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Deficit Deal More Likely in 2013?

By Rebecca Adams, CQ HealthBeat Associate Editor

October 11, 2011 --A former Medicare administrator expressed some doubts about whether the committee charged with reaching a deal on deficit reduction can come up with a plan that can pass Congress.

Former Centers for Medicare and Medicaid Administrator Tom Scully was pessimistic about the prospects, saying that the political environment has only worsened throughout the year. If the supercommittee, formally known as the Joint Select Committee on Deficit Reduction, does not reach an agreement on at least $1.2 trillion in deficit reduction savings that Congress passes, then across-the-board cuts will be triggered under the August debt ceiling law (PL 112-25). The idea behind sequestration was to give lawmakers a reason to act, but Scully said it gives them an out. Scully spoke at an Alliance for Health Reform briefing and answered questions afterward.

When asked to predict what the supercommittee would come up with, Scully had a short response: "Nothing."

He said that although members of the committee are sincerely interested in finding a deal, the political atmosphere and pressures from groups that might be subject to cuts from the panel make it difficult. He also did not think it likely that the group would be able to reach consensus on a package that would impose some cuts of their own that would move partly toward the $1.2 trillion goal, while allowing across-the-board cuts to fill in the remaining gap. Under the rules, programs such as Medicaid are exempt from sequestration, but Medicare provider reimbursements are not.

"Why would a conservative House Republican say 'I'll vote for half a loaf?' " said Scully. "I just don't see that happening."

He predicted that the exercise would help build relationships among lawmakers who might work together in 2013 on a budget deal that has a better chance of becoming reality, when lawmakers are "shooting with real bullets."

During the Alliance briefing, Scully predicted that Congress would debate a "big, brutal, massive deficit reduction deal in 2013."

He also said that Congress might delay the implementation of the health care law (PL 111-148, PL 111-152) and that if policy makers had known in 2003 that the economy and deficits would be in such bad shape now, the prescription drug benefit would never have been created.

Scully shared the stage with his successor, former CMS Administrator Mark McClellan, who said that payment delivery changes, including bundling payments and creating medical homes, are the best way to get additional savings from Medicare. McClellan said that, in part because the health care law already puts in place reductions in Medicare spending growth, "it is hard to get more savings at this point" from reducing providers' payments, and it will be "hard to do any of this in the coming months."

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