Posts Tagged ‘Health insurance exchanges’

HHS Sets November 16 Deadline for Healthcare Marketplace Details

Wednesday, July 11th, 2012

States must give detailed information to the federal government by November 16 – just 10 days after the 2012 presidential election – on how they intend to run their online insurance marketplaces, according to Kaiser Health News.  States that miss the deadline — or can’t operate their own marketplaces – will have it done for them by the federal government, starting in January 2014.

The marketplaces, which are mandated by the Patient Protection and Affordable Care Act (ACA), are designed to increase competition among insurers and make coverage more affordable.  States can opt to run the exchanges, perform limited services, or yield control to the federal government.  The Department of Health & Human Services (HHS) “will seek to harmonize…policies with existing state programs and laws wherever possible.”  Although the guidance does not state whether there will be a governing board overseeing the federal exchanges, it does say the federally-overseen marketplaces will accept any insurer that meets the basic requirements.  Consumer groups, such as the American Cancer Society Cancer Action Network, wanted the federal government to be more selective, in hopes that it would make insurers compete more on pricing and quality measures.

Steve Larsen, the federal official overseeing the federal exchange creation, said the initial approach will be an open marketplace, although in the future, other options may be explored.  States that operate their own exchanges are free to choose whichever model they prefer.  While many states are moving forward – 34 have received federal grants to fund planning efforts – others are moving slowly or not at all.  Six states — Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington – recently received additional grants totaling more than $181 million.

Officials in some state say they are holding back pending the Supreme Court’s decision on the constitutionality of the ACA.  The court could uphold the entire law, strike it down entirely or eliminate some parts of it.  Other state lawmakers have said they want to hold off on creating marketplaces until after the November election.  Larsen reiterated the government’s stance that the court will uphold the law and that President Obama will be re-elected, noting that “states should turn their attention to moving forward.”

The ACA requires states to establish exchanges that offer federally subsidized health coverage to an estimated 16 million people who currently lack healthcare insurance.  The exchanges let consumers purchase their insurance from an easily readable menu of competing plans, at premiums set on a sliding scale according to the buyer’s income.

“What this shows is that states are making real progress in delivering quality, affordable health coverage to their residents and they want to be up and running by January 2014,” said Kathleen Sebelius, HHS Secretary.  She said that 34 states — including some that want the ACA overturned — and the District of Columbia have accepted federal grant money to help establish the insurance exchanges.  Approximately 15 states have moved to establish exchanges, either through legislation or executive order.

HHS also released guidelines for helping states that might not be able to offer full exchange services by 2014 and for establishing federal exchanges in states that refuse to participate.  According to officials, the administration will partner with state governments in two realms: certifying health insurance providers for the exchanges and helping consumers apply for coverage and enroll in the chosen plan.

Karen Ignani, President of America’s Health Insurance Plans, is taking a wait-and-see attitude According to Ignani, “Exchanges work best when they are true marketplaces that maximize choice and competition so that individuals, families, and small businesses can purchase plans that are right for them.  States are in the best position to establish exchanges because they have the experience and local-market knowledge to meet the consumers’ needs.  If a state chooses not to establish its own exchange, any exchange that is implemented should seek to preserve consumer choice and avoid regulatory duplication that will add complexity and increase costs for consumers.  We appreciate that the Department has prioritized minimizing administrative burdens, encouraging choice, and preserving the states’ traditional role of regulating health insurance as these exchanges are developed.  Allowing all health plans that meet new quality and performance standards to offer coverage in an exchange will help ensure competition and preserve consumer choice.  Moreover, we agree that exchanges should be developed with input from all stakeholders to ensure they are able to provide individuals, families, and small businesses with the most accurate and up-to-date information about all of their coverage options.”

