/PRNewswire/ -- The following is released by Lockton:
Human resource and benefits managers--and perhaps a lot of CEOs and CFOs--who in recent weeks had begun thinking seriously about the impact of federal health reform on their profitability, workforce structure and health plan viability, may have awoken Nov. 3 asking, "What now?"
What now, indeed. As Republican candidates in federal, state and local races swept into office in historic numbers, promising a change in the course of government, attention has centered on the impact of the election results and on the future of the federal health reform law.
The answer is: Don't expect much in the way of change. At least not yet.
Repeal is Not an Option...For Now
There was a never a chance that Republican mid-term victories, under the most optimistic of projections, would or could unravel the health reform law. Even had Republicans managed to capture control of the Senate in addition to their reclamation of the House, the health reform law was in no danger of repeal. Any attempt by Congress to do that would be vetoed by President Obama, and the Republicans lack the 67 Senate votes necessary to override a Presidential veto. Any serious attempt at repeal must await the results of the 2012 elections. Repeal will require the complete reversal of 2008: Republican control of the White House and both chambers of Congress.
If the GOP cannot now outright behead the law, can they strangle it by denying it funding? To be sure, the funding issue is the law's weak underbelly. The law requires federal funding of more than 100 key components of the bill, most notably grants to states to establish insurance exchanges by 2014, and of course the $500 billion necessary to provide subsidies toward individuals' purchases of insurance in the exchanges. Federal taxpayers are also picking up, for the first several years, all or nearly all of the additional Medicaid expenses associated with the expansion of Medicaid eligibility.
Risky Business
But holding up the federal budget - threatening the shutdown of the government - is risky business. Many voters are weary of partisanship and are looking for Congress to make something good happen. Republicans must remember that according to a number of exit polls, voters identified the economy as their main concern, by a wide margin (about 62% of voters picked the economy as their primary issue; only 18% cited the health reform law). The American electorate wants results.
The new makeup of the Congress doesn't bode well in that regard. Among the many Democrats swept out of the House are a significant number of self-styled moderates, known as "Blue Dogs." This purging of Democratic moderates means we'll now have in the Congress, particularly on the Democratic side of the aisle, a caucus whose center of gravity is a fair bit farther left than before. Throw in a Republican majority infused with new blood drawn from the mid- to far-right, and you have all the makings of political gridlock.
What's in Store?
So what will happen, then? Our best guess, for the short term, is that Republicans in the House will pass a symbolic bill repealing the health reform law, a bill that will go nowhere in the Senate. Again, here the Republicans must be prudent. Voters, particularly those in the all-important political center, are likely to have little tolerance for symbolic gestures while the nation's economy festers. For the same reason, if Republicans allow themselves to become bogged down over fringe issues, they will have misread the lessons of the election results.
Some nibbling around the soft edges of the health reform bill is likely. The business community is rightly aghast at the new Form 1099 reporting requirement appended to the law. The requirement compels businesses to issue a Form 1099 to every vendor - from copy repairmen to bartenders - to whom the company pays $600 or more during a year. House Republicans will move swiftly to repeal that provision, and will likely attract enough Senate Democrats - spooked by the election bloodletting - to get it done.
There is talk of attempting to do even more, perhaps repealing the "Individual Mandate" (the provision that compels nearly all Americans to have minimum health coverage by 2014 or face a modest penalty) or the "Free Rider Surcharge"(the penalty employers will pay beginning in 2014 if they fail to offer affordable coverage to full-time employees who instead obtain subsidized coverage in the insurance exchanges).
Such actions, like the health reform bill itself, may have unintended consequences. The health reform law requires insurers to issue policies to all applicants, without pre-existing condition restrictions. That works only if the nation gets everyone in the risk pool. Otherwise, people will simply wait to buy insurance until they get sick. Removing the individual mandate without relieving carriers of the obligation to issue a policy to all applicants, without restrictions, makes it even more difficult for private insurance companies to survive.
