Health on the Hill

Capitol Health Group has clients from many sectors of the health care industry.  We specialize in Medicare and Medicaid coverage and payment issues as well as private sector health care initiatives.  Our work includes both legislative and regulatory activities.  Listed below are some of the issues we follow through the regular course of our business. 

Cloning
Research in this arena is producing numerous scientific breakthroughs, including promising therapies for diseases such as Alzheimer's and diabetes, as well as tissue replacement for the body.  At the heart of this research is the ethical debate on using fetal stem cells as a basis for study and discovery.  Also of great concern are the ethical implications of human reproductive cloning.  Issues in the debate include:  a complete ban on cloning, heavy criminal consequences on human cloning, bans on the importation or collection of stem cells not grand-fathered for research, bans only on reproductive cloning, legal cloning under strict guidelines or moratoriums on the use of cloning.

Drug Costs
As health care costs continue to increase, prescription drug purchasers – including individuals, employers, and public program managers – are utilizing a wide variety of mechanisms to slow the rate of growth in their prescription drug spending.  These cost control mechanisms, the ability of individuals to cross international borders and purchase drugs, and the increased focus on the cost of prescription drugs in price controlled countries have combined to make the issue a prime target for legislative action.

Health Insurance Access
Varying approaches to helping the uninsured gain health care access is a complicated and contentious issue.  Some believe the best solution is for the government to offer a refundable tax credit enabling purchase of individual insurance policies.  Some feel the government should directly subsidize premiums.  Some think the government should temporarily broaden the criteria for Medicaid so more people are covered, while others feel offering states grants for health coverage expansion programs are the best solution. 

Increasing Health Insurance Costs
Increasing health care costs have led employers to revise their health insurance plans offered to their employees.  Employers believe employees should shoulder more health care costs through increased co-pays, tiered prescription prices, and higher deductibles.  Payers also have significant concerns about the cost of coverage mandates that further drive up the cost of insurance.  Additional initiatives offered by health care plans are aimed more towards strategies for disease management, patient management, and coordination of medical and pharmaceutical expenses. 

Medical Malpractice Reform
Physicians are being forced to severely limit their practice, join with larger hospital groups or retire from their practices because of rapidly increasing insurance premiums.  Physicians and insurers argue that premiums have skyrocketed due to large jury settlements in medical malpractice cases and the rising costs of health care.  Initiatives being debated include capping the awards given in malpractice cases, limiting attorney fees, and prohibiting contingency fees. 

Medicare Modernization
Reform and modernization of Medicare remains one of the most controversial issues facing Congress.  While legitimate problems exist and are recognized within the Medicare program, the two parties offer dramatically different approaches to improving the system. 

Medicare Regulatory Reform
There will be a continued focus on eliminating overly burdensome regulations, which cost Medicare provider’s significant financial resources, without improving the quality of the service they provide. Targets for reform of Medicare regulations include, appeals, recovery, and overall contracting. 

Medicare Prescription Drug Benefit
The Medicare Prescription Drug Act was passed in the 108th Congress.  Initial efforts will be focused on getting the new Medicare discount card and the low-income benefit up and running by early summer.  Several payment changes and updates will follow into the fall and then efforts will focus squarely in implementing the new drug benefit in 2006.

Patients’ Bill of Rights (PBOR)
Unresolved items has held up a compromise between parties in the past.  These issues include whether or not to link patient protections and proposals, how to expand court access to patients and the monetary caps on court awarded damages.

Waste, Fraud & Abuse
As Medicare and Medicaid become increasingly more expensive programs; their managing agencies will increase their oversight and enforcement efforts against all health care providers receiving reimbursement.  At the same time, government watchdogs are increasing efforts to assure quality and safety.

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