Supporters Of Medicaid Expansion Fight To Be Heard In Some Statehouses

Topics: Medicaid, Politics, Health Costs, Health Reform, States

Apr 01, 2013

Mississippi House Democrats blocked passage of the state’s Medicaid budget Sunday to force a vote on expanding the program, while supporters and critics do battle in Missouri, Montana and Arkansas.

Clarion Ledger: Mississippi House Democrats Block Medicaid Budget
House Democrats on Sunday night blocked passage of the $840 million Medicaid budget, a move to try to force a vote on expanding the program and to block Gov. Phil Bryant from running it by executive order. “The federal government is offering venture capital to expand the largest industry we’ve got in this state, and we can’t even get a vote and debate on it,” said Rep. Steve Holland, D-Plantersville. “So we’re doing what we have to do. We are going to have an up-or-down vote on Medicaid expansion — it may be in a special session — or we are not going to have Medicaid” (Pender, 3/31).

The Associated Press: FACT CHECK: Corbett And The Medicaid Expansion
For now, (Pennsylvania) Gov. Tom Corbett has decided against embracing an expansion of Medicaid that could extend taxpayer-paid health care coverage to hundreds of thousands of low-income adult Pennsylvanians. The 2010 Affordable Care Act pledges to shoulder the lion’s share of the cost of the expansion, but Corbett says he is still concerned about the cost to Pennsylvania taxpayers and cautions that the federal government cannot always be trusted to deliver on its funding promises to states. Here is a look at the validity of some of his claims about the Medicaid expansion (Levy, 3/31).

The Associated Press/Kansas City Star: Medicaid Debate In Missouri Gets Hyperbolic
If Missouri expands Medicaid health coverage for lower-income adults, could it create a crisis for public schools? If Missouri fails to expand Medicaid, could it result in millions of Missourians‘ tax dollars going to health care in other states? In the tense Medicaid debate at the Missouri Capitol, both assertions have been put forth as plain facts by opponents or supporters of a plan that could add as many as 300,000 adults to the Medicaid rolls. But they might best be labeled as hyperbole (Lieb, 3/31).

Helena Independent Record: Democrats Vow To Pass Medicaid Expansion As Republicans Say It Will Blow State Budget
Last week, Republicans on two legislative committees used their majorities to kill Democrat-sponsored bills to expand the program starting in 2014. Gov. Steve Bullock and fellow Democrats vow to keep searching for a way to pass the expansion, although it could be difficult, as long as Republican majorities at the Legislature oppose it (Dennison, 3/31).

The Associated Press: Health Care, Tax Cuts Issues Colliding (AP Analysis)
How do you convince Republicans who took over the Arkansas Legislature by vowing to fight “Obamacare” to support government-subsidized health insurance? The same way you convince a Democratic governor who has said his budget can’t include more tax cuts to agree to a large package of reductions. As Arkansas lawmakers approach what could be the final weeks of this year’s session, it’s becoming clearer that proposals to expand health insurance to low-income workers and to cut $100 million in taxes are colliding (DeMillo, 3/31).

Baltimore Sun: Health Reform’s Changes Stir Worries As They Take Shape In Md.
State lawmakers put finishing touches last week on plans to apply federal health care reforms in Maryland come Jan. 1. But who becomes newly insured — and at what cost —still worries stakeholders as the state speeds toward becoming one of the first to adopt a revamped system. Under legislation passed by the House of Delegates and Senate, more low-income Marylanders would qualify for government-funded health care through Medicaid, and an existing tax on health insurers would sustain a new insurance marketplace once federal support wanes (Dance, 3/31).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Image via CrunchBase

Arkansas’ ‘Third Option’ For Medicaid Expansion Draws Attention

Earl Ray Tomblin (Photo credit: Wikipedia)

Topics: Medicaid, Politics, Health Reform, States

Mar 26, 2013

The approach, which is under consideration by state lawmakers, has attracted the interest of conservative governors and legislators in other states who had previously opposed the program’s expansion. Meanwhile, news outlets track Medicaid expansion news from Iowa and West Virginia.

NPR: Arkansas Medicaid Expansion Attracts Other States’ Interest
Since the Supreme Court made the Medicaid expansion under the federal health law optional last year, states’ decisions have largely split along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back. But now Arkansas – at the suggestion of the federal government – has suggested a third option: Enroll those newly eligible for Medicaid in the same private insurance plans available to individuals and small businesses. And some think that could shake things up. A lot (Rovner, 3/26).

