In 2014, Congress gets Obamacare. Here’s how they’ll pay for it.

By Ezra Klein – Washington Post

Starting in 2014, members of Congress and their staffs will have to get their health insurance through Obamacare’s insurance marketplaces. But according to a regulation that the Obama administration’s Office of Personnel Management plans to announce on Friday and release next week, the federal government can continue to contribute toward the cost of their health plans.

The regulation comes after months of worry on Capitol Hill. The Affordable Care Act includes a provision, first proposed by Sen. Chuck Grassley (R-Iowa), forcing members of Congress and their staffs to buy insurance through Obamacare. But it didn’t provide a clear mechanism for them to do so.

The insurance marketplaces are built for individuals, not employers, and there was concern that the federal government could not continue paying its traditional share of congressional health plans. That would mean the entire cost would fall to members of Congress and their staffs, many of whom would likely flee the institution.

The Obama administration’s compromise is to permit the federal government to contribute toward employee insurance on the exchanges, but to render those employees ineligible for any tax credits or subsidies.

“Members of Congress and their staff must go into the exchange,” said an administration official. “No ands, ifs, or buts. They will not be eligible in any way for subsidies or tax credits. But they don’t lose their current employer contribution.”

Congress is the only large employer that has to enter the exchanges or is even allowed to do so. Some on Capitol Hill have asked why the White House staff doesn’t follow suit.

“We have no legal authority to do that,” the official said. “But we would support legislation that would apply the same standard to the President and the White House staff and the cabinet members. We believe the insurance exchanges are a very good deal, a very good benefit, and we’re happy to be in them.”

Popularity: 2% [?]

Obamacare 2013: Battle over Obamacare continues on law’s third anniversary

By: CNN Wire

Some see 2013 shaping up as 2012 all over again — at least on the issue of health care.

The dispute over President Barack Obama’s signature health reform law, which he signed three years ago on Saturday, is back on. Democrats say the law will expand access to health care and rein in the rising costs of healthcare. Republicans say the law is bad news for the health care system and the economy.

Obama was flying home on Saturday from his trip to Israel and Jordan, but noted the anniversary with a statement saying the law reflected “the principle that in the wealthiest nation on Earth, no one should go broke just because they get sick.”

“Already, millions of seniors are saving $600 a year on their prescription drugs,” he said, touting what he described as the law’s successes. “Millions of young people have been able to stay on their family’s health plan until age 26. Preventive care, like mammograms for women and wellness visits for seniors, is covered free of charge. Most importantly, for the sake of our fiscal future, the growth of health care costs is beginning to slow.”

Republican opposition

But Republicans don’t see successes. House Speaker John Boehner said Saturday Democrats passed the law with a “host of promises that are proving more empty by the day.”

“Instead of keeping the coverage they have, an estimated 7 million Americans are at risk of losing their health insurance, including millions of low-income and minority seniors enrolled in Medicare Advantage,” Boehner said.

“Far from ‘bending the cost curve,’ Obamacare’s projected price tag has nearly doubled. Health insurance premiums have spiked and are expected to climb even further when the law takes full effect next year. The millions of jobs Democrats promised are nowhere to be found, and businesses large and small are already pointing to the impact of Obamacare as the reason for ‘planned layoffs and a reluctance to hire more staff,’” he said.

Both chambers held votes this week on a repeal of the law.

Senate Republicans united behind an amendment to the Senate budget resolution which would repeal the health reform law. It failed in the Democratic-held body 55-45 while the overall budget proposal passed early Saturday morning.

The left-leaning group Center for American Progress says Senate Republicans proposed at least seven amendments to that resolution to either partially or fully roll back the law.

The main amendment for repeal was proposed by Sen. Ted Cruz, a freshman Republican from Texas. He told CNN on Friday that if it goes into effect “it could very well cause a recession.”

“I intend to keep trying to repeal Obamacare and to fight for pro-growth policies every single day,” he said. “The economy is not growing, and implementing Obamacare now raises a real possibility that we will push this economy into a recession.”

The fight to repeal the law has fared better in the Republican-controlled House. Budget Chairman Paul Ryan included a repeal in his budget that passed the GOP-controlled body on Tuesday.

But that’s where the progress stops. Even if the Senate were to do the unlikely and pass a repeal of Obamacare, the president would veto it. It appears unlikely that Republicans could muster the two-thirds majority in both chambers needed to overturn a presidential veto.

“The House Republicans have voted more than 30 times to repeal Obamacare,” White House press secretary Jay Carney told reporters last week. “That seems at some point to be time not well spent.”

