Editor: Randy
Revelle
Volume 9, No. 8
December 15, 2009
New Senate
Details Emerging
Vigorous debate on health care
reform continues as U.S. Senators strive to find common ground on key
issues, including a public option, Medicare expansion, and cost
control. In mid-November, the Senate released a health care
reform
bill, the Patient Protection and
Affordable Care Act (H.R. 3590) and
obtained the 60 votes necessary to begin floor debate. The
Senate’s next step requires another vote of 60 Senators to end debate
and
approve a bill.
After the Senate failed to
obtain 60 votes to move the original bill forward that included a
public option, a group of 10 moderate and liberal Democratic Senators
worked out a new, tentative compromise. The new proposal expands
Medicaid from 133 percent in the original bill to 150 percent of the
federal poverty level. The bill would also allow individuals over
the age of 55 to enroll in Medicare. In lieu of a public option,
nonprofit insurance plans, modeled after the Federal Public Employees
Benefits Program, would be created and overseen by the U.S. Office of
Personnel Management. Under the compromise, if insurers neglect
to offer new national health plans, a public option would be
“triggered.”
The U.S. Senate awaits the
Congressional Budget Office’s cost projection of the legislation.
A handful of Senators are still not pleased with this new proposal, and
it remains to be seen if Majority Leader Harry Reid will secure the 60
votes necessary to approve a bill by the holiday break.
The American Hospital
Association is concerned about the expansion of Medicare and Medicaid,
since these programs have historically paid hospitals low rates.
Comparison
of Health Care Bills
Do you want more information
comparing the two versions of the federal health care reform
bills? The Healthcare Association of New York State recently
published a PowerPoint outlining the key differences of the bills – H.R.
3590 in the U.S. Senate and H.R. 3962 in the U.S. House of
Representatives. For a copy of the presentation, please click
here.
MedPAC
Report on Regional Variation
The hot issue of regional
variation in the use of health services recently received another boost
of energy with the release of a new MedPAC report on Measuring Regional
Variation in Service Use. Despite the overuse of services
and the
potential to save lots of money, Congress has yet to put forth a
significant proposal to resolve the issue. The House bill
approved in November, H.R. 3962, takes a first step in directing the
Institute of Medicine to develop a budget neutral plan addressing
variation and cost of services, including recommendations for payment
changes for inpatient and outpatient services. The Senate’s bill
does not specifically address the variation issues, but does call for a
new efficiency measure to be developed through a value-based purchasing
program.
The December 2009 MedPAC
report to Congress reinforces the long held position of Washington
State as an efficient provider of health services with low use rates
per Medicare beneficiary. MedPAC compared the regional use of
Medicare services in metropolitan service areas and controlled for
differences in health status, special payments, and adjustments from
cost of living differences and/or teaching designations. In other
words, regional variation in Medicare services reflects only
differences in the volume and intensity of services that beneficiaries
with comparable health benefits receive from Medicare.
Key findings in the report
include: (1) Medicare spending varies in part because of payment
adjustment factors, such as wage index and health provider shortage
area payments; (2) regional variation in service use is smaller than
regional variation in Medicare spending, but the differences are still
substantial; (3) regions with high levels of service use are not always
the regions with high growth rates; (4) service use varies at all
geographic levels, including within states and among providers within
metropolitan service areas. The service area data reflect the
average utilization rates of services according to the beneficiary’s
residence, not the average services provided by hospitals in the
service area. To read the full MedPAC report click
here.
To see how Washington State’s
metropolitan service areas compare with the national average click
here. For more detailed information, please contact Jim
Cannon at the Health Information Program at jimc@wsha.org or 206-216-2551.
If you have any questions
about federal health care reform, please contact Chelene Whiteaker at chelenew@wsha.org or 206-216-2545.
Washington
State Hospital Association
300 Elliott Avenue West, Suite 300, Seattle, WA 98119-4118
Phone: (206) 281-7211, Fax: (206) 283-6122, Web Site: www.wsha.org
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