The unveiling of a compromise healthcare proposal has Senate Democrats pondering how to keep all 59 Democrats united and attract at least one Republican to pass an overhaul measure. Advocates of healthcare overhaul face an extremely delicate balancing act: With the death of Senator Edward M. Kennedy of Massachusetts, Democrats control 59 seats, meaning they need at least one Republican to join them if they are to proceed without employing a procedural shortcut that could cause havoc in the Senate, notes the New York Times.
While health insurers were careful to publicly praise Senator Max Baucus' healthcare proposal as offering something that might have bipartisan appeal, they were also quick to raise concerns about new nonprofit insurance co-operatives. Insurers also voiced objections, shared by some other segments of the healthcare industry, about the proposal's call for new fees or taxes that companies would have to pay to help finance the healthcare overhaul. The American Hospital Association, which said its members were still reviewing the plan, praised Baucus' efforts to expand insurance coverage to more people.
Nevada Gov. Jim Gibbons has signed an executive order creating a state task force to recommend how to implement a health information technology network in the state. Gibbons says the goal is to give healthcare providers easier access to patient medical records without compromising a patient's privacy.
The Philadelphia Board of Health has approved a sliding scale of fees to be charged to uninsured people for care at the city's eight primary-care health centers. The fees—from $5 to $20 per visit—were announced earlier this year as part of the city budget. The health clinics have been free to the uninsured for years, and no date has been set for when the fees will be imposed.
Needing to present a balanced budget for Miami-Dade County Commission's approval, Miami-based Jackson Health System is proposing to close two primary care centers, both of its nursing homes, outsource inmate healthcare, and reduce support to other entities that care for the poor and uninsured. Some doctor services at Jackson Memorial may also be curtailed, Jackson Health System officials said.
A surgical technician convicted of firing a gun into an occupied car was back on the job recently at Harbor-UCLA Medical Center, just days after being released from jail, despite vows by Los Angeles County officials to crack down on medical personnel with criminal records. Norris Smith, 53, had spent 169 days behind bars before pleading no contest to the felony charge Aug. 26. Smith's return to work at the hospital shocked colleagues, who said they have been concerned about his behavior since 2005, when he was suspended after threatening a doctor. He was also arrested by Long Beach police in 2004 on suspicion of assault with a firearm.
A healthcare overhaul proposed by Sen. Max Baucus does not include an excise-tax measure that had been contemplated just a few months ago for hospitals not offering enough charity care. For months, nonprofit hospitals have feared minimum charity-care requirements after a set of options released in May by the Baucus-led Senate Finance Committee suggested Congress would take the tax route. Instead, the Baucus bill adds four relatively benign requirements of hospitals, many of which have already adopted most of the practices, according to the Wall Street Journal Health Blog.
The major new healthcare overhaul bill sets the lines for a fall showdown over taxes, spending, and coverage for millions of uninsured Americans, notes the Wall Street Journal. Beneficiaries of the Baucus bill include people who lack insurance, especially older people who have trouble buying coverage on their own. The Baucus plan would require insurers to accept all comers, even those who are already sick, and establish subsidies for lower- and middle-income Americans to buy insurance.
Senate Finance Committee Chairman Max Baucus (D-MT) released on Wednesday the panel's healthcare reform bill, called America's Healthy Future Act, that was hammered out with an eye toward bipartisan support. But if its release is any indication, this Chairman's Mark will be facing an uphill battle when hearings begin next week.
Already, two of the three GOP senators who had worked with Baucus on the bill--part of his bipartisan "gang of six" senators--in recent weeks are choosing not to support it.
Sen. Charles Grassley (R-IA), who is also the ranking minority members on the Finance Committee, said in a statement that he's disappointed because "it looks like we're being pushed aside by the Democratic leadership so the Senate can move forward on a bill that, up to this point, does not meet the shared goals for affordable, accessible health coverage that we set forth when this process began."
Grassley was particularly concerned about "some serious outstanding issues that have yet to be resolved like preventing taxpayer funding of abortion services and the enforcement against subsidies for illegal aliens."
Sen. Mike Enzi (D-WY) said "fundamental issues" existed that were not able to be resolved "by the deadline that was set for us." He said that the measure that was released "still spends too much, but it does too little to cut healthcare costs for those with health insurance."
The Congressional Budget Office estimates the Chairman’s Mark would cost $856 billion over 10 years. This amount would be paid for mostly through "increased focus on quality, efficiency, prevention, and adjustments in federal health program payments, without adding to the federal deficit," according to Baucus in a statement.