10 Percent of America’s Veterans Have No Healthcare Coverage

Tuesday, June 12th, 2012

Ten percent of the nation’s 12.5 million non-elderly veterans do not have health insurance coverage or use Veterans Administration (VA) health care according to the 2010 American Community Survey (ACS).  The Urban Institute report, which was released by the Robert Wood Johnson Foundation, is the first to provide estimates of a lack of insurance among veterans and their families both nationally and at the state level, and to assess the potential for the Patient Protection and Affordable Care Act (ACA) to reduce these rates.  Veterans are less likely be uninsured than the overall population.  Uninsured veterans and their families report significantly less access to healthcare than their counterparts with insurance coverage.  Forty-one percent of veterans who lack healthcare coverage have untreated medical needs, while nearly 34 percent have put off getting care because of the expense.

The ACA’s coverage provisions have the potential to increase coverage among the U.S. population, including uninsured veterans.  An estimated 50 percent of veterans who currently do not have insurance would qualify for expanded Medicaid coverage; another 40 percent have the potential to receive subsidized coverage through health insurance exchanges if they lack access to affordable employer coverage.  Not surprisingly states that have made minimal progress in setting up health insurance exchanges have the most uninsured veterans — nearly 40 percent.  Success in bringing coverage to uninsured veterans will depend primarily on aggressive ACA implementation and enrollment efforts.

The Veterans Administration (VA) –  with more than 1,400 hospitals nationally and nearly 15,000 physicians – covers the majority of veterans, although not all: Eligibility is determined by income, injuries sustained in combat and length of service.  Because of the eligibility requirements, 1.3 million veterans and 0.9 million family members have no healthcare coverage.

Uninsured veterans typically are younger than those with coverage and less likely to have been injured in combat.  Uninsured veterans tend to have higher unemployment rates, less income and usually are not married — all of which reduce the odds of having private coverage.  “Their lower likelihood of being full-time workers and being married likely contribute to their lack of coverage, as these attributes are characterized by lower access to employer-sponsored health insurance,” according to the Urban Institute study.

Writing for the Non-Profit Quarterly, Rick Cohen notes that “Among the states with the worst rates of uninsured veterans, Louisiana, Oregon, and Idaho all top 14 percent, and Montana comes in at a woeful 17.3 percent.  This past weekend, the streets of Washington, D.C. were occupied by participants in the Rolling Thunder demonstration, the annual Memorial Day gathering of veterans (and non-veterans) on motorcycles focused on calling the nation’s attention to the POW/MIA issue.  The Robert Wood Johnson Foundation report would suggest that, in the U.S., there is an abundance of veterans and their families who are being treated as if MIA when it comes to health insurance.”

According to Dr. Jonathan D. Walker, assistant clinical professor at the Indiana University School of Medicine in Fort Wayne,  “A Harvard study estimated that more than 2,200 veterans died in 2008 due to lack of insurance.  You may have thought that veterans can automatically be treated at a veterans’ hospital, but this is not the case.  Uninsured veterans face a “means test” based on their income.  The test determines their priority level for care and how much they have to pay.  And if the system doesn’t have enough money, it can stop enrolling veterans if they fail the means test – as happened from 2003 to 2009.  But even if the VA were able to fully cover every veteran, it would still leave a lot of veterans without care because they do not live near a VA hospital.  And even if they live near a hospital, they still may need to drive far away to get services that aren’t available locally.  There are laws that make it illegal for an insurance company to force patients to drive an excessive distance to stay in their network, yet we think nothing of making veterans drive long distances simply to get the care to which they are entitled.”

Consumerism Comes to the Healthcare Market

Wednesday, May 2nd, 2012

While the nation waits for the Supreme Court to hand down its decision on the constitutionality of the Patient Protection and Affordable Care Act (ACA), businesses and their employees are voting with their wallets for one approach that’s already available: Account-based health insurance plans (ABHPs), which combine lower premiums in exchange for high deductibles.

