The President's Speech

The following comes from a White House fact sheet, as republished by Kaiser Health News:

DETAILS OF THE PRESIDENT’S FRAMEWORK FOR SHARED PROSPERITY AND SHARED FISCAL RESPONSIBILITY

4. Health Care

• Medicare and Medicaid Savings of $480 Billion by 2023 and At Least an Additional $1 Trillion over the Subsequent Decade, Providing Better Care at Lower Costs:


• Building on the Affordable Care Act, the President is proposing additional reforms to Medicare and Medicaid designed to strengthen these critical programs by reducing waste, increasing accountability, promoting efficiency, and improving the quality of care, without shifting the cost of care to our seniors or people with disabilities.


• The framework will save $340 billion over ten years and $480 billion by 2023 (including the proposals already included in the President’s Budget). This framework includes the same aggregate savings that House Budget Committee Chairman Paul Ryan proposed in his November 2010 plan with Alice Rivlin and an amount sufficient to fully pay to reform the Medicare Sustainable Growth Rate (SGR) physician payment formula while still reducing the deficit.


• Over the subsequent decade, the President’s proposal will save well over $1 trillion by further bending the cost curve, doubling the savings from the Affordable Care Act.


• The President’s framework offers a stark contrast with the House Republican plan that would increase seniors’ health costs by $6,400 annually starting in 2022, raise health insurance premiums for middle-class Americans and small businesses, cut Federal Medicaid spending by one-third by the end of the decade, and increase the number of uninsured by 50 million.


• The President’s framework proposes specific reforms to strengthen Medicare and Medicaid over the long term, including:


• Addressing the long-term drivers of Medicare cost growth: The President’s framework would strengthen the Independent Payment Advisory Board (IPAB) created by the Affordable Care Act. The IPAB has been highlighted by economists and health policy experts as a critical contributor to Medicare’s solvency and sound operations. Under the Affordable Care Act, IPAB analyzes the drivers of excessive and unnecessary Medicare cost growth. When Medicare growth per beneficiary exceeds growth in nominal GDP per capita plus 1 percent, IPAB recommends to Congress policies to reduce the rate of growth to meet that target, while not harming beneficiaries’ access to needed services. Congress must consider IPAB’s recommendations or, if it disagrees, enact policies that achieve equivalent savings. If neither acts, then the Secretary of Health and Human Services would have to develop and implement a proposal to achieve the savings target.

The President’s framework will strengthen IPAB to act as a backstop to the other Medicare reforms by ensuring that Medicare spending growth does not outpace our ability to pay for it over the long run, while improving the program and keeping Medicare beneficiaries’ premium growth under control. Specifically, it would:

• Set a new target of Medicare growth per beneficiary growing with GDP per capita plus 0.5 percent. This is consistent both with the reductions in projected Medicare spending since the Affordable Care Act was passed and the additional reforms the President is proposing.


• Give IPAB additional tools to improve the quality of care while reducing costs, including allowing it to promote value-based benefit designs that promote proven services like prevention without shifting costs to seniors.


• Give IPAB additional enforcement mechanisms such as an automatic sequester as a backstop for IPAB, Congress, and the Secretary of Health and Human Services.


• Reforming the Federal-State partnerships to strengthen Medicaid and promote simplicity, efficiency, and accountability: Under current law, States face a patchwork of different Federal payment contributions for Medicaid and the Children’s Health Insurance Program (CHIP). The President’s framework would replace the current complicated Federal matching formulas with a single matching rate for all program spending that rewards States for efficiency and automatically increases if a recession forces enrollment and State costs to rise.


• In addition, the President has called on the National Governors Association (NGA) to make recommendations for ways to reform and strengthen Medicaid, and the framework will consider the ideas that its Task Force produces. The President also supports reform of Medicaid to incentivize more efficient, higher quality, care for high-cost beneficiaries, including those who are eligible for both Medicaid and Medicare. These nine million beneficiaries comprise 15 percent of Medicaid enrollment but consume nearly 40 percent of total Medicaid spending.


• Improving patient safety: Together with employers, States, hospitals, physicians and nurses, the Administration has launched a new public-private partnership called Partnership for Patients that will help improve the quality, safety and affordability of health care for all Americans. The two goals of this new Partnership are: preventing patients from getting injured or sicker while they are in the hospital and helping patients heal without complication. Achieving the initiative’s goal would mean more than 1.6 million patients will recover from illness without a preventable complication, reducing costs by up to $50 billion in Medicare and billions more in Medicaid over the next 10 years.