When hearings begin next week, it's likely that the process is going to turn into "the wild West," said Julian Hobson, a senior policy advisor at international law firm Bryan Cave LLP, in Washington, DC.
"Usually when Chairman's Mark comes out, it's all set: Everybody's negotiated what they wanted in [the bill], and that's sort of it. The deal is [to] defeat all amendments," he said. This will likely be different with Republicans and Democrats both expected to offer a significant number of amendments.
One area where amendments are expected to be introduced is over the area of a public insurance option, which is excluded from Baucus' bill. While several senators—including Sen. Jay Rockefeller (D-WV) and Sen. Charles Schumer (D-NY)—have voiced strong support for the public option, it is likely that the votes won't be there to include that option in the Senate Finance bill.(It is currently included in the bill approved by the Senate Health, Education, Labor and Pensions Committee in July.)
The Chairman's Mark basically includes provisions outlined a week's earlier in the reform framework released a week earlier by the Senate Finance Committee. The provisions touch on the areas of healthcare coverage, costs, quality, preventive care, efficiency, and wellness.
Among the bill's highlights are:
Reforming the insurance market to prevent individual exclusion from insurance coverage based on pre-existing conditions and health status.
Eliminating yearly and lifetime limits on the amount of coverage plans can provide.
Creating Web-based insurance exchanges to standardize health plan premiums and coverage information to make purchasing insurance easier.
Giving consumers the choice of nonprofit, consumer-owned and oriented plans (CO-OPs).
Standardizing Medicaid coverage for everyone under 133% of the federal poverty level.
Providing value based incentive payments to acute care hospitals that meet certain quality performance standards beginning in fiscal 2012.
Creating incentives for healthcare providers to improve quality by using safer, more cost effective health technology, such as electronic medical records.
Providing annual wellness visits for Medicare Creating a new Medicaid state plan option under which Medicaid enrollees—with at least two chronic conditions or with one chronic condition and at risk of developing another chronic condition—could designate a provider as their health home.
Eliminating out-of-pocket costs for screening and prevention services in Medicare.
Creating incentives in Medicare and Medicaid for completing healthy lifestyle programs.
The Office of Inspector General has issued lengthy audit reports for Pennsylvania, Connecticut, and Texas documenting the extent to which each state's agencies sent in claims for more reimbursement than they could justify.
In Pennsylvania, Medicaid officials have disallowed one in 10 sampled state claims for reimbursement of case management services targeting people with mental illness or mental retardation, about $11.8 million, because they lacked case record support.
About $6.5 million of the amount was spent from federal funds, which the OIG recommends the state should refund.
In Connecticut, Medicaid officials have questioned $19.8 million in claims for 80 contracted mental health and related social services. Connecticut's documentation did not contain enough information to determine whether the claims qualified for payment.
"The state agency's calculation of the CBMACs (Community Based Medicaid Administrative Claim) was based on the Medicaid-allocable costs incurred by the 80 contracted organizations ($161,480,735), which exceeded by $19 million the total amount that the DMHAS (the Department of Mental Health and Addiction Services) actually paid to these contracted organizations for both Medicaid and non-Medicaid services and activities," the OIG audit said.
And, in Texas, 22% of sampled medical claims for care provided to undocumented immigrants did not satisfy the state's definition of emergency care. In Texas, as in other states, coverage for medical care and prescription drugs for undocumented people is allowed only during medical emergencies. The amount in question involved 193 of 854 claims for care, totaling $262,000, which lacked documentation.
Texas officials requested federal reimbursement for 7,114 claims for prescription drugs totaling $147,805 that did not meet the state's definition of emergency care.
In addition, the program to "prevent payment of family planning services claims for undocumented aliens and legal aliens did not always operate correctly or was manually overridden to allow services to be claimed as family planning services, which are paid at an enhanced federal medial assistance rate of 90%."
Perhaps more important, the OIG said, the Texas "state agency did not have adequate internal controls to ensure that, for undocumented aliens and legal aliens restricted to emergency services, federal reimbursement was claimed only for those conditions that it defined as emergency services."
The claims are quite old. For Pennsylvania, they involve services provided between Jan. 1 2003 and Dec. 31, 2005. For Connecticut, they involved spending in fiscal years 2005 and 2006, and in Texas, they covered Oct. 1, 2004 through Sept. 30, 2005.
