News in brief - Oct 31, 2011

White House discontinues long-term care program

Health and Human Services Secretary Kathleen Sebelius announced on Oct. 14 that the department is suspending its efforts to implement a long-term care program authorized by the health system reform law -- a move that will increase the law's cost. HHS had spent 19 months examining methods to implement the Community Living Assistance Services and Supports program, which would have given Americans the option to buy long-term-care insurance policies not available on the private market.

"Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time," Sebelius wrote in an Oct. 14 letter to congressional leaders. The health reform law required the secretary to launch a program that is actuarially viable for 75 years, fully paid for by enrollee premiums, and offers lifetime and cash benefits, but HHS determined that is not possible.

Republicans and other Obama administration officials, including Centers for Medicare & Medicaid Services Chief Actuary Richard Foster, had said the CLASS Act was financially unsustainable. Sen. Edward M. Kennedy (D, Mass.) advocated for the program's inclusion in the health reform package before he died in August 2009.

Rep. Charles Boustany Jr., MD (R, La.), suggested that Republican opposition to the long-term-care program was instrumental in its demise.

"This program was foolishly created, unworkable and fiscally unsustainable," Dr. Boustany said in a statement. "As HHS continues to work and implement Obamacare, I will continue my vigorous opposition and fight to repeal this egregious plan. This decision is proof that Obamacare must be replaced with true health care reform enhancing the doctor-patient relationship."

Joyce A. Rogers, senior vice president for government affairs at AARP, said her group was disappointed with the HHS decision and insisted that an actuarial report on the program left open the possibility that the program could be made sustainable. She urged the White House to keep working on developing the benefit.

Sebelius' decision means that the health reform law will cost more. The Congressional Budget Office estimated in March 2011 that the CLASS Act would reduce federal deficits by $83 billion over a decade, mostly because the program initially would collect more premium dollars than it would need to pay for benefits.

Sebelius' letter and a report detailing HHS' work on the CLASS Act is available online (www.hhs.gov/secretary/letter10142011.html).

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Senators propose changes to Medicare secondary payer process

A bipartisan group of senators has proposed legislation that would reform Medicare's secondary payer process for medical liability cases.

Currently, Medicare patients who are injured by a third party and receive an injury settlement must recover damages for related medical expenses. If Medicare paid for treatment of the injuries, the Centers for Medicare & Medicaid Services would be entitled to be reimbursed for the care provided.

Sens. Ron Wyden (D, Ore.) and Rob Portman (R, Ohio) have proposed legislation to streamline that process. The Strengthening Medicare and Repaying Taxpayers Act would allow the Medicare agency to disclose the secondary payer amount so it can be factored into settlements for an injured party.

CMS no longer would be required to pursue secondary payer amounts that do not cover its own expenses. The legislation also would direct CMS to provide an alternative method for identifying injured patients so sensitive personal information is not compromised.

"By making the process more efficient, Medicare will be repaid more quickly and more accurately than before and the repayment process will work the way it was designed to work," Wyden said.

Sens. Michael Bennet (D, Colo.), Richard Burr (R, N.C.), Ben Nelson (D, Neb.) and John Thune (R, S.D.) also support the bill.

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Judge blocks Oklahoma abortion law

An Oklahoma judge on Oct. 19 temporarily barred a state law that restricts how doctors can treat women using abortion-inducing drugs.

The Oklahoma law, passed earlier this year, was scheduled to take effect on Nov. 1. The measure mandates that doctors abide by strict protocols regarding drugs for women seeking abortions. Doctors also must examine women and document certain medical conditions.

The Center for Reproductive Rights sued the state on Oct. 5 on behalf of the Oklahoma Coalition for Reproductive Justice, a nonprofit organization dedicated to ensuring the availability of reproductive health care services to women throughout the state.

The law jeopardizes women's health and undermines their ability to exercise the full range of their constitutionally protected reproductive rights, according to a statement by the center, a national advocacy organization that provides legal assistance to organizations fighting anti-abortion measures.

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House members oppose MedPAC's Medicare doctor pay plan

A group of House lawmakers has drafted a letter opposing the Medicare Payment Advisory Commission's plan to replace the Medicare sustainable growth rate formula with a system that cuts some doctor pay rates and freezes others.

Reps. Michael Burgess, MD (R, Texas), and Gene Green (D, Texas) have been gathering signatures on the letter expressing opposition to the MedPAC recommendations released Oct. 6. MedPAC recommended that Congress repeal the SGR, which is set to cut Medicare pay by nearly 30% in 2012, and replace it with two fee schedules. One would freeze payments for primary care services during the next decade. The other would cut pay for all other services by 5.9% a year for three years, and then freeze those rates for seven years.

"Unfortunately, while MedPAC's recommendation would eliminate the SGR, it would do so in a manner that would threaten access to care for millions of America's most vulnerable citizens," the letter reads.

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