Posts Tagged ‘Senate Finance Committee’

Can Marilyn Tavenner Save Medicare?

Monday, December 5th, 2011

President Barack Obama’s choice of Marilyn Tavenner as administrator of the Centers for Medicare and Medicaid Services — to replace Dr. Donald Berwick, whose recess appointment was set to expire at the end of the year – is more likely to survive the Senate confirmation process relatively unscathed.

A Harvard-educated pediatrician, Berwick won praise and the backing of major healthcare groups for his academic work, which focused on cutting the cost of care while improving quality and patient experience.  Republicans took exception to his praise of Britain’s National Health Service as an “example” for the United States to emulate.  Others accused him of supporting “rationing” healthcare services, a claim Berwick rejects.  “Every bone in my body, as a physician, even as a person, is to get everything (patients) want and need and to help them at every step,” he said.  “I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia…and they are telling me I’m rationing?  They haven’t met me.”

White House officials said, “Before entering government services, Tavenner spent nearly 35 years working with health care providers in significantly increasing levels of responsibility, including almost 20 years in nursing, three years as a hospital CEO, and 10 years in various senior executive-level positions for Hospital Corporation of America.”

According to Ezra Klein, “Tavenner’s healthcare experience lies much more in management than policy.  Former colleagues describe her as a patient-centered manager, a hands-on medical professional equally comfortable in the board room and the emergency room.  And in contrast to Berwick, Tavenner isn’t associated with a grand vision for health reform, or a particular policy agenda for Medicare and Medicaid.  ‘With Marilyn, you present the information, then she makes a decision, and you move on,’ said Patrick Finnerty, who served as Virginia’s Medicaid director under Tavenner.  ‘She doesn’t make promises she can’t keep.  There are differences of opinions, and she would try to work through those.  She’s straight with folks but always respectful.’”

Tavenner started her career as a nurse at Virginia hospitals owned by the Hospital Corporation of America (HCA).  Tavenner met with success, rising from chief nursing officer to CEO.  In 2004, she was again promoted to HCA’s president of outpatient services, her first national position with the firm.  She resigned two years later, when then-Virginia Governor Tim Kaine tapped her to head the state’s Health and Human Resources department.

Tavenner has already won the American Medical Association’s (AMA) backing. “We have worked extensively with her in her role as deputy administrator, and she has been fair, knowledgeable and open to dialogue,” AMA President Peter Carmel said.  “With all the changes and challenges facing the Medicare and Medicaid programs, CMS needs stable leadership, and Marilyn Tavenner has the skills and experience to provide it.”

Senator Orrin Hatch (R-UT), the ranking Republican on the Senate Finance Committee, said that the panel would thoroughly scrutinize Tavenner, but did not say he opposes her nomination.  Despite Hatch’s mild comment, Tavenner is expected to face some difficult questioning because Senate Republicans have not overtly endorsed her.  According to a Republican healthcare lobbyist, “I can’t imagine a lot of support for her,” noting that the high-profile CMS role “always gets sucked into the controversy of the day.”  Ultimately, Tavenner is likely to be confirmed for the CMS post.

Tavenner is widely seen as a pragmatic administrator who will not rock the CMS boat. “The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs,” she said.  Tavenner also said she opposed Republican efforts to turn Medicaid into a block grant that would limit the amount of federal funding states can receive for the program.  “That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above,” she said.  Tavenner “brings continuity in terms of implementing the mission,” said Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics.

Republicans Vow to Take on Healthcare Entitlement Programs

Wednesday, March 23rd, 2011

With the power shift in the House of Representatives, Medicare, Medicaid and Social Security are being targeted in proposed budget cuts designed to bring down the deficit. “It will likely be the first time you see a House have a prescription for Social Security, Medicare and Medicaid,” House Majority Leader Eric Cantor (R-VA) said at the Federation of American Hospitals’ annual public policy conference and business exposition in Washington.

Mississippi Governor Haley Barbour, a Republican, said that members of Mississippi’s Medicaid program saw its enrollment drop approximately 23 percent to 580,000 beneficiaries from 750,000 after the state started requiring beneficiaries to establish their eligibility in person.  Barbour began this practice in his first year as governor in 2004.  Senator Orrin Hatch (R-UT), the ranking Republican on the Senate Finance Committee, slammed the Patient Protection and Affordable Care Act (ACA), noting that its expansion of Medicaid will “bankrupt” the states, which already have strained budgets.  Hatch also cited Congressional Budget Office figures that say the ACA’s Medicaid expansion will cost taxpayers $435 billion over the next decade.

