June 29, 2010

Press Clips: June 29, 2010

Granite Staters Have Spoken
June 29, 2010
Public News Service


CONCORD, N.H. – “America Speaks” asked the questions – and Granite Staters answered them. However, not all groups are convinced they were the right questions to help the nation’s economy, long-term. “America Speaks” held a national town hall-style event on Saturday linking cities across the country, and Portsmouth was included. In discussion groups, people were asked for their ‘fixes’ for the federal budget, and a majority supported the idea of raising the age for receiving full Social Security Benefits to 69.

Ed Coyle, executive director of the Alliance for Retired Americans, says Social Security has not added one dime to the deficit.

“It is not part of the deficit problem and frankly, I resent the fact that people try to point to Social Security or Medicare as part of the deficit problem.”

Proponents of raising the retirement age cite many reasons, including people living longer and, therefore, having the ability to work longer. Coyle says not all jobs or people are the same, and that for physical labor as an example, many would not be able to continue working past today’s early retirement age of 62.

Nancy Altman, co-director of the group Social Security Works, says Social Security doesn’t affect the deficit negatively because of the way it is structured.

“Social Security – it has no borrowing authority, it cannot pay benefits, by law, it cannot pay a single dollar of benefits, unless it has the amount of money on hand to pay those benefits.”

In all, about 3500 people from across the country participated in the town hall events. Some other popular solutions included raising tax rates on corporate income and reducing defense spending.

“America Speaks” presents the results to the Commission on Fiscal Responsibility and Reform today.

1.2 Million to Lose Benefits In Days If Stalemate Continues
By: Vicki Needham
The Hill


Millions of people will lose their health insurance and unemployment benefits because of the Senate stalemate over a tax package.

More than 1.2 million Americans will exhaust their unemployment benefits by the end of June if Congress fails to work out a deal on an extension of unemployment benefits, according to the National Employment Law Project, a group studying the issue.

In addition, neither the House nor the Senate bill have approved an extension of the COBRA subsidy that requires unemployed workers to pay only 35 percent of a premium to maintain health insurance. That subsidy was originally included in last year’s stimulus bill.

The premium generally costs hundreds of dollars, a price many unemployed people are unlikely to be able to afford without the subsidy.

GOP Sen. Olympia Snowe (Maine) on Friday suggested the unemployment benefits be offered as a stand-alone package, but it is unclear whether Democrats are willing to go along with that deal.

Democrats have argued the unemployment benefits should be considered emergency spending that does not have to be offset with other spending cuts or tax increases. Republicans have balked at the $33 billion cost, which would be added to record deficits.

The latest version of the tax bill package paid for every provision except the unemployment benefits extension, but it still failed to move forward in a 57-41 vote.

More than 2 million workers have benefited from the COBRA healthcare subsidy, according to NELP. It estimates that 144,000 people per month will lose out on the subsidy due to its discontinuation.

The elimination of the subsidy will also hurt those still collecting unemployment.

Without the subsidy, a much greater share of money included in unemployment checks would be spent on health insurance. Many are likely to drop their insurance.

The Senate measure had previously cut an extra $25 per week in unemployment insurance that was included in the stimulus bill.

Snowe has been seen as a possible yes vote, and unemployment is a concern in her state.

The jobless rate in Maine stood at 8 percent in May, third among New England states.

Other Republicans have said pressure is mounting to pass unemployment benefits but it’s unknown who might vote for a stand-alone package.

Republican Sen. Bob Corker (Tenn.), whose state is one of 17 with double-digit unemployment at 10.4 percent, said on Friday that he can’t vote for any bill that isn’t fully offset.

“My heart goes out to Americans who are hurting because Washington can’t agree on a way to pay for an extension of unemployment benefits,” Corker said in a release. “I voted several times to pass and pay for an extension, but I cannot in good conscience continue voting for bills that aren’t paid for.”

The Snowe solution is unlikely to satisfy Nebraska Democrat Ben Nelson either, the lone member of his party to vote against the bill, who has remained steadfastly against any legislation that adds to the deficit.

