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The following post comes from Donna E. Shalala, former HHS Secretary and University of Miami President:
The Supreme Court’s decision to uphold the individual mandate as a tax will open up the opportunity for good health insurance for millions of Americans and will protect those of us with good health insurance from continuing to pay for their emergency care.
Now the real work begins. Under the supreme court ruling those states that want to expand their Medicaid plans will be able to do so. All the states, whether required or not, will be under enormous pressure from the healthcare providers and institutions in their communities not to walk away from millions of dollars that will offset their current charity care.
Every American who has health insurance will gain from this decision because the cost shifting to them from the millions that don’t have health insurance will begin to be phased out. I expect increases in healthcare costs to slow down.
Unlike so much else in the 112th Congress, the package of legislation to authorize Food and Drug Administration user fee agreements is humming along. At a House markup last week, Rep. Henry Waxman, D-Calif., was one of many members who commended his colleagues for their ability to collaborate and compromise: "Consideration of this bill should be a model for legislative action," he said. The "UFA" legislation, as it's known, is nearly identical on the House and Senate sides, has passed through markups with nary a complaint, and looks set to pass months before the programs it reauthorizes are set to expire at the end of September.
In a session marked by so much partisan rancor, why are the UFA bills different? What can Congress learn from this process?
The following entry comes from Sen. Michael Bennet, D-Colo.:
From my perspective, someone who’s only been here a few years, this process can be a model for making Washington work.
The conversation we’re having in Washington is too often decoupled from the conversations in my town hall meetings and across the country about the challenges we need to address – the gap is miles apart.
Chairman Harkin and Ranking Member Enzi have run a very good process that has enabled me to be responsive to what Coloradans say they want: a modern FDA, improved patient safety and innovation. We’ve also had committee members interested in rolling up their sleeves and doing hard work together, including working through a mark-up with virtually no partisanship. It has been a singularly and uniquely good process, which has give great momentum toward a full extension. In what I’ve called the land of flickering lights, it’s gratifying to work on something that isn’t a 3 month extension.
This bill still has a ways to go before it beco
What role should employer-sponsored health insurance plans play in U.S. health care?
House Republicans have bashed the health reform law as the beginning of the end of the employer-sponsored health insurance market, since it would be less expensive for some employers to drop their plans and pay a fine to the federal government. The House Ways and Means committee released a report last week finding 71 of Fortune 100 companies could save $422 billion by simply paying fines for their employees, instead of the insurance plans they offer now.
But Republicans haven't been huge fans of employers dictating health insurance coverage for individuals in the past. Sen. John McCain, R-Ariz., proposed getting rid of the employer-sponsored health insurance tax exclusion in his failed 2008 presidential campaign, which could incentivize people to buy their own plans. Gov. Mitt Romney, the presumptive Republican presidential nominee for 2012, hasn't gone that far yet. But he does want to "equalize" the
Last week the federal government announced it had signed up 27 hospital and doctor groups to participate as accountable care organizations, one of the health reform law's great cost-saving hopes.
The number is well under federal projections from October, which predicted up to 270 groups would sign up to become Medicare accountable care organizations, or ACOs. The ACO program pays bonuses to doctor and hospital groups if they successfully coordinate care and improve health outcomes for certain Medicare patients. The groups can eventually lose money from the federal government if they don't meet those standards.
Does the low turnout mean ACOs are over? Or is the program just off to a slow start? Why?
After tougher-than-expected questioning for the Obama administration at last week's historic Supreme Court arguments on the health reform law, figuring out how to make the law work if the court strikes down the insurance coverage requirement has become a fulltime hobby.
Several options have been floated-- like auto-enrolling people in health insurance plans or restricting enrollment to certain times of the year--but so far no formal strategy has emerged.
Are there any ways to salvage the health care law that have been missed? What programs do you see surviving if the Supreme Court decides the insurance requirement is unconstitutional?