Business has many reasons to oppose the Free Rider Surcharge. But if the insurance exchange concept survives until 2014, and employers find then that their employees have another, taxpayer-subsidized option for health coverage available, and no surcharge binding the employers to their existing group health plans, a great many more employers may simply terminate their group coverage. That will improve employers' bottom lines (although many employees will fare worse in the exchanges), but not the nation's.
The Congressional Budget Office, when estimating the first decade's cost of the bill at $1 trillion, assumed only about 4-5 million Americans (net) who have group insurance today will lose it by 2019, as a result of the health reform law. A recent study suggests that the cost of federal subsidies in the insurance exchanges rises about $300 billion for every additional six million Americans who seek exchange-based coverage. If the 4-5 million estimate balloons to 40-50 million, the first decade's cost of the program leaps to $2.5 - $3 trillion, a number that is simply not sustainable.
Stay the Course
So we shall see. Experienced political pundits say that prognostications based on mid-term election results are almost always wrong. In other words, we should not read too much into the results, although there is still much to make of them. Our advice to employers who are beginning to assess the impact of health reform and chart a course to address the issues it poses, is to "stay the course." There is still much to do, and health reform isn't going anywhere, at least not for a while.
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Showing posts with label congress. Show all posts
Showing posts with label congress. Show all posts
Thursday, November 04, 2010
Tuesday, August 24, 2010
136 Members of Congress Demand that Medicare Release Key Information about Controversial Bidding Program for Home Medical Equipment
/PRNewswir/ -- A bipartisan group of 136 members of Congress recently requested that the federal Centers for Medicare and Medicaid Services (CMS) disclose the list of homecare providers whose bids were used to calculate home medical equipment reimbursement rates under the Medicare "competitive" bidding program. See letter at www.aahomecare.org.
"Without knowing the identity, as well as the appropriate overall qualifications of these providers, we cannot evaluate the program's impact in terms of quality and access to care for seniors we represent," states the congressional letter to CMS Administrator Donald Berwick, M.D.
While CMS intends to release this information in the fall after contracts are finalized, members of Congress are calling on CMS to share this information now to make sure that the disastrous mistakes of the 2008 Round One of bidding are avoided and to uphold President Obama's pledge of "transparency and open government."
"We want to ensure that qualified providers have been chosen to provide these items and services to our constituents," said the congressional letter to CMS. "The healthcare community will again have very serious problems if it turns out once more that these companies are unable to provide sufficient access to quality items and services or do not have the financial ability to operate under the new contracted rates."
When CMS held its Round One bid for home medical equipment in 2008, Congress halted implementation and called for a re-bid of the program after numerous problems emerged. For example, under the Round One bidding in 2008, Medicare contracts were granted to providers that were not appropriately licensed and lacked experience with the devices for which they were awarded contracts.
The American Association for Homecare, which represents durable medical equipment providers, is encouraged by the House letter and urges CMS to comply with this important request. The congressional letter, sent on August 11, asked CMS to respond by August 20. At the time of this press release, the Association is not aware of any response so far by the agency.
"We are pleased that so many members of Congress understand the need for transparency and the urgency of this request," said Tyler Wilson, president of AAHomecare. "Transparency for the bid process is critical given past problems with this whole program. If CMS delays the release of information until fall, it will impede the ability to assess the impact of the bidding program on Medicare patients.
"One of our concerns is that providers who submitted low, desperation bids out of their perceived need to remain a Medicare supplier could well determine the government's reimbursement rates - even if those companies ultimately declined to actually provide the equipment at those rates."
The Medicare bidding program for home medical equipment uses a degree of economic coercion to force homecare providers to submit bids necessary to win a contract. Because Medicare is the largest third-party purchaser of home medical care, its market power effectively coerces providers to bid at reimbursement rates low enough to ensure the opportunity to continue serving Medicare beneficiaries. Ultimately, the below-market rates achieved through this bidding program may be unsustainable, reducing competition in the long term and reducing seniors' access to care and choice of providers.
