WeeklyFinancingNewsPulseNationalEditionfinal20091113.pdf (PDF | 274.42 kb)
SAMHSA222s Weekly Financing News Pulse: National Edition November 13, 2009 11/13/09 1 SAMHSA222s Weekly Financing News Pulse: National Edition National News Senate Democrats Await CBO Scores, Adjust Health Reform Timeline, and Consider New Taxes Legislators Plan to Attach Cost Saving Commission Provision to Debt Ceiling Legislation Democrats Strike Deal With Sen. Coburn Clearing Way for Veterans Health Bill House Clears Way for Vote on Medicare 223Doc Fix224 Bill Sen. Bayh Requests CBO Estimate of Health Reform222s Impact on Employer - Sponsored Insurance Secretary Sebelius Appoints 7 Members to AHRQ National Advisory Council FTC Investigating CVS Caremark Studies Released NCCBH Survey Finds Veterans Face Barriers to Behavioral Health Care CBPP Report Outlines How Medicaid ARRA Funding E xpiration Will Affect States, Calls for Additional Federal Relief Thomson Reuters Study Finds Hospitals Have Recovered to Pre - Recession Levels Survey Finds Physicians Favor Tort Reform Over Other Health Care Refo rms Report Estimates ACO222s Effect on Health Care Cost and Quality KFF Releases Summaries of HR 3962 Provisions KFF Examines Express Lane Eligibility for Medicaid and CHIP KFF Releases Resources Examining 2010 Medicare Offerings RAND Examines Multiple Approaches to Controlling Health Care Spending Study Attributes Increasing Medicaid Cost to Enrollment, Examines Cost Containment Strategies Some Cost Saving Innovations May Improve Outcomes Even When Slightly Less Effective Than Other Options Study Examines Adverse Selection in Medicare 223Part D224 Study Finds Primary Care Visit Duration and Quality Increased from 1997 to 2005 Around the Hill: Hearings on Health Financing To Subscribe to SAMHSA222s Weekly Financing News Pulse, please go to the following link and choose 223Health Care Financing224: https://service.govdelivery.com/service/multi_subscribe.html?code=USSAMHSA&origin=http://www.samhsa.go v/enetwork/success.aspx For quest ions or comments, please contact Kevin Hennessy ( kevin.hennessy@samhsa.hhs.gov ). SAMHSA222s Weekly Financing News Pulse: National Edition November 13, 2009 11/13/09 2 National News Senate Democrats Await CBO Scores, Adjust Health Reform Timeline, an d Consider New Taxes : After the House passed Democratic health care reform legislation ( HR 3962) on November 7, Senate Majority Leader Harry Reid (D - NV) is waiting for the Congressional Budget Office (CBO) to return cost estimates for numerous versions of the Senate Democrats222 health reform legislation before proceeding with a vote. Sen. Reid said he expects to begin floor debate on the Senate222s bill the week of November 16 and intends to pass health care reform in the Senate by the end of 2009, facilitating full congressional approval of a conference committee bill by January or February 2010. However, Senate Majority Whip Dick Durbin (D - IL) noted that Senate Democratic leadership will not schedule a procedural vote until they are certain that they have the 60 votes needed to invoke cloture and move on to the bill ( CQ Politics, 11/10 ; The Hill, 11/12 ; Kaiser Health News, 11/10 ). Still, on November 9, White House Press Secreta ry Robert Gibbs asserted that the Obama Administration remains committed to passing health care reform by the end of 2009 ( Kaiser Health News, 10/ 10 ). Meanwhile, as Sen. Reid awaits the CBO222s cost estimates, details emerged on two possible tax expansions under consideration as revenue sources for health care reform legislation. Sen. Reid222s aides and White House Office of Management and Budget (OMB) Director Peter Orszag say that the senator is considering applying Medicare taxes to non - wage income of couples earning $250,000 annually or increasing the 1.45 percent employee Medicare wage tax by 0.4 or 0.5 percent for individual222s wages above $200,00 0 and for joint - filers222 wages over $250,000. Sources say that any new tax would allow Sen. Reid to decrease the 40 percent excise tax on 223Cadillac224 health insurance plans presumed to be part of the Senate bill ( AP, 11/12 ; Kaiser Health News, 11/12 ). Finally, in the House, House Majority Leader Steny Hoye r (D - MD) issued a revised legislative calendar on November 11, keeping the house in session the weeks of November 16, November 30, December 7, and December 14 and indicating that House votes are possible December 21 and 22. The move is designed to allow f or a final House vote on health care reform by the end of the year and to provide the House additional time for numerous other crucial votes ( CQ Politics, 11/11 ). Legislators Plan to Attach