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Q & A: HHS’ Corr Beliefs

Deputy Secretary Weighs In on How Reform Helps Seniors

William Corr returned to the Department of Health and Human Services this year as deputy secretary following several years as executive director at the Campaign for Tobacco-Free Kids. But he knows the agency well, having served as HHS’ chief of staff during the Clinton administration, working under then-Secretary Donna Shalala.

Corr has also worked on Capitol Hill, for Rep. Henry Waxman (D-Calif.) and former Sen. Howard Metzenbaum (D-Ohio). Before coming to Washington, D.C., he worked at rural health centers in Appalachia.

Corr spoke last week with Roll Call Senior Editor Josh Kurtz about how the ongoing debate over health care reform could affect the oldest Americans.

ROLL CALL SENIOR EDITOR JOSH KURTZ: What, in the view of the administration, is health care reform going to mean for the elderly?

DEPUTY SECRETARY OF HEALTH AND HUMAN SERVICES WILLIAM CORR: I think everyone in this country has something to gain from health reform and particularly our seniors do. Not only will they benefit from a reformed health care delivery system, but from overall improved health and certainly from an improved economy.

But I think there are also some specific things that we see coming out of health reform for seniors. First of all, the administration has identified hundreds of millions of dollars in savings over the next decade in the Medicare and Medicaid programs. We believe it will not impact care, and it reduces waste and fraud. And by doing, incurring those savings, we’ll bring down premiums for seniors, and we’ll lengthen the life of the Medicare fund.

Secondly, by focusing on the need to reduce prescription drug cost for seniors — as you know, the pharmaceutical industry has pledged to provide seniors with a 50 percent discount on their medication cost that fall within the coverage gap. That’s a very important provision for many, many seniors. We expect the legislation will address the need to prevent that 20 percent cut in doctor payment rates that’s scheduled to start in January. By doing so we’ll ensure that doctors continue to provide, stay in the program, and provide care to Medicare beneficiaries.

Forms and paperwork, hopefully, will be streamlined and simplified in this process; that’s a very important goal. And I think last, certainly one of the main priorities of health reform is to improve the quality of care that all Americans will receive, but particularly our seniors because they’re such heavy users of health care. Building in prevention and wellness, so that we try to prevent illness and try to help seniors to get well faster. Managing chronic diseases better, reducing medical errors and readmission in hospitals. I think those are all attainable goals that different health systems around the country have demonstrated they can accomplish and that we believe can be accomplished through health reform legislation and its implementation.

ROLL CALL: You mentioned reforms in Medicare and Medicaid; are there specifics that you’re looking at, that you’re pushing, that are likely to be a part of any proposal that comes out of Congress?

CORR: I was referring to the savings proposal that the president has already put forward — that simply by reducing the cost of the current system we will bring down the pressure on premiums that seniors will be paying.

ROLL CALL: What, in your view, is the need for expanded long-term care, and do you envision more federal safety nets for long-term care?

CORR: Well there’s no question that there’s a significant unmet health care needs with long-term care. I think you know the numbers; an estimated 10 million Americans currently need the long-term-care services. That number is projected to double over the next several decades, and I suppose we all understand that there’s a significant lack of insurance protection for long-term-care services and supports. And so many people wind up eligible for long-term-care services and Medicaid by spending down, losing all their assets. So there’s no question that we have a significant unmet health care need. And I think there are many vehicles for addressing it.

The administration has some administrative steps that we can take, through the Medicaid program, you know, home- and community-based-care waivers through the Administration on Aging, where we have a series of programs. This administration is going to do everything it can with our existing authority to address the need for long-term-care services and supports.

The health reform legislation, as you know, at least in one of the [Congressional] committees, includes the [Community Living Assistance Services and Supports] Act. That’s something that the president has supported and endorsed as a part of health reform. That’s a critical benefit that would be available, that’s completely paid for, the [Congressional Budget Office] tells us, over the next several decades that would give people the opportunity to avoid an institutional setting by staying in their home or community with some additional resources to provide for personal caregivers, for modifying their home situation with additional technologies. And the administration certainly has assured the Congress that we want to work with them to address the long-term-care needs in this legislation and throughout this administration. There’s a great deal that needs to be done, and the administration is committed to doing it.

ROLL CALL: I know some Republicans are arguing that the cost of the CLASS Act is simply too prohibitive, but I take it the administration disagrees.

CORR: Well, with the amendments that have been made to it, my understanding is that the CBO has scored the bill as solvent, in fact, over the next 40 years. And it generates savings in the next decade, including reducing Medicaid cost. So the CLASS Act is a very important step forward that will benefit many people, and it’s not a hundred percent solution, but it’s a very critical tool that can be used to benefit many, many seniors.

ROLL CALL: And I take it the administration is supportive of efforts to improve home care and community care, things of that sort. Because I know there are some proposals floating out there both in the reform bill and in separate legislation.