The Associated Press: Ark. GOP Leader Floats Special Session On Medicaid
The top Republican in the Arkansas House on Monday said lawmakers should delay taking final action on a proposal to expand health insurance to low-income residents so state officials can answer questions about how the program would operate. Democratic Gov. Mike Beebe quickly dismissed the idea, repeating his call for lawmakers to vote on the proposal before the end of this year’s legislative session (3/25).

The Associated Press: Iowa Senate Backs Medicaid Expansion Legislation
Lawmakers in the Democratic-controlled Senate approved an expansion of Iowa’s Medicaid program Monday, though Republican Gov. Terry Branstad remains firmly opposed to growing the program in the state. In a 26-23 vote, split down party lines, the Senate backed the legislation. During the 90-minute debate, Democratic lawmakers argued that expanding Medicaid will provide care to more low-income Iowans with little cost to the state (3/26).

Des Moines Register: Senate Approves Medicaid Expansion Plan
The Iowa Senate approved legislation Monday night to add more than 100,000 low-income Iowans to the state-federal Medicaid health insurance program, setting up a showdown with Gov. Terry Branstad. Senate File 296 was approved 26-23 on a straight party line vote with Democrats in favor and Republicans against (Petroski, 3/25).

The Associated Press: W. Va. Diocese Joins Call For Expanding Medicaid
The leader of West Virginia’s Roman Catholic community has joined the chorus urging Gov. Earl Ray Tomblin to expand Medicaid to cover more low-income residents. Bishop Michael J. Bransfield wrote the governor Friday, citing deep concerns about the health and wellbeing of West Virginians he’s developed in his eight years with the Diocese of Wheeling-Charleston and its 83,000 or so Catholics (3/26).

And, on the topic of health exchanges –

The Associated Press/Washington Post: Maryland House Passed Bill Further Implements Health Care Reform
A measure to further implement federal health care reform in Maryland passed the House of Delegates on a 93-43 vote Monday with little debate. The measure creates a dedicated funding stream for the Maryland Health Benefit Exchange, which is a new insurance market that will offer residents a choice of private health plans. While the exchange is on track to be up and running by Jan. 1 with federal help in the first year, the state will begin paying roughly $24 million in fiscal year 2015. The money will come from an existing 2 percent tax on insurance plans that are state-regulated (3/25).

Arkansas Medicaid Plan, Born Of Necessity, Shakes Things Up

English: Great Seal of the State of Arkansas (Photo credit: Wikipedia)

By Julie Rovner, NPR News

March 26th, 2013, 9:13 AM

This story comes from our partner ‘s Shots blog.

Since the Supreme Court made the� Medicaid expansion under the federal health law optional last year, states’ decisions� have largely split along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back.

Illustration by Darwinek via Wikimedia Commons

But now Arkansas – at the suggestion of the federal government – has suggested a� third option: Enroll those newly eligible for Medicaid in the same private insurance plans available to individuals and small businesses.

And some think that could shake things up. A lot.

The Arkansas proposal was crafted as much out of political necessity as from substantive desire, says Andy Allison, the state’s Medicaid director.

“I think this is likely to be the only way that expansion or coverage for this population could occur,” he says.

There are two reasons for that. One is that the state has a Democratic governor (Mike Beebe, now serving his second term), but a heavily Republican state legislature, which has� not looked favorably on expanding Medicaid.

A second reason is that few adults currently qualify for Medicaid in Arkansas. And those who do have to be really poor, says Allison: “We cover just at 17 percent of the poverty level for those who are parents and we don’t cover childless adults unless they have a disability.”

For the record, 17 percent of poverty is less than $2,000 a year. Expanding Medicaid under the Affordable Care Act to 133 percent of poverty — about $15,000 — could potentially add as many as 250,000 Arkansans to the rolls.

But what was a political nonstarter gained new life when someone suggested the idea of enrolling those new people in the same private plans individuals and small businesses will be purchasing — the� new marketplaces, called exchanges.

So far the state has gotten a� tentative go-ahead from the U.S. Department of Health and Human Services. That’s caught the attention of several other Republican-run states that had been holding out on the Medicaid expansion, including Ohio, Florida, and even Texas.

But experts insist the proposal is hardly as new as some have suggested.

“The authority to use Medicaid funds to buy insurance has been in the law since it was first enacted,” said� Sara Rosenbaum, a law professor and Medicaid expert at the George Washington University.

Still, when the Arkansas arrangement first went public about a month ago, there was some immediate hand-wringing about its potential cost.

“We have to … recognize that it will cost more,” said� Austin Frakt, a Boston University health economist. “You don’t get something for nothing.”

But Frakt concedes that paying somewhat more — how much more remains a subject of contention — might not be all bad.

“One of the basic critiques of the Medicaid program is they pay providers too little and that’s why too few of them participate,” he said.

