March 2010 Archives

BusinessWeek reports that the Medicare payment cut scheduled for April 1 has been put on hold for a couple of weeks:

Doctors slated to have their Medicare reimbursements cut 21 percent on April 1 got a reprieve from the Centers for Medicare and Medicaid Services, which is delaying lowered payments until after Congress reconvenes.

The agency, which administers the U.S. health program for people 65 years and older and the disabled, has ordered that claims submitted on or after April 1 be held for an added 10 days before being paid, said spokesman Peter Ashkenaz. That's on top of the 14 days the Baltimore-based CMS usually holds claims.

The decision delays scheduled reductions in Medicare payments until after Congress reconvenes April 12. Lawmakers have put off those cuts every year, except one, since they were introduced as part of the Balanced Budget Act in 1997. The American Medical Association says the reductions will make doctors less willing to accept Medicare patients and is pushing lawmakers to increase payments.

For the whole article, click here:  Doctors Get Reprieve From 21% Medicare Payment Cut; BusinessWeek - March 29, 2010

In the April 5 edition of The New Yorker, Dr. Atul Gawande, using the passage of Medicare as a model, discusses some of the hurdles that still  face the health care reform package that just gained final approval from both Congress and President Obama last week:

On July 30, 1965, President Lyndon Johnson signed Medicare into law. In public memory, what ensued was the smooth establishment of a popular program, but in fact Medicare faced a year of nearly crippling rearguard attacks. The American Medical Association had waged war to try to stop the program, and doctors weren't about to abandon the fight against "socialized medicine" simply because it had passed into law. The Ohio Medical Association, with ten thousand physician members, declared that it would boycott Medicare, and a nationwide movement began. Race proved an even more explosive issue. Many hospitals, especially in the South, were segregated, and the law required them to integrate in order to receive Medicare dollars. Alabama's Governor George Wallace was among those who encouraged resistance; just two months before coverage was to begin, half the hospitals in a dozen Southern states had still refused to meet Medicare certification.

Either boycott could have destroyed the program. Hundreds of thousands of elderly and black patients would have found their hospitals and doctors' offices closed to them. But, as David Blumenthal and James A. Morone recount in "The Heart of Power," their riveting history of health-care politics, Johnson recognized the threat and outmaneuvered his opponents. With the doctors, he cajoled and compromised, giving the A.M.A. a seat on an advisory council that oversaw the rules and regulations, and working with it on a series of thirty "improving" amendments to the legislation. With hospitals, however, the President brooked no compromise. He convened a battle council of top advisers; set Vice-President Hubert Humphrey phoning mayors to pressure resistant hospitals; and deployed hundreds of inspectors to make sure that participating hospitals integrated their wards. There was fury and acrimony. In the final weeks before Medicare's start, though, the hospitals decided to abandon segregation rather than lose federal dollars. Only then was Medicare possible.

Erza Klein writes in Sunday's Washington Post that the historic passage of health care reform last week is just the first piece of the puzzle and that how the legislation is implemented will have a big effect on how big of a change is in store:

As someone who has spent the past year tangled in the minutia of excise taxes and curve bending and subsidy levels, it is good to finally say this: With the passage of the reconciliation fixes, the health-care reform debate is finally over. But if you're thrilled to hear that, then I also have some bad news: Health-care reform itself is just beginning.

This bill marks an evolution, not a revolution, for our health-care system. Whether it proves the cornerstone of a better, fairer, more affordable system or simply another expansion of the federal welfare state has as much to do with what happens when the law is implemented as with what's written in the legislation.

The system will not change in a year. Even by 2014, when it is broadly implemented, life will not change for most people. This is not single-payer (though you wouldn't know it listening to the GOP) or the ambitious Wyden-Bennett reforms. Come 2019, about 10 percent of Americans will have a different insurance arrangement than they would have had without the bill. Most of us won't notice any difference.

Late this evening, the House voted 219 to 212 to pass the health care reconciliation bill.  No Republicans voted for the bill and 34 Democrats also voted no.   From NPR News:

Capping a year of legislative activity and ending decades of Democratic frustration, the House on Sunday passed a bill designed to provide widespread health coverage to Americans.

"We have come to a defining moment in our nation's history," said James Clyburn (D-SC), the House Democratic whip. "This is the civil rights act of the 21st century."

As the GOP promised, not a single Republican voted for the measure. "This is truly a remarkable moment in the life of this nation. Some say we're making history. I say we're breaking history, breaking with our best traditions," said Mike Pence (R-IN), who chairs the House GOP Conference. "Only in Washington, D.C, can you spend a trillion dollars and say that you're saving the taxpayers money."

The AMA has announced its qualified support of passage of health system reform legislation that the U.S. House of Representatives that on Sunday, March 21, is expected to go up for a vote. From the AMA letter of support to Speaker of the House Nancy Pelosi:

By extending coverage to the vast majority of the uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, we believe that H.R. 3590 does, in fact, improve the ability of patients and their physicians to achieve better health outcomes.

As the House debate on the health bill heads into late evening, the rhetoric is just as divided along partisan lines as the final vote will be.

Democrats appear confident that they will have the 216 votes needed to pass a pair of bills designed to provide near-universal health insurance coverage. Republicans, who are unanimous in their opposition, have described the bills as "a disgrace."

The quest for widespread health care coverage has gone on for a century. Democrats are highly aware that they are about to prevail on a historic vote, making references to past landmark legislation such as Social Security and figures such as Martin Luther King Jr.

In good news for Democrats, the nonpartisan Congressional Budget Office has released its analysis of the compromise health care bill.  The Democratic health care bill would cost $940 billion over 10 years but would also cut the federal deficit over the next two decades -- figures that should help ease the worries of fiscal hawks who have been reluctant about supporting the sweeping measure.

The bill would reduce the deficit by $138 billion in the first 10 years and by $1.2 trillion over the second 10 years, while expanding health coverage to 95% of Americans. 

Congressional Budget Office releases health bill estimates -Politico, March 19, 2010. 

For the  CBO report, click here. 

House leaders announced a $940 billion compromise bill that would extend coverage to the vast majority of Americans, cut billions of dollars from Medicare, and impose new taxes on the wealthy and the well-insured.  From The Washington Post:

The compromise would extend coverage to an additional 32 million Americans over the next decade by expanding Medicaid eligibility and creating state-run insurance exchanges and federal subsidies for lower-income families who lack access to employer-provided coverage.

All Americans would be required for the first time to obtain insurance or face an annual penalty of $695; employers could face penalties of $2,000 per worker for not offering affordable coverage. In exchange for the new business, private insurers would be subject to an array of rules, including a ban on the practice of denying coverage to people with preexisting medical conditions and a requirement that adult children be permitted to stay on their parents' policies until age 26.

Compared with the Senate bill, the compromise would offer more generous tax credits to people who may otherwise be unable to afford insurance and would fully close the "doughnut hole" -- a gap in the Medicare prescription drug program that is costly for many seniors -- beginning with a $250 rebate for those affected this year.

For the full story click here: House Leaders Announce $940 Billion Health Care Compromise Bill; The Washington Post - March 19, 2010

Related Coverage:

Fine-Tuning Led to Health Bill's $940 Billion Price Tag - The New York Times--March 19, 2010

Democrats Say Health Bill Will Pay for Itself in the Long Run; The New York Times - March 19, 2010