Health On The Hill Spotlight
Topics: Politics, Health Reform
KHN’s Mary Agnes Carey and Jackie Judd discuss the congressional wrangling over the federal budget and what’s ahead for the automatic cuts scheduled for January.
> > Listen to audio of the interview.
Here's a transcript of the conversation:
JACKIE JUDD: Good day, This is Health On The Hill. I’m Jackie Judd. The House is expected to vote tomorrow on a series of spending cuts that — in the words of one journalist — contain some “tough love priorities.”
The package is almost certain to pass in the House and almost equally certain to die in the Senate. Here to discuss what cuts are being proposed in health care programs is Mary Agnes Carey of Kaiser Health News. Welcome back, Mary Agnes.
What are the cuts? What programs would be most impacted?
MARY AGNES CAREY: There are a lot of cuts we’ve heard about all year long. Many of them involve funding for the health care law, the health care law’s prevention fund, grants programs to the states to allow them to set up health insurance exchanges in 2014. There would also be cuts to [subsidies for] individuals to help them purchase coverage on those exchanges: cuts to the Medicaid program, cuts to the Children’s Health Insurance Program, cuts to hospitals that take care of a lot of poor and uninsured individuals.
And also, there’s a provision in there Republicans favor to put a cap on punitive and noneconomic damages in medical malpractice lawsuits.
JACKIE JUDD: This is a real guns-and-butter question. One reason the Republicans are proposing this is to avoid some mandated cuts down the road in the military.
MARY AGNES CAREY: Right, there’s a series of automatic cuts that kick in on Jan. 1. Republicans do not want these cuts to impact defense, and so they’ve gone after domestic spending to shield the defense cuts from happening.
JACKIE JUDD: What are the ideological arguments that you’re hearing on the Hill that separate the two sides so widely?
MARY AGNES CAREY: You’re going to hear the word “priorities” a lot. Republicans say enough is enough in federal spending and that the government has simply overspent. And that no taxpayer should have to pay more money to correct Washington’s mistakes. And that these proposed cuts make good sense.
Democrats say that if Republicans would simply be open to raising taxes on some industries and wealthier individuals, they could shield not only defense, but individuals from these cuts that are coming up in January.
JACKIE JUDD: And Republicans are also arguing, are they not, that the cuts in the health care programs would not be as draconian as the Democrats are portraying it, because some federal purse strings would be loosened. It would allow states, the Republicans say, to act in a more efficient manner.
MARY AGNES CAREY: For example, in Medicaid, there’s a “maintenance of effort” provision that states have to maintain those Medicaid programs as they were before the health law passed. And to your point, Republicans are saying if you lifted that constraint from states, they could do it in a more economical way. They could take care of that same vulnerable population.
Of course, Democrats say that is not the case. They fear deep cuts to those individuals if this maintenance of effort provision were lifted.
JACKIE JUDD: Given the extremely dim prospects for this in the Senate, should we view this as more of a political document than a fiscal document?
MARY AGNES CAREY: I think it is. It’s political as much as policy. It’s out there because both sides want to appeal to voters, especially those independent voters who are yet undecided, to try to get their votes, and they’re using this to try to craft the differences between the two parties.
JACKIE JUDD: And a final question: As you mentioned earlier, the military cuts are due to kick in in January of next year. Unlikely this Congress will have a meeting of the minds before then. So in the lame duck session later this year, is it likely that they will – one of Washington’s favorite phrases of the moment – ‘kick the can down the road’?
MARY AGNES CAREY: I think it is. The bipartisanship, if you will, on this issue is that both Democrats and Republicans really dislike the idea of the automatic cuts. The problem is they disagree wildly over how to stop them.
But I think in that lame duck session, they’re going to come together and find a way to stop these cuts. For how long, to what extent, we don’t know. But I think, to use your phrase, they will ‘kick the can down the road’ once again.
JACKIE JUDD: Thank you, Mary Agnes Carey of Kaiser Health News.
MARY AGNES CAREY: Thank you, Jackie.
May 09, 2012
Topics: Medicare, Aging, Politics
KHN's Mary Agnes Carey and Marilyn Werber Serafini join Jackie Judd to preview this week's House hearings on Medicare and to dig into the details of the Medicare trustees' report.
>> Listen to audio of the interview.
Read Related:
>> An Even Bleaker Prognosis For Medicare?
