|
------------------------------------------
VOR Weekly E-Mail Update
June 23, 2006
------------------------------------------
=======================================================
1. Success in Washington, D.C: VOR 2006 Washington Initiative Draws
Participants from 25 States, Covers Key Issues
2. THANK YOU VOR ANNUAL MEETING SPONSORS!!
3. The Everything Commission - Can Congress and the president get the
fiscal house in order -- or must that job be outsourced?
4. 88 Republicans in Congress Ask Secretary of HHS, Michael Leavitt, not to
Implement Medicaid Cuts
5. 19 Republicans in Congress ask Mark McClellan, Administrator, Centers
for Medicare and Medicaid Services (CMS) to issue clarifying regulations to
the Deficit Reduction Act
6. States' Changes Reshape Medicaid - New Restrictions Aim to Save Money
7. Do you support VOR's Mission? Then help us accomplish it by joining VOR
or contributing today. A form is provided at the end of this E-Mail update.
Thanks!
=======================================================
---------------------------------------------------------------------------
1. Success in Washington, D.C: VOR 2006 Washington Initiative Draws
Participants from 25 States, Covers Key Issues
---------------------------------------------------------------------------
VOR's 2006 Washington Initiative, held the week of June 12, was a success.
We enjoyed broad state representation, with 25 states represented by 75
people. Every Member of Congress received VOR's presentation folder which
detailed VOR's opposition to several Sunset Commission proposals (see
below), support for a Deficit Reduction Act (DRA) technical correction
bill, and support for adequate funding for federal programs serving people
with mental retardation, including Medicaid. Our presentation leave-behind
folders also included background papers on the critical needs of people
with mental retardation by describing the population for which we advocate,
sharing an overview of residential service needs, and calling for
legislative action to address access to health care challenges.
Our issues were timely, as evidenced by the selection of articles below.
While we were in Washington, D.C., the Washington Post included an article
about state Medicaid reform initiatives being pursued since the passage of
the DRA of 2005 (see article below). The Washington Post also carried an
editorial criticizing a proposed Entitlement Commission (see below). Rep.
Peter King (R-NY) recently sent to the U.S. Department of Health and Human
Services (HHS) a letter signed by 19 of his Republican colleagues asking
that the DRA regulations address some of the technical corrections and
clarifications needed, and also in May, 88 Members of the House of
Representatives sent a letter to the Centers for Medicare and Medicaid
Services (CMS), expressing concern regarding the President's proposed cuts
to the Medicaid program (see below).
In its presentation to Congress, as well as several meetings with offices
in HHS and CMS, VOR touched on every one of these issues, while also
providing critical background information on the needs of people with
severe and profound mental retardation. See
http://www.vor.net/LeaveBehindPositions2006.html for a copies of the
position papers shared with Congress.
VOR expresses sincere gratitude to the participants who attended VOR's
Initiative, as well as the "folks back home" who wrote and called to
support VOR's issues and the participants in D.C. It was a terrific
collaborative effort. We thank you!!
---------------------------------------------------------------------------
2. THANK YOU VOR ANNUAL MEETING SPONSORS!!
---------------------------------------------------------------------------
Each year generous Annual Meeting and Washington Initiative Sponsors make
VOR's most important annual event possible. Visit
http://www.vor.net/Sponsors2006.html for links to our Medal and Meeting
Sponsors for this year's event. A complete list will also be published in
the next issue of VOR's quarterly newsletter, The Voice.
---------------------------------------------------------------------------
3. The Everything Commission - Can Congress and the president get the
fiscal house in order -- or must that job be outsourced?
---------------------------------------------------------------------------
Summary: The Everything Commission is an editorial by the Washington Post.
VOR has joined a letter being distributed by the American Federal of State
County and Municipal Employees (AFSCME) that expresses opposition to Sunset
Commissions, stating in part, "Sunset commissions are unnecessary and
duplicative: Congress and other federal bodies, including the Government
Accountability Office and Inspectors General, are already charged with
overseeing federal programs and agencies. The Congressional Research
Service concluded in 1998 that, instead of stopping waste and duplication,
"the commission, ironically, is itself an example of an agency for which a
public need does not exist.'" This letter will be sent to Congress soon,
with more than 100 organizations expected to sign the letter.
The Everything Commission
Can Congress and the president get the fiscal house in order -- or must
that job be outsourced?
