Council News

April 14, 2011

Tavenner Talks Reform (Nashville Medical News)

Tavenner Talks Reform (Nashville Medical News)
by Cindy Sanders, Nashville Medical News | Apr 14, 2011

On Tuesday, March 22 – one day shy of the first anniversary of the Patient Protection and Affordable Care Act being signed into law – Centers for Medicare & Medicaid Services Principal Deputy Administrator and Chief Operating Officer Marilyn Tavenner updated local healthcare executives on progress in implementing the nation’s sweeping, but controversial, reform mandates.

The high-ranking federal official touted progress and defended elements to an audience of more than 300 at Belmont University’s Curb Center as part of the Nashville Health Care Council’s ongoing series on health reform. Tavenner, an alumnus of Nashville-based HCA, spent four years as secretary of Health and Human Services for the Commonwealth of Virginia before joining CMS in 2010. As second in command, she has oversight of the federal agency’s $700 billion budget.

Prior to passage of the Affordable Care Act (ACA), Tavenner said there were three main issues President Obama and Congress hoped to resolve. “First was to ensure that all Americans would have access to quality care. The second thing was to build a health insurance marketplace that was fairer, that was more affordable and that was consumer oriented. And the third … and the one that often gets lost in the dialogue … was to ensure that Americans are getting maximum value for their healthcare dollar … that is better care for individuals and better health for the nation.”

Working toward full implementation, Tavenner said CMS has a very clear strategic plan. “But,” she continued, “it’s a five-year path that cannot be done without everyone in this room. It’s not a ‘government only’ project. It’s going to require the government; it’s going to require states; and it’s going to require the private sector all working together.”
Looking back on the last 12 months, Tavenner admitted ACA, like most new acts, had seen its share of ups and downs. “Working with you all, we want to continue to improve the access, improve the act. And I think the president has been very clear that he is willing to modify and make adjustments … work with Congress to make changes as we go forward,” she said.

Tavenner added that in this first year of ACA several things have already happened. “First of all, the sky did not fall, and government did not take over healthcare,” she said, garnering a chuckle from the audience. “This certainly came as a surprise to many Americans given the heated rhetoric that has accompanied healthcare reform.” She added officials throughout HHS understand the bill “has created a great deal of confusion and with it much anxiety and unease.” The latest Kaiser Family Foundation Tracking Poll confirmed the sentiment with its finding that 53 percent of Americans said “confused” best describes their feelings about the law.

While the American public might still be seeking clarity, Tavenner said she felt very optimistic about the law. One of the mandates was to improve access to prescription drugs for Medicare beneficiaries. “We were attempting to lower the costs to those who fall in the infamous doughnut hole,” she said. “In the first year, we have sent $250 rebate checks to almost 3.8 million people.” In Tennessee, 86,685 seniors have received checks. By 2020, the coverage gap for Part D is to be closed. “Beginning Jan. 1 of this year, however,” Tavenner continued, “drug companies must offer a 50 percent discount on covered brand name drugs sold to seniors in the doughnut hole, and seniors will pay 7 percent less for generic drugs.” Tavenner was quick to add this was due in part to ACA but also in part to pharmaceutical companies stepping up to offer private support, as well.

Preventive care is another area where ACA has begun to make a difference. Beginning this year, there is no longer a co-pay or co-insurance for Medicare recipients on many preventative services, and a free annual physical was added to Medicare benefits. Tavenner said in the first two months of 2011, more than 150,000 seniors had taken already advantage of the physical. She added the expectation is to begin paying physicians for counseling services around issues such as tobacco cessation and flu vaccines. “We’re also beginning to pay for bone density, diabetic coverage, cardiovascular problems and many of the common types of cancer screenings … again without a deductible or co-pay.”

Another key element is covering the uninsured. A centerpiece of ACA was to provide access to coverage for more than 30 million of the nation’s 50 million uninsured. Working with insurers, protections under the new Patient’s Bill of Rights were developed and implemented effective Sept. 23, 2010. Protections include eliminating pre-existing conditions for children under 19 as exclusions to coverage and doing away with lifetime caps on benefits. Additionally, ACA now allows parents to carry young adults on their policies until the age of 26.

A number of temporary programs have been created to expand access. PCIP – Pre-Existing Condition Insurance Plan – has $5 billion to provide coverage or assistance to those who have previously been denied. “It’s designed to build a bridge until 2014 when all Americans, regardless of their health status, will have access to coverage through their employer or through competitive marketplaces called the exchange,” she said.

Tavenner added several billion dollars has already been awarded to states in the form of grants to assist in creating programs tied to reform. She also recognized the financial pressure states are under with tight budgets in a weakened economy and acknowledged the concern states have over expanding Medicaid by 2014. “One thing I want to emphasize is that from 2014 to 2019, you’ll see the state share is very small and that the federal government is covering most of the Medicaid expansion. And that was by design in order to give states some relief,” she said.

By 2019, Tavenner said the vision is to pick up 32 million in insured lives. The belief is that approximately half of those would be covered under the expanded Medicaid rolls with the other half qualifying for exchange tax credits. To care for these new patients, Tavenner said there is nearly $2 billion in the budget for training and education to expand the healthcare workforce by more than 30,000.

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