October 30, 2014

Posts on health care

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Wednesday, June 16, 2010 - 1:23 PM

Debate on the so-called “extenders” bill has focused on the size and duration of unemployment benefits, health insurance assistance for those who recently lost their jobs, Medicare physician payments, state aid for health care and various offsets to mitigate the overall effect on the deficit.

Conspicuously missing from the debate is any scrutiny of the extenders themselves. It’s a missed opportunity to raise needed revenue while simplifying the tax code and broadening the tax base -- goals that economists of all ideological stripes have long advocated. 

Both the House and Senate versions of the extenders bill contain more than 60 narrowly targeted tax breaks that expired last year. Extending them just through this year will cost about $32 billion. The long-term cost runs to over $350 billion. That cost will add to the debt unless it is offset by corresponding tax increases or spending cuts that may prove more harmful to the economy than failing to renew some, or all, of the extenders. 

At a time when the President is commendably urging all federal agencies to identify their lowest priority and least effective items, Congress should devote the same level of scrutiny to the tax code. The extenders would be a good place to...

Wednesday, March 31, 2010 - 11:00 AM

According to a March 29 Roll Call article (subscription required), Senate Republicans have gone home for the two-week congressional recess with a strategy memorandum advising them to call for repeal of “Medicare cuts, tax hikes, mandates and sweetheart deals” in the new health care reform legislation.

Leaving aside the sweetheart deals, repeal of the other three items would amount to a fiscal catastrophe. One can legitimately argue that the law will end up costing more than anticipated or that some of the proposed savings will fail to materialize. Claims of big deficit reduction do indeed rest on some shaky assumptions, and the law certainly leaves a lot of work to be done on fiscal sustainability. However, the surest way to guarantee exploding deficits would be to leave in place all of the popular insurance reforms and repeal the politically difficult choices that have been made to pay for them.

Expanding health insurance coverage costs money. Unlike the 2003 Medicare prescription drug bill, this plan at least attempts to pay for its new spending by cutting future Medicare costs and raising new revenues. Constituents may not like these things but they are essential parts of the law. They are also protected by...

Friday, March 19, 2010 - 2:25 PM

It looks like we might be entering the final week(s) of (at least) this year's legislative push on health care reform.

Thursday brought us legislative text of the amendments to the Senate bill that the House will take up through the reconciliation process as well as an updated CBO score of the whole package. It is likely the House will vote on the bill package Sunday. If they do so, the Senate bill will become the law of the land, and the reconciliation amendments will then have to make it though the Senate before those become law.

The main fiscal takeaway from this week is that there really has not been any substantial change in what heath care reform is attempting to accomplish and whether it will ultimately be fiscally responsible legislation. Today we released a series of video discussions (see above) between Bob Bixby and I explaining the big picture and how the reconciliation tweaks effect that. One of the issues discussed is that clearly the most consequential fiscal change through reconciliation is the delay in implementation of the excise tax on cost insurance plans.

For a more complete view, our December Issue Brief, created as the Senate bill neared passage,...

Tuesday, March 2, 2010 - 10:47 AM

The end game for health care reform may finally have arrived. Some in Congress are suggesting that a decision should be made by the Easter break, which begins on March 26. Time is running short.

If we learned anything from last week’s health care summit, it is that the final end game negotiations will not take place between Democrats and Republicans but among various factions of Democrats.

Republicans now sense big gains coming in the November elections and thus have no motivation to move in Obama’s direction. Any attempt to draw them into a negotiation –- including the “start from scratch” option Republicans themselves are pushing -- will likely fail.

Democrats are split, with some fearing for their jobs if they support an unpopular bill while others believe that passing even a flawed bill will leave them better off in November.

One casualty of the situation may be cost containment. Democrats are mostly united around coverage expansion. That’s the easy part. Their biggest difference is on the more difficult question of aggressive cost containment. The two most promising cost-containment strategies still on the table are the tax on high-cost health care plans and the...

Sunday, January 24, 2010 - 9:06 PM

As the White House and congressional leaders rethink health care reform after the Republican upset in the Massachusetts Senate race, there is a growing danger that Congress will jettison comprehensive health care reform altogether. Even worse, they might pass stripped-down measures that eliminate politically difficult cost-containment, while popular but costly provisions are kept.

President Obama has suggested narrowing the focus of national reform, advising that Congress should “try to move quickly to coalesce around those elements of the package that people agree on.” Some members of Congress have also expressed support for a limited bill.