So putting people in private plans with higher provider payments could help address those access problems.

Meanwhile, Medicaid watchers say proposals like the one in Arkansas could solve other problems — for the new Medicaid recipients and for the others who will be buying coverage in the new exchanges.

One potential problem the private plans could address is called� churning. It happens when a person’s income is near the threshold between qualifying for Medicaid and qualifying for� federal help to buy private coverage.

Imagine, says Rosenbaum, someone working 30 hours a week in the summer, whose hours are cut back so they qualify for Medicaid part of the year, then expanded, pushing them back out of the program.

“And you get a letter saying, ‘Now you’re earning more money, so now you have to leave your plan. You and your kids have to leave your doctors; you have to pick a new plan.’ And then in winter, if your hours drop back down, you get another letter saying, ‘Oh, sorry, you have to leave your plan, [and] your doctors,’ ” she says. “Those people could be forced to change plans multiple times a year.”

Rosenbaum says enrolling Medicaid beneficiaries in plans in the exchange instead could protect as many as 28 million people a year from churning if their income does get too high.

“Your plan will stay your plan, your doctors will stay your doctors,” she said. Basically the “bank of Medicaid” and the “bank of the exchange” will have a conversation with each other about who pays the bills. And your premium may be a little bit different and your co-pays may be a little bit different, but your healthcare won’t be interrupted.”

And it’s not just those on Medicaid who could benefit.

Many of the new Medicaid enrollees will be relatively healthy, relatively young people with relatively low insurance costs. They could help bring premiums down for those in the exchanges who are older and sicker.

“It’s the woman who’s 32 working at Wal-Mart with a couple of kids who we really need in the exchange,” Rosenbaum says. “And so if we buy her in and keep her in, it’s going to be that much better off for the 55-year-old woman who is sick and unable to work and needs coverage through the exchange because of a lot of health conditions. ”

Still, one of the fundamental appeals of putting new Medicaid enrollees in private plans remains political.

“I think in states where the resistance to the Medicaid expansion was based primarily on ‘This is a big government program that we can’t make any bigger,’ finding a way to do the expansion through private coverage will open a door to a conversation that was otherwise not taking place,” said Alan Weil of the� National Academy for State Health Policy.

What remains a key issue for many states, however, is that the federal government hasn’t yet said exactly how much states can spend on the private plans — only that what they spend to enroll Medicaid beneficiaries in the plans should be “comparable” to what they would have spent otherwise.

Health and Human Services Secretary Kathleen Sebelius says officials will spell out more details on that issue “in the very near future.”

Senate Narrowly Passes Budget Proposal For Fiscal Year 2014

English: President Barack Obama, Vice President Joe Biden, and senior staff, react in the Roosevelt Room of the White House, as the House passes the health care reform bill. (Photo credit: Wikipedia)

Topics: Health Costs, Medicare, Medicaid, Politics, Health Reform

Mar 25, 2013

The next step will come when President Barack Obama releases his budget, although that is not likely to offer details about changes in Medicare and other entitlement programs that the president might be willing to support.The Wall Street Journal: Congress Set To Alter Focus After Passing Two Budgets
After the Senate passed its budget this weekend, Congress is expected to pivot to issues such as immigration and guns before attempting a broader deal on taxes, spending and the national debt later this year. … Mr. Obama has indicated a willingness to support bigger changes in Medicare and other entitlement programs than the Democratic budget called for, but only as part of broader deficit-reduction deal with Republicans that includes tax increases. The president isn’t likely to detail such entitlement cuts as part of his formal budget request (Hook, 3/24).

The Associated Press: Analysis: Balance Is In The Eye Of The Congressional Beholder When It Comes To Budgets
Well before then, on April 8 in fact, Obama will present a budget of his own. It is long overdue, to the disappointment of Republicans who had hoped to make it an object of ridicule in the just-completed budget debates in the House and Senate. It gives Obama the chance to align himself entirely with his Democratic allies, or possibly to edge away when it comes to government benefit programs that have largely escaped cuts in earlier compromises. Republicans will watch to see what steps, if any, the White House is willing to recommend to slow the growth of Medicare or perhaps Social Security. Given Obama’s recent series of meetings with Republicans, some GOP lawmakers say privately it would be a positive sign for him to include a proposal curtailing the rise in cost of living increases in benefit programs (Espo, 3/25).

News outlets also reported on the scores of amendments the Senate considered as part of its budget debate, including those that sought to de-fund elements of the health law and repeal the medical device tax.