Cost Saving Commission Provision to Debt Ceiling Legislation: Senate Budget Committee Chair Kent Conrad (D - ND) and Senator Judd Gregg (R- NH), the key architects of a measure to create an independent commission to draft proposals controlling costs for long - term entitlement programs, say they plan to attach the measure to a bill increasing the government222s debt ceiling. The measure would empower the commission to draft proposals controlling Medicare, Medicaid, and Social Security c osts and demand a swift congressional vote, requiring a super - majority to approve the proposals. A group of 15 Democratic senators said they would not approve a bill to increase the country222s debt ceiling without a provision to create such a commission. In addition, Senate Minority Leader Mitch McConnell (R - KY) said that he was open to the idea of such a commission, though he would not commit to the provision without knowing the details ( Kaiser Health News, 11/11 ; Kaiser Health News, 11/12 ). Dem ocrats Strike Deal W ith Sen. Coburn Clearing Way for Veterans Health Bill: On November 10, Senate Democratic leaders reached a tentative agreement with Senator Tom Coburn (R- OK) to stop blocking a vote on the Caregivers and Veterans Omnibus Health Services Act of 2009 ( SB 19 63 ), which provi des benefits to caregivers of veterans from the wars in Iraq and Afghanistan and expands veterans222 services in rural areas. Under the tentative deal, Sen. Coburn will introduce an amendment to offset the bill222s $3.7 billion cost and expand the bill to apply to all veterans. However, a spokesman for Senate SAMHSA222s Weekly Financing News Pulse: National Edition November 13, 2009 11/13/09 3 Veterans Affairs Committee Chair Daniel Akaka (D - HI) said cost offsets must come from within the bill itself ( CQ Today, 11/11 ; Kaiser Health News, 11/11 ; CQ Politics, 10/10 ; THOMAS). H ouse Clears Way for Vote on Medicare 223Doc Fix224 Bill: On November 7, the House passed H.Res.903 , approving the rules for debate on the De mocratic health care reform legislation ( HR 3962 ) and for the House222s bill ( HR 3961 ) to permanently alter the sustainable growth rate used to calculate physicians222 Medicare reimbursement rates. Under the current Medicare formula, physicians222 reimbursement rates will be reduced by 21 percent in January 2010. The CBO estimates that HR 3961 would cost $210 billion over 10 years and contains no revenue offsets, therefore adding to the deficit. House Majority Leader Steny Hoyer (D - MD) says the House will not take up the bill until the week of November 16 ( CQ Politics, 11/6 ; THOMAS ). S en. Bayh Requests CBO Estimate of Health Reform222s Impact on Employer -Sponsored Insurance: Following a Senate Health, Education, Labor and Pensions (HELP) Committee hearing at which both conservative and liberal health policy experts agreed that there is no concrete evidence on the potential effects of health care reform legislation on employer- sponsored insurance, Senator Evan Bayh (D - IN) requested a CBO analysis out lining those effects. The CBO analysis will focus on the legislation222s effect on insurance premiums under employer- sponsored plans ( Politico, 11/11 ). S ecretary Sebelius Appoints 7 Membe rs to AHRQ National Advisory Council: On November 12, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius appointed seven new members to the Agency for Healthcare Research and Quality222s (AHRQ) National Advisory Council , which pro vides advice on national health care research priorities. The newly appointed members are: Nancy E. Donaldson , Arthur Garson Jr., Junius J. Gonzales, Lisa M. Latts, Keith J. Mueller, Xavier Sevilla, and Bruce Siegel. The council222s next meeting is Novembe r 13 ( AHRQ, 11/12 ). FT C Investigating CVS Carem ark: On November 5, CVS Caremark Corp. announced that the Federal Trade Commission (FTC) has been investigating the company222s business practices since August 2009. After CVS acquired Caremark in March 2007, numerous groups, including eight U.S. congressmen, called for FTC investigations into the company222s practices, alleging that the company altered pharmacy benefits to increase prices, lower the quality of care, and increase utilization of CVS pharmacies. Representatives of CVS Caremark did not provide details of the FTC222s investigation ( Reuters, 11/5 ; Kaiser Health News, 11/6 ). Studies Released NCCBH Survey Finds Veterans Face Barriers to Behavioral Health Care: A National Council for Community Behavioral H ealthcare (NCCBH) survey found that, despite passage of the Veterans Mental Health Act in 2008, veterans continue to face significant barriers to accessing