The super committee, a.k.a. the Joint Select Committee on Deficit Reduction, must offer Congress by Nov. 23 its ideas on how to trim at least $1.2 billion over 10 years from the federal deficit. In the weeks since this panel was established, thousands of organizations have weighed in — offering ideas and assistance about how to reach this target, and even warnings about the dire implications some steps could have.
To help give a sense of the enormity of the pressure faced by panel members, KHN has examined just one of many areas the committee must consider. Here is a sampling of the advice and requests from health care interests.
| Selections From Interest Group Advertising Messages | |
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| AARP | Primary goal: |
| To prevent cuts to Medicare and Medicaid benefits, and the increased cost-shifting that would affect beneficiaries’ access to care. | |
| Quote: | |
| “Older Americans recognize the urgent need to address the nation’s fiscal deficit … But older Americans, across party and regional lines, strongly oppose fast-track cuts to the health care and retirement benefits they have paid into and depend upon.”
– A. Barry Rand, CEO of AARP, in an Oct. 19 letter. |
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| Access To Medical Imaging Coalition | Primary goal: |
| To avoid prior-authorization requirements for Medicare imaging services and reimbursement cuts for advanced diagnostic imaging services. | |
| Quote: | |
| “A burdensome and unsubstantiated prior authorization program and further reimbursement cuts — before the effects of existing policies can be understood — are ill-advised and will only continue to reduce access to life-saving medical imaging services for our seniors.”
– Nov. 3 letter signed by AMIC and 22 other patient advocacy and professional organizations. |
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| American Academy Of Actuaries | Primary goal: |
| With an eye on the future of Medicare, urges the super committee to slow health care spending growth. | |
| Quote: | |
| “As you consider potential Medicare reforms in the context of deficit reduction, it is important to evaluate the impact those reforms could have on the viability of the Medicare program including cost, access, and quality of care. In addition, improving Medicare’s long-term sustainability requires slowing the growth in overall health spending – not simply shifting costs from one payer to another.” – Edwin C. Hustead, chairperson of the AAA’s Medicare Steering Committee, in an Aug. 31 letter. | |
| American Dental Association | Primary goal: |
| To ensure adequate funding of programs that prevent oral disease, conduct cutting edge research and train the next generation of dentists. | |
| Quote: | |
| “As you work to achieve savings in the federal budget, please do not sacrifice the strides we have made in preventing oral disease and improving dental access for America’s most vulnerable populations, and consider the long-term cost savings associated with maintaining the nation’s oral health through vital and proven federal programs.”
– Raymond Gist, ADA president, and Kathleen O’Loughlin, ADA executive director, in an Oct. 6 letter. |
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| American Diabetes Association | Primary goal: |
| To prevent cuts to Medicare, Medicaid, the Centers for Disease Control and Prevention’s diabetic surveillance programs and the National Institute of Diabetes and Digestive and Kidney Diseases. | |
| Quote: | |
| “Over 14 million people rely on Medicare and Medicaid for their diabetes care, so for us this is why protecting the services that exist in Medicaid and Medicare for people with diabetes is critical.”- Tekisha Dwan Everette, ADA managing director of federal government affairs, in an interview. | |
| American Health Care Association | Primary goal: |
| To change the current payment system from one that pays providers based on the type of facility to a new model that pays providers based on the type of care the patient needs. | |
| Quote: | |
| “We have a demographic tidal wave that’s coming up for our sector. … Demand is going to grow, so if you decrease supply, access will be affected. It’s just that simple. So as demand grows, we would like to at least keep pace.”
– Greg Crist, AHCA vice president of public affairs, in an interview. |
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| American Hospital Association | Primary goal: |
| To avoid Medicare and Medicaid hospital payment cuts, therefore preventing negative effects on the health care workforce and care for the vulnerable. | |
| Quote: | |
| “We would like to work with you to find positive solutions to alleviate this pressure while maintaining a strong safety net. Sound policy changes would reduce the overall costs in the health care system—not simply shift existing and growing costs onto states, providers and beneficiaries, and damaging the nation’s already fragile economy.”