CORR: We certainly want to work with the Congress on those proposals. There’s recognition as you look across the health care system that the long-term-care needs are so important. We certainly recognize that when you put someone in a nursing home you’re paying for needed health care services and you’re also paying for housing. And if you keep them in the community, in their own home, you’re only paying for health care services. There are many ways that we can attack this problem, and the administration is certainly committed to doing so.

ROLL CALL: Getting back to the [Medicare] doughnut hole, to prescription drugs, the agreement you have with the pharmaceutical companies calls for a 50 percent reimbursement. Is there a hope of doing even better down the line, optimally, or is it as good as we’re going to get, at least in the short term?

CORR: Well, this is an issue that’s actively under consideration, as you know, in all the committees that are looking at it. I think this is a great first step, and we’ll be working closely with the committees. If they want to approach this in a different way, or choose to approach it in a different way, we want to work with them to be sure that we address this issue because it’s so important to seniors.

ROLL CALL: Let me ask you a broader reform question, but it relates in a way to health care for seniors. A lot of people say that Medicare program is just about the best out there and the perfect example of how a government-run insurance program can work. Does the administration plan to kind of make those arguments as it advances its push for a public plan in the overall reform bill?

CORR: There’s no question Medicare has been successful. I’m just trying to think about how to respond to what you’re asking because the president has said that the public plan is a very important option. He’s also said that we want to build upon the existing health care system, and that means strengthening Medicare and Medicaid, strengthening the health care delivery system by improving access and quality and by building on the employer-based health care system so that more people are covered. The public plan, of course, and I know you’ve heard him say this many times, is, in his view, a very important option for instilling competition, for giving individuals a choice of plans, which is a key as far as he’s concerned, and so maintaining both a very strong Medicare program is a key to keeping that part of the health system strong, and continuing this discussion about the best way to ensure that there’s competition so that when we say to all Americans, you’re going to have guaranteed health care available to you and health insurance available to you, that they have a robust choice and that those choices invoke competition and hold down health care costs.

ROLL CALL: Beyond the immediate next few months and the overall reform debate, does the administration have a vision for other health care initiatives that would impact seniors particularly, that might come down the line?

CORR: Oh, absolutely, and I think there are a number of things that are under way that will certainly benefit Medicare beneficiaries and the Medicare trust funds. I’m sure you’re aware of the effort, the joint effort between the Department of Justice and our department to reduce fraud and abuse in the Medicare and Medicaid programs. The Department of Justice has already announced a number of new enforcement actions, and there are going to be additional steps taken to prevent fraud and abuse from occurring in the first place and from strengthening our ability to identify much more rapidly and to investigate it and prosecute it.

And we already know from the work that the Department of Justice has done that when criminals understand that we have the capacity to quickly track them, you see a dramatic drop in the kind of billings that are the part of that criminal activity. Even though you haven’t necessarily prosecuted many people, because they understand that we’re going to get them, and they move on. So you’ve got to then be vigilant in other areas of the health care system, and that’s the structure that we’re trying to put into place.

As you know, there’s a major effort, funded in part by Congressman [David] Obey [D-Wis.], through the Recovery Act, to reduce hospital-acquired infections. It’s a place that we know we can generate important savings and they’re not hundreds of billions of dollars, but this is how we reduce the cost of the health care system, by taking those problems on that we know we can solve and addressing them effectively.

ROLL CALL: Let me ask you, personally, you were around under Secretary Shalala, you’ve worked for nonprofits and advocacy groups. What feels different at HHS this time around? What feels different for the reform movement this time around?

CORR: We have unprecedented recognition throughout our country that our economy requires us to do health reform, that the health of our nation requires us to do health reform. We’ve got a president who has crystallized that view and that understanding, I think, for the American people. And they have responded with unprecedented support, and I think Members of Congress, in unprecedented numbers, recognize that we simply cannot delay a very important change, fundamental changes in health insurance and in our health delivery system, and in producing better health through more active public health interventions.

We’ve got a secretary [former Kansas Gov. Kathleen Sebelius] who’s spent the bulk of her political career working in insurance, health insurance and as governor of Kansas, deeply committed to health reform. We’ve got the business community, and the provider community recognizing, and really, these are things I know you’ve heard from others, but as I sit here it’s so clear that we’ve got a consensus that has really been built. It’s still difficult to get through the details, and that’s what we’re witnessing now, but this is just, this is the way Congress works. It’s a tough, complex issue; they’re into the nuts and bolts of it now, and I think there’s no question we’re going to come out of this with health reform legislation. You know the president has made that clear in the last days.

We are certainly hopeful and expect that there will be bipartisan support — all Members of Congress care about making sure the American people get the health care system they need. But it requires action now and backing off now and saying, “This is too tough. We don’t have the right options on the table,— is no way to go forward.

Within this department, I think we see a career staff that has a morale that is skyrocketing. They recognize that the time has come, that the American people want the time to be here, when we focus on our health through public health and we focus on our health care system in a way that significantly improves the health of the American people. So this is a time of great change, of great opportunity, and I think that the country and our leaders are going to rise to the occasion and we’re going to produce important legislation.

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