President Barack Obama said his proposed 2012 budget was a “down payment,” on cutting the federal budget deficit, and said that more work is needed to address “long term challenges”. Cantor said that on “individual items” there were “probably some areas of agreement” between the President and Republicans.  “But we can’t keep taking the savings and going to spend it,” he said.  “The object here is to cut.”  According to Cantor, the President’s plan “just misses the mark of living up to the expectations” Obama laid out in his State of the Union speech in January.  Asked if Cantor expected adjustments to Social Security and Medicare, Cantor said he was “hopeful that we can get some cooperation from [Senate Majority Leader] Harry Reid [D-NV] and the President, because these are programs that touch the lives of every American and we don’t want, nor can we, make these changes by ourselves.”

Writing on the Huffington Post, Richard Eskow took an alarmist tone, saying that “entitlement reform” is a euphemism for allowing the elderly to die if they become ill. “’The President’s budget punts on entitlement reform,’ reads a statement by House Republicans.  ‘Our budget will lead where the President has failed, and it will include real entitlement reforms.’  ‘You have to do entitlement reforms if you are serious about this budget,’ according to Representative Paul Ryan (R-WI).”  Eskow counters “Reality check: Nobody’s proposing ‘entitlement reform.’ That term is a cloaking device for some very ugly intentions.  It’s a meaningless manufactured phrase cooked up by some highly-paid consultant, and it diminishes the sum total of human understanding every time it’s used.  The phrase is a euphemism for deep cuts to programs that are vital and even life-saving for millions of elderly and poor people, but it’s politically unpalatable to say that.  So it became necessary to come up with yet another cognition-killing term designed to numb us from the human toll of our political actions.  ‘Entitlement reform’ is the new ‘collateral damage.’”

The Washington Post’s Ezra Klein is more diplomatic in his assessment of the possibility of entitlement reform. “We’ll see.  I wouldn’t be surprised if Obama has his name on a broader deficit-reduction bill at this time next year.  If he takes the deficit away from Republicans before 2012, his reelection campaign becomes considerably easier.  And on a less cynical level, his administration is stocked with deficit hawks — the same folks who actually balanced the budget under Bill Clinton.  And similarly, Republicans want to deliver on the deficit-reduction promises they’ve made to their base.  In theory, everyone’s incentives and ideologies are pointing in the same direction.  That’s a good sign for progress.”

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).

2012 Budget Has Funds to Reform Medical Liability Laws

Wednesday, March 2nd, 2011

In a move that builds on the healthcare reforms contained in the Patient Protection and Affordable Care Act – and one that will make physicians very happy — President Barack Obama’s fiscal 2012 budget includes $250 million in grants over the next three years to subsidize efforts to help the states overhaul their medical liability laws. If the budget passes, the grants will be administered by the Justice Department in consultation with the Department of Health and Human Services (HHS).  As much as $100 million will be disbursed in fiscal 2012, with $50 million in each of the succeeding three years.  According to the Justice Department’s budget outline, the grants will fuel reforms that “fairly compensate patients who are harmed by negligence, reduce providers’ insurance premiums, weed out frivolous lawsuits, improve the quality of healthcare, and reduce medical costs associated with defensive medicine.”  The grants build upon $25 million in grants HHS awarded last June through the Agency for HealthCare Research and Quality safety and medical liability demonstration projects by states and health systems.

“I think the president is very serious about following up on this,” HHS Secretary Kathleen Sebelius,  whose agency would advise the Justice Department on awarding the grants, told the Senate Finance Committee.  Specific reforms might exclude caps on jury awards that the American Medical Association and Republican lawmakers have wanted for years.  At the same time, they include measures unacceptable to trial lawyers, a group that contributes heavily to Democratic candidates.

Philip K. Howard, chairman of Common Good, described the budget item as “A very significant moment for controlling healthcare costs.” Based in New York, Common Good has taken the lead in supporting special courts in which judges with healthcare backgrounds would resolve medical liability cases.  “With this budget item, President Obama is moving beyond bipartisanship and, in effect, saying that the country can no longer afford the rising healthcare costs that defensive medicine unnecessarily fuels,” Howard said.  President Obama also called for tort reform legislation in his 2011 State of the Union address.

The cost of defensive medicine to American healthcare consumers is not easy to estimate. Conservative estimates place the cost at approximately $50 billion a year.  The Obama debt commission estimated that its recommendations could save government programs $17 billion through 2020, calling for an aggressive effort to rewrite malpractice laws.

