Congressional Documents
GAO report finds Medicare demonstration project ineffective
Posted on April 23, 2012
According to a new Government Accountability Office (GAO) report, Medicare is spending $8 billion on an experimental program that rewards providers of less than stellar health care. The report recommends that the Obama administration cancel the demonstration program, which pays bonuses to health insurance companies caring for millions of Medicare beneficiaries. The administration defended the project, arguing that it could improve care quality for older Americans. The Affordable Care Act (ACA) cut Medicare payments to managed care plans, known as Medicare Advantage (MA), and authorized bonus payments to those that provide high-quality care. However, the GAO letter reports that the majority of the money paid under the demonstration program went to “average-performing plans” rated lower than Congress’s benchmarks. GAO reported that the project would cost $8.35 billion over 10 years, with 80 percent of the cost occurring in the first three years. Although the project dwarfs other Medicare demonstrations in its budgetary impact, the GAO report found that the project is so poorly designed that researchers could not determine whether the bonus payments correlated with improved care. As a result, the report argues, the project is unlikely to produce meaningful results. Currently, over 12 million Americans are enrolled in MA plans. About one-third of them are in plans that would receive bonuses under the original ACA. Under the demonstration project, 90 percent are in plans eligible for bonuses.
Another report released the same day by…
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CRS releases two new reports
Posted on April 23, 2012
The Congressional Research Service (CRS) recently published two reports, one of which covers statistics on teenage pregnancy prevention and the other of which reviews factors affecting long-term care insurance demands.
The report on teen pregnancy examines data collected…
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CRS publishes report on ACA litigation resources
Posted on March 23, 2012
In March 2010, Congress passed P.L. 111-148, the Patient Protection and Affordable Care Act of 2010 (ACA), and amended it by passing P.L. 111-152, the Health Care and Education Reconciliation Act of 2010 (HCERA). Subsequently, lawsuits were filed in multiple courts challenging various aspects of the new law. Many of these cases were heard in the district courts and a few were appealed to appellate courts. In November 2011, the Supreme Court granted three petitions for certiorari in one of these cases and later scheduled oral arguments for March 26-28, 2012. This report contains resources for retrieving background information and selected legal material relevant to these cases. It also includes information on Congressional Research Service (CRS) experts and products to assist in understanding the legal and policy issues related to the act.
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CRS releases report on federal health center program
Posted on March 21, 2012
The federal health center program, authorized in Section 330 of the Public Health Service (PHS) Act, awards grants to support health centers: outpatient primary care facilities that provide care to primarily low-income individuals. The program—administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS)— supports four types of health centers: (1) community health centers; (2) health centers for the homeless; (3) health centers for residents of public housing; and (4) migrant health centers. According to HRSA data, there are over 8,633 unique health center sites (i.e., unique health center facility locations). Facilities must meet a number of requirements to receive a Section 330 grant, but receiving these grants enables health centers to receive services or in-kind benefits from a number of federal programs.
This report released by the Congressional Research Service (CRS) provides an overview of the federal health center program including its statutory authority, program requirements, and appropriation levels. The report then describes health centers in general, where they are located, their patient population, and some outcomes associated with health center use. It also describes some federal programs available to assist health center operations including the federally qualified health center (FQHC) designation for Medicare and Medicaid payments. The report then concludes with a brief discussion of issues for Congress such as the potential effects of the ACA on health centers, the health center workforce, and financial considerations for health centers in the context of changing federal and state budgets. Finally, the report has two appendixes that describe (1) FQHC payments for Medicare and Medicaid beneficiaries served at health centers; and (2) programs that are similar to health centers but not authorized in Section 330 of the PHS Act.
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CBO updates cost estimates of ACA
Posted on March 13, 2012
The Congressional Budget Office (CBO) released today an update on the budgetary impact of the Affordable Care Act (ACA). Although overall projections are similar to those released in prior years, there are several important changes in this year’s updated estimates. For example, in March 2010 when the ACA was enacted, CBO estimated that the number of uninsured individuals would fall by 32 million by 2019. Now CBO estimates that the number will only fall by 31 million by 2019, but by 33 million by 2022.
