WASHINGTON — The deal that President Barack Obama and Congress struck this week to raise the nation's debt ceiling calls for creating a 12-member commission made up of an equal number of Republicans and Democrats selected from the House of Representatives and the Senate that will recommend how to trim at least $1.2 trillion in federal spending over the next decade.

Here's a guide to how the panel's deliberations could influence Medicare and Medicaid.

Q. Aren't Medicare and Medicaid protected from cuts right now?

A. Yes — and no. The debt deal itself made $917 billion in discretionary spending reductions during the next decade, and exempted Medicare and Medicaid. But the programs aren't protected in the next round of cuts.

Q. Won't deep differences between the parties over entitlements and taxes prevent the panel from reaching any agreement?

A. With Democrats likely to insist on tax increases and Republicans sure to seek entitlement cuts, agreement will be difficult. Stan Collender, a partner at Qorvis Communications and a former congressional budget staffer, said there was less than a 5 percent chance that the committee would come to an agreement that Congress would approve.

But if Congress doesn't agree on a debt plan, the debt-ceiling law triggers automatic cuts, including a 2 percent reduction in Medicare payments to hospitals and other providers. The trigger wouldn't touch Medicaid funding.

Q. There have been plenty of commissions that have worked on debt reduction. What makes this one different?

A. The threat of automatic, across-the-board spending cuts is what gives the debt panel more clout than its predecessors had. Many lawmakers dislike the idea of surrendering any power over the federal purse, especially when it could mean that spending on a favorite program could be at risk.

Q. What might the committee look at?

A. Among some of the alternatives that are expected to be considered are Medicare premium supports, which would give enrollees vouchers or credit to purchase private insurance plans rather than having the government directly pay for covered services; converting Medicaid to a block grant program, which also would limit federal funding; or asking higher-income Medicare beneficiaries to pay more for their coverage. Changes in spending for the 2010 health care overhaul also may be considered.

Bob Crittenden, the executive director of the Herndon Alliance, a liberal health care advocacy group, said Medicaid was most at risk in the committee because the group was unlikely to agree on cuts to Medicare or Social Security.

Q. Why are Medicare and Medicaid part of the debt discussions?

A. Medicare and Medicaid make up about 23 percent of federal spending and their costs have been growing faster than the economy overall has. Medicare costs have climbed partly because of the aging population, which has meant that more people are eligible for coverage. Medicaid costs increased with the recent economic downturn, which led to dramatic uptick in enrollment as people lost jobs and private health coverage.

Q. What do doctors and hospitals say about the cuts proposed as part of the automatic trigger?

A. Medicare providers say the reductions would hurt their ability to deliver medical care and that they'd mean less access to care for seniors. "If it affects providers, it affects beneficiaries," said Chip Kahn, the president and chief executive officer of the Federation of American Hospitals.

Q. How does a "fix" to Medicare's doctor payments figure into the issues the committee faces?

A. At the end of the year, Medicare is scheduled to cut pay to physicians by about 30 percent because of a budget rule adopted years ago. Since 2003, Congress has granted an extension each time the requirement has come due. Some analysts argue that the debt reduction efforts and the need to fix the doctor reimbursement formula could collide, especially because of the cost of fixing doctor pay. Pushing the issue off for another year would cost about $25 billion, although doctors have been pressing for a two-year fix at a cost of roughly $50 billion. These fixes would add to the nation's budget deficit and complicate the committee's work.

(With thanks to Kaiser Health News, an editorially independent news service of the Kaiser Family Foundation, a nonpartisan health care policy organization that isn't affiliated with Kaiser Permanente.)

A view from the GOP side regarding restructuring Medicaid.  Click here for the full report.

GOP Governors.pdf (736.60 kb)

Click here for a report by the Sunlight Foundation.

There are several thousand professional lobbyist in the City on the Potomac and the Super Committee has them scurrying to find ways to influence the work of the Congressional "super committee" which is charged with the task of identifying up to $1.5 trillion in deficit reductions.  Many of the professionals are openly worried about how to gain access to its 12 members.

The Committee will report its findings by Thanksgiving.  With such massive potential cuts to the U.S. federal budget [Yes, even in D.C., $1.5 trillion is a big number] being decided by just a dozen lawmakers in such a short timeframe, lobbyists say their job to protect their clients is potentially impossible.