Gibson Vance, president of the American Association for Justice, described the proposal as “bad policy and bad for patients.”  The president’s proposal also got a chilly reception from congressional Republicans, who contend that he has promised more on malpractice than he has been able to deliver.  Obama initially voiced an interest in the issue during the lengthy healthcare reform debate.  He has opposed another malpractice alternative: capping the amount a patient can receive in a medical liability case.  This alternative is favored by many physicians and Republicans, but opposed by the majority of Democrats.

“These grants will help states reform their laws to pursue innovative approaches that will improve the quality of healthcare, fairly compensate patients who are harmed by negligence, reduce medical costs and liability, and protect patient safety,” said Justice Department spokeswoman Tracy Schmaler.

Senate Acts to Halt Medicare Reimbursement Cuts

Thursday, December 2nd, 2010

The Senate is on the verge of passing emergency legislation to postpone the 25 percent cut in Medicare reimbursements until January 1, 2011, according to leaders on the Senate Finance Committee. Senators Max Baucus (D-MT) and Charles Grassley (R-IA) said “Working together, this agreement makes certain that seniors and military families can be confident they will be able to see a doctor and get the medicines they need.  It is our hope the Senate will pass this package as soon as possible to give doctors, seniors and military families the care and the certainty they deserve.”  The House of Representatives next must pass the bill and send it to President Obama for his signature by December 1.  According to the Senators’ statement, the extra funds required to extend the cut will come from the Physician Payment and Therapy Relief Act of 2010.

“Once signed into law by the President, it will mean that seniors and military families are spared the threat of a lapse in care.  The next step is moving onto finding a yearlong extension before this fix runs out,” according to Baucus

The American Medical Association (AMA) and other physician groups applauded the Senate’s action.  “The Senate’s action to stop the Medicare cut for one month will help avert a healthcare crisis for seniors that would have begun in just two weeks,” said Cecil Wilson, M.D., the AMA’s president.  “This is a short-term reprieve and the AMA is urging Congress to pass a one-year fix.  Delaying the 25 percent cut to the end of 2011 will inject some stability into the Medicare program for patients and physicians and provide lawmakers with time to develop a long-term solution to the broken physician payment system.”

Public Support for the Public Option Grows

Wednesday, December 2nd, 2009

The public’s support for the public option in healthcare reform is on the upswing, as the Senate debates whether to include such a plan in the ultimate healthcare overhaul bill.  According to a new Washington Post-ABC News poll, fully 57 percent of Americans favor a public option, a rise from the 52 percent reported in August.  Even so, the statistic is below the 62 percent approval rating the public option received in June.

At present, the Senate is working to reconcile the Finance Committee’s healthcare bill and the Health Committee’s legislation.  Only the Health Committee’s legislation includes a public option, which President Obama favors but has said is not a requirement.  The public option is a bone of contention in the healthcare reform process, and has strong opposition from Republicans who believe it could drive private insurers from the marketplace and result in a single-payer system.

Patients First, a conservative group, believes the poll’s methodology is flawed.  According to Phil Kerpen, the group’s policy director, “The poll is a mirage designed to create the illusion of a groundswell of support for government-forced healthcare when no such support exists.  The poll reflects the political aspirations of a few peddlers of failed big-government ideas, not the common sense wishes of the American people.”

President Obama has said he wants to sign healthcare reform legislation by Christmas.

CBO Report: Baucus Healthcare Reform Bill Could Cut the Deficit

Monday, October 26th, 2009

Health Care RallyThe nonpartisan Congressional Budget Office (CBO) has reported that the Senate Finance Committee healthcare reform bill would cost $829 billion over 10 years and reduce the deficit by $81 billion.  This report on the bill, which would cover 94 percent of Americans, could bolster President Barack Obama’s healthcare reform initiative.  As authored by Senator Max Baucus (D-MT) and amended by committee members, the bill would fulfill Obama’s preference for healthcare reform legislation that does not increase the deficit.

The Finance Committee is expected to vote on the plan, which does not include the public option that Obama and liberals want, next Tuesday.  Instead, the Baucus bill proposes a nonprofit cooperative as an alternative, an option that the CBO report noted was unlikely to attract significant enrollment or spend all the subsidies allocated to it.  All three House of Representatives committee bills include a public option, as does legislation passed by the Senate Health Committee.

Once the Democratic-controlled Finance Committee bill is approved, it will be merged with the Health Committee legislation and sent to the full Senate for debate later this month.  In the House of Representatives, Democrats are holding meetings to merge their three healthcare reform bills into a single one that could win the 218 votes necessary for passage.

Senate Minority Leader Mitch McConnell (R-KY) said the CBO news on costs is “irrelevant” because he believes that Democrats will pump up the Baucus bill to make it more expensive.