Friday marks the second anniversary of the health reform law. Just three days later, what Republicans like to deride as "Obamacare" will face the biggest challenge it has ever seen: oral arguments at the Supreme Court on whether the law is constitutional. Democrats are spending the week telling voters just how they've benefited from the law, and what they'd lose if it is overturned. Republicans are keeping on their message that the law is an unprecedented government intrusion into Americans' health care. In the meantime, states are scrambling to get insurance exchanges up and running while every facet of the health industry--from insurance companies to doctors to hospitals--are making significant changes to their businesses to adhere to the law's new rules.
If you were implementing the law, what would you have done differently? What would you keep the same? In the battle for public opinion, who is winning: Democrats or Republicans?
House Budget Committee Chairman Paul Ryan is getting ready to release his second budget blueprint, and he isn't expected to pull any punches on Medicare.
Ryan told National Journal's Nancy Cook that the budget plan is more important than Republicans winning the White House in November.
"The moral obligation to do something about the debt crisis trumps everything," Ryan said.
For health policy that means one thing: Medicare and Medicaid are once again in for a significant overhaul from Ryan, despite the upcoming presidential election and political challenges of tweaking popular health programs. Medicare and Medicaid make up a huge chunk of the deficit, especially in the long run.
Has Ryan succeeded in changing the dialogue of Washington policymakers when it comes to Medicare and Medicaid? Is a Medicare voucher system or block grants for Medicaid becoming an inevitable solution to the country's fiscal woes?
Two House committees meet this week to mark up a bill repealing the Independent Payment Advisory Board, an executive-branch board with control over Medicare prices that even Democrats don't like. A bill from Rep. Phil Roe, R-Tenn., to repeal IPAB has 19 Democratic cosponsors.
The 15-member IPAB garners ire on Capitol Hill because it can cut Medicare payment rates to doctors and hospitals without congressional approval. To override the board, Congress must pass its own equivalent cut with a supermajority.
Congress doesn't have a great track record when it comes to Medicare prices. One easy example: the sustainable growth rate that controls Medicare physician payments. Democrats and Republicans want to get rid of it, but can't agree how to do it. Should the executive branch get to control Medicare pricing? The executive branch controls the money supply through the Federal Reserve - is IPAB really that different?
HHS is due out with its rules for insurance exchanges any time now. But states and private enterprises aren't necessarily waiting for the details.
What interesting solutions do you see coming from the states, from the private sector and, yes, even from the federal government? Are there any missed opportunities out there? What will these exchanges look like five years from now? Will states be ready to run exchanges by this time next year?
Much of the talk from Republican lawmakers on health care reform has focused on efforts to repeal the 2010 health care reform law. But this year, they are talking about what could replace it if they accomplished that goal. Last week Rep. Joe Pitts, the chairman of the health subcommittee of the Energy and Commerce Committee, described a package of policy initiatives that he hoped his committee would tackle later this year.
The planks of the package included medical liability reform, rules to make health insurance purchases possible across state lines, and efforts to ensure that employees could take their insurance with them if they left a job.
Would such policies be a good replacement for the current health care reform package? Would they expand access to health insurance? Would they bring down costs?
In order to survive 2012, the health care law will have to overcome two major hurdles: a Supreme Court hearing on its constitutionality, and an election that could tilt Congress, the White House or both in favor of repeal.
Which pathway do you think will be more likely to bring down the legislation: the Supreme Court's June decision, or the November election?
Or despite these challenges, do you think the health reform law will survive to see 2013?
Believe it or not, we are just one week away from President Obama's fourth State of the Union address, scheduled for January 24. We want to know what you want to hear from the president when it comes to health policy.
Do you think the president should defend his landmark health reform law, especially in front of the Supreme Court justices who are set to rule on its constitutionality this year?
Should the president offer up ways to save money in Medicare and Medicaid, like raising eligibility age for Medicare or changing how the federal government matches state Medicaid contributions?
Should President Obama address Republican efforts to convert Medicare into a program that gives seniors a subsidy to purchase private health insurance?
Or do you think the president should steer clear of health policy altogether?
