This Week in Health Reform

No Easy Homecoming

Republicans have spent much of their two-week congressional recess fending off questions from voters about their new budget proposal, which includes a revamping of the Medicare system.

Wisconsin Republican Representative Paul Ryan is the architect of that plan, a cornerstone of the GOP budget that the House passed on April 15. Beginning in 2022, the proposal would ask new retirees to select a health insurance plan from among a list approved by the government, which would provide a subsidy to the provider. But guaranteed benefits would be eliminated.

While many in the crowd were supportive, the meetings did have tense moments from some who were in attendance — as Politico’s Jennifer Haberkorn reported Thursday from the last of the 19 scheduled public events.

The crowd, packed into a high school auditorium in this Milwaukee suburb, responded with skeptical boos when he said his proposed changes to Medicare would provide seniors with benefits similar to those of a member of Congress and wouldn’t affect those over age 55.

“What about my son!” a woman shouted. “Oh, come on!” shouted another. Ryan appealed for calm.

“Let me just say, we’re Wisconsinites, we’re civil with one another,” he said. “Come on. We’re bigger than that.”

The day before, Ryan had to duck out a back entrance on advice of police as protesters surrounded his car.

Rep. Ryan was not the only one to get static from constituents during the break. Rep. Chris Gibson, R-N.Y., Reps. Daniel Webster and Allen West. R-Fla., and Rep. Lou Barletta, R-Pa., also faced tough crowds at home over their budget proposals.

But Republicans — and several news outlets — question whether the rowdy town halls were orchestrated Washington politics, far outside the beltway.

Majority Leader Harry Reid, D-Nev., said Wednesday he’ll hold a vote on the GOP budget when the full Congress returns from recess. “We’ll see how much the Republicans like it here in the Senate,” said Reid during a call with reporters Wednesday.

But What Does the Public Really Think?

The polls on proposed changes to Medicare are out — but why do they vary so much?

Last week’s New York Times/CBS poll found 57 percent of respondents agreeing that it would be “necessary” to make changes to Medicare to reduce the budget deficit, compared to 34 percent who thought those changes unnecessary.

A Washington Post/ABC poll, however, found a whopping 78 percent of respondents somewhat or strongly opposed “cutting spending on Medicare… in order to reduce the national debt.”

NPR’s Julie Rovner explains these different findings — it all depends on how you ask the question.

What’s even more interesting, however, according to a new study published … by the polling team at the Kaiser Family Foundation, is just how malleable public opinion on the subject of Medicare is, depending on how much people are told about the various proposals on the table.

Kaiser’s own monthly tracking poll for April shows just how easily the tide can turn on as sensitive a subject as changing Medicare.

How Much Would De-funding the Health Exchange Grants Save?

And what if some of the Republican efforts to repeal the new healthcare overhaul went through? Sam Baker of The Hill writes this week:

Congress could save roughly $14 billion over the next decade by repealing grants to help states set up the health insurance exchanges established by health care reform, according to the Congressional Budget Office.

CBO also said eliminating the planning grants would lead fewer people to enroll in the exchanges.

The House Energy and Commerce Committee passed a bill earlier this month to repeal the planning grants. CBO released its score of that bill Wednesday evening.

But if states don’t get planning grants, CBO said, they likely won’t get their exchanges up and running as quickly, and some would probably opt to let HHS take over — leading to a decline in enrollment, and thus the amount of subsidies the government would have to pay.

Vermont: One Step Closer to Universal Coverage

Right now, many states are battling with crippling budget deficits and cutting back on health care programs. But not Vermont. This week, the Vermont Senate passed a bill designed to put the state on a path toward a publicly financed, single-payer health care system.

The measure, which preserves a role for private insurers alongside a single public plan, passed easily last month in the state House.

But, as Vermont Public Radio reported, “the bill does not actually implement such a system. A five-member Health Care Board would be established to oversee most aspects of the system.”

A conference committee will now work out the differences between the two versions. One of the major differences is the path to implementation. The Senate version sets up a series of thresholds that must be met before the system can be set up. The legislation will then go back to each chamber for a final vote, which could happen as early as next week.

Total health care costs in Vermont are rising by about $350 million a year.

Peter Shumlin, Vermont’s new Democratic governor, campaigned on a promise to deliver a single-payer, health care-for-all system and said he looks forward to signing it.

But, the National Journal reported, that’s not the last hurdle for the bill.

Shumlin will have to obtain approval from the Obama administration before he could begin to implement the single-payer system, which would begin in 2013. President Obama offered waivers to states to implement their own health care systems if the state’s plan covers as many people as the federal overhaul at the same level of coverage, and if it doesn’t add to the federal deficit.

And support for the bill in Vermont’s statehouse was far from universal, with the vote largely along party lines. The Burlington Free Press reported why Republicans opposed the bill:

Sen. Vincent Illuzzi, R-Essex/Orleans, who has served in the Senate longer than McCormack, judged the bill to be far from historic in scope. He opposed its passage.

Much of the bill puts in place a new insurance marketplace mandated by the federal Affordable Care Act, Illuzzi said: “We are simply implementing what we were asked to do by Congress.

The rest of the bill he characterized as a planning document: “This is a wholesale delegation of authority to plan Vermont’s health-care future to the governor and his administration.”

Other critics worry the legislation could drive physicians out of state, limit patient choice and raise taxes.

Health Care Reform Appeals: On the Slow Track

The Supreme Court on Monday refused to speed up consideration of legal challenges to the new federal health law.

On Monday, the Court turned back the Virginia’s unusual request — and offered no reasoning (and no noted dissenting votes) in its one-line order.

Virginia’s Attorney General, Ken Cuccinelli, wanted to speed the state’s challenge. But, in a statement after the ruling, he said “The Supreme Court rarely expedites cases…Expediting our case would have been the exception and so, although disappointing, this is not surprising.”

He argued that it would have saved states and businesses money they’d have to spend to implement a law that could be struck down.

At issue is the provision in the law that requires nearly every American to have health insurance starting in 2014, or pay a tax penalty.

There are similar lawsuits working their way through a half dozen appellate circuits right now.

The rulings so far have been mixed. Two judges, one who heard Cuccinelli’s case in Virginia and another who heard a multi-state case in Florida, have ruled the mandate is unconstitutional.