PPACA Impact and Opportunities : Health Care Lawyer & Attorney : Epstein Becker Green Law Firm : Insurance & Costs : Health Reform Musings Blog

Now that we have sweeping new health care legislation, the Patient Protection and Affordable Care Act ("the Act"), let's look at the rollout of the accountable care provisions--i.e., those changes to the payment and delivery system that hold the most long-term promise of improving quality and cost-efficiency. They are discussed in my most recent article: "The Timeline for Accountable Care: The Rollout of the Payment and Delivery Reform Provisions in the Patient Protection and Affordable Care Act and the Implications for Accountable Care Organizations," published last week in the BNA's Health Law Reporter.  Click here to read the full article (PDF).

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Barack Obama signed an executive order on April 8, 2009 to formally lay infrastructure in the executive branch to facilitate health care reform activities. The executive order officially creates the White House Office of Reform (the “Health Reform Office”) and lays out its principle functions, including coordination across executive departments and agencies, outreach activities with state and local policymakers, and working with Congress for the purpose of enacting and implementing health care reform. As we reported on March 6, 2009, Nancy Ann DeParle was selected to be the Director of the Health Reform Office. The order grants DeParle the discretion to work with “established or ad hoc” committees, task forces, or interagency groups. It remains to be seen how DeParle will use this authority to promote the goal of the Obama Administration to have an open, inclusive and transparent process for health care reform.

The order also creates the HHS Office of Reform “to coordinate closely” with the White House office. InsideHealthPolicy reports that Jeanne Lambrew is the lead candidate to head the HHS office. Lambrew originally was tapped as the deputy director of the White House office when Tom Daschle was nominated for HHS Secretary and selected for the Health Reform Office in December 11, 2008. Prior to joining the Obama Administration, Lambrew was an associate professor of public affairs at the Lyndon B. Johnson School of Public Affairs at the University of Texas at Austin where she specialized in health care policy.

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Things are heating up for those of us following, participating in, and blogging on the process to enact comprehensive health reform. Hearings over the past few days, including those in the Senate Finance and HELP Committees, and the House Energy and Commerce Committee, focused on topics critical to any reform package: improving access to care, reforming the insurance market, and long term care issues. However, it was the House Budget Committee’s passage of its annual budget resolution that really lit up the debate.

As the FY 2010 budget process continues to unfold, a parliamentary argument involving the use of budget reconciliation instructions has imploded in both bodies of Congress. While President Obama met with Senate leaders to defend his top budget priorities, comprehensive health reform being chief among these, Democrats on the other side of Capitol Hill were laying their own set of rules for passage of health reform legislation. 

Both the House and Senate budgets contain a deficit neutral reserve fund, or placeholder, to enact health reform. However, only the House budget blueprint, which passed out of the House Budget Committee on Wednesday night, contains reconciliation instructions. The use of this parliamentary procedure would enable passage of health reform in the Senate with only a majority of votes (as opposed to the 60 votes needed to invoke cloture). Chairman Conrad’s mark did not contain reconciliation instructions on health reform, but Majority Leader Reid has not ruled out employing reconciliation to enact reform.   

Also, with the introduction of the new coalition of 15 moderates in the Senate led by Senator Evan Bayh of Indiana and created to “work with the Senate leadership and the new administration to craft common-sense solutions to urgent national problems,” it appears that enactment of meaningful health reform is increasingly dependent on the Democratic leadership’s ability to heed the concerns of those in their own party, not just those of their Republican colleagues on the other side. In fact, Senator Ben Nelson, a member of the moderate coalition, called the use of reconciliation to enact health reform “a deal-breaker.”

The stakes are high and the need for reform is very real. But as the political maneuvering continues, we are left asking what the prospects for true reform – reform which includes consensus building on polarizing key issues such as an individual mandate, the availability of a public plan, paths to expanded coverage, and the all-important sources of revenue and savings– really are.

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In yesterday’s post on The Health Care Blog, Bill Kramer remarks upon a key difference in the health reform discourse this go-round. Simply put, “the Obama Administration is changing the debate in a fundamental way.” As President Obama stated in his opening remarks to last week’s White House Forum on Health Reform, “[h]ealthcare reform is no longer just a moral imperative, it is a fiscal imperative.”

Kramer explains that past attempts at reform suffered from political sticker shock over concerns that health reform would dramatically enlarge the federal deficit. However, this time, the Obama Administration is emphasizing that reform will not pose an additional burden to the already laden deficit. Indeed, health reform is a necessary tool to “tame” the deficit over the long term.

And framing health reform as an economic necessity is already having an effect. As Nancy-Ann DeParle, director of the White House Office for Health Reform, pointed out in her Wednesday op-ed in The Boston Globe: there are no defenders of the status quo. Two happenings from yesterday, both involving key stakeholders, echo this sentiment:

Regional White House Forum on Health Reform - Dearborn Michigan
Underscoring the link between long-term economic prosperity and health reform, the White House chose Michigan, the state with the highest unemployment rate in the nation, as the site for the first of five Regional White House Forum on Health Reform. In his announcement of the Regional White House Forum series, President Obama called on participants of these forums to “put forward their best ideas about how we bring down costs and expand coverage for American families."