Nelson said his state’s 4.9 percent unemployment rate has made it easier to wait out his colleagues in hopes that they can solve the deficit-spending issue.

He doesn’t oppose the extension of unemployment benefits but he doesn’t want the cost adding to the deficit.

“At some point they need to be paid for,” he said. “Some people think it’s an emergency. I think it’s important.”

States To Miss Health Care Deadline
By: Alison Young
June 28, 2010
USA Today


Beginning Thursday, residents in most states will be able to apply for new federal health coverage for people denied insurance because of medical problems, but some of the nation’s largest states will miss the deadline, according to state insurance departments.

The key early program of the nation’s new health law aims to provide affordable coverage to about 200,000 people with pre-existing medical conditions, such as cancer or diabetes, through federal high-risk insurance pools. The law called for the program to be in place last week, 90 days after its enactment, though the Department of Health and Human Services had said the programs would launch Thursday to coincide with the start of states’ fiscal years.

Sen. Mike Enzi of Wyoming, the top on the Senate health committee, sent a letter last week to HHS Secretary Kathleen Sebelius criticizing the department forRepublican missing the health law’s 90-day deadline, delaying health coverage for people who can’t get it elsewhere.

RISK POOLS: New health care law traps some in pricey state plans

Ron Pollack, executive director of the consumer health group Families USA, said, “I believe it’s truly remarkable that so many states will have these pools operational in such a short period of time.”

Applications to buy the coverage will be ready Thursday for residents of about 20 states that asked HHS to run the program for them, said Richard Popper of the department’s insurance programs division. Details of the costs and coverage will be posted at www.healthcare.gov.

About 30 states opted to run the programs themselves. Of those, he said about 20 will be ready to accept applications in early to mid-July. About 10 states are working through legislative and other issues that may take weeks or months to resolve.

States that reported issues to USA TODAY include:

  • Michigan, where residents won’t be able to get the insurance until October, said state Insurance Commissioner Ken Ross. The state is accepting bids from companies to manage the program.
  • Illinois, which also is in the bidding process, said Michael McRaith, state insurance director. He hopes to enroll people in August.
  • California, which needs its Legislature to pass two bills to allow it to run the program, said Jeanie Esajian, spokeswoman for the state’s insurance program. Votes are expected this week, she said. “Our plan, if everything goes smoothly, is to begin taking enrollment in August and be open for business in September,” she said.

The health law allocates $5 billion for states to run the programs — along with the insurance premiums consumers will pay — until 2014. That’s when most of the law’s provisions take effect and the pools are replaced by health insurance exchanges where everyone can buy insurance that can’t discriminate against people with health problems.

To qualify for the temporary pool coverage, a person can’t have had health coverage for six months. Because funds are limited, enrollment will be capped in some states. It’s unclear how quickly the programs will fill up.

Still Waiting: Millions of Americans Who Qualify For Disability Who Qualify For Disability Must Wait Two Years For Medicare
By: Anne Saker
June 27, 2010
The Oregonian


Sue Sherman of Southwest Portland lived a peaceful, healthy life until she was dealt an ugly card last year: a diagnosis of pancreatic cancer.

From the whirl of appointments, tests and drugs arose an enduring irony of any serious illness: too many moments surrendered just to the act of waiting, for doctors, for results, for help.

Sherman, 57, believed she had bought some time when she qualified for Social Security disability income. But that only brought on the worst wait of all.

“How do people survive this?” she said. “The ripple effect of this is tsunami-huge.”

She joined nearly 2 million disabled Americans — at least 15,000 in Oregon — who fall into a twilight with the first monthly Social Security disability payment, for they then must wait two years to become eligible for Medicare.

Many of them, like Sherman, have spent their savings on the care necessary to reach a diagnosis and now cannot get private insurance. Sherman spent the early months of her wait hoping that the debate over health care legislation would fix the problem.

“I was never around people who were sick,” she whispered last week from a bed at OHSU. “I didn’t know what a horrific disaster it could be to a person to have a catastrophic illness. And then the economic consequences … .”

She sighed and closed her eyes.