• Cutting unnecessary prescription drug spending: The framework would limit excessive payments for prescription drugs by leveraging Medicare’s purchasing power – similar to what was called for by the bipartisan Fiscal Commission. It would speed up the availability of generic biologics, and prohibit brand-name companies from entering into “pay for delay” agreements with generic companies. And, it would implement Medicaid management of high prescribers and users of prescription drugs.


• Reducing abuse and increasing accountability in Medicaid and Medicare: The framework would clamp down on States’ use of provider taxes to lower their own spending while not providing additional health services through Medicaid; recover erroneous payments from Medicare Advantage; establish upper limits on Medicaid payments for durable medical equipment; and take other actions to improve program integrity.


• A major contrast with the House Republican approach. The President’s framework rejects plans that would end Medicare as we know it or transform Medicaid into a dramatically underfunded block grant, putting at serious risk not only seniors but also the most vulnerable children and people with disabilities. Some of the major problems with the House Republican approach include:


• The House Republican plan does nothing to reduce health costs. Instead it actually increases costs by doing nothing to reform the way health care is delivered in addition to putting a larger fraction of the burden on beneficiaries and States.


• In the first year the Republican plan goes into effect, a typical 65-year-old who becomes eligible for Medicare would pay an extra $6,400 for health care, more than doubling what he or she would pay if the plan were not adopted.


• States would get one-third less for Medicaid by 2021, potentially leaving 15 million people without coverage, including seniors in nursing homes, people with disabilities, children and pregnant women.


• The House Republican plan would no longer guarantee the same level of benefits and choices that seniors have today in Medicare, because the proposal allows private health plans to determine benefits, raise cost sharing, and limit choice of doctors and hospitals.

More later. Jennifer

Hump Day Headlines

My body thinks it's a day to stay in bed, but we have interns and stuff to do today, so that's not going to happen. And first, I have to give you the news:

President Obama will give a speech this afternoon in which he will lay out his plan to address the federal debt. The possibilities are many, from raising the age of eligibility to increasing premiums and charging copays. It won't be as drastic as the GOP plan, which would end Medicare and simply provide seniors with a subsidy to purchase private insurance. But I think it signals that we can expect changes to Medicare for those of us who aren't quite old enough to need it yet. The President will also include tax reform in his budget proposal, unlike the GOP, which does nothing to raise taxes. GOP Speaker Boehner says tax increases are a non-starter. It seems only the poor and middle class can be asked to sacrifice under a GOP plan. Meanwhile, the left is pretty unhappy with President Obama right now, claiming that cutting the deficit isn't as important as saving jobs. The Wall St. Journal predicts that both the right and the left will be unhappy with the President's speech today. And the Dems in the House will be offering their own plan for 2012.

Meanwhile, the details of the 2011 budget came out yesterday (see my last post) and the House GOP is having to push some to round up enough votes to pass it. You see, with all those cuts to the poor and middle class, there are some who don't think it cut enough. Here's an agency-by-agency guide to the 2011 budget cuts. The two health reform program cuts are funding to start co-ops and funding to allow people to opt-out of expensive employer-sponsored insurance and get something akin to a voucher to buy more affordable insurance on the Exchanges. The author if the second of these says he will vote against the budget deal.

There's also the fact that we're about to hit the federal debt ceiling -- we would destroy our and other economies if we fail to raise it, but several in Congress say they won't vote to raise it without even more big budget cuts.

How much more will be cut from health care, Medicare, Medicaid, community health centers, and the like, before all of this cutting is over?

Possible Presidential candidate Haley Barbour says people have to pay a greater share of their medical costs. Apparently, he hasn't talked to too many people with chronic illnesses, whose out of pocket costs are already staggering.

In other news, the White House launched an initiative yesterday to reduce hospital errors and acquired infections.

The life of kids with chronic illnesses -- a childhood of limitations, says USA Today.

Chronic illness self-management, starting with arthritis, is being taught to patients -- a great program.

Americans rate their health care highly -- but more so if they have more income. Another publication (The Hill) interprets the results of this study differently, as a negative take on the quality of health care in America.

Emergency rooms provide care of last resort for the mentally ill, who have increasingly difficult time getting care.

And in Connecticut, advocates push for a federal option to expand home care to the elderly and disabled.

A California man who's a quadriplegic is running out of money and would rather die in his home than in a nursing home. This is a very moving story.

Electronic medical records may help with patient safety and patient care, reducing costs.

And that's today's news. Have a great day. Jennifer

Who Are the Losers in the 2011 Budget?

