Medicare-Medicaid-Health Reform on Budget Cutting Block: Advocates, Docs Say Fight is On!

By Talib I. Karim, Esq., Health & Law Writer

August 16, 2011

Advocates for seniors, disabled, and the poor along with health providers are gearing up for a fight to convince Congress to protect Medicare, Medicaid, Health Reform (Photo Courtesy of AARP).

Through an 11th-hour deal, Congress recently avoided a potential “debt-magetton” — a predicted financial melt-down had the federal government defaulted on its debt by not raising its borrowing limit.

To be clear, the deal signed into law by the president on Aug. 2 contained no cuts to Medicare, Medicaid, and Social Security.  However, in exchange for the $900 billion debt-limit hike, $917 billion was axed in federal spending through capping discretionary budgets over the next 10 years.  This comes on the heels of $38 billion in federal cuts required by an earlier deal to avoid a government shutdown this spring.  While not directly affecting Medicare, Medicaid, and Social Security, these new cuts will no doubt impact health agencies responsible for critical components of social safety-net programs including the Department of Health and Human Services, the Food and Drug Administration, and the Health Resources and Services Administration (HRSA).

How Much Will it Hurt

 

The immediate cuts may be the least of worries for Medicare, Medicaid, and health reform advocates such as Dr. Cedric Bright, M.D. who leads the 30,000-member National Medical Association (NMA).  Dr. Bright is particularly focused on round two of the default-saving deal, which he fears could gut safety-net programs like Medicare and further stymie the landmark health reform law.

Under the deal-now-law, by year’s end, Congress is required to reduce the federal deficit by $1.5 trillion through one of two ways.

The first approach is via a newly formed Congressional bipartisan panel consisting of 12 members of both legislative chambers.  The special panel is charged with combing the entire federal budget to find savings and/or new revenues.  As far as cuts, even defense spending and guaranteed federal benefits (or “entitlements”) such as Medicare and Medicaid (long regarded as “sacred cows”) are on the chopping block.  Analysts with the law firm of Patton Boggs expect a Supercommittee deal to be painful for the nation’s health system.  “[Reductions] that would produce significant savings, including cuts to graduate medical education programs, home health providers, labs, rural hospitals, Medigap and Medicaid,” are likely targets for the budget-ax according to a Patton Boggs client update.

If this new committee cannot reach a consensus on at least $1.2 trillion in additional debt reductions by November 23 or if Congress does not approve a package recommended by this committee within 30 days later, a trigger automatically kicks in to guarantee the $1.2 trillion in federal deficit savings.  This mechanism, in the form of a federal sequestration process, would amount to across-the-board cuts in defense and non-defense spending over the next decade.  Included in these cuts would be a two-percent reduction in Medicare health provider payments.  Medicaid would not be affected by the trigger.

The president and some Congressional Democrats hope to avoid the cuts-by-trigger because the required deficit reductions would completely shield the wealthy from new taxes, which President Obama has spoken out against as he campaigns for re-election.

Similarly, Republicans don’t see the trigger as the ideal solution as it portends deep cuts to the military, the most significant since before the Bush presidency.  Sen. John McCain (R-AZ), the top Republican on the Senate Armed Services Committee described the possible military sequestration as “extraordinarily difficult.”

However amongst Progressives who generally opposed the deficit-deal, some such as Robert Creamer who writes for the blog Americans Against the Tea Party, suggest that the triggered cuts may be preferable to a supercommittee plan that could weaken  Medicare and similar programs.

Health Reform, Medicare Doctors in Bullseye of Budget Cutters

Either path to federal budget austerity threatens health care reforms created by the Obama Administration’s prized achievement, the Affordable Care Act.  Both deficit reduction approaches could zero-out funding for key health reform programs such as those supporting disease control efforts, initiatives to increase physicians of color, and aid for state health insurance exchanges.  At least two health reform programs have already been scrapped, a win for conservatives who have made the reforms their top legislative target.

Health providers are also caught in the cross hairs of both deficit reduction paths.  According to NMA’s Dr. Bright the anticipated reductions in health provider fees are “a double-edged sword” in light of the 29.5 percent Sustainable Growth Rate (SGR) formula’s cuts to Medicare physician payments set to kick in on January 1, 2012.  The NMA and others are working to include a full repeal of the SGR in the next budget deal, yet such a proposal would require $300 billion in offsets elsewhere.

The Fight for Medicare, Medicaid, Health Reform is On!