– Oct. 12 letter signed by AHA, the National Association of Public Hospitals and Health Systems, the Association of American Medical Colleges, the National Association of Children’s Hospitals and others. |
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| American Medical Association | Primary goal: |
| To prevent an estimated 30 percent cut from taking effect Dec. 31st by repealing Medicare’s physician payment formula. | |
| Quote: | |
| “With a 30 percent across-the-board payment cut in physician services scheduled for January 1, 2012, the implications of continuing this practice of simply putting off cuts to future years are clear. Continued access to care for our nation’s senior and disabled citizens is seriously threatened.”
– A Sept. 20 letter signed by the AMA, state medical societies and many specialty medical societies. |
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American Occupational Therapy Association (and other related advocacy groups) |
Primary goal: |
| To secure a permanent repeal of Medicare’s annual financial cap on physical therapy, speech-language pathology services and outpatient occupational therapy. | |
| Quote: | |
| “An arbitrary therapy cap on outpatient services without regard to clinical appropriateness of care discriminates against the most vulnerable of Medicare beneficiaries. … Repeal of the therapy caps is the only effective way to provide a long term solution to this flawed policy and to enact responsible deficit reduction.”
– A Sept. 27 letter signed by AOTA, the American Physical Therapy Association and a number of other organizations. |
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| America’s Health Insurance Plans | Primary goal: |
| To streamline benefits for the Medicare and Medicaid “dual-eligible” beneficiaries to coordinate care better and reduce the costs for this very expensive population. | |
| Quote: | |
| “Although they comprise only 15 percent of all Medicaid beneficiaries, dual eligibles account for nearly 40 percent of all Medicaid expenditures. Addressing the challenges of bringing together two distinct programs to produce a comprehensive approach to care can have substantial rewards for beneficiaries, offer efficiencies that produce savings for States and the Medicare program.”
– AHIP Proposal: Achieving Medicare/Medicaid Integration for Dually Eligible Beneficiaries |
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| amfAR: The Foundation for AIDS Research | Primary goal: |
| To avoid across-the-board cuts that will result in a $5 billion reduction over nine years to global health investments, which would include HIV/AIDS programs. | |
| Quote: | |
| “We urge the House and Senate members on the super committee — as well as the full Congress — to consider the human lives at stake in the budgeting process, and to recognize how damaging it would be to make serious cuts in global health funding.”
– Kevin Frost, amfAR CEO, in an Oct. 14 statement. |
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| Chamber of Commerce | Primary goal: |
| To reform entitlement programs, reduce debt and completely restructure the U.S. tax code in order to stimulate job growth. | |
| Quote: | |
| “Entitlement spending is out of control, on autopilot, and leading America toward fiscal disaster. Moreover, Congress cannot fix the root cause of the problem without addressing the entitlement programs of Medicare, Medicaid, and Social Security.”
– Bruce Josten, the Chamber’s executive vice president for government affairs, in an Aug. 16 letter. |
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| Children’s Health Fund | Primary goal: |
| To make sure that children’s health safety net programs are not harmed in federal budget negotiations. | |
| Quote: | |
| “Medicaid and the Child Health Insurance Program … must be preserved no matter what else changes in our country. When you start to cut the funds for Medicaid and CHIP you see children suffer.”
– Dr. Irwin Redlener, CHF president and co-founder, in an Oct. 25 statement. |
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| Congressional Black Caucus | Primary goal: |
| To urge the super committee to consider the effect of their proposals on the nation’s most vulnerable, including minority populations. | |
| Quote: | |
| “As the committee reviews issues in areas including energy, telecommunications, financial services, healthcare and education, careful consideration must be given to the impact of the various recommendations on minority communities. … These programs are vital to national interests as they train our workforce, stabilize our economy, and provide funding for our cities.”
– an Oct. 12 letter signed by Reps. Emanuel Cleaver, II, CBC chairman, and Robert C. “Bobby” Scott, chairman of the CBC Budget, Appropriations and Taxation Task Force. |
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| Democratic Governors Association | Primary goal: |
| To protect against Medicaid cuts and proposals to block grant the program while finding Medicaid savings using medical homes and coordinating care for “dual eligibles.” | |
| Quote: | |
| “Federal funding shortfalls for Medicaid could be even larger in certain years under a block grant because the proposal would not provide for any funding increases in … economic downturns. Such draconian cuts to a program that serves as the last line of defense for many hard-working Americans in need of critical health care services will increase the number of uninsured and emergency room costs.”
