Nar­row­ing tar­get for cuts

Providers seem likely to get caught in cross hairs

Modern Healthcare - - THE WEEK IN HEALTHCARE - Rich Daly

The con­gres­sional panel look­ing to en­act long-term deficit re­duc­tions ap­pears in­creas­ingly likely to tar­get Med­i­caid providers in a fi­nal pro­posal ex­pected within the next two weeks. Pre­lim­i­nary pro­pos­als from mem­bers of the deficit re­duc­tion su­per­com­mit­tee and re­cent dis­cus­sions with mem­bers of Congress have left provider and Med­i­caid ad­vo­cates more con­cerned about Med­i­caid cuts than at any point since the panel be­gan meet­ing two months ago.

“We’ve got­ten much more con­cerned about the cuts over the last week,” Dr. Bruce Siegel, CEO of the National As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems, said in an in­ter­view. “Some politi­cians think that they can cut Med­i­caid and get away with it, po­lit­i­cally” (See re­lated story, p. 14).

Those grow­ing con­cerns stemmed from leaked de­tails of com­pet­ing Repub­li­can and Demo­cratic pro­pos­als by mem­bers of the Joint Se­lect Com­mit­tee on Deficit Re­duc­tion, which is charged with iden­ti­fy­ing at least $1.2 tril­lion in 10-year deficit re­duc­tions by Nov. 23.

Both pro­pos­als would un­der­take Med­i­caid and Medi­care cuts, but Repub­li­cans have placed a par­tic­u­lar em­pha­sis on Med­i­caid cuts. The Demo­cratic plan would de­rive about $400 bil­lion in sav­ings from Medi­care, ac­cord­ing to con­gres­sional sources, with the sav­ings roughly split be­tween providers and ben­e­fi­cia­ries. Also, the plan’s Med­i­caid cuts would range from $50 bil­lion to $100 bil­lion and would come mostly through re­duc­tions to states. The GOP plan is more ag­gres­sive in cut­ting both pro­grams, ac­cord­ing to con­gres­sional sources, with about $500 bil­lion com­ing from Medi­care and $185 bil­lion from Med­i­caid.

The ex­act form Med­i­caid cuts would take un­der the pro­pos­als was not spec­i­fied by con- gres­sional sources, but sev­eral com­mon op­tions have emerged in re­cent lead­ing deficit re­duc­tion pro­pos­als, in­clud­ing a blended fed­eral med­i­cal as­sis­tance per­cent­ages rate, and lim­it­ing state use of provider taxes.

A pro­posed fed­eral match to state Med­i­caid and Chil­dren’s Health In­sur­ance Pro­gram spend­ing would aim to stan­dard­ize the match­ing rate that now varies by state. Sev­eral deficitre­duc­tion pro­pos­als have in­cluded such a mea­sure, in­clud­ing Pres­i­dent Barack Obama’s rec­om­men­da­tions to the su­per­com­mit­tee in Septem­ber that would re­sult in some states re­ceiv­ing a to­tal of $14.9 bil­lion less over 10 years.

The bi­par­ti­san agree­ment to cut both pro­grams ap­peared to ex­tend out­side the 12-mem­ber deficit panel. Although not all Democrats on the panel sup­ported the $3 tril­lion Demo­cratic deficit re­duc­tion plan, House Mi­nor­ity Leader Nancy Pelosi with­held judg­ment last week on it while stress­ing that there were “no sa­cred cows” im­mune from cuts in the bud­get.

But Repub­li­cans are ap­par­ently ready­ing a push for the in­clu­sion of even larger sav­ings from Med­i­caid.

House Speaker John Boehner (R-ohio) said at a news con­fer­ence that be­cause the fed­eral health­care en­ti­tle­ment pro­grams and

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