Two years ago, Sherman worked in Phoenix, Ariz., as a fitness trainer at an Air Force base; for fun, she rode horses on long-distance adventures. Then she felt pain under her rib cage. In April 2009, a scan found a tumor on her pancreas already too big for surgical removal. The search for a specialist led to OHSU.

Sherman’s daughter Bethany, 30, had just moved to a Hillsdale apartment with daughters Sedona, 9, and Jasmin, 6. Sherman flew to Portland for what she expected would be a few days of consultation. Instead, her treatment began immediately. Only 20 percent of pancreatic cancer patients live more than a year past diagnosis.

“I told the doctor, ‘You must have the wrong file,'” Sherman said.

Bethany dropped out of the nursing program at Concordia University to care for her mother. Sherman’s Arizona friends put her belongings in storage. Her employer gave her a leave and extended her medical insurance for a year under the federal COBRA law.

Right after diagnosis, Sherman qualified for Social Security disability, and only then did she learn of the waiting period. “I couldn’t believe it. Who can wait two years?”

Her own health crisis coincided with the national discussion about overhauling health care, and she took hope. Surely, she said to Bethany, this problem would be fixed. Someone must know about it. Someone must care about it.

At the apartment, morning and night, Sherman watched television news hoping to hear from Washington about the waiting period. Nothing.

At the apartment, while her energy allowed, Sherman researched the waiting period. She learned it went into effect in 1972 to keep costs down, avoid overlaps with private insurance and to preserve Medicare for those with severe, long-lasting disabilities.

The only exceptions to the wait are for people in end-state renal failure or with amyotrophic lateral sclerosis.

This year, nearly 8 million Americans are receiving Social Security disability income. About a quarter, 1.8 million, are in the 24-month waiting period.

For at least the past two sessions of Congress, a proposal has come forward to phase out the waiting period over 10 years. Late last year, a bill got a heavy push from the grass-roots lobby Medicare Rights Center and dozens of patient advocacy groups.

Then the Congressional Budget Office, which estimates the cost of legislation to the taxpayer, calculated that eliminating the wait would cost an average of $10 billion a year over 10 years.

By comparison, health care for the 2.4 million members of the U.S. armed forces this year will cost $44 billion.

A private 2003 study found that nearly 25 percent of the disabled in the waiting period go the two years without any insurance. In that sense, Sherman was fortunate: When her COBRA plan expired in the spring, she was then poor enough to qualify for the Oregon Health Plan. But her Social Security benefit that began in November 2009 put her over the plan’s eligibility.

Her only option was to go into Oregon’s “high-risk” coverage pool, for about $800 a month. That covers a portion of her doctor bills and hospitalization, but not her drugs, which run at least $8,000 a month. Bethany said, “We’re paying on 11 medical bills right now.”

The Congressional Budget Office’s estimate effectively killed the waiting period bill in January. The reform package that ultimately passed will provide government subsidies to people like Sue Sherman to buy private health insurance on an “exchange.”

But that doesn’t go into effect until 2014.

Sherman never heard a word on the news broadcasts about the waiting-period bill. So as her body weakened, she called or wrote lawmakers for information. The response was not informative. Rep. David Wu, D-Ore., sent back a blizzard of research papers.

In April, Sherman beat the odds and passed her first anniversary since diagnosis. But in May and June, she has gone from Bethany’s apartment to OHSU and back again. She is having trouble keeping food and water down, which put her in the hospital last week.

“We have no idea how we’re going to pay for this, probably financial aid from OHSU,” Bethany said. “But that only means that the costs ultimately get spread to everyone else.”

In bed, nearly as pale as its linens, Sherman opened her eyes, looked at her daughter and sighed again. Bethany was reading some of the papers that Wu’s office had sent and hit upon a striking figure: About 12 percent of Social Security disability recipients do not last the two years.

“Well, that’s it then,” Sherman said. “They’re just waiting for us to die.”

When she can, Sherman said, she wants to restart the fight over the waiting period because it’s not just the patient who suffers. Sherman looked at Bethany.

“She’s got the kids to juggle, a sick mother to juggle, a job to juggle,” Sherman said as Bethany sat across the hospital room, smiling at her. “That’s what I mean by the ripple effect. She’s got all this, and she took a year off of college, to take care of me. An obstacle.”