Consumer-directed health insurance is the foundation of market-oriented health reform solutions and will be offered as an option in the public health insurance exchanges if the ACA is found to be constitutional.  At present, 59 percent of major employers have an account-based health plan option, an increase of 53 percent when compared with last year, according to a survey by Towers Watson and the National Business Group on Health.  More importantly, employee enrollment in ABHPs has risen at companies offering them as a choice.  This year, 27 percent of eligible employees are enrolled, a 35 percent increase over 2011.  That finding is similar to a Fidelity Investments report showing a 61 percent surge in sign-ups for health savings accounts (HSAs) among its client companies — the largest one-year gain on record.  ABHPs are linked to tax-advantaged HSAs, because contributions can be used to accumulate funds to pay costs not covered by the high-deductible plans.  Reduced premium costs are the key driver.

Employers anticipate that their healthcare costs to rise 5.9 percent in 2012, according to the Towers/NBGH survey.  Total yearly premiums paid by employers and workers for high-deductible plans in 2011 were 10 to 19 percent lower than for managed care or traditional point-of-service plans, according to a Kaiser Family Foundation study. According to Kaiser, the average annual cost for individual coverage through a high-deductible plan last year was $4,793 — 15 percent lower than for a PPO managed care option.  “Everyone saves some money, and that really matters in tough economic times,” said Helen Darling, president and CEO of NBGH.

The downside is that high-deductible accounts shift much of the burden to the employee.  Out-of-pocket expense can be painfully high in the event of illness.  By law, there is a maximum yearly out-of-pocket liability of no more than $5,950 for single coverage and $11,900 for family coverage, although the Kaiser survey reports that the average maximum out-of-pocket cost in plans for single coverage was $3,304.  Supporters of ABHPs say that a higher out-of-pocket responsibility will create smarter, more careful healthcare consumers — which is expected to slow the rapid growth of healthcare spending.

As some employers adopt health plans that require patients to pay more out of their own pockets, demand for medical pricing information is on the rise.  In response, a new crop of entrepreneurial companies is providing price transparency tools to self-insured employers.  “The consumerism movement is finally getting wired,” said Cyndy Nayer, president, CEO and founder of the Center for Health Value Innovation in St. Louis, who believes pricing transparency in health care will lower costs by fostering competition.  “This is one of the best disruptive technologies.”

The dearth of price information in healthcare has been a major driver of ballooning costs, medical cost containment experts say.  Managed care had made pricing of individual medical services unknown to health care consumers.  Providers participating in HMOs had traditionally been paid on a per-head-per-month — basis, while insurers’ negotiated discounts off fees charged by doctors participating in their preferred provider networks were rarely disclosed to patients.  Because health insurance has been primarily paid for by employers, employees had little incentive to shop around for medical care.

HHS Issues New Rules on Healthcare Insurance Exchanges

Wednesday, April 4th, 2012

The Department of Health and Human Services (HHS) has issued its final rule aimed at implementing state health insurance exchange provisions of the federal healthcare law.  The rule becomes effective 60 days after it is published in the Federal Register.  The regulation outlines details of the exchanges, which are scheduled to launch on January 1, 2014, and offer insurance plan options for individuals and small businesses, as well as federal subsidies for premiums.

The final rule outlines the minimum standards states must meet in establishing and operating their exchanges, such as individual and employer eligibility for enrollment.  The rule also outlines minimum standards that health insurers must meet to participate in an exchange and the standards employers must meet to participate in the exchange.  The regulation offers states “substantial discretion” in how to design and operate their exchanges.  HHS will accept comment on nine sections of the exchange rule, including provisions regarding the ability of a state to allow agents and brokers to assist qualified individuals in applying for advance payments of the premium tax credit and cost-sharing reductions for qualified health plans; Medicaid and CHIP regulations; options for conducting eligibility determinations; and verification for applicants.  This final rule does not address all of the insurance exchange provisions of the Patient Protection and Affordable Care Act (ACA).

