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Congress Warns Against Medicaid Cuts: ‘You Just Wait for the Firestorm’

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WASHINGTON — If President Trump allows states to convert Medicaid into a block grant with a limit on health care spending for low-income people, he will face a firestorm of opposition in Congress, House Democrats told the nation’s top health official on Tuesday.

The official, Alex M. Azar II, the secretary of health and human services, endured more than four hours of bipartisan criticism over the president’s budget for 2020, which would substantially reduce projected spending on Medicaid, Medicare and biomedical research. Democrats, confronting Mr. Azar for the first time with a House majority, scorned most of the president’s proposals.

But few drew as much heat as Mr. Trump’s proposed overhaul of Medicaid. His budget envisions replacing the current open-ended federal commitment to the program with a lump sum of federal money for each state in the form of a block grant, a measure that would essentially cap payments and would not keep pace with rising health care costs.

Congress rejected a similar Republican plan in 2017, but in his testimony on Tuesday before the Health Subcommittee of the House Energy and Commerce Committee, Mr. Azar refused to rule out the possibility that he could grant waivers to states that wanted to move in that direction.

Under such waivers, Mr. Azar said, he could not guarantee that everyone now enrolled in Medicaid would keep that coverage.

“You couldn’t make that kind of commitment about any waiver,” Mr. Azar said. He acknowledged that the president’s budget would reduce the growth of Medicaid by $1.4 trillion in the coming decade.

Representative G. K. Butterfield, Democrat of North Carolina, said that “block-granting and capping Medicaid would endanger access to care for some of the most vulnerable people” in the country, like seniors, children and the disabled.

Mr. Trump provoked bipartisan opposition by declaring a national emergency to spend more money than Congress provided to build a wall along the southwestern border. If the president bypasses Congress and allows states to convert Medicaid to a block grant, Mr. Butterfield said, he could face even more of an outcry.

“You just wait for the firestorm this will create,” Mr. Butterfield said, noting that more than one-fifth of Americans — more than 70 million low-income people — depend on Medicaid.

As a candidate, Mr. Trump said he would not cut Medicare, but his new budget proposes to cut more than $800 billion from projected spending on the program for older Americans in the next 10 years. Mr. Azar said the proposals would not harm Medicare beneficiaries.

“I don’t believe any of the proposals will impact access to services,” Mr. Azar said. Indeed, he said, the cutbacks could be a boon to Medicare beneficiaries, reducing their out-of-pocket costs.

After meeting an annual deductible, beneficiaries typically pay 20 percent of the Medicare-approved amount for doctor’s services and some prescription drugs administered in doctor’s offices and outpatient hospital clinics.

Mr. Azar defended a budget proposal to impose work requirements on able-bodied adults enrolled in Medicaid. Arkansas began enforcing such requirements last year under a waiver granted by the Trump administration. Since then, at least 18,000 Arkansans have lost Medicaid coverage.

Mr. Azar said he did not know why they had been dropped from Medicaid. It is possible, he said, that some had found jobs providing health benefits.

Representative Joseph P. Kennedy III, Democrat of Massachusetts, said it would be reckless to extend Medicaid work requirements to the entire country without knowing why people were falling off the rolls in Arkansas.

If you are receiving free coverage through Medicaid, Mr. Azar said, “it is not too much to ask that you engage in some kind of community engagement.”

Representative Fred Upton, Republican of Michigan, expressed deep concern about Mr. Trump’s proposal to cut the budget of the National Cancer Institute by $897 million, or 14.6 percent, to $5.2 billion.

Mr. Azar said the proposal was typical of the “tough choices” in Mr. Trump’s budget. He defended the cuts proposed for the National Cancer Institute, saying they were proportional to the cuts proposed for its parent agency, the National Institutes of Health.

The president’s budget would reduce funds for the N.I.H. as a whole by 12.6 percent, to $34.4 billion next year.

Mr. Azar was also pressed to justify Mr. Trump’s proposal to cut federal payments to hospitals serving large numbers of low-income patients. Representative Eliot L. Engel, Democrat of New York, said the cuts, totaling $26 billion over 10 years, would be devastating to “safety net hospitals” in New York and other urban areas.

Mr. Azar said that the Affordable Care Act, by expanding coverage, was supposed to “get rid of uncompensated care” so there would be less need for the special payments.

While Democrats assailed the president’s budget, Mr. Azar relished the opportunity to attack Democrats’ proposals to establish a single-payer health care system billed as Medicare for all.

Those proposals could eliminate coverage provided to more than 20 million people through private Medicare Advantage plans and to more than 155 million people through employer-sponsored health plans, he said.

But Mr. Azar found himself on defense on another issue aside from the president’s budget: immigration. He said he was doing his best to care for migrant children who had illegally entered the United States, were separated from their parents and are being held in shelters for which his department is responsible.

He said he was not aware of the “zero tolerance” immigration policy before it was publicly announced in April 2018 by Attorney General Jeff Sessions. If he had known about the policy, Mr. Azar said, “I could have raised objections and concerns.”

Representative Anna G. Eshoo, Democrat of California and the chairwoman of the subcommittee, summarized the case against the president’s budget.

“The Trump administration,” she said, “has taken a hatchet to every part of our health care system, undermining the Affordable Care Act, proposing to fundamentally restructure Medicaid and slashing Medicare. This budget proposes to continue that sabotage.”