In the first round of the bidding program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items. Congress delayed the implementation of the initial bidding program in 2008 to allow for needed changes. The home medical equipment sector paid for that delay by taking a 9.5 percent nationwide reimbursement cut. However, CMS ignored congressional intent, did not address the flaws that precipitated the delay two years ago, and is now charging headlong into the program in 9 of the 10 largest metropolitan statistical areas in the U.S. An additional 91 areas will be subjected to the bidding process next year.
A bipartisan bill pending in Congress, H.R. 3790, calls for the repeal of the Medicare bidding program for home medical equipment and it would substantially reduce reimbursement rates for the equipment but preserve the nation's vital, cost-effective homecare infrastructure. That bill is supported by 255 members of the U.S. House of Representatives.
The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.
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"Without knowing the identity, as well as the appropriate overall qualifications of these providers, we cannot evaluate the program's impact in terms of quality and access to care for seniors we represent," states the congressional letter to CMS Administrator Donald Berwick, M.D.
While CMS intends to release this information in the fall after contracts are finalized, members of Congress are calling on CMS to share this information now to make sure that the disastrous mistakes of the 2008 Round One of bidding are avoided and to uphold President Obama's pledge of "transparency and open government."
"We want to ensure that qualified providers have been chosen to provide these items and services to our constituents," said the congressional letter to CMS. "The healthcare community will again have very serious problems if it turns out once more that these companies are unable to provide sufficient access to quality items and services or do not have the financial ability to operate under the new contracted rates."
When CMS held its Round One bid for home medical equipment in 2008, Congress halted implementation and called for a re-bid of the program after numerous problems emerged. For example, under the Round One bidding in 2008, Medicare contracts were granted to providers that were not appropriately licensed and lacked experience with the devices for which they were awarded contracts.
The American Association for Homecare, which represents durable medical equipment providers, is encouraged by the House letter and urges CMS to comply with this important request. The congressional letter, sent on August 11, asked CMS to respond by August 20. At the time of this press release, the Association is not aware of any response so far by the agency.
"We are pleased that so many members of Congress understand the need for transparency and the urgency of this request," said Tyler Wilson, president of AAHomecare. "Transparency for the bid process is critical given past problems with this whole program. If CMS delays the release of information until fall, it will impede the ability to assess the impact of the bidding program on Medicare patients.
"One of our concerns is that providers who submitted low, desperation bids out of their perceived need to remain a Medicare supplier could well determine the government's reimbursement rates - even if those companies ultimately declined to actually provide the equipment at those rates."
The Medicare bidding program for home medical equipment uses a degree of economic coercion to force homecare providers to submit bids necessary to win a contract. Because Medicare is the largest third-party purchaser of home medical care, its market power effectively coerces providers to bid at reimbursement rates low enough to ensure the opportunity to continue serving Medicare beneficiaries. Ultimately, the below-market rates achieved through this bidding program may be unsustainable, reducing competition in the long term and reducing seniors' access to care and choice of providers.
In the first round of the bidding program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items. Congress delayed the implementation of the initial bidding program in 2008 to allow for needed changes. The home medical equipment sector paid for that delay by taking a 9.5 percent nationwide reimbursement cut. However, CMS ignored congressional intent, did not address the flaws that precipitated the delay two years ago, and is now charging headlong into the program in 9 of the 10 largest metropolitan statistical areas in the U.S. An additional 91 areas will be subjected to the bidding process next year.
A bipartisan bill pending in Congress, H.R. 3790, calls for the repeal of the Medicare bidding program for home medical equipment and it would substantially reduce reimbursement rates for the equipment but preserve the nation's vital, cost-effective homecare infrastructure. That bill is supported by 255 members of the U.S. House of Representatives.
The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.