>> Trustees Issue Warnings On Medicare, But Make No Changes To Solvency Projections
Transcript:
JACKIE JUDD: Good day, this is Health on the Hill. I'm Jackie Judd. A House subcommittee returns this week to the idea of expanding the role of the private sector in Medicare. This against the backdrop of the latest projections about Medicare's financial health. Joining me to discuss all of this: Mary Agnes Carey and Marilyn Werber Serafini of Kaiser Health News. Welcome ladies.
MARY AGNES CAREY: Thank you.
MARILYN WERBER SERAFINI: Thank you.
JACKIE JUDD: Mary Agnes, you first, give us a preview of the hearing and why now.
MARY AGNES CAREY: The hearing will look at this idea of premium support, of the government limiting the contribution per beneficiary in Medicare. And the committee wants to do this now because there is all this discussion about the debt and the deficit. As you mentioned the Medicare trustees' report just came out. The solvency has not been extended. It's still at Year 2024. So the idea is let's look at the idea of limiting the government's contribution. Let's bring in a lot of witnesses. They are going to include Henry Aaron of the Brookings Institution, who is one of the founding architects of the premium support idea. Another witness is John Breaux, a former Democratic senator of Louisiana, who along with the former Ways and Means Committee Chairman Bill Thomas of California came up with a premium support idea. So they want to do this now in part because of the trustees' report from yesterday and also, you know, the Republican message has been let’s control federal spending, especially in entitlements and here's a way to do it.
JACKIE JUDD: When Paul Ryan brought this idea back again last year, some members of the Republican establishment were pretty chilly toward the idea. Has that changed at all?
MARY AGNES CAREY: One change that Paul Ryan made was to include Medicare fee-for-service as an option for beneficiaries. That wasn't in the plan last year. And also, as we know, Paul Ryan has been reaching out to Democrats, including Ron Wyden, a Democratic senator from Oregon, to revise and work on his idea on premium support.
They feel with this addition of traditional fee-for-service, it inoculates them from attacks from President Obama and Democrats who are saying Republicans are trying to change Medicare as we know it.
JACKIE JUDD: Marilyn, you dug pretty deep into this report we've been talking about, particularly what Rick Foster, the chief actuary, had to say. What struck you?
MARILYN WERBER SERAFINI: What struck me is that you had a report that was almost 300 pages long, and right at the end of it were three pages that Rick Foster wrote – his opinion – that basically said the projections by the trustees: They're accurate. They did their job. But those projections are based on current law, and current law contains many changes that he says are unrealistic. Congress will not let them stand.
He says Congress will not allow 30 percent cuts to physician payments in Medicare starting in January, that Congress will not allow deep cuts to hospitals and other medical providers that were created by the 2010 health care law. He's saying that the kind of productivity improvements that are assumed will take place because of the health care law – you know he says that they will lower the health care costs but not the overall growth. Growth will still continue on an unsustainable path. So he's saying that given all this, Congress will absolutely step in and they will change those provisions so that they are more generous in payments to medical providers. And if you do that, that means less savings, and if you have less savings, that means a harder financial hit to Medicare.
JACKIE JUDD: Even before this report came out, the White House talked about it. Soon after it came out, the Republicans started talking about it. Does it become a lightning rod for each side and how is each side positioning it to work in their favor?
MARILYN WERBER SERAFINI: It already is a lightning rod. This is something that Romney talks about all the time. He came out with a statement yesterday already saying, "Look, what they’re doing, this is bad news, it's only going to get worse." And actually, two hours before the trustees' report came out, the Obama administration came out with something of a pre-emptive strike with a small report that said, "Medicare is getting better, beneficiaries are going to get – their costs are going to go down." They, again, are basing those projections on current law and what’s supposed to happen and that’s based on all of these assumptions that Rick Foster says are unrealistic.
JACKIE JUDD: A lot of debate, a lot of spinning. But Mary Agnes, you’ve covered the hill for a long time as it pertains to health care policy. Is it safe to presume that nothing of substance will happen this year? No votes will be taken -
MARY AGNES CAREY: That's correct.
JACKIE JUDD: - to change the program?
MARY AGNES CAREY: In the lame duck session which is predicted to happen after the elections, I think that both parties will be laying out their markers: this is what we will do about the deficit; this is what we will do about the debt. Of course, we have this automatic sequestration – this two percent cut in Medicare just to providers – about to kick in in 2013. They've got to figure out a way around that. But most folks predict that nothing really major is going to happen until next year.
JACKIE JUDD: OK, thank you both so very much.
