Congress’s agreement to raise the U.S. debt ceiling could be bad news for healthcare providers. Hospitals in particular are concerned about the “trigger” mechanism — a cut of up to 2 percent in Medicare spending that would kick in if a newly formed joint committee doesn’t come up with roughly $1.5 trillion in cuts.
Providers are likely to face cuts, whether they come from the trigger or the joint committee. And either way, they’ll come just before another round of cuts — the regular scramble to offset a temporary patch in Medicare payments to doctors, which costs about $25 billion per year. Healthwatch’s Sam Baker has more on the potential for back-to-back hits.
{mosads}The American Medical Association said it expects the joint committee to tackle the Medicare payment-rates issue.
“We anticipate the Medicare physician payment issue will be among the issues the committee will address, as everyone agrees that a 30 percent cut in payments to those who care for Medicare patients would hurt seniors’ access to the healthcare they need and deserve,” AMA President Peter Carmel said in a statement.
Contraception conundrum: The Obama administration on Monday announced that new healthcare plans will be required to cover contraceptive drugs and counseling without co-pays, starting next year. Healthwatch’s Julian Pecquet has the story here.
The guidelines sparked controversy for two main reasons.
The first, of course, is the debate over birth control. The U.S. Conference of Catholic Bishops and others criticized the rules for requiring coverage of drugs, such as the new morning-after pill Ella, that they say amount to a form of abortion. Other groups faulted the Department of Health and Human Services (HHS) for going too far in exempting certain religious employers from the contraception requirement.
“The guidelines … reflect common sense,” HHS Secretary Kathleen Sebelius told reporters on a conference call. “Since birth control is the most common drug prescribed to women ages 18 to 44, insurance plans should cover it.”
The second is cost.
HHS officials said the new guidelines would have little impact on premiums, because many employer plans already cover preventive care. Furthermore, they argue, prevention can save money down the line.
But insurers disagree. The Council for Affordable Health Insurance, for example, estimates that coverage of contraceptives adds 1 to 3 percent to the cost of group health plans.
The trade association America’s Health Insurance Plans (AHIP) said the guidelines exceed evidence-based recommendations and “set a troubling precedent” ahead of regulations that will determine the full scope of “essential health benefits” that health plans will have to cover on insurance exchanges starting in 2014.
“The preventive care coverage recommendations recently issued by the IOM would increase the number of unnecessary physician office visits and raise the cost of coverage,” AHIP President and CEO Karen Ignagni said in a statement. “The IOM’s recommendations would broaden the scope of mandated preventive services beyond existing evidence-based guidelines, suspend current cost-sharing arrangements for certain services and encourage consumers to obtain a prescription for routine supplies that are currently purchased over-the-counter.”
SBA slammed in Ohio: A federal judge in Ohio ruled that the healthcare reform law doesn’t allow taxpayer-funded abortion, a blow to the Susan B. Anthony List (SBA). The anti-abortion-rights group is fighting a legal complaint that it violated state law with billboard ads that accused then-Rep. Steve Driehaus (D-Ohio) of voting for taxpayer-funded abortion when he supported the law. Healthwatch’s Sam Baker has more.
SBA List said the ruling would have a chilling effect on criticism of elected officials.
“Steve Driehaus’s constituents saw the truth about his pro-abortion record and made their voices heard on Election Day,” the group said. “Their conclusion — that Steve Driehaus voted for a bill allowing taxpayer funding of abortion — is backed by every major pro-life organization in the country, along with the United States Conference of Catholic Bishops, the Congressional Research Service and other nonpartisan organizations. The SBA List will continue to defend its actions, the voters and the right to criticize our elected officials.”
While Planned Parenthood breathes easy in Kansas: A federal judge in Kansas blocked a new state law that strips family-planning funding for Planned Parenthood. Read the Healthwatch post.
Peter Brownlie, the president and CEO of Planned Parenthood of Kansas and Mid-Missouri, issued a statement Monday afternoon.
“We’re very grateful that the court issued a preliminary injunction of the defunding budget provision, allowing thousands of women and families across our state to continue to receive low-cost and vital services from Planned Parenthood,” Brownlie said. “The court issued a strong ruling that Planned Parenthood is likely to prevail on all our arguments and ordered the state to continue funding Planned Parenthood under the Title X program, effective July 1 of this year, until a final decision is reached on the merits of the case.”
IPAB inquiry: Energy and Commerce Republicans want Sebelius to clarify her recent testimony that people would be able to legally challenge decisions by the health law’s Independent Payment Advisory Board, which is tasked with constraining Medicare spending. The letter says the law’s language appears to contradict that statement and asks for detailed examples of when judicial review would or would not be permitted.
Hospital rates: Medicare issued the final 2012 payment rates for acute- and long-term-care hospitals. Acute-care hospitals will get a 1 percent bump (versus a 0.5 percent cut in the earlier proposed rule), while long-term care hospitals get a 2.5 percent increase (versus 1.9 percent in the proposed rule). Medicare payments to acute-care hospitals are expected to increase by $1.13 billion (1.1 percent) over 2011, while long-term-care hospital payments are on track to rise by $126 million (2.5 percent).
Tuesday’s agenda:
Healthcare reform premiums: The Senate Health, Education, Labor and Pensions Committee holds a 10 a.m. hearing on the health law’s insurance premium regulations. Insurance reform chief Steve Larsen is scheduled to testify at the full committee hearing, which comes just as HHS’s expansion of mandatory health benefits for women has rekindled debate on the law’s impact on premiums.
Lobbying registrations:
B&D Consulting / EMD Serono (infertility issues)
Baker & Hostetler / Coalition of Free-Standing Children’s Hospitals
Cavarocchi Ruscio Dennis Associates / American Society of Hematology
Cavarocchi Ruscio Dennis Associates / National Hemophilia Foundation
Hague Associates / TrioMed Innovations (research, development and production of healthcare technologies)
J M Burkman & Associates / Vanni (educational and anti-obesity initiatives in Colorado)
King & Spalding / Albany Medical Center (academic health sciences center)
Shelter Rock Strategies / New York Medical College
Tauzin Consultants / CaptureRx (pharmacy benefits management)
Walden Associates / Iowa Chronic Care Consortium
Reading list:
The Washington Post highlights five cuts a debt commission might make to Medicare and Medicaid.
The nation’s largest healthcare-focused law firm launches a Long-Term Care blog.
What you might have missed on Healthwatch:
Pressure grows on CMS to get tough when reviewing state Medicaid cuts.
Comments / complaints / suggestions?
Please let us know:
Julian Pecquet: jpecquet@digital-release.digital-release.thehill.com / 202-628-8527
Sam Baker: sbaker@digital-release.digital-release.thehill.com / 202-628-8351
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