NCHC Encouraged By Push to Avert Medicare Spike and Sequester

“The National Coalition on Health Care is encouraged that Congress appears close to a deal to stop the Medicare spike and partially roll back sequestration.

The projected 52% increase in Medicare Part B premium and deductibles set for January 1 would shift billions of new costs onto beneficiaries, employers and state taxpayers. Continued sequester-level spending caps will strangle the investments in prevention and primary care that we’ll need to keep health care costs down over the long-term.  Allowing either the Medicare spike or sequestration cuts to proceed would be counter-productive to health and fiscal policy.”

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Without Congressional Action, Cost Increases to Hit Medicare Beneficiaries Just After the Holidays

“Unless leaders on Capitol Hill get moving on a bipartisan solution, Congress will be leaving a very expensive lump of coal in the holiday stockings of seniors and disabled Americans.”

“If Congress does nothing, on January 1, millions of Medicare beneficiaries could face an unanticipated 52% increase in their Part B premiums and Part B deductibles will climb from $147 to $223. Just as importantly, this Medicare spike will impose even greater costs on employers’ retiree health plans  and shift billions in Medicaid costs to state taxpayers in all fifty states.”

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Post-King v. Burwell, NCHC Calls on Congress to Address Costs and Quality

“With today’s verdict behind us, it is time to move forward on the health care issues all Americans care about: cost and quality.

American families and businesses continue to shoulder a growing health care cost burden. Yet the problems driving unsustainable health care expenses—growing chronic disease costs, volume-driven provider payment, and lack of market transparency and competition in prescription drugs—are imminently solvable.

We urge Congress to build on April’s successful  passage of SGR reform and children’s coverage legislation and pursue new, bipartisan solutions to our chronic disease, payment reform, and prescription drug problems.”

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NCHC Submits Bipartisan Chronic Care Policy Reform Recommendations

WASHINGTON, DC –The National Coalition on Health Care (NCHC) put forward a set of detailed, bipartisan policy recommendations to improve chronic care in a letter yesterday to Finance Committee Chairman Orrin Hatch (R-UT), Ranking Member Ron Wyden (D-OR), and Senators Johnny Isakson (R-GA) and Mark Warner (D-VA), who have been appointed to lead the Committee’s chronic care working group. The letter was submitted in response to a call for health care stakeholder input to inform the working group’s efforts.

“Congress should act now to ensure that Medicare policy is aligned with and builds upon what is already working in the private sector, the states and successful federal initiatives,” wrote NCHC President and CEO John Rother in the letter.

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NCHC Commends Constructive, Bipartisan MA Reforms, Urges Caution on IPAB Repeal

“Chairman Ryan and Ranking Member Levin are to be commended for working together to advance legislation improving care and lowering costs in Medicare and Medicare Advantage (MA) in particular.

“Today’s markup will consider several constructive, bipartisan bills, including measures to:

  • Enable MA plans to test Value-Based Insurance Designs (VBID) which lower cost-sharing for beneficiaries seeking the best care and the best providers (H.R. 2581);
  • Provide greater opportunity for public input in the establishment of policies affecting the MA and Part D plans (H.R. 2507); and
  • Instruct CMS to take a second look at risk adjustment policies that may be punishing MA plans that enroll chronically ill beneficiaries (H.R. 2579).

“The Committee will also act on S. 971, a Senate-approved bill to extend the Independence at Home Demonstration, a proven model of in-home primary care which is already improving outcomes and lowering costs.

“The VBID and Independence at Home provisions, in particular, advance alternative models of payment and delivery central to long-term health care affordability. NCHC especially welcomes their consideration today.

“However, the inclusion in today’s markup of legislation repealing the ACA’s Independent Payment Advisory Board (IPAB) is less encouraging. As structured under current law, the IPAB does have flaws, but Congress has yet to unite around an alternative approach to curb Medicare or systemwide cost growth over the long term. With health care costs continuing to squeeze families and employers alike, rolling back existing cost containment mechanisms is ill-advised.

“Instead, going forward, let’s hope lawmakers keep their focus on bipartisan improvements that actually curb costs and improve care.”