When federal funds are being targeted in traditional congressional committees, work is more predictable, with lobbyists knowing there are only a handful of legislators who need to be approached on any given issue.

This special bipartisan committee, made up of six Republican and six Democrats, was formed as part of a to raise the U.S. debt limit. 

The Super Committee will meet independently from Congress, set its own rules and must come up with at least $1.2 trillion -- and potentially $1.5 trillion -- in budget savings for the next ten years.. If it fails, or if Congress does not endorse its plan, $1.2 trillion in mandatory cuts will be triggered in 2013.  Those in the know suspect that the Committee will not be able to come up with a plan.

Many lobbyist agree that the work of this Super Committee is unprecedented. As one senior advocate said; “This is deficit reduction. It will touch every industry, every spending category. This has not happened before. So everyone is in the position of determining the art of the possible in terms of influencing the outcome."

If the panel fails to reach a deal and the automatic spending cuts kick in, this could result in a pitched battle between costly government health insurance programs such as Medicare and Medicaid, and the Pentagon budget.

One lobbyist, speaking on the condition of anonymity, predicted "Holy War" between the health and defense industries, and their legions of lobbyists as they try to protect their budgets ahead of the potential automatic cuts.

Government watchdog groups already are questioning how impartial committee members can be in deciding where to make cuts because of campaign contributions received in the past.

Between 1999 and August 2011, the 12 lawmakers collectively received more than $9.2 million in campaign contributions from the healthcare industry, according to a Reuters analysis of Federal Election Commission data compiled by the watchdog group OpenSecrets.org.

According to OpenSecrets, the real estate industry -- determined to stop the debt committee from closing the home mortgage interest deduction in the tax code -- has donated more than $8.2 million to the Democratic members since 1989, and nearly $3.8 million to the Republican members.

The Sunlight Foundation, another non-partisan watchdog, says at least five of the panel's members are scheduled to hold fundraisers after the committee begins it work.

There are 13,000 registered lobbyists in Washington.  There are 12 members of the Super Committee.

Stay tuned.

Click here and see Page 9

IDEA Part B Program. Under Part B of the Individuals with Disabilities Education Act (IDEA), the Department provides grants to States, outlying areas, and freely associated States, as well as funds to the Department of the Interior, to assist them in providing special education and related services to children with disabilities ages 3 through 21.

There are four key purposes of the Part B program and implementing regulations: (1) ensuring that all children with disabilities have available to them a free appropriate public education that includes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living; (2) ensuring that the rights of children with disabilities and their parents are protected; (3) assisting States, localities, educational service agencies, and Federal agencies in providing for the education of children with disabilities; and (4) assessing and ensuring the effectiveness of efforts to educate children with disabilities.

Over the last six months, we have engaged in a review of one particular provision of the Part B regulations, relating to the use of public benefits or insurance to pay for services provided to children under Part B. IDEA and the Part B regulations allow public agencies to use public benefits or insurance (e.g., Medicaid) to provide or pay for services required under Part B with the consent of the parent of a child who is enrolled under the public benefits or insurance program. Public insurance is an important source of financial support for services required under Part B. With respect to the use of public insurance, §300.154(d)(2)(iv)(A) of our current regulations specifically provides that a public agency must obtain parental consent, consistent with §300.9, “each time that access to public benefits or insurance is sought.”

We will soon be issuing a notice of proposed rulemaking to amend §300.154(d)(2)(iv) with the goals of maintaining critical parent protections and ensuring parents have the information they need regarding a public agency’s use of their public benefits or insurance as part of providing FAPE while reducing unnecessary burden on a public agency’s ability to access public benefits or insurance in appropriate circumstances.

As part of its implementation of Executive Order 13563, "Improving Regulation and Regulatory Review," issued by the President on January 18, 2011, the Department of Education has issued its final "Plan for Retrospective Analysis of Existing Regulations." Executive Order 13563 recognizes the importance of maintaining a consistent culture of retrospective review and analysis of regulations throughout the executive branch, consistent with law and each agency's resources and regulatory priorities. The Department's plan is designed to create a defined policy, method, and schedule for identifying significant regulations, as determined under Executive Order 12866, that may be outmoded, ineffective, insufficient, or excessively burdensome, as well as regulations that can be modified, streamlined, expanded, or repealed to be more effective and efficient, achieve better outcomes for students, and be easy to understand.

To see the full DOE release, dated 8/22/2011, click here.