Fiscal Cliffnotes: 6 Health Care Questions, Answered

By Mary Agnes Carey, Kaiser Health News

(Graphic: Kaiser Health News)

(Graphic: Kaiser Health News)

The so-called “fiscal cliff” is a package of automatic spending cuts and tax hikes set to kick in next month unless President Obama and Capitol Hill agree on a way to stop them.

Negotiations to avert the cuts are ongoing and both sides have exchanged offers. On one side, the president and congressional Democrats have said they will reduce spending on entitlements, including Medicare, if Republicans will agree to increase tax rates on the highest earners.

And on the other side, Republicans have agreed to more revenue — but by closing loopholes and eliminating some deductions. They oppose raising tax rates.

Here are answers to six questions about what could happen in health care before the end-of-year deadline.

Q: If no deal is struck, how would that affect Medicare patients as well as the hospitals and physicians and other providers who care for them? Continue reading

No Matter Who Wins, We’re Still Heading for A Cliff

By Julie Rovner, Kaiser Health News

(Su-Lin: Flickr)

(Su-Lin: Flickr)

Whatever the outcome on November 6th, officials in Washington will still have to deal with a looming “fiscal cliff” before the end of the year.

What’s coming is a perfect storm of expiring tax cuts, scheduled budget cuts, and various other spending changes scheduled to take place Jan. 1 unless Congress and President Obama (who, no matter what, will still be president until next Jan. 20) agree on a way to avert them.

As two of the largest spending items in the federal budget, the Medicare and Medicaid health programs are expected to play a role in how the deal gets done. Under the provisions of the law that created the budget deal Congress will attempt to undo, Medicare is subject to a two percent cut in provider payments, while Medicaid is exempt.

But two new studies and a proposed class action lawsuit settlement suggest a lot of dollar signs could change as lawmakers start to think about how to address the impending mess. Continue reading

Presidential Debate: Health Care Excerpts from Both Candidates

From Kaiser Health News

Even when the questions aren’t about health care, many of the responses are. Here’s what President Barack Obama and his Republican opponent, former Mass. Gov. Mitt Romney had to say Tuesday night about contraception, Medicare and the health law. A transcript follows.

BARACK OBAMA: Katherine, I just want to point out that when Gov. Romney’s campaign was asked about the Lilly Ledbetter bill, whether he supported it, he said, “I’ll get back to you.” And that’s not the kind of advocacy that women need in any economy. Continue reading

Voucher Program Could Raise Medicare Premiums Across Country

If the program had existed in 2010, Californians would have paid in excess of $100 more per month, study finds

By Jordan Rau, Kaiser Health News

The type of proposal championed by Republicans to overhaul Medicare by giving beneficiaries a fixed amount of money to purchase insurance could lead to significant increases in premium costs in some parts of the country, according to a new study.

If the plan had been in place in 2010, six in 10 Medicare beneficiaries—about 25 million people both in traditional Medicare and in private Medicare Advantage plans —would have faced higher premiums if they didn’t switch to a cheaper plan, according to researchers at the Kaiser Family Foundation. (The foundation is not affiliated with Kaiser Permanente).

The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.

The new study estimated how the plan would have worked in 2010 by looking at the cost of traditional Medicare and private Medicare Advantage plans around the country. The study’s authors emphasized that their model was not an exact replica of any existing proposal for a variety of reasons, including that most plans, among them Ryan’s, wouldn’t phase in for a decade and even then would affect only new Medicare beneficiaries.

The study found that 59 percent of Medicare beneficiaries would have paid higher premiums in 2010 unless they shifted into a cheaper plan. In California, Michigan, New Jersey, Nevada and New York, average extra premiums would exceed $100 a month, and in Florida they would exceed $200 a month, the study calculated. Continue reading

Closing in on 65? Critical Medicare Decisions Waiting for You

By Sarah Varney, Kaiser Health News

(Image: Kaiser Health News)

(Image: Kaiser Health News)

Bruce Osterweil is a lucky man to live just a short walk from where San Francisco’s Golden Gate meets the cold, rough waters of the Pacific Ocean. He is also a lucky man to have married his wife, Patricia Furlong, who has long provided the family’s health insurance through her job at a small financial consulting firm.

But last month, Osterweil’s wife turned 65 and decided to retire, and although she may walk away with a crystal bowl or a golden watch for all those years of service, she will also walk away from her company’s generous health insurance benefits. That means Osterweil, who is 59 and a self-employed benefits consultant, is shopping for his own health insurance.

“I’m really surprised at how hard it could be for just the average person who isn’t an actuary or benefits consultant to figure any of this out. It’s astonishing,” he says.