MARY AGNES CAREY: Thank you.
MARILYN WERBER SERAFINI: Thank you.
Apr 25, 2012
Topics: Health Costs, Medicare, Quality, Delivery of Care
KHN's Jordan Rau and Mary Agnes Carey discuss Medicare's transition to compensating doctors based on the quality of the medical care they provide.
>> Listen to audio of the interview.
>> Read related story: Medicare To Tie Doctors' Pay To Quality, Cost Of Care
Transcript:
MARY AGNES CAREY: Hello and welcome to Health on the Hill. I’m Mary Agnes Carey. The 2010 health care law requires that Medicare providers be paid on the quality of medical care they give and the amount their patients cost Medicare. That's a change from the current Medicare system, which is based on the number of services provided. Making this payment change for physicians is turning out to be more complicated than experts anticipated. Jordan Rau of Kaiser Health News is here to give us the details.
Now as we know, backers of the health law have said that linking provider payment to the quality of the service that they provide, something known as value-based purchasing, is really important to reducing health care costs. But when it comes to implementing this for physicians, it’s turning out to be a little more complicated than it is for other providers, like a hospital. Why is that?
JORDAN RAU: It’s really interesting – this was part of the law that was least controversial when it was passed, because everyone thinks, well, pay more for quality and less for low quality, that doesn’t sound unreasonable. But now that they’re getting to the details, it’s proving to be very difficult. And it’s more difficult for physicians than just about anyone, because, first of all, there are fewer number of patients that a physician sees and you need a large sample or mass to really figure out how they’re treating the patients. Because if you just have a couple and one patient is particularly sick or doesn’t do that well, you don’t want it to unfairly reflect on the physician. So that’s one reason.
Another problem or challenge that they have is who to compare the doctors to. You don’t want to compare one type of specialist to a different type that isn’t exactly the same. And then they also have the challenge of figuring out – and this is probably the hardest thing – how much resources that doctor uses of Medicare. That is proving very challenging, because you can’t just take a look at the Medicare billing of that doctor, but you have to figure out what they’re doing: Are they referring too many people to high priced specialists and not intervening early enough? Are they having too many lab tests? Conversely, you want to make sure you’re not thinking that someone who is not doing enough is actually doing a great job.
MARY AGNES CAREY: In the story that you recently did on this issue, you talked about 20,000 physicians in four states getting reports from Medicare about the care that they deliver to patients. What sorts of things did those reports discuss?
JORDAN RAU: These are really long reports. They’re 14 pages long, and they were links [that] were e-mailed in, and they have extensive amounts of the quality measures that the Centers for Medicare and Medicaid Services are considering using. So [it asks] everything from "How did you handle a patient with diabetes?" to "Did you do depression screening?" Just dozens -- I think 28 -- so two dozen, different potential tests. And they also have in them -- what I think is going to be the most disconcerting for some physicians -- they have the average amount that their patients cost Medicare compared to all other doctors. And that’s not just including what that doctor did that cost Medicare, but all of the patient’s services.
MARY AGNES CAREY: And what’s Medicare going to use all this information for?
JORDAN RAU: These are technically called "feedback reports," and that is actually very accurate. These were started because Medicare is really trying to figure out how to do this correctly, so they are sending these out to doctors to see what the doctors are going to say: You know what, this is really unfair or inaccurate because of x, y or z.
It’s almost like a survey. Rather than waiting until they’ve implemented this program, and people’s pay are actually being affected by it, they want to do a dry run of their initial efforts, and then they’re going to use these to fine-tune their metrics.
MARY AGNES CAREY: Do they have a time yet, when by this date, this is how Medicare will evaluate what you’re paid as a physician.
JORDAN RAU: The law says that they have to start doing this new payment system in 2015, but they have a lot of leeway. They’re supposed to do it for large-group practices and some specialists as the government sees fit. But they’re supposed to have it all wrapped in by 2017. And then it should apply to most physicians.
For the people that are picked in 2015 – and the government hasn’t decided who those are going to be – their initial pay is going to be based on what happened to their patients in 2013. So that’s actually pretty close. That’s just a couple of months away.
MARY AGNES CAREY: We know that physicians are unhappy with the current Medicare payment system. Something known as the Sustainable Growth Rate always calls for these large reductions unless Congress steps in to stop it. They can’t be happy about this.