Law was challenged in 2012

The Supreme Court heard challenges to the law last year and upheld it by a 5-4 vote. The high court found constitutional the law’s key individual mandate provision, which requires most Americans to obtain health insurance or face a tax penalty.

The four conservative-leaning justices who dissented argued the majority — the four liberal-leaning justices and Chief Justice John Roberts, who was appointed by President George W. Bush — was rewriting the law to consider the individual mandate a tax.

That decision also paved the way for the full law to take effect next year.

It also came amid the 2012 election year politics, as the two parties were wrangling for control over the White House and Capitol Hill.

Obamacare, Romneycare and Obamaneycare

The health care law was heavily debated on the campaign trail between Obama and Republican presidential nominee Mitt Romney, who drew cheers at his campaign rallies with the promise to repeal the law. Ryan was then his vice presidential candidate and also pledged to abolish Obamacare.

The term Obamacare itself was initially seen as a derogatory term. Rep. Debbie Wasserman Schultz, D-Florida, protested Republican use of the word on the House floor in 2011, saying, “It [is] a violation of the House rule wherein members are not permitted to make disparaging references to the president of the United States.”

But the president eventually embraced the term, saying on the campaign trail that yes, as the moniker implied, he did care, and that was why he proposed the health law.

On his own road to the White House, Romney faced challenges from within his own party on the health care issue.

When governor of Massachusetts, he signed a 2006 health care law which included an individual mandate. He wasn’t helped by the Obama administration, which said it drew from the Massachusetts law in crafting its own plan. The candidate defended “Romneycare” as a state-level solution for his state’s issues, arguing states should design their own health care systems because a one-size, nationwide solution would not fit all.

Poll: Opinions mixed

The most recent CNN/ORC poll showed Americans are as split as Washington over the law. The January survey shows that 51% favor most or all of the proposals, while 44% oppose most or all elements of the law. Those numbers are reversed from 2011, when only 45% were in favor and 51% opposed.

A Bloomberg poll conducted in February found 55% thought health care costs would become worse in the next 12 months. Only 22% said health care costs would get better, and 21% expected costs to remain about the same.

The law remains unpopular in Republican circles, giving those who vocally oppose it an audience in the GOP.

“Ted Cruz is putting down some markers,” Republican strategist and CNN contributor David Frum said Friday on CNN’s “The Situation Room.”

“There is a struggle to define who is going to be the next leader of the Republican Party, and a lot of people who have emerged early are people who have one strike or another against them,” he said. “Rand Paul, they’re too exotic. Another case is they may not have the force of character, but Ted Cruz has the toughness and brains, and he represents an important fundraising state. He is putting down his marker to be at least a Senate leader, maybe more.”

Much of the law takes effect next year

There are, however, a few Republican leaders supporting portions — but only portions — of the law taking effect.

At least eight Republican governors have said they support an expansion of Medicaid, the health coverage program for the poor, which is included in the health reform law. The Supreme Court ruled the federal government could not compel the states to accept this portion of the law.

Some have said they only support the expansion for three years, when the federal government funds the entire cost. After that, the federal government will fund 90% and the states 10% of the program.

Governors who have accepted the program include New Jersey’s Chris Christie and New Mexico’s Susana Martinez, both of whom are thought by some as potential White House contenders.

Arizona’s Jan Brewer, Michigan’s Rick Snyder, Nevada’s Brian Sandoval, North Dakota’s Jack Dalrymple and Ohio’s John Kasich have also voiced support for the program.

Gov. Rick Scott of Florida said he would accept it, but his state legislature voted not to.

The Medicaid expansion is one of several health care changes set to take effect next year, including the law’s most high-profile elements, including the ban on dropping patients with pre-existing conditions, ban on annual benefit limits and the health insurance exchanges. About half of the states have said they will conduct their own exchanges; exchanges in the other states will be run by the federal government.

Federal agencies are already deep into the complicated rule-making process which will stand behind the actual law.

Senate Minority Leader Mitch McConnell, a Kentucky Republican, wheeled out this week a hand truck stacked with documents that towered over him.

“You know nothing sums up all the excesses of the Obama Administration like Obamacare,” he said. “For example, these are the first regulations: 20,000 pages, 7 feet tall, and they’re just getting started. Everything they promised about Obamacare isn’t coming true.”

And as people around the country start to navigate the law, expect the arguments for and against the law from both sides of the aisle to continue.

Popularity: 2% [?]

5 Things to Know about Healthcare Post-Debate

(CNN) — During the first presidential debate Wednesday night, the candidates talked a lot about how they would lower the cost of your medical care.

