Editorial June 19, 2015

TheWeekinCongress.com

Editorial

It’s About These Bill Titles

Four bills this week are related to Medicare. Medicare Advantage in particular. The popular program that offers Medicare coverage through a private company began with the idea that the private sector can do a better and less expensive job of providing Medicare services than the Federal Government.

While many we talk to are satisfied with their Medicare Advantage coverage it is not less expensive than regular Medicare. Because of that the Affordable Care Act (ACA) and many spending conscious Republicans wanted to repeal the program. ACA transferred funds out of the program for use in other areas of coverage. Republicans just didn’t like the price tag: Medicare Advantage cost around $250 per beneficiary more than the cost of standard Medicare per person and there are over 15 million on the Advantage plan.

This week’s bills sound as though they are doing wonderful things for those on the Advantage plan. Maybe or maybe not. The bill titles are inspiring; ‘H.R. 2505 Medicare Advantage Coverage Transparency Act’, ‘H.R. 2582 Seniors’ Health Care Plan Protection Act’, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act’, and ‘H.R. 1190 Protecting Seniors’ Access to Medicare Act’.

While HR 2505 sounds like all that is Medicare Advantage will be made transparent to us the bill only requires a report to Congress on the plan’s details.

HR 2582 would seek to protect your healthcare plan. Whatever that may mean to you what it really does is delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings. Medicare Advantage providers are rated by a star system. The bill aims to ensure that such rating system properly accounts for the socioeconomic status of enrollees in such plans and the extent to which such plans serve such individuals. The question is what will Congress do with the information; increase or decrease benefits?

We look at HR 1190 the title of which promises to protect seniors’ access to Medicare. The bill goes on about Congress’s concerns over the Independent Payment Advisory Board (IPAB) created in the Affordable Care Act whose primary responsibility, according to the bill, will be to cut Medicare spending which could result in restricting access to health care services and/or de facto rationing of care. The official stated purpose of the IPAB is to “…recommend policies to Congress to help Medicare provide better care at lower costs.  This could include ideas on coordinating care, getting rid of waste in the system, incentivizing best practices, and prioritizing primary care; and IPAB is specifically prohibited by law from recommending any policies that ration care, raise taxes, increase premiums or cost-sharing, restrict benefits or modify who is eligible for Medicare.”  and “Congress then has the power to accept or reject these recommendations. If Congress rejects the recommendations, and Medicare spending exceeds specific targets, Congress must either enact policies that achieve equivalent savings or let the Secretary of Health and Human Services follow IPAB’s recommendations.”There is some irony in the bill; Republicans have been hell bent on repealing the IPAB since the law was created in 2010  concluding that the IFAB would cut Medicare spending and thereby reduce spending on the program. The irony is that the bill proposes that the IPAB will cut benefits but the bill then requires “… proposals to reduce the per capita rate of growth in spending under title XVIII (Medicare) of the Social Security Act.” How that would be done and if it will also reduce services to beneficiaries the bill remains silent. So what this bill really does is remove the board whose job is to propose reductions in the cost of Medicare but not reduce benefits and replace it with the the the requirement to reduce ‘per capita’ spending for Medicare benefits.

Finally we look at HR 2570 the title of which promises better care through a ‘Value-based insurance design’. Congress finds that co-pays and similar expenses keep people away from seeking health care. To overcome that problem the bill would “…establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the co-payments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures.” What remains to be seen is who pays the copay the beneficiary is relieved of? We are hard-pressed to imagine that the insurers will absorb the copay, take the loss. Taxpayers?

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WASHINGTON, DC – House Democratic Whip Steny H. Hoyer released the following statement today after the Congressional Budget Office released its Long-Term Budget Outlook:

“The Long-Term Budget Outlook released today by the nonpartisan Congressional Budget Office is a chilling and powerful reminder of the consequences of continued partisanship.  Debt as a share of our GDP, which the CBO projects will rise sharply over the long run, left unchecked, will severely limit our ability to prioritize investments in economic competitiveness and expand on efforts to combat poverty and promote opportunity.

“Not only will demographic trends and growing interest payments cause these challenges to become more difficult the longer Congress waits to act, but House Republicans are pursuing an agenda that will add more to our debt burden.  House Republicans have already passed $586.3 billion in unpaid-for tax cuts since January, and have scheduled two bills this week that would add another $24 billion to deficits and bend the health care cost curve back in the wrong direction.