JORDAN RAU: You would think that in some ways that half of them would be happy, because most doctors, you would think, think that they do a pretty good job. But they’re very, very worried about this. The professional societies are very worried about this. We did a story about this for the Washington Post and it got over 200 comments, and they were all concerned -- because doctors are already so frustrated with the Medicare payment levels, because they are so much less than commercial insurance – that they just see this as another uncertainty, another potential for them to lose out on money. And they are very worried about it.
MARY AGNES CAREY: Thank you so much, we appreciate your time, Jordan Rau of Kaiser Health News.
JORDAN RAU: Thanks.
Apr 17, 2012
Topics: Health Costs, Medicare, Politics, Medicaid, States, Health Reform
KHN's Marilyn Werber Serafini and Mary Agnes Carey discuss the budget Wis. Republican Rep. Paul Ryan released today and how it differs from the proposal he released last year.
>> Listen to audio of the interview.
>> Read related story: New Ryan Budget Would Transform Medicare And Medicaid
Transcript:
MARY AGNES CAREY: Good day, this is Health on the Hill. I'm Mary Agnes Carey.
House Budget Committee Chairman Paul Ryan unveiled his fiscal 2013 budget plan today, which includes major changes to Medicare and Medicaid. Ryan's proposal would also repeal the health law, which he says would have dire consequences for Medicare providers and patients.
REP. PAUL RYAN: Providers will get paid at about 80 cents on the dollar to begin with, going down to 30 cents on the dollar. The hospitals and docs will get paid less than Medicaid. And the problem is - what ends up happening is they'll just stop seeing patients. You'll just have reduced access and quality to Medicare for current seniors. The other thing it does is it takes a half trillion dollars from Medicare to spend on creating the president's new health care law. What our budget does is this: It gets rid of that.
MARY AGNES CAREY: With us today to discuss the details of the Ryan plan is Kaiser Health News correspondent Marilyn Werber Serafini. Hi, Marilyn, thanks for coming.
MARILYN WERBER SERAFINI: My pleasure.
MARY AGNES CAREY: Paul Ryan made a lot of headlines last year when he introduced his Medicare overhaul proposal. Can you tell us about what he introduced today and how is that different or the same as what he introduced last year?
MARILYN WERBER SERAFINI: Well the proposals are really very similar, in that they both would limit the amount of money that the federal government spends on Medicare. But they differ in two important ways. One is that the cap for how much the federal government would spend is tighter this year. Both times, it's tied to the growth of gross domestic product. But last year, tied to Gross Domestic Product plus one percentage point. And this year, tied to gross domestic product plus one-half of a [percentage point].
And that is really the same as what President Obama was talking about not too long ago – the GDP plus one-half of a percent. So Ryan picked up on that and went with it this year.
Also is fee-for-service. Now, that is the traditional Medicare program. Last year, Paul Ryan would have given seniors a percentage of the premium that they could choose for a list of private health care plans. He would have totally done away with traditional fee-for-service Medicare. This year, he includes the promise of traditional Medicare.
MARY AGNES CAREY: He partnered with Ron Wyden, a senator from Oregon, on this idea to broaden the premium support concept to include traditional fee-for-service and the private plans. Is Ron Wyden on board with what Ryan did today?
MARILYN WERBER SERAFINI: No, he's actually not. But it doesn't have to do with the promise of fee-for-service. It's more that when Ryan and Wyden partnered together, they had a cap on federal spending, but they had limited it to GDP plus one. And with Ryan coming across with a tighter cap; that is not what Wyden had supported.
MARY AGNES CAREY: Paul Ryan's talking about in his view, the president's health law would so drastically reduce payments to providers that Medicare providers and beneficiaries would be hurt. How does he deal with that in his plan?
MARILYN WERBER SERAFINI: Well, actually, critics are already saying the same thing about his plan. There's only so many places to take cuts out of Medicare. And if you're not going to it with beneficiaries, then, historically, what Congress has done is to take Medicare savings from making cuts in payments to doctors, hospitals and other medical providers.
So, already today, we have hospitals complaining that: "Look, if you decrease our payments any more, we're going to look a lot more like Medicaid. And if we look a lot more like Medicaid, people are going to have trouble getting in to see a doctor. Because physicians, hospitals, medical providers – they're just not going to want to take those kinds of payments."
MARY AGNES CAREY: On the House floor this week, they are scheduled to vote on legislation that would do two things, would eliminate this panel created in the health law to make recommendations on how to reduce Medicare spending and it would also overhaul current medical malpractice laws. Chairman Ryan also looks at those in his plan. What does he do?
