Medicare

The Obama administration has misused its regulatory authority to prevent planned cuts to seniors' health plans from taking effect one month before the 2012 election, Republican lawmakers alleged Thursday.

The lawmakers take issue with the Department of Health and Human Services' recent decision to spend $8.3 billion on a nationwide Medicare Advantage payment reform demonstration. The demonstration will increase payments to MA plans by 0.4 percent, they argue, helping offset the healthcare reform law's $200 billion in cuts to the plans that cover 25 percent of seniors on Medicare.

A Medicare agency official denied the charge, and said the payment reform demonstration program was authorized under the healthcare reform law. The pilot demonstration, the official said, aims to incentivize all Medicare Advantage plans to improve quality outcomes.

The allegation was made in a letter to HHS Secretary Kathleen Sebelius from Ways and Means Committee Chairman Dave Camp (R-Mich.) and Sen. Orrin Hatch (R-Utah), the top Republican on the Senate Finance Committee.

President Obama on Wednesday rejected a Republican proposal to overhaul Medicare and Medicaid as he outlined a deficit reduction framework that aims to cut healthcare entitlement spending by $480 billion over 12 years.

The president is under pressure to tackle the long-term costs of the healthcare programs, which are expanding at an unsustainable rate and driving the growth of the deficit.

House Republicans last week proposed a budget that would largely privatize Medicare and turn Medicaid over to the states, but Obama rejected both approaches in a speech Wednesday afternoon.

The House Republican proposal “lowers the government’s healthcare bills by asking seniors and poor families to pay them instead,” Obama said. “Our approach lowers the government’s healthcare bills by reducing the cost of healthcare itself.”

President Obama finally threw his hat in the deficit-fighting ring Wednesday with a "40,000-foot" framework for cutting federal healthcare spending by $480 billion over 12 years.

Instead of the major overhaul unveiled last week by House Budget Chairman Paul Ryan (R-Wis.), the president favors building on cost-saving measures in last year's healthcare reform law by expanding the role of a payment advisory board that would recommend cuts to reimbursement rates if Medicare costs grow too fast. The president also wants to extend drug rebates to the 9 million or so low-income seniors and people with disabilities who are on both Medicare and Medicaid. Read the Healthwatch story.

No-PAB: The Alliance for Specialty Medicine almost immediately put out a press release blasting the proposal.

"The President's proposal to expand IPAB only furthers the largest problem facing Medicare patients, and that is access to physicians," Alliance spokesman Alex Valadka said. "Doctors cannot continue to ably treat Medicare patients if they are constantly wondering whether or not the money will be there to reimburse them."

The New York Times takes a look at the leading proposals to reform Medicare.

Support for Democrats' healthcare reform law polls at an all-time low, reports The Associated Press. 

Obama administration officials, however, draw attention to two favorable results: Respondents still say they trust Democrats over Republicans to handle healthcare, 53 percent to 36. And 52 percent approve of the president's handling of the issue versus 48 percent who disapprove.

House Republicans are touting the cuts to the healthcare reform law in their budget deal with the White House. These include: 

• Forcing another repeal vote in the Senate;

• Requiring an internal audit of the law's impact on the economy, premiums, comparative effectiveness research and the hiring of contractors needed to implement it;

• Freezing the IRS budget, which will affect enforcement of the law's new taxes and mandates;

• Restricting the use of the law's Prevention and Public Health Fund;

• Eliminating Free Choice Vouchers that would have allowed some employees to opt for coverage in state exchanges instead of their employer's plans; and

• Cutting start-up funding for the law's healthcare cooperatives.

All eyes are on President Obama Wednesday, when he will outline long-term deficit reduction proposals in a high-profile speech at George Washington University. The speech will be an answer for the budget proposed last week by House Budget Chairman Paul Ryan (R-Wis.), who included major overhauls to the Medicare and Medicaid programs.

White House spokesman Jay Carney refused to preview details on Tuesday, but senior adviser David Plouffe said on Sunday the speech will touch on Medicare and Medicaid. Republicans have criticized the administration over the past two months for punting on entitlements in his 2012 budget proposal released in February.

The speech presents a delicate balance for Obama: Avoid too many cuts that will upset Democrats, but provide a serious enough alternative that can rival Ryan's plan.

Enter Simpson-Bowles?: Some reports indicate Obama will embrace the his fiscal commission's report. The plan laid out several major healthcare recommendations: freezing Medicare's sustainable growth rate through 2014 while coming up with a long-term solution; establishing a global budget for total healthcare spending; speeding up some payment reforms included in the Affordable Care Act; and strengthening a new independent Medicare advisory board.

House Dems will offer up plan: Rep. Chris Van Hollen (D-Md.), the House Budget Committee's ranking member, said the panel's Democrats will put out their own budget proposal Wednesday. However, he didn't offer any details on how Democrats will address healthcare entitlement programs. Check out The Hill's story.