Los Angeles Times: Senate Narrowly Approves Democratic Budget
More than 600 amendments were filed on the bill, from the lofty to the parochial. They included proposals to de-fund new healthcare laws, to restrict potential surveillance by domestic drone aircraft, and to prevent a Western bird called the sage grouse from being listed as an endangered species. Like some members of the Senate, it is known for its strutting displays. … Senators dispatched with several key amendments. They tossed aside the House GOP budget drafted by Rep. Paul D. Ryan of Wisconsin, which calls for deep cuts to the social safety net, including Medicare, and in an effort to achieve balance in 10 years. Five GOP senators defected on their party’s defining document (Mascaro, 3/23).

Politico: An Obamacare Rerun: Senators Target Health Law In ‘Vote-A-Rama’
Proving that the Obamacare wars are far from over, the health reform law was one of the favorite targets of amendments during Friday night’s “vote-a-rama” on the Senate floor. Dozens of amendments were filed to the budget resolution picking apart various elements of health care policy: whether employers should provide contraceptives in their insurance policies, whether a tax should be imposed on medical device-makers, whether Medicare can adjust payments based on the state (Haberkorn, 3/23).

Politico: Democrats Join Push To Dump Obamacare Tax
Thirty-four Senate Democrats joined Republicans on Thursday night in a nonbinding but overwhelming vote to repeal a key tax in President Barack Obama’s health reform law. The Senate voted 79-20 to get rid of the law’s 2.3 percent sales tax on medical device-makers (Haberkorn, 3/22).

The Wall Street Journal: Medical-Device Tax Repeal Faces Uphill Climb In Senate
The push to repeal the 2010 federal health-care law’s tax on medical devices got a boost in the Senate this week, but the search to replace the nearly $30 billion the levy provided to fund other parts of the law will impede efforts to unwind it. Intense lobbying from the medical-device industry helped nudge the Senate to vote 79-20 Thursday night to repeal the 2.3% tax on sales of pacemakers, surgical tools and a swath of other devices. Strikingly, 34 lawmakers who caucus with the Democrats signed onto the repeal, including many who created the tax by voting for the 2010 Affordable Care Act (Peterson and Weaver, 3/22).

The Hill: Senate Rejects Ban On Allowing Former Illegal Immigrants Healthcare Benefits
The Senate rejected an amendment to the budget that would have banned illegal immigrants from qualifying for “ObamaCare” and Medicaid during the period of legal status. Senate Budget Committee ranking member Jeff Session (R-Ala.) introduced the amendment, which failed on a 43-56 vote. His amendment would have prohibited illegal immigrants, who later gain citizenship, from getting healthcare coverage under the Affordable Care Act or through Medicaid (Cox, 3/23).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Party Lines On Entitlement Programs Play Role In ‘Fiscal Cliff’ Negotiations

Topics: Health Costs, Medicare, Medicaid, Politics

Nov 28, 2012

Congressional leaders signal they are making progress in “fiscal cliff” talks. Rep. Tom Cole, R-Okla., urged his party to back an immediate extension of Bush-era tax cuts for households earning less than $250,000 and focus on tax breaks for higher-income people later. Meanwhile, Sen. Dick Durbin, D-Ill, said that Medicare and other federal health care programs should be part of long-term solutions, but not a short-term deal.

The New York Times: House Republican Urges Party To Yield On Tax Cuts For Most Earners
Democrats said they would not accept cuts to Medicare or Medicaid as part of the upfront “down payment” on deficit reduction that would be passed next month along with a broader framework on tax and entitlement changes to be worked over in 2013. In a speech at the liberal Center for American Progress, Mr. Durbin still expressed confidence that beneath all the public posturing, the White House and Speaker John A. Boehner, Republican of Ohio, were making progress toward averting the so-called fiscal cliff. … Mr. Durbin said that Medicare should not be tapped for that upfront down payment but that federal health care programs should be part of next year’s deliberations. And he opened the door for money-saving adjustments to Mr. Obama’s signature health care law (Weisman, 11/27).

Los Angeles Times: Senate’s No.2 Democrat Calls For Cuts To Social Safety Net
A top Democrat pressured fellow progressives Tuesday to consider long-term changes to the social safety net, even as the party digs in for a fight to save Medicare and other government programs from deep budget cuts. As closed-door talks continue with the hope of a year-end deal, President Obama will travel to a Pennsylvania toy store this week to pressure Congress to extend the expiring tax cuts for the middle class, while letting those for the wealthiest 2% of Americans expire (Mascaro and Parsons, 11/27).

USA Today: Durbin Outlines Liberal Plan To Avert ‘Fiscal Cliff’
Sen. Richard Durbin, D-Ill., is optimistic President Obama and congressional leaders will reach a deal to avert the “fiscal cliff” of tax hikes and spending cuts at the end of the year only if Republicans relent on their opposition to raising individual tax rates on the wealthy (Page, 11/27).