Bethany, gazing at her mother, replied softly, “You’re not an obstacle. You’re a person.”

“Well, you know … .”

“Concordia will always be there,” Bethany said. “I’ve told you that.”

“But I’m talking about the practical sacrifices for the life of the family that this causes,” Sherman said. “It doesn’t just happen to one person. It’s not just one person who has to wait.”

New CMS Rules Focus On Primary Care, Target Radiology Cuts
By: Emily Walker
June 29, 2010
MedPage Today


WASHINGTON — Physicians would receive new payments for annual physicals under a proposed rule on 2011 Medicare payments to doctors released by the Centers for Medicare and Medicaid Service (CMS).

The 1,250-page proposed rule provides updates on how doctors will be reimbursed for treating Medicare patients in 2011 under the Medicare Physician Fee Schedule (MPFS). It also addresses how several key preventive service provisions contained in the Patient Protection and Affordable Care Act (PPACA) will be implemented.

Under PPACA, co-pays are eliminated for certain preventive care services that are ranked a grade A or B by the U.S. Preventive Task Force — this includes annual cervical cancer screenings for sexually active women under 65 and smoking cessation counseling for patients who smoke. The PPACA also waives shared payments for annual wellness visits.

Medicare currently pays for a one-time wellness visit included in the Initial Preventive Physical Examination, or the “Welcome to Medicare Visit.” The new rule would extend payments to include annual wellness exams.

CMS will develop a new payment code for the first wellness visit, and pay for subsequent visits as a level 4 office visit, according to a fact sheet from the agency.

Under the healthcare reform law, the wellness visit must include an update of the patient’s medical and family history; a list of all current medical providers and medications; measurement of height, weight, body mass index, and blood pressure; detection of any cognitive impairments; and establishing a screening schedule for next five to 10 years.

The visit will be “an opportunity for the physician and patient to develop a more comprehensive approach to maintaining or improving the patient’s health and reducing risks of chronic disease,” said Jonathan Blum, deputy administrator and director of CMS’s Center for Medicare, in a press release.

The proposed rule also would implement 10% incentive payment for primary care services provided by a primary care doctor, nurse practitioner, clinical nurse specialist, or physician assistant. To determine which providers are “primary care practitioners” and eligible for the payments, CMS will review claims data from 2009 and then revise their list of primary care practitioners on annually.

“The rule we are proposing today is just one part of the Administration’s efforts to improve the health status of Medicare beneficiaries by expanding access to preventive services, and promoting early detection and prompt treatment of medical conditions,” Blum said.

While primary care physicians stand to gain under the proposed rule, radiologists will see a continued reduction in payments under the proposed rule for using computed tomography (CT) and magnetic resonance imaging (MRI) — just as they did under last year’s MPFS.

“It’s just one more step in [CMS] devaluing radiology services,” Bibb Allen, MD, chairman of the American College of Radiology’s (ACR) economics commission, told MedPage Today.

Radiologist saw their reimbursement cut in the 2010 MPFS after CMS used a new formula that estimated radiologist and cardiologists use their computed tomography (CT) and magnetic resonance imaging (MRI) machines 63% of the time, rather than about half of time, which was the previous estimate. The higher utilization rate allows Medicare to pay less for each scan, because it assumes radiologists and cardiologists are getting enough business to offset the costs of their expensive machines.

The PPACA capped that utilization rate at 75%, which means scans performed in 2011 will be reimbursed at lower rate than in 2010, said Shawn Farley, a spokesman for ACR.

And reimbursement may slip even more because of a new formula CMS plans to use to bundle payments for scans on consecutive parts of the body.

Under the PPACA, beginning July 1, if a radiologist performs a CT scan of a patient’s abdomen, and then a scan of the patient’s pelvis, Medicare must shave 25% off the amount it reimburses for the cheaper of the two scan, explained Allen.

But under the rule, CMS is proposing to increase that reduction for the second scan to 50%. It also is proposing applying the discount to scans that aren’t on consecutive body parts — such as an office visit for knee scan and a brain scan.

