Category Archives: health care

Kasich: Full Speed Ahead With Medicaid Expansion

In announcing his support for Medicaid expansion, Ohio Governor John Kasich said that while he “opposes” Obamacare his move “makes great sense for the state of Ohio.” As FL GOP Gov. Rick Scott and AZ GOP Gov. Jan Brewer have already signed on to Medicaid expansion, the longer term practicality of the policy is, some say, superseding political ideology. That remains to be seen — but there’s no question Kasich is a huge ‘get’ for the White House.

Kasich statement in release of his proposed state budget: “While a complex decision, this reform not only helps improve the health of vulnerable Ohioans and frees up local funds for better mental health and addiction services, but it also helps prevent increases to health care premiums and potentially devastating impacts to local hospitals. Additionally, it avoids leaving Ohioans’ federal tax dollars on the table and keeps the federal government from simply giving them away to other states. Importantly, Ohio will roll back this extension if the federal government changes the rules.”

Enitlement Reform Options: The Clear Leaders

While it appeared a “Grand Bargain” was conceivable following the 2012 election, the unfortunate fact in the wake of President Obama’s ideologically combative State of the Union speech — and other recent smoke signals from Senate leadership offices — is that we’re headed for another depressing, budget crisis-to-budget crisis session of Congress at least through the 2014 mid-terms.

Despite the odds of major entitlement reform are now far less than 50/50, Politico, National Journal and other new reporting indicates there are several structural savings opportunities through proposals already on the shelf at influential progressive think tanks in Washington. The menu is as follows:

Social Security: ‘Chained CPI’ — Savings: $112 billion

The idea is to change the way the government figures out how much more seniors should get in Social Security benefits each year to account for changes in their cost of living. This new formula — a tweak to the consumer price index — would assume that people switch their buying habits when prices rise, rather than just buying the same things over and over. So, for example, if the price of ground beef goes up, someone might buy chicken or fish instead. The result: Social Security benefits will rise more slowly.

Social Security: Lift cap on taxable earnings – Revenues: $500 billion or more

Even if the Democrats accept chained CPI, they’re going to want something in return. One big one: Let the highest earners pay more Social Security payroll taxes. Lift the cap so 90 percent of all Americans’ earnings are taxed — it’s only about 83 percent now — and a Social Security deal could raise about $550 billion in revenues over the next 10 years, according to estimates by Third Way, which has endorsed the approach. It would also wipe out Social Security’s deficit through 2020.

Medicare: Expanded means testing — Savings: $20 billion

Obama has said he won’t consider Medicare changes that would shift costs to seniors, but an expansion of the program’s means testing is the one benefit cut Democrats have hinted they might accept <http://politi.co/WfWdNI>  — because it would hit wealthier seniors and spare the rest. There’s already some means testing of premiums for Medicare coverage of doctors and prescription drugs, thanks to Obamacare and the 2003 law that created the Medicare prescription drug program. The version that Obama proposed in his 2011 deficit plan and could put on the table again, would extend that means testing to charge higher premiums and hit a larger group of seniors.

Medicare: Faster payment reforms — Savings: $10 billion

Republicans often complain that Democrats don’t want to make any real changes to bring more money into Medicare — they just want to keep cutting payments to providers. But there’s no real controversy over Obamacare’s incentives to provide more efficient medical care, and that’s where some on the left think there’s potential for common ground — by just beefing up those experiments.

Medicare: Drug rebates — Savings: $135 billion

One of Obama’s biggest Medicare savings ideas would come straight out of the pockets of drug companies — which means he’d face a fight, but probably not from Democrats. Right now, pharmaceutical companies have to pay a rebate when the government buys prescription drugs for people on Medicaid but not for low-income seniors who qualify for both Medicare and Medicaid. The proposal, which Obama included in his deficit plan, would make the drug manufacturers give the same rebates for these “dual eligibles,” adding up to huge savings for Medicare.

 

 

 

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.

Romney Achieves Parity on Medicare With Obama

Despite DCSpectator’s prior skepticism that the GOP in general and the Romney campaign in particular could achieve a level of parity with the Democrats on the issue of protecting Medicare, Kaiser data suggests the Romney campaign has largely succeeded.

Even though seniors reject the Medicare-reform proposal Romney has endorsed, Kaiser finds, they trust him more than they do President Obama when it comes to the future of the program. Forty-eight percent of seniors trust Romney, compared with 43 percent who trust Obama.

Compare that to the numbers on policy: 72 percent of seniors think Medicare should stay as it is, while only 18 percent would prefer the Romney system.

