January 2013 Government Affairs Summary
January 2013 Government Affairs Summary
By Catherine Carver, MS, ANP, CDE, Vice President, Advocacy and Planning
Medicare doctors will get paid more. Medicare hospitals will get paid less.
The fiscal cliff deal averted a 26.5 percent pay cut for the doctors who see Medicare patients by including a “doc-fix,” a short-term funding patch to keep doctors’ salaries stable for the next year. Doctors had hoped for the longer term solution that the Obama administration had proposed last month, which would have permanently fixed the formula that creates the regular funding shortfall.
In order to keep doctor salaries stable, Congress had to come up with new funds. They found about half of the $30 billion they needed in cutting Medicare reimbursements to hospitals. The hospitals obviously were not pleased. So doctors end up with stable salaries for the next year, but this just essentially kicks the can down the road.
Affordable Care Act
This year, the Obama administration will have to guide states through set-up of health care exchanges (a mechanism for organizing the health insurance marketplace to help consumers and small businesses shop for coverage ) — or, in many states, set them up entirely on their own. The law will have to withstand some level of rate shock as insurers adjust to new coverage requirements. The health law will certainly have to withstand new attempts to dip into its funding as the next fiscal “negotiations” occur. In Massachusetts, since we already have an exchange, the issue is to resolve differences between the federal and MA legislation and regulations.
Sequestration and Entitlements
There is a lot of talk about the discussion on taxes being over. Assuming there is some truth to this, the next discussions will almost definitely result in cuts in federal programs, including NIH. We need to remain on top of this in the coming months. As Senator McConnell noted in a Yahoo op-ed following passage of the fiscal cliff legislation, “We simply cannot increase the nation’s borrowing limit without committing to long overdue reforms to spending programs that are the very cause of our debt.”
Extension of Special Diabetes Program for Type 1 Diabetes and for American Indians
The fiscal cliff legislation (American Taxpayer Relief Act of 2012) continues funding authorization for research for Type I diabetes and supports diabetes treatment and prevention initiatives for American Indians and Alaska Natives. The Special Diabetes Program (SDP) expires at the end of 2013, but early reauthorization ensures continuation of the existing research projects. This provision would extend the SDP through 2014.
Competitive Prices for Diabetic Supplies
This proposal applies Medicare competitive bidding to diabetic test strips purchased at retail pharmacies with a projected savings of $60 million.
Commonwealth of Massachusetts
Implementation of the cost control and delivery system reforms
.Last summer the legislature passed comprehensive legislation (Chapter 224) to control health care cost growth, and to reorient our health system to promote integrated, patient-centered care. With these changes, the system will focus more on keeping people healthy, saving money by reducing waste and preventing acute illness. In 2013, the implementation process begins, with new boards and agencies digging in and creating the regulations and guidelines as the state moves from fee-for-service to accountable care organizations.
Senator Elizabeth Warren
In addition to being appointed to the Banking Committee, she also was named to the Senate Health, Education, Labor and Pensions Committee, usually called the HELP Committee. The Committee works on a wide variety of health issues, with Medicare and Medicaid being the notable exclusions. They oversee public health and health insurance issues. Their jurisdiction includes most of the agencies and programs of the Department of Health and Human Services, including the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, the Administration on Aging, the Substance Abuse and Mental Health Services Administration, and the Agency for Healthcare Research and Quality.
Catherine Carver, MS, ANP, CDE
Vice President, Advocacy and Planning
Page last updated: July 24, 2016