Politics and the Stars Bonus Program: A Combustible Mix

There are many reasons to hate presidential election years, and the elevation of political considerations beyond even their usual high level in oratorically overstretched Washington could be among the major ones. That was evident again in a July 25 hearing of the House Oversight and Government Relations Committee about CMS's huge star ratings quality bonus demonstration initiative, and, as seems often to be the case the days, both sides contributed to the hostile climate.

Republicans, who control the House, called the hearing so that they again could air their view that the $8.3 billion three-year stars demonstration is wasteful and won't succeed in boosting quality in the Medicare Advantage program. But any discussion of the merits of the stars initiative soon got overridden by partisan sniping. Committee Chairman Rep. Darrell Issa (R-Calif.), for instance, said, "What seniors need to understand is the $8.3 billion you're taking is because Obamacare was screwed up." Specifically, he said, the demo was "designed to offset Obamacare's massive cuts to Medicare Advantage ahead of an election." By giving bonuses even to three-star plans, added Rep. Scott DesJarlais (R-Tenn.), it rewards a "large group of mediocre plans" in an experiment that is "a gamble" unlikely to succeed.

But if Republicans at the hearing may take the prize for most intemperate rhetoric, Democrats and the Obama administration may get the honors for being the least informative. Asked to justify the legal authority for the huge demo, they instead defended the goals and early anectotal results of the initiative. CMS Center for Medicare Director Jonathan Blum said the stars demo was "designed by career civil servants" and is consistent with broad authority that the HHS secretary has. Asked one day after the hearing for an elaboration, CMS spokesperson Brian Cook said, "There is longstanding precedent for this type of demonstration, with Republican and Democratic administrations using this authority in this way."

What do you think will be the net effect of the attacks and defenses on the stars initiative? Will it result in changes in the demo for MA plans, or is it just part of a summer that is full of sound and fury but signifying nothing?