With the battle lines drawn between conservatives—set on dismantling Medicare and other safety-net programs and outright killing health reform initiatives—and care providers, progressives who see the nation’s growth and prosperity rooted in the health and well-being of its people, observers expect a huge fight in Washington over the next few months, with millions being spent to sway Congress in one direction or another.

And if the conservatives win, seniors and the nation as a whole will lose, “[because] doctors simply wont be able to afford to treat them…and the adage of cutting off our nose to spite our face could become a reality,”  says the NMA President Dr. Bright.

Profile of Health Industry Power-Broker: Dr. Cedric Bright, NMA President

By Talib I. Karim, Esq., Health & Law Reporter

Dr. Cedric Bright, MD, Assistant Dean for Admissions at University of North Carolina recently assumed the post as the 112^th President of the National Medical Association(NMA).  Dr. Bright spoke with me about the ongoing relevance of NMA and the group’s fight to protect Medicaid and Medicare, which he describes as “products” of the NMA.

The NMA has just wrapped up its annual convention in Washington, which I found quite informative.  From here, what are the top challenges facing the NMA today?

I would rank our challenges as follows: (1) the possibility of cuts to Medicare and Medicaid funding, (2) opposition to fully funding key provisions of the Affordable Care Act, the result of which would prevent those eligible for free health insurance from getting the care they need, particularly those who lose their jobs; and (3) cardiovascular disparity.

What’s cardiovascular disparity?

In 1999, the Institutes of Medicine reported that African Americans with similar health insurance as those from other ethnic groups received unequal health treatment.  One of the most egregious disparities identified was in the outcome of cardiovascular patients based solely upon their race.  Our goal is to decrease and eventually eliminate the gap of health outcomes between [European-American] and underrepresented [African American] populations.

In this environment of budget-tightening and consolidation, has there been any thought for a merger of NMA with other African American health professional organizations to expand your political and economic power?

We have explored such collaborations, but we’ve not yet been able to come to a mutually beneficial agreement.  However, many of our NMA local societies are mixed societies.

In my hometown, I’m a member of the Durham Academy of Medicine, Dentistry, and Pharmacy.  On the local level you see the value of combined economic and political power; it’s my hope to expand this collaboration on the national level.  For now, there’s nothing to stop us from collaborating with other African American health professionals to construct a common health agenda for our community.  That’s something that I would like to see during my presidency.

Some have asked whether African American organizations remain relevant in this era of the Nation’s first African American President, why should a young physician out of medical school join the NMA and is your organization still relevant?

Relevance is demonstrated in that we still have health disparity, which doesn’t dissipate based upon income.  You can have the same health insurance but different outcomes from your colleague who does not look like you.

In addition, the medial profession is still fraught with institutional barriers that impact the development of African American physicians.  Evidence of this is found in the number of professors in academic medicine, compared to the junior faculty (assistant professors and clinical assistants) who are unlikely to be promoted.  Let’s also look at health care professionals in administrative positions in hospitals, the number continues to hold stagnant and has not grown.

It’s a fact that 70% of successful Black physicians face a challenge in their careers that jeopardize their ability to practice their profession.  From frivolous law suits to sham peer reviews.

Third, look at our economic condition, which is connected to our health condition.  A recent PEW study showed that in 2004, net worth at of white families stood at $134,000, compared to $12,000 for African Americans.  By 2009, the average net worth of the white family dropped to $113,000 and the black family dropped to $5600, Latinos fared a bit better at $6300.  For every one dollar in net worth black household had $.05.

Even with a Black President we still are economically disadvantaged and your wealth is determinative of your health.  Your zip code can tell more about your life expectancy than your genes.

The NMA was founded in 1895, what accomplishments stand out most over its history?

By far, it’s our role in establishing Medicaid and Medicare 46 years ago.  The NMA lobbied LBJ [President Johnson] for these initiatives when other professional organizations lobbied vehemently against them.  We understood the value in taking care of our seniors and other vulnerable populations understanding the strength of a nation is only as strong as its weakest links.

What legacy do you intend to leave from your term as President?

I hope to leave a legacy of expanded collaborations between the NMA and other African American health organizations and to bridge gaps between the generations.  I gave a lecture to the Student National Medical Association.  I asked the students how many had to drink from a white-only water fountain.  My generation’s realization that we were different from our white colleagues served as the tie that bound us.  That’s not the tie that binds this new generation of physicians.

We have to build relationships with younger professionals so when they start to be affected by professional barriers they will view NMA as a source of advocates and champions.

Dr. Cedric Bright, serves as Assistant Dean for Admissions at University of North Carolina and also leads 30,000 African American physicians as the newly inducted President of the National Medical Association (courtesy)