ŠThe Washington Post Company
Tuesday, June 13, 2006
THE POLITICAL system is proving itself incapable of addressing hard
budgetary questions even as the time to act grows shorter. President Bush
tried -- and failed -- on Social Security, the easiest of the three big
entitlement programs to "fix." His efforts on tax reform fizzled -- though
less spectacularly, since the president never put his energy into the issue
in the first place. Congress had such a hard time agreeing on small cuts in
Medicare and Medicaid last year that it abandoned any pretense of trying
again this time around. And Mr. Bush's proposal for a bipartisan commission
to examine the costly health-care programs has foundered as Democrats
balked at signing up for any examination that put taxes off the table.
Into this standoff comes Rep. Frank R. Wolf (R-Va.) with a proposal for a
base-closure-style commission to beat all commissions. It would look at the
tax code and the array of entitlement programs and produce a set of
recommendations, decided by a two-thirds vote, to put them on a fiscally
sustainable course. Its 15 members would be appointed by the president
(three members) and the congressional leadership (three each for the House
and Senate majority and minority leaders). Its recommendations would come
before Congress for an up-or-down vote, although the president or either
chamber's budget committee would also be able to submit alternatives.
Mr. Wolf's proposal is laudable in some ways, disturbing in others. The
congressman, who supported all of Mr. Bush's tax cuts, deserves credit for
being explicitly willing to put tax increases on the table. New revenue is
a necessary part of any solution, a reality Mr. Bush and his fellow
tax-cutters have been unwilling to acknowledge. As Mr. Wolf said in
announcing his plan last week, "Given the enormity of the challenge, the
commission needs to be able to look at every component of our fiscal policy
to fairly assess where we stand and how we can best move toward a sound
fiscal future."
Mr. Wolf's big-picture approach also has much to recommend it. These issues
are complex on their own but they are also interrelated, with trade-offs to
be made that can't be addressed if each program is considered individually.
Chipping away problem by problem might be easier -- though even that
approach has proved all but impossible -- but it would avoid an urgently
needed discussion of national priorities.
What gives us pause is the acknowledgment, implicit in Mr. Wolf's
base-closing-commission approach, that the political system is so broken it
must outsource these fundamental policy questions. Perhaps that is true;
certainly, the evidence supports this gloomy assessment. But rewriting the
tax code, restructuring Social Security and reshaping government-paid
health care are not parochial matters like military bases that call for a
special process to overcome elected officials' geographic and political
self-interest. They are the bedrock questions of government and the job of
elected officials, who should look at Mr. Wolf's proposal and feel
embarrassed that it has come to this.
---------------------------------------------------------------------------
4. 88 Republicans in Congress Ask Secretary of HHS, Michael Leavitt, not to
Implement Medicaid Cuts
---------------------------------------------------------------------------
On May 8, 2006, 82 House Republican members sent a letter to Michael
Leavitt, Secretary of the U.S. Department of Health and Human Services
(HHS), asking him not to implement Medicaid cuts of $12.2 billion over 5
years in President Bush's fiscal 2007 budget proposal through the
regulatory process, asking instead that the Administration work with
members of congress to "protect and improve the Medicaid program for our
constituents."
The legislators expressed concern that the cuts are too broad in scope,
including limiting payments to providers, reducing the allowable provider
tax rate from 6 to 3 percent and curbing Medicaid financing mechanisms. The
lawmakers argue that these cuts do not address the root causes of Medicaid
growth and would "seriously disrupt financing of Medicaid programs around
the country", jeopardize providers' ability to serve Medicaid populations,
undermine states' 1115 waiver agreements, and "undermine ongoing Medicaid
innovation and reform efforts."
"The magnitude and scope of such proposals are such that input from
Congress, states, health care providers and patient groups is essential in
order to avoid serious, unintended consequences," the letter states.
The letter is available online at
http://www.ancor.org/issues/medicaid/0506Letter2Leavitt.pdf.
---------------------------------------------------------------------------
5. 19 Republicans in Congress ask Mark McClellan, Administrator, Centers
for Medicare and Medicaid Services (CMS) to issue clarifying regulations to
the Deficit Reduction Act
---------------------------------------------------------------------------
On May 25, 2006, 19 House Democrats sent a letter to CMS Administrator Mark
McClellan asking that the regulatory process be used to ensure careful
implementation of key provisions of the Deficit Reduction Act of 2005,
while also clarifying the intent of Congress that these "new policies
should not harm innocent people who relay on Medicaid for essential health
and long-term care needs.
The letter, coordinated by Rep. Peter King (R-NY), covers the areas of cost
sharing and hardship exceptions. Regarding cost sharing, the letter relates
to provisions in the DRA that could be construed to impose unlimited cost
sharing on low income beneficiaries. The 19 House Members urge Dr.
