White House warns of sequester’s healthcare impact

By Rich Daly

Posted: February 8, 2013 – 7:15 pm ET

Tags: Management, Medicare, Nursing, Quality, Research

The Obama administration is warning that budget cuts scheduled for March 1 would hit especially hard in mental healthcare, medical research and the drug approval process.

On Friday, the administration released details of some of the nonmilitary cuts under the Budget Control Act of 2011, which required $1.2 trillion in across-the-board spending cuts from most federal programs over 10 years.

The White House paper said the cuts would mean the loss of 12,000 research positions funded by grants from the National Institutes of Health and the end of treatment for 373,000 people with mental illness due to reductions in the Mental Health Block Grant.

The paper also warned that administrative cuts at the FDA’s Center for Drug Evaluation and Research could result in “delays in new drug approvals.”

The administration previously offered more detailed accounts of the so-called sequester’s impacts on federal agencies but now says the effects could be worse. That is because the roughly 5% annual reduction in nondefense federal programs would need to occur with only seven months remaining in the fiscal year so they would deepen to an “effective” 9% cut in those programs’ budgets.

“These large and arbitrary cuts will have severe impacts across the government,” the White House said in the report.

The message followed a growing number of statements by Republican members of Congress that they expect the reductions won’t be averted or delayed again, much to the alarm of Democrats.

Obama “is particularly concerned these days, as you heard from him the other day, about the apparent willingness —almost seeming desire—by some Republicans to allow the sequester to kick in,” White House Press Secretary Jay Carney said Feb. 7.

The president has urged Republicans to accept a package of alternate cuts and taxes to allow for a short delay while a permanent replacement to sequester is developed. The sequester was previously scheduled to begin Jan. 2 but was delayed by an end-of-the-year deal.

Unmentioned in Friday’s paper was the 2% cut to Medicare provider and insurer payments that also will occur under the sequester. That reduction would eliminate $100 billion in Medicare spending over 10 years, including $3 billion in the current fiscal year, according to updated estimates released this week by the Congressional Budget Office.

“Cuts to physician payments resulting from sequestration would further destabilize the Medicare program and compound the already dire situation for medical group practices caused by the sustainable growth rate formula,” Dr. Susan Turney, president and CEO of the MGMA-ACMPE Medical Group Management Association, wrote in a Feb. 8 letter to congressional leaders.

Several provider advocates, however, said in recent interviews that they were resigned to the cuts taking effect because of the political stalemate and were developing strategies to reverse them later.

“The probabilities are very high that the sequester will go into effect,” said Kenneth Raske, president of Greater New York Hospital Association.

Others have raised concerns that a package of replacement cuts, which the administration has avoided specifying, could be worse than the sequester. For instance, some proposals have surfaced to replace defense cuts with further reduced payments to Medicare providers, said Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care.

“Under the present political situation, there is still concern that they could replace a meat ax approach with something that is still a very blunt instrument,” he said.

Read more: White House warns of sequester’s healthcare impact | Modern Healthcare http://www.modernhealthcare.com/article/20130208/NEWS/302089949#ixzz2KbrD1L6c?trk=tynt

CMS Officials Postpone Basic Health Program for One Year

Washington Health Policy Week in Review

By Rebecca Adams, CQ HealthBeat Associate Editor


February 7, 2013 — Federal officials are delaying until 2015 the Basic Health Program, a health care overhaul option that would allow states to use federal tax subsidies to help cover low-income people whose income is too high to qualify for Medicaid.

The program is an alternative to offering that population coverage in the exchanges that will begin operating in January 2014 under the overhaul (PL 111-148, PL 111-152). It is intended to help those with incomes between 139 percent and 200 percent of the federal poverty level. The delay in the start of the program was explained in a “frequently asked questions” document from the Centers for Medicare and Medicaid Services (CMS).