According to Huffington Post, some of the things that are cut are the following:

• $600 million in cuts to community health centers.
• $414 million in cuts to grants for state and local police departments.
• A whopping $1.6 billion cut in the Environmental Protection Agency's budget, of which nearly $1 billion comes from grants for clean water and other projects by local governments and Indian tribes.
• Cuts to homeland security programs for the first time ever, though much of the agency's two percent decrease stems from a $786 million cut in first responder grants to state and local governments.
• A $7 million cut to the Bureau of Public Debt, which accounts for and provides reports on the debt.
• A $1 billion cut to HIV and disease-prevention funds.
• A $3 billion cut to agriculture programs, the biggest portion of which comes from the Women Infants and Children fund, which loses $504 million.
• A $390 million cut to low-income heating assistance; Community Development Funds are cut by $942 million.
• Contributions to the United Nations and other international institutions are cut by $377 million.
• $45 million pulled from nuclear nonproliferation funds.
• A $650 million cut to federal highway investments.
• A rider tucked in by lawmakers from Western states that allows states to remove wolves from the endangered species list.

Community Health Centers, where the poor and uninsured can get care. HIV and disease prevention. Women Infants and Children (WIC) program. Low income heating assistance. State and local police departments. Environmental protection.

Does this make you fiscal conservatives out there happy? Jennifer

Back to the Grind Edition

I guess I have to get back to the usual schedule today, despite the fact that I'm a total zombie. So we'll start with the news:

The parties' plans for Medicare could shape the 2012 elections. The GOP want to transform Medicare into a system that provides vouchers for people to buy health insurance -- except the vouchers won't cover the whole cost, and there will be deductibles and copays, and the size of the vouchers will differ based on income. The CBO says this would shift the cost of health care to taxpayers, greatly increasing their health care expenditures. This plan has been criticized by many -- here's Ezra Klein of WaPo. However, several Republican Governors are following suit, cutting health benefits for the poor while also cutting taxes to the rich. (Does anybody get the irony besides me? They call Obama a socialist for redistributing wealth from rich to poor, but what does that make them for redistributing wealth from the poor to the rich?) President Obama is supposed to lay out a plan that also confronts the growth of Medicare this week, but he will go at it with a scalpel rather than a machete, he says. And the President will propose tax increases for the wealthy, whereas the GOP would cut taxes for the rich and corporations. At least we know the choice between them will be pretty clear. A bipartisan group of six Senators that's been working on a deficit reduction plan are not happy that the President is coming out with a proposal because they're afraid that it will be opposed simply because the President proposed it. Nice way to govern.

And we are starting to get the details of the 2011 budget deal and where exactly those $38.5 billion in cuts are coming from. Regardless, the majority of Americans -- especially Dems -- support the budget deal. President Obama gets a lot of the credit. And some reports stress that the 2011 budget isn't all about cuts.

The House is still going after health reform, now trying to repeal a provision that would fund public health and prevention. Meanwhile, states -- including our home state, Connecticut -- are working on designing and preparing to establish their Exchanges, the marketplaces where insurance will be sold and subsidies will be claimed.

How can consumers make health care decisions without knowing what things cost? Here's one couple's story -- and it's a cautionary tale for all of us.

And this is fascinating -- doctors make medical choices for themselves differently than they make recommendations to the rest of us. They'll choose something riskier but with fewer risks of side effects for themselves, but recommend the opposite for their patients.

Community health centers provide an increasingly important model for primary care delivery as the ranks of the uninsured continue to grow.

Here's a heartwarming tale of a couple, both of whom have cancer, and are fighting it together.

In an effort to improve nutrition, the Chicago schools are prohibiting kids from bringing lunch from home. Hmmm.

Should the government be involved in preventing assisted suicide for the terminally ill?

HIV-infected organs should be available to people with HIV who need transplants, some say.

Advice for joint pain? Get moving. Which reminds me -- I'm due to get back in the swimming pool now that the weather's better.

And that's today's news. Have a great day. Jennifer

Monday Moaning Abbreviated Edition

Well, I touched down in Connecticut at about 2 am and I should still be sleeping, but one woman called at 4 am and a man called at 8:30 am, so I'll have to work on getting back to sleep. In the meantime, I thought I'd give you a quick update.

As you know, we have a budget deal. $38.5 billion in budget cuts, and I'm still not clear on where are the cuts will come. But the cuts are real. Details are still emerging. And it appears that, despite the fact that the cuts are deep, some conservative GOPers will vote against the deal. Speaker Boehner is in the awkward position of needing Dem votes to pass the deal in the House. As for health reform and family planning, part of the deal is that there will be full debate and vote on repeal in the Senate. And a couple of health reform subsidies -- for example, allowing people to opt-out of employer-sponsored insurance and buy insurance on the Exchange with subsidies -- will be cut, as well. Although full repeal won't pass, it will force Dems to go on the record, and that's good enough for the GOP as we head up to the 2012 elections.