Bloomberg: Durbin Says Deficit-Reduction Talks Can Include Medicare
Deficit-reduction talks can include savings from Medicare without raising the eligibility age or turning it into a voucher program, said Richard Durbin, the Senate’s second-ranking Democrat. Still, proposals to address the long-term solvency of Medicare and Social Security shouldn’t be part of the current short-term negotiations to avert the year-end fiscal cliff, Durbin said in remarks prepared for his speech today in Washington. Though he didn’t deliver that portion of his prepared speech, he told reporters he stood by the full text (Rubin, 11/27).

Reuters: Senior Democrat Durbin Urges Talks On Medicare
Dick Durbin, a senior Senate Democrat and close ally of President Barack Obama, urged fellow liberals on Tuesday to consider reforming Medicare and Medicaid, the U.S. healthcare programs they have long fought to shield from spending cuts. The timing of his message – just as Democrats and Republicans struggling to avoid the “fiscal cliff,” looming early next year – and its prominence may signal that Democratic leaders and the White House will discuss social programs at the fiscal policy negotiating table (Dixon and Ferraro and Morgan, 11/27).

The Wall Street Journal: Democrats Harden Budget Positions
The White House and congressional Democrats hardened their budget positions on Tuesday and signaled they are prepared for partisan jockeying before any agreement to block impending spending cuts and tax increases can be reached with Republicans. Sen. Dick Durbin (D., Ill.), a rare liberal who has supported changes in Medicare and other entitlements as part of a broad budget deal, made clear he wouldn’t back them under a short-term agreement to avoid the fiscal cliff (Hook and Lee, 11/27).

The Associated Press/Washington Post: Senate Democrats Divided Over Cuts To Benefit Programs, Raising Roadblock To Any Fiscal Deal
Deep divisions among Senate Democrats over whether cuts to popular benefit programs like Medicare and Medicaid should be part of a plan to slow the government’s mushrooming debt pose a big obstacle to a deal for avoiding a potentially economy-crushing “fiscal cliff,” even if Republicans agree to raise taxes (11/28).

Politico: Democrats Talk Tough On Entitlements In Fiscal Cliff Debate
Congressional Democrats are starting to draw a much tougher line on entitlements in the increasingly messy fiscal cliff talks, warning Republicans to keep their hands off Social Security and Medicare benefits. Democrats also say they’ll refuse to look at GOP calls to dramatically slash Medicaid. And for them to even entertain any changes to Medicare and Medicaid, they say the price is for Republicans to agree to far higher taxes than they have flirted with so far (Raju, 11/27).

Los Angeles Times: Reid, McConnell Clash On ‘Fiscal Cliff,’ Filibuster Rules
Asked about Sen. Richard Durbin’s (D-Ill.) comments earlier in the day calling for major entitlement programs to remain open to negotiations, Reid partially agreed with his colleague. … Despite his complaints about Republican stonewalling, Reid said that he’s still optimistic that a deal can be reached before the end of the year, when automatic federal tax hikes and spending cuts would kick in (Little, 11/27).

CQ HealthBeat: Labor Lobbies Hill On Entitlements, Bush Tax Cuts
AFL-CIO leaders orchestrated a “lobby fly-in day” Tuesday on Capitol Hill, with local labor leaders and their advocates from 33 states visiting lawmakers to urge them to refuse benefit cuts to Medicare, Medicaid and Social Security and to let the 2001 and 2003 tax cuts expire for the top 2 percent of American earners. The effort coincided with a report the AFL-CIO issued that lists the number of people per state who currently get their health coverage through Medicaid. The report also highlights the amount of money Medicare, Medicaid and Social Security pump into each state’s economy and the economic costs to individuals if the Medicare eligibility age were increased (11/27).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

U.S. Senator Richard Durbin, of Illinois. (Photo credit: Wikipedia)

What The Health Law’s Future Holds

English: President Barack Obama, Vice President Joe Biden, and senior staff, react in the Roosevelt Room of the White House, as the House passes the health care reform bill. (Photo credit: Wikipedia)

Topics: Health Costs, Politics, Health Reform

Nov 19, 2012

Even with the election in the rear view mirror, efforts to implement the health care law will continue to face challenges. Meanwhile, experts discuss what steps must be taken to control health care costs and to educate the public about the health overhaul.