– An Oct. 13 letter signed by Maryland Gov. Martin O’Malley and other members of the DGA. |
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| Families USA | Primary goal: |
| To preserve Medicaid and ensure half of any deficit reduction figure approved by the super committee comes from new revenue. | |
| Quote: | |
| “Focusing on cuts alone will short-change our future opportunities, continue to pinch the middle class, and hurt the most vulnerable among us. A balanced approach that brings in significant revenue makes sense, protects critical programs, and is what the public wants.”
– Families USA, A Message to Congress and the Super Committee, Sept. 2011 |
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| Health Care Leadership Council | Primary goal: |
| To advance recommendations for overhauling Medicare that include a Medicare “exchange” modeled after the Federal Employees Health Benefits Program; raising the program’s eligibility age; and updating Medicare’s cost-sharing structure. | |
| Quote: | |
| “We fully agree with [the super committee] that in order to achieve sustainability and long term savings that Medicare does need some form of reform and structuring and we think it ought to be along these lines to enable competition between private plans to drive value up and drive cost down.”
– Michael Freeman, HCLC executive vice president, in an interview. |
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| Kidney Care Partners | Primary goal: |
| Since they are dependent on Medicare for life-sustaining dialysis, to prevent cuts to Medicare beneficiaries with kidney failure as well as guard against cuts to Medicare reimbursement rates that disproportionately affect dialysis facilities. | |
| Quote: | |
| “We in the kidney care community urge you to avoid across-the-board cuts. MedPAC has consistently recognized the extremely narrow Medicare margins of dialysis facilities. Because Medicare becomes available to individuals upon diagnosis with kidney failure rather than age, approximately 80 percent of all dialysis patients are Medicare beneficiaries.”
– Ronald Kuerbitz, chairman of Kidney Care Partners, in a Sept. 19 letter. |
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| Medicare Rights Center | Primary goal: |
| To focus attention on the need to address health care costs by considering delivery and payment system reforms that reward quality over quantity. Increases in revenue also must be part of the equation. | |
| Quote: | |
| “As the deadline for a deficit-reduction package fast approaches, we ask members of the super committee and policymakers at large to remember that people with Medicare already have ‘skin in the game.’ Proposals that increase costs or cut benefits for Medicare beneficiaries can have tragic consequences for their health, quality of life, and financial well-being, as well as the financial well-being of their families and caregivers.”
– MRC President Joe Baker in a Nov. 1 statement. |
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| National Association of Chain Drug Stores | Primary goal: |
| To ensure that prescription drug spending is not considered in a vacuum, and to focus instead on policies that increase medication adherence and maintain patient choice. | |
| Quote: | |
| “While reducing healthcare costs is essential, it is not possible or advisable to consider spending on prescription drugs in a vacuum, separate from the substantial cost avoidance that they make possible. Furthermore, community pharmacy’s role in maximizing the effectiveness of prescription drugs makes community pharmacy’s value unsurpassed within healthcare delivery.”
– Steven C. Anderson, president and CEO of NACDS, in a Sept. 8 letter. |
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| National Association of Community Health Centers | Primary goal: |
| To stave off direct cuts to community health centers, as well as cuts to Medicaid, which covers many patients who use the centers. | |
| Quote: | |
| “Do not undermine the successful Health Centers program as you negotiate Medicaid changes and cuts to the federal budget.”
– Oct. 14 message of a nationwide call-in to lawmakers. |
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| National Association for Home Care and Hospice | Primary goal: |
| To prevent the creation of a Medicare home-health copayment — which would shift costs to older, poorer, sicker people who are least able to afford it. | |
| Quote: | |
| “We had a home health co-pay in Medicare prior to 1972 and Congress eliminated it because it tended to cost more to collect than you saved and it shifted seniors into more costly settings such as nursing homes and hospitals. We don’t want to go backwards.”
– Jeff Kincheloe, vice president for government affairs at the NAHCH, in an interview. |
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| National Council of La Raza | Primary goal: |
| To reject plans to shift federal costs to state Medicaid programs, or to Medicare and Medicaid beneficiaries; and fend off efforts to undermine implementation of the health law. | |
| Quote: | |
| “The fact is, is that Medicaid is one of the foundations for our health care system and it serves one in six Americans and so we can’t take cuts to that system lightly. … Medicaid is not driving the health care spending and we really need to be looking at other ways to seek savings out of the system instead of targeting the most vulnerable.”