“These policies give states the flexibility they need to design an exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business.  More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

Among the regulations are a guide to set standards for establishing exchanges; setting up a Small Business Health Options Program (SHOP); performing the basic functions of the exchange; and certifying health plans for participation in the exchange; as well as setting up a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.  The announcement is the culmination of more than two years’ work with states, small businesses, consumers, and health insurance plans.  The administration examined models of exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers.  To finalize the rules, HHS accepted public comment to learn from states, consumers, and other stakeholders on how to improve the rules; HHS adapted the proposals based on feedback from the American people.

Unfortunately, many state lawmakers are hesitant to move forward with creating the exchanges until the Supreme Court has ruled on the ACA’s constitutionality, according to Joy Johnson Wilson, federal affairs counsel and health policy director at the National Conference of State Legislatures.  “It’s fair to say that legislation has kind of slowed,” Johnson Wilson said, noting that many lawmakers are taking a “wait-and-see approach” in anticipation of the high court’s oral arguments this month.  Legislators do not want to make plans that have to be revisited and revised, Johnson Wilson said.

Despite the ambivalence of some states, they will be given great flexibility in setting up the exchanges. The concept is the eligibility for determining the premium tax credit is going to be done by the exchange…but also in the state-based exchange to allow — whether it’s a web-based broker or a small-business broker or agent — to interact with the exchange in an automated way,” Tim Hill, deputy director in the Centers for Medicare and Medicaid Services insurance-regulation office, said.

“Those are all relationships that are regulated on the state level…to determine the fee structure for how agents or brokers can be compensated for bringing business to the exchange,” Hill said.  “That’s something we’re going to leave to the state.”  Hill said allowing third-party companies or brokers access the exchanges will help inform people about the insurance exchanges.  “There are lots of folks out there who can generate interest and marketing…it’s a source of leverage that we want to leverage if the states choose to,” Hill said.

Writing on The Hill’s Healthwatch blog, Julian Pecquet notes that “States will have ‘substantial flexibility’ to operate a key provision of President Obama’s healthcare reform law.  The long-awaited final rules expand states’ ability to craft insurance marketplaces that meet their residents’ needs.  This includes allowing states to structure their health insurance exchange in a variety of ways — for example, as a nonprofit entity established by the state, as an independent public agency or as part of an existing state agency.  The final rules also offer each state more time to set up its exchange.  The law requires states to ‘demonstrate complete readiness’ to guarantee they’ll be operational 12 months later.  If states don’t meet the deadline, a federal exchange will take over.  The final rule, however, allows for ‘conditional approval’ if a state is ‘advanced in its preparation’ by January 1, 2013.  In addition, states that aren’t deemed ready for 2014 can apply to operate their own exchange in 2015 or any subsequent year.  ‘HHS may conditionally approve a state-based exchange upon demonstration that it is likely to be fully operationally ready by October 1, 2013, which provides States with flexibility in meeting exchange development timelines,’ according to the regulation.  ‘HHS will provide additional details in future guidance.’”

States Want Feds to Move Faster on ACA Rules

Tuesday, February 21st, 2012

Although the Patient Protection and Affordable Care Act’s (ACA) major provisions don’t go into effect until 2014, states and insurers must be prepared to enroll some 32 million Americans who currently lack insurance coverage into Medicaid or private insurance programs.  According to Kaiser Health News, the fly in the ointment is that to successfully unveil their individual programs in just two years, the states must make important crucial decisions and take actions this year.

It will be difficult for many states to meet fast-approaching deadlines, and some may not make it, said Brett Graham, managing director at Leavitt Partners, a consulting firm.  Two years is surprisingly brief and many states need information from the federal government detailing the various insurance exchange options and precisely which benefits must be included in health plans.  Complicating the situation is the fact that states are competing for a limited pool of information technology vendors to give them the help they need.  “It’s a pressure cooker,” said Graham. States are “in a position where they have to act with imperfect information.”

