Thursday, May 3, 2012

A New Reason to Not Overturn the Current Health Reform Law


Last year, in a lower court filing on the case, Justice Department lawyers said reversing the Medicare payment changes "would impose staggering administrative burdens" on the government and "could cause major delays and errors" in claims payment.

WASHINGTON (AP) - Medicare's payment system, the unseen but vital network that handles 100 million monthly claims, could freeze up if President Barack Obama's health care law is summarily overturned, the administration has quietly informed the courts.

The administration fails to address how much it will cost to continue developing an overly burdensome re-organization of health reform.  The true cost is the difference between continuing the present implementation of Obama care, or rescinding part of or all of Obama care.

Although Obama's overhaul made significant cuts to providers and improved prescription and preventive benefits, Medicare was overlooked in Supreme Court arguments that focused on the law's controversial requirement that individuals carry health insurance.

Yet havoc for Medicare could have repercussions as both parties avidly court seniors in this election year and as hospitals and doctors increasingly complain the program doesn't pay enough.

The truth is that Medicare already operates in a climate of havoc now.


Each year there are an assortment of systemic changes foisted upon congress, providers, patients,hospitals and in order to continue operating these institutions face considerable costs annually to meet governmental and insurance regulations.

Annually Congress refuses to make a definitive change to the SGR (sustainable growth rate) for provider reimbursement. Beginning over ten years ago the SGR has been delayed…..each year it called for adjustments between 3% and 5%. until today when the accumulated SGR is 30% or more. This,s is not a well known issue among the public sector.  Each year it is not addressed until the final 11th hour and then attached to another bill for last minute approval.

The devil in Medicare’s details are hidden, buried in the Federal Register, attached to another bill (usually not health related)

In papers filed with the Supreme Court, administration lawyers have warned  of "extraordinary disruption" if Medicare is forced to unwind transactions that are based on payment changes required by more than 20 separate sections of the Affordable Care Act.

This predicament can be squarely placed upon members of congress and Nancy Pelosi. Most of congress did not read the bill, and had they it most likely would have faced considerable amendments.

Nancy Pelosi made the pronouncement  “we would know what was in it when it is passed.”

Passage was accomplished  for political expediency. It was immediately obviously because of it’s partisan support and the reaction of the American public.  It was not greeted with enthusiasm, except for a sigh of relief by Democrats.

Opponents say the whole law must go. The administration counters that even if it strikes down the insurance mandate, the court should preserve most of the rest of the legislation. That would leave in place its changes to Medicare as well as a major expansion of Medicaid coverage.

Former program administrators disagree on the potential for major disruptions, while some private industry executives predict an avalanche of litigation unless Congress intervenes.

Tom Scully, who ran Medicare during former President George W. Bush's first term, does not foresee major problems, although he acknowledges it would be a "nightmare" for agency bureaucrats.

"It is highly unlikely in the short term that any health plan or provider would suffer," said former CMS head  Scully. "They're probably likely to get paid more going forward. If you look at the way the law was (financed), it was a combination of higher taxes and lower (Medicare) payments. That's what you would be rolling back."

Another former CMS head  Don Berwick, Obama's first Medicare chief. "I would not be surprised if there are delays and problems with payment flow. Medicare has dealt with sudden changes in payment before, but it is not easy." (they have done it every year in the past) No one in administration or congress complained this loudly then.

It's not just reimbursement levels that would get scrambled, Berwick said. The law's new philosophy of paying hospitals and doctors for quality results, rather than for sheer volume of tests and procedures, has been incorporated in some payment policies.

In truth no one really knows what the  effect would be since the whole process is arcane and byzantine.

The White House declined to comment


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