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March 24, 2019

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State’s physician-congressman talks shop at Nevada Health Forum

Rep. Joe Heck says Medicare reimbursements, health exchanges top his list of concerns

health care ruling joe heck


Rep. Joe Heck, R-Nev., speaks during the GOP Doctors Caucus news conference in response to the Supreme Court health care ruling in Washington, June 28, 2012.

Rep. Joe Heck, speaking Tuesday morning at the annual Nevada Health Forum, offered his perspective on the future of health care and cited his top three issues facing the nation’s medical industry.

The osteopathic physician who is seeking a second term in the U.S. House against Democratic challenger John Oceguera said his biggest concerns were implementation of the Affordable Care Act, Medicare reimbursement rates and the aging of the U.S. health care workforce.

Heck, a member of the congressional GOP Doctors Caucus, said he was worried about the Silver State Exchange, Nevada’s version of the health care exchanges required under the Affordable Care Act (Obamacare) that are intended to provide insurance options to consumers with easily comparable rates. Heck said he had “great concern” over the public’s ability to make a good decision based on information provided at a state website.

“This isn’t like going to the Best Buy website and picking three large-screen TVs and lining them up and comparing, you know, how many inputs they have, what kind of stereo speakers they have. I mean this is really complicated stuff for the average individual,” Heck said. “And so there has been talk of having navigators, somebody that people are able to call to ask questions about the policies they may bring up on the website to determine what policy is best for them. The question is: Who is that navigator? Is it someone who has worked in the health insurance industry, or is it an entry-level government employee who’s got the same screen in front of them and they’re trying to answer the questions?”

Heck also expressed concern that as the nation turns its attention to lowering health care costs, physicians will be squeezed as the government reduces reimbursement rates.

First, he said the independent payment advisory board, established by the Affordable Care Act to suggest ways to control the rate of growth of Medicare if expenditures exceed certain targets, would have to turn to cuts in reimbursements because its mission precludes recommendations that increase premiums or limit services.

The board is charged with making broad policy recommendations for keeping Medicare costs under certain targets, which can include reductions in the amount the government pays health care providers for services. Congress is not bound by the board’s recommendations, and cost-cutting measures also could include reducing payments to hospitals with abnormally high rates of re-admissions. Recommended reductions also could include innovations or efficiencies that cut wasteful spending. Payments to hospitals and hospices cannot be cut until 2020, and the board is obligated to make recommendations that enhance access to quality care for beneficiaries, under federal law.

Next, Heck took aim at the sustainable growth rate, a measure approved by Congress in 1998 to control Medicare costs. The government sets yearly and cumulative spending targets for Medicare. If spending in a given year exceeds the target, reimbursement rates are adjusted downward. However, Congress has routinely stepped in to prevent reimbursements rates from going down.

“I don’t think there is any single greater threat to Medicare than (the sustainable growth rate). It’s been kicked down the road for the last 20 years, it will be kicked down the road in the lame-duck session. Because if the cuts that were mandated to take place would take place on Jan. 1, you’re looking at a 30 percent cut in Medicare reimbursements,” Heck said referring to “sequestration” measures put in motion when the congressional “super committee” on the federal budget did not reach an agreement on deficit-reduction procedures.

Heck said he and Rep. Allyson Schwartz, D-Pa., have proposed a bill to replace the sustainable growth rate and reform the reimbursement system.

Finally, Heck said the increasing average age of health care professionals was not “high on anyone’s radar” but should be.

“This is a huge threat to how we provide health care in this nation. The entire health care workforce in the United Sates is getting old,” Heck said. “There is a gray on our health care workforce, and our replacement ratios aren’t keeping track with those who are exiting.”

Heck said the federal government has been shifting Medicare dollars away from training to save money at a time when more training opportunities are needed.

Tuesday’s fifth annual Nevada Health Forum attracted a group of about 300 government officials and health care professionals to Green Valley Ranch in Henderson, organizers said.

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