MARILYN WERBER SERAFINI: He would do both of those. He wants to repeal this board, called the IPAB – the Independent Payment Advisory Board. Frankly, it hasn't been a very popular part of the health law since its inception. So he wants to get rid of that. And he wants to do some malpractice reforms. He wants to cap non-economic damages in malpractice awards – that's for pain and suffering. He doesn't say by how much, but he wants to cap that, to help with the cost of health care.
MARY AGNES CAREY: Now let's turn and close with Medicaid, the federal-state program for the poor and disabled. What would Ryan's plan do to Medicaid?
MARILYN WERBER SERAFINI: He would simply block-grant the Medicaid program. Right now, it’s a federal-state partnership. What he wants to do is give states the ability to take a federal chunk of money – the federal government sends the states the money and the states would simply run the program. He has said this has been a very successful model under welfare. And he believes that this would work very well for both controlling costs and potentially improving quality in the Medicaid program.
MARY AGNES CAREY: And that's similar to what he did on Medicaid in his proposal a year ago?
MARILYN WERBER SERAFINI: Exactly.
MARY AGNES CAREY: Thank you so much, Marilyn Werber Serafini, Kaiser Health News.
MARILYN WERBER SERAFINI: Thank you.
Mar 20, 2012
Topics: Politics, Health Reform, Medicare
KHN's Mary Agnes Carey talks with Jackie Judd about President Obama's State of the Union speech. Obama talked little about health care, reflecting maybe the hard sell they're having getting the public to buy into the health law's benefits. Republicans talked about reforming Medicare in their response.
> > Listen to the audio.
JACKIE JUDD: Good day, This is Health on the Hill. I’m Jackie Judd. President Obama delivered his State of the Union message last night and made only a modest mention of the issue that helped define the first half of his administration: health care reform.
PRESIDENT BARACK OBAMA (video clip): I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny your coverage, or charge women differently than men.
JACKIE JUDD: Here to discuss the State of the Union and the Republican response is Kaiser Health News reporter Mary Agnes Carey. Welcome, as always.
MARY AGNES CAREY: Thank you.
JACKIE JUDD: I took a look at earlier State of the Union speeches, and back in 2010 the president devoted about 7 paragraphs to the issue of health care reform. A couple last year. What was the administration’s calculation to give it such small play?
MARY AGNES CAREY: Basically, everyone knew this was going to be a speech about the economy and that certainly was a speech about how to repair the economy, how to get it back on track, how to create more jobs. But the minimal mention of the health law may be a reflection of the difficulty that the president, the administration, supporters of the health law are having selling it to the public.
For example, the latest Kaiser Family Foundation tracking poll found that just 41 percent of Americans have favorable views of the law; 43 percent have unfavorable views. The individual mandate – the requirement that most Americans by 2014 have to purchase insurance or pay a fine, that’s the issue before the Supreme Court right now – that is wildly unpopular with the public. (note: KHN is an editorially-independent program of the foundation.)
So the president focused on the provisions that are popular. For example, talking about insurers will no longer have unchecked power to cancel your coverage; they can’t charge women more. In a counterpunch to Republican attacks against the health law, President Obama talked about how the health law relies on a reformed private market. It’s not a government program.
JACKIE JUDD: As many analysts said last night, this was as much a State of the Union as it was a campaign speech. So, it was a hint as to how the president will address this issue on the campaign trail.
MARY ANGES CAREY: I think he’ll talk about it. He’ll talk about again the issues that are popular with folks. But he has to maneuver around the fact that a lot of Americans are wrestling with the health law: "What’s in it for me? What matters for me?" And a lot the big provisions don’t even kick in until 2014.
JACKIE JUDD: And last night in his speech, he made brief mention that he’s prepared to make reforms to rein in Medicare and Medicaid spending. And that’s what Indiana Gov. Mitch Daniels zeroed in on in the Republican response. Take a listen.
GOV. MITCH DANIELS (video clip): We must unite to save the safety net. Medicare and Social Security have served us well, and that must continue. But after half and three-quarters of a century, respectively, it’s not surprising they need some repairs. We can preserve them unchanged and untouched for those now in or near retirement, but we must fashion a new, affordable safety net so future Americans are protected, too.
JACKIE JUDD: So, in a way, the Republicans made a more sustained statement on health care than the president did. The same question I asked you earlier: What was the GOP calculation?