Next New Year’s Day, the Department of Health and Human Services (HHS) will certify which states are ready to run their own exchanges.  To earn certification, a state must put in place laws to fund the exchanges’ continuing operations.  While the federal government is providing financial help up front for the creation of exchanges, states will assume the cost once they are underway.  HHS can issue a conditional certification for those states that are making progress but need more time.

Only 14 states and the District of Columbia have made significant legislative progress toward creating exchanges, according to a Robert Wood Johnson Foundation report prepared by the Urban Institute. The study’s authors reach the conclusion that because of the ACA, the percentage of the population that is uninsured will decline in all 50 states and Washington, D.C.

While some states are aggressively moving forward, “at the other end are states that say, ‘no way, no how, we’re not doing it.’  Montana, Texas, Louisiana, Florida, they are not going to build it and they’re playing a game of chicken,” said Graham.  “They’re waiting for the Supreme Court,” hoping it will declare the ACA unconstitutional in June.

The majority of states cannot make up their minds about whether to build their own exchanges and or participate in the proposed federal model. It’s ironic that some states that are participating in the Supreme Court challenge have taken action: Colorado, Washington and Nevada have set up exchanges.

According to the Robert Wood Johnson/Urban Institute report, “Without action by these states, their populations will still benefit from health reform through the expansion of Medicaid/CHIP, but will have to rely on the federal government to create exchanges, as called for under the ACA.  This creation will be dependent on adequate federal resources and political support.”

According to the Robert Wood Johnson Foundation and the Urban Institute, 15 states have made “little or no progress” implementing insurance exchanges where individuals and small businesses can buy private insurance.  The states that haven’t started working on creating exchanges are among the states with the most residents eligible for federal subsidies to help buy insurance.  According to the analysis, the federal government has the ability to establish and run a substitute in any state that does not establish its own exchange.

Creating a full or partial federal exchange also could be a problem, although some healthcare analysts are unsure whether it will be any easier for the federal government.  It faces the same brief timeline as the states.  While Obama administration officials say they have the money to fund exchanges, many healthcare analysts aren’t so certain.  Most state legislatures will adjourn for the year by March or April — before the Supreme Court hands down its ruling — according to the National Conference of State Legislatures.  Special sessions after the ruling would be virtually impossible in an election year.

Wisconsin a Model for Creating Healthcare Insurance Exchanges

Tuesday, April 12th, 2011

Wisconsin is a national model for implementing the Patient Protection and Affordable Care Act (ACA).  The state has accepted $37.7 million in federal funding to begin designing the state’s health insurance exchange as required by the law.  But it remains unclear how the funding will be used under the administration of Governor Scott Walker, who opposes the law.  Earlier this year, the Department of Health and Human Services (HHS) announced that Wisconsin, along with Kansas, Maryland, New York, Oklahoma and Oregon, had been selected as “early innovators”, meaning they received $241 million in federal grants to design IT systems for their exchanges.  The systems developed will ultimately be used as models by other states, according to the department.  Wisconsin applied to become an “early innovator” under former Democratic Governor Jim Doyle, who supports the new federal healthcare reform law.

Early innovator states will play a critical role in developing a consumer-friendly marketplace where insurers must compete to deliver the best deal,” said HHS Secretary Kathleen Sebelius.  She noted that the grants will lay the groundwork to “ensure consumers in every state will be able to easily navigate their way through health insurance options.”  Although states must begin operating the exchanges only in 2014, they are required to declare their intent to form them by January 1, 2013.  The federal government will run the exchanges in states that refuse to comply.

Wisconsin Department of Health Secretary Dennis Smith said his state will fulfill that commitment.  “Wisconsin has a bit of a head start,” Smith said, noting how the state began developing an automated eligibility system for its state-based health insurance programs.  “That’s one thing that makes this state a leader.  Part of what we believe is important with this exchange is to demonstrate that it should not be used in a regulatory manner that would disrupt our competitive market.”  Wisconsin applied for the innovator grant while Doyle still was still the state’s governor.  The chosen states were selected based on their technical expertise, readiness to develop information technology to operate the exchanges, the adaptability of their systems to other states and a demonstration that planning already was underway.

