Post-Election Random Thoughts
In no particular order, here are some questions we're thinking about in relation to the new post-election administration and Congress:
1. Stimulus Bill - FMAP? Will Congress pass a new economic stimulus bill during a lame duck session, and will it include an FMAP increase - more Medicaid funds for states? For Massachusetts, a temporary FMAP increase that would allow easing of some of the harsh MassHealth rate cuts and would prevent layoffs and maintain critical health services. One option suggested by Speaker Pelosi would be for the Senate to take up the stimulus bill already passed by the House in September. That bill would provide several hundred million dollars to Massachusetts. Or, does this have to wait until President Obama takes office, further delaying the needed help?
2. SCHIP? What will Congress and the new administration do about SCHIP - the State Children's Health Insurance Program, which expires the end of March? Massachusetts depends on SCHIP to cover some 90,000 children and their parents through MassHealth. One option is to do a short-term extension, and then roll the long-term discussion into the bigger health reform debate. Another option is to quickly pass a 5-year reauthorization, and notch an early win for the new President and Congress. But no one knows how quickly that can be done, since there some tricky issues that must be worked out. We can be assured that the program won't be allowed to just end.
3. National Health Reform? Will national reform still be at the top of the President and new Congress' agenda? Or does the financial meltdown mean that health reform must wait? One signal came today, when Senate Finance Chair Max Baucus put out a letter to the President-elect saying "I intend for us to move swiftly and decisively with [health reform] legislation in early 2009." The letter laid out these goals for the bill:
- Universal coverage through a mix of public and private sector solutions
- Shared burden and new risk pooling arrangements
- Cost control through changes in the tax code, savings, and greater efficiency
- More emphasis on prevention and wellness
- Shared responsibility so that individuals, employers and the government all play a part in creating and funding a new health care system
We like those goals, and are pleased that Senator Baucus is in synch with Senator Kennedy on the urgent need for health reform (for the latest on Baucus, read this). The case can be made that the financial crisis makes health reform more urgent, not more unaffordable. Steve Coll put it well in a this week's New Yorker:
The accumulating failures in the country's health-care system are a cause of profound weakness in the American economy; unaddressed, this weakness will exacerbate the coming recession and crimp its aftermath. A large number of the country's housing foreclosures in recent years appear to be related to medical problems and health-care expenses. American businesses often can't afford to hire as many employees as they would like because of rising health-insurance costs; employees often can't afford to quit to chase their better-mousetrap dreams because they can't risk going without coverage. Add to this the system's moral failings: about twenty-two thousand people die in this country annually because they lack health insurance. That is more than the number of Americans who are murdered in a year.
4. Who's who? Of course we're all waiting to see who will be appointed to the key health posts (sidenote: check out the way cool transition web site: not this one, but this one: change.gov). But we'll also be interested to see if the Obama administration appoints a new New England Regional Director of the US Department of Health and Human Services. The current director is former Rep. Brian Golden. The regional director is an important contact for MassHealth and other programs, and provides guidance to DC on what's happening here.
5. Waiver Impact? We haven't heard of any substantive issues holding up the final approval of the renewal of the MassHealth waiver, now extended again until November 17. But having a Governor who's a good friend with the incoming president can't hurt, right?
6. Get Moving on Payment Reform? Section 44 of Chapter 305 directs the creation of health Payment Reform Commission, co-chaired by the Secretary of A&F and the Commissioner of DHCFP. A key goal of the Commission is to "recommend a plan for the implementation of the common payment methodology across all public and private payers in the commonwealth, including a plan under which the commonwealth shall seek a waiver from federal Medicare rules to facilitate the implementation of the common payment system." The Commission was supposed to be up and running in September, but so far nothing has happened. With the new administration that would have to approve a all-payer waiver of Medicare rules about to get organized, it would be helpful for some progress to be made so the expectation of a proposal can be on the mind of the incoming federal government officials.