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Posts Tagged ‘CMS’
January 15th, 2019 at 11:31 am
Drug Price Controls Would Kill Innovation
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We at CFIF have been emphasizing the threat posed by new drug price controls inexplicably contemplated by the Department of Health and Human Services (HHS).  In December, CFIF filed formal Comment opposing that ill-advised proposal, and hopefully wiser minds will prevail before the damage is done.  In similar vein, The Wall Street Journal ran a welcome commentary entitled “The Drug Price-Control Threat” on January 8 of this year, and a followup letter from reader Bruce Zessar of Highland Park, Illinois in today’s edition offers a personal, real-world illustration of what could be lost:

Insulin isn’t the same now as when it was discovered a century ago.  My wife is a Type I diabetic, diagnosed when she was 14 in 1980.  She has been a beneficiary of the tremendous advances in insulin therapy during the last four decades, including Lantus and Humalog.  When we got married in 1990, she had to live on a rigid schedule, eating lunch at, say, noon, and then dinner by 6:30-7:00 every day.  That’s becaue of the way prior insulin therapies worked in managing blood sugar.  With the invention of Lantus and Humalog, she can now live a normal life like everyone else.

Insulin is a shining example of why drugs deserve the utmost patent protection to encourage continual innovation.”

Price controls have never worked in any nation that has tried them, or with any commodity.   Few, if any, products are as important to our lives as America’s world-leading pharmaceutical sector, and we mustn’t let the price control scheme contemplated by the HHS kill the goose that continues to lay golden eggs.

May 18th, 2015 at 6:13 pm
CMS Hush-Hush on New ‘Epic’ Medicaid Rules

The Centers for Medicare and Medicaid Services won’t say what’s coming before it announces new rules for long-term managed care, the first in 13 years.

“The number of people enrolled roughly quadrupled, from 105,000 in 2004 to 389,000 in 2012,” reports National Journal. “And overall Medicaid spending on long-term care is projected to balloon from $60 billion annually to more than $100 billion in 2023, the Congressional Budget Office has estimated, as the baby boomers get older and require more care.”

Health care industry leaders are anxiously awaiting the new regulations without any indication of what’s coming. CMS has been working on the updated regulatory scheme for more than a year, and so far is keeping the people most effected in the dark.

“It’s a lot like the recent Mayweather-Pacquiao fight,” a representative of managed care plans is quoted as saying. “There’s lots and lots of hype around it, and it’s either going to be epic or it’s going to kind of fizzle.”

With President Barack Obama’s penchant for going big, it will be shocking if his administration opts for fizzle instead of epic. That nameless bureaucrats have this much control over major policy decisions says a lot about the real do-nothing tendencies of Congress. Rather than debate and deliberate over such a consequential matter, Members of Congress have outsourced their lawmaking function to an executive agency.

That’s not leadership. It’s a dereliction of duty.

April 29th, 2015 at 5:58 pm
IG Warning: States May be Illegally Using ObamaCare Grants

At least 37 states have received a total of $4.8 billion to implement ObamaCare, but under the terms of the “establishment grants” those monies cannot be used to pay for overhead costs like rent, software maintenance, staffing and utilities.

That hasn’t stopped some states from trying, apparently.

“We have concerns that, without more detailed guidance from [the Centers for Medicare and Medicaid], [State-based ObamaCare exchanges] might have used, and might continue to use, establishment grant funds for operating expenses after January 1, 2015, contrary to law,” writes the Inspector General at the Health and Human Services Department.

“In media reports and during our review of [states’] budget information, we have observed that some [states] face uncertain operating revenues in 2015 and future years. Because operating revenues are uncertain, there is a risk that [states] might use establishment grant funds to cover operational expenses,” warns the IG’s letter.

The IG points to evidence that the Rhode Island exchange does not have a dedicated funding source, and the Washington exchange is short $125 million unless the state legislature steps in.

In other words, ObamaCare gave seed money to start expensive new state agencies that are now supposed to be self-sustaining. At least two are not, and the tone of the IG’s letter implies that many more are suspect.

If an enterprising conservative committee chairman wants to protect taxpayers while exposing one of the failures of ObamaCare, following up on the IG’s warning letter with a detailed investigation would be a good strategy.

H/T: The Hill

April 23rd, 2015 at 3:19 pm
Obama Admin Also Pressuring Kansas, Tennessee to Expand Medicaid or Lose Funds

First Florida, then Texas, and now Kansas and Tennessee have been told by the Obama administration that unless they expand Medicaid under the rules laid out in ObamaCare the federal government will withhold payments from local hospitals.

Florida’s Republican Governor Rick Scott is so angry at the move he’s promised to sue the Obama administration for violating a 2012 U.S. Supreme Court ruling prohibiting the feds from conditioning Medicaid funding on ObamaCare expansion.

