Congressional Democrats Pan Obama's "Compromise Budget."

Epps Financial Services  Congressional Democrats Pan Obama's "Compromise Budget." Roll Call  (4/9, Shiner, Subscription Publication), in an article titled, "Obama Budget Strategy Irks Democrats," reports that Democrats in Congress "continue to be baffled by - and frustrated with - the White House's legislative strategy, with many aides questioning the wisdom of offering a compromise budget before negotiations have even begun." Roll Call goes on to report that "several Democratic sources outside the White House" described the President's budget as "not just a bad bargaining stance but also another instance in which the president appears to be taking a position in the middle, only to later be pushed by Republicans to the right." Roll Call continues, "With his budget's unpopular entitlement cuts, many Democrats caution that Obama not only is starting talks from a position that might alienate the Democratic base but also is helping Republicans make Obama and the Democrats own even more spending cuts - including those to Medicare or Social Security, which Democrats have used as a political bludgeon for years."         The Wall Street Journal  (4/9, Mckinnon, Subscription Publication) reports that as part of an effort to mollify some liberal critics, the President's budget will not propose reducing the rate of entitlement benefits' cost increases - via a shift to the so-called "chained CPI" - for older seniors, the poorest seniors or veterans.         Meanwhile, according to Politico  (4/9, Isenstadt), the Progressive Change Campaign Committee, Democracy for America, and MoveOn.org "have released sharply worded statements putting Democrats on notice" that an endorsement of the President's budget "would be tantamount to betrayal," and the PCCC is actually threatening to "support primary challenges to congressional Democrats who support benefit cuts."         On the other hand, Politico  (4/9, Gibson) also reported that while the President "might think he's offering a compromise budget," Republicans in the Senate "are expected to vigorously push back, casting the 2014 spending plan as another attempt to raise taxes to fuel more deficit spending." According to Politico, "When Obama's budget is released, the first message from Senate Republicans will be that it raises taxes too much," and they "also won't miss an opportunity to point out that the president missed his deadline, which is set by law as the first Monday in February."         The AP  (4/9, Pace) reports that in an effort to "soften bipartisan opposition to his budget proposals, Obama will dine Wednesday night with a dozen Republican senators, part of the broader charm offensive he launched in recent weeks."         Echoing the Republican critique of the President's FY'14 budget, Mark Trumbull, in a piece for the Christian Science Monitor  (4/8, Trumbull), says the President "is proposing some deficit-reducing entitlement reforms and tax hikes, but not enough to bring the national debt sharply downward." Trumbull goes on to write that the President "seems to be opting for a philosophy that small and slow adjustments are the right approach to reducing federal deficits."         The Cato Institute's William Poole, a former president of the Federal Reserve Bank of St. Louis, in an op-ed for the Wall Street Journal  (4/9, Poole, Subscription Publication), says the magnitude of the Federal debt is routinely underestimated because the CBO's projections must be based on "current law," meaning, for example, that the CBO has to score as though Congress will not implement another "doc fix" to avoid scheduled Medicare reimbursement cuts although few analysts expect this to be the case.         Analysis: Obama's "Small-Bore Budget Cuts" Have Failed To Gain Traction In The Past. In an article titled, "Obama Budget Plan Revisits Small-bore Budget Cuts," the AP  (4/9, Taylor) reports that the President's FY'14 budget "will reprise lots of smaller bore proposals that have gone nowhere." According to the AP, that includes "ideas like higher Transportation Security Administration fees on airline tickets, the end of Saturday mail delivery and higher pension contributions for federal workers," which are "the hardy perennials of Obama's budgets, reprised year after year." The AP adds that the President's "proposal to save about $140 billion over a decade by reducing Medicare payments to drug companies is opposed by both Republicans and Democrats," while his "proposal to require federal workers to contribute more to their pensions is opposed by both his labor union allies and many Democratic lawmakers."

