Category Archives: CMS

Legal Challenge to Obamacare Fading

Politico is reporting today, correctly, that window is closing for those who want to bulldoze the Obama health law in court. It is going to become increasingly difficult because courts are much less willing to overturn something that is already entrenched said Randy Barnett, the Georgetown University law professor who helped construct the Supreme Court argument against the law earlier this year.

Critics are still fighting the law in court on several fronts, and Barnett hasn’t given up hope that one of those challenges could succeed. But the more Obamacare benefits become available to people, the harder it is to undo.

There’s no question that one of the reasons why we had as much room to run as we did is we had a two-year delay in implementing most of the law, he said, referring to the multi-state lawsuit he helped fight. Had more of the health law been up and running, it would’ve been much more difficult for us to even make the challenge. That opening is closing.

Some of Barnett’s allies in the Supreme Court case seemed to indicate as much with their silence. Michael Carvin and Paul Clement, two of the other lead attorneys, said they were not tracking other anti-Obamacare litigation and declined to comment to Politico. That’s good news for the law’s backers.

Randy Barnett is right. He’s a legal scholar with a relationship to reality, said Ethan Rome, executive director of Health Care for American Now. I think that courts don’t like to undo programs that are already being implemented that are impacting millions of people, especially when the highest court in the land found the law to be constitutional. Revisiting parts of it is obviously political and ideological.

The 2012 Election Aftermath Analysis

Looking past the fact the 2012 election was a GOP debacle, and the allegation — fair or not — that the GOP has a “polling problem,” the election result is best analyzed by a Resurgent Republic analysis authored by by Whit Ayres, Jon McHenry and Luke Frans. Charlie Cook said this analysis, specifically, is the best he has yet to peruse.

The basics of the analysis:

The 2012 election marks the year when the inexorable march of demographic change caught up with the Republican Party. While multiple factors led to President Obama’s reelection, none was as important as rapidly increasing demographic change in the American electorate. Mitt Romney won white voters by a landslide, 59 to 39 percent, in the process achieving the highest percentage of the white vote of any Republican
challenging an incumbent president in the history of exit polling. Yet that was not enough to craft a majority of the popular vote.

Resurgent Republic’s 2012 post-election survey polled 1000 likely voters nationally, starting on the night of the election, November 6, and concluding on Thursday, November 8. The results were weighted to conform to the popular vote outcome of 50 percent for Obama and 48 percent for Romney. Following are key highlights of the survey. Full results are available at resurgentrepublic.com.

Structure of the Electorate from Exit Polls

1. The 2012 electorate contained the smallest share of white voters and the largest share of nonwhite voters in American history. White voters constituted 72 percent of the electorate, down from 74 percent in 2008, 77 percent in 2004, and 81 percent in 2000.

African-Americans made up the next largest share at 13 percent, the same as 2008, and up from 11 percent in 2004 and 10 percent in 2000.

Hispanics constituted 10 percent of the electorate in 2012, compared to 9 percent in 2008, 8 percent in 2004, and 7 percent in 2000.

Asian voters made up 3 percent of the 2012 electorate, an increase from 2 percent each in 2008, 2004, and 2000.

2. Mitt Romney won a larger share of the white vote than either John McCain or George W. Bush. Romney defeated Obama by 59 to 39 percent among whites, compared to McCain winning whites by 55 to 43 percent over Obama in 2008, while Bush won whites by 58 to 41 percent over John Kerry in 2004 and by 54 to 42 percent over Al Gore in 2000.

3. Mitt Romney won white voters in almost all demographic groups, usually by substantial margins. Romney’s campaign was extremely successful at appealing to white voters across the board, and won almost all white groups except Jewish voters.

Health Reform Underway Regardless of Supreme Court Decision

Former Centers for Medicare & Medicaid Services (MedPAC) Administrator Donald Berwick is right about one thing: regardless of the Supreme Court ruling on the Affordable Care Act (ACA), health care reforms are already being driven in the private sector marketplace.

In a speech Monday at the American Health Lawyers Association’s annual meeting in Chicago, Berwick noted that the “reform train has already left the station.” He added that many changes, such as the shift toward team-based care structures and the implementation of care coordination programs are already meeting their goals in terms of lowering healthcare costs.

