News in brief - Sept. 26, 2011

New Jersey backs off Medicaid cuts

New Jersey Gov. Chris Christie removed proposed Medicaid cuts and co-payments from a Medicaid waiver request after an uproar from Democrats, consumer advocates and others.

The state will maintain Medicaid eligibility for parents -- up to 133% of the federal poverty level -- under a revised waiver proposal the New Jersey Dept. of Human Services submitted on Sept. 9 to federal Medicaid officials. The state also will scrap a $25 hospital emergency department co-pay initially proposed for nonemergency conditions.

"This waiver reflects months of constructive and thoughtful collaboration among stakeholders and consumers," New Jersey Dept. of Human Services Commissioner Jennifer Velez said in a Sept. 12 statement. "The final product rebalances the system to generate greater flexibility, increase choices and expand services for those who need it most."

The state had considered asking the federal government for permission to reduce Medicaid eligibility for parents to 27.5% of the federal poverty level, or $5,100 for a family of three, according to details the agency released in early June.

The state anticipates that Medicaid physician fees will increase as it moves more Medicaid enrollees into managed care. These plans are expected to pay physicians more than the existing average Medicaid fee-for-service rate of 41% of Medicare rates, according to the waiver proposal.

Back to top

2 physicians appointed to Vermont health reform board

Vermont Gov. Peter Shumlin on Sept. 13 announced the five appointees to the Green Mountain Care Board. Board members will determine the benefits and craft a funding plan for Green Mountain Care, a state universal health plan. The board also will have wide authority over state health spending and health system reform.

Shumlin signed legislation creating the board in May. The board will begin work on Oct. 1.

"In putting together this team, I looked for five really smart people who are fully committed to the goal of controlling health care costs, achieving universal coverage, and who can work as a team," Shumlin said. More than 100 people applied for the five positions.

Shumlin appointed two physicians to the board: Allan Ramsey, MD, and Karen Hein, MD.

Dr. Ramsey, a family physician, has been a leader in palliative care. He has received the Vermont Medical Society's Distinguished Service Award, the society's highest member recognition. Dr. Ramsey also was the society's Physician of the Year in 2005.

Dr. Hein is immediate past president of the William T. Grant Foundation and a former executive director of the Institute of Medicine. She also is a faculty member at Columbia University and the Albert Einstein College of Medicine, where she has conducted extensive research on adolescent HIV/AIDS.

The other board members are Chair Anya Rader Wallack, PhD, who led Shumlin's legislative effort on health reform during the 2011 session and worked on health reform for former Vermont Gov. Howard Dean; Al Gobeille, a member of Vermont's Payment Reform Advisory Group; and Con Hogan, an advocate of a single-payer health care system and secretary of human services under Vermont Govs. Dean and Richard Snelling.

Back to top

Medicare Advantage enrollment to increase 10% in 2012

Participation in private Medicare insurance programs is expected to grow by 10% in 2012, the Dept. of Health and Human Services announced on Sept. 15. Average premiums also would drop 4% in 2012, or 11.5% below 2010 rates, according to projections.

HHS officials expect more patients to take advantage of lower premiums during Medicare's annual open enrollment period, which takes place from Oct. 15 to Dec. 7. In 2010, 11.7 million of the 47.5 million Medicare beneficiaries enrolled in the private health plans, according to Medicare trustees. In 2011, an estimated 12.4 million enrolled in the private plans.

The Centers for Medicare & Medicaid Services will pay more to private Medicare Advantage plans that provide higher quality care in 2012. All patients would have access to preventive services, including Medicare's annual wellness visit, without paying co-pays or deductibles.

Back to top

Bipartisan bill would revamp Medicare cards

A group of lawmakers wants patients to use new Medicare insurance identification cards to help eliminate fraud and waste in the program.

A bipartisan bill introduced in the House and Senate would institute "smart card" technology for Medicare patients to use in doctors' offices and hospitals. The Medicare Common Access Card Act of 2011, introduced on Sept. 14, would establish over two phases the use of ID cards similar to those issued by the Defense Dept. The first phase would test the new cards during a pilot project in regions where there are high rates of health care fraud. HHS would expand the use of the cards a year later.

The patient's Social Security number would not be printed on the card. Physician practices would gain access to beneficiary information electronically.

The proposal is sponsored by Sens. Mark Kirk (R, Ill.), Ron Wyden (D, Ore.) and Marco Rubio (R, Fla.) and Reps. Jim Gerlach (R, Pa.), Earl Blumenauer (D, Ore.) and John Shimkus (R, Ill.).

Back to top

Catholic doctors fight birth control pay mandate

A group of Catholic physicians is challenging a rule under the health system reform law that requires health plans to provide contraceptives and other preventive health services to women without patient cost sharing.

The physicians, members of the St. Gianna Physician's Guild, launched an online petition in August requesting the Obama administration and Health and Human Services Secretary Kathleen Sebelius to withdraw all references to contraception and contraception counseling in reform law regulations. The petition also asks the government to provide a "conscience clause" in the regulations to protect the religious freedom of Catholic health professionals (www.stopthebirthcontrolmandate.com).

HHS has said the contraception language has an expressed exception for "religious institutions that offer insurance to their employees." Catholic groups, however, call that exception too limited. Doctors and others in the group say the contraception mandate is discriminatory and violates religious rights.

Back to top