Maine Senator Susan Collins Jumping on the Healthcare Reform Bandwagon

Monday, October 19th, 2009

collinsAnother Republican senator from Maine has expressed support for healthcare reform legislation, although Susan Collins believes that the Senate Finance committee bill needs some work. As expected, the moderate Collins has joined her colleague, Senator Olympia Snowe, in backing healthcare reform.  Before voting in favor of the legislation, Collins wants changes to the bill to make coverage more affordable, control costs and protect Medicare.

“My hope is that we can fix the flaws in the bill and come together with a truly bipartisan bill that could garner widespread support,” Collins said.  “I think this bill is far superior to the ones passed by the Senate (health) committee and the three House committees, but it needs substantial additional work.”

The Senate Finance Committee’s centrist $829 billion, 10-year bill was approved on a 14 – 9 vote after Snowe broke with Republicans to support the legislation written under Senator Max Baucus’ (D-MT) leadership.  The legislation, which does not include the public option that President Barack Obama wants, does include a trigger mechanism that would kick in if private insurers failed to keep premiums affordable for all Americans.

The next step is for the Senate to merge the Finance and Health committees’ bills, which will be led by Majority Leader Harry Reid (D-NV).  Reid’s goal is to bring the healthcare reform legislation onto the Senate floor as quickly as possible.  Although the two bills have the common goal of providing all Americans with access to healthcare, they differ on how to accomplish that objective.

Democrats Go Head-to-Head on Healthcare Reform

Wednesday, October 7th, 2009

Healthcare reform is putting Democrats at loggerheads with each other, as the party’s liberal wing failed to include a public option in legislation now being negotiated in the Senate Finance Committee. The two failed votes (which saw some Democrats cross the aisle to vote with Republicans) were a victory for Senator Max Baucus (D-MT), whose committee is trying to finalize the proposed legislation.  At the same time, Democrats in the House of Representatives were looking at ways to trim approximately $900 billion over 10 years from their legislation, President Obama’s suggested price tag.bilde

Baucus and four other Democrats voted against Senator Jay Rockefeller’s (D-WV) amendment to include a public option in the proposed bill.  “The public option would help to hold insurance companies’ feet to the fire, I don’t think there’s much doubt about that, but my first job is to get this bill across the finish line,” Baucus said.  “No one shows me how to get 60 votes with a public option.”

The second failed amendment was a proposal from Senator Charles Schumer (D-NY), designed to increase competition into the insurance market.  This amendment would have let the government negotiate payments with physicians, hospitals and other healthcare providers for two years rather than pay them at Medicare rates.

Advocates of the public option believe that private insurers are placing profits before coverage and vowed to insert this amendment into the legislation once the full Senate votes on healthcare reform.  “With some work and some compromise, we can get the 60 votes on the floor of the Senate that will make our system better by providing for a strong, fair and viable public option,” Schumer said.

Could Olympia Snowe Be the Key Healthcare Reform?

Tuesday, October 6th, 2009

olympia_snowe2The name Olympia Snowe (R-ME) has been prominent in the debate on healthcare reform —  and for good reason.  Snowe is the lone Republican member of the Senate Finance Committee who is still talking with Democrats to shape the ultimate bill.  This willingness to engage the opposition party gives Snowe significant leverage because she may provide the 60th vote that Democrats need to prevent a Republican filibuster.  In return, Snowe is likely to get what she wants in healthcare reform legislation — affordability.

Snowe’s perspective may be due to the fact that she represents a relatively poor state whose health insurance market is dominated by a single large firm that charges some of the country’s highest premiums.  Maine insurance costs are rising at nearly four times the rate of wages, hurting the small businesses that form the core of the state’s economy.

Even though Democrats are actively courting Snowe, her “yes” vote is not guaranteed.  She voted with Senate Finance Committee Republicans when they insisted that Senator Max Baucus (D-MT) submit his measure to the Congressional Budget Office to determine the bill’s price tag.  Additionally, Snowe was the sole member of Baucus’ bipartisan “Gang of Six” who complained that the federal subsidies included in the bill to help low- and middle-income people buy insurance were too small.  Baucus’ response was to increase the size of the subsidies.

Snowe’s most provocative input to the healthcare debate is her proposal for a trigger that would set in motion a Medicare-like, government-run public option to provide affordable coverage if private insurers don’t step up to the plate.  “It would be a safety net, a fallback mechanism,” Snowe says.  She points out that a similar idea was effective to stimulate competition in the Medicare prescription-drug program.