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Healthcare groups’ message to deficit panel: Spare us
Healthcare industry groups are less concerned about the lineup of the newly appointed federal deficit-reduction “super committee” than they are about that team’s game plan for Nov. 23.
In the middle of Washington’s August recess, healthcare associations are preparing to educate members of Congress—and especially the six senators and six representatives appointed to the high-profile debt panel— when they return after Labor Day about how cuts to their respective segments would have disastrous consequences on patients, physicians, hospitals and the economy at the local and federal levels.
The majority and minority leaders in the House and Senate chose the 12 committee members: Sens. Max Baucus (D-Mont.), John Kerry (D-Mass.), Jon Kyl (R-Ariz.), Patty Murray (D-Wash.), Rob Portman (R-Ohio) and Pat Toomey (R-Pa.), and Reps. Xavier Becerra (D-Calif.), Dave Camp (R-Mich.), James Clyburn (D-S.C.), Jeb Hensarling (RTexas), Fred Upton (R-Mich.) and Chris Van Hollen (D-Md.).
The Budget Control Act—the legislation that defused the debt-ceiling stalemate this month—tasked the super committee, as it’s known, with submitting a proposal by Thanksgiving that identifies at least $1.5 trillion in deficit reductions through cuts or tax increases (Aug. 8, p. 6). If Congress fails to approve the proposal, automatic cuts of $1.2 trillion—or the trigger—split between domestic and defense spending will take effect. Medicare cuts, limited to providers, would be capped at 2%.
“I think all of this is so fluid and so difficult to predict what will happen,” said Dr. Atul Grover, the chief advocacy officer for the Association of American Medical Colleges. “I’m not confident at all GME (graduate medical education) will be spared,” he added. “I think if they make smart policy decisions, GME will be spared.”
Grover said Kerry has previously taken a stand opposing cuts to teaching hospitals, and he described Baucus as a moderate who likes to reach across the political aisle.
More specifically, Grover highlighted how academic teaching hospitals also serve as economic engines in the states represented by super-committee members. For instance, Toomey represents Pennsylvania—home to UPMC, West Penn Allegheny Health System, and a new medical school in Scranton. Portman, a former director of the Office of Management and Budget, represents Ohio, home to the Cleveland Clinic and the Ohio State University Health System. And then there is Van Hollen, the ranking member on the House Budget Committee, whose district includes employers Johns Hopkins Hospital
“We oppose any further reductions in payment for hospital services under Medicare.”
—American Hospital Association
and federal agencies such as the National Institutes of Health and the Food and Drug Administration.
Grover said his group has spent the past months helping members of Congress understand that cutting GME does not just cut the number of providers today, but will compromise the number of providers who are produced in the future. Meanwhile, there is also the threat of cutting indirect medical education, referred to commonly as IME. This funding, Grover said, could affect the level of trauma services in a teaching hospital, which includes making sure specialists and nurses are available around the clock. “That is an expensive proposition,” he said. “If you’re not getting support for those positions, you’re going to see trauma centers close in the short term.”
Other healthcare providers offered similar fears about programs that affect their work. The National Association of Public Hospitals and Health Systems, for example, opposes across-the-board cuts to Medicaid FMAP rates or blending rates to a common lower rate, said Beth Feldpush, vice president of advocacy and policy at NAPH. The group also opposes cutting or eliminating provider taxes under the Medicaid program and supports a plan to expand patient access to lower-cost drugs in the inpatient setting. That approach, Feldpush said, is part of legislation introduced by Rep. Cathy McMorris Rodgers (R-Wash.), and has been scored by the nonpartisan Congressional Budget Office to save the government money.
Groups such as the American Hospital Association, America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America were reluctant to comment specifically on the selections or qualifications of the various members of the super committee, opting instead for statements supporting their respective positions on the process. A spokesman for PhRMA said the association will remain focused on educating federal lawmakers about the Medicare Part D program, which the association said in a statement saves Medicare about $12 billion a year.
AHIP is likewise seeking to protect Part D, which is administered by private insurers, as well as Medicare Advantage and supplemental coverage, and Medicaid managed care.
Not surprisingly, the AHA said that regardless of the super committee’s composition, “We oppose any further reductions in payment for hospital services under Medicare,” according to a statement from Matt Fenwick, an AHA spokesman. “Americans depend on the care Medicare provides and cuts would jeopardize care for seniors,” the statement continued.
Meanwhile, the Medical Group Management Association is firm in its stance that any fiscally responsible proposal from the panel must include a repeal of the contentious sustainable growth-rate formula for physicians.
“I think they’ll consider it because you have