-----
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Tuesday, October 06, 2009
Insurance Deregulation Is Not Financial Reform, Says Consumer Watchdog
/PRNewswire/ -- Consumer Watchdog called on Congress to reject legislation allowing the Treasury Department to use international agreements to override state insurance laws, including those requiring insurers to hold enough money to pay all claims. The proposal is under consideration in the U.S. House Financial Services Committee today.
"State insurance regulators made sure that insurance companies had enough money in the bank to pay policyholder claims and weather the financial storm. Congress should not give a political appointee the power to take away that authority on behalf of foreign insurance companies," said Carmen Balber, Washington Director for Consumer Watchdog. "This bill promotes insurance deregulation as Congress should be strengthening financial service sector regulation."
Download Consumer Watchdog's letter with Public Citizen and US PIRG here: http://www.consumerwatchdog.org/resources/FedInsOfc10-6-09.pdf
The proposal, a discussion draft amending H.R. 2609 offered by Rep. Kanjorski, would give the Treasury Secretary unilateral new authority to negotiate international insurance agreements on prudential issues, determine if state insurance laws are "inconsistent" with such an agreement, and then preempt those state laws. Safeguards intended to exempt specific state insurance laws from preemption do not go far enough to protect important consumer protections, wrote the groups.
The letter reads: "Never before has the U.S. government allowed a federal agency to unilaterally interpret or enter into international agreements on subject matter under the authority of the legislative branch, and then preempt states through rule-making on the basis that state policies are in contradiction to those agreements."
Consumer Watchdog also objected to the lack of consumer representation on the Financial Services witness panel today.
Rep. Kanjorski offered similar legislation last year, which was pulled back in the wake of AIG's dramatic collapse.
Download Consumer Watchdog's letter opposing last year's legislation here: http://www.consumerwatchdog.org/resources/HR5840.pdf
Download last year's letter from Public Citizen and US PIRG: http://www.consumerwatchdog.org/resources/HR-5840-letter-Consumer.pdf
The groups supported efforts to develop greater federal information and expertise in insurance but noted that the proposed legislation goes far beyond information gathering.
In California, where voters enacted the nation's toughest system of insurance regulation with Proposition 103, consumers are protected from unfair or excessive insurance rates, illegal surcharges and other abusive and discriminatory practices. Any move to federalize insurance regulation would jeopardize these consumer protections, said Consumer Watchdog.
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"State insurance regulators made sure that insurance companies had enough money in the bank to pay policyholder claims and weather the financial storm. Congress should not give a political appointee the power to take away that authority on behalf of foreign insurance companies," said Carmen Balber, Washington Director for Consumer Watchdog. "This bill promotes insurance deregulation as Congress should be strengthening financial service sector regulation."
Download Consumer Watchdog's letter with Public Citizen and US PIRG here: http://www.consumerwatchdog.org/resources/FedInsOfc10-6-09.pdf
The proposal, a discussion draft amending H.R. 2609 offered by Rep. Kanjorski, would give the Treasury Secretary unilateral new authority to negotiate international insurance agreements on prudential issues, determine if state insurance laws are "inconsistent" with such an agreement, and then preempt those state laws. Safeguards intended to exempt specific state insurance laws from preemption do not go far enough to protect important consumer protections, wrote the groups.
The letter reads: "Never before has the U.S. government allowed a federal agency to unilaterally interpret or enter into international agreements on subject matter under the authority of the legislative branch, and then preempt states through rule-making on the basis that state policies are in contradiction to those agreements."
Consumer Watchdog also objected to the lack of consumer representation on the Financial Services witness panel today.
Rep. Kanjorski offered similar legislation last year, which was pulled back in the wake of AIG's dramatic collapse.
Download Consumer Watchdog's letter opposing last year's legislation here: http://www.consumerwatchdog.org/resources/HR5840.pdf
Download last year's letter from Public Citizen and US PIRG: http://www.consumerwatchdog.org/resources/HR-5840-letter-Consumer.pdf
The groups supported efforts to develop greater federal information and expertise in insurance but noted that the proposed legislation goes far beyond information gathering.