Heavy on data and large numbers, the debate may not have been the easiest to follow for Americans interested in the subject.

Ken Thorpe, an Emory University economist who specializes in health care costs, may have been one of the few excited by all these numbers.

“It was about as substantive a debate as I think we’ve ever seen,” Thorpe said. “The problem is, even after this debate, I don’t think people truly understand the similarities and the differences in what these candidates are proposing for health care.”

Here are five things you should know about what the candidates said about health care in last night’s debate:

1. You do pay more for health insurance, but Obama’s policy isn’t totally to blame.

The first mention of health care came about six minutes into the debate. Discussing how “middle-income Americans have been buried” financially under the president’s policies, Republican challenger Mitt Romney said health care costs have gone up by $2,500 a family.

Each year, health care costs have gone up during Obama’s administration — that is true. But experts say the increases have not been due to policy, but because of the rising cost of health care. The figure Romney used is not quite right.

The Kaiser Family Foundation, which conducts an annual survey of health care costs, found that since 2008 the average family premium has gone up about $1,698. For context, that is the total cost that you and your employer pay — it’s not $1,698 out of your pocket. In fact, the report said the increase you personally pay was not “statistically significant.”

Rising health care costs are a significant problem, though. The same survey found that the average premiums for family coverage have increased a whopping 113% since 2001. That means the trend started long before President Barack Obama took office.

2. Medicaid and Medicare fraud is a huge problem and more needs to be done.

Obama’s first specific reference to health care described how the administration pursued medical fraud in Medicare and Medicaid “more aggressively than ever before,” which saved the system tens of billions of dollars.

Medicare and Medicaid fraud is what one expert called “one of the most profitable crimes in America.” It costs taxpayers billions of dollars annually — $60 to $90 billion a year, based on government estimates. That’s money that could be better spent on taking care of actual health care costs.

Historically, it was up to states to police this problem, but the fraud grew too big for them to handle. A Republican-backed bill called the Deficit Reduction Act of 2005 created the Medicaid Integrity Program, which gives the federal government the ability to oversee and support states’ anti-fraud efforts.

The Obama administration launched several key programs to protect against fraud. They have saved taxpayers billions; however, a Government Accountability Office investigation concluded that while progress has been made under Obama, more could be done.

In a report this June, in fact, it found at least one of the major programs — an audit conducted by the government — costs taxpayers $102 million, but only found $20 million in excess payments.

“They have certainly been increasing their work in this area,” Thorpe said. “A certain kind of focus definitely did help eliminate some of this fraud.”

3. Sending Medicaid back to the states would save the federal government money, but cost states more and adversely impact those using the benefits.

Obama criticized Romney’s idea of sending Medicaid back to the states. He argued that this would mean a “30% cut in the primary program (for) seniors who are in nursing homes, for kids who are with disabilities.”

The plan GOP vice-presidential candidate Paul Ryan, as the head of the House Budget Committee, suggested in April — which Romney adopted as his own — would cut $1.4 trillion in Medicaid in the next 10 years. It would accomplish this by converting the program into a block grant that would in large part shift costs to the states, which Romney argued would give states more flexibility to do what they deem best to help their Medicaid population.

The nonpartisan Congressional Budget Office conducted an analysis of the proposal, which found that it would save the federal government a significant amount. Medicaid costs would be 49% lower by 2030 than current spending under Ryan’s plan. That’s because the block grant spending caps the cost and makes fewer adjustments.

The CBO concluded that while the federal government would save money, the states would “face significant challenges in achieving sufficient cost savings.”

In Wednesday night’s debate, Romney spelled out how he would adjust spending behind these block grants. “I would like to take the Medicaid dollars that go to states and say to a state, ‘You’re going to get what you got last year, plus inflation, plus 1%, and then you’re going to manage your care for your poor in the way you think best,’ ” he said.

That formula doesn’t account for rising health care costs (remember the cost of health insurance has gone up 113% since 2001), nor does it account for the aging population. With “baby boomers” getting older, there will be 63 million more people over 60 by the time 2030 comes around, according to U.S. Census projections.

Health care costs would go up significantly to accommodate this 20% increase in the number of people over 60 who will need more health care. Nor does Romney’s formula account for economic downturns where more people would qualify for the Medicaid program, like the current government formula — which would leave the states in a much more uncertain position.

The CBO analysis concludes about these block grants that these proposed cuts would “likely force states to scale back their Medicaid programs considerably.” Since poor people, seniors, and people with disabilities make up the majority of those who receive Medicaid, “they’d be hit the hardest.”

4. Romney’s accusation that Obