Commonwealth Fund Report Examines U.S. Health Care Spending, Outcomes

The United States spends more per person on health care than other wealthy countries, but often has worse health outcomes, according to a new report from the Commonwealth Fund. The United States spent $9,086 per person on health care in 2013. Among a comparison group of 12 other wealthy countries, the next closest to the U.S. in health spending was Switzerland, which spends $6,325 per person. Despite ranking above the other 12 countries in spending, the life expectancy in the U.S. is 78.8 years, the lowest in the comparison group. Switzerland has a life expectancy of 82.9 years. The U.S. also has the highest percentage of people age 65 or older with two or more chronic conditions.

Reconciliation Advanced by House Budget Committee

On Friday, the House Budget Committee approved a reconciliation bill by a 21-11 party line vote. The bill would reduce the deficit by $78.9 billion over the next decade, but add at least $5 billion to the deficit in each of the four decades following 2025. It would partially repeal the Affordable Care Act (ACA) and would redirect funds for Planned Parenthood to community health centers for a year. The reconciliation bill would repeal the individual and employer mandates, defund the Prevention and Public Health Fund, and repeal a future requirement for large employers to automatically enroll their employees in health insurance plans. While several elements of the bill have bipartisan support – such as repeal of the medical device tax, the Cadillac Tax, and the Independent Payment Advisory Board (IPAB) – reconciliation will likely face strong opposition by Democrats. Additionally, the Senate’s “Byrd rule” permits a point of order against a reconciliation provision that would increase the deficit during the years following the budget window or is considered “extraneous matter” not impacting the budget. While it only requires a simple majority to pass a bill under reconciliation, it takes 60 votes to overcome a point of order raised against a violation of the Byrd rule. The reconciliation bill is expected to pass the House in its current form, and any changes necessary to comply with the Byrd rule would be handled by the Senate. If it is cleared by Congress, the President is expected to veto the bill. The bill could be considered on the floor soon after the House returns from its week-long recess.

Meaningful Use Final Rules Released

Last week, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the Meaningful Use electronic health records (EHR) program. The rule makes a number of changes to the program, such as allowing providers to apply for hardship exemptions. The final rule does not, however, delay the implementation of Stage 3, the final stage of Meaningful Use. Chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee Lamar Alexander (R-Tenn.) was angered by the release of the final rule. He has pushed for a delay to the EHR incentive program until no earlier than January 1, 2017. Alexander has asserted that Congress will review the rule, and consider fixing it through legislation or overturning it through the Congressional Review Act. The administration “missed a golden opportunity to develop bipartisan support in Congress and throughout the country for an electronic health records system that would genuinely help patients,” Alexander said. “Instead, they’ve rushed ahead with a rule against the advice of some of the nation’s leading medical institutions and physicians.” The final rule allows for a 90-day period for additional comment.

Brown Introduces Medicare Advantage Network Legislation

Sen. Sherrod Brown (D-Ohio) has announced plans to reintroduce legislation with Sen. Richard Blumenthal (D-Conn.) that would keep Medicare Advantage networks intact for a full year following the open enrollment period. The bill would only allow Medicare Advantage plans to drop providers from their networks under extraordinary situations, such as criminal behavior on the part of the provider or an inability to provide care to patients. Additionally, plans would have to determine their provider networks at least 60 days before the open-enrollment period. Rep. Rosa DeLauro (D-Conn.) is expected to introduce the companion bill in the House.

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