When a spouse or parent signs up for Medicare, it is often perplexing – and unnerving – for the rest of the family who may have grown used to cushy employer-sponsored coverage. For example, young adults up to age 26, who were covered under their parent’s insurance, are no longer covered when their parent moves to Medicare. Continue reading

Paul Ryan’s Plan for Medicare

By Marilyn Werber Serafini, Kaiser Health News

Republican Presidential Candidate Mitt Romney Announces Rep. Paul Ryan As His Vice Presidential Pick

Mitt Romney introduces Paul Ryan as his choice for running mate in Norfolk, Va., last Saturday. (Photo by Win McNamee/Getty Images)

Wisconsin Republican Paul Ryan, GOP presidential hopeful Mitt Romney’s choice for vice president, has provoked consternation from Democrats and anxiety among some congressional Republicans with his proposals to reshape Medicare.

The Republican-controlled House, along party lines, twice approved his proposals to overhaul the popular social insurance program for the elderly and disabled by giving beneficiaries a set amount of money every year to buy coverage from competing health plans. That is a fundamental shift from today’s program, where the federal government pays for as many services as beneficiaries use.

The proposals were never enacted because of opposition from the Democratic-controlled Senate and President Barack Obama.

This year, Democratic congressional candidates nationwide are making the protection of traditional Medicare a centerpiece of their campaigns, just as Republicans attacked them two years ago for curbing future Medicare spending as part of the 2010 health care law. Now, Democrats are hammering their GOP opponents for voting for Ryan’s proposals, which were included in the last two House budget resolutions.

Here is a guide to some of the issues and questions raised by Ryan’s plan.

Q. What is Ryan’s latest Medicare plan? Continue reading

Doctors Fall Short in Helping Seniors, Poll Reveals

(Photo: Kaiser Health News)

(Photo: Kaiser Health News)

Medicare provides free screening on more than a dozen primary care tests, but a new poll shows that seniors are not receiving the benefit. The poll comes from the John A. Hartford Foundation and looked at Americans age 65 and older.

The Foundation was interested in whether seniors had received seven services that would support “healthy aging” including:

  • an annual medication review
  • falls risk assessment
  • screening for depression
Kaiser Health News reported details of the poll’s findings: Continue reading

Medicare Quality Ratings: No Effect on Patient Deaths

By Jordan Rau, Kaiser Health News

Medicare’s seven-year effort to spur quality improvements in hospital care by publishing key performance metrics on its Hospital Compare website has not resulted in fewer patient deaths, according to a new Health Affairs study.

In 2005, Hospital Compare started rating more than 3,000 hospitals on how well they adhere to basic guidelines for clinical care, such as giving flu vaccinations to pneumonia patients. Over time, Hospital Compare has added the results of patient experience scores, readmission and mortality rates, and, most recently, rates of complications and other patient safety mishaps.

There’s been little evidence that consumers use the site in choosing hospitals. Still, health policy experts have hoped poor performing hospitals would nonetheless be embarrassed enough by their public scores to make changes. Indeed, scores on many of the measures have improved over time.

But the new study questions whether any of this was actually leading to better outcomes for patients, such as their chance of survival in the month after they were discharged. The study found that at the time Hospital Compare was launched, mortality rates for patients with three common ailments — heart attacks, heart failure and pneumonia — were already decreasing. After those trends were taken into account, Hospital Compare was found to have no effect on the 30-day survival rate of heart attack and pneumonia patients, according to the study.

There was only a “modest” reduction in death rates for heart failure, and that could have been due to something other than Hospital Compare, the study said. “Hospital Compare did not result in patients’ shifting toward high-quality hospitals, and led to little or no reduction in mortality rates within hospitals beyond existing trends,” the paper concludes.

Starting in October 2013, hospitals will have an added reason to improve their mortality rates. As part of the health law’s value-based purchasing programmortality rates will added to the factors Medicare uses in determining how much to reimburse hospitals.

Quick Read: Most Hospital Errors Go Unreported

(Tim Samoff: Flickr)

(Tim Samoff: Flickr)

The New York Times reports that “hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized.” The Times cites a federal study [PDF] released today.

In order to be paid by Medicare, hospitals must track and report errors. A major study by the Institute of Medicine in 1999 found that between 44,000 and 98,000 hospital patients die each year because of errors that could have been prevented.

Perhaps the most troubling point in the Times piece was this, from Daniel R. Levinson, inspector general of the Department of Health and Human Services, which published the report:

…the problem is that hospital employees do not recognize “what constitutes patient harm” or do not realize that particular events harmed patients and should be reported.

In some cases, he said, employees assumed someone else would report the episode, or they thought it was so common that it did not need to be reported, or “suspected that the events were isolated incidents unlikely to recur.”