The Obama Administration kicked off the Supreme Court case on health care reform Friday with its brief defending the 2010 law's most controversial feature -- its requirement that individuals buy health insurance. The government offered several legal arguments in support of the provision, contending that it is a valid exercise under Congress's powers to regulate interstate commerce and to collect taxes. The legal analysis was no surprise--the government has been making similar arguments for nearly two years in the lower courts, with mixed results.
Will these arguments be persuasive to the justices? Will the Supreme Court uphold the health reform law?
After a year-long reprieve from having to fix the Medicare "sustainable growth rate" formula, Congress is once again scrambling to avoid a 27 percent cut to Medicare physicians pay in January 2012.
Hopes for a permanent fix this year dimmed with the failure of the super committee. That means any "doc fix" Congress passes will last no longer than a year, at most maybe two years.
How many more years will it take before a permanent solution is found? Is a bill from Rep. Alyson Schwartz, D-Pa., a first step to permanently addressing the Medicare SGR? Or is a Medicare Payment Advisory Commission plan, which cuts most doctors pay, a more realistic solution?
If the super committee fails to reach a deal, how badly do you think Medicare and Medicaid will be cut in 2013 and beyond?
The federal health programs, along with Social Security, are projected to grow from 10 to 15 percent of GDP in the next 25 years. Democrats are already looking at ways to hem that in - last week Democrats floated a super committee proposal to cut $400 billion from federal health programs, in part by asking Medicare beneficiaries to pay an extra $100 billion to cover the cost of their care.
Republicans have been pushing for more drastic, structural changes to Medicare, like transforming the entitlement program into a voucher system where seniors would get government subsidies for private insurance coverage. Short of that change, Republicans in the super committee have regularly pushed for significant entitlement spending cuts.
Are the federal health programs destined for the chopping block once the 2012 presidential election is over?
Last week the federal government did its best to reignite enthusiasm around the so-called accountable care organizations, making significant changes that are meant to coax doctors and hospitals to come on board.
Accountable care organizations, or ACOs, are a centerpiece of the 2010 health reform law that aim to get doctors and hospitals to work together to keep patients healthier. The interim rule released in March was panned by doctors and hospitals expected to volunteer for the program.
The revisions include allowing ACOs to operate without financial risk and will let ACOs collect a full bonus once they hit a savings target; the interim rule would have kept the first 2 percent of savings for the federal government.
They also eliminate a confusing and unpopular provision that would have kept patients and doctors in the dark about who was actually included in an ACO, and they slash the number of quality measures doctors and hospitals will have to report from 65 to 33.
Are these changes enough to attract wary doctors and hospitals back to the ACO drawing board
The Food and Drug Administration has been the target of criticism from Republicans and the medical device industry alike, arguing that increased medical device approval times are pushing innovation abroad.
After holding several hearings examining the FDA's approval process, House Energy and Commerce Chairman Fred Upton, R-Mich., last Friday unveiled a package of legislation that Republicans say will "improve the predictability, consistency, and transparency of FDA's medical device review and approval process."
The legislation would require FDA reviewers to provide "scientific or regulatory rationale for major decisions," and reaffirms that FDA should follow "least burdensome" practices to approve devices. You can read more about the bills here.
Do you think these proposals will be useful to getting new treatments to market? Or will these changes put patients in danger with unchecked devices?
This response comes from Rep. Cathy McMorris Rodgers, R-Wash.
Last month, I hosted the first “Jobs and Innovation Forum” on Capitol Hill with a special focus on medical device innovators, how the regulatory process impedes innovators, which ultimately hurts patients, and how to improve that process. The job creators who participated in our forum had a simple yet powerful message: While America has led the medical technology industry for decades, our leadership is being threatened by the Food and Drug Administration’s unpredictable, inconsistent and inefficient regulation of medical devices. To maintain our leadership, they want Congress to charge the FDA with improving the regulatory climate. Should the FDA do that, it would spur innovation in a high-tech, high-paying field, expedite approval of life-saving and life-improving treatments, bolster America’s competitiveness, and create much-needed jobs.