While the power and import of the Supreme Court, the President and Congress are preeminent in the context of law and regulatory policy, the dynamism of the U.S. private sector and the healthcare marketplace itself is the primary driver of transformative changes that elevate quality and comparative provider costs to the fore, where they belong.

Health Providers Must Emphasize Cost-Efficiency in FY 2012 Budget Debate

Capitol Hill lawmakers, regulators and the media have heard it all before at the onset of the annual budget dance: No cuts to Medicare — especially as state budgetary chaos has eroded Medicaid funding stability. With the 2012 budget debate about to get underway on Capitol Hill, the nature and composition of the new Congress — with an eye on spending cuts — will require health care providers of every stripe to emphasize how they’re part of the solution when it comes to saving tax dollars.

As Skilled Nursing Facilities (SNFs) are the dominant provider of Medicare post-acute services, a recent Health Affairs article, “The Revolving Door of Rehospitalization From Skilled Nursing Facilities,” corroborates the general viewpoint that care quality and spending efficiency can be enhanced by policy reforms.

States the article, authored by Vincent Mor, Orna Intrator, Zhanlian Feng, and David C. Grabowski: “Payment incentives in Medicare do not encourage providers to coordinate beneficiaries’ care. Revising these incentives could achieve major savings for providers and improved quality of life for beneficiaries.”

An Avalere Health study conducted for one major provider group, the Alliance for Quality Nursing Home Care, echoes this sentiment in terms of possible savings: “Health policy experts view many of these [rehospitalization] incidents as preventable — to the tune of potentially $12 billion in annual savings, according to the Medicare Payment Advisory Commission (MedPAC).”

It further suggests “studying the sector can provide a unique window into addressing rehospitalizations, and that potential strategies to reduce this growing phenomenon can help sustain ongoing improvements in nursing home care, in addition to saving tax dollars.”

The first quarter 2011 health policy debate — with its inherent savings discussion — will be fertile ground upon which to advance SNFs’ and others’ public policy objectives in terms of making “savings” a central messaging thrust. Gordon Hensley

Medicare Cuts in House Health Reform Bill Politically Unrealistic

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The health care reform bill (HR 3962) that passed in the U.S. House of Representatives by the slimmest of margins last week was dealt a serious setback this weekend when the Centers for Medicare and Medicaid Services (CMS) released a new study that, according to the Washington Post, “found Medicare cuts contained in the health package approved by the House on Nov. 7 are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether.”

The lede of the Post story, entitled, “Report: Bill Would Reduce Senior Care” is brutal:

A plan to slash more than $500 billion from future Medicare spending — one of the biggest sources of funding for President Obama’s proposed overhaul of the nation’s health-care system — would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others, according to a government evaluation released Saturday.

Following the taxpayer-funded abortion controversy surrounding the Stupak amendment, and the Democratic leadership’s need to retreat in order to pick up moderate Blue Dog support, the CMS study has enormous implications in terms of how a final bill will be shaped in Conference once a Senate bill clears the floor.

The fact the Post reported the House bill “would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others,” has provided the GOP with yet another weapon to hammer marginal House and Senate Democrats, and another reason to vote against or be extremely leery of a final bill that slashes seniors’ benefits.

The CMS study is somewhat helpful to the Skilled Nursing Facility (SNF) sector’s effort to help ensure the $23.9 billion, ten year cuts contained in HR 3962 to help finance the package could be pushed downward more in line with the existing Senate Finance Committee package crafted by Sen. Max Baucus (D-MT).

Interestingly, in regard to the whole notion of “cuts” to Medicare needed to finance any final reform bill, Sen. Kent Conrad (D-ND) engages in a bit of selective memory by stating, ”I think we’ve got to be very careful about our language. There are no cuts in any of these bills. There are reductions in the increases that they’re scheduled to receive” (“State of the Union,” CNN, 11/15).

In 1996, when Republicans sought to trim the growth in Medicare spending, much like what is being attempted now by the Democrats, GOP Senate and House candidates — as well as presidential nominee Bob Dole — were skewered for “cutting” Medicare. Besides the burden of defending the steep costs of a health care bill, House and Senate leaders will inevitably be forced to deal with the political implications of cutting Medicare spending — or, more accurately, trimming the growth of the program. This will become a more significant issue once a bill, presumably, makes it to Conference. The bottom line it very unlikely the high level of Medicare spending reductions providers now face in the House bill will survive.