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Legislation and Policy Analysis: Health Insurers Need Bargaining Power To Control Costs. Modern Healthcare  (4/9, Block, Subscription Publication) reports, "Insurers must be given the same bargaining power that providers have in order to help rein in rising healthcare costs," according to the authors of an analysis  published in April 8 issue of Health Affairs. In the analysis, the authors contend, "'Health insurance exchanges in Switzerland and the Netherlands offer five key lessons for the operations of US exchanges.' They say other measures are necessary to create incentives to contain costs." Sebelius Expresses Frustration With "Relentless" ACA Opposition. Reuters  (4/9, Malone) reports that HHS Secretary Kathleen Sebelius said Monday that she was not expecting such "relentless" and long-lasting opposition to the Affordable Care Act. While speaking at an event at the Harvard School of Public Health, Sebelius said, "The politics has been relentless and that continues. There was some hope that once the Supreme Court ruled in July and then once an election occurred there would be a sense that, 'This is the law of the land, let's get on board, let's make this work.' And yet we will find ourselves having state by state political battles." She continued on the subject of states resisting the law, saying, "It is very difficult when people live in a state where there is a daily declaration, 'We will not participate in the law,' for them to figure out whether they are going to benefit."         The Topeka Capital-Journal  (4/9, Carpenter) also reports on Sebelius' comments Monday, noting that in addition to her "frustration," Sebelius touted benefits of the law, including the fact that "70 million people are receiving preventative health services without a co-pay through Medicare or private insurance companies due to the law," and that in the last year, consumers saw $2 billion in rebates due to an ACA provision. GOP Looking To Strengthen ACA's Pre-Existing Coverage Pools. The Hill  (4/9, Viebeck) "Healthwatch" blog reports that House Majority Leader Representative Eric Cantor (R-VA) revealed his party's priorities in a memo Friday, which include healthcare items like "shoring up ObamaCare's high-risk insurance pools and strengthening federally funded research on pediatric diseases." Specifically, Cantor "defended the forthcoming bill on ObamaCare, saying that one move to strengthen the law does not eliminate the GOP's goal of repealing it," writing, "Full repeal of ObamaCare remains our goal, but we can take this specific action to help Americans with pre-existing conditions receive insurance coverage now." Exchange Leaders Express Hesitations About Readiness For Launch. Modern Healthcare  (4/9, Block, Subscription Publication) reports that "the heads of two state-run health insurance exchanges say they are concerned that there may not be enough time for testing the marketplaces before open enrollment begins Oct. 1." Kevin Counihan, CEO of the Connecticut Health Insurance exchange, and Richard Onizuka, CEO of the Washington State Health Benefit Exchange, both questioned their readiness Monday. Counihan, for example, said that he is "unsure about the status of the federal data services hub," and "also expressed reservations about Navigators, the grant-funded companies and not-for-profit organizations that will help consumers fill out application forms and answer questions about the exchanges."         Colorado Exchange Scales Back Goals For Launch To Meet Deadlines. The Denver Post  (4/9, Booth) reports that Colorado's insurance exchange has lowered its expectations for Oct. 1, the first day of enrollment, in order to meet the approaching deadlines. Programmers for the exchange told the board Monday that "the first release of the exchange system will have a base level of functionality," and that the public should be made aware of this scale-back. One staff member called the decrease in goals "a big change in scope," although the timeline for launching the exchange remains "aggressive." Sebelius: Contraception Mandate Will Take Effect August 1. The Washington Times  (4/9, Howell) reports that on Monday, HHS Secretary Kathleen Sebelius said the Administration "will finalize its new rules granting free birth control, saying the controversial policy will go into effect in August." Sebelius is quoted as saying, "As of Aug. 1, 2013, every employee who doesn't work directly for a church or a diocese will be included in the benefit package." The Times notes that Sebelius's "comments came the same day that the public comment period for the contraception mandate ended, and even as a bevy of nonprofit groups and companies are fighting in court to overturn it." Grassley Questions Early Prediction Of HHS' Medicare Advantage Cut Reversal. In continuing coverage, the Wall Street Journal  (4/9, Mullins) "Washington Wire" blog reports that Senator Charles Grassley (R-IA) is seeking information as to how Height Securities, a investment-research firm, correctly predicted that HHS' Centers for Medicare and Medicaid Services would reverse planned cuts to Medicare Advantage reimbursement rates. The firm sent a report detailing the reversal before CMS announced it, sending stocks for insurance companies soaring. According to Grassley, this raises "serious questions regarding how political intelligence brokers are able to gather information for their clients in advance of market moving events."         