Yet this is precisely what the Centers for Medicare and Medicaid Services (CMS) is doing. According to Kaiser Health News, CMS “confirmed Tuesday that it gave officials in [Kansas and Tennessee] the same message that had been delivered to Texas and Florida about the risk to funding for so-called ‘uncompensated care pools’ – Medicaid money that helps pay the cost of care for the uninsured.”

“Medicaid expansion would reduce uncompensated care in the state, and therefore have an impact on the [Low-Income Pool], which is why the state’s expansion status is an important consideration in our approach regarding extending the LIP beyond June,” a CMS official warned.

The reason states have resisted expanding Medicaid under ObamaCare is that it transforms a program currently helping discrete populations – e.g. pregnant women, the disabled, elderly, blind, and children from needy families – into a universal, taxpayer-funded health insurance program for every person earning less than 133 percent of the federal poverty level. That change translates into large amounts of new spending that will eventually lead to increased state taxes.

By making a state’s refusal to expand Medicaid a factor in deciding whether Medicaid dollars will continue to flow, the Obama administration is directly flouting a prohibition handed down by a 7-2 Supreme Court majority (liberal Justices Kagan and Breyer sided with their five more conservative colleagues). If the Supreme Court wants to ensure that its rulings will be taken seriously, it should fast-track Florida’s lawsuit and let the Obama administration know it must follow the law.

January 18th, 2015 at 10:00 pm
Key ObamaCare Implementer Resigning

Marilyn Tavenner, the chief administrator of the Centers for Medicare and Medicaid Services (CMS), announced in an email last Friday to staff that she is stepping down at the end of February.

The move comes as something of a surprise, but the timing is similar to that of Tavenner’s former boss, Health and Human Services Secretary Kathleen Sebelius. Last year, Sebelius said she was leaving her post after ObamaCare’s initial enrollment period ended. Tavenner’s resignation is effective when the controversial health law’s second enrollment period concludes.

Tavenner’s time in office was marred by a glitch-ridden rollout of Healthcare.gov, the federal ObamaCare website that earned the ire of millions of Americans. She also came under fire for overstating ObamaCare’s enrollment figures by inaccurately including 400,000 dental plans that have never been counted toward health insurance numbers.

With Republicans in control of the Senate that will confirm Tavenner’s replacement, it will be interesting to see who President Barack Obama taps to fill her shoes.

October 6th, 2014 at 6:49 pm
Expert: ObamaCare Bailout of Insurance Industry Similar to Bush Era Prescription Drug Program

The Obama administration has been catching some flak over its intent to redirect taxpayer dollars toward a controversial “risk corridor” program designed to bailout ObamaCare-friendly health insurance companies that lose too much money.

The primary line of attack stems from the absence of any specific congressional appropriations to fund the program. Congressional Republicans and the Government Accountability Office say this precludes any end-run maneuvers to pay for it anyway, while the Obama administration is ignoring opposition.

But in the drive to add this abuse of executive discretion to President Barack Obama’s long list of power grabs, a bit of history is sure to make Republican critics think twice before pushing much farther.

“But Loren Adler, research director for the Committee for a Responsible Federal Budget, points out that a similar risk-protection program in the Medicare prescription drug program does not receive an explicit annual appropriation, yet has not been challenged,” reports an entry on the Modern Health Care blog. “He thinks that makes it highly unlikely that HHS will be deterred from making the payments to insurers under the risk corridors program.”

Indeed, any federal judge reviewing a future legal challenge to HHS’ pending move would very likely analogize the two programs and conclude that if Congress has not objected to the practice in one instance, and the two cases are similar, it probably intended to defer on both. In such a scenario, the end result is a judge (rightly) telling Congress to speak more clearly and fix the law.

The upshot of all this is that it makes everyone painfully aware of how important it is for Congress to pass clear laws. Republicans aren’t responsible for ObamaCare’s poor draftsmanship, but if they ever get enough power to make changes, they should take care to make them unambiguous to interpret.

October 3rd, 2014 at 11:24 am
ObamaCare Nearing a Fannie and Freddie-Style Bailout of Insurance Companies?

Could ObamaCare’s “risk corridor” program become the health insurance industry’s equivalent of Fannie Mae and Freddie Mac – the federally funded entities that spent $180 billion bailing out banks who issued subprime mortgages?

Stephen Moore, the chief economist at the Heritage Foundation, thinks so.

“But insurance experts warn that [the risk corridor] program creates the same moral hazard problem for health insurance that we saw in the mortgage market with Fannie Mae and Freddie Mac,” Moore writes at Investor’s Business Daily. “The guarantee on bad mortgages encouraged bad mortgages. The guarantee against losses on ObamaCare enrollees encourages insurers to toss sound underwriting standards out the window. This didn’t turn out so well with Fannie and Freddie, which received a taxpayer-funded bailout of more than $180 billion after issuing subprime mortgages that should never have been written.”

Moore goes on to say that surveys of health insurance companies selling plans on ObamaCare exchanges say that the vast majority expect to receive a payment from the federal government to cover their losses. Estimates for the first year near $1 billion. And, since there is no cap to how much the feds will reimburse, there is no limit to how much money a company can lose and still expect a check from Uncle Sam.