In California, where voters enacted the nation's toughest system of insurance regulation with Proposition 103, consumers are protected from unfair or excessive insurance rates, illegal surcharges and other abusive and discriminatory practices. Any move to federalize insurance regulation would jeopardize these consumer protections, said Consumer Watchdog.
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Friday, March 13, 2009
The Amputee Coalition of America and Nearly 200 Amputees and Patient Advocates Go to Washington
(BUSINESS WIRE)--On Tuesday, March 10, the Amputee Coalition of America had nearly 200 amputees and patient advocates from 34 states in Washington, D.C., to urge members of Congress to support fair insurance coverage for artificial arms and legs. Their message was simple: Arms and legs are not a luxury!
These citizen lobbyists made this trip to tell lawmakers that they need their own “bailout.” Many of them have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to work and live.
“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition president and CEO. “We intend to turn this tide, and this event is a great example of the grassroots support we have from across the country. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”
Jeffrey Cain, MD, is a bilateral lower-limb amputee and a member of the Amputee Coalition’s Board of Directors and Medical Advisory Committee. Dr. Cain is an excellent example of how prosthetic devices can help amputees function in their daily lives and contribute to society rather than become dependent on it.
“Being able to have prosthetic devices means that I can take care of my patients and teach medical students,” said Dr. Cain.
Unfortunately, working people with employer-provided health insurance plans are often the ones with the biggest problems, Dr. Cain noted. “Because employer-provided insurance plans are increasingly introducing unreasonable limits and caps, if you have a job in America – if you are a hardworking member of society – you can’t afford a leg to stand on. It’s gotten that bad.”
In fact, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.
“Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime,” Calhoun said. “No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”
These types of insurance company practices pose especially grave challenges for families of children with limb loss.
Rick Castro, of Connecticut, took two of his children to the event because he wanted to try to get better prosthetic coverage for all families, including his own. Castro’s 4-year-old daughter Jennifer was born missing part of her arm below the elbow, and Castro is well aware that, as she grows, she’ll need several highly expensive prosthetic devices.
“When people find out that their insurance company doesn’t provide fair coverage for prosthetic devices, what do they do?” asked Dr. Cain. “They mortgage their homes, raid their children’s college fund, go into debt, turn to government programs for assistance, or are forced to have bake sales to try to pay for these medically necessary and often very expensive devices. That’s pretty sad, especially when they’ve paid their insurance premiums for years for this very purpose.”
David Ross, of New York City, lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway in 1997. He’s seen what happens when amputees have to settle for devices that are not really what they need because of the limitations in their insurance policies, and that’s what brought him to Capitol Hill.
“It’s so unfair that prosthetics are not covered by health insurance plans to the same degree that other conditions are,” Ross said. “It’s a shame that a lot of my fellow amputees who have already had to get over a traumatic accident or being born without a limb have to fight for something that should already be included in their insurance policy.”
Robert D. Doty, Jr., MD, who lost his left arm as a result of a car falling on him, has had problems with his insurance company not understanding – or not acknowledging – his prosthetic needs.
“My carrier did not want to cover a body-powered prosthesis after covering a myoelectric prosthesis,” Doty said. “The company said that one prosthesis is as good as another and that they can do the same thing, which is not true. I can’t do anything around water, liquids, chemicals or heavy machinery or do any heaving lifting with my myoelectric prosthesis without damaging it. It’s great for doing fine, precise work, but if I’m going to be doing heavy lifting or working around water or liquids, a body-powered prosthesis is better. I really need both.”
As these nearly 200 citizen lobbyists hustled from office to office, they made it clear that they want change. In a single day, they made more than 60 Senate visits and more than 100 House visits. In addition, 26 organizations, including disability rights groups and O&P [orthotic and prosthetic] professional organizations, have now signed on with the Amputee Coalition of America to help move this legislation forward.