The Washington Times  (4/9, Howell) "Inside Politics" blog adds that Grassley "has asked Marilyn Tavenner of the Centers for Medicare and Medicaid Services (CMS) for a timeline and details of any communications about the decision to replace a proposed 2.2 percent cut with a 3.3 percent increase to rates for the Medicare Advantage program." Online Insurance Brokers Seek Access To ACA Enrollees. The Washington Post  (4/9, Kliff) "Wonkblog" reports that "online insurance brokers see a potential windfall when the federal government doles out billions in subsidies to buy help Americans buy health insurance." These brokers "want millions of new insurance customers to be able to use those subsidies to buy health coverage through their Web sites, rather than shop exclusively on the new exchanges being set up by states and the federal government." Gary Lauer, CEO of EHealth, "the country's largest online insurance broker," said, "We have the expertise and already generate a tremendous amount of volume of sale. The exchanges are spending a lot of money to enroll people, which is all fine, but we could do the same thing at no charge to the federal government." The article notes that recently, Representative Emanuel Cleaver (D-MO), who chairs the Congressional Black Caucus, "wrote HHS Secretary Kathleen Sebelius, urging her to give states the flexibility to work with these websites." Tavenner Hearing Set For Tuesday; Confirmation Expected. Politico  (4/9, Haberkorn) reports that Marilyn Tavenner, "President Barack Obama's nominee to run the Centers for Medicare & Medicaid Services, will go before the Senate Finance Committee on Tuesday with potential for bipartisan support for her confirmation." According to the article, Tavenner "appears to have risen above the volatile politics of health reform to garner support - or at least not vocal, universal opposition - on Capitol Hill." If confirmed, "Tavenner would be the first leader at CMS to get through the Senate since 2004, when Republican Mark McClellan got Senate approval."         Modern Healthcare  (4/9, Daly, Subscription Publication) reports that although "senators are planning a bipartisan policy grilling of Marilyn Tavenner" Tuesday, "they're likely to move her toward becoming the first confirmed CMS administrator since 2006." As a Republican Senate aide said, "My understanding is that there's no opposition to the nomination on the Republican side. Republicans are expected to complain about a lot of things but ultimately vote for her." According to the article, this "represents a significant change for Republicans."         Bloomberg BNA  (4/9, Teske) notes that "Tavenner's chances have improved as anger over ACA has subsided somewhat. She also is highly regarded by many lawmakers and providers." Public Health and Private Healthcare Systems Some Look To Combining Medicare Deductibles To Lower Costs. Roll Call  (4/9, Ethridge, Subscription Publication) looks into one strategy sometimes floated to lower Medicare costs: combining the deductible for parts A and B, which supporters say would "modernize Medicare and make it easier for beneficiaries to get cost-effective care." The article examines how much this move would save the program and "the odds that lawmakers would rally behind it." Across US, Medicaid Expansion Decisions Progress. Medicaid expansion remains in the news, though no story today merits wide national attention. Still, progress in Ohio, where the GOP-led House has stripped expansion from its budget proposal, and Indiana, where a top Republican managed to block a bill that would force Governor Mike Pence to expand the program, garners significant regional coverage.         Ohio House Strips Medicaid Expansion Provision From Budget. The AP  (4/9, Smyth) reports that the Ohio House Finance and Appropriations Committee will "drop Gov. John Kasich's proposal to expand the Medicaid program from the state's two-year budget plan." A person "with knowledge of the budget negotiations confirmed to the AP on Monday that House lawmakers will strip the idea from their version of the state spending blueprint."         