This response comes from Janet Trunzo, executive vice president of regulatory affairs at AdvaMed:
America’s medical device and diagnostics companies are engines of innovation -- developing life-changing, life-enhancing technologies and, in the process, creating nearly 2 million U.S. jobs. In order to improve patient access to these technologies and address some of the critical issues impeding our industry’s global competitiveness, the Energy and Commerce committee, under Chairman Upton’s leadership, has put forth the Saving American Jobs and Saving American Patients legislative package.
The package reflects the committee’s extensive work in examining the need for reform through hearings and debate. We believe the effort is an excellent starting point in a legislative discussion to address several important issues critical to maintaining our global leadership and competitiveness.
In addition, we are continuing to work collaboratively with the FDA to make improvements in the device review process, which are
The controversial long-term disability insurance program, known as the Community Living Assistance Services and Supports program or CLASS, had a rough month in September. But the Obama administration hopes a report, expected out this week, might clear some of the bad air.
The insurance program, established under the 2010 health reform law, is on an indefinite hiatus. Staff at the CLASS office within HHS were reassigned last month. Senate Democrats removed all funding for CLASS in the Labor-Health and Human Services 2012 spending bill because program "implementation has been delayed." The program was originally intended to start collecting premiums in October 2012.
Assistant Secretary on Aging Kathy Greenlee said the report would include "recommendations about how to proceed."
Do you think the CLASS program can be saved? Is it possible to tweak the voluntary program so the premiums collected can cover the cost of benefits?
If not, what is needed for the estimated 10 million Americans that need long-term support services not covered in traditional health insura
(These comments were submitted by Kathryn Nix, a policy analyst in the Center for Health Policy Studies at The Heritage Foundation.)
Health and Human Services will not be able to fix CLASS. The program’s poor design makes it unsustainable, and only significant changes by Congress can address this. Broad eligibility requirements allow almost anyone to enroll, with students and those below the poverty line paying just $5 in premiums. Combined with the policy of guaranteed issue and the program’s voluntary nature, CLASS will experience severe adverse selection.
One solution put forth by Secretary Sebelius is to index premiums to inflation. But the premiums required to cover CLASS’ high costs are likely to be unaffordable for most Americans. Increasing premiums even further would exacerbate adverse se
The Institute of Medicine is expected to release a report Friday detailing exactly how the federal government should go about selecting what health benefits need to be covered by insurance plans in order to get on state exchanges.
The highly anticipated report has insurance companies concerned that HHS will add too many benefits, while consumer groups want as many covered benefits as possible.
Between both of those positions is the difficult balance of giving consumers affordable care that has enough benefits to help keep people healthy. Is it possible to give consumers affordable coverage with generous benefits? If you were at HHS, how would you balance affordable insurance coverage with adequate benefits?
This week's question comes from one of our newest experts, Cindy Gillespie. Gillespie served as an adviser to former Massachusetts Gov. Mitt Romney during the state's health reform efforts, and now leads the health care policy team at McKenna Long & Aldridge.
"In addition to the individual and small business exchanges mandated under PPACA, private exchanges are emerging as potential vehicles for innovation in the way employers offer coverage to their workforce.
For example, WellPoint recently announced the acquisition of Bloom Health, through which 20,000 employees at 50 companies purchase coverage using pre-tax dollars and a defined contribution from their employers.
What impact do you think that exchanges, public and private, will have on the employer-sponsored insurance
President Obama's latest plan to reduce federal health costs kept true to his call for "modest" adjustments to Medicare. Obama didn't go for any big reforms--like increasing the Medicare eligibility age to 67--but his proposal does go after a few Democratic sacred cows, namely by asking seniors to pay more for their care.
The plan is full of policy proposals that have been around for months, wringing $248 billion in savings from Medicare and $73 billion in savings from Medicaid and other health programs.
They are also items that every lobby can love to hate. The savings come from hits to pharmaceutical companies, hospitals, doctors, insurance companies, and beneficiaries -- a combination that will be a tough vote for politicians in either party. Democrats loathe asking seniors to pay more for their care, and cuts to hometown hospitals are hard for any member of Congress to support, regardless of party. Republicans will especially oppose charging pharmaceutical companies more.
What do you think of the president's plan for Medicare? Does it stand a chance of passing,
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