And now we're on to the 2012 budget. The President is going to lay out a plan to cut Medicaid and Medicare this week, and also to raise taxes. It will not be as brutal as the GOP plan, who proposed tax cuts for the wealthy and corporations rather than tax increases to raise revenue, but it will disappoint progressives and probably seniors, as well, some of whom are already upset at the concessions made in the 2011 budget deal. Meanwhile, the GOP are getting ready for the next fight -- Speaker Boehner has said the 2011 budget deal is only a first step.

And on that note, I'm going back to bed to try to get a little more sleep. Have a great day. Jennifer

Flight to Mars Day Edition

Of course, I couldn't get on a plane and head to Seattle without first giving you today's news. So here goes.

No deal on the budget yet, but they say they're still talking and making progress. They are about $5 billion apart, so that can be handled. But they are stuck on the policy issues -- gutting the EPA regulatory authority and further tightening restrictions on abortion (how much tighter can they get than no federal funding ever under any circumstances?). Once again, it appears the issue isn't really about money. At least some of the policy issues are deal breakers, though. They issues are environmental regulation, allowing abortions in the District of Columbia with non-federal dollars, and defunding Planned Parenthood, which is a poison pill for Dems. But some Dems say they'd accept a short-term extension like the GOP proposes, but without the policy riders that the GOP attached to their latest proposal. The Wall St. Journal calls it dickering and they blame President Obama, suggesting that he wants a shutdown. But HuffPo blames the GOP for threatening a shut-down over defunding Planned Parenthood. Harry Reid says it's all about GOP culture wars. Sen. Schumer says there will be a shutdown unless the GOP drops the policy riders.

A shut down would have wide implications. Federal workers don't take a shut down lightly at all. Some would like members of Congress to forgo paychecks along with the 800,000 workers who would be furloughed. And both parties could be blamed -- although my opinion is that the blame will go to the Tea Party if there's a shutdown, as at least one poll shows. There are comparisons to 1995, when we last had a shutdown when Newt Gingrich and Bill Clinton locked horns. A shutdown could slow mortgage relief, harming a housing market that is struggling to recover. There's surely enough blame to go around -- one Tea Party Senator says the President planned this all along. Sen. DeMint says the Dems are choreographing the shutdown. Sen. Schumer blames it on Speaker Boehner's refusal to lead.

And remember the scary 2012 budget that ends Medicare and Medicaid as we know them? Well, some conservative GOPers have drafted an alternative -- that cuts way more spending. It would cut $9.1 trillion over the next decade, and like the Ryan proposal, it does not raise taxes.

Amidst all the budget turmoil comes the clear and unwavering voice of Dr. Pauline Chen, this month talking about the changes in hours that residents are working, and asking whether this is a positive change for patients.

And in other news, two Senators push to open the Medicare database as the best way to find fraud in the system.

Congresswoman Gabrielle Giffords's office is proposing ways to expand insurance coverage of traumatic brain injury.

Express Scripts -- a mail order pharmacy that provides prescription drugs through many insurance plans -- says we need to use mail order pharmacies to bring down the cost of drugs. Setting aside their blatant self-interest for a moment, I can report that I tried mail order pharmacy years ago, and they were so bad at getting refills on time and asking doctors for new prescriptions when refills ran out that I gave up on them. So maybe instead of criticizing patients, they should try doing their job a little better.

And Arielle Levin Becker of the Connecticut Mirror writes today about the fate of small physician practices -- are they a thing of the past, like house calls?

Here's an interesting interview with Aetna's CEO, Mark Bertolini. He's had some first-hand experience with health care issues, so he's somewhat more thoughtful than most large insurer CEOs.

Babies traveling abroad should have the measles vaccine first.

I hope, by the time I get home, that the budget will have been resolved. In the meantime, I plan to enjoy some great music and even greater friends. Have a great day and a great week-end! Jennifer

Last Budget Update of the Day

The House passed a one week budget extension that would require $12 billion in additional cuts, but would have funded the Pentagon through the end of the fiscal year (September). The Dems in the Senate won't pass it and the White House issued a veto threat.

The Speaker and Senate Majority Leader met with the President again today and did not reach an agreement. The plan is for talks to resume at 7 pm.

I'll give you one more update in the morning before I leave to go to FLIGHT TO MARS!!!!!! Jennifer