As the Columbus (OH) Dispatch  (4/9, Candisky, Siegel) puts it, "Ohio will forgo $13 billion in federal aid over the next seven years that would have paid to provide health care to thousands of uninsured Ohioans under a budget plan House GOP leaders will unveil Tuesday." The article continues, "Facing immense pressure from tea-party-affiliated groups, Republican leaders will strip Gov. John Kasich's proposed Medicaid expansion to cover 275,000 adults without health insurance, with the entire cost paid by the federal government under Obamacare for three years. It also would have saved Ohio taxpayers $400 million over the next two years."         Indiana Republican Blocks Move To Force Pence To Expand Medicaid. The AP  (4/9) reports that Indiana House Ways and Means Chairman Tim Brown (R-IN) "is blocking a measure that would force Gov. Mike Pence to expand Medicaid coverage in Indiana." The AP notes that "Pence said he preferred a Senate measure freeing him to do no expansion or possibly pay for an expansion with federal block grants." Pence, who "has proposed expanding Medicaid using the state's Healthy Indiana Plan," also indicated "he might reject that plan even if the Centers for Medicare and Medicaid Services approve the state's application."         Despite Perry's Reluctance, Texas GOP Seeking Alternative To Medicaid Expansion. The Texas Tribune  (4/9) reports, "Republicans who want to draw down billions in federal dollars to reform Medicaid and shore up the state's budget have been running in circles trying to find common ground between Gov. Rick Perry and the Obama administration and craft a 'Texas solution.'" However, "the party-line vote in the House on Thursday to reconsider legislative guidance on Medicaid expansion from the budget - even without an up-or-down vote on the substance - left the issue on life support." According to the article, despite jockeying between Perry, his health secretary Kyle Janek, and the Legislature, Texas remains at "square one."         Echoing this report, the Houston Chronicle  (4/9, Fikac) notes that "top GOP lawmakers are working to come up with an alternative to Medicaid expansion that would provide health care to more people and bring billions more to the state."         Scott Defends Medicaid Expansion Support As Debate Continues In Florida. The Palm Beach (FL) Post  (4/9, Abramson, Bennett) reports that in an interview Monday with the paper's editorial board, Florida Governor Rick Scott discussed his stance on Medicaid expansion, noting that it was a lower "legislative priority for him" than "boosting teacher pay and eliminating sales taxes on manufacturing equipment." Still, "he stood by his decision in February to support" expansion, saying, "It's the law of the land. While the federal government is going to pay 100 percent (of the expansion cost), I can't in good conscience deny people that don't have health care access."         Columnist Steve Bousquet discusses the continuing debate over Medicaid expansion in the Florida Legislature in a piece for the Tampa Bay (FL) Times  (4/9). He writes about a recent speech in which Florida House Speaker Will Weatherford expressed his disappointment that "Democrats agreed in advance to use the budget to make a statement of opposition over Medicaid." As Bousquet explains, "Weatherford sees Medicaid as an issue separate from the budget. Democrats see Medicaid as the budget issue - its single-most glaring omission."         Arkansas House To Consider Private Option Bill. The AP  (4/9, DeMillo) reports that the Arkansas state House is expected to begin considering the so-called "private option" for Medicaid expansion that the Senate approved Friday. This alternative would allow Arkansas to use Federal funding "to purchase private insurance" for residents under 138% of the poverty line. House Public Health Committee Chairman John Burris said of the plan, "This is about as far away from Medicaid expansion as you could possibly get."         HHS Signals Willingness To Grant Corbett Flexibility For Pennsylvania Medicaid Expansion. The Harrisburg (PA) Patriot-News  (4/9, Wenner) reports that a top official in Governor Tom Corbett's Administration said Monday that "the federal government seems willing to give" the governor the "flexibility he demands as a condition of any possible Medicaid expansion in Pennsylvania." Corbett is asking HHS for "permission to make changes to Pennsylvania's present Medicaid program, which he contends is financially unsustainable." Beverly Mackereth, the acting secretary for the Pennsylvania Department of Public Welfare, said, "They were very, very open to that. The people at (the Centers for Medicare and Medicaid Services) said we'll work with you."         