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From Spencer's Benefits Reports: This is another in a series of regular health care reform updates from Spencer's Benefits Reports. Included are links to items already covered, brief summaries of actions taken by the federal government, recent reports and studies on health care reform, policy statements by major stakeholders, and other recent health care reform activity.
States Voice Concerns Over Cost Shifts, Unfunded Mandates In Health Care Bill
As the Senate Finance Committee continued to work on its version of health insurance reform (see http://finance.senate.gov/), the National Conference of State Legislatures (NCSL) sent a letter urging the committee to avoid passing the costs of health care reform on to the states.
In the letter, states urged the federal government to provide 100% federal matching payments for new mandatory eligibility categories or services and for mandatory increases in provider reimbursements.
“Just when states need more money to meet the increased demand for Medicaid services, they have less, which is why any federal expansion of eligibility and provider reimbursements has to come with full funding,” said State Sen. Don Balfour, a Georgia state senator and president of the NCSL. “A lesser commitment from the federal government would shift billions of dollars in costs to states.”
Also, to assist states and Medicaid beneficiaries during an economic downturn, the NCSL is calling for a provision that would trigger an automatic increase in the amount of federal Medicaid matching money provided to states. This “countercyclical assistance” would support increased demands placed on the state-federal Medicaid program in tough economic times and negate the need to pass legislation whenever the economy sinks. Massachusetts state Sen. Richard Moore, president-elect of the NCSL, stated that “the automatic stabilizer is critical and is also an important provision for the future.”
For more information, visit http://www.ncsl.org/?tabid=18623.
Reform In Payment And Delivery Systems Could Finance Coverage Expansion
In light of the large variances in health care costs across different geographic regions of the United States, reorganizing and improving care nationwide to eliminate or drastically reduce waste could help finance expanded access to cover the uninsured. This is the primary premise of Getting Past Denial—The High Cost of Health Care in the United States, by physician Elliott S. Fisher from the Dartmouth Medical School and colleagues from the Dartmouth Institute for Health Policy and Clinical Practice in an article published in the September 24 New England Journal of Medicine.
The Dartmouth group found that health status accounts for $593 of the $3,280 difference between the lowest- and highest-intensity regions, or only about 18% of the difference. Differences in poverty and income levels in regions accounted for little, if any, of the cost and intensity of care variation. More than 70% of the differences in spending “cannot be explained away by the claim that ‘my patients are poorer or sicker,’” Dr. Fisher wrote.
The Dartmouth group’s previous research on medical practice patterns across the United States has shown that “discretionary decisions by physicians seem to account for most of the regional variation in spending.”
“We should recognize that so much discretionary care is provided in the United States that we could easily afford to expand coverage without increasing taxes—or rationing care—as long as we couple coverage expansion with a commitment to rapidly test and broadly implement successful reforms in payment and delivery systems,” the Dartmouth researchers emphasized. “We should not let denial get in the way of acceptance of the need to move forward on fundamental reform of the U.S. health care delivery system. We can’t afford the alternative.”
The article is available at http://healthcarereform.nejm.org/?p=1739&query=home.
State Insurance Commissioners Warn Insurers To End “Scare Tactics” On Medicare Beneficiaries
In a letter to Sens. Max Baucus (Mont.), and Charles Grassley (Iowa), respectively chairman and ranking member of the Senate Finance Committee, the National Association of Insurance Commissioners (NAIC) reiterated the Centers for Medicare and Medicaid Services’ warning to insurance companies to end practices that alarm Medicare beneficiaries about federal health care reform efforts. The NAIC, a national organization of state insurance regulators, is calling on Congress to make legislative changes to end marketing and sales abuses.
“State regulators believe that these troublesome practices are directly tied to excess payments made to Medicare Advantage plans, and support changes made to federal law that would reign in these abuses,” said chair of the NAIC health insurance and managed care committee and Kansas Insurance Commissioner Sandy Praeger. “In addition to changes to payments made to Medicare Advantage plans, we urge you to restore state insurance regulatory authority over Medicare private plans.”
For further information, visit http://www.naic.org.
Treasury Department Report Bolsters Urgent Need For Health Insurance Reform
The Treasury Department has released a report examining recent, more complete data on the number of adult Americans without health insurance over a ten-year period. “The report underscores the urgent need for comprehensive health insurance reform,” stated Treasury Secretary Tim Geithner in a press release. “While over 15% of Americans go without insurance in a given year, nearly 50% will go uninsured at some point over the next decade” and thus would benefit from measures designed to enhance coverage options for the uninsured.
The Treasury Department report, The Risk of Losing Health Insurance Over a Decade: New Findings from Longitudinal Data, revealed the following results on uninsurance rates at some point over a ten-year time span for adults younger than age 65:
The Treasury Department report is available at http://www.treas.gov.
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