MARY ANGES CAREY: Well, they evidently have a great comfort level now talking about Medicare, talking about Medicaid and the safety net. Mitch Daniels mentioned the safety net six times. He talked about how we can’t afford to give Medicare benefits to millionaires anymore: this whole issue of income-relating that has come in and out of the discussion.
I think that Republicans intend to – they’re trying to cast themselves as protectors of Medicare and Medicaid. Of course, the views they have vs. Democrats and the president are extremely different. But I think it shows a comfort level that they would hit this so hard in their response and have such a sustained discussion.
JACKIE JUDD: Change of course, but sticking on the issue of Medicare. Yesterday, just before the State of the Union, House and Senate conferees got together for the first time to discuss the payroll tax extension, the cut, and part of that of course is the “doc fix.” What should doctors who treat Medicare patients be reimbursed? Any progress in those conversations?
MARY AGNES CAREY: This was about an hour and a half of opening statements, but it became clear that both Republicans and Democrats on the conference committee do not want Medicare physicians to face a 27 percent payment cut at the end of February, which is when the current fix expires. The difference of course, as always, is on how do you pay for it? Several Democrats talked about using the war savings to pay perhaps for a long-term fix for the sustainable growth rate. Republicans aren’t really crazy about that. Dave Camp, who heads the conference, head of the Ways and Means Committee, said using war savings for the SGR is not on his top 10 list. But everyone seems committed to fixing it. The question is how do you finance it.
JACKIE JUDD: OK, thank you so much, Mary Agnes Carey, Kaiser Health News.
MARY AGNES CAREY: Thank you.
Jan 25, 2012
Topics: Politics, Medicare, Health Reform
KHN's Mary Agnes Carey and Marilyn Werber Serafini talk with Jackie Judd about Tuesday's New Hampshire GOP primary. The GOP field is united in their opposition against Obama's Health Law, but differences remain in how they would reform Medicare.
>> Listen to the audio.
JACKIE JUDD: Good day, this is Health on the Hill. I'm Jackie Judd.
Another day, another state. The Republican presidential candidates have moved on to South Carolina where the next primary will be held January 21st. Last night in New Hampshire, in Mitt Romney's victory speech, he again promised to roll back the health care overhaul law.
(ROMNEY SOUNDBITE: This president has enacted job-killing regulations; I’ll eliminate them. He lost our AAA credit rating; I’ll restore it. He passed Obamacare; I’ll repeal it. )
JACKIE JUDD: Repealing so-called "Obamacare" is an issue that unites the GOP candidates. What separates them from each other in terms of health care policy? Here to answer that question: Kaiser Health News reporters Mary Agnes Carey and Marilyn Werber Serafini. Welcome to you both.
The common ground is repeal Obamacare. But what separates them, it seems to me, is the issue of Medicare. Most of the comments of the candidates tee off the Ryan plan, which was proposed in the House; the linchpin being a voucher system, which would put seniors into the private marketplace as opposed to a government-run medical care system. What are the differences then, on that plan?
MARILYN WERBER SERAFINI: This is where the candidates have talked about their differences. The differences are relatively minor; they're not huge differences. They all believe in this general concept of less government, of the government limiting the amount of money that it spends on Medicare. Currently it's an entitlement – that doesn't happen. So we had Huntsman and we had Santorum immediately come out and support the Ryan plan. We also had Romney say that he would sign a bill that was the Ryan Plan. He said he would prefer to have his own legislation, put his own mark on it, but he would sign it. You also had Newt Gingrich who came in and was very critical initially; he believed that it was important to give seniors the choice to stay in traditional Medicare.
MARY AGNES CAREY: And then when Paul Ryan modified his plan, which he did last month with Ron Wyden, a Democratic senator from Oregon – when fee-for-service was added to the mix, then Newt Gingrich was more complimentary to the Ryan program.
MARILYN WERBER SERFAINI: And Romney was also then more on-board.
MARY AGNES CAREY: Exactly. And to be fair, Gov. Romney also proposed his own modified version of Ryan a few months ago, so Ryan is definitely the linchpin. But we have some Republican candidates that are talking about Medicare in different ways. For example, Ron Paul has said Medicare is fine for current beneficiaries; he wants younger folks to get their care in a different way in the private market when they reach their senior years. And Rick Perry has suggested maybe states could do a better job than the federal government at running Medicare.
JACKIE JUDD: Medicare has proven to be treacherous territory for politicians in the past. Older citizens don't have to see a change to the program – for the most part. How much of what's being debated during the primary season, how real is it?