“We can’t afford to waste more time on efforts that make our problems worse.  Instead, I continue to urge my colleagues to work toward a long-term deficit reduction package that is balanced and that enables us to invest in America’s economy and in its people, provides certainty, and encourages private sector job growth.” ##

 

Quotes on the Issues

HR 160 Protect Medical Innovation Act

“Because most sectors of the health industry were correctly expected to benefit from additional revenue when millions of previously uninsured Americans gained coverage under the ACA, the ACA included a series of provisions that asked those industries that are benefitting to contribute a portion of their additional revenue to help pay for the newly insured.  These provisions helped to ensure that the ACA reduces the deficit, as confirmed time and again by the Congressional Budget Office.  In the case of the medical devices, this contribution comes in the form of a 2.3% excise tax on revenues from all devices sold in the United States.

The JCT estimates that this permanent tax cut will add $24.4 billion to the deficit over 10 years, and Republicans have chosen to bring the bill to the Floor without providing an offset.

Office of House Minority Whip.

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H.R. 2596 – Intelligence Authorization Act for Fiscal Year 2016

” Overall funding for FY 2016 is authorized 1% below the President’s request but 7% above FY 2015.

The bill makes cuts to less productive programs while increasing funding for certain critically important programs. It sustains capabilities to fight terrorism and counter the proliferation of weapons of mass destruction.  However, the bill includes restrictions on the transfer of Gitmo detainees, including transfer to the United States or to a “combat zone,” which is defined broadly by an IRS statute.

Also similar to the NDAA, the bill inappropriately misuses the Overseas Contingency Operations (OCO) designation, authorizing approximately 43% more OCO funds than requested by the President – a dangerous gimmick intended to go around the sequester level defense spending cap from the Budget Control Act, while leaving the non-defense sequester level cap in place. This gambit will destabilize long-term national security planning, and allow domestic priorities to wither on the vine.  By removing pressure to replace the sequester level defense caps, it makes a new budget agreement less likely, with drastic negative consequences for our nation’s schools, roads and bridges, law enforcement, scientific research, and other domestic priorities critical to all hardworking Americans. If Republicans want to lift spending above the Budget Control Act’s caps, then they should work with Democrats to replace the dangerous and irrational sequester for both defense and non-defense spending with a balanced solution. Lastly, the White House has issued a SAP stating that the President’s senior advisers would recommend that he veto the bill.”

House Minority Whip Offcie

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Foreign Affairs

 Military Strategy in the Middle East

Comments by House Armed Services Committee Chair Mac Thornberry on a meeting with Secretary of Defense Ash Carter on military strategies in the Middle East

“We should acknowledge at the outset that this region is not subject to easy or simple solutions and has bedeviled statesmen of many countries for generations.

Yet, there is a sense that we are at a particularly perilous time and that U.S. policy and strategy are inadequate.

Dr. Henry Kissinger testified earlier this year before our counterparts in the Senate:

‘In the Middle East, multiple upheavals are unfolding
simultaneously. There is a struggle for power within states; a
contest between states; a conflict between ethnic and sectarian
groups; and an assault on the international state system.’

President Obama admitted recently that there is not a complete strategy for dealing with ISIS, but others argue that maybe there is actually a strategy at work here – one of ‘retrenchment and accommodation,’ so that the U.S. plays a lesser role in the Mid East and elsewhere.

I think virtually everyone can agree that 450 more U.S. personnel in Iraq will not turn the tide against ISIS.”

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White House Sends 450 Advisers as Part of ISIS StrategyNew York Times

“The United States forces will use Al Taqqadum, an Iraqi base near the town of Habbaniya in eastern Anbar Province, as their training hub, the White House said. Mr. Obama opted to send them at the request of Prime Minister Haider al-Abadi of Iraq”.

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Hezbollah repels ISIS attack on Lebanon-Syria border – al Aribiya

“Hezbollah has been on the offensive in Syria’s Qalamoun mountains for weeks and has captured territory from al-Qaeda’s branch in Syria, the Nusra Front.”

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Pentagon breaks down price tag of war against ISIS – CBS News

The U.S. has spent more than $2.7 billion on the war against Islamic State of Iraq and Syria (ISIS) militants since bombings began last August, and the average daily cost is now more than $9 million, the Pentagon said Thursday.

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