WASHINGTON--The debt-reduction deal passed by Congress this week may have eased
concerns about default, but it has ratcheted up anxiety on other
fronts--particularly among health care providers.
WASHINGTON--The debt-reduction deal passed by Congress this week may have eased
concerns about default, but it has ratcheted up anxiety on other
fronts--particularly among health care providers.
Doctors, hospitals, and others
in the health care industry are deeply worried about how the agreement--in
particular, a second phase of deep spending cuts to be outlined later this
year--could impact their financial stability and patients' access to care.
"There's a huge amount of
uncertainty," said Dr. David S. Katz, president of the Connecticut State
Medical Society. He said that while the scope of the pain to be inflicted on
health care providers is not yet clear, they are certain to take a hit because
of the way the agreement is structured.
"With the way this table
is set, the only way to squeeze lemonade out of this lemon is [for Congress to
create] a lower fee structure for all providers" who serve Medicaid and
Medicare patients, Katz said. That will make it harder for doctors to serve
those patient populations, further curbing access to needed health services.
Under the debt deal, Congress agreed to create a 12-member
bipartisan, bicameral "super committee" tasked with finding at least
$1.5 trillion in debt-reduction measures before Thanksgiving. The panel can
look at entitlement reform and tax increases to reach that goal.
Medicare and Medicaid account
for nearly one-quarter of all federal spending, and the costs of those two
health care programs are on the rise. So they will be key targets in any
serious debt-reduction package considered by the committee.
If the special committee fails
to agree on a $1.5 trillion in savings, or if Congress can't pass whatever the
panel comes up with, then $1.2 trillion in automatic spending cuts will go into
effect. And while the triggered cuts will not touch Medicaid, it will hit
Medicare providers, who are slated to get a 2 percent reduction in
reimbursements.
Either way--through a super
committee agreement or via the automatic cuts--"there's cause for
concern," said Patty Charvat, a spokeswoman for
the Connecticut Hospital Association.
Marie Watteau,
a spokeswoman for the American Hospital Association, said the automatic cuts
would cost hospitals across the country $45 billion over nine years. The AHA
tried to argue, in the short window before the deal was approved, that Medicare
should not be subject to the triggered cuts, but to no avail.
Now, the hospital association
and other health care groups are turning their attention to the special
committee. Congressional leaders have about two weeks to appoint the 12
members, and whoever sits on that panel will be the target of an intense,
already-launched lobbying campaign.
Interest groups will be
scrambling to shape and limit whatever cuts that panel comes up with. And it's
far from clear whether a deal produced by the committee will be better, or
worse, than the 2 percent triggered Medicare cuts.
"That's the question of
the day," said Charvat. "We don't know."
Charvat noted that the special committee will almost certainly look at other
recent debt-reduction proposals on the table, such as the one generated by
President Obama's bipartisan fiscal commission.
The commission's report recommended tackling health care spending in a myriad
of ways.
For example, the commission
proposed cuts to graduate medical education funding. Right now, Medicare gives
teaching hospitals supplemental funding to cover costs of providing residents
with their graduate medical education.
The commission's proposed cuts
would cost Connecticut
hospitals $95.6 million a year, said Stephen Frayne, the hospital association's
lobbyist. He said it could hamper efforts to enlist and educate new doctors in Connecticut at a time
when such access to both primary care and specialty physicians is strained.
"Obviously as the funding
for these programs goes down, one has to assess again your ability to be able
to continue to provide that training," Frayne said.
The commission also called for
limiting the ability of states to levy provider taxes on hospitals, such as the one Connecticut recently
adopted. Those provisions are used to help cover the costs of Medicaid, a joint
federal-state program. Many states currently impose a levy on hospitals,
nursing homes, or other health care providers, and then they devote that
funding stream to Medicaid payments that flow back to those providers.
So any change in provider taxes
could affect both state budgets and hospitals' bottom lines. "Cuts in
Medicare or Medicaid at this point in time for Connecticut hospitals would be very, very
worrisome," Charvat said. "That's makes it
really challenging to meet the needs of your community, with all this
volatility and uncertainly."
Katz took a similar view. Asked
whether he thoughts the triggered cuts would be better
than whatever the committee comes up with, Katz said: "That's a tough one.
That's like a choice between Scylla and Charybdis."
He was referring to the Greek
myth, in which Odysseus was forced to choose between steering his ship closer
to one of two perils: Scylla, a rock shoal, or Charybdis,
a whirlpool. Sailing too close to either could mean death,
Odysseus picked Scylla so he would only lose a few men instead of his entire
ship.
Which deal would be the health
providers' Scylla?
"If I had to make a choice
like that, I'd probably go with the known entity of 2 percent, as opposed to
the unknown entity of what these politicians--in parenthesis clowns--could come
up with," Katz quipped. "Because I think they could always come up
with something that's worse that 2 percent."
No matter what, he added, this
agreement has put health providers on edge. "Providers, and more
importantly patients, are going to be sitting white-knuckled" as the
implications of the debt deal unfold, Katz said
http://www.ctmirror.org/story/13502/healthcaredebtdeal