Wisconsin Alliance for Women's Health
Received this today, I am so pleased to see so many organizations fighting for Medicaid/Medicare.
As Democrats and Republicans in Congress pursue negotiations on raising the debt ceiling, the future of Medicare and Medicaid remains a top concern. According to The Hill, Republicans appear to have temporarily dropped their calls for replacing Medicare with subsidies to buy private insurance. The GOP’s $750 billion in cuts to Medicaid, however, remain in play as part of a debt-ceiling deal.
Adding to the uncertainty, Senate Budget Committee Chairman Kent Conrad (D-N.D.) is expected to unveil a budget proposal this week, and Vice President Joe Biden will convene a second meeting today of a group of legislators to talk about deficit reduction. President Obama will also get involved in talks later this week, meeting with Senate Democrats on Wednesday and Senate Republicans on Thursday.
Meanwhile, providers and advocates continue to voice their opposition to Medicaid cuts. Attached is a letter to Senate leadership from the Partnership for Medicaid, a nonpartisan, nationwide coalition made up of organizations representing doctors, health care providers, safety net health plans, counties and labor. The letter opposes both a Medicaid block grant and federal spending cap arguing that such changes would likely result in cuts to benefits, decreases in provider rates, limits on eligibility and barriers to access to care. The letter was signed by:
American Academy of Family Physicians
American Academy of Pediatrics
American Congress of Obstetricians and Gynecologists
American Dental Education Association
American Health Care Association
American Public Health Association
Association for Community Affiliated Plans
Association of Clinicians for the Underserved
Medicaid Health Plans of America
National Association of Children's Hospitals
National Association of Community Health Centers
National Association of Counties
National Association of Public Hospitals and Health Systems
National Center for Assisted Living
National Council for Community Behavioral Healthcare
National Health Care for the Homeless Council
National Hispanic Medical Association
Cate HodgettsStaff Attorney
National Health Law Program
National Health Law Program
"Securing health rights for those in need"
1444 I Street NW, Suite 1105
Washington, DC 20005
May 2, 2011
Senate Majority Leader Harry Reid
522 Hart Senate Office Building
Washington, DC 20510
Re: “Gang of Six” Deficit Reduction Efforts and Medicaid Impacts
Dear Majority Leader Reid:
As you tackle the ongoing need to reduce the federal deficit, the Partnership for Medicaid – a nonpartisan,
nationwide coalition of safety-net providers and other key organizations with a role in
delivering services to Medicaid enrollees – urges you to protect the Medicaid program’s long-term
viability and role as a safety net for our nation’s most vulnerable populations. While we recognize
the importance of reducing the deficit, some of the structural changes to the Medicaid program
being discussed could simply shift costs to states and local governments, providers, or beneficiaries
without actually slowing growth in underlying health care costs. The Partnership believes that any
deficit reduction proposal, as a fundamental principle, must not jeopardize access to care for
already vulnerable populations. In fact, deficit reduction packages passed in 1990, 1993, and 1997
all specifically exempted Medicaid from automatic spending caps and the Partnership believes the
same consideration should be included in any moving deficit reduction legislation this Congress.
In particular, the Partnership is very concerned about either a block grant or upper limit spending
cap for the Federal share of Medicaid, in which the Federal government would pay a fixed dollar
amount to the states rather than a fixed percentage, leaving states and local governments
responsible for all remaining health care costs for low-income populations, including poor children,
individuals with disabilities, pregnant women and seniors. Caps on spending have not historically
kept pace with the cost of health care, and would likely result in an arbitrary cut-off of benefits and
services, a precipitous decrease in provider rates, or limit on eligibility. While some argue that a
block grant or cap on spending would mean improved predictability of costs, it is improved
predictability for the Federal government only—in fact it would make costs less
predictable for
states and for recipients, who can least afford such increases.
During economic downturns, periods of increased unemployment, public health emergencies, or
other unexpected events, more people rely on Medicaid. At a time when our economy is still
recovering from the recent downturn, and while unemployment levels are still high in some areas,
Medicaid continues to play an important safety net role. Medicaid’s current financing structure
gives it the flexibility to respond to increased need.
Additionally, we are concerned that changing the fundamental financing and entitlement structure
of Medicaid would further undermine provider rates and access to care. House Budget Committee
Chairman Ryan notes in his Path to Prosperity that Medicaid payments to providers are already so
low that many doctors refuse to take Medicaid patients. However, in reference to the Medicaid
block grant provision included in the House-passed budget, the Congressional Budget Office (CBO)
said H. Con. Res. 34 would “…probably require states to decrease payments to Medicaid providers,
reduce eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more
themselves than would be the case under current law.” While the Partnership is committed to
serving Medicaid patients, we are concerned proposals to institute a block grant or cap federal
spending would leave states with few options other than reducing already low provider payment
rates or eroding our current system of care by cutting benefits or limiting eligibility.
Inappropriate restrictions and reductions in Medicaid eligibility and services will lead to increased
utilization of emergency rooms for non-emergency services and uncoordinated care for high-cost
populations. It is well-documented that utilization of the emergency room in this manner not only
shifts costs to other areas of the health care sector (such as providers and individuals with private
insurance), but that the cost of providing care in the emergency room is actually more expensive
and less effective for patients.
Medicaid plays a critical role in supporting vulnerable populations and new policies should focus on
strengthening linkages among preventive, primary, acute, and long-term care services and supports.