Senator Indicates No Deal On Medicaid Expansion In Missouri. The St. Louis Beacon  (4/9) reports that "one week after discussing Medicaid expansion with House Republicans, Gov. Jay Nixon will sit down Tuesday morning with Republican members of the Missouri Senate to talk about the issue." However, "the meeting may not go too smoothly" after Sen. Tom Dempsey (R-MO) indicated on Monday "that Medicaid expansion may be dead for the session." According to another senator, "the Senate won't approve either an expansion of the program to 138 percent of the federal poverty level or a Republican proposal that passed out of a state House committee last week."         Mississippi Lawmakers Continue To Disagree About Medicaid Expansion. The AP  (4/9, Pettus) reports that Sen. David Blount (D-MS) and Rep. Andy Gipson (R-MS), "who spoke at a press luncheon Monday, disagreed about whether Mississippi should expand Medicaid, reflecting the partisan split that left the health program in limbo when the House and Senate ended their three-month session last week." Blount claimed that "adding an estimated 300,000 people to Medicaid - most of them working poor - makes sense because Mississippi would receive billions of federal dollars over 10 years, and that money would support health care jobs." However, Gipson countered that Mississippi "can't afford to pay its share of expansion, and he doesn't believe federal money is guaranteed."         Democrats Hope To Expand Medicaid In Michigan. The Detroit Free Press  (4/9, Gray) reports that, "as the state Legislature returns from a two-week spring break and begins action on the state's budget, House Democrats would like to repeal a tax on pensions, invest millions in education, and make investments in a film credit, brownfield redevelopment and historic preservation." Specifically, "to pay for the tax cut and incentives program, the Democrats would... accept $206 million in federal Medicaid expansion dollars." The Free Press notes that "the chances for inclusion of the proposals in the final budget package is slim," because "Republicans hold a 59-50 majority in the House and a 26-12 majority in the state Senate." North Carolina Terminates Medicaid Contract With Western Highlands Network. The Asheville (NC) Citizen-Times  (4/8, Ball) reports that North Carolina "is terminating its Medicaid contract with Western Highlands Network as of July 31, meaning mental health providers and Medicaid clients will have to go through another managed care organization." According to Charles Vines, Western Highlands Network board chairman, "the decision by the state came as a surprise." Senior Market News AARP Poll Shows Older Voters "Overwhelmingly" Oppose Proposed Switch To Chained CPI. AARP's recent survey, which found that more than two-thirds of older voters oppose changing the formula that is used to make cost-of-living adjustments in Social Security, veterans benefits, food stamps and other federal programs, continued to garner detailed coverage in a variety of television, print and online sources. The survey's findings are said to provide motivation and muscle behind AARP's push to defeat the proposed chained CPI anticipated in President Obama's forthcoming budget plan. AARP's Nancy LeaMond and Beth Finkel are again quoted in the coverage.         The Los Angeles Times  (4/8, Mascaro) reports that a survey released Monday by AARP shows older Americans "overwhelmingly resisting President Obama's effort to pare back cost-of-living adjustments for seniors, veterans and the disabled as part of his budget overture to the GOP." Nearly 70 percent of those age 50 and older oppose lowering the annual inflation adjustment, "including robust majorities of Republican, Democratic and independent voters." Seventy-eight percent oppose applying the reduction to veterans' benefits. AARP notes that 66 percent of older American voters "would be considerably less favorable to their representatives or senators if the member of Congress voted in favor of the proposal. 'This cut to Social Security would break the promise to seniors and hurt veterans who've sacrificed so much for this great country,' said AARP Executive Vice President Nancy LeaMond. 'As this survey shows, older Americans oppose the 'chained CPI' and they've historically made their opinions known to their elected officials.'"         AARP's LeaMond is similarly quoted in The Hill  (4/9, Viebeck) "Healthwatch" blog, which notes that she "denounced the proposal as a tax increase." The blog says "messaging from AARP, including Monday's poll, indicates that the powerful senior lobby will also flex its muscle against chained CPI." The survey, which was conducted March 19-20 and reflects the responses of 801 voters, "found broad bipartisan opposition to chained CPI among voters over 50, with 69 percent of Democrats, 60 percent of Republicans and 67 percent of unaffiliated voters in agreement that Congress should not support the policy." Overall, 87 percent of those voters oppose benefit cuts for today's seniors in order to reduce the deficit.         