For additional information, please see:

NCHC’s endorsement letter for the VBID for Better Care Act of 2015

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NCHC Applauds Senate Vote to End SGR, Looks Ahead to Post-SGR Priorities

“The National Coalition on Health Care (NCHC) and its member organizations applaud important steps taken by Congress moving from volume to value as the basis for physician reimbursement. That’s good for physicians, good for patients, and potentially good for a more sustainable Medicare program. We are all pleased that an end to SGR’s mandated Medicare cuts and an additional two years of secure children’s coverage are headed to President Obama’s desk.

“NCHC has expressed reservations regarding H.R. 2’s offsets. But after years of gridlock, it’s important that lawmakers chose a common path forward—a path built around value-based payment, transparency, and innovative models of care. With cost pressures growing for employers and families, our nation will soon face a similar choice again: embrace additional policies that accelerate our progress toward value or slip backwards to additional beneficiary cost-shifting and blunt provider cuts.

“NCHC is already working hard to ensure that we keep moving forward—starting with our Capitol Hill Forum tomorrow morning, Health Policy after the SGR:  What’s Possible in Value-Based Payment and Benefits. And in the coming months, NCHC and its members look forward to working with Congress and the administration to build and improve upon H.R. 2’s reforms.”

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NCHC Applauds House Vote to End SGR, Advance Health Care Delivery and Transparency Reforms

“The House has now voted overwhelmingly not just to end SGR’s automatic Medicare cuts but to enact delivery reform and transparency measures that can make health care more affordable for all of us. We applaud them for their leadership.

“This compromise bill is not perfect. NCHC has long supported an alternative approach to offsets through stronger delivery and prescription drug reforms, not cost-shifting to beneficiaries or others. We also prefer a longer CHIP extension and a long-term solution for Medicare therapy caps.

“But failure to act could jeopardize care for seniors, children, and disabled Americans while leaving unchecked the fee-for-service incentives at the heart of our health care cost problem. In the next few days, Congress must work together to get these important reforms to the President’s desk.”

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NCHC President and CEO John Rother Urges House Passage of SGR/CHIP Legislation

WASHINGTON, DC – National Coalition on Health Care (NCHC) President and CEO John Rother urged House passage of H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 in a letter to the members of the House of Representatives today.

“This legislation is far from perfect, but Speaker Boehner and Leader Pelosi have crafted a strong compromise that can make health care more affordable–for families and the country as a whole,” wrote Rother. “I urge you to act this week to strengthen Medicare and finally consign the Sustainable Growth Rate (SGR) to the history books.”

The full text of the letter can be found here.

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House SGR/CHIP Deal Enhances Health Care Affordability

“Congress now has the opportunity to strengthen Medicare and end the annual need to cut the program to avoid drastic physician reimbursement reductions. Speaker Boehner and Leader Pelosi have crafted a framework that, over time, can make health care more affordable–for families and the country as a whole. Without action, Medicare physicians will see their reimbursement slashed, children could see their coverage taken away, and an outmoded fee-for-service system will continue to drive up the cost of health care.

“The House strategy is to pair a repeal of threatened  provider cuts with real, long-term reform. The full legislative package would:

  • Move Medicare past its current fee-for-service system by encouraging physicians to embrace new care and payment models, which are driving down costs in the private sector;
  • Introduce new transparency reforms that will help Americans know exactly what they’re paying for at the hospital and doctor’s office;
  • Preserve CHIP and its investments to ensure the next generation is healthier (and less costly long-term);
  • Make permanent beneficiary protections for those moving from welfare into a job or for those who make under $15,750 a year; and
  • Yield substantial reductions in federal spending over the next two decades… without broad-based cuts to benefits or increases to original Medicare’s deductibles.

These are important legislative achievements.

“But in Washington as in life, nothing good comes free. Those physicians who prosper simply by ordering more procedures and tests will have to accept having a greater share of their reimbursements tied to value. The hospital and nursing home industries will have to accept $30 billion in lower payments over ten years.  And, it may be that 2% of Medicare beneficiaries who make more than $133,000 a year will have to accept a higher premium, and, beginning in 2020, that those who purchase certain new Medigap policies will have to shoulder a small deductible in their supplemental plan.