Allen said he doesn’t think bundling those types of scans together and cutting reimbursement is appropriate, because it takes nearly just as much time and effort to do a knee scan and a brain scan in one visit as it would in two visits.

The proposed rule also would require physicians who refer patients for CT, MRI, and positron emission tomography (PET) facilities in which they are owners to provide patient with a list of other providers in a 25-mile radius who can provide the same services.

The proposed rule would also:

  • Provide quarterly incentive payments for general surgeons who perform major surgery in areas designated to be “Health Professional Shortage Areas.” Each payment would be equal to 10% of the MPFS payment for surgery.
  • Pay certified nurse midwives at the same rates as physicians
  • Increases the payment for two dual-energy x-ray absorptiometry (DXA) CPT codes for measuring bone density for 2010 and 2011

CMS will accept comments on the new rules until Aug. 24 and will issue a final rule by Nov. 1. The new payment rules will apply to physician services provided after Jan. 1, 2010.

America Speaks In La- They Want Economic Recovery, No Social Security Cuts
By: David Dayen
June 26, 2010


*To see the article please click on the above link.

America Speaks Back: The Effort To Gut Social Security and Medicare Takes A hit
By: Dean Baker
June 28, 2010
Talking Points Memo


The opponents of Social Security and Medicare are getting in high gear. After all, it makes perfect sense that after the collapse of a housing bubble has just destroyed the life savings of near retirees that we would cut their Social Security and Medicare. Okay, at least in Washington that makes perfect sense.

President Obama’s deficit commission is moving forward with Social Security and Medicare explicitly in their sights. They got a dry run for how this effort is likely to sell with the public on Saturday as the Peter Peterson funded group America Speaks sponsored a series of 19 “21st Century Town Meetings.” It seems that events didn’t quite go as planned.

The exercise was intended to show convince people that there were no options other than large cuts to Social Security and Medicare to hit their deficit targets. To ensure this result, the America Speaks crew put together a booklet that exaggerated future budget problems (the exercise was for the year 2025) by assuming a worse budget path than the country is currently facing.

America Speaks also excluded the possibility that the Fed would buy and hold more debt, in effect continuing its current course. This would substantially reduce the interest burden facing the country in 2025. While in normal times this could cause inflation, that is unlikely to be a problem in the foreseeable future. In comparable circumstances, Japan’s central bank has bought an amount of debt nearly equal to the country’s GDP (the equivalent of $14 trillion for the U.S.) and its economy is still facing deflation. There is no reason that the Fed could not follow the same path, unless the goal is to force cuts in Social Security and Medicare.

The America Speaks folks also denied participants the option of reducing public sector health care costs by reforming the U.S. health care system. As they say at America Speaks, everything is on the table, except reforms that would hurt powerful industry lobbies. The America Speaks crew also neglected to mention the Social Security trust fund and that it would have enough assets to pay all benefits through the year 2043, according to the Congressional Budget Office.

Given this stacked deck the participants rose up in revolt. They demanded the option to vote on a single-payer type health care system. The idea being to reduce costs by making health care more efficient rather than just cutting services in Medicare and other public sector programs. They also voted overwhelmingly for defense cuts and for every progressive tax option in the book, even though many had been seriously mischaracterized. For example, they listed the potential revenue from a financial speculation tax in 2025 as $30 billion a year even though there is good reason, based on the experience of other countries, to believe that we could raise close to ten times this amount.

Remarkably, even after spending more than 6 hours with the America Speakers, participants were still very poorly informed on several key budget issues. For example, more than 80 percent of the participants thought that the country had large budget deficits in the years immediately before the recession. (The budget deficits were less than 2.0 percent of GDP in the two years prior to the downturn.)

Less than a quarter of the participants realized that average wages are projected to increase substantially over the next three decades. The fact that real wages are projected to be more than 30 percent higher in 2040 would be an important consideration in an issue like increasing the payroll tax. And, less than a quarter of participants realized that the Social Security trust fund is projected to be fully solvent for more than 25 years into the future.

