Erin Will Morton

About Erin Will Morton

Erin Will Morton, a government relations manager in the Washington, D.C., office of Drinker Biddle & Reath, works with a range of non-profit health care clients providing both government relations and association management services. Through her client endeavors, Erin has developed extensive experience in managing and convening coalitions and building support among coalition member organizations. She works on a variety of policy areas in the health care arena, including medical simulation, Medicare reimbursement and grassroots advocacy.

Post-Acute Care Subject of New House Legislation

Payment and policy for post-acute care have long been topics of interest to policymakers on Capitol Hill.  Furthering this discussion, Representative David McKinley (R-WV) introduced H.R. 4673, the Bundling and Coordinating Post-Acute Care Act of 2014 (also known as BACPAC) on May 19, 2014.  H.R. 4673 was referred to the Committee on Ways and Means, and the Committee on Energy and Commerce.

Click here to view a summary of the Bill by District Policy Group President, Ilisa Halpern Paul.

Click here to visit the Library of Congress page for the legislation.

Health Care on the Hill – Upcoming Events

December 4, 2013; 3:00pm
“Adjudicating VA’s Most Complex Disability Claims: Ensuring Quality, Accuracy, and Consistency on Complicated Issues”
House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs (DAMA)
334 Cannon House Office Building

December 11, 2013; 2:15pm
“Protecting Seniors from Medication Labeling Mistakes”
Senate Special Committee on Aging
562 Dirksen Senate Office Building

December 12, 2013; 10:00am
“Open Executive Session to Consider an Original Bill to Repeal the Sustainable Growth Rate System and to Consider Health Care Extenders”
Senate Committee on Finance
215 Dirksen Senate Office Building

December 18, 2013; 2:15pm
“The Future of Long-Term Care Policy: Continuing the Conversation”
Senate Special Committee on Aging
562 Dirksen Senate Office Building

Health Care on the Hill: Week of November 18, 2013

Tuesday, November 19 

Health Care Website Data Security
House Science, Space and Technology Committee
10:00am; 2318 Rayburn House Office Building

Regulation of Mobile Medical Apps
House Energy and Commerce — Subcommittee on Health
10:00am; 2322 Rayburn House office Building Security
House Energy and Commerce — Subcommittee on Oversight and Investigations
10:15am; 2123 Rayburn House Office Building

Wednesday, November 20 

Public and Community Health
House Energy and Commerce — Subcommittee on Health
2:00pm; 2123 Rayburn House Office Building

Small Business Health Care Exchanges
Senate Small Business and Entrepreneurship Committee
10:00am; 428 Russell Senate Office Building

Social, Economic Status and Health
Senate Health, Education, Labor and Pensions — Subcommittee on Primary Health and Aging
10:00am; 430 Dirksen Senate Office Building

The U.S. Role in Global Health

May is global health month!  Now, you might be thinking, what does global health have to do with me, and why should I care?  Well, the reality is global health is America’s health.  As Health and Human Services Secretary Kathleen Sebelius said at the unveiling of the new HHS Global Health Strategy, “Health is an issue which aligns the interests of the countries around the world. If we can limit the spread of pandemics, all people benefit. A new drug developed on one continent can just as easily cure sick people on another. A safe global food and drug supply chain will mean better health for every country.”

In the U.S., this is exactly what we are working towards. U.S.-based scientists and researchers collaborate with government agencies, private research companies, and international organizations through public-private partnerships to develop new tools and technologies to fight disease both at home and abroad.  In many ways, the U.S. is leading the way in terms of research and development for new tools in global health and infectious disease.  In the 2012 G-Finder report, a five year review of neglected disease research and development by Policy Cures,the National Institutes of Health (NIH)continue to be the largest single funder of neglected disease research and development.  NIH funding outranks that from the Bill and Melinda Gates Foundation, industry, and other European donor countries.