MARY AGNES CAREY: I think it's absolutely real. There are so many pressures on the budget with entitlements. We have more baby boomers coming in and flooding the system. Fiscal conservatives want to see an answer on entitlements. They want to hear Republican candidates talking about it.
So I think this is absolutely a sign of what's in play, not only in the election, but in 2013 and beyond.
MARILYN WERBER SERAFINI: Right. Ask any Republican who freshman came in in 2010 if they think it’s real, and they will say: Medicare won me my election. A lot of them do actually say that.
It all comes back to the health care law that passed. Republicans made a big deal about in 2010 in saying: Look, the Democrats took $500 billion out of your Medicare program. And the seniors responded. That was a very salient message with seniors in the 2010 election. That's when the Republicans took control of the House, and lot of the Republican freshman who came in do attribute that to that message.
JACKIE JUDD: To some degree, it was Michele Bachmann, who dropped out after Iowa, who really drove the issue about what to do with health care policy in the future. She's gone now. Does it seem to either of you that a little bit of the air has been let out of this issue on the campaign trail in the past week or so?
MARY AGNES CAREY: I think it has. Michele Bachmann was always the one jabbing on who favored the individual mandate and looking at different positions that they had. I also think that the candidates are looking at the electorate. The economy is the predominant issue.
The Associated Press did an exit poll in New Hampshire, saying that only 5 percent of people who voted said health care was their top concern. So while we may not hear as much about this now as the primaries continue, when you get to the general election, where Republicans want to repeal President Obama’s signature policy achievement, the health care law, then I think it will be center stage again.
MARILYN WERBER SERAFINI: It's also important to remember that while health care might not be the top issue for Republicans in the primary, it never is. And it's not this time, as well. As Mary Agnes said, it's the economy; it's all about the economy.
However, you have to remember that seniors – Democrats and Republicans – care very deeply about their Medicare. And it doesn't take much to make a difference in an election.
JACKIE JUDD: Final question: A little bit of a reality check. When Michele Bachmann was still in the race and she would talk about repealing "Obamacare," she said it in the context of: We need to elect x number of Republican senators so we can control both the Senate and the House in order to repeal.
What is the reality of any of the candidates, should they become president, being able to roll the law back?
MARILYN WERBER SERAFINI: First of all, what we haven't talked about is we've got a Supreme Court decision coming that could –
JACKIE JUDD: There is that.
MARILYN WERBER SERAFINI: – There is that. That could have a bearing on this.
But even so, even if the Republicans take control of the Senate, which is not really expected to happen, any party in charge really needs 60 votes really to be able to do anything. Moreover, even if you can roll back a piece of this, there are benefits that are already in place – popular benefits that are already in place. Even some of the candidates as they go around talking about wanting to repeal, they say: Well, I do like this element, and I do like that element.
JACKIE JUDD: So there's more nuance to it.
MARILYN WERBER SERAFINI: I think that's right.
MARY AGNES CAREY: Absolutely. I agree.
JACKIE JUDD: Thank you so much, both of you: Marilyn Werber Serafini and Mary Agnes Carey.
Jan 11, 2012
Topics: Politics, Health Reform
KHN's Mary Agnes Carey talks with Jackie Judd about what a divided Congress returns to in Washington this month as it begins dealing with fixing how Medicare pays doctors. A conference committee has until the end of February to fix the so-called "Sustainable Growth Rate" or doctors face a big pay cut.
>> Listen to the audio.
Here's a transcript:
JACKIE JUDD: Good day. This is Health On The Hill. I’m Jackie Judd.
It’s a new year, but Congress will turn to some of the same old issues, when lawmakers come back to Capitol Hill later this month. Chief among those issues is what to do about reimbursing doctors who treat Medicare patients. But there others, and here to fill us in is KHN correspondent Mary Agnes Carey. Happy new year, Mary Agnes.
MARY AGNES CAREY: Thank you.
JACKIE JUDD: Before Congress left in December, they put into place this two-month fix that essentially froze the levels of reimbursements to doctors. That expires at the end of February. In Congress time, that’s no time at all. So what happens when they return in mid-January?
MARY AGNES CAREY: A House and Senate conference committee – this is a bicameral, bipartisan panel – will sit down to try to resolve these differences. But he same obstacles remain that were there before the holiday break: How large of a fix do you pass? How do you finance it? The numbers are fairly daunting: It’s $21 billion for a one-year fix, about $38 billion for a two-year fix. And if you wanted the problem to go away forever, that would be $300 billion over the next decade.
