While it seems like only yesterday that we all endured
the debt-ceiling debate, it is already time to focus on the next major threat
facing Medicaid.
Today the “super committee”, which was created by the
debt-ceiling deal, held its first meeting. The committee is charged with finding at least $1.2
trillion in deficit savings through spending cuts and/or tax changes over the
next 10 years. They have until
November 23rd to report out a bill or trigger automatic across-the-board
cuts. The automatic cuts or
“sequester” would be split 50-50 between defense and non-defense spending. The cuts would impact providers who
accept Medicare–not recipients–
but Social Security and Medicaid would be exempted from the automatic cuts.
The big question on everyone’s mind is whether the
committee will take a “balanced approach” and include revenues in the package
or just look at cuts. Most Republican members of the super committee have
publicly pledged to reject options that raise revenues, almost any plan approved
by the panel, which raises the specter of extremely damaging cuts to Medicaid
and funding needed to implement the Affordable Care Act. Health policy expert,
Chris Jennings, provides an insightful look into these issues in a New England Journal of Medicine article. From the perspective of most health care advocates, automatic cuts would
be preferable to a legislative package that would put Medicaid and the
Affordable Care Act in greater jeopardy. However, it is important to keep in
mind that there are many other public health programs, outside of Medicaid,
that will be negatively impacted by a sequester, making the next few months a
very difficult balance for all.
Many have urged the powerful committee to conduct
business in a transparent manner and to keep all proceedings open to the
public. However, at today’s
organizational meeting, a rules package was unanimously approved which granted
the panel the authority to go into closed-door session if a majority of members
agree to do so.
The committee has until November 23 to report a bill with
its recommendations, which must then be passed by the House and Senate under
special rules by December 23. The President must sign the bill by January 15 in
order to avoid the automatic cuts.
That’s a pretty tight legislative schedule under regular procedure but
the package the committee approves will be granted protection from amendments
and filibusters and will only need a simple majority for passage.
Here is the schedule:
Sept. 13: First hearing of joint committee. CBO Director
Doug Elmendorf will testify on “The History and Drivers of Our Nation’s Debt
and Its Threats”.
Oct. 14: Deadline for standing committees to forward
their recommendations to joint committee.
Nov. 23: Deadline for joint committee to vote on
legislative proposals, with a 10-year deficit reduction goal of $1.5 trillion.
Dec. 2: Deadline for joint committee to formally report
proposals.
Dec. 23: Deadline for House and Senate to vote on
proposals, without amendment.
Jan. 15, 2012: Deadline for President to sign measure or
across-the-board spending cuts will be triggered.
Jan. 2, 2013: If triggered, across-the-board cuts will
take effect.