The Hill: Five ‘ObamaCare‘ Battles To Watch
Republicans aren’t going to repeal “ObamaCare” in the next four years, but there’s still plenty of room for both political fights and policy changes. Republicans have begun over the past two weeks to acknowledge — albeit grudgingly — that President Obama’s reelection took repeal off the table for the next four years. Conservatives have responded by stepping up the pressure on Republican governors to stand in the law’s way as much as possible at the state level, and governors do have considerable power over how the law is implemented. In Washington, deflated partisan rancor over the Affordable Care Act could be a blessing to industry groups with smaller, more targeted complaints about the law. Republican lawmakers and healthcare lobbyists say smaller fixes are more realistic if every minor issue doesn’t blow up into a full-scale war over ObamaCare, and the appetite for that war is finally starting to wane (Baker, 11/18).

The Wall Street Journal: Remaking Health Care: Change The Way Providers Are Paid
In the debate over the nation’s finances, health care is one of the biggest items on the agenda. How do we bring down soaring costs as more people get coverage and more baby boomers head into retirement? The Wall Street Journal’s Laura Landro moderated the task-force discussion on remaking health care (Landro, 11/19).

Politico: McClellan: Public Needs Education On Obamacare
Mark McClellan, who helped implement the Medicare prescription drug benefit for President George W. Bush, says the two parties should separate their political battles over Obamacare from the need for broad public education about how the law will affect ordinary people. Now at The Brookings Institution, McClellan was the Centers for Medicare & Medicaid Services administrator when the largely GOP-designed drug benefit was rolled out from 2003 to 2006. He says the two parties had very strong differences over the prescription drug law but were able to have two parallel tracks — one fighting about the policy and one helping to explain what it would mean to a constituent (Kenen, 11/19).

Dr. Mark B. McClellan http://www.fda.gov/oc/commissioners/mcclellan.html (Photo credit: Wikipedia)

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Even As Leaders Appear ‘Upbeat’ After ‘Fiscal Cliff’ Meeting, Taxes, Benefit Programs Remain Flashpoints

Topics: Health Costs, Medicare, Medicaid, Politics

Nov 19, 2012

President Barack Obama and House Speaker John Boehner, R-Ohio, appeared optimistic about a deal to avert automatic spending cuts and tax increases, but major issues must be tackled.

The Associated Press/Washington Post: Taxes, Benefit Programs Key Flashpoints In ‘Fiscal Cliff’ Negotiations
There are numerous hurdles, big and small, in front of President Barack Obama and lawmakers on Capitol Hill as they seek a budget and tax agreement to avoid economy-rattling tax increases and automatic spending cuts known as the “fiscal cliff” (11/19).

Los Angeles Times: Obama And Boehner Upbeat After ‘Fiscal Cliff’ Meeting
The outline of a compromise over impending tax hikes and spending cuts began to come into focus Friday after President Obama convened top congressional leaders at the White House. The first part of such a deal would be legislation this year that would commit Congress to specific revenue increases, favored by Democrats, and spending cuts, as advocated by Republicans. How those increases and cuts would be achieved would be worked out in the second stage next year by the new Congress (Mascaro, 11/16).

The New York Times: Back On Hill, Ryan Remains A Fiscal Force
Speaker John A. Boehner has tapped Mr. Ryan, who has returned to his post as the House Budget Committee chairman after an unsuccessful run for vice president, to help strike a deal to avoid big tax increases and spending cuts by the end of the year, and to bring along fellow Republicans. … The test will be whether Mr. Ryan … can make the transition from House budget philosopher to governing heavyweight who can help negotiate a bipartisan deal and sell it to his colleagues. While President Obama and the Democrats are expected to give ground on entitlements and discretionary spending, it is likely that Mr. Ryan will be the player under the most pressure to back away from his previous conservative positions in order to form a bipartisan agreement (Steinhauer, 11/18).

NPR: In Fiscal Cliff Talks, Higher Taxes Vs. Closing Loopholes
The White House and Congress continue to work on a deal that avoids the fiscal cliff and cuts deficits in the long run. One of the biggest hurdles is President Obama’s proposal to raise tax rates for the wealthy (Ydstie, 11/19).

The Wall Street Journal: What A Deal Might Look Like
North Dakota Democrat Kent Conrad, retiring chairman of the Senate Budget Committee, spoke with The Wall Street Journal’s John Bussey about why he’s hopeful, and what he thinks a deal could look like (Bussey, 11/19).

The Associated Press: Democrats Toughen Stance On Trimming Benefits
President Barack Obama’s re-election has stiffened Democrats’ spine against cutting popular benefit programs such as Medicare and Social Security. Their new resolve could become as big a hurdle to a deal that would skirt crippling tax increases and spending cuts in January as Republicans’ resistance to raising tax rates on the wealthy (Taylor, 11/17).