The Partnership is prepared to work with you to develop sound policy for Medicaid that achieves
these goals, such as prioritizing protections for vulnerable populations, improved quality and
reduced health care costs using managed care, care coordination and other models of care
integration, elimination of waste, fraud and abuse, and appropriate accountability and performance
measures. We look forward to working with you and your staffs in the coming weeks as you
develop a plan for tackling our nation’s budget deficit.
Sincerely,
American Academy of Family Physicians
American Academy of Pediatrics
American Congress of Obstetricians and Gynecologists
American Dental Education Association
American Health Care Association
American Public Health Association
Association for Community Affiliated Plans
Association of Clinicians for the Underserved
Medicaid Health Plans of America
National Association of Children's Hospitals
National Association of Community Health Centers
National Association of Counties
National Association of Public Hospitals and Health Systems
National Center for Assisted Living
National Council for Community Behavioral Healthcare
National Health Care for the Homeless Council
National Hispanic Medical Association
cc: Majority Leader Reid, Republican Leader McConnell, Gang of Six, Senator Sessions
Senate Majority Leader Harry Reid
522 Hart Senate Office Building
Washington, DC 20510
Re: “Gang of Six” Deficit Reduction Efforts and Medicaid Impacts
Dear Majority Leader Reid:
As you tackle the ongoing need to reduce the federal deficit, the Partnership for Medicaid – a nonpartisan,
nationwide coalition of safety-net providers and other key organizations with a role in
delivering services to Medicaid enrollees – urges you to protect the Medicaid program’s long-term
viability and role as a safety net for our nation’s most vulnerable populations. While we recognize
the importance of reducing the deficit, some of the structural changes to the Medicaid program
being discussed could simply shift costs to states and local governments, providers, or beneficiaries
without actually slowing growth in underlying health care costs. The Partnership believes that any
deficit reduction proposal, as a fundamental principle, must not jeopardize access to care for
already vulnerable populations. In fact, deficit reduction packages passed in 1990, 1993, and 1997
all specifically exempted Medicaid from automatic spending caps and the Partnership believes the
same consideration should be included in any moving deficit reduction legislation this Congress.
In particular, the Partnership is very concerned about either a block grant or upper limit spending
cap for the Federal share of Medicaid, in which the Federal government would pay a fixed dollar
amount to the states rather than a fixed percentage, leaving states and local governments
responsible for all remaining health care costs for low-income populations, including poor children,
individuals with disabilities, pregnant women and seniors. Caps on spending have not historically
kept pace with the cost of health care, and would likely result in an arbitrary cut-off of benefits and
services, a precipitous decrease in provider rates, or limit on eligibility. While some argue that a
block grant or cap on spending would mean improved predictability of costs, it is improved
predictability for the Federal government only—in fact it would make costs less
predictable for
states and for recipients, who can least afford such increases.
During economic downturns, periods of increased unemployment, public health emergencies, or
other unexpected events, more people rely on Medicaid. At a time when our economy is still
recovering from the recent downturn, and while unemployment levels are still high in some areas,
Medicaid continues to play an important safety net role. Medicaid’s current financing structure
gives it the flexibility to respond to increased need.
Additionally, we are concerned that changing the fundamental financing and entitlement structure
of Medicaid would further undermine provider rates and access to care. House Budget Committee
Chairman Ryan notes in his Path to Prosperity that Medicaid payments to providers are already so
low that many doctors refuse to take Medicaid patients. However, in reference to the Medicaid
block grant provision included in the House-passed budget, the Congressional Budget Office (CBO)
said H. Con. Res. 34 would “…probably require states to decrease payments to Medicaid providers,
reduce eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more
themselves than would be the case under current law.” While the Partnership is committed to
serving Medicaid patients, we are concerned proposals to institute a block grant or cap federal
spending would leave states with few options other than reducing already low provider payment
rates or eroding our current system of care by cutting benefits or limiting eligibility.
Inappropriate restrictions and reductions in Medicaid eligibility and services will lead to increased
utilization of emergency rooms for non-emergency services and uncoordinated care for high-cost
populations. It is well-documented that utilization of the emergency room in this manner not only
shifts costs to other areas of the health care sector (such as providers and individuals with private
insurance), but that the cost of providing care in the emergency room is actually more expensive
and less effective for patients.
Medicaid plays a critical role in supporting vulnerable populations and new policies should focus on
strengthening linkages among preventive, primary, acute, and long-term care services and supports.
The Partnership is prepared to work with you to develop sound policy for Medicaid that achieves
these goals, such as prioritizing protections for vulnerable populations, improved quality and
reduced health care costs using managed care, care coordination and other models of care
integration, elimination of waste, fraud and abuse, and appropriate accountability and performance
measures. We look forward to working with you and your staffs in the coming weeks as you
develop a plan for tackling our nation’s budget deficit.
Sincerely,
American Academy of Family Physicians
American Academy of Pediatrics
American Congress of Obstetricians and Gynecologists
American Dental Education Association
American Health Care Association
American Public Health Association
Association for Community Affiliated Plans
Association of Clinicians for the Underserved
Medicaid Health Plans of America
National Association of Children's Hospitals
National Association of Community Health Centers
National Association of Counties
National Association of Public Hospitals and Health Systems
National Center for Assisted Living
National Council for Community Behavioral Healthcare
National Health Care for the Homeless Council
National Hispanic Medical Association
cc: Majority Leader Reid, Republican Leader McConnell, Gang of Six, Senator Sessions
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