All in all, this was a good day for democracy. The America Speaks gang tried to shove their agenda down the public’s throat and the public pushed back. Let’s hope that the deficit commission gets the message.

An Appointed Senator Will Succeed West Virginia Senator Byrd
By: Paul Kane & Brady Dennis
June 29, 2010
The Washington Post


The seemingly irreplaceable Robert C. Byrd (D-W.Va.) will be succeeded by an appointed senator until November 2012, when the state’s voters will select a permanent replacement to the man who has been their leading voice in Washington since the Eisenhower administration.

This means that Byrd’s death on Monday will have no impact on the partisan makeup of the chamber, assuming West Virginia Gov. Joe Manchin III appoints a fellow Democrat, during the rest of President Obama‘s term. But it could complicate the timing for passage of the landmark financial legislation Democrats hope to send to the president this week.

Although the House probably has the votes to approve the far-reaching new financial rules hammered out by a conference committee last Friday, Byrd’s absence creates a potential math problem in the Senate.

“If the House acts, we’re prepared to do so right after that,” Jim Manley, spokesman for Senate Majority Leader Harry M. Reid (D-Nev.), said Monday. As for whether Democrats could secure enough votes, Manley said: “Where are the Republicans? Are they all going vote against it? . . . We’re just going to have to wait and see.”

Democrats need GOP support to reach the 60 votes required to clear procedural hurdles standing in the way of a final vote, which takes only a majority. When the Senate passed its initial bill last month, Sens. Olympia J. Snowe (R-Maine), Susan Collins (R-Maine) and Scott Brown (R-Mass.) joined Democrats in a 60 to 40 tally to end debate on the legislation and allow a final vote.

Without Byrd, that effort would have failed. The two Democrats who opposed the legislation — Russell Feingold of Wisconsin and Maria Cantwell of Washington — will face pressure to rejoin the fold.

Manchin will make an interim appointment to replace Byrd, likely sometime after a memorial service and burial of the 92-year-old senator. West Virginia’s secretary of state, Natalie Tennant (D), announced late Monday afternoon that a special election would be held in 2012 to fill out the final two months of Byrd’s term; on the same ballot will be the election for the full six-year term.

Byrd’s replacement will be the seventh appointed senator since the start of the 111th Congress in January 2009, a flurry of replacement senators first caused by a new administration led by two ex-senators who then selected two former Senate colleagues for Cabinet posts.

Democratic sources, who spoke on the condition of anonymity to discuss internal party deliberations, said they expect Manchin to appoint a caretaker senator, just as Sen. Ted Kaufman (D-Del.) was selected to replace his former boss, Vice President Biden, knowing he would not run in the special election to succeed Biden permanently. This is because Manchin is widely seen to have an eye on the Senate race in 2012, when his second term is up.

Although Manchin would not officially discuss his 2012 ambitions — in part out of respect to Byrd and his family — those close to him indicated the governor is going to consider his options. “Joe Manchin is ready to do whatever he needs to in order to promote West Virginia values, nationally and in Washington D.C.,” a source close to Manchin said, requesting anonymity.

Republicans are likely to turn to five-term Rep. Shelley Moore Capito (R) as their candidate. Capito, the daughter of former governor Arch Moore (R), considered a 2006 run against Byrd before bowing out.

South Carolina Begins New Investigation Of Alvin Greene
June 28, 2010
Congressional Quarterly


State investigators are looking into whether South Carolina’s surprise Senate nominee, Democrat Alvin Greene, lied about his inability to pay for a criminal lawyer to defend him in an obscenity case, reports The State.

Reggie Lloyd, director of the South Carolina Law Enforcement Division, tells the newspaper his agency’s inquiry was triggered by inconsistencies between Greene’s assertion to the court that he had no money and needed a taxpayer-supported lawyer, and his unexplained acquisition of $10,400 to pay the filing fee.

“We want to see how he came up with the money,” Lloyd said.

Meanwhile, Greene — who shocked the political world by winning 59 percent of the Democratic primary vote, apparently without campaigning — will be going to court without a public defender.

Public Defender Doug Strickler told The State that he received a letter from a private attorney telling him he represents Greene in the obscenity case.


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