WASHINGTON–Hospitals have launched a pricey ad blitz. Medicaid recipients held an emotional rally on Capitol Hill. And doctors pitched their message in a letter laced with urgent pleas and dire warnings.
The target of all this activity? The Joint Select Committee on Deficit Reduction, dubbed the “super committee” for its broad powers to reduce the federal debt.
Health care groups have started flooding the super committee with appeals to protect their sliver of federal health care programs. Because the panel’s mandate is to find at least $1.2 trillion in debt-reduction over the next decade, Medicare and Medicaid are prime targets.
Together, those two government insurance programs account for nearly one-quarter of all federal spending. The simple math has put every sector of the health care industry on edge–from nursing homes to physicians to patient advocates.
“Everybody’s out there,” Jeff Kincheloe, Vice President for Government Affairs at the National Association for Home Care and Hospice (NAHC), said of the efforts to influence the super committee’s deliberations. “It’s very, very intense.”
But each health care group seems to have a slightly different message. And some fear the disparate pleas being delivered to the super committee could end up making an already vulnerable line item even easier to target.
“They’re getting a lot of input, and it’s often inconsistent input,” said Ron Pollack, executive director of Families USA, a health care consumer advocacy group. “The providers want to protect their pocketbooks–how much they get paid and how they get paid. There are groups like ours that are trying to protect the most vulnerable people in society from having to pay more out of pocket or losing benefits.”
Pollack said the lobbying by health groups is significantly different from other special interests in Washington trying to influence the 12 lawmakers on the super committee. For example, he said the defense industry is “functioning in a more unified fashion.” Major military contractors have one simple message: Don’t cut defense or it will harm national security.
And health care interests? “Maybe the best way to the health care sector is, it’s one for one and none for all,” Pollack said.
Here’s a sampling:
The home care providers, along with seniors and disability groups, are deeply anxious about a proposal, outlined by President Obama among others, to require a co-pay for home health care services. “We think that’s a movement in the wrong direction,” said Kincheloe.
His group has labeled co-pays a “sick tax,” and is arguing it would cause a spike in hospital visits by patients who could be taken care of at home, for less money and better quality.
Physicians, meanwhile, are lobbying the super committee to repeal a set of scheduled cuts to their Medicare reimbursement payments, known as the SGR. If the panel doesn’t, they warn, that will only hide and exacerbate the true scope of the nation’s deficit situation.
“Continued delay in replacing the SGR has escalated the cost of permanent payment reform, from $48 billion in 2005 to nearly $300 billion today,” the American Medical Association wrote last week in a letter to the super committee members. “We estimate additional short-term interventions will double the cost to approximately $600 billion by 2016.”
Pollack’s group, meanwhile, is particularly concerned about possible cuts to Medicaid, the federal insurance program for the poor and disabled. One proposal, for example, would lower Medicaid reimbursement rates to the states, which advocates fear would cause local officials to trim benefits or eligibility for that program.
Pollack said it might be better if the super committee fails to reach any agreement on deficit reduction–although others in Washington greatly fear that outcome.
The panel has until Nov. 23 to agree on a package of cuts, which would then go the full House and Senate for an up-or-down vote. If the committee fails to act, or Congress rejects their agreement, then automatic cuts would go into effect, slicing $1.2 trillion from the federal budget, split 50/50 between defense and domestic programs.
The triggered cuts–officially known as “sequestration” in Washington parlance–would not impact Social Security or Medicaid. And for Medicare, the health insurance program for the elderly, the automatic cuts would hit providers, not beneficiaries.
“That’s why I would prefer to have the sequestration process move forward rather than have the committee cobble together” some other package of cuts, said Pollack. “From the perspective of the people who count on these programs, there’s no question that there is far greater danger in what the super committee would do than there is through the sequestration.”
To be sure, Kincheloe said that across Washington, advocates are trying to calculate whether they would be better off dealing with the triggered cuts or with a deal crafted by the super committee. The latter, of course, is a complete unknown at this point.
The automatic cuts “would be painful, but the consequences of a co-pay to Medicare beneficiaries and providers would be worse,” Kincheloe said.
Among health care groups, in particular, there’s some wariness of how one sector might fare compared to another.
Kincheloe, for instance, is concerned that the super committee might endorse Medicare cuts but not address the reimbursement rate for doctors, leaving that for later this year. That would force lawmakers to take a second crack at a so-called “doc fix”–along with finding additional savings from Medicare.
“We fear that Congress could come at us twice–first for deficit reduction and then to offset the cost of the physician fix,” he said.
Other groups are similarly pitted against one another. Hospitals, for example, have touted the idea of raising the Medicare enrollment age from 65 to 67 as one way to reduce the deficit. But that runs directly afoul of the wishes of AARP and other seniors’ groups who say that forcing the elderly to wait two more years to be eligible for the program would be a terrible hardship.
Given the competing messages and different pressure points, all directed at the super committee, it’s no wonder that many think they won’t be able to come to any agreement on a package of cuts at all.
“I think it’s far less than 50-50,” Pollack said of the prospects for a $1 trillion-plus debt-reduction agreement. And that might be the best outcome possible-at least from his point of view.