Through the exchange, Wisconsin wants to deliver affordable care to as many as 160,000 individuals in the non-group market, 770,000 BadgerCare Plus and Medicaid clients, and one million small-business employees.  “Wisconsin’s proposal envisions a single, intuitive portal through which residents can access subsidized and non-subsidized healthcare and other state-based programs,” according to HHS.  “The exchange will integrate across health and human services programs to promote efficiency and lower overall administrative cost.”

Finding affordable health insurance has long been a challenge for rural Americans, but the Affordable Care Act presents new opportunities for Wisconsin’s farmers and rural residents by creating health-insurance exchanges. Jon Bailey, director of research and analysis for the Center for Rural Affairs, says the new law is ideal for them.  “The groups that the exchange marketplace is meant for, in large numbers, are more predominant in rural areas than in urban areas.  So the small businesses, the people who buy through the individual market, the uninsured, these are the people the exchange marketplace is meant for.  Those who get health insurance through their work probably aren’t going to be involved in this at all.”

The Affordable Care Act gives states multiple options on how to set up the insurance marketplaces, Bailey said.  “Every state is just kind of making that basic decision right now: Do we want to run our own exchange or do we want the federal government to come in and do it?  There’s some other basic questions: Do we want to cooperate with other states?  Have a regional exchange?  Things like that.”

Affordable Care Act Under Siege As It Celebrates Its 1st Birthday

Wednesday, March 30th, 2011

As the Patient Protection and Affordable Care Act (ACA) celebrates its first birthday, the future of the law is still unclear, but its effects have been enormous.  The debate over the law likely created the “tea party” movement.  Last November, Republicans took control of the House of Representatives and strengthened their numbers in the Senate.  Potential contenders for the 2012 Republican presidential nomination need only say one word, “Obamacare,” to get a negative reaction from a crowd.  President Obama at times himself has struggled to ensure that his first term isn’t defined solely by this legislation.

Public opinion over the ACA remains divided, despite the efforts of Democrats to showcase how it will provide healthcare insurance to millions of uninsured Americans.  Additionally, most Americans remain confused about what the healthcare overhaul actually accomplishes.  Republicans considering a 2012 presidential race for the most part stand united in their opposition to the legislation.  Former Minnesota Governor Tim Pawlenty is using his opposition to the law to gain a national following.  “If courts do not do so first, as president, I would support the immediate repeal of Obamacare and replace it with market-based healthcare reforms,” Pawlenty said.  Former Massachusetts Governor Mitt Romney is in a different position because he supported a similar law during his tenure.

Representative Steve King (R-IA), the Iowa Congressman who is in the vanguard to repeal the ACA, says that “America will never become the nation it can be if were saddled with Obamacare“, “I have a deep conviction that this is unconstitutional, that this is unsustainable, and I have a duty.  And that doesn’t mean I sit back and wait for the Supreme Court to save America from itself.  It’s my job to step up and lead.”

Taking a difference stance, Carmela Coyle, president and chief executive of the Maryland Hospital Association, said her group strongly supports the reform law and will work to assure that the effort translates into better and cost-effective care.  “We support healthcare reform because hospitals see every day what happens when patients don’t have the healthcare coverage they need and can’t get their care at the right time and in the right setting.  Expanding coverage was necessary, and it was right.  We must ensure that the health coverage now guaranteed to many Marylanders is meaningful coverage.”

What’s the future of the Affordable Care Act? House Republicans, who say the law gives the federal government too much control and doesn’t cut costs, passed a repeal bill after they became the majority in January.  Full repeal is unlikely unless Republicans successfully take control of the Senate and the presidency in the 2012 presidential elections.  The current Democratic-led Senate will not vote to repeal and President Obama would certainly veto a repeal bill.  Democrats argue the law’s reforms will slow the growth of healthcare costs while improving care and reducing the ranks of the uninsured.  Republican efforts to withhold funds to block the law’s implementation will be DOA in the Senate.  That leaves Republicans the option of picking apart the law regulation by regulation, a strategy that could prove more successful.

