Federal Budget Fight Throws Another Wrench into HME Works

WASHINGTON—A radical Republican plan that would slice $6
trillion off federal spending over the next decade got a thumbs up
on Friday—but only by House Republicans. Every Democrat voted
“no.”

By a vote of 235-193, the Republican-run House managed to push the
$3.5 trillion, 2012 blueprint for government spending from Rep.
Paul Ryan, R-Wis., onto the Senate floor, though by some accounts
there it is DOA.

The Democrat-run Senate is expected instead to go along with
President Obama’s 2012 budget and companion cost-cutting
measures, which, announced last week, would generate $340 billion
in savings by 2021 and at least $1 trillion in the following
decade, in addition to savings under the Patient Protection and
Affordable Care Act.

The question for those in the HME sector is, will either plan harm
the industry’s already challenging chances of getting

H.R. 1041 passed?

The bill would repeal the industry’s nemesis competitive
bidding program and pay for it with $20 billion in appropriated but
untapped federal discretionary funds. As of Friday afternoon, the
bill had 80 cosponsors.

However, both new budget-cutting measures include curtailing
discretionary spending. That, coupled with the “everything is
on the table for cuts” mentality in Washington, makes repeal
of the bidding program a tough goal according to Washington
lobbyist Dean Rosen of Mehlman Vogel Castagnetti, which works with
the American Association for Homecare. The country’s
financial doldrums are coloring virtually every issue on Capitol
Hill, Rosen said.

One reason, he told Medtrade Spring attendees at AAHomecare’s
Washington Update Wednesday, is that by 2025, all the
government’s money would go to its entitlement
programs—Social Security, Medicare and Medicaid—and to
service the national debt. Lawmakers are all too aware the
situation needs to be fixed, he said.

Also, Ryan’s plan throws into question the very structure of
the HME sector since it appears to remove the government from
paying for HME, as well as hospitalizations or other health care
services, instead transferring that responsibility to insurance
companies.

Under the plan, the president’s health reform law would be
repealed, and for those now 54 and younger, Medicare would become a
voucher system under which participants would select a private
insurance plan. The government would shell out about $15,000 to
each Medicare beneficiary to pay the premium cost. Ryan’s
plan for Medicaid is to give the states block grants and let them
administer the program.

“Medicare is projected to go bankrupt in just nine years
unless we act to curb the relentlessly rising cost of health
care,” Ryan wrote April 14 in an op-ed piece in The
Washington Post. “This cannot be done with
across-the-board cuts in Washington. It has to be done by giving
seniors the tools to fight back against skyrocketing costs.
That’s why our budget saves Medicare by using competition to
weed out inefficient providers, improve the quality of health care
for seniors and drive costs down.”

President Obama’s map for deficit reduction charts a
decidedly different course.

With an aim of reducing the nation’s staggering
deficit—$1.6 trillion projected this year—Obama would
initiate Medicare and Medicaid reforms that would not, he said,
shift costs onto seniors and those with disabilities.

“We will reduce wasteful subsidies and erroneous
payments,” he said in announcing the cost-cutting measures
during a speech at George Washington University April 13. “We
will change the way we pay for health care: not by the procedure or
the number of days spent in a hospital, but with new incentives for
doctors and hospitals to prevent injuries and improve
results.”

The president said the growth of Medicare costs could be slowed by
strengthening an independent commission of doctors, nurses, medical
experts and consumers to recommend the “best ways to reduce
unnecessary spending.”

As Republicans and Democrats duke it out over the budget and fixes
for the embattled Medicare and Medicaid systems in the coming
weeks, AAHomecare President Tyler Wilson told the audience at the
Update session that providers have got to keep up the noise on H.R.
1041.

“We know home care can play a role [in reducing health care
costs] but you can’t decimate the industry with competitive
bidding and you can’t decimate the industry with audits and a
whole bunch of other regulatory burdens and expect the industry to
serve the needs of the Medicare population going forward,”
Wilson said.

“We all have to become advocates,” he said, and
providers need to get involved now. “Don’t wait for
tomorrow because, in all candor, there is no tomorrow.”

Added Rosen, “The industry has a lot at stake. We’re
going to have to be part of the solution.”