 

 

 

 

The “Medicare for All” Continuum: A New Comparison Tool for Congressional Health Bills Illustrates the Range of Reform Ideas

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https://www.commonwealthfund.org/blog/2019/medicare-all-continuum

Medicare for all paperwork

Several 2020 Democratic presidential candidates have called for “Medicare for All” as a way to expand health coverage and lower U.S. health care costs. Replacing most private insurance with a Medicare-like system for everyone has instilled both hope and fear across the country depending on people’s perspective or financial stake in the current health care system. But a closer look at recent congressional bills introduced by Democrats reveals a set of far more nuanced approaches to improving the nation’s health care system than the term Medicare for All suggests. To highlight these nuances, a new Commonwealth Fund interactive tool launched today illustrates the extent to which each of these reform bills would expand the public dimensions of our health insurance system, or those aspects regulated or run by state and federal government.1

The U.S Health Insurance System Is Both Public and Private

The U.S. health insurance system comprises both private (employer and individual market and marketplace plans) and public (Medicare and Medicaid) coverage sources, as the table below shows. In addition, both coverage sources are paid for by a mix of private and taxpayer-financed public dollars.

Most Americans get their insurance through employers, who either provide coverage through private insurers or self-insure. Employers and employees share the cost through premiums and cost-sharing such as deductibles, copayments, and coinsurance. But the federal government significantly subsidizes employer coverage by excluding employer premium contributions from employees’ taxable income. In 2018 this subsidy amounted to $280 billion, the largest single tax expenditure.

About 27 million people are covered through regulated private plans sold in the individual market, including the Affordable Care Act’s marketplaces. This coverage is financed by premiums and cost-sharing paid by enrollees. The federal government subsidizes these costs for individuals with incomes under $48,560.

For 44 million people, Medicaid or the Children’s Health Insurance Program is their primary source of coverage. These public programs are financed by federal and state governments, and small individual premium payments and cost-sharing in some states. In most states, these benefits are provided through private insurers.

Medicare covers 54 million people over age 65 and people with disabilities. The coverage is financed by the federal government along with individual premiums and significant cost-sharing. About 20 million people get their Medicare benefits through private Medicare Advantage plans and most beneficiaries either buy supplemental private insurance or qualify for additional coverage through Medicaid to help lower out-of-pocket costs and add long-term-care benefits.

Millions Still Uninsured or Underinsured, Health Care Costs High

The coverage expansions of the ACA — new regulation of private insurance such as requirements to cover preexisting conditions, subsidies for private coverage on the individual market, and expanded eligibility for Medicaid — lowered the number of uninsured people and made health coverage more affordable for many. But 28 million people remain uninsured and at least 44 million are underinsured. In addition, overall health care and prescription drug costs are much higher in the United States than in other wealthy countries. U.S. health care expenditures are projected to climb to nearly $6 trillion by 2027.

The Medicare for All Continuum

To address these problems, some Democrats running for president in 2020 are supporting Medicare for All. Meanwhile, in Congress, Democrats have introduced a handful of bills that might be characterized as falling along a continuum, with Medicare for All at one end.

As our new Commonwealth Fund interactive tool illustrates, the bills range from adding somewhat more public sector involvement into the system, to adding substantially more public sector involvement. The bills may be broadly grouped into three categories:

  • Adding public plan features to private insurance. These include increasing regulation of private plans such as requiring private insurers who participate in Medicare and Medicaid to offer health plans in the ACA marketplaces, and enhancing federal subsidies for marketplace coverage.
  • Giving people a choice of public plans alongside private plans. These bills include offering a Medicare-like public plan option through the marketplaces, extending that option to employers to offer to their employees, giving people ages 50 to 64 the option to buy in to Medicare, and giving states the option to allow people to buy in to Medicaid. These bills also bring the federal government’s leverage into provider rate-setting and prescription drug price negotiation.
  • Making public plans the primary source of coverage in the U.S. These are Medicare-for-All bills in which all residents are eligible for a public plan that resembles the current Medicare program, but isn’t necessarily the same Medicare program we have today. The bills vary by whether people would pay premiums and face cost-sharing, the degree to which they end current insurance programs and limit private insurance, how provider rates are set, whether global budgets are used for hospitals and nursing homes, and how long-term care is financed. All of the bills in this category allow people to purchase supplemental coverage for benefits not covered by the plan.

Looking Forward

Many Democratic candidates who have called for Medicare for All are cosponsors of more than one of these bills. The continuum of approaches suggests both the possibility of building toward a Medicare for All system over time, or adopting aspects of Medicare for All without the disruption that a major shift in coverage source might create for Americans. We will continue to update the tool as new bills are introduced or refined. Users also can view a comparison tool of other wealthy countries’ health systems, which shows where select countries fall on a continuum ranging from regulated systems of public and private coverage to national insurance programs.

 

 

CEO of Hahnemann, St. Christopher’s hospitals ousted

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https://www.beckershospitalreview.com/hospital-executive-moves/ceo-of-hahnemann-st-christopher-s-hospitals-ousted.html

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Suzanne Richards, CEO of Hahnemann University Hospital in Center City, Pa., and St. Christopher’s Hospital for Children in Philadelphia, is no longer employed at the organizations, according to The Inquirer.

A spokesperson for Paladin Healthcare, the owner of the two hospitals, confirmed to The Inquirer March 7 that Ms. Richards was dismissed. The spokesperson did not comment on the reason for her dismissal.

Ms. Richards assumed the role two months ago, after several years of experience at hospitals in Southern California.

In 2018, Paladin created an affiliate, El Segundo, Calif.-based American Academic Health System, to buy the two hospitals as well as their related operations from Dallas-based Tenet Healthcare. American Academic Health System replaced several top executives at Hahnemann University Hospital after its purchase.