behavioral health care. Among other findings, nearly two - thirds of respondents said that veterans report long delays and excessive wait times when scheduling behavioral health appointments ( NCCBH , 11/10 ; WHYY, 11/11 ). C BPP Report Outlines How Medicaid ARRA Funding Expiration Will Affect States, Calls for Additional Federal Relief: A report published November 11 by th e Center on Budget and Policy Priorities (CBPP) estimates how the expiration of Medicaid American Recovery and Reinvestment Act (ARRA) funding on December 31, 2010, will affect states and the country. The report notes that, because FY2011 begins July 1, 2010 for most states, states222 budget processes will begin as early as SAMHSA222s Weekly Financing News Pulse: National Edition November 13, 2009 11/13/09 4 January or February 2010, forcing state lawmakers to create budgets assuming that ARRA assistance will expire. The CBPP estimates that those budgets will reduce U.S. GDP by nearly 1 percent and force states to cut numerous safety net programs and/or raise taxes to generate additional revenue. The CBPP report adv ocates additional federal funding for states, extending beyond the ARRA222s 2010 cap on Medicaid funding ( CBPP, 11/11 ; Wall Street Journal, 11/12 ). Thomson Reuters Study Finds Hospitals Have Recovered to Pre-Recession Levels: On November 10, Thomson Reuters (TR) published a study c oncluding that U.S. hospitals have recovered to pre - recession levels. The study, which surveyed over 400 hospitals, found that profit margins rose from 0.37 percent in the third quarter of 2008 to 8.4 percent in the second quarter of 2009, with all classe s and sizes of hospitals reporting positive median margins. In addition, the study found that hospital admissions have increased while hospital labor costs are down an average of 2.25 percent, largely because of reductions in average length of stay (LOS). TR also found that 20 percent of hospitals had negative total margins for the Q2 2009; however, that figure is roughly similar to the pre - recession rates of early 2007 ( Dallas Morning News, 11/10 ; Kaiser Health News, 11/10 ; TR , 11/9 ). Survey Finds Physicians Favor Tort Reform Over Other Health Care Reforms: A physician survey published November 6 by Jackson Healthcare found that 85 percent of respondents reported that the threat of medical malpractice lawsuits is the primary obstacle to practicing medicine as they see fit. When asked to select priorities for health care reform legislation, 92 percent selected tort refo rm, with 78 percent selecting insurance industry reforms, 54 percent selecting the creation of an insurance exchange, and 32 percent selecting the creation of a public plan option. The results show markedly lower support for the public plan option than a physician poll published in the New England Journal of Medicine in September in which 63 percent of respondents favored a public plan. The Jackson Healthcare survey also found that 62 percent of respondents 223disagreed with the American Medical Association (AMA) on health care reform.224 The AMA recently endorsed the health care reform bill ( HR 3 96 2 ) which passed in the House on November 7 ( Tampa Bay Business Journal, 11/9 ; Kaiser Health News, 11/10 ). Report Estimates ACO222s Effect on Health Care Cost and Quality: A brief released by the Urban Institute and the Robert Wood Johnson Foundation (RWJF) examines accountable care organizations222 (ACOs)227 local entities and affiliated networks of providers that are held accountable for the cost and quality of care delivered to specific populations 227 effect on U.S. health care financing. The authors concluded that, though ACOs are worthy of further experimentation and study, they will not have a significant effect on U.S. health care costs or quality in the short te rm ( RWJF, 10/29 ; Kaiser Health News, 11/6 ; SAMHSA Financing CO E, 11/12 ). KFF Releases Summaries of HR 3962 Provisions : The Kaiser Family Foundation (KFF) released a summary of the House health care reform legislation222s ( HR 3962 ) effect on Medicaid and the Children222s Health Insurance Plan ( CHIP ) and a summary of the legislation222s effect on Medicare . The KFF also updated its side - by - side health care reform tracker to include the latest provisions form HR 3962 ( KFF, 11/10 ; KFF, 11/12 ). KFF Examines Express Lane Eligibility for Medicaid and CHIP: The KFF r eleased two briefs examining express lane eligibility (ELE), a new tool provided by the Children222s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) to reach and enroll uninsured children who are eligible for SAMHSA222s Weekly Financing News Pulse: National Edition November 13, 2009 11/13/09 5 Medicaid or CHIP by utilizing data from public need- based programs or tax returns. 