McClellan to "make clear in your regulations that the previous cost sharing
rules remain in effect for beneficiaries below the poverty level." This
position is consistent with a position circulated by VOR during its 2006
Washington Initiative just last week. We urged Congress to address this
concern with a technical corrections bill; a regulatory fix is just as
welcome and perhaps more easily achieved.
The letter also addresses hardship exceptions, noting, "The DRA also
mandates a process for granting hardship exceptions for people who might be
denied needed help with long-term care costs because of changes to asset
transfer rules," noting that these changes are "not intended to prevent
people from making donations to charities or helping family members in
need." The Lawmakers request that the regulations set minimum standards for
the exceptions process, stipulating the types of asset transfers that
should be presumed to be legitimate and not subject to penalty, including
donations to churches, charities, or family members for such things as
medical expenses.
---------------------------------------------------------------------------
6. States' Changes Reshape Medicaid - New Restrictions Aim to Save Money
---------------------------------------------------------------------------
By Amy Goldstein
The Washington Post
June 12, 2006
After winning greater freedom from federal Medicaid rules, states are
moving aggressively to transform the nation's largest public health
insurance program, adding fees, restricting benefits and creating
incentives for patients to take responsibility for their health.
The changes are just beginning in several states that are being watched
closely by governors nationwide. Those changes are reshaping Medicaid,
which covers 55 million poor and disabled Americans, so that the program
more closely resembles private insurance, rather than a social welfare
system run with a strong, central government hand.
Starting July 1, West Virginia will phase in a redesigned form of Medicaid
that requires patients to sign a "member agreement," promising that they
will keep doctors' appointments, take prescribed medicine and not overuse
hospital emergency rooms. Patients who refuse to sign or to follow the
rules will be eligible for less care.
Kentucky is dividing its Medicaid patients into four categories, depending
on their health and their age, with different benefits for each group. Most
adults will face higher co-payments for medical services and new limits on
prescription drugs. But patients who sign up for a "disease management"
program eventually will be able to earn credits toward extra "get-healthy
benefits," such as eyeglasses or classes to quit smoking.
Florida, meanwhile, will privatize part of its Medicaid system in
September, directing patients in Jacksonville and Broward County to pick
from 19 health plans, each offering different services. In a departure from
how states have reimbursed doctors or health plans, Florida health
officials will rate the health of every Medicaid patient in the two
communities and pay for only as much care as officials predict they should
need.
"We've got a whole new dialogue about how health care should be delivered
and financed," said Diane Rowland, executive director of the Kaiser
Commission on Medicaid and the Uninsured, a nonpartisan policy group.
The emerging shape of Medicaid represents a victory for governors of both
political parties and for fiscal conservatives, who argued for years that
states deserved more control over the program so it would place less strain
on their budgets. Some patients advocates, however, warn that the
vulnerable patients Medicaid was designed to help will be less certain to
get the health care they need.
Since its creation in the 1960s, Medicaid has been a shared responsibility
of the federal government and the states. States shoulder more than 40
percent of the cost, which totals $338 billion this year, and have always
had certain freedom to decide how many benefits to cover. But the federal
government has determined many of the program's basic contours.
Last December, Congress granted states broad flexibility to alter benefits,
charge patients more and expand the role of private insurers as part of a
law that will cut federal Medicaid spending by $43 billion in the next
decade. Even before the law, the Bush administration was sympathetic to
states that wanted greater say over how their programs are designed.
The law, called the Deficit Reduction Act, and the administration's
policies have eliminated a hallmark of the program: Until now, every
Medicaid patient within a state has qualified for the same benefits.
Medicaid's new direction borrows ideas from the overhaul of the welfare
system a decade ago. That transformation also decentralized a major piece
of the social safety net, limited government assistance, expanded the
private sector's role and tried to instill self-reliance in low-income
people who had depended on government help.
The Bush administration is encouraging states to embrace the altered view
of Medicaid. "We are trying to be as supportive as we can," said Mark B.
McClellan, administrator of the federal Centers for Medicare and Medicaid
Services. His agency has been coaching states on the changes they can make
-- and swiftly approving states' revisions. When West Virginia's Medicaid
commissioner, Nancy V. Atkins, sent the federal agency the proposal for the
state's redesigned program on April 26, she was startled that it was
approved one week later.