– Jennifer Ng’andu, deputy director of NCLR’s Health Policy Project, in an interview. |
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| National Medical Association | Primary goal: |
| To avoid Medicaid and Medicare cuts in order to protect vulnerable Americans who are looking for affordable and timely care. | |
| Quote: | |
| “[NMA physicians] remain committed to caring for Medicare patients and are keenly watching any proposed changes in this program. If reductions in federal spending force providers out of the Medicare system … more and more vulnerable Americans will postpone much needed care because they cannot find a physician in a timely manner. This … leads to more expensive care down the road, with less desirable clinical outcomes.”
– Dr. Cedric Brite, NMA’s president, in an Aug 29 letter. |
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| National Rural Health Association | Primary goal: |
| To avoid Medicare cuts that would particularly affect critical access hospitals. | |
| Quote: | |
| “Elimination of these crucial payments or reductions in payments … will be devastating to rural hospitals in rural America and facilities will close.”
– NRHA message to the super committee. |
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| Partnership to Fight Chronic Disease | Primary goal: |
| To generate significant savings in Medicare and Medicaid by using well-tested strategies to better manage the care of chronic conditions and encourage health behaviors. | |
| Quote: | |
| “In light of the evidence, there is a clear path forward which will pull costs out of the system and do so without sacrificing the benefits and quality of services upon which millions of Americans rely.”
– a Nov. 10 letter signed by Kenneth E. Thorpe, PFCD executive director, and organization partners. |
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| Pharmaceutical Research and Manufacturers of America | Primary goal: |
| To ensure that deficit reduction efforts don’t undermine Medicare’s drug benefits. | |
| Quote: | |
| “We believe that proposed changes to Medicare prescription drug programs would be harmful to patients. Robust prescription drug benefits are critical to the health of Medicare beneficiaries. Implementing shortsighted policies could harm seniors, the Medicare program and the economy.”
– Senior Vice President Matt Bennett in a Nov. 7 statement. |
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| Pharmaceutical Care Management Association | Primary goal: |
| To offer debt-reduction solutions that involve greater use of pharmacy benefit management tools to save more than $100 billion in prescription drug costs over 10 years. | |
| Quote: | |
| “Appreciating the serious challenges you (the super committee members) face as you work to address the nation’s budget deficit and long-term debt, PCMA and its member companies stand ready to provide our insights and solutions to help lower costs while maintaining high access to prescription drug benefits.”
– PCMA President and CEO Mark Merritt in an Aug. 31 letter. |
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| Republican Governors Public Policy Committee | Primary goal: |
| Reform Medicaid to save states money using block grants or other financing methods; stop tax increases. | |
| Quote: | |
| “Going to a new ‘blended rate’ for FMAP and reducing provider fees collected by states are unfair cost-shifting measures that increase the burden to states. We are willing to do our share to save federal Medicaid dollars, but let us do it in a way that will reduce state taxpayer cost, too.”
– An Oct. 24 letter signed by Republican Govs. Bob McDonnell, Va.; Haley Barbour, Miss.; Chris Christie, N.J.; and Mitch Daniels, Ind. |
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| Research!America: | Primary goal: |
| To prevent cuts in federal funding for medical research and prevention programs, including automatic cuts that would result if the super committee fails to reach a deal. | |
| Quote: | |
| “Our nation is at a crisis point. The question for the members of the super committee is whether they will have profiles in courage or profiles in cowardice. In my judgment, if they fail to come to an agreement, the reaction of the public and the business community could be strong. Sequestration would be devastating for medical research funded by the National Institutes of Health and prevention programs offered by the Centers for Disease Control and Prevention. We simply can’t allow this to happen.”
– Honorable John E. Porter, chair of Research!America, in a Nov. 7 statement to KHN. |
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| Veterans of Foreign Wars | Primary goal: |
| To maintain veterans’ retirement benefits and avoiding a health care premium increase. | |
| Quote: | |
| “In establishing your committee, Congress acknowledged this sustained sacrifice by deeming veterans’ program as sacrosanct, should no debt reduction deal be reached in time. We ask that you take this caveat to heart when determining your course of action on veterans’ benefits.”
– an Oct. 21 letter by Robert Wallace, VFW executive director. |
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— Compiled by Sarah Barr, Shefali S. Kulkarni, Jessica Marcy, Christian Torres, Stephanie Stapleton, Andrew Villegas
