Republican governor breaks with House GOP over Medicare cuts

By Julian Pecquet - 07/12/11 03:59 PM ET

Georgia Gov. Nathan Deal (R) is asking House Republicans to reject cuts to home healthcare that debt-ceiling negotiators say could save Medicare billions of dollars.

Deal, a former chairman of the Energy and Commerce Health subcommittee, wrote to House Speaker John Boehner (R-Ohio) urging him not to impose co-payments on home healthcare services covered by Medicare and Medicaid. The co-pays are included in a list of Medicare cost reductions that House Majority Leader Eric Cantor (R-Va.) brought to White House negotiations on Monday; the policy, coupled with cost-sharing for nursing homes and cuts to payments for post-acute care, would save $50 billion over 10 years, according to the document.

In a letter dated Thursday, Deal shares his personal experience as caregiver for his mother and his parents-in-law.

"I am confident such a co-payment requirement would only serve to shift thousands of low-income seniors out of home-based care into much more costly nursing homes," he wrote, "and impose billions of dollars in additional Medicaid costs onto the states."

Some policy experts say co-payments can help drive healthcare costs down by cutting down on overutilization of healthcare services by people who don't have any "skin in the game." But the industry says the cuts would disproportionately affect poor sick people, shift patients to more costly settings such as nursing homes and increase Medicare and Medicaid costs. Lobbyists also point out that such co-pays are unpopular and were repealed in 1972 after being included in the 1965 Medicare law.

Deal offered his own savings proposal, saying he supports an industry-supported proposal to fight fraud and abuse in the home health setting that could save more than $20 billion over 10 years.

This isn't Deal's first time bucking conservatives on healthcare issues since he became governor. In February, he told Georgia Public Broadcasting that House Republicans shouldn't rush to defund the healthcare reform law that he voted against when he was in the House.

"One of the real problems that some of us as governors foresee is that, if the mandates on states remain in place, but the funding from the federal level to carry out those mandates is withheld, that's the worst possible condition that states could be left in," Deal said in the interview.