Given the current global economic crisis and the challenges faced by U.S. policymakers, some might jump to the conclusion that this isn’t where the U.S. should invest its precious resources.  Not so fast!  First of all, U.S. foreign aid is less than one percent of all federal government spending, and the money that the U.S. invests in NIH research in infectious disease is going to create high-level U.S. jobs.  In Research!America’s “Top 10 Reasons Why the U.S. Should Invest in Global Health R&D,” they note that “64% of every dollar the U.S. government spends on global health R&D goes to supporting jobs for U.S.-based researchers and product developers and building and improving U.S. research and technological capacity.”  Furthermore, the U.S. is at risk of losing its competitive edge in science and research to countries like China that are investing heavily in vaccine and other research.

It’s not just about jobs, though.  The world is becoming increasingly smaller as international travel rises and new pathogens are constantly on the move.  Infectious diseases do not respect international borders. We have seen this with SARS, avian influenza, and dengue fever, all of which made it to U.S. soil.  U.S. researchers and epidemiologists at the Centers for Disease Control and Prevention (CDC) practice monitoring and surveillance for the threat of new infections in the U.S.  Our ability to control and fight these diseases relies on the longstanding investment that the U.S. makes in research and development in global health and infectious diseases.

The benefits of U.S. investment in tropical diseases are humanitarian, diplomatic, and economic.  We cannot afford to rest on our laurels and wait for the next disease to cross U.S. borders.  The infectious disease and global health work being done by the NIH, the CDC, the Department of Defense (DoD), and the U.S. Agency for International Development (USAID) is essential to ensuring a healthy world and a healthy America.

Dewonkify – Chained CPI

Word: Chained CPI

Meaning: A revised method of calculation for the Consumer Price Index (CPI) that the Bureau of Labor Statistics (BLS) could use to estimate inflation, which takes into account assumptions about how people spend money.

Used in a sentence: “Chained CPI is one of many ways to approximate the impact to consumers’ pocketbooks of rising or falling prices.”

What it really means:  Chained CPI is a clever way of saying “slow the growth of inflation” without actually coming out and saying it.  Currently, CPI is calculated by BLS based on data collected on the prices paid by consumers for goods and services. Chained CPI would add another level to this calculation by taking into consideration what consumers might buy in place of something that has become too expensive.  For example, if you plan on having broccoli for dinner tonight and head to the store to get some, but then you realize the cost of broccoli has gone up since the last time you were in the store, you might settle for spinach instead.  Now, instead of everyone paying more for broccoli, consumers are choosing other vegetables, so the demand for broccoli goes down, and eventually so does the price.  Overall, the impact is a much slower rate of inflation.

The Catch:  So, what does slowing inflation actually mean politically, and why is it suddenly getting all of this attention—from Democrats and Republicans?  You have probably heard chained CPI being discussed as an offset for part of the current deficit negotiations.  Slowing inflation would be a huge cost saver for the federal government because of all of the programs tied to the CPI, with Social Security the most popular example.  The benefits that seniors receive are updated annually to account for inflation, and that update is calculated based on the BLS CPI estimates.  If chained CPI goes into effect, Social Security checks annual increases could get smaller and smaller.

In addition to Social Security, chained CPI would also slowly affect tax rates because the IRS updates tax brackets based on inflation—this keeps people’s taxable rates in line with cost of living increases in salaries.  If CPI slows down, salaries will rise ahead of the IRS adjustments, meaning some Americans will pay higher taxes.

CPI also determines reimbursement rates for some health care providers in the Medicare system.  Annual updates to these rates would not be as high if chained CPI were implemented.  Given productivity updates and cuts implemented as part of the Affordable Care Act, the slower growth of CPI could cause problems for some providers.

What’s interesting about chained CPI is that it has been supported by both Democrats and Republicans.  Even though it cuts spending (Medicare and Social Security) and raises taxes, it has unique bipartisan support.  While some Democrats are skeptical about the impact it will have on seniors, Obama has been on record supporting it.  The chained CPI proposal was dropped during round one of the fiscal cliff negotiations, but is likely to resurface as Congress looks for a long term solution to the debt.

If you are interested in reading more on chained CPI, see these articles:

“Chained CPI: The Sneaky, Complicated Idea That Could End the Fiscal Cliff Showdown—Explained” (The Atlantic)

“What is Chained CPI” (The Washington Post)

Dewonkify – Offset

Word: Offset

Definition: A funding source used to pay for new government spending, usually comprised of reductions to, or elimination of, other government programs.