Meanwhile, news outlets offer advice for retirees about how to “survive the fiscal cliff,” and warnings about how the automatic cuts could affect the health care system, including the health law’s implementation –

The Fiscal Times: 4 Ways Retirees Can Survive The Fiscal Cliff
The past few years haven’t been great for those who have just retired or are nearing their golden years. And unfortunately with the fiscal cliff on the horizon — more than $600 billion in spending cuts and tax increases coming January 2 — things could get a lot worse. Lawyer and certified public accountant Leon LaBrecque predicts in a Bankrate analysis that retirees could face a 17 percent increase in their 2013 federal income taxes, in addition to increases in state, local and property taxes. And if the nation slips into another recession, they’ll see a significant dent in their portfolios. … As part of the spending cuts mandated by Congress last year, Medicare Part D would get a 2 percent cut, which could increase out-of-pocket costs for Medicare recipients. Physicians who take Medicare patients could also see a pay cut, which might prompt more to stop accepting Medicare (Johnson, 11/18).

CQ HealthBeat: Experts See Trouble For Health Care In The Fiscal Cliff And Beyond
Budget and health policy experts Friday painted a grim picture of the implications for health care should automatic scheduled cuts go into effect at the end of the year, including an 8.2 percent slash in administrative costs for the Department of Health and Human Services as it struggles to establish insurance exchanges. Members of the Alliance for Health Reform discussion panel also were skeptical, for the most part, that Congress and the White House will allow the cuts and tax increases that would prevent the fiscal cliff to take effect. They said they expect some kind of temporary solution followed by talks and legislative action through 2013 on long-term solutions that would have to involve health care costs. However, fiscal expert Stan Collender said he’s heard increasingly in recent days from both Democrats and Republicans who think the fiscal cliff should go into effect — even if just for a few days — so that those who are affected will become angry and lawmakers will be forced into a decision (Norman, 11/16).

President Barack Obama with Senate Budget Committee Chairman Kent Conrad (left) and House Budget Committee Chairman John Spratt. (Photo credit: Wikipedia)

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

States Detail Questions About Their Exchange Options

Official portrait of United States Health and Human Services Secretary . (Photo credit: Wikipedia)

Governor of New Jersey at a town hall in Hillsborough, NJ 3/2/11 (Photo credit: Wikipedia)

By Ankita Rao

November 19th, 2012, 3:03 PM

Iowa Gov. Terry Branstad said Friday that he will build a health exchange in his state – as soon as the Obama administration can explain exactly what that means. The Republican governor submitted 50 questions to Health and Human Services Secretary Kathleen Sebelius about how the state-built online insurance markets are supposed to be set up.

“As a former governor, I trust you know the challenges states face when trying to navigate the murky waters of implementing a federal mandate without clear guidance,” he wrote in a Nov. 16 letter  intended to meet a now-extended deadline for states to decide whether to build their own insurance markets. “We continue to struggle with too many unanswered questions on topics critically important to the final development of an exchange that meets the needs of Iowans, including the cost of building and operating an exchange.”

Branstad and New Jersey Gov. Chris Christie, also a Republican, are more public than some other state leaders in their criticism of  the health law, but they are not the only ones demanding answers on how the exchanges must be set up. A National Association of Insurance Commissioners committee is compiling a working document of state queries about exchange regulations, which had 40 questions as of Monday afternoon. The nonpartisan group said it will also post answers as the questions are answered by the administration.

Exchanges are websites where individuals and small businesses will be able to shop for coverage and find out if they are eligible for federal subsidies or Medicaid beginning in 2014. Under the law, the federal government must set them up in states that don’t build them.  As of Friday, 18 states and the District of Columbia had indicated they planned to go ahead with state-based markets.

States have until mid-December to inform federal regulators if they will build their own markets and until mid-February to say if they want to partner with the federal government.

Viewpoints: Voters Voice Abortion Positions; Obama’s ‘Tough Road Ahead’ On Health Reforms; Mass. Paves The Way On Cost Control?

Topics: Health Reform, Politics, Marketplace, Insurance, Women’s Health, Supreme Court, Health Costs

Nov 09, 2012

The New York Times: Voters Speak on Abortion Rights
On Election Day, Florida voters wisely rejected a proposed amendment to the State Constitution that would prohibit abortion coverage as part of health plans for state workers and Medicaid recipients (such coverage is already severely limited by law). … The measure received only 45 percent of the vote — far short of the 60 percent required for a constitutional change. The defeat should send a strong message to politicians in Florida and elsewhere who might want to broadly attack women’s reproductive rights (11/8).