“NCHC has repeatedly urged Congress to pursue offset alternatives that achieve savings through better care, not shifting costs. And over the next few days, we will continue working with our member organizations to ensure final legislation does more to curb wasteful or unnecessary costs and offer the best possible deal for kids and seniors.

Failure to act now will only increase the cost of a solution later—for taxpayers and beneficiaries. If you’re a working parent who needs CHIP to keep your kid covered, or if you’re a senior who wants your Medicare to be there for the long haul, you need this deal to get done. These important reforms must not wait.”

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Broad Support for Bipartisan Data Sharing Legislation

Washington, D.C. (March 11, 2015) – Today, 37 organizations representing patients, providers, insurers, employers and researchers called on Congress to quickly pass bipartisan legislation that amends the Qualified Entity (QE) statute to allow for broader sharing of Medicare data. The Quality Data, Quality Healthcare Act was introduced on March 9th by Senators Tammy Baldwin (D-WI) and John Thune (R-SD). The House version of the proposal was introduced on February 6th by Congressman Paul Ryan (R-WI) and Congressman Ron Kind (D-WI).

Joel C. White, President of the Council for Affordable Health Coverage and head of the Clear Choices Campaign, said, “This bill will put data in the hands of experts who will be able to identify and correct many of the problems plaguing our health system – high cost, poor quality, bad health outcomes. We are encouraging Congress to take the bill up immediately.”

The legislation will provide more flexibility to data crunchers, known as Qualified Entities, by permitting them to use and share actionable data with providers, payers and health care consumers. The bill revises the QE program by broadening non-governmental access to claims data collected under the Medicare program. Current law, enacted in 2010, gives QEs access only to Medicare claims data (Parts A, B and D), and requires that all analyses be published. The reforms would permit QEs to provide analyses and, in some cases, data for a range of non-public uses, such as assisting providers in developing and participating in quality and patient care improvement activities, population health management, disease monitoring and insurance network development and selection.

As a result, the legislation will:

  • Double the amount of data available for analysis;
  • Expand the number of experts who can analyze the data; and
  • Permit more uses of the data, such as for developing new models of care, improving benefit design, or identifying wasteful or unsafe practices.

John Rother, President and CEO of the National Coalition on Health Care said, “By enabling consumer transparency tools to draw on Medicare’s vast trove of cost and quality data, these reforms will bring us closer to the day when every consumer can access clear understandable cost and quality information on their provider and treatment choices.”

The bill has been included in numerous proposals, including:

  • SGR Repeal and Medicare Provider Payment Modernization Act of 2014
  • House Ways and Means Health Subcommittee Chairman Kevin Brady’s Hospital Improvements for Payment (HIP) Act of 2014 Discussion Draft
  • House Energy and Commerce Committee Chairman Fred Upton’s 21st Century Cures Discussion Document White Paper

In addition, the President’s FY 2016 Budget included a proposal to expand data sharing through the QE program.

“Healthcare costs are rising faster than quality is improving,” says Dr. John Toussaint, CEO of ThedaCare Center for Healthcare Value. “Healthcare cost and quality data, including Medicare data, are largely unavailable to purchasers and consumers, so the market can’t reward the ‘good guys.’ Medicare’s qualified entity program was a well-intended program to make Medicare data available for assessment of cost and quality, but there are limits in the statute as to how the data can be used.”

Elizabeth Mitchell, CEO of the Network for Regional Healthcare Improvement, added, “We believe that Medicare data contains critical information that if made more fully available would help empower communities across the country to identify opportunities to improve value in healthcare.”

White concluded, “The QE language is a product of many compromises carefully crafted over years of intense, bipartisan negotiations,” he said. “There aren’t many things Republicans and Democrats agree on these days, but providing additional data to promote a better, lower cost health system is clearly one of them. With such overwhelming support for better tools to shop for better, more efficient care, health care transparency is a win for consumers, payers and politicians.”

Endorsing the QE language is a diverse group of stakeholders, from AARP to the National Association of Manufacturers, including both supporters and critics of the Affordable Care Act. The letter can be found here.

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