Another pressure here is the calendar. Presidents Day recesses are scheduled now for the Senate and the House. In the Senate, Presidents Day recess is scheduled the 20th through the 24th of February. And the House, of course, as a different week, the 18th through 26th. So that creates even more pressure.
JACKIE JUDD: You raised the issue of how to finance a fix, so that there is not a 27 percent cut in reimbursement rates. The idea that the Republicans put forth late last year was to make some cuts in Medicare spending, to make some cuts in health reform, where they could find some revenue. Are there any other ideas floating out there so that the ball can be moved?
MARY AGNES CAREY: Some lawmakers – one that comes to mind is Jon Kyl, who is the second-ranking Republican in the Senate, has said, let’s take the savings from Iraq and Afghanistan, that war drawdown money, and use that to get rid of the SGR forever. That doesn't have a lot of appeal with the House Republicans, so I’m not quite sure if that will get traction. But as you note, Congress seems to be going to the tried and true. Do you reduce the hospital payments? Do you reduce payments for skilled nursing facilities? There’s been debate about asking Medicare beneficiaries who have higher income to pay even more to help fund their coverage. So a lot of the old ideas are on the table, perhaps some new ideas, and they may come up with some things we haven’t even thought of.
JACKIE JUDD: Jon Kyl is among the 20 members on the conference committee. Each side has appointed those they want to serve. Can you divine anything from the make-up of this group?
MARY AGNES CAREY: Well, you do have some prominent members of committees of jurisdiction. In the Senate, for example, you’ve got Max Baucus, who runs the Senate Finance Committee, a Democrat. In the House, you’ve got Dave Camp, who runs Ways and Means – he's a Republican from Michigan. Another Michigan Republican, Fred Upton, runs the Energy and Commerce Committee. And there are some freshman faces. In the House Republicans, for example, you've got Renee Ellmers of North Carolina and Nan Hayworth of New York. So you've got some new blood; you've got some established players. But again, the difficulties remain in this. There are deep philosophical divides between the parties on how to approach many issues that are involved in this. The payroll tax cut is one. The Medicare "doc fix." And so, I think, ultimately, we may see this going back to the leadership level, just as it did before the break, to try to reach a resolution that will get enough support in both the House and the Senate.
JACKIE JUDD: As I said at the top: New year, some old issues. What other issues or questions must the Congress face as this year unfolds?
MARY AGNES CAREY: I think you'll continue to hear a lot from House Republicans about the health law; they don't like it. They’ve tried numerous times to repeal it or defund it. While those attempts to repeal the law or defund it passed in the House, they're stopped cold in the Senate. And even if for some reason, it got to President Obama's desk, he would certainly veto that. But I think you'll continue to hear that. Republicans want to do as much as they can to point out what they think are the weak spots in the health law to the public. They don't like the Medicaid expansion. They don’t like the individual mandate that you have to purchase insurance. They have concerns about how high the subsidies are that allow people to purchase coverage on the exchanges in 2014. So you’ll hear a lot about that issue.
On Medicare, Paul Ryan, who is the head of the House Budget Committee may come back with his budget resolution, his Medicare proposal, again, that would provide a limited amount of money to help people purchase coverage. He’s revised that recently with Ron Wyden, a Democratic senator from Oregon, that would keep fee-for-service in the mix. But Paul Ryan’s views have been very controversial. You could expect to see that again, more discussion about it. And as we know, with the failure of last year’s super committee, there are automatic cuts set to begin next January, in 2013. You may find members of both parties very interested in looking at some way to stop sequestration. On health care, of course, we remember that in Medicare, the providers are shielded at 2 percent cuts and there’s no cuts in Medicaid. But with 50 percent of that money coming from defense and 50 percent non-defense programs, again, there'd be bipartisan interest in trying to stop that. But the problem is where do you get the money?
And of course, we talked about the individual mandate earlier. All eyes will be on the Supreme Court. Briefs are being filed this month and next month, February, oral arguments in March, a decision in June, and of course we have the elections this fall. So what the Supreme Court says or doesn’t say about the health law may very well play into the elections.
JACKIE JUDD: A full calendar.
MARY AGNES CAREY: Absolutely.
JACKIE JUDD: Thank you so much, Mary Agnes Carey of Kaiser Health News.
MARY AGNES CAREY: Thank you.
Jan 04, 2012