my local paper linked with an POLITICO article quoting Kerry.

But Obama has asked Reid to strike a provision that would send $1.1 billion in extra Medicaid funding to Massachusetts and Vermont -- states that have already expanded Medicaid coverage but would otherwise not be reimbursed at the same level as states that would boost their Medicaid populations for the first time under the bill's mandate.

"What I told Harry Reid is that Vermont does the right thing, and I don't want Vermont to be penalized for doing the right thing," Sen. Patrick Leahy (D-Vt.) said in a statement.

Through a spokeswoman, Sen. John Kerry (D-Mass.) said he, too, was working with the president "to make sure Massachusetts's past investment to expand health coverage to low-income individuals is recognized in health reform."



Read more: http://www.post-gazette.com/pg/10070/1041902-473.stm#ixzz0hs17nGew

(1) Early Expansion States - The House bill recognized that some states took the lead on expanding coverage to more citizens by "grandfathering" in their programs so they would not be harmed by the new federal proposal. This helps Massachusetts, since we are one of the leaders on this issue. The Senate bill does not take the general grandfathering approach but it includes language that specifically protects Massachusetts. Although the Senate language is not as generous as the House language, the Commonwealth does have some protection.

I am concerned that in reaction to other state-specific Senate language such as the now infamous "Cornhusker Kickback," legitimate state-specific Senate provisions will be dropped, which would seriously damage Massachusetts. In fact, a March 10th article in Politico raises this very question and reports that the President wants the Massachusetts language out of the Senate bill. It is my understanding that without some type of grandfathering language; Massachusetts could lose in the range of $300 million per year. I am gathering more information about this aspect of the bill to determine if my concerns are valid.

(2) DSH cuts - Currently, Medicare and Medicaid provide extra payments to hospitals that serve higher-than-average shares of people without health insurance. These hospitals are called Disproportionate Share Hospitals, or DSH. In the 8th District for example, Boston Medical Center and Cambridge Health Alliance both depend on millions of dollars a year in DSH payments. The Senate bill would cut DSH payments by $42 Billion per year, as opposed to the $20 Billion cut proposed in the House. Such cuts, made before a new health care system is allowed to fully develop, would curtail the amount and quality of health care provided by DSH hospitals and their uninsured patients, thereby driving these sick and poor persons to other hospitals that will not be equipped or paid to handle the medical and social challenges they present. I am looking into this aspect of the Senate bill as well.

(3) Value Index - The Senate bill includes a proposal to adopt a so-called "value index"; the House bill does not include this proposal. It would adjust the way payments to physicians and other non-hospital providers are calculated. Supporters suggest it would encourage practices that are more frugal by rewarding "low cost areas". Massachusetts is considered a "high cost area" due to various factors, including the regional cost of living, the relative poverty of the people served, and our financial commitment to educating America's next generation of doctors. There are no limits on how much a physician's payments could be reduced by this so-called "value index" and the method has never been tested at the physician level. Due to the probability of much lower payment rates to Massachusetts doctors, this proposal seems as though it would influence (1) where doctors practice (discouraging practice in Massachusetts), (2) how they treat patients in so-called "high cost areas", and (3) how many doctors will be trained in America. Absent a thorough study of the impact of this so-called "value index", it seems to me that it could seriously harm the quality of care in Massachusetts.
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Obama, facing an electorate angry over side deals in the massive package, has told congressional leaders to remove them to make the proposal more salable to the public. One of those deals is a Senate provision to reimburse Massachusetts and Vermont for having already expanded Medicaid coverage to a broader base of low-income people.

But Senator John F. Kerry, a key Obama ally in the health care talks, said the White House has given him personal assurances that Massachusetts will not suffer in the final package.

“I’m confident we will resolve this issue in a way that is fair to all states, and Massachusetts will come out stronger than we are now,’’ Kerry said as he left a Democratic Senate caucus meeting on health care. One way, he said, would be to fix the Medicaid reimbursement formula so that all states are repaid up to a certain level, giving Massachusetts what it needs without appearing to single it out for special treatment.

“We will not be penalized for going above and beyond federal mandates, and believe me, we’ve sent the message loud and clear, and I’m confident it’s been received and understood at the highest levels,’’ Kerry said. “The White House and congressional leadership have assured us that Massachusetts will get the money we deserve.’’