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This Week in Health Care Reform - February 28th, 2014

CMS announces proposed changes to Medicare Advantage; while, both parties jockey for the political high ground on health care reform; most Americans are unaware of the open enrollment deadline; and, the promise of telehealth is explored.


Health Care Reform

Medicare Advantage on the Clock: As expected, last Friday, the Centers for Medicare & Medicaid Services (CMS) released its long-anticipated proposed changes to Medicare Advantage for 2015.  And, also as expected, the announcement was met with more than a little displeasure…with equal parts confusion and anger mixed in for good measure.  At dispute, just how large – or small – the proposed rate cuts to the popular program really are.  With more than 15 million seniors and persons with disabilities – over a quarter of the total Medicare population – depending on Medicare Advantage, it’s easy to see why supporters are so eager to step to its defense.  For those that have been following along, already we’ve seen a who’s who of trade associations, business organizations, and medical groups unite in opposition to any proposed cuts to Medicare Advantage.  The issue has even drawn considerable support from lawmakers on both sides of the aisle, with 40 U.S. Senators – nearly half of whom were Democrats – sending a bipartisan letter to CMS earlier this month, urging the agency that oversees the program to maintain level funding for Medicare Advantage for 2015.  (A similar letter is currently being circulated in the House.)  In the wake of last week’s release, Republican Senate leaders (who just saw their party edge out Democrats in a recent poll of seniors’ views on how both parties handle Medicare issues), led by Senate Minority Leader Mitch McConnell (R-Kentucky), called upon the Administration this past Tuesday to suspend the proposed cuts.  And, yesterday, a new analysis was released showing just what beneficiaries can expect should the proposed payment cuts go into effect.  Prepared by management consulting firm, Oliver Wyman, their report estimates that CMS’ proposed changes would result in a 5.9 percent cut to Medicare Advantage payments in 2015.  That translates into those seniors and persons with disabilities that currently depend on their Medicare Advantage plans for their critical care having to face benefit reductions and premium increases of as much $75 per member per month next year.  When combined with last year’s 6 percent cut, the program now faces the very real possibility of being hit with a double-digit cut over just two years, leaving beneficiaries on the hook for as much as $1,740 over that same period.  The report goes on to warn that, cuts of this magnitude could result in a “high risk of disruption” in the market, as well as the “potential for plan exits, reductions in service areas, reduced benefits, provider network changes, and (Medicare Advantage) plan disenrollment.”  With CMS expected to announce its final decision on the proposed changes in early April, supporters continue to raise their voices in support of this vital program.  We will be looking to our Health Action Network members, like you, to join the effort, too.  In the meantime, keep up with the latest by visiting the Coalition for Medicare Choices to learn how you can help. 

The Politics of Reform: It’s no secret that Washington finds itself locked in a seemingly endless game of political chicken.  The hyper-partisanship that divides Capitol Hill’s denizens into starkly red and blue camps has become more rule than exception.  Perhaps nowhere is this more evident than in each party’s approach to health care reform.  Already, we’ve seen the GOP readying votes on a handful of issues (some relating to the health care law), seizing upon states’ struggles with implementation, all the while, openly questioning the President’s newfound preference to “sidestep Congress” to advance his agenda.  Meanwhile, Democrats, believing the health care law’s fortunes to have taken a turn for the better, have pledged to take the offensive on the issue heading into November’s midterm elections, despite overtures of finding legislative comity amongst the parties.  Regardless, it’s clear that the politics of health care reform (not to mention the delays that have pockmarked the road to implementation) will continue to shape the national discussion.

What Deadline?: Earlier this week, CMS released the latest enrollment numbers for the state and federal exchange marketplaces.  So far this month, approximately 700,000 people have signed up for coverage through the exchanges, bringing the total enrollment to roughly 4 million since October of last year.  Whether the improved pace speaks to a vastly improved user experience on the troubled website or is more a result of the concerted outreach efforts currently underway, officials were encouraged by the “strong demand nationwide” that they are seeing.  Surprising, some would say, given the recent Kaiser Family Foundation poll that found that the vast majority of the uninsured (76 percent) were completely unaware of the looming open enrollment deadline, just a month away, not to mention the recent revelation that enforcement of the controversial individual mandate by the IRS may be less than aggressive.  Despite the uptick, many are left scratching their heads over the original projected target of 7 million enrollees, while others are more concerned with what the numbers behind those that have signed up aren’t telling us.

Realizing Telehealth: With so much attention being paid to the numerous ways we can improve the nation’s health care system, it’s perhaps surprising to find that so little of that focus is being devoted to exploring the role that technology can play in helping us find common sense solutions.  That was the focus of a briefing this past Wednesday held by the Information Technology & Innovation Foundation (ITIF) on Capitol Hill.  The focus: Realizing the promise of telehealth.  As health care coverage continues to expand under the health care law, new and greater demands will be placed on our already overtaxed health care system.  As such, lawmakers need to leverage available technologies to increase access, lower costs, and improve the quality of care.  One way this can be done is to deploy telehealth capabilities to connect patients and doctors in ways that encourage routine encounters across previously inconvenient divides.  However, despite these technologies being available today, widespread adoption remains elusive, likely due to the variety of policy barriers that stand in the way.  This week’s ITIF event, featuring Reps. Doris Matsui (D-California) and Bill Johnson (R-Ohio) – cosponsors of the Telehealth Modernization Act – brought the issue into the legislative spotlight, discussing what Congress can do to help remove these barriers to adoption and ensure that all Americans can tap into the benefits of telehealth.      

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