Seniors are a key part of Romney’s coalition, and Democrats had hoped they could use Romney’s Medicare positions to their advantage with that segment of the electorate.

It remains to be seen, however, how the issue plays in the toss-up Senate and House contests.

Medicare Issue Turns Against GOP

When Mitt Romney selected Paul Ryan as his Veep nominee, and initially seized the offensive on Medicare by charging “Obamacare” was funded by actually siphoning-off Medicare dollars, too many GOP consultants rejoiced prematurely.

One NRCC operative was quoted as predicting the Democrats would retreat on Medicare, and that the GOP had turned a corner on the always controversial and dangerous issue. As Charlie Black noted, if we could ‘break-even’ on Medicare, we’d be doing quite well.

But that was then. Now? GOP candidates are well advised to fight back on the issue, but not lead with it.

That was always the best approach, and the initial glow of the first Ryan offensive has clearly worn off.

Predictable DC Drumbeat that Romney is Toast

If one listened only to the Washington Beltway echo chamber this week, the presidential campaign is over.

Not only did Romney ‘mishandle’ the sacking of the U.S. embassy in Libya, but he’s also “lost Ohio” and thus the election because of several polls confirming the President maintains a small “lead.”

And that’s one of the biggest flaws of the reporting and armchair commentary.

When one sees reporting that says Obama ‘leads’ Romney 47%-45% is state X, that’s actually terrifying news for any incumbent. This is the case in any number of states where Obama ‘leads’ Romney but is not close to 50%.

This is what GOP pollster Whit Ayres correctly calls the incumbent’s ‘never-never land of 47%, 48% and 49%.” Hitting 50% +1 for Obama will be a continual uphill fight in a variety of battleground states like Florida and Virginia — no matter what we hear and see now — due to the economy and horrendous right track/wrong track #’s.

Granted, Romney still has quite a bit to do in terms of even getting to the point of possibly closing the deal — he’s indeed behind, still needs to package his agenda more succinctly, and the ruthlessness of the Obama campaign has kept him back on his heels.

But still, campaigns change quickly.

With debates and so many surprises left in store, anything can happen — and Romney is very much in the thick of the contest, no matter what one sees from DC talking heads, most of whom, pathetically, have never even worked on a campaign.

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.

POS/Hart Survey Underscores Potency of Attacking Lawmaker Votes to Cut Medicare

As the U.S. Senate and House of Representatives begin making crucial budgetary decisions for FY 2013, a recent survey conducted for the Alliance for Quality Nursing Home Care by Public Opinion Strategies and Hart Research Associates underscores the saliency political operatives find in attacking incumbents who expose themselves to such attacks by supporting Medicare cuts — in this case to nursing homes.

The survey (January 26-30, 800 RV’s [700 landline/100 cell] +/- 3.46%) finds 82% of RV’s oppose reducing Medicare funding for seniors’ nursing home care; 90% say funding for U.S. nursing home care should either “remain the same” or “increase”; and, interestingly, a full 69% support the concept of phasing-in a controversial 2011 Obama Medicare regulation that reduced Medicare funding by 11.1% all at one time.

With Republicans and Democrats both suffering major losses in back to back congressional elections — as each side in successive cycles absorbed attacks ads accusing incumbents for cutting seniors’ Medicare benefits — it’s no surprise both sides are circling each other warily as the FY 2013 budget negotiations take shape.

Private polling done for a health care provider group in Texas last year, as well as polling conducted for the Texas Tribune, found cuts to seniors’ nursing home care are among the most unpopular cuts of nearly a dozen options mentioned. This is not lost on ad makers, pollsters, campaign operatives and lawmakers themselves.

Wyden Says Dem Outrage Over Teaming With Ryan on Medicare Will Subside

Senate Democrats on Capitol Hill were more than miffed at Sen. Ron Wyden’s (D-OR) decision to join Republican Paul Ryan on a new Medicare reform plan. But Wyden says the negative criticism will subside once the plan is actually reviewed.

But that’s not likely in this hyper-partisan environment — and especially because it dilutes the attacks the DCCC and DSCC hoped to use (and will still use) against GOP candidates who had expressed previous support for the first Ryan plan earlier this year.

wyden1“There’s no question that when you try to break the gridlock and in this case for the longest running battle since the Trojan War, you stir a lot of passions,” Wyden told POLITICO. “My hope is in the days ahead that folks are going to read it.”

Not likely. House Minority Leader Nancy Pelosi suggested that the Wyden-Ryan plan would allow Medicare to “wither on the vine,” and White House spokesman Jay Carney said it was just another plan to “end Medicare.”