Among the 250 attendees were doctors, patients, insurers, policy experts and health care advocates. The forum was hosted by Governors Jennifer Granholm of Michigan and Jim Doyle of Wisconsin. Notable politicos in attendance included Congressmen John Dingell and John Conyers, Jr., as well as White House Domestic Policy Director Melody Barnes, who helped to moderate the event. Reports of the town hall-style event indicate that “guests in the room uniformly supported broad and sweeping reform focused on expanding access to the uninsured, improving medical records and emphasizing preventative care.”

The remaining four regional forums will take place in Burlington, VT (March 17th), Des Moines, IA (March 23rd), Greensboro, NC (March 31st), and Los Angeles, CA (April 6th).

Business Roundtable urges lawmakers to act quickly on health reform
Yesterday heard from another key stakeholder group, Business Roundtable. The association released a study showing that American companies were losing out to other countries with cheaper healthcare and healthier workers. As reported by Reuters, Business Roundtable “wants changes that would reduce costs through greater use of technology and other efficiencies and require everyone to obtain health coverage. The group also supports plans to provide government aid to help those who cannot afford insurance, but said they do not want to see a government insurance plan that dominates the market.”

Members of the Business Roundtable also heard from President Obama yesterday on the critical need for health reform. A transcript of the President’s speech is posted on the Wall Street Journal’s Washington Wire blog.

If yesterdays goings-on are any indication, Kramer and DeParle are right: the landscape has changed and the health form battle will be fought on different grounds. Everyone is in favor of change. The devil, of course, will be in the details.

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Thursday's White House Forum on Health Reform brought together people who have a stake in our health care system with people who have the ability to change it. Prior to his inauguration, President Obama called on Americans to hold community discussions about health care. More than 9,000 Americans signed up to host discussions in all 50 states and more than 30,000 Americans attended these discussions. These community groups submitted reports to the White House that detailed their concerns about the health care system and their suggestions for reform. At the Forum, several of these community participants joined health care experts to participate in the Forum discussions.

Did these community representatives have any meaningful impact on Thursday’s discussion? Let’s hope so – engaging members of our nation’s communities adds a necessary human element to these debates as they begin to take shape and hopefully will demonstrate to those who can effect change that every ordinary person must be involved in this important national discussion. The President expressed his desire see change by the end of this year. We should harness the energy generated by yesterday's discussions to promote actions that result in health reform efforts and engage all Americans - all "stakeholders" - in these efforts. 

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On Tuesday, President Obama announced Kansas Governor Kathleen Sebelius as his nominee for Secretary of Health and Human Services. She is known for her bipartisan approach to politics and her efforts as a governor in the health care arena. If confirmed, Governor Sebelius has a once in a lifetime opportunity to execute health care reform – a President enjoying positive public opinion, a national sense of urgency, and resources to get the job done.

The President also announced his choice for Director of the White House Office of Health Reform, Nancy-Ann DeParle, a former Administrator of HCFA (now CMS) during the Clinton administration who also has extensive experience in the private health care sector. Although this private sector experience has prompted criticism from some, Ms. DeParle’s appointment has drawn praise from both sides of the aisle because, despite her career-long identification with Democrats, DeParle has credibility with Republicans as well. Ms. DeParle is comfortably familiar with Washington and, drawing upon her previous White House, HCFA and Hill experiences, should be able to integrate herself within the White House policy operation easily while also serving as a powerful ally to Governor Sebelius. When it comes to crafting a health reform plan and then actually enacting it, Ms. DeParle’s role is likely to be unique and pivotal.

The President’s choices of Governor Sebelius and Ms. DeParle reflect a commitment to change that is likely to move us forward in our health reform efforts!

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Article by Paul Campbell and Maura Farrell

The President’s 2010 Budget includes a $634 billion reserve fund for health reform, funded equally by tax revenue and budget savings. The Budget outlines $316 billion in Medicare and Medicaid savings; 58 percent of which will be generated by using a competitive bidding process to set Medicare Advantage rates. Hospitals and homecare providers would share almost one-quarter of the budget reductions. The hospital savings are associated with policy changes designed to reduce readmission rates and to bundle post-acute care services. The homecare savings are associated with reducing provider payments to reflect costs.

SECTORS IMPACTED BY FEDERAL SAVINGS IN PRESIDENT'S 2010 BUDGET

The Budget does not provide any specific information on the physician payment “fix”, except to say that “the baseline reflects our best estimate of what the Congress has done in recent years”. The potential “cliff” associated with the current fix, which expires on December 31, 2009, is shown in the following chart.

MEDICARE SPENDING IN 2010 BUDGET PERCENT CHANGE FROM PRIOR YEAR

Presumably, the Administration will wait for Congress to address physician payment. In the meantime, the $430 billion moderate fix scored by CBO is not likely to compete for heath reform funds. 

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