The F-22 Model for Medicare
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/21/AR2009072102811.html?wpisrc=newsletter
By Ruth MarcusWednesday, July 22, 2009
"If you're interested in how to get health-care costs under control, the case of the F-22 offers an instructive example"
Marcus provides a great example about what we are in for without a buffer for ongoing health policy.
From my experience, my state hasn't passed anything that resembles policy in over 20 years. But they have passed lots of political solutions.
The MedPac type option is the only thing that will allow healthcare to progress....
when we talk about "disruptive technologies" to begin to change the cost picture in healthcare, we are not talking about anything that exists in Congress! Pray for the MedPac (with some power) option to survive.
Wednesday, July 22, 2009
Saturday, July 18, 2009
...And this is the AHA's take on the Public Option
From the AHA's position paper on Reform
The Public Plan Option
"National health insurance can be a useful medium in providing private coverage for those who
don’t receive it through their employer or qualify for public programs. The AHA has serious concerns, however, about establishing a new public plan that could exacerbate the underpayment American Hospital Association 2 of providers by paying rates at Medicare or Medicaid levels. The Medicare Payment Advisory Commission (MedPAC) projects that hospitals will have a negative 6.9 percent Medicare margin in 2009 – down from a positive 6.2 percent Medicare margin in 1999 – the lowest level in more than a decade. Hospitals also experience severe payment shortfalls when treating Medicaid patients; on a national level, the Medicaid payment shortfall amounted to $10.4 billion in 2007. These underpayments affect families as well. A recent AHA study by Milliman, Inc. found that annual health care spending for an average family of four is $1,788 higher than it would be if Medicare, Medicaid and private employers paid hospitals and physicians similar rates, with total provider reimbursement unchanged. The scope of such a plan should be limited to the uninsured, the selfemployed and small businesses.
Medicaid
The AHA supports expanding Medicaid eligibility with federal financing for the new populations
covered through expanding eligibility for children, parents and pregnant women up to 150
percent of the federal poverty level. It is important also to include provider payment protections as Medicaid expands. The AHA also supports a permanent process that, in times of economic
downturn, provides states temporary increases in the Federal Medical Assistance Percentage
(FMAP) to help support their Medicaid programs. Through maintenance of effort criteria, states
should be required to maintain their current levels of eligibility and enrollment, benefits and
provider payment rates. Any FMAP increase should apply to Disproportionate Share Hospital
(DSH) payments, with a corresponding increase in DSH allotments to accommodate the
enhanced federal match. These reforms are critical because states typically target their Medicaid programs in a search for savings through provider payment freezes or reductions, as well as benefits and eligibility changes, in times of economic turmoil. "
The Public Plan Option
"National health insurance can be a useful medium in providing private coverage for those who
don’t receive it through their employer or qualify for public programs. The AHA has serious concerns, however, about establishing a new public plan that could exacerbate the underpayment American Hospital Association 2 of providers by paying rates at Medicare or Medicaid levels. The Medicare Payment Advisory Commission (MedPAC) projects that hospitals will have a negative 6.9 percent Medicare margin in 2009 – down from a positive 6.2 percent Medicare margin in 1999 – the lowest level in more than a decade. Hospitals also experience severe payment shortfalls when treating Medicaid patients; on a national level, the Medicaid payment shortfall amounted to $10.4 billion in 2007. These underpayments affect families as well. A recent AHA study by Milliman, Inc. found that annual health care spending for an average family of four is $1,788 higher than it would be if Medicare, Medicaid and private employers paid hospitals and physicians similar rates, with total provider reimbursement unchanged. The scope of such a plan should be limited to the uninsured, the selfemployed and small businesses.
Medicaid
The AHA supports expanding Medicaid eligibility with federal financing for the new populations
covered through expanding eligibility for children, parents and pregnant women up to 150
percent of the federal poverty level. It is important also to include provider payment protections as Medicaid expands. The AHA also supports a permanent process that, in times of economic
downturn, provides states temporary increases in the Federal Medical Assistance Percentage
(FMAP) to help support their Medicaid programs. Through maintenance of effort criteria, states
should be required to maintain their current levels of eligibility and enrollment, benefits and
provider payment rates. Any FMAP increase should apply to Disproportionate Share Hospital
(DSH) payments, with a corresponding increase in DSH allotments to accommodate the
enhanced federal match. These reforms are critical because states typically target their Medicaid programs in a search for savings through provider payment freezes or reductions, as well as benefits and eligibility changes, in times of economic turmoil. "
A Must Read on Public Option
The latest in Health Affairs/ Robert Wood Johnson Foundation's health policy briefs was released late last month. It provides the pros and cons of the public option in the health reform legislation making its way through Congress this month. http://www.healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_4.pdf.
It is one more piece of information as the Congress got slammed by its budgeteers on the cost of the entire reform package.
Public options are filtered for health leaders on their relationship with Medicaid and Medicare. Patients seem to have a different view. Most of us have had opportunity after opportunity to see bad policy created in the name of politics....and this is coming from a philosophical "single payor" person!
Health executives are in a position to frame this complicated information for their communities. Read on.
It is one more piece of information as the Congress got slammed by its budgeteers on the cost of the entire reform package.
Public options are filtered for health leaders on their relationship with Medicaid and Medicare. Patients seem to have a different view. Most of us have had opportunity after opportunity to see bad policy created in the name of politics....and this is coming from a philosophical "single payor" person!
Health executives are in a position to frame this complicated information for their communities. Read on.
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