Glance: Senate and House farm bills

The House and Senate this week are considering legislation that would cut federal farm and food subsidies. A look at the bills:

OVERALL COST: Both five-year bills would cost about $100 billion annually, with almost $80 billion of that annual total going to domestic food aid. The Senate bill would save about $2.4 billion yearly from current spending, and the House bill would save around $3.8 billion, including about $600 million saved in each bill due to across-the-board spending cuts that kicked in earlier this year.

FOOD STAMPS: Food stamps, now known as the Supplemental Nutrition Assistance Program, or SNAP, have for decades been part of the farm bill in an effort to garner urban lawmakers' votes for rural programs. The Senate farm bill would cut about $400 million from the $80 billion annual total by targeting states that give people who don't have heating bills very small amounts of heating assistance so they can automatically qualify for higher food stamp benefits. The House bill would cut $2 billion yearly by making similar changes and also eliminating what is called "broad-based categorical eligibility," or granting automatic food stamp benefits when people are signed up for certain other programs.

DIRECT PAYMENTS: Direct payments, which cost the government around $5 billion annually, would be phased out in both bills, with the savings split between other subsidy programs and deficit reduction. Those subsidies have been controversial because they are paid out every year regardless of crop prices or crop yield. The Senate bill would eliminate the program immediately while the House bill would phase it out over the next two years for cotton farmers who rely on the program.

CROP INSURANCE: Both bills would increase subsidies for federally-subsidized crop insurance and create a new crop insurance program that covers smaller revenue losses on planted crops before crop insurance kicks in. This revenue protection program favors Midwestern corn and soybean farmers and would be more generous in the Senate bill.

PRICE PROTECTION: Both bills would raise what are called "target prices" for some crops. Certain subsidies kick in if prices drop to those targets, meaning farmers will only receive them if prices are low. While many of these programs haven't been used for the last several years because crop prices have been at unprecedented highs, these subsidies exist as a safety net. Both the House and Senate bills would raise these target prices for rice and peanuts, since farmers of those crops also often depend on direct payments that would be eliminated. The House bill would raise those target prices higher than the Senate bill would, meaning it would be easier for the subsidies to kick in.

FOOD AID: Neither bill includes an Obama administration food aid proposal to shift the way food aid is sent abroad. The United States now donates much of its food aid by shipping homegrown food overseas, but the Obama budget last month proposed shifting the aid money to more flexible accounts that allow for cash purchases abroad or from U.S. farmers, saying such a move would be more efficient. Both House Agriculture Committee Chairman Frank Lucas, R-Okla., and Senate Agriculture Committee Chairwoman Debbie Stabenow, D-Mich., have sided with farm groups against the proposal.

View the original article here

High hospital bills go public, but will it help?

WASHINGTON (AP) — For the first time, the government is publicly revealing how much hospitals charge, and the differences are astounding: Some bill tens of thousands of dollars more than others for the same treatment, even within the same city.

Why does a joint replacement cost 40 times as much at one hospital as at another across the country? It's a mystery, federal health officials say.

"It doesn't make sense," Jonathan Blum, Medicare deputy administrator, said Wednesday. The higher charges don't reflect better care, he said.

And the amounts are too huge to be explained by obvious differences among hospitals, such as a more expensive regional economy, older or sicker patients, or the extra costs of running a teaching hospital, he said.

The average charges for joint replacement range from about $5,300 at an Ada, Okla., hospital to $223,000 in Monterey Park, Calif., the Department of Health and Human Services said. That doesn't include doctors' fees.

Hospitals within the same city also vary greatly. At Beth Israel Medical Center in New York, the average charge to treat a blood clot in a lung is $51,580. Down the street at NYU Hospitals Center, the charge for the same care would be $29,869.

At the Mayo Clinic in Minnesota, the list price is $16,861.

That isn't necessarily what you pay.

Medicare pays hospitals on its own fee schedule that isn't based on the listed charges, Blum said. And insurance companies routinely negotiate discount rates with the hospitals.

But patients who are uninsured can be billed the full amount. And some with private insurance may find their share of the bill is inflated as a result of a hospital's higher charges, officials said.

Blum said the Obama administration hopes that releasing the information, at the website www.cms.gov, will help lead to answers to the riddle of hospital pricing — and pressure some hospitals to lower their charges.

The database also will help consumers shop around, he said.

The variations shouldn't be a surprise, since hospitals might violate antitrust regulations if they shared "proposed or negotiated rates" with each other, said Rich Umbdenstock, president of the American Hospital Association. Forty states do require or encourage hospitals to make some payment information publicly available, he said.

"The complex and bewildering interplay among 'charges,' 'rates,' 'bills' and 'payments' across dozens of payers, public and private, does not serve any stakeholder well, including hospitals," Umbdenstock said.

Consumer advocates said making the charges public is significant, even if most patients don't pay those rates.

"I think the point is to shame hospitals," said Chapin White of the nonprofit Center for Studying Health System Change.

Dr. David Goodman, co-author of the Dartmouth Atlas of Health Care, said, "It does show how crazy the system really is, and it needs some reform."

Goodman argues that hospitals should be required to go further and post the charges that patients actually pay out-of-pocket, depending on what medical coverage they have. The Dartmouth Institute for Health Policy has long found wide geographic variation in Medicare payments for the similarly ill, yet people who receive more expensive care don't necessarily receive better care. Sometimes hospitals just add tests or treatments they don't really need.

A hospital's charges are akin to a car dealership's "list price." Hospitals say they frequently give discounts to the uninsured — $41 billion in financial aid in 2011.

But some people pay full price, or try to afford it, because they don't know they can seek a discount, White said.

And even for those who do bargain, the listed charge "is the opening bid in the hospital's attempt to get as much money as possible out of you," he said.

At Suburban Hospital in Bethesda, Md. — serving an affluent community at the gates of the National Institutes of Health — the average charge for simple pneumonia was $5,284. Compare that to $79,365 at Hahnemann University Hospital in Philadelphia.

The database lists the average charges for the 100 most common Medicare inpatient services at more than 3,000 hospitals. The prices, from 2011, represent about 60 percent of Medicare inpatient cases.

"Hospitals that charge two or three times the going rate will rightfully face scrutiny," Health and Human Services Secretary Kathleen Sebelius told reporters.

And consumers will get insight into a mystifying system that too often leaves them with little way of knowing what a hospital will charge or what their insurance companies are paying for treatments, Sebelius said.

Previously, the price information that the government collects from hospitals wasn't available to the average consumer, although the data could be purchased for uses such as research, officials said.

The department also is making $87 million in federal money available as grants to states to improve their hospital rate review programs, research why hospital charges vary so much, and get more information to patients.

Todd Park, an assistant to President Barack Obama on technology issues, said he envisions entrepreneurs creating apps to help consumers compare hospitals and researchers combing through the data to explain the cost differences.

"Transparent marketplaces are more competitive, and more competitive marketplaces drive down costs," Park told reporters at the White House. "And that's certainly the hope here."

___

Online:

CMS data: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html

___

Follow Connie Cass on Twitter: http://www.twitter.com/ConnieCass

View the original article here