Los Angeles Times: The Tough Road Ahead
[Obama] earned reelection by keeping the country from falling into a depression and persuading Congress to enact vital reforms to healthcare and the financial industry. … As hard fought as the campaign was, the task of governing this divided country will be even more difficult. … The longer-term problem for the president will be coping with the dueling pressures of an economy that’s growing too slowly and a federal debt that’s growing too fast, largely because of the rising cost of Medicare and Medicaid (11/8).

Minnesota Star Tribune: Health Care Shopping
Teamwork still will be needed to build a Minnesota health exchange, even though the DFL now has the legislative votes and the governor’s signature to unilaterally make the new online health insurance shopping site a reality. … The new DFL leadership can create the sorely needed buy-in by inviting the business community and Republicans back to the table. The main mission for Minnesota’s exchange: getting consumers to use it. Gathering good ideas and forging a consensus among stakeholders will create the foundation to make that happen (11/8).

The Lund Report: A New Way Of Shopping For Health Insurance Gets A Trial Run
Earlier this week, I took part in a trial run of the user interface system for the website of the Oregon health insurance exchange — now called Cover Oregon. Cover Oregon is a lot of things: a new marketplace for health insurance, a means to leverage the buying power of hundreds of thousands of Oregonians to drive a hard bargain with the insurance industry, and a new way to spark competition between insurers, to the benefit of consumers. But it’s also a website, and like all big IT projects, it faces some real challenge (Jesse Ellis O’Brien, 11/8).

WBUR’s Cognoscenti: Advice To The Next President: Health Care Cost Containment
As anyone following the 2012 election knows, Massachusetts has served as a model for the expansion of health care coverage nationally. … Now, Massachusetts could become the standard bearer for how to get costs under control. In August of this year, state lawmakers passed landmark legislation aimed at containing rising health care costs. In a discussion held just days before Tuesday’s election, four veteran observers of and participants in Massachusetts’ ongoing efforts to provide universal health care access at affordable prices … offered their advice to the next president (David Seltz, James Roosevelt, Regina Herzlinger, and Stephen D’Amato, 11/8).

Minnesota Post: Time For Minnesota To Move Forward On Health Care Reform
Thursday, the Access Work Group of the Minnesota Health Care Reform Task Force will vote on whether to recommend that the state cover nearly all non-elderly individuals with incomes up to 138 percent of the federal poverty line through Medicaid … A “yes” vote from the Work Group will keep Minnesota moving forward on improving access to affordable health insurance. If Minnesota fails to expand Medicaid, it will not only increase costs for the state, for people with private insurance and for health care providers, it will also leave tens of thousands of Minnesotans struggling to get the health care they need (Christina Wessel, 11/8) .

Bill Clinton made health care reform one of the highest priorities of his administration. He asked the First Lady to chair the Task Force on National Health Care Reform. (Photo credit: Wikipedia)

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Will Sebelius Stay At HHS?

Topics: Politics, Health Reform

Nov 09, 2012

CQ HealthBeat says there is little talk of her moving on but even so, four years is a long tenure in the job.CQ HealthBeat: Health Team May Stay Steady In Key Phase Of Overhaul Implementation
There’s little or no talk thus far that Health and Human Services Secretary Kathleen Sebelius is on her way out, particularly with the possibility that her legacy would be burnished by seeing through the job of implementing the health law if she does stay. But four years as HHS secretary is a long time. Staying through a second term would be highly unusual. “Only one HHS secretary has stayed on that long, and the job was much easier then,” said a former administration official, referring to the tenure of Donna Shalala as head of HHS during the eight years of the Clinton administration. “As for Sebelius, it’s hard to say,” the former official adds. “She’s got a helluva lot of energy and wants to see things through, so I expect she’ll stay for at least part of a second term” (Reichard, 11/8).

Meanwhile, some of President Barack Obama’s political advisers say the health law played a role in his re-election.

The New York Times: Don’t Credit Us, Obama’s Tacticians Say
But less than 48 hours after Mr. Obama clinched re-election, his aides were becoming wary that the first draft of history on the campaign was turning into a story about how smart campaign tactics had delivered victory to an embattled president rather than one about how it was all due to the president himself and his policies. … Jim Messina, the campaign manager who oversaw the creation of the system that surprised Republicans by getting more Obama supporters to the polls than Republicans had expected, argued that the results should be viewed as vindication for the president’s call for higher taxes on the rich as part of any deal to reduce the deficit. And Mr. Obama’s aides noted that exit polls showed that only a minority want to see the president’s health care plan entirely repealed (Rutenberg, 11/8).

English: Kathleen Sebelius speaking after her official nomination as Secretary of Health and Human Services. President Barack Obama is standing behind Sebelius (Photo credit: Wikipedia)

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.