November 2009 Archives

Updated at 5 p.m. on Nov. 30.

What are the policy implications for delaying benefits under health reform legislation? The Senate bill under consideration would implement benefits in 2014.

Opponents of the Senate Democratic health care reform bill have been critical of the timeline for implementing changes. After the bill was unveiled Nov. 18, House Minority Leader John Boehner, R-Ohio, was asked whether the House or the Senate bill was paid for in a more fiscally sound way.

"Are you kidding me?" he asked. The Senate bill has "a smaller number. You know why? Because the benefits start a year later. Oh, what a surprise. This is over $1 trillion. It's the same nonsense that passed the House. It's 2,074 pages. Give me a break."

Is it a bad or good idea to wait on benefits to reduce the cost projections? Is there something to be learned from Massachusetts' health reforms, where the state offered up some benefits immediately? How much of a risk is there that delaying benefits could give opponents of health care reform more time to try to repeal it -- or parts of it -- after it becomes law but before it is implemented?

CBO: Some Premiums Will Rise

Reaction was mixed today to a new Congressional Budget Office report, with some arguing that it shows that nongroup insurance premiums would be higher, and some arguing that they would be lower under the health reform bill under consideration in the Senate than under current law, without the help of federal subsidies. This could prove troublesome for Senate Democratic leaders as they struggle to win the support of moderstae senators, according to CongressDaily.

According to CongressDaily, the report found that the legislation "would increase average nongroup premiums 10 percent to 13 percent by 2016 above what premiums would be if current law remained in place. The change represents an average premium of $5,800 for individual policies and $15,200 for family policies under the proposal. The increase becomes a 56 percent to 59 percent decrease for the 57 percent of purchasers in the nongroup market that will receive federal subsidies, which totals about 18 million subsidized enrollees. That leaves 14 million coverage purchasers who will pay the higher premiums."

You can see the CBO report here.

7 responses: John C. Goodman, Henry J. Aaron, Marilyn Werber Serafini, Uwe Reinhardt, James P. Gelfand, Robert J. Blendon, Rep. John Boehner, R-Ohio

Updated at 12:45 p.m. on Nov 19.

What concerns you most about the direction that health care reform proposals are taking in Congress? A few that have drawn particular scrutiny:

• Financing and taxes
• Affordability to individuals
• The overall price tag
• Cost to businesses
• Medicare cuts
• Reductions in payments to medical providers
• Medicaid and other government program expansions
• Scope of provisions to bend the cost curve

Information about the plan released by Senate Democrats:
• Summary Of Senate's Health Care Reform Bill [PDF]
• Timeline For Implementation Of Senate Bill [PDF]

14 responses: Michael F. Cannon, Robert Greenstein, Marilyn Werber Serafini, Ron Pollack, Jason Rosenbaum, Drew Altman, Andy Stern, Marilyn Werber Serafini, Newt Gingrich, Darrell G. Kirch, Karen Davis, John C. Goodman, Joseph Antos, Stuart Butler

Editor's Note: This week, former House Speaker and founder of the Center for Health Transformation Newt Gingrich is providing the question and serving as guest host for the blog.

The U.S. health care system wastes between $505 billion and $850 billion every year -- 22 percent, or approximately $200 billion, of which is fraudulent Medicare claims, kickbacks and other scams -- according to an October Thompson Reuters report. A few weeks ago, "60 Minutes" estimated that Medicare fraud costs U.S. taxpayers about $60 billion a year and has become among the most profitable crimes in America today, with increasing participation by organized crime.

I remember a 2005 New York Times article that revealed that New York's Medicaid program had become so massively complex and so lightly policed that it was easily exploited by a new breed of criminals. Stories like a dentist who billed 991 procedures in one day and one Buffalo school official who sent 4,434 students to speech therapy in a single day without talking to them or reviewing their records never cease to amaze. James Mehmet, the former chief inspector, estimated that up to 40 percent of all claims were questionable.

This New York Times story was the spark that eventually led to our book Stop Paying The Crooks. It provides an in-depth look at the fraud, waste and abuse crippling the U.S. health care system and offers solutions designed to end it. We believe it totals at least $100 billion each year in Medicare and Medicaid alone.

Unfortunately, current draft legislation does nothing proactive to eliminate fraud, waste and abuse in our health care system. Congressional Budget Office projections put savings at less than 1 percent of what they could be. We need real solutions that would dramatically reduce health care fraud so that savings could serve as a major pay-for for health information technology and covering the uninsured.

Questions:

• Reuters estimates $200 billion and 60 Minutes says $60 billion in annual Medicare fraud. We at CHT believe it is at least $100 billion in yearly Medicare and Medicaid fraud. Are these figures reasonable? If not, how much fraud do you think is actually out there?

• Are the anti-fraud efforts contained in the leading Senate and House bills likely to produce significant savings?

• What sort of provisions should be contained in order to maximize savings?

-- Newt Gingrich

What The Bills Would Do

John Iglehart wrote a primer on the issue over the summer in the New England Journal of Medicine ("Finding Money for Health Care Reform -- Rooting Out Waste, Fraud, and Abuse").

Here's how the major health reform bills propose to tackle fraud, according to the Kaiser Family Foundation.

• The Senate HELP bill would establish an integrity coordinating council; a fraud, waste and abuse commission; and two federal positions to oversee and coordinate oversight of health care fraud, waste and abuse in public and private coverage.

• The House committees approved bills that would allow provider screening, enhanced oversight periods and enrollment moratoria in areas at elevated risk of fraud in all public programs; they would also require Medicare and Medicaid providers and suppliers to establish compliance programs.

• The Senate Finance Committee bill calls for intensive screening of providers, the development of a database to capture and share data across federal and state programs, increased penalties for submitting false claims, and an increase in funding for anti-fraud activities.

6 responses: Newt Gingrich, Marilyn Werber Serafini, Uwe Reinhardt, Marilyn Werber Serafini, Henry J. Aaron, John C. Goodman

Health insurers woke up policymakers and the public with claims that health reform bills on the table would increase insurance premiums -- not decrease them.

When it comes to affordability for individuals, what is most important to remember as members of Congress move forward with reform legislation? Are premium subsidies set properly at about 400 percent of the federal poverty level? How far up the income scale should Medicaid reach? What percentage of income should a person be required to spend on health care before they qualify for an exemption?

5 responses: Karen Davis, John Rother, Sen. Ron Wyden, D-Ore., Ron Pollack, Drew Altman