Bloomberg News  (4/8, Dorning) also quotes AARP's LeaMond, who "said in a statement [Monday] morning that members of Congress who back Obama's proposed reduction in the Social Security cost-of-living adjustment would risk alienating older voters." Uninsured ACA Taxes Aim To Encourage Uninsured To Purchase Coverage. The Fiscal Times  (4/9, Boak) reports, "Much of Obamacare's success hinges on whether a pair of new taxes can compel more Americans to have health insurance." In addition to taxes on medical devices and so-called Cadillac health insurance plans, the "two big ones" will "hit employers and consumers directly." Together, these taxes aim "to change the behavior of a projected 58 million uninsured." Growing Your Business Small Businesses Seeking Ways To Avoid ACA Cost Hikes. The Huffington Post  (4/9, New) carries a report based on Monday's Wall Street Journal story about the "drastic measures" small businesses will take "to avoid paying for basic health care coverage for their employees, including cutting hours and firing workers." As the WSJ article explained, "An increasing number of companies now say paying the government's penalty to break the law will be cheaper than following it." Still, the Huffington Post points out that, according to a recent Urban Institute study, "overall, the cost of implementing the Affordable Care Act may be less than many companies claim."         Similarly, the Kaiser Health News  (4/9, Hancock) "Capsules" blog reports on a new study from the Robert Wood Johnson Foundation and the Urban Institute which found that small businesses are showing "brisk interest" in "self coverage" in order to exempt themselves from some of the Affordable Care Act's "taxes, benefit rules and price reductions."         Hartford Business  (4/9, Bordonaro) reports that "more Connecticut employers are seriously considering a move to self-insured health plans as a way to bypass some of the extra costs and mandates from the federal health care reform law, industry experts say." However, these experts also say that if this trend "gains steam, it could create major issues for Connecticut's fully-insured marketplace and its insurance exchange, leaving insurers to compete for sicker, older patient populations deemed too risky by employers to self insure."         Some Experts Not Expecting Big Changes In Employee Coverage Next Year. The Indianapolis Business Journal  (4/9, Wall) reports that many "Indianapolis-area benefits brokers and attorneys who are helping employers" believe that these businesses are waiting to make big changes based on the law until its "changes play out after 2014." For example, Chris Sears, an employee benefits attorney, said, "In terms of making big, grand design changes, I get a real hesitance among employers to make those kinds of decisions this year." He continued, "I don't see many employers making radical changes this year." Another attorney, Katy Sowers, predicted the year will be "pretty anticlimactic in terms of wholesale change." Also in the News Burdick: Medical Advertising Drives Up Healthcare Costs. In an op-ed for the Baltimore Sun,  (4/8, Burdick) Dr. James Burdick, a professor of surgery at Johns Hopkins University School of Medicine, writes that advertising in the medical field is causing costs to climb higher. Dr. Burdick says that many test may not help a patient if they are not needed and "could even have some chance of decreasing" a person's life expectancy. He writes that this is "harmful profiteering" and that the ads themselves are also expensive. "The country can little afford the money spent by profitable hospitals, clinics and testing facilities to drive up their market share through advertisements" because it is "needed by our health care system to extend coverage that will keep people healthy and protected from medical bankruptcy, and to help the nation's finances," he says. Dr. Burdick claims that there are other developed nations which prohibit medical advertising and says that the practice needs to stop in the United States. Staten Island Doctor Convicted of Medicare Fraud. The AP  (4/9) reports that Dr. Gustave Drivas, 50, of Staten Island "has been convicted of participating in a $77 million Medicare fraud scheme." A Brooklyn jury convicted Drivas Monday "of health care fraud conspiracy and health care fraud following an eight-week trial. He was acquitted of kickback conspiracy." According to prosecutors, "Bay Medical Care, for which Drivas was listed on bank paperwork as president, paid cash kickbacks to Medicare beneficiaries and used beneficiaries' names to bill Medicare for more than $77 million for fraudulent and unnecessary medical procedures."

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