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PEACH comments on CMS’ proposed use of the Medicare Cost Report’s revised S-10 Worksheet to determine Medicare DSH payments

January 15, 2013 PEACH Medicare DSH & S-10 comment letter

Los Angeles Times: Obama’s reelection cements his healthcare law

Republican state leaders must decide quickly whether to implement it or have the federal government do so. Obama also faces imminent challenges to carry out the legislation.

http://www.latimes.com/health/la-na-healthcare-analysis-20121109,0,6639904.story

By Noam N. Levey, Washington Bureau
5:49 PM PST, November 8, 2012

WASHINGTON — President Obama’s victory all but assures that his landmark healthcare law and its guarantee of insurance coverage for nearly all Americans will be implemented, effectively putting an end to the Republican campaign to derail the law.

That outcome — which seemed almost unimaginable this spring when the Supreme Court considered whether the Affordable Care Act was constitutional — puts immediate pressure on many Republican state leaders who fought it. They must decide in days whether to implement it or have the federal government do it for them.

Tuesday’s results also present Obama with a new set of challenges as he tries to fulfill the promise of his signature legislative achievement, the biggest expansion of the social safety net since Medicare and Medicaid were created in 1965.

Federal and state officials nationwide must create systems to handle millions of new insurance customers. Key will be setting up insurance marketplaces, known as exchanges, in every state by next October. (California has established one, but most states have not.)

Under the law, millions of Americans should be able to get health insurance for the first time starting in 2014. Millions more who don’t get coverage through work should be able to buy a health plan that meets new basic standards.

“It’s all over but the shouting,” said Families USA Executive Director Ron Pollack, a consumer advocate and leading champion of the law. “What was very questionable at the start of the year has been settled. … The Affordable Care Act will be a permanent fixture of the American healthcare system.”

But Obama will face renewed pressure to scale back the law as Congress tries to rein in federal budget deficits.

The act authorizes more than $1 trillion in new federal spending over the next decade. Although that is offset with new taxes and other spending cuts, critics say the law’s program to provide insurance subsidies to households making up to four times the federal poverty level — or about $90,000 for a family of four — is overly generous.

At the same time, health insurance companies, hospitals, employers and other interest groups are gearing up lobbying campaigns to modify the law, parts of which threaten to push up healthcare costs.

Also unclear is how the administration will contend with GOP governors who continue to resist the law and may spurn hundreds of billions of federal dollars to provide insurance coverage.

Several states, including Texas, Florida and Louisiana, have indicated they will not open their Medicaid programs in 2014 to cover all low-income citizens. Most states — including those with Republican statehouses — are expected to expand Medicaid because of the federal money the law provides.

The president could face even more resistance to the law if insurance premiums and other medical costs continue to rise in coming years, undermining a pledge he made in pushing for reform.

“It will be full-speed ahead with implementation. But there could still be some rocky going,” said Dean Rosen, a Republican healthcare lobbyist and onetime aide to former Senate Majority Leader Bill Frist.

James Capretta, associate director of the White House Office of Management and Budget under President George W. Bush, said many conservatives would not stop contesting the law. “The fight over the size and scope of government will continue,” he said. “Giving up is not an option.”

Polls show the public is evenly divided over the legislation. Republicans remain strongly in favor of repeal. And with control of the House, GOP lawmakers could continue to push proposals to eliminate or roll back parts of the law.

Obama in the past has signaled willingness to modify the law. But he has flatly rejected any major retrenchments. As the presidential campaign drew to a close, Obama increasingly defended the law. The president was introduced at one of his final rallies by a father whose 8-year-old daughter got treatment for leukemia thanks to the law, an anecdote he repeated in his victory speech Tuesday night.

Administration officials also insist they will not delay the law, which will allow Americans who don’t get coverage through work to buy insurance on Internet-based marketplaces called exchanges. “Consumers in all 50 states will absolutely have access to an exchange come January of 2014,” said Department of Health and Human Services spokeswoman Erin Shields Britt.

