In this week’s summary: Republican members of Congress are questioning fundraising efforts by Secretary Kathleen Sebelius; we track some big developments in Medicare & Medicaid; NPR has the details on a major advance in the manufacture of stem cells; and MUCH MORE!
Affordable Care Act
The New York Times reports that U.S. Department of Health and Human Services Secretary Kathleen Sebelius has solicited donations from the Robert Wood Johnson Foundation and H&R Block, as part of a multimillion-dollar campaign to ensure the success of the Affordable Care Act. The fundraising push comes after Congress repeatedly rejected the Obama administration’s requests for additional funds to set up the ACA, leaving HHS to implement the president’s signature legislative accomplishment on what officials have described as a shoestring budget The Department of Health and Human Services announced these efforts on Sunday which has sparked questions from Senate Republican regarding the legality of Sebelius’s outreach. The foundation is expected to contribute as much as $10 million, while H&R Block is expected to make a smaller donation of about $500,000, the officials said (Pear, 5/12).
The Affordable Care Act (ACA) aimed to end an increase in doctor-owned hospitals, a profitable niche known for its luxury facilities. The Wall Street Journal highlights efforts by a number of these hospitals to work around the ACA’s growth caps. The ACA blocked building any new physician-owned hospitals and prevented existing ones from adding beds or operating rooms in order to qualify for Medicare payments. The intent of the restrictions was to clamp down on a sector that some policy experts contend is prone to perform unnecessary procedures at high prices, driving up overall health spending (Mundy, 5/13).
Medicare & Medicaid
Hospital administrators around the country were relieved when the Centers for Medicare & Medicaid Services within the Department of Health and Human Services released its proposed rule on disproportionate share hospital (DSH) payments. DSH payments generally go to hospitals that treat large numbers of poor patients who are covered by Medicaid, or who are uninsured. The rule clarified that the federal government doesn’t plan to penalize states that have yet to expand Medicaid coverage under the Affordable Care Act (ACA). The rule provides that for the next two years, the DSH dollars be reduced based partly on a state’s percent of uninsured residents (states with the lowest percent of uninsured receive larger reductions). CMS also seeks in the proposal to protect state DSH funding that is used to increase coverage under Medicaid demonstration waivers. The proposed methodology encourages states to target Medicaid DSH payments to high Medicaid volume hospitals and hospitals with high levels of uncompensated care. CMS said it will revisit its DSH funding cuts formula after 2015.
The Washington Post reports that the Centers for Medicaid and Medicare Services (CMS) finally has a new chief for the first time in six and half years. CMS’s acting chief, Marilyn Tavenner, won Senate confirmation yesterday. Tavenner, a former state health official in Virginia, was endorsed by Representative Eric Cantor of Virginia, the House Republican leader. She will oversee CMS, which as part of the Health and Human Services Department, has a budget of about $850 billion. Her primary challenge for the upcoming year will be to ensure the smooth rollout of the Affordable Care Act ( 5/15).
A 2013 report by Genworth Financial, an insurance provider based in Richmond, Va., shows that the cost of providing long-term care continues to rise across the country. The report estimates the national median daily cost of a private room in a nursing home at $230 a day, an increase of 3.6 percent over 2012 — some $6,900 per month. Sharing that room is only $27 less a day, according to the report. With 10,000 baby boomers retiring every day for the next 19 years, the issue of how to pay for care is more pressing than ever.
The New York Times reports, that at least through the end of May, the Plan B One-Step morning-after contraceptive will not be sold over the counter for all ages. A federal appeals court on Monday temporarily granted the Obama administration’s request for a stay of an order by Judge Edward R. Korman of Federal District Court that the pill be available without a prescription for everyone. The Justice Department has appealed that order and the appeals court said it would keep the order from being implemented until it hears from both sides. In the interim, the pill is available without a prescription for women and girls ages 15 and older.
NPR reports that for first time, scientists have created human embryos that are genetic copies of living people and used them to make stem cells. If replicated in other labs, the methods detailed Wednesday in the journal Cell would allow researchers to fashion human embryonic stem cells that are custom-made for patients with Alzheimer’s disease, diabetes and other health problems (Rovner, 5/15).