“We are thrilled with the results of the day,” said Morgan Sheets, the Amputee Coalition’s national advocacy director. “We are already hearing from House and Senate members who are interested in co-sponsoring our bills and supporting our efforts for fair coverage of artificial arms and legs. The turnout exceeded our expectations, and the great enthusiasm of the participants has certainly encouraged us to continue this important fight for fairness.”
-----
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These citizen lobbyists made this trip to tell lawmakers that they need their own “bailout.” Many of them have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to work and live.
“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition president and CEO. “We intend to turn this tide, and this event is a great example of the grassroots support we have from across the country. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”
Jeffrey Cain, MD, is a bilateral lower-limb amputee and a member of the Amputee Coalition’s Board of Directors and Medical Advisory Committee. Dr. Cain is an excellent example of how prosthetic devices can help amputees function in their daily lives and contribute to society rather than become dependent on it.
“Being able to have prosthetic devices means that I can take care of my patients and teach medical students,” said Dr. Cain.
Unfortunately, working people with employer-provided health insurance plans are often the ones with the biggest problems, Dr. Cain noted. “Because employer-provided insurance plans are increasingly introducing unreasonable limits and caps, if you have a job in America – if you are a hardworking member of society – you can’t afford a leg to stand on. It’s gotten that bad.”
In fact, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.
“Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime,” Calhoun said. “No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”
These types of insurance company practices pose especially grave challenges for families of children with limb loss.
Rick Castro, of Connecticut, took two of his children to the event because he wanted to try to get better prosthetic coverage for all families, including his own. Castro’s 4-year-old daughter Jennifer was born missing part of her arm below the elbow, and Castro is well aware that, as she grows, she’ll need several highly expensive prosthetic devices.
“When people find out that their insurance company doesn’t provide fair coverage for prosthetic devices, what do they do?” asked Dr. Cain. “They mortgage their homes, raid their children’s college fund, go into debt, turn to government programs for assistance, or are forced to have bake sales to try to pay for these medically necessary and often very expensive devices. That’s pretty sad, especially when they’ve paid their insurance premiums for years for this very purpose.”
David Ross, of New York City, lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway in 1997. He’s seen what happens when amputees have to settle for devices that are not really what they need because of the limitations in their insurance policies, and that’s what brought him to Capitol Hill.
“It’s so unfair that prosthetics are not covered by health insurance plans to the same degree that other conditions are,” Ross said. “It’s a shame that a lot of my fellow amputees who have already had to get over a traumatic accident or being born without a limb have to fight for something that should already be included in their insurance policy.”
Robert D. Doty, Jr., MD, who lost his left arm as a result of a car falling on him, has had problems with his insurance company not understanding – or not acknowledging – his prosthetic needs.
“My carrier did not want to cover a body-powered prosthesis after covering a myoelectric prosthesis,” Doty said. “The company said that one prosthesis is as good as another and that they can do the same thing, which is not true. I can’t do anything around water, liquids, chemicals or heavy machinery or do any heaving lifting with my myoelectric prosthesis without damaging it. It’s great for doing fine, precise work, but if I’m going to be doing heavy lifting or working around water or liquids, a body-powered prosthesis is better. I really need both.”
As these nearly 200 citizen lobbyists hustled from office to office, they made it clear that they want change. In a single day, they made more than 60 Senate visits and more than 100 House visits. In addition, 26 organizations, including disability rights groups and O&P [orthotic and prosthetic] professional organizations, have now signed on with the Amputee Coalition of America to help move this legislation forward.
“We are thrilled with the results of the day,” said Morgan Sheets, the Amputee Coalition’s national advocacy director. “We are already hearing from House and Senate members who are interested in co-sponsoring our bills and supporting our efforts for fair coverage of artificial arms and legs. The turnout exceeded our expectations, and the great enthusiasm of the participants has certainly encouraged us to continue this important fight for fairness.”
-----
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