Health overhaul raises stakes for Medicare job
WASHINGTON (Reuters) - The healthcare overhaul moving through Congress elevates the job of running the government's $700-billion Medicare agency to new heights and all but guarantees a political battle over filling the post.
The Centers for Medicare and Medicaid Services (CMS), which oversees the government's health insurance programs for the elderly, disabled and poor, would emerge with more power over the insurance sector and could oversee a new public health insurance plan.
But the Obama administration has yet to nominate a leader for the Centers for Medicare and Medicaid Services (CMS) and shows no sign of offering an appointee while tensions are high over the final shape of the legislation.
President Barack Obama has already tapped leaders to head other major federal health agencies -- the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health.
But his choice for CMS is certain to face tough questioning from Republicans who have criticized reform legislation and are unlikely to back the final plan.
If Democrats successfully pass legislation to overhaul the nation's health care system, CMS could see its role swell as overseer of a potential public insurance option. CMS could also see its workload increase with various Medicare payment changes and an expansion of eligible Medicaid patients.
"CMS is really the only operating division at the department that knows anything about insurance," said Leslie Norwalk, who served as an acting administrator for CMS during the last Bush administration. The agency "naturally would be the place to implement any expansion of access."
One name that has circulated in Washington as a potential head of CMS is Liz Fowler, a senior aide to Senate Finance Committee Chairman Max Baucus. Fowler returned to Capitol Hill in February to help draft the healthcare reform legislation.
A lawyer who competes in triathlons, Fowler also has industry experience from serving as a vice president at WellPoint Inc (WLP.N). Other names surfaced earlier in the year but have since faded amid the fight over health reform.
Fowler had no comment on whether she was in the running for the job. The White House also had no comment.
BIGGER THAN PART D
While the top job remains vacant, CMS is being run by Acting Administrator Charlene Frizzera, former chief operating administrator of the agency. Whoever takes over from her will face some of the biggest changes the agency has seen in years.
The last time CMS saw such an expansion was in late 2003 when Congress passed Part D, Medicare's prescription drug program that allows private companies to offer cover medication costs with CMS oversight.
Under current reform proposals, the agency would likely handle more than just oversight of private companies, taking on an entire new responsibility of regulating the multibillion dollar U.S. health insurance industry.
Insurers now are governed by state rules that vary widely. Healthcare reform bills would impose national regulations over everything from eliminating discrimination to out-of-pocket costs. A government-run insurance plan, which would compete against private companies, could also fall under CMS's watch.
"Part D was just a drug benefit folded into an already existing program. This healthcare reform bill... is going to require the creation of a whole new infrastructure," said Kim Monk, an analyst with Capital Alpha Partners.
Additionally, the nominee will face pressure from an aging U.S. population and looming financial woes, with Medicare's trust fund expected to dry up by 2017 unless drastic changes are made.
While markets crave certainty, investors are not so worried about the CMS vacancy since whoever gets the job will have to carry out the legislation.
"It's not like there's an empty CEO slot at a big health care company," said Tom Carroll, an analyst at Stifel Nicolaus.
REPUBLICAN HOLD?
Obama's pick to lead CMS would first have to pass muster with the Senate Finance Committee. The Democratic-led panel saw a deep party-line division in advancing its version of the reform bill, with just one Republican voting in favor of it.
Republicans have already threatened to block several other lower level health officials in the wake of a CMS dispute with Humana Inc (HUM.N) last month.
CMS is investigating a letter Humana sent to customers enrolled in its private Medicare Advantage plans, a move Republicans immediately challenged. The letter, tucked inside an envelope touting important plan information, warned that Democratic health bills could reduce benefits.
A spokeswoman for the committee's top Republican, Charles Grassley, who voted against the committee's health bill, said placing a hold on any nominee is always a possibility.
Grassley, speaking last week at the Reuters Washington Summit, said he wanted a CMS nominee with medical expertise but had no specific person in mind. Representatives for Baucus did not reply to requests for comment.