Despite all this, the Obama administration is chugging ahead with plans to make payments under the risk corridor program without explicit congressional appropriations. Republicans are contesting President Barack Obama’s authority to do this – with an assist from a recent GAO legal opinion – but they should really train their fire on eliminating the risk corridor program as is. As with IRS tax credits, ObamaCare can’t survive without a convoluted shell game that hides the true cost of health care.

We’ll never get health care policy right until we can talk honestly about how it’s funded. Now would be a good time for the GOP to being that process.

October 1st, 2014 at 6:29 pm
GAO Says CMS Lacks Authority to Bail Out ObamaCare Insurers

It’s been a rough couple of weeks for power-hungry bureaucrats.

Recently, the General Accountability Office (GAO) issued a report faulting the Centers for Medicare and Medicaid Services (CMS) for being unable to produce itemized spending documents, and thus not complying with federal audit guidelines.

This week, the non-partisan government watchdog agency issued a legal opinion saying CMS does not have the authority to bail out ObamaCare-aligned insurance companies, unless Congress agrees.

GAO’s non-binding but influential legal opinion was generated by a request from congressional Republicans concerned about a CMS announcement that it would use money appropriated for other activities to fund ObamaCare’s “risk corridor” program.

Risk corridors refer to a scheme within ObamaCare to compensate insurance companies who lose more than a specified amount of money covering high-cost patients. Initially, funds are redistributed from highly profitable companies. But if the losses exceed a certain threshold, federal taxpayers step in via CMS, the primary agency implementing ObamaCare.

With all of ObamaCare’s pricey mandates – most importantly “guaranteed issue,” which requires insurers to enroll customers with preexisting conditions – there is concern that significant losses among participating companies could put taxpayers on the hook to bailout several firms in the health insurance industry.

It’s worth noting that GAO released its legal opinion on the same day Federal District Judge Ronald A. White struck down a similar bureaucratic power grab by the Internal Revenue Service. While the timing is unconnected, the central issue is not. In both cases agencies within the Obama administration are attempting an end run around the plain meaning of a statute in order to make the president’s legacy program appear to work better than it is.

The rule of law is more important than avoiding bad press for a poorly written bill. Bravo to the GAO and Judge White for having the courage to hold the executive branch accountable.

September 23rd, 2014 at 5:24 pm
New ObamaCare Glitch Could Cost Doctors Millions

Doctors who spent heavily trying to comply with ObamaCare’s electronic health records mandate could still be hit with costly penalties.

ObamaCare gives doctors until October 1, 2014, to switch from paper-based to electronic health records. Failure to comply results in losing 1 percent of federal reimbursements for treating Medicare patients.

Here’s the rub.

“[P]hysicians who went electronic for the first time this year are discovering that [the Centers for Medicare and Medicaid Services, or CMS] won’t be ready to officially register the evidence of their work until mid-October. That means they will miss the Oct. 1 deadline, and CMS will withhold 1 percent of their 2015 Medicare payments,” reports Politico.

That means that a doctors’ group like Morganton Eye Physicians in North Carolina spent $1.3 million to buy and implement new software – and added $250,000 to its annual operating budget – only to be threatened with a $65,000 penalty because the federal government can’t meet its own compliance deadline.

One would think CMS has a moral obligation to waive compliance until the agency is able to do its job, but so far it’s requiring doctors to submit to a cumbersome hardship process. How does a business politely explain that the hardship exists completely because of government ineptitude?

Welcome to ObamaCare’s bureaucratic hell. More episodes to follow.

August 29th, 2014 at 6:09 pm
Pennsylvania Governor Says Yes to ObamaCare Medicaid Expansion

After years of rebuffing calls to participate in ObamaCare’s Medicaid expansion, Pennsylvania Republican Governor Tom Corbett is changing his mind.

Sort of.

While the announcement comes as a bit of a surprise, it doesn’t appear to be a total loss for fiscal conservatives. (Others may disagree, of course.)

According to the terms of the agreement between Gov. Corbett’s office and the Centers for Medicare and Medicaid, Pennsylvania won’t simply be expanding its Medicaid program. Instead, it will use the extra dollars made available under ObamaCare to pay for (i.e. subsidize) private health insurance plans for newly eligible state Medicaid beneficiaries.

The agreement stipulates that Corbett’s alternative is being allowed as a five-year “demonstration project,” meaning that its future is not assured. Much will depend on how the project’s measurements are defined, if the reforms Corbett supports are to survive.

For now, Pennsylvania joins the ranks of Indiana, Arkansas and Iowa as states that are attempting to use ObamaCare’s Medicaid expansion to decrease their uninsured population – without, of course, breaking the bank.

It’s hard to see how that will happen, but we now have at least four states offering themselves as very costly social science experiments. It should be interesting to see what the results will show.