Other states are not far behind the leading edge. South Carolina's governor
has been pushing for changes that would include health savings accounts and
rewards for being a good patient. Oklahoma's legislature has just passed a
bill that would allow the state to pay health plans a defined amount
depending on a patient's health. And a recent Missouri law calls for the
current Medicaid system there to be abolished in 2008; its replacement is
being designed.
State health officials say such changes make sense, particularly because
Medicaid has expanded in many states in recent years from a program that
covered only the very poor and dispossessed into one that includes a
growing share of children -- and sometimes parents -- in working-class
families.
The most basic force behind the changes, though, is that Medicaid costs
continue to increase more rapidly than state revenues. Ray Scheppach,
executive director of the National Governors Association, said the states'
new strategies are a trade-off, imposing "additional co-pays and small
reductions in benefits" to avoid eventually "pushing hundreds of thousands
of women and children off the rolls." Medicaid directors say they do not
expect large savings in the next few years but hope to curb costs in the
long run.
They are emphasizing preventive care and predict that patients will think
twice about how much care to seek if they have to pay a fraction of the
bill. And by specifying different benefits for different groups of
patients, "we are trying to take advantage of a tool that's really been
available in the private sector," said David Rogers, Medicaid administrator
for Idaho, which -- like Kentucky -- is starting next month to divide
patients into "health-needs categories."
Like Florida, several states are trying to steer Medicaid patients into
private-sector health insurance. Arkansas, for example, has just received
federal permission to use Medicaid money to subsidize small companies with
low-wage workers if they begin to offer employee health benefits.
The focus on private-sector insurance and self-reliance is favored by
conservative groups, such as the Heritage Foundation and the Center for
Health Transformation, which was founded three years ago by former House
speaker Newt Gingrich (R-Ga.). "If you look particularly at the states like
Florida that are emphasizing more individual responsibility," Gingrich
said, "they are moving in exactly the right direction."
On the other hand, Ron Pollack, executive director of Families USA, a
consumer health lobby, said, "Low- income individuals are increasingly
going to be put at far greater risk of not receiving critically important
services that they used to receive."
Joan Phillips, a West Virginia pediatrician, said she worries that, with
the member agreements, children could be denied certain medical services if
"the parent is not motivated or is dysfunctional." And Phillips said
doctors who report to the state that a patient is not following the rules
will face an ethical bind, knowing the patient will lose benefits as a
result.
In Florida, Lori Parham, a state lobbyist for the AARP, worries about
Medicaid patients who are healthy when they join a health plan but later
get cancer, say, or have a heart attack, requiring more expensive treatment
than their plan has been paid to provide. "The question becomes, will the
care be available?" she said.
Alan Levine, secretary of Florida's Agency for Health Care Administration,
said the revised Medicaid will give patients more "emotional buy-in" by
increasing their choices and incentive to take care of themselves, while
eventually saving the state money. "We are doing it for the right reasons,"
Levine said. "I just hope it works."
---------------------------------------------------------------------------
Tamie Hopp
REFERRAL/MEMBERSHIP/CONTRIBUTION FORM
THREE EASY WAYS TO SUPPORT VOR > REFER, CONTRIBUTE OR JOIN
THANK YOU FOR YOUR SUPPORT!
TO JOIN OR CONTRIBUTE: $25 per individual, $150 per family organization, or
$200 per provider/professional organization. Extra donations are welcome!
You may pay by credit card or check.
TO REFER SOMEONE TO VOR: Use the form below, including the additional
sections for referrals.
Mail the completed form (if joining or contributing) with payment to:
Voice of the Retarded
5005 Newport Drive, Suite 108
Rolling Meadows, IL 60008
847-253-6054 fax (for referrals or credit card payments)
vor@compuserve.com (for referrals or credit card payments)
FOR REFERRALS: ____ The contact information provided is for someone I
think would consider membership with VOR.
FOR REFERRALS: _____ You may use my name in any correspondence with this
individual. My name is ________________________.
____________________________________________
Name
_____________________________________________
Address (if paying by credit card, use billing address). All forms must
include complete address including zip code)
_____________________________________________
City St Zip
_____________________________________________
Phone Fax
_____________________________________________
E-Mail
_________________________________________________
Family/Professional Organization Affiliation (if applicable)
VOR now accepts Master Card and Visa. If paying by credit card, please
provide the following information:
Amount to charge to card:
$1000___$500___$250 ___$150 ___$100 ___$50 ___$25 ___ $_____ Other amount
_____ Master Card
_____ Visa
Card Number: ___________________________________
Expiration Date: __________________________________
Cardholder's Signature: ___________________________
|