Under the law, states have until Nov. 16 to tell the department whether they will set up an exchange, a complicated project requiring new data systems, regulations and bureaucracy.

Just 15 states, including California, Maryland and Connecticut, as well as the District of Columbia, have established an exchange, according to the nonpartisan Kaiser Family Foundation. More than a third of the states are expected to reject that option, forcing the federal government to step in.

There has been much hand-wringing among state officials and others over the slow process of writing regulations outlining how these federal exchanges will work. But several experts said it was highly likely the Obama administration would be ready to open exchanges next fall.

Heather Howard, who directs the State Health Reform Assistance Network at Princeton University, cited Washington’s recent experience creating the popular Medicare Part D prescription drug program.

More uncertain is what smaller modifications the Obama administration may agree to make.

Insurance companies have been warning that a new tax on insurers — scheduled for 2014 — will be passed on to consumers, further inflating healthcare costs. Many insurers also warn that regulations limiting how much more insurers can charge older consumers could mean much higher rates for young people.

Many hospitals, meanwhile, are worried they could be saddled with more uninsured patients as states with conservative leaders decline to extend Medicaid coverage.

And employers are stepping up warnings that the law’s mandate requiring them to provide health benefits to full-time employees may prompt some to shift more workers to part-time, depressing employment.

Adjusting the law has been all but impossible over the last 2 1/2 years as Republicans pledged to destroy the legislation, fueling Democratic resistance to acknowledging emerging problems.

Those political dynamics may shift in Obama’s second term as implementation becomes an accepted reality, said Neil Trautwein, vice president of the National Retail Federation, many of whose members have been ardent opponents of the law.

“What gives me hope now is that so long as the Affordable Care Act remains the law of the land, I think Republicans and Democrats alike will have an interest in preventing any harmful effects on the economy,” he said.

San Diego Union-Tribune: Scripps Mercy unveils larger ER

http://www.utsandiego.com/news/2012/jan/04/scripps-mercy-unveils-larger-er/

By Janet Lavelle

Wednesday, January 4, 2012

They were all there for the festivities Wednesday morning: the mayor, a city councilman, the hundreds of donors, hospital officials and medical staff. There were speeches, buffets of cranberry juice and muffins, and long lines to tour the new Conrad Prebys Emergency & Trauma Center at Scripps Mercy Hospital in Hillcrest.

But it was Dr. Valerie Norton, the emergency department’s medical director, who described the new facility’s importantance.

“This means so much, I get tears just talking about it,” she said, her voice choking up. “We had been in a cramped outdated space for so long. We were sometimes putting patients in hallways, we couldn’t see them quickly enough, it was noisy. This is huge, to have so much room and a healing space with quiet and privacy.”

Scripps Mercy Hospital has the one of the county’s busiest emergency departments and one of just two Level 1 trauma centers for adults, able to care for the most critical patients (nearby UCSD Medical Center is the other). The 513-bed hospital treats nearly 60,000 patients in its emergency room and 2,400 patients in the trauma unit each year.

The new $41.3 million facility, which will see its first patients early next week, is a three-phase project that doubles the size of the current emergency department. The facility that opens next week has 27 emergency department beds in individual glass-walled rooms, and a 4-bed trauma unit with room for eight gurneys if needed. The department has its own dedicated lab, and sophisticated 64-slice CT-scanner to diagnose patients more quickly without having to rely on equipment being used by the rest of the hospital. Wireless technology will be used to monitor patients. A large waiting room was designed in soothing tones of teal and wood.

When the new facility opens, half of the adjacent old emergency department will be closed for renovations, leaving 20 beds still available in the old wing. The process will be reversed so that when all three phases are done in 2013, the entire department will have 49 beds, all in private glass rooms large enough to accommodate family members.

The center is named after San Diego developer and philanthropist Conrad Prebys, who gave Scripps Mercy $10 million in 2006 for the project. Since then, he’s given $45 million to Scripps Health for the Conrad Prebys Cardiovascular Institute, which is expected to open in La Jolla in 2015.

