President Obama’s decision to use his recess appointment powers to nominate Donald Berwick to head the Centers for Medicare and Medicaid Services continues to anger Republicans who wanted a public examination of Berwick’s record. Meanwhile, several less-known provisions of the health care law, including more coverage of preventive services and help with employers to cover early retirees health care costs, go into effect this year.
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JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. It’s been about four months since Congress passed the health care reform bill and President Obama signed it into law. Today, we review some of the lesser known changes to the health care system that are coming up, as well as the controversy over the man President Obama selected to oversee changes to Medicaid and Medicare. Joining me as always, Mary Agnes Carey, senior correspondent for Kaiser Health News. Welcome, Mary Agnes.
MARY AGNES CAREY: Thank you.
JACKIE JUDD: Don Berwick is the man the President selected to oversee Medicare and Medicaid. You’ve spent a lot of time reviewing his very long record in the health care field - what should we expect of him?
MARY AGNES CAREY: I think you can expect for him to come in and get to work right away. He has talked a lot in his career about making health care more efficient for consumers, for providers. There’s a lot in the health care law to focus on making Medicare and Medicaid more efficient. I think that he will want to get in and get to work right away to implement these changes with the thought of making these programs more efficient, again for the people that they serve and the people that provide the care.
JACKIE JUDD: President Obama bypassed the typical, the usual confirmation process. There will not be confirmation hearings in the Senate. Republicans are angry; some of them oppose Don Berwick. They believe that he believes in rationed care and that that’s what he will bring with him to this job. Did the White House not want to have this argument this close to the November elections?
MARY AGNES CAREY: I think number one they would disagree that Don Berwick is about rationing health care and, of course, Dr. Berwick himself would disagree on that point. And then, also the administration would make the point, as many Democrats, that the current system rations health care if you have so many people without health care insurance. But to your point, I think you are exactly right. You could have had a long nomination battle, the confirmation battle would have been long, it would have been nasty, the outcome was uncertain, and we do have an election just a few months away. All of the debate would have given Republicans another chance to bring up everything about the law they dislike; to take certain particular remarks or writings of Dr. Berwick’s and focus on them, and debate them. And I think that everyone involved as far as the proponents of the bill wanted to side step that and just get to the implementation of it.
JACKIE JUDD: Okay. You recently reported a story that is now on our website about some of the lesser known provisions of the health care reform law, and one of them has to do with paying for preventive services. What is that about? When does it happen, the change?
MARY AGNES CAREY: The provision for patients would mean no co-pays and no deductibles for certain preventive services. Here you are talking about things like breast cancer screening, blood/cholesterol screening, and immunizations. No co-pays, no deductibles. The thought is that if you make that more acceptable in the sense of a patient doesn’t have to have a co-pay or a deductible, they might go in and get these services and that could save money in the long run. Some analysts are debating if these provisions and other requirements of the health care law are included that they could drive up the cost of health insurance. Proponents of the bill, administration officials say that impact is going to be miniscule. This is going to take effect for plan years after September 23rd. If your health insurance new plan year is in January, for you it would not start until next January.
JACKIE JUDD: Another element of this is for early retirees, people who retire from 55 onward are not yet eligible for Medicare. Who has helped in this scenario and how?
MARY AGNES CAREY: The thought is you want to incentivize employers to keep early retirees on their health insurance plans, and so this is a provision in the bill to do that. It would help. It would cover about 80 percent of medical claims from 15,000 up to 90,000 for the retirees, their spouses, and their dependents. One concern here is will the $5 billion that is appropriated for this be enough money? Health and Human Services Secretary Kathleen Sebelius at a recent news conference talked about employers delivering their applications by hand for this program. I think that is a sign of great enthusiasm. Employers want help with their health care costs so while this does stand to benefit a lot of folks, will there be enough money for it?
JACKIE JUDD: What is the expectation about how quickly the $5 billion might run out?
MARY AGNES CAREY: Well, there was one report that suggested that it could last if it were drawn down for all retirees and their dependents, it could last no more than two years. Now whether or not that actually occurs, we will have to see.
JACKIE JUDD: And finally, there is this expansion of Medicaid that we have heard so much about. At least one state, in the District of Columbia, is acting on this sooner than the law mandates - where and how?
MARY AGNES CAREY: Well, as we know, in 2014 a very broad expansion of Medicaid will take place. Individuals who make by today’s standards about $14,400 will be eligible for Medicaid. That is up to about 133 percent of the federal poverty level. What the law says to states is while you won’t get the full federal match for that additional population like you will get in 2014, if you want to expand your programs, right now your Medicaid programs, to cover childless adults, we will help you with the costs. Connecticut already moved ahead covering some of these childless adults. Now they will get federal assistance. As you mentioned, the District of Columbia has also decided to do this. So it is a way again, let’s get more people covered earlier than the law would allow.
JACKIE JUDD: I can’t imagine that there is going to be a stampede by many states to do this, given the economic situation so many of them find themselves in.
MARY AGNES CAREY: Well, I think that is certainly an area of concern. We have talked a lot about the governors’ pressing Congress for more Medicaid money, so I think that it is a decision a state has to make. While they will get matching federal dollars, can they extend their own resources now to cover more folks under Medicaid?
JACKIE JUDD: Okay, thank you very much, Mary Agnes Carey of Kaiser Health News. I’m Jackie Judd and this has been Health on the Hill.