Monday, July 11, 2005

Federal Medicaid Commission Named; Former Tennessee Governor To Lead Panel
[Jul 11, 2005]

      HHS Secretary Mike Leavitt on Friday announced 13 voting members and 15 nonvoting members of a federal Medicaid commission that will be charged with recommending short- and long-term reforms to the program, the Memphis Commercial Appeal reports. The committee, created as a result of negotiations over the fiscal year 2006 federal budget, will be required to submit two reports. The first, which must be submitted by Sept. 1, will include recommendations on how to reduce Medicaid spending growth by $10 billion over the next five years. The second report, due Dec. 31, 2006, will include recommendations for stabilizing Medicaid over the long term, focusing specifically on "how to expand coverage to more Americans while still being fiscally responsible; ways to provide long-term care to those who need it; a review of eligibility, benefits design and delivery; and improved quality of care, choice and beneficiary satisfaction," Leavitt said (Locker, Memphis Commercial Appeal, 7/9).

Members
Former Tennessee Gov. Don Sundquist (R), who also served in Congress and now works as a lobbyist and consultant, has been appointed to lead the panel (de la Cruz, Tennessean, 7/9). Angus King, a former independent governor of Maine, was named vice chair (Pear, New York Times, 7/9). Other voting members of the panel include:

• Nancy Atkins, commissioner for the Bureau for Medical Services in the West Virginia Department of Health and Human Resources;
  


• Melanie Bella, vice president for policy at the Center for Health Care Strategies;
  


• Gail Christopher, vice president for health, women and families at the Joint Center for Political and Economic Studies and director of the Joint Center Health Policy Institute;
  


• Gwen Gillenwater, director for advocacy and public policy at the National Council on Independent Living;
  


• Robert Helms, a resident scholar and director of health policy studies at the American Enterprise Institute;
  


• Kay James, a former director of the Office of Personnel Management;
  


• Troy Justesen, deputy assistant secretary for the office of special education and rehabilitative services at the Department of Education;
  


• Tony McCann, secretary of the Maryland Department of Health and Mental Hygiene;
  


• Mike O'Grady, assistant secretary for planning and evaluation at HHS;
  


• Bill Shiebler, former president of Deutsche Bank; and
  


• Grace-Marie Turner, president of the Galen Institute (HHS release, 7/8).
  

Other Members
The 15 nonvoting members will provide advice to the voting members (New York Times, 7/9). According to CongressDaily, Leavitt also left open two positions on the commission for governors. Previously, the National Governors Association said it will not participate in the commission because it has offered its own recommendations. HHS noted that governors might participate in the commission when it begins to consider long-term changes after Sept. 1. The commission also likely will include several members of Congress, who will be appointed by party leaders. HHS said in May that eight nonvoting seats on the commission will be reserved for lawmakers. Democrats have said they will not participate in the commission, saying that a nonvoting advisory role is insufficient (Heil, CongressDaily, 7/8).

Criticism of Panel
According to CQ HealthBeat, the commission makeup was "criticized by most Democrats," who said it is not a bipartisan advisory panel. Rep. Jeff Bingaman (D-N.M.), who proposed the creation of the panel, said, "This is a long way from the bipartisan panel I had envisioned. Any report they produce is likely to be lopsided and therefore not a useful tool for Congress." Rep. Henry Waxman (D-Calif.) said the announcement "confirms that the purpose of the commission is to rubber-stamp the administration's failed Medicaid policies." Sen. Max Baucus (D-Mont.) said, "[S]ix weeks is not enough time for a commission to develop the thoughtful approach that was intended." Ron Pollack, executive director of Families USA, said the commission was "a sham that deserves -- and will receive -- no credibility." He added that Leavitt's announcement "reinforces our judgment that this commission is designed to promote pre-determined and very destructive Medicaid changes dictated by the Bush administration." One former Democratic aide said, "My overall reaction is congratulations. I bet I'm the only Democrat in town saying that." However, he added that the commission's recommendations will have only "minimal" impact on lawmakers, who are developing their own Medicaid reform plan (CQ HealthBeat, 7/8).

Criticism of Sundquist
According to the Times, Sundquist's "view of Medicaid is shaped by his experience with TennCare," Tennessee's Medicaid managed care program (New York Times, 7/9). Tennessee Democrats and patient advocates "blame" Sundquist, who was governor from 1995 to 2003, for many problems currently "plaguing TennCare, which is now undergoing massive downsizing," the Commercial Appeal reports. "TennCare's current struggles are directly related to the eight years of failing to effectively manage the program," Tennessee Sen. Roy Herron (D), said, adding, "During that time, many of us in both parties questioned the mismanagement and proposed changes" (Memphis Commercial Appeal, 7/9). State Sen. Doug Jackson (D), co-chair of the state Legislature's TennCare Oversight Committee, said, "It's the blind leading the blind. I'm in amazement that the White House does not know [Sundquist's] track record on Medicaid issues here, where he demonstrated a very shallow depth of knowledge. He left the TennCare program in a disastrous position. The decisions he made were fundamentally flawed." Michele Johnson, an attorney with the Tennessee Justice Center, said, "To say he was a Medicaid expert would be a stretch. It is startling -- breathtaking -- that he would be in charge of a Medicaid commission." State Sen. Randy McNally (R), said, "I think he was a good administrator, but TennCare -- Medicaid -- is a difficult program to deal with" (Tennessean, 7/9).

Reaction
Leavitt said, "In Washington and state capitols across America, there is consensus that now is the time to reform and modernize Medicaid. I look forward to having a robust conversation in an open and bipartisan manner with the commission members. Together with Congress and the states, we will create a plan that will better help Medicaid fulfill its commitment to quality care in a way that is financially sustainable" (HHS release, 7/8). Sundquist said, "I'm not in the blame business. We're going to work at solutions and trying to solve the problems" (Memphis Commercial Appeal, 7/9). He added, "We are trying to come together in a bipartisan effort to improve Medicaid, not destroy it" (Pear, New York Times, 7/9). Referring to his tenure as Tennessee governor, Sundquist said that he is particularly proud of his efforts to preserve TennCare coverage for children. HHS spokesperson Christina Pearson said that Sundquist has "dealt with many of the challenges we face on the local level," adding, "We are now facing those on a national level. He's very familiar and has hands-on experience working with the challenges we face. He brings a lot of qualifications that Secretary Leavitt has high respect for." Senate Majority Leader Bill Frist (R-Tenn.) issued a statement praising Sundquist's appointment, saying the former governor "will bring a unique perspective to the challenges facing the Medicaid program broadly" (Tennessean, 7/9).

Medicaid Planning Examined
In related news, the Times on Saturday examined how many elderly individuals or their relatives are working closely with attorneys to "figure out how to qualify" for Medicaid coverage of nursing home or other long-term care. According to the Times, the rules for qualifying for Medicaid -- created "before anybody anticipated today's exploding nursing home population" -- require potential beneficiaries and their relatives to use a "series of techniques for disposing of assets." Tools include giving money away to meet poverty guidelines or "spousal refusal," in which a spouse refuses financial responsibility for his or her partner to avoid becoming impoverished. But with nursing home care spending reaching $183 billion annually -- half of which is paid by Medicaid -- many of the techniques currently used to shelter assets "are likely to be restricted within a year," as states and the federal government seek to reduce overall Medicaid spending, the Times reports (Gross, New York Times, 7/9).

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