CMS officials cited as the reason for delay “the scope of the coverage changes that states and the federal government will be implementing on January 1, 2014, and the value of building on the experience that will be gained from those changes.”

People who get their insurance through this program would not have to reimburse the federal government if their income fluctuates during the year, unlike under other health programs where a change in circumstances could change their eligibility. For example, without the basic program, if someone’s income increased slightly, he or she could become eligible for private insurance through the exchange markets, while a slight decrease could shift them into the population that is eligible for Medicaid. People not in the basic program who get their coverage through the exchanges also would have to pay back any subsidies that they received during the year if it was determined later that they had not actually qualified for them.

The benefit to the federal government is that the Basic Health Program would simplify and perhaps reduce the costs of overseeing the care of this population. A state that decided to use this option would receive 95 percent of the amount of the premium tax credits and cost-sharing reductions that would have been provided in the exchange for this group of people.

CMS officials said they will release proposed rules for the basic health program for comment in 2013 and final guidance in 2014, so that the program will start in 2015.

In the meantime, state officials who want to create a system for the population whose income is near the dividing line between eligibility for Medicaid and the exchanges are encouraged to talk to CMS officials about other options in 2014. For instance, CMS officials have said in the past that states can use Medicaid funds to buy coverage in the exchange market for Medicaid beneficiaries. And some states that already have expanded their Medicaid coverage for adults could offer to help that population pay their premiums in the exchange.

The document covers a wide range of other topics, as well. It provides technical details about the higher federal matching rate for the people who become newly eligible for Medicaid in 2014 if a state expands and how states should transition to a system that uses modified adjusted gross income as a method of figuring out individuals’ eligibility. The memo also answers detailed questions about coverage for pregnant women and children.

Article Link: http://www.commonwealthfund.org/Newsletters/Washington-Health-Policy-in-Review/2013/Feb/February-11-2013/CMS-Officials-Postpone-Basic-Health-Program-for-One-Year.aspx



Affordable Care Act Helps New Moms Pay for Breast Pumps

By: Laurie Patton


Updated: February 8, 2013


SPRINGFIELD, Mo. — They add hundreds of dollars onto the already huge cost of having a baby.  

Now parents are now getting help purchasing a breast pump under the Affordable Care Act. It’s part of the comprehensive coverage for women’s preventive care.

Nurse Lyndsay Wingo says she will breastfeed her baby Jack.

“Both my sisters have babies and they breastfed with them and I just think it’s the best choice for him.”

Like many moms, Lyndsay will have to balance work and breastfeeding.

“I am going to take eight weeks of maternity leave, but when I go back to work I’ll still have to breastfeed, so I am going to pump while at work and then breastfeed while at home.”

Aside from logistics, the cost of a breast pump is often surprising and daunting for parents.

“They are very expensive,” says Wingo.

Electric pumps range in price from $300 to $1,000. Now under the Affordable Care Act, and depending on your insurance plan, all or part of the cost can be covered.

“What’s really cool is now we have federal laws to support a mom’s decision to breastfeed so you can take the time to go in and pump when you are working,” says lactation consultant Becky Cave with Mercy’s NICU.

Breast feeding is credited with helping to connect to baby, giving the baby the immune benefits of anti-bodies and a life threatening gastrointestinal issue that plagues preemies.

“I think they are just recognizing that it is a form of preventative care when you look at the well being of the infant and the mother there’s benefits for both,” says Cave.

Cave says here there is a payoff for parents and baby.

“Even without the reimbursement, if you look at breast feeding and let’s say the cost of a good breast pump is approaching $300, the cost of formula feeding is probably $1,500, so there’s still a cost savings even without any reimbursement now that we have the option for reimbursement it is going to be that much sweeter.”

The first thing you need to do to take advantage of this benefit is to check with your insurance provider. They have different criteria, such as from a medical supplier as opposed to a major retail outlet.


Article Link: http://ozarksfirst.com/fulltext?nxd_id=765232