However, most policy experts agree that a limited bill is nearly impossible to construct without running into some major issues with short and long-term costs. That is because the easier elements -- the ones that “people agree on” -- are interlocked with elements whose benefits are far less apparent to many voters.

The key reforms for the health insurance industry are popular -- for instance, prohibiting discrimination based on pre-existing conditions. Yet, just doing that would lead to an insurance "death spiral" where only the sick would get insurance when needed, driving up the cost of premiums. The only way around this spiral is to have an individual mandate to...

Tuesday, January 12, 2010 - 11:48 AM

In my previous post, I spent some time clarifying how “advance care planning” is in no way, shape or form the same as a “death panel,” and how palliative care does not equate to any "rationing of care." Rather, both these health care interventions are patient-centered and improve the value of the health care experience for severely, chronically, and terminally ill patients and their families.

As Congress resumes its work and health reform continues to dominate talks on Capitol Hill, I'd like to put these in context given the status of health reform today.

The philosophy behind advance care planning fits nicely with the promotion of an Independent Payment Advisory Board tasked to make recommendations to Congress on slowing future Medicare cost growth. Similarly to advance care planning, where potential treatment options and often difficult decisions are discussed prior to a health crisis, the Independent Payment Advisory Board (IPAB) is being asked to evaluate the tough choices facing the longevity and fiscal health of the Medicare program in advance of a federal budget crisis. The Advisory Board would be made up of health care experts, people who entered their professions because...

Friday, January 8, 2010 - 4:15 PM

When discussing health care reform, if we cannot even be clear that “advance care planning” is in no way, shape or form the same as a “death panel,” how will we ever be able to talk about the real (and factual) challenges facing the Medicare program and its long-term sustainability?

Ugh….

Let’s be clear: there are no “death panels” included in the health reform bills adopted by the House of Representatives and the Senate, although misinformation on this topic has been swirling for months. For example, last August during the Congressional recess I was quite distraught when my own Senator Charles Grassley stated in an Iowa town hall meeting that he was worried that efforts to increase the efficiency of Medicare or to create an Independent Medicare Advisory Commission would indeed mean that the federal government would be making decisions about when to “pull the plug on Grandma.” More recently, the clause in the House bill that allowed reimbursement to Medicare providers who hold “advanced care planning consultations” with their patients has been equated with a “death panel” deciding when a senior would die.  Nothing could be further from the truth.

Having studied end of life care in graduate school and...

Wednesday, January 6, 2010 - 10:57 AM

When we finished our issue brief on the health care reform "endgame" before the holidays, we had a difficult time trying to isolate the key 10-year costs and savings of different components of the legislation. Now that we have had a bit more time with the final House and Senate versions of the legislation and the CBO analyses, we wanted to present the following table:

 House BillSenate Bill
Insurance Coverage Expansion1052871
   
Minus Offsets  

Spending Cuts

352413
CLASS Act10272
Tax Increases570474
Penalties16843
Subtotal (offsets)1,1921,002
   
Deficit Reduction-138...
Wednesday, December 23, 2009 - 4:07 PM

With the House having passed its version of health care reform (H.R. 3962) and the Senate on the verge of passing its version (H.R. 3590), the outline of a final bill is beginning to take shape. In our new Issue Brief, we look ahead at the fiscal considerations that will likely be the subject of conference committee discussions and “end game” negotiations. These include the cost of expanding coverage, the methods used to prevent that cost from adding to the deficit, and the prospects for systemic reforms to reduce cost growth over time. 

This issue brief gives The Concord Coalition’s perspective on how the bills measure up, what the risks are and how these risks could be lessened. We conclude that:

•    Both bills establish...
Thursday, December 17, 2009 - 1:48 PM

As mentioned in the last post, the Senate dramatically weakened the Independent Medicare Advisory Board in the health care legislation currently being debated.

Today, Concord released an issue brief discussing this and highlighting the fact that there is an amendment being proposed by Senator Rockefeller that would restore the board's potential for cost control and delivery system reform. 

The legislative process right now is quite a jumble and it is unknown whether any amendments still have a chance to be voted on or folded into the final "manager's amendment." Hopefully, Senators concerned about cost control will see the wisdom in still altering the bill to strengthen its provisions on that score. Ruth Marcus at the Washington Post had a good column about this in the paper yesterday.