Ris­ing to the top

In­dus­try groups quiet about Ryan’s ef­fect on poli­cies

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jes­sica Zig­mond

Mitt Rom­ney’s se­lec­tion of Rep. Paul Ryan (R-Wis.) as his GOP vice pres­i­den­tial run­ning mate raised Medi­care and Med­i­caid as top cam­paign is­sues across the coun­try, but health­care in­dus­try groups were rel­a­tively mum last week about how Ryan’s ad­di­tion to the Repub­li­can ticket will af­fect their pol­icy agen­das.

“I don’t think we’re chang­ing our mes­sag­ing, and I don’t think other folks are chang­ing theirs,” said Shawn Grem­minger, as­sis­tant vice pres­i­dent for leg­isla­tive af­fairs at the Na­tional As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems, which rep­re­sents the na­tion’s safety-net providers.

“I think peo­ple are go­ing back to the Ryan pro­posal,” he said, adding that en­ti­tle­ment re­form will cer­tainly be a dis­cus­sion in 2013, and that Rom­ney’s choice of Ryan “puts a finer point on where Rom­ney will be if he’s elected.”

Marie Wat­teau, a spokes­woman with the Amer­i­can Hospi­tal As­so­ci­a­tion, said in an email that “clearly, the choice of Paul Ryan as VP can­di­date el­e­vates the Medi­care is­sue,” but that the or­ga­ni­za­tion would not be able to com­ment fur­ther for this story. A rep­re­sen­ta­tive for the Fed­er­a­tion of Amer­i­can Hos­pi­tals was not avail­able for an in­ter­view last week, and a spokes­woman for Amer­ica’s Health In­sur­ance Plans said the group was not able to com­ment at this time.

As chair­man of the pow­er­ful House Bud­get Com­mit­tee, the 42-year-old Ryan made na­tional head­lines in April 2011 when his con­tro­ver­sial fis­cal 2012 bud­get—called the Path to Pros­per­ity—pro­posed sweep­ing en­ti­tle­ment pro­gram changes that would of­fer a pre­mium-sup­port model for Medi­care and trans­form Med­i­caid to a block grant pro­gram. His bud­get for fis­cal 2013, which passed in the House but went nowhere in the Se­nate, called for sim­i­lar re­forms and was sig­nif­i­cant for map­ping out the Republicans’ pol­icy agenda for the com­ing year. Now the ques­tion is whether Ryan will push that agenda as an eight-term con­gress­man (Wis­con­sin law al­lows him to run con­cur­rently) or as the na­tion’s vice pres­i­dent.

Also, the health­care in­dus­try should also pre­pare for an­other at­tempt to over­turn the Pa­tient Pro­tec­tion and Af­ford­able Care Act if Rom­ney and Ryan win in Novem­ber. Rom­ney has said that he would seek to re­store the $716 bil­lion spend­ing re­duc­tions to Medi­care em­bed­ded in the law, but he has not spec­i­fied

how he would do that.

In re­sponse to a ques­tion for this story, Lanchee Chen, Rom­ney’s pol­icy di­rec­tor, sent a state­ment that said, “Mitt Rom­ney and Paul Ryan have al­ways been fully com­mit­ted to re­peal­ing Oba­macare, end­ing Pres­i­dent Obama’s $716 bil­lion raid on Medi­care, and tack­ling the se­ri­ous fis­cal chal­lenges our coun­try faces. A Rom­ney-Ryan ad­min­is­tra­tion will re­store the fund­ing to Medi­care, en­sure that no changes are made to the pro­gram for those 55 and or older, and im­ple­ment the re­forms that they have pro­posed to strengthen it for fu­ture gen­er­a­tions.”

Among those re­forms is a plan—which Ryan out­lined in his bud­get—to trans­form Med­i­caid into a block-grant pro­gram for states. Ed­win Park, vice pres­i­dent for health pol­icy at the Cen­ter for Bud­get and Pol­icy Pri­or­i­ties, said Ryan’s plan for block grants and cut­ting the pro­gram by $800 bil­lion over 10 years will re­sult in huge cuts to el­i­gi­bil­ity, ben­e­fits and provider rates.

“For hos­pi­tals in par­tic­u­lar, not only would the House plan re­peal the ACA but block grants would lead to more unin­sured,” Park said. “These are real fun­da­men­tal changes to the pro­gram, and that would ul­ti­mately have a caseload im­pact on providers.”

An­ders Gil­berg, se­nior vice pres­i­dent of the Med­i­cal Group Man­age­ment As­so­ci­a­tion gov­ern­ment af­fairs staff, said the se­lec­tion of Ryan will not change the group’s ad­vo­cacy ef­forts, which will continue to fo­cus on re­peal­ing the sus­tain­able growth-rate for­mula that Medi­care uses to pay physi­cians.

“You’ve got the short-term is­sue of the 27% cut on Jan. 1 and then the $300 bil­lion to $400 bil­lion cost to fully re­peal (the SGR) as part of Medi­care re­form or deficit re­duc­tion or both,” Gil­berg said. “It re­mains to be seen how much the ad­min­is­tra­tion af­fects those de­bates ver­sus the Congress.”

Dur­ing a nor­mally quiet Au­gust re­cess, lead­ers of both po­lit­i­cal par­ties sent elec­tronic mes­sages and alerts last week that in­di­cated they’re gear­ing up for an in­tense fight over Medi­care in the months ahead. Democrats continue to as­sert that the Ryan bud­get will “end Medi­care as we know it” and in­crease costs to se­niors by about $6,400. Republicans say their plan will save the pro­gram for fu­ture gen­er­a­tions, while the cur­rent ad­min­is­tra­tion cut Medi­care pay­ments by $716 bil­lion over 10 years to fund the 2010 health­care re­form law.

“Ryan was cer­tainly an in­ter­est­ing pick,” said the NAPH’s Grem­minger. “In a lot of ways, it comes down to how good Paul Ryan is—and he’s very good; he’s very smart, a ter­rific speaker—ver­sus his bud­get, which is un­pop­u­lar among vot­ers,” he added. “Can Paul Ryan’s skills as a can­di­date out­weigh the drag that his bud­get is?”


Republicans say Ryan’s bud­get will keep Medi­care run­ning, while Democrats main­tain the plan would end the pro­gram.

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