223 Why Express Lane Eligibility Makes Sense for States and Low - Income Families 224 provides an overview of ELE and highlights general benefits of the initiative for both states and families while 223 Express Lane Eligibility Efforts: Lessons Learned from Early State Cross - Program Enrollment Initiatives 224 provides more specific lessons learned from early programs that utilized cross - program information ( KFF, 8/26 ; KFF, 10/30 ; Kaiser Health News, 11/6 ). KFF Releases Resources Examining 2010 Medicare Offerings: With the Medicare open enrollment period beginning November 15, the KFF released numerous reports examining Medicare Advantage (MA) and Me dicare Prescription Drug Benefit Program (Part D) stand - alone drug plans available in 2010. KFF released, 223 Medicare Advantage 2010 Data Spotlight: Plan Availability and Premiums 224 and 223 Medicare Part D 2010 Data Spotlight: The Coverage Gap 224 as well as numerous updated factsheets outlining 2010 offerings. RAND Examines Multiple Approaches to Controlling Health Care Spending: A RAND Corp. article published in the New England Journal of Medicine (NEJM) uses data extrapolated from a Massachusetts study to estimate the effects of eight cost- controlling mechanisms. RAND finds th at bundled payments are the most promising cost control, potentially lowering health care costs 5.4 percent by 2019. The study also found that, among other mechanisms, changes in hospital rate regulation, implementation of health IT measures, increased disease management, increased use of medical homes, and expansion of retail clinics also have the potential to reduce U.S. health care costs, though less than bundled payments ( Reuters, 11/11 ). S tudy Attributes Increasing Medicaid Cost to Enrollment, Examines Cost Containment Strategies: A study published in Health Affairs examines Medicaid spending, finding that the program222s spending growth is due to increased enrollment and noting that Medicaid222s per enrollee costs compare favorably to increases in medical care prices and gross domestic product (GDP). The authors attribute Medicaid222s success to lim its on provider reimbursements, expanded use of managed care, limited use of prescription drugs, and expanded use of community - based programs. The study also suggests strategies for further cost containment ( Kaiser Health News, 11/6 ; SAMHSA Financing COE, 11/4 ). S ome Cost Sav ing Innovations May Improve Outcomes Even When Slightly Less Effective Than Other Options: A literature review published in the Annals of Internal Medicine found that some cost - saving innovations may improve overall outcomes even when such innovations are slightly less effective than other available options because the innovations permit better overall resource allocation. The review found that 0.4 percent of the innovations examined in 887 pub lications saved at least $100 000 per quality - adjusted life - year lost and that, per patient, those innovations 223y ielded savings from $122 to almost $12 , 000 but losses of 0.001 to 0.021 quality-adjusted life - years (approximately 8 hours to 1 week) 224 ( Kaiser Health News, 11/6 ). S tudy Examines Adverse Selection in Medicare 223Part D224: A study published in Health Affairs examined Medicare Prescription Drug Benefit Program (Part D) selection in 2006, finding that enrollees in stand - alone prescription drug plans had higher baseline costs and poorer health than enrollees in Medicare Advantage (MA) prescription plans. The authors speculate that such patterns could adversely affect Medicare costs in the future ( Kaiser Health News, 11/6 ). SAMHSA222s Weekly Financing News Pulse: National Edition November 13, 2009 11/13/09 6 Study Finds Primary Care Visit Duration and Quality Increased from 1997 to 2005: A study published in the A rchives of Internal Medicine found that visit duration and quality of care at primary care physicians increased between 1997 and 2005. The study found that, while primary care visits in the U.S. increased 10 percent per capita, average visit duration incr eased from 18.0 minutes to 20.8 minutes over the same period. In addition, quality of care improved for one of three counseling and screening indicators and for four of six medication indicators ( Kaiser Health News, 11/11 ). Around the Hill: Hearings on Health Financing House Energy and Commerce Subcommittee on Health: H1N1 Preparedness November 18, 10:00 a.m., 2123 Rayburn Senate Veterans222 Affairs Subcommittee on Health: Project HERO November 19, 10:00 a.m., 334 Cannon