Whoever takes the top CMS job will face tough scrutiny from lawmakers, the public and others in carrying out reforms mandated by Congress while keeping an eye on dwindling funds.
"The person who gets into that role is going to really be under the microscope," said Stifel Nicolaus' Carroll. "That makes it even that much more difficult and even that much more important to find the right person."
(Reporting by Susan Heavey; Editing by Julie Vorman and Tim Dobbyn)
Source: Reuters
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'I'd like a myocardial infarction with extra pickles, a side of diabetes and a super-sized colon tumor, to go."That may not be what Americans are ordering when they pull up to the drive-in window at the local fast-food joint, but it's what an alarming number are getting. Obesity, and the serious health conditions that result, are rising sharply in the U.S., in part because portion sizes and fat content at restaurants are growing as fast as our waistlines. Food choices are a matter of individual preference and not something the government can or should oversee. On the other hand, society is facing a large and growing burden because of the bad choices made by some, and as Congress looks to increase that burden on taxpayers by reforming the nation's healthcare system, it's also looking to play a bigger role in controlling health costs. The upshot: The food police may soon be coming to an Arby's near you.Among the many provisions of the sweeping healthcare reform bill being considered by the Senate is a requirement that chains with more than 20 restaurants operating under the same name must post the calorie counts of all their dishes on their menus. A similar law is already on the books in California, where chains must comply by 2011; New York City also has one, and other states and cities will probably follow suit in the absence of federal action.Though the calorie-count rule is only a tiny part of the healthcare reform proposal, it brings up surprisingly controversial and complex issues -- illustrated by the fact that it has provoked a food fight in the restaurant industry, with the National Restaurant Assn. supporting the provision, while a splinter group of 21 big restaurant chains wants it amended. What's beyond dispute is that obesity is expensive, and not just for the obese. Last month, the journal Health Affairs published a study showing that the medical costs of obesity have nearly doubled since 1998, to $147 billion last year, about half of which was financed through Medicare and Medicaid. Obesity accounts for 9.1% of national healthcare spending, according to the study, up from 6.5% a decade ago. The costs are rising because Americans are getting fatter. The average citizen is now 23 pounds overweight, according to the Centers for Disease Control and Prevention, and obesity rose by 37% between 1998 and 2006.We're under no illusions that posting calorie counts on menus is the miracle-diet solution to the country's weight problem. Nobody goes to Taco Bell expecting to get health food; some consumers will pay no more attention to the calorie information than they do to the nutritional labels on packaged foods. Yet those labels do make a difference for many people, and although savvy consumers can already find health statistics on common fast-food menu items by checking websites that track them, the group that is least likely to access this kind of information -- people from low-income and minority communities -- is also the group that's most at risk of obesity. The calorie-count mandate would not only give people information that's vital to protecting their health, it would encourage restaurants to offer low-cal alternatives.The compliance costs are small. Software is available for as little as $20 that can calculate the calorie tab for meals, based on their ingredients. Chains would have to reprint their menus or add numbers to the menu boards above the counter, but that's hardly a budget-buster. The real worry for the eateries is that if consumers discovered, for example, that a Low-Carb Breakfast Bowl at Carl's Jr. (which sounds like a diet-conscious choice) has a whopping 900 calories, they might not buy it, forcing the company to create new offerings -- and that could indeed turn out to be expensive. To which we respond: tough luck.The chains also argue that they're being unfairly singled out. There are many companies that would be exempt because their restaurants operate under different names and offer different menus. The L.A.-based Patina Restaurant Group, for example, takes in $200 million a year and operates 60 outlets, but because they're not all called "Patina," it's off the hook. The big chains want the calorie rule to apply to any restaurant company with more than $1 million in annual revenues. That would certainly be more fair, but it wouldn't do a thing for American gastronomy. 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