Provider cuts still an op­tion un­der any debt deal

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Provider cuts still seen as op­tion in debt deal

Mem­bers of Congress are giv­ing providers no prom­ises that they will avoid cuts or in­creased costs un­der any debt deal, even as many rank-and-file leg­is­la­tors say they un­der­stand the eco­nomic pres­sures on the health­care sec­tor.

A se­ries of pro­posed cuts in provider pay­ments have emerged from on­go­ing ne­go­ti­a­tions to­ward an agree­ment that would lift the fed­eral gov­ern­ment’s debt limit while re­duc­ing fu­ture deficits. The gov­ern­ment is ex­pected to reach its statu­tory bor­row­ing limit by Aug. 2, re­quir­ing a con­gres­sional vote lift­ing it.

Repub­li­cans have gen­er­ally called for spend­ing cuts equal to any in­crease in the debt limit, while Democrats have urged var­i­ous com­bi­na­tions of cuts and new taxes.

Al­though much of the dis­cus­sion be­tween the White House and con­gres­sional lead­ers re­mains se­cret, one sum­mary of about $350 bil­lion over 10 years in health­care cuts dis­cussed dur­ing the nearly seven weeks of talks was leaked this week.

Mem­bers of the Obama ad­min­is­tra­tion and con­gres­sional lead­ers have re­mained tightlipped about any spe­cific cuts un­der con­sid­er­a­tion. And rank-and-file mem­bers of Congress have told Mod­ern Health­care and provider ad­vo­cates re­cently that they can­not con­firm any of the spe­cific cuts un­der dis­cus­sion be­cause their lead­ers have not re­vealed any spe­cific plans or pro­pos­als to them.

“In both Repub­li­cans’ and Democrats’ of­fices, the lack of any­one hav­ing any de­tailed knowl­edge was the same ev­ery­where,” said Scott Malaney, CEO of Blan­chard Val­ley Health Sys­tem in Ohio, who vis­ited Ohio’s con­gres­sional rep­re­sen­ta­tives last week.

That has left many providers and their ad­vo­cates to fo­cus on the leaked list of health­care cuts dis­cussed in ear­lier phases of deficitre­duc­tion ne­go­ti­a­tions that Pres­i­dent Barack Obama asked House Ma­jor­ity Leader Eric Can­tor to com­pile.

A range of provider cuts were in­cluded in the “ar­eas of com­mon­al­i­ties” list at­trib­uted to the Biden talks. Those in­cluded $100 bil­lion in re­duced spend­ing by stan­dard­iz­ing Med­i­caid fed­eral med­i­cal as­sis­tance per­cent­ages, or FMAP, pro­gram; about $50 bil­lion in pay­ment re­duc­tions and co-pay­ments for skilled­nurs­ing fa­cil­i­ties and home health; and about $14 bil­lion in sav­ings from changes in Medi­care’s ru­ral hos­pi­tal pay­ments. Other pro­posed cuts in­clude up to $26 bil­lion from the gov­ern­ment cut­ting back on re­im­burse­ments for un­paid hos­pi­tal debts and $4 bil­lion in low­ered fed­eral Med­i­caid pay­ments to hos­pi­tals that treat an es­pe­cially high per­cent­age of low-in­come pa­tients.

The list pro­vided no specifics on the struc­ture or im­ple­men­ta­tion of the pro­gram changes.

Those and other pro­posed cuts have drawn con­cerns from providers and their ad­vo­cates, who have launched in­creas­ingly ag­gres­sive outreach to mem­bers of Congress over the debt talks in re­cent weeks.

“Sev­eral mem­bers of Congress ex­pressed great concern” about the im­pact of po­ten­tial provider cuts, Hugh Til­son, se­nior vice pres­i­dent of the North Carolina Hos­pi­tal As­so­ci­a­tion, said about dis­cus­sions he had last week with fed­eral leg­is­la­tors.

How­ever, lawmakers stopped short of promis­ing to vote against any deal with provider cuts, ac­cord­ing to in­ter­views with a half dozen hos­pi­tal ex­ec­u­tives and ad­vo­cates who last week vis­ited Capi­tol Hill.

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