Medicaid block granting gets a boost: Douglas Holtz-Eakin's American Action Forum is building support for Medicaid vouchers with a report that proposes a long-term strategic plan for tackling the program's exploding costs. Called FLEX — Financial accountability, Lean operations, Ensured access to care, Xpanded state ownership — the proposal aims to give states more power to create payment models that encourage and reward care management and savings.

Rep. Chris Van Hollen (D-Md.) said House Democrats will unveil a 2012 budget plan of their own on Wednesday, framing it as a clear alternative to the Republican budget blueprint released last week.

In a speech at the liberal Center for American Progress, Van Hollen, ranking member of the House Budget Committee, said Social Security would be separated from the House Democrats’ discussion of the 2012 budget. But he did not divulge many details of his party’s plan, especially on how it will handle healthcare entitlements.

Van Hollen sharply criticized the House GOP budget, crafted in large part by Rep. Paul Ryan (R-Wis.), the Budget Committee chairman.

“When you strip away all the soothing, sweet-sounding talk of reform, at its core — at its core — the Republican budget is the same tired formula of extending tax breaks to the very wealthy and the powerful at the expense of the rest of the country,” Van Hollen said. “Except this time, it’s on steroids.”

The nation’s top Medicare official on Monday rebuked the House GOP’s plan to radically overhaul the healthcare program for seniors.

Medicare Administrator Don Berwick, who told reporters on Monday he hadn’t seen the specifics of House Budget Chairman Paul Ryan’s (R-Wis.) Medicare overhaul, said lawmakers need to find the “political will” to maintain the program’s current structure while finding additional savings.

“I think Medicare system now is viable, it can improve, and that’s my commitment to help do that,” Berwick told reporters.

Berwick, speaking to the American Hospital Association’s (AHA) annual meeting, cited healthcare reform’s new accountable care organization regulations, its focus on rewarding quality care and a new Medicare innovation center as major tools built into the overhaul to help control cost.

“Our country is facing a choice. … We can either cut care, or we can change how healthcare does its work,” Berwick told the AHA. “I’m not for cutting. I’m for changing.”

With lawmakers striking a deal to keep the government running through 2011, the focus will turn to what will be an even bigger fight: the 2012 budget. The House will begin consideration of the Republican budget proposal on Thursday, and a full vote is expected Friday.

Democrats have mounted a strong offense against House Budget Chairman Paul Ryan’s (R-Wis.) plan to transform Medicare into a voucher-like system and to block-grant Medicaid, but the party doesn’t yet have its own vision for making the entitlement programs sustainable over the long term. That changes on Wednesday, when President Obama outlines a deficit-reduction plan that will take on entitlements.

House Republicans will take another shot at the healthcare reform law Wednesday, when the full House votes on repealing the overhaul’s $17 billion prevention and public health fund.

In what's sure to be an ongoing theme, Democrats went on the attack against Budget Chairman Paul Ryan's (R-Wis.) proposed Medicare and Medicaid overhauls. The Budget Committee met this morning to mark up the GOP blueprint, and the meeting is expected to run until midnight.

Democrats on the House Energy and Commerce Committee pushed out a fact sheet highlighting the Congressional Budget Office's unfavorable Tuesday evening review of the House GOP's Medicare and Medicaid proposals. The Congressional Progressive Caucus and the House Democratic Caucus Seniors Task Force both criticized the entitlement reforms in separate press conferences Wednesday.

Ryan defends Medicare reform: As Democrats piled on against his Medicare plan, Ryan defended it vigorously during the markup. He said the overhaul would provide more for the poor and sick, while asking the wealthy to chip in more. "Wealthy people have money because they're wealthy, so we don't need to subsidize them as much as everybody else," he said. "More for the poor, more for the sick, less for the wealthy. ... You not only save Medicare, you help the country from going off the debt cliff."

For Ryan, the bottom line is that Medicare is headed for financial ruin on its current trajectory. "We've got to stop demagoguing and fix this problem," he said. "If we keep kicking this can down the road, it's going to get ugly."

Medicare beneficiaries for the first time will have access to data about hospital-acquired condition (HAC) rates, the agency announced on Wednesday, despite industry objections.

Data posted by the Centers for Medicare and Medicaid Services (CMS) makes public data on eight types of HACs, which often result from improper patient-care procedures.

Medicare has, since 2008, banned reimbursements for care resulting from HACs, and the healthcare reform law enacted a year ago requires the same policy to be extended to state Medicaid programs.

Injury from a fall or other trauma has been the most common HAC, occurring once for every 2,000 discharges, and more than 70 percent of hospitals reported at least one fall over a two-year period, CMS said. Meanwhile, blood or urinary tract infections were reported once for every 3,000 discharges, and 45 percent of hospitals reported at least one case, according to CMS.