday to Health and Human Services Secretary Kathleen Sebelius.

Doctors in Texas are threatening to drop Medicaid patients if a scheduled reimbursement cut takes hold later this summer, the Dallas Morning News reported Sunday. 

To help shore up their budget in a tough economy, Texas lawmakers have scheduled a 1 percent cut in Medicaid provider rates, which takes hold Sept. 1. 

But Medicaid rates in Texas are already so low that most doctors already limit the number of Medicaid patients they’ll see — or refuse them outright. The new, looming cut would mean that even more doctors would likely stop seeing those patients, leaving some of the most vulnerable in the state without access to care. And the 1 percent cut could just be the start.

“State leaders’ instructions for agencies to identify additional 10 percent budget cuts in the next two-year budget cycle mean more fee cuts may come next summer,” the Morning News reported. “Experts say further reductions could drive off doctors, dump more patients on hospital emergency rooms and ensure a rocky start for the federal health care overhaul, which by conservative estimates could add 1.5 million Texans to Medicaid by 2015.”

The issue has national implications. Although not every state is eying Medicaid cuts, low provider reimbursements have limited doctors’ participation in the program country-wide. The problem is especially pressing because the Democrats’ new health reform law expands Medicaid considerably. Indeed, roughly half of the 30 million uninsured Americans estimated to get new coverage under the law will be enrolling in Medicaid.

To address the reimbursement issue, the law includes a provision hiking Medicaid rates to equal Medicare rates for primary care services. But the hike is temporary, meaning that lawmakers will likely have to return to the issue in 2014 if they hope to ensure that Medicaid coverage translates into care for those patients.

A dozen governors on Wednesday pleaded with Congress to quickly pass legislation extending enhanced federal Medicaid funding for states or risk a double-dip recession. The state leaders also suggested they're open to phased-down funding if that's what it takes to avoid the drastic cuts to state services that are looming because of congressional inaction.

Forty-seven governors of states and territories signed a letter in February asking that Congress extend for six months the 6.2 percent enhanced federal matching rate when it expires at the end of the year. But the Senate this month considered two proposals with lower rates in an unsuccessful bid to get support for its tax extenders bill from centrist Republicans such as Sen. Susan Collins (Maine).

"Could we live with that? It would be hard, because every increment means pain, every increment means job losses [and] none of them make sense to us. But sure," Gov. Ed Rendell (D-Pa.) said at a press conference. "But I think the key is action, and I can't stress [enough] the point about action now."