NASW Health Care Reform Roundup – February 23, 2009

Feb 23, 2010

Earlier this week the White House released a summary of its $950 billion plan to reconcile the House and Senate versions of comprehensive health reform legislation. Release of the plan marks a new phase of more direct presidential involvement in the legislative negotiations. The President’s plan largely favors the Senate’s bill and clarifies use of a legislative strategy known as budget reconciliation, which could pass the bill through Congress with 51 votes. Democrats on Capitol Hill reacted in a receptive manner to the proposal, although leaders are expected to flesh out many important details as the plan is worked into legislative language.

On Thursday, February 25, the President will meet with Democratic and Republican congressional leaders at Blair House in an attempt to reach compromises on comprehensive legislation. However, Republicans have not accepted the President’s premise for the meeting, which is to bring forward their own plans to address comprehensively the major coverage and costs problems that plague the U.S. health system. Absent a breakthrough at the talks this week, Democratic leaders are expected to attempt to pass final legislation without Republican votes. The President’s proposal generally follows NASW principles for health reform, and we expect to support the compromise legislation as it moves toward House and Senate consideration.\

The Kaiser Family Foundation created a side-by-side chart comparing the health care proposal unveiled by President Obama on February 22 and the previously passed House and Senate health care bills.  To view the full chart, please go here.

Urgency for State Medicaid Relief Grows

A new report by Families USA, an NASW coalition partner, documents a large number of states facing Medicaid cutbacks unless Congress quickly increases temporary funding for state Medicaid programs. Families USA reports that States are dealing with unprecedented budget shortfalls as a result of declining tax revenues, high levels of unemployment, increasing poverty and declining wages.  They concluded that at least 30 state legislatures are contemplating cutbacks to Medicaid, beginning this July.

In addition to protecting funding for current services to Medicaid recipients, the report shows that increased federal funding will improve state economies while expanding and protecting jobs. The Families USA report is available here: States in Need: Congress Should Extend Temporary Increase in Medicaid Funding.

President Obama’s federal budget proposal released earlier this month called for maintaining current Medicaid services during the economic downturn with an additional $25 billion in federal fiscal relief for state Medicaid programs. NASW has joined with Families USA and other advocacy groups in pushing for the funds in new legislation. The proposal would include a 6.2 percent increase in the amount of money states receive for Medicaid, and those with higher unemployment rates would receive more. Our coalition urges passage at the earliest opportunity as most state legislatures are already well along in the development of their budgets for their new fiscal year.

Essential Medicare Legislation Still Delayed

Partisan gridlock is continuing to stall legislation extending expiring Medicare provisions that establish provider payment rates. Congress had hoped to use the comprehensive health reform bill as a vehicle to address Medicare provider payment extensions, but the cost of the Medicare provisions and confusion on the health reform bill led to their being temporarily set aside for another legislative vehicle. Earlier this month the Senate Finance Committee attempted to again pass the Medicare “extenders package,” but the vehicle, a large jobs bill, was rejected by party leaders before coming to the floor. Currently, leaders know the Medicare package is urgent to pass now, but they have not found an acceptable vehicle for the multi-billion dollar package.

The expiring Medicare provisions include large rate cuts that directly impact payments to clinical social workers billing Medicare independently under Part B. Clinical social workers face two large rate cuts under expiring law. These include the physician payment provision in Medicare law that leads to a 21 percent cut in all Medicare Part B rates due to the Sustainable Growth Rate (SGR) formula that affects all practitioners. For more than a decade, all Medicare Part B payment rates have been set by the SGR formula, which by statute annually expire, cutting payments to providers. Each year Congress has intervened to postpone the SGR cut, but due to the costs of a permanent repeal, Congress has not agreed to a solution to the underlying flaws in the formula. NASW supports a permanent change in the Medicare formula (see our letter HYPERLINK ““here). In late December Congress agreed to postpone the SGR cut for two months, but on March 1, 2010, the SGR cut will again go into effect. That agreement leaves Congress only a few days to enact another extension to correct the SGR formula.

In addition to the SGR reduction, Medicare psychotherapy rates already received a five percent cut on January 1st due to a CMS five-year rate review implemented in 2008. Clinical social workers and psychologists are working together to ensure the psychotherapy rate cut is restored in any bill delaying the larger SGR cut.  An increase for psychotherapy billing codes was included in the House version of health care reform (H.R. 3590), but not the Senate version (S. 3962). Again, with the delay in enacting comprehensive reform, a new legislative vehicle must be found to delay this cut. NASW is working very aggressively with a coalition of health practitioner groups to pressure Congress to attach the psychotherapy rate provision in the larger SGR legislation.

County of Residence Impacts Personal Health

A new project undertaken by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute ranks county health status in every state in the nation. The project found that the health of a community depends on many different factors – ranging from individual health behaviors, education and jobs, to quality of health care, to the environment. The project has recently released a collection of 50 state reports designed to help community leaders demonstrate that where people live influences how healthy they are and how long they live. For information on health by county in any state, see HYPERLINK ““here.