The House of Representatives may vote on legislation this week that would stop a scheduled June 1 payment cut for doctors who accept Medicare physicians. Lawmakers may also act to extend higher Medicaid payment to states and subsidies to help laid-off workers purchase health care coverage. Separately, Republicans have begun to criticize the Obama administration’s nomination of Donald Berwick to head the Centers for Medicare and Medicaid Services (CMS).
JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. Congress is hoping to get out of town later this week for the Memorial Day recess, but before lawmakers head home, there is some unfinished business to deal with related to health care spending and more. Here to fill us in is Mary Agnes Carey, senior correspondent for Kaiser Health News. Welcome, as always.
MARY AGNES CAREY: Thank you.
JACKIE JUDD: There are three items I want to walk through first off. One is called the Doc Fix, two a Cobra extension, and three the Medicaid Life Line. The Doctor Fix: years ago the government established a very complicated system by which to reimburse doctors who treat Medicare patients, and every year Congress has to come back or sometimes more frequently to make sure that the doctors don’t realize a serious cut in the payments. That is what Congress is facing now. What are the options before Congress and what does it look like they will ultimately decide upon?
MARY AGNES CAREY: It looks like they are zeroing in on a doc fix, if you will, that would stop the payment cuts for a few years but they would resume in 2014. We are talking about modest increases, maybe 1-percent, in that ball park, with doctors who do preventative care possibly getting a bit more.
The American Medical Association is very unhappy about a fix that is not permanent. They have said for years, please let’s fix this problem. As we’ve talked about many times here, Congress continues to face and doctors continue to face who take Medicare patients these potential payment cuts. They are looking at a June 1st payment cut of 21-percent, so that is what Congress wants to stop.
JACKIE JUDD: And what is the likelihood that there will be a settlement that both Democrats and Republicans can agree upon?
MARY AGNES CAREY: I think if they can’t agree to a multiyear fix at this point, they might go for a shorter fix. We have had these short-term extensions. The nearest one is expiring June 1st.
There is some conversation now as we head into the Memorial Day weekend that if they can’t agree on a longer package, perhaps to a shorter term fix, but Congress, Republicans and Democrats, tend to unite on this because nobody wants to cut Medicare payments for physicians because that could mean that they don’t take Medicare patients who are their constituents.
JACKIE JUDD: Okay. Item number two, the Cobra extension. Cobra of course is the health insurance intended to carry people through a period of time when they are unemployed. During the high unemployment months of the previous year and a half or so, the government has offered a subsidy of 65-percent. What would this extension do if passed?
MARY AGNES CAREY: They want to take that 65-percent subsidy through the end of the year. That was also going to expire on June 1st. But, as we know, a lot of people have lost their jobs; they have lost their health insurance. Cobra is quite expensive for people. They have to pay the full freight of their premium, so this would extend that subsidy through the end of the year.
JACKIE JUDD: Is there any opposition to this proposal?
MARY AGNES CAREY: Well, there is always concern, especially now about the price. This whole package is close to $200 billion. Now, it also includes a lot of tax extenders and other provisions, but Democrats, especially moderate Democrats, are getting a little sensitive about the price factor, but then again these are their constituents, they have lost their jobs, the economy is still struggling and we have got an election coming up in November, so I think that they will try to get some sort of resolution on this to help people.
JACKIE JUDD: Okay and item three, the Medicaid Life Line. The Federal Government essentially increased the payments it makes to states so the states need to pony up a little less, what would this do?
MARY AGNES CAREY: This would take those increased Federal matching for Medicaid through June of next year. States are now beginning to plan their budgets for next year. They have been looking to Congress; will you help us with this Medicaid money?
And Congress is likely to respond because again, as we have talked about a weak economy, people have lost their jobs, they have turned more to Medicaid, the Medicaid enrollment is increasing, and states bear the brunt as does the Federal government, this is an increase in that Federal match to help.
JACKIE JUDD: And yet there has to be an argument from the other side about the increasing Federal deficit.
MARY AGNES CAREY: There exactly is and that is going to pervade all these three times and many more in this package, how much do we want to spend? How much do we want to raise the deficit? What are the pros? What are the cons? It is going to be a continuous thing throughout the fall.
JACKIE JUDD: Okay, Don Berwick, nominated by President Obama to run Medicare and Medicaid, some delays going on in Congress, what is your forecast on this?
MARY AGNES CAREY: The Senate Finance Committee is now reviewing all of his paperwork for the nomination. This is a very time consuming process and I think it is very clear that when the Finance Committee considers that nomination, Republicans will use this to their vantage point to try to point out flaws in the Health care bill, things they disagree with.
It will be another chance for them to say things such as the Health care bill is too expensive, you shouldn’t require people to buy health care coverage. Again, this is the whole individual mandate issue. The bill doesn’t do enough to reduce costs. They will look to things Dr. Berwick has said and written over past years.
For example, they will look to previous speeches and say they indicate that he wants to ration health care, and the counterpoint will be of course that you’ve got to look at his remarks in a fuller context, and that there is already rationing of the current health care system, why not put in an expert like Dr. Berwick who wants to improve the quality of the health care system, and perhaps lower its cost.
JACKIE JUDD: If this is delayed for a considerably long period of time, will that have ramifications on not only Medicare and Medicaid as it now stands but the implementation process?
MARY AGNES CAREY: I think it only hurts the implementation process and will slow it. CMS has not had an administrator for awhile. Dr. Berwick is very clearly aligned with the ideas in the Health care bill that many Democrats and some Republicans support as well, improving quality in Medicare and Medicaid, and while you have got a lot of great folks, of course, at HHS and CMS working away on implementation, if you don’t have an administrator, it does slow and complicate the process.
JACKIE JUDD: Okay and the final item, last week of course we spent a lot of time talking about last Tuesday’s elections. Given the results, what is your take on how important an issue the health care reform law was in any of these contests?
MARY AGNES CAREY: We talked about several contests, but I think if you look at Arkansas, that is where health care really played out. Blanche Lincoln, a sitting Senator, is trying to get reelected again. There was a three way primary and no one got enough votes and so there will be another run off. She is going to go up against the Lieutenant Governor Bill Halter. But health care is squaring off there very important as an issue.
Blanche Lincoln kind of got it from both sides. Liberals said you weren’t strong enough in your support of the President’s health care package. You should have strongly come out in favor of a public option, which she did not. Conservatives were angry that she backed an earlier version of the bill, saying she shouldn’t have done that.
The health care bill appears very unpopular in Arkansas and so I think that is a race to watch, to see how health care plays out for this primary, which will come up again on June 8th and the fall elections.
JACKIE JUDD: Okay we covered a lot of territory.
MARY AGNES CAREY: We did.
JACKIE JUDD: Thank you so much, Mary Agnes Carey. Thank you for watching. This has been Health on the Hill and I’m Jackie Judd.