Used in a sentence:GOP Lawmakers Not Calling for Offsets for Sandy Aid

What it means:  When Congress passes legislation that costs the government money—with the exception of the annual appropriations bills—they look to find “offsets,” or savings from other government programs to “pay for” the new legislation.  Sometimes, offsets are colloquially referred to as “pay-fors”—literally, paying for something that the government wants to buy. Finding an offset can be a challenge because every Member of Congress has specific priorities and programs he or she wants to protect and taking funding from one program to pay for another often leads to internal debates between political parties or chambers.

History:  It was not always the case that offsets were required for new government spending.  In years past, when the economy was doing better and fiscal constraint was not governing Washington, new legislation could be passed without a specific offset—meaning the government would just pay for the program with new money—either adding to the deficit, or using tax revenue.

Off and on over the past 20 years, Congress has operated under a mechanism called PAYGO, under which any new government spending needed to be offset by savings from (or cuts to) current programs.  In 2010 President Obama signed the Statutory Pay-As-You-Go Act into law, thus making PAYGO mandatory.  Occasionally, Congress will pass legislation for disaster relief—as could be the case with Hurricane Sandy—or emergency spending to stimulate the economy—as with the American Recovery and Reinvestment Act—that is exempt from the PAYGO rules.  This exemption allows money to move more quickly through the legislative process without finding an offset.

As an example of offsets in practice, the current fiscal cliff negotiations must deal the disagreement over how to offset the cost of extending several tax provisions like middle income tax cuts and unemployment benefits.  If cost was no obstacle, extending these popular provisions would be a no-brainer, but finding a politically acceptable offset presents a real challenge.

Two Approaches to Health Care Spending in NEJM

The debate on health care spending and cost cutting ideas continues in the New England Journal of Medicine (NEJM).  Earlier this month, NEJM published two articles, which discuss two different approaches to addressing the rising cost of health care in America.

The first article, “A Systematic Approach to Containing Health Care Spending,” was authored by 23 health policy experts, including Zeke Emanuel, Donald Berwick, Tom Daschle and Peter Orzag.  The authors put forward several ideas about how they would reduce health care costs over the coming years including, alternatives to fee-for-service Medicare, an expanded use of competitive bidding within the Medicare system, price transparency for health care costs, a greater emphasis on using non-physician providers, and evidence-based clinical practice guidelines reduce the cost of defensive medicine.

The second article, written by Joseph Antos, Mark Pauly, and Gail Wilensky, is called, “Bending the Cost Curve through Market-Based Incentives.” In this article, the authors suggest that insurance subsidies that would enable beneficiaries to purchase their own insurance (one option of which would be traditional Medicare) is the best path forward—allowing for a competitive marketplace with fewer regulatory controls.

So, what do the two sides have in common?  Both articles place blame on the fee-for-service model of Medicare payment suggesting that it leads to waste in the system as providers are encouraged to use more services.  Likewise, both groups of authors suggest some type of bundling for Medicare services and both seem to favor a wider use of competitive bidding across Medicare services.

State of the Union and Health Reform

For some of us in Washington, watching President Obama’s State of the Union Address last night was about waiting to see what he would say about the health care law.  Given the law’s mixed reviews among Americans, it wasn’t too much of a surprise that the entire speech went by with almost no mention of health care.  Obama did make clear he would not go back to a time when insurance companies could cancel an individual’s coverage, but a larger defense of the controversial law was missing.

While this means that health care might not play a huge role in the Obama campaign’s platform for 2012, health reform is by no means a thing of the past.  The coming year promises to be an exciting one for the new law as the Supreme Court examines the constitutionality of the law and implementation of State Health Exchanges gets under way.  Undoubtedly, the law will continue to face a beating from the Republican presidential candidates as they make promises to repeal the law immediately upon taking office.

In the coming months, the talk in Washington will be about what happens if the law is repealed.  How much of the law will actually be thrown out  by the Supreme Court and  if the entire law is thrown out then what happens to the parts that have already been implemented.  It is hard to know the answers to these questions this early in the game, but it will an interesting year trying to figure it all out.