As he toured the gleaming new Hillcrest facility on Wednesday, Prebys said he decided to make the donation during a breakfast with Scripps officials.

“I saw how we were going to be able to increase the size of the emergency and trauma center and that it’s open to everyone,” he said. “I shot from the hip and said yes. And, boy, did I hit a home run, from the way this looks today.”

All five hospitals in the Scripps Health system will be undergoing renovations or expansions in the next two decades, both to handle patient demand and to comply with tougher state earthquake standards in 2030, Scripps Chief Executive Chris Van Gorder said.

The Office of Statewide Health Planning and Development approved construction plans this week for a 2-story, 60,000-square-foot facility at Scripps Memorial Hospital in Encinitas, Van Gorder said. The building, expected to open by 2015, will house a 27-bed emergency department on the first floor and 36 private rooms for acute-care patients on the second floor.

“By the end of February, we’ll be starting construction there,” he said. “We’ll use what we learned here in building that emergency department.”

Associated Press/Los Angeles Times: Federal judges torn over Obama’s healthcare law

A conservative-leaning appellate panel is concerned about the insurance mandate but says legal challenges may be premature.

http://www.latimes.com/health/la-na-healthcare-hearing-20110924,0,6511276,print.story

Associated Press

5:41 PM PDT, September 23, 2011

Reporting from Washington

A conservative-leaning panel of federal appellate judges raised concerns about President Obama’s healthcare overhaul Friday, but suggested the challenge to it may be premature.

The arguments at the U.S. Court of Appeals in Washington over a lawsuit against Obama’s signature domestic legislative achievement focused on whether Congress overstepped its authority in requiring people to buy health insurance or pay a penalty on their taxes beginning in 2014.

But Judge Brett Kavanaugh, a former top aide to George W. Bush who was appointed to the bench by the former president, said he has a “major concern” that courts might not be able to rule on the law’s constitutionality until 2015. That’s because a federal law bars most challenges to tax-related legislation before the tax or penalty is paid.

A federal appeals court in Richmond, Va., cited that law in throwing out another challenge to the overhaul. Two other appeals courts have reached differing conclusions — one declaring the law unconstitutional and the other upholding it. The Supreme Court is expected to weigh in and could decide to review the law before the Washington circuit issues an opinion.

The Washington case was brought by the American Center for Law and Justice, a legal group founded by evangelist Pat Robertson, on behalf of five Americans who chose not to buy health insurance because of religious beliefs that God heals their afflictions or because they have a holistic approach to medical care. Their attorney, Edward White, told the appellate judges that one of the plaintiffs, Charles Edward Lee of San Antonio, is so devoted to faith healing that he hasn’t been to a doctor in 20 years and has told his family that even if he has a heart attack or is hit by a car just to pray for him and not seek medical care.

White argued that the healthcare act passed by Congress is unconstitutional. “Congress cannot force people into private commerce and to buy a private product for the rest of their lives,” White said.

But Kavanaugh pointed out that Congress has the power to regulate commerce and can require insurance companies to cover all Americans. “It won’t work without an individual mandate attached to it,” Kavanaugh said. He also theorized that the healthcare law could mark the shift in the social safety net to private industry. “Why should the court risk getting in the middle of that?” the judge questioned.

But later, when questioning government attorney Beth Brinkmann, Kavanaugh and the panel’s other Republican-appointed judge, Laurence Silberman, expressed concern that if the court upholds the requirement to buy health insurance, Congress could require Americans to buy a wide variety of other products. Kavanaugh said that could include individual retirement accounts to replace Social Security, and Silberman wondered whether wealthy Americans could be required to buy a car from General Motors if the company fell toward bankruptcy again.

Brinkmann responded that the government wasn’t requiring Americans to buy healthcare for the product’s own sake, but to finance the system as part of an expanded regulatory scheme.

A requirement to buy a product “has never been done in 222 years,” Kavanaugh said. “That alone is cause for judicial hesitation.”