The projections regarding health insurance coverage has also changed…
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GAO report finds Medicare covered preventive services do not always align with clinical recommendations
Posted on February 18, 2012
According to a report released by the Government Accountability Office, Medicare coverage of preventive services is not consistently aligned with recommendations by the U.S. Preventive Services Task Force. Preventive care services have the potential to improve health outcomes and lower health care expenditures. Thr report examines (1) whether preventive service use by Medicare fee-for-service (FFS) beneficiaries aligns with recommendations from the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices (ACIP), (2) use of the Welcome to Medicare (WTM) exam and its association with use of preventive services, (3) preventive service use in Medicare Advantage (MA) relative to FFS, and (4) service use among MA health maintenance organizations (HMO) and efforts by high-performing HMOs to encourage preventive care. To do this, GAO selected eight preventive services that had Task Force or ACIP guidelines for the general Medicare population. GAO analyzed the most recently available data from Medicare claims, a beneficiary survey, and MA plan ratings. GAO also interviewed representatives of selected HMOs.
GAO recommends that Congress consider…
GAO report suggests HHS address contractor performance and plan for needed measures
Posted on January 30, 2012
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed the Department of Health and Human Services (HHS) to enter into a 4-year contract with an entity to perform various activities related to health care quality measurement. In January 2009, HHS awarded a contract to the National Quality Forum (NQF), a nonprofit organization that endorses health care quality measures—that is, recognizes certain ones as national standards. In 2010, the Affordable Care Act (ACA) established additional duties for NQF. This is the second of two reports MIPPA required GAO to submit on NQF’s contract with HHS. In this report—which covers NQF’s performance under the contract from January 14, 2010, through August 31, 2011—GAO examines (1) the status of projects under NQF’s required contract activities and (2) the extent to which HHS used or planned to use the measures it has received from NQF under the contract to meet its quality measurement needs, as of August 2011. GAO interviewed NQF and HHS officials, reviewed relevant laws, and reviewed HHS and NQF documents.
GAO recommends HHS: (1) use all monitoring tools required under the contract to help address NQF’s performance, (2) complete testing of retooled measures, and (3) comprehensively plan for its quality measurement needs. HHS neither agreed nor disagreed with these recommendations. NQF concurred with many of the findings in the report and provided additional context.
GAO compares PCIP implementation with CHIP
Posted on December 15, 2011
The U.S. Government Accountability Office (GAO) has issued a report comparing the early stages of the federal Pre-Existing Condition Insurance Plan (PCIP) with the Children’s Health Insurance Program (CHIP). The federal PCIP was authorized by the Affordable Care Act (ACA), and is intended to provide insurance for individuals with previously existing medical conditions who have been unable to obtain health insurance coverage for at least 6 months. GAO was tasked by the Senate with comparing early enrollment and implementation across both PCIP and CHIP. GAO found that like CHIP, enrollment in PCIP was slow in the beginning, but increased over time. GAO also found that enrollment in PCIP was generally lower in States that had high risk pools than in States that did not.
For more information on pre-existing conditions, click here.
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CRS issues report regarding presidential power over the ACA
Posted on November 15, 2011
On November 14, 2011, the Congressional Research Service issued a memorandum regarding the extent to which a President, through use of an executive order or other administrative actions, could impact provisions under the Affordable Care Act (ACA). The report confirms that while the President would be able to alter certain regulations, a “President would not appear to be able to issue an executive order halting an agency from promulgating a rule that is statutorily required by PPACA, as such an action would conflict with an explicit congressional mandate…” CRS examined the issue for Republican Senator Tom Coburn of Oklahoma, finding that federal courts would frown upon any attempt to undo White House legislation.
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GAO recommends automatic increases in FMAP
Posted on November 10, 2011
A recent Government Accountability Office (GAO) report introduces a prototype formula to provide states with temporary Medicaid assistance during national economic downturn. Once a threshold number of states–26 in the GAO formula–demonstrate a sustained decrease in their employment-to-population ratio, temporary increases to the Federal Medical Assistance Percentage (FMAP) will be automatically triggered under the GAO plan. This assistance will end when fewer than the threshold number of states show a decline in the ratio. Targeted state assistance would be calculated based on 1) increases in unemployment, as a proxy for changes in Medicaid enrollment; and 2) reductions in total wages and salaries, as a proxy for changes in states’ revenues. Such assistance would facilitate state budget planning, provide states with greater fiscal stability, and better align federal assistance with the magnitude of the economic downturn’s effect on individual states.
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