In the meantime, implementation is underway.  “As we look forward with implementation of the health reform law, the states really become the focus now,” said Jennifer Tolbert, a principal policy analyst at the Kaiser Family Foundation.  “When thinking about the coverage expansions in particular because it is going to be up to the states to implement the expansion of the Medicaid program for lower-income individuals and to create the new health-insurance exchanges that will provide access to private insurance for moderate and middle income individuals.”

Senate Republicans Refusing to Confirm Dr. Donald Berwick

Monday, March 14th, 2011

Senate Republicans are trying to block the nomination of Harvard-educated pediatrician Dr. Donald Berwick to serve a full term as the administrator of the Centers for Medicare and Medicaid Services.  Led by Senators Orrin Hatch (R-UT), the ranking member of the Senate Finance Committee, and Mike Enzi (R-WY), the ranking member of the Senate Health, Education, Labor and Pensions Committee, the senators contend that President Barack Obama’s recess appointment last year was completed before a hearing was held.  The senators contend that this hindered the 111th Congress’ ability to fully consider Berwick’s nomination.

“This abrupt and unilateral action meant that no senator — Democrat or Republican — was given the opportunity to ask Dr. Berwick a single question before he was placed in charge of an agency with a budget larger than the Department of Defense; which controls four percent of our nation’s gross domestic product; and, most importantly, directly impacts more than 100 million American lives every single day,” according to the Senators’ letter.  The senators say that Berwick’s “past record of controversial statements, and general lack of experience managing an organization as large as complex as CMS should disqualify him” from the post.  “Once you have withdrawn his nomination, we are confident we can all work together to find a nominee for administrator we can support and confirm after appropriate hearings are held,” the letter stated.

Even some Congressional Democrats are urging the Obama administration to find another Medicare chief after concluding that the Senate is unlikely to confirm Dr. Berwick. The most-favored nominee is Dr. Berwick’s principal deputy, Marilyn B. Tavenner, a nurse and former Virginia secretary of health and human resources who has extensive management experience and would likely be confirmed.  President Obama bypassed Congress and named Dr. Berwick to his post while the Senate was in recess last summer.  The current appointment allows him to serve to the end of 2011.

Despite the vocal opposition to Dr. Berwick, President Obama is refusing to withdraw his nomination. “The president nominated Don Berwick because he’s far and away the best person for the job, and he’s already doing stellar work at CMS: saving taxpayer dollars by cracking down on fraud, and implementing delivery system reforms that will save billions in excess costs and save millions of lives,” White House spokesman Reid Cherlin said.  Unfortunately for the president, even some Senate Democrats believe that Berwick cannot be confirmed.  Senate Finance Committee Chairman Max Baucus (D-MT) has said that he would not commit to a confirmation hearing, and other Democrats have acknowledged that the nomination is in trouble.  “I think it would be very tough in this environment.  If we can get some bipartisan products moving forward, then the answer is yes. If you can’t get some bipartisan products moving forward, it’s going to be difficult,” said Senator Ben Cardin, (D-MD).

The Medicare administrator’s job involved significant responsibilities under the healthcare law, such as establishing new insurance markets, expanding Medicaid, and overhauling the way Medicare pays providers to reward quality instead of volume. Republicans need 41 votes to block Berwick’s confirmation in the full Senate; their letter indicates they have more than enough.  The loss of Berwick, a respected medical innovator and patient advocate, would be a blow to the administration as it moves ahead in its implementation of the healthcare reform law.

Five Republican senators did not sign Hatch’s letter.  They are Scott Brown (R-MA), Susan Collins (R-ME),  Olympia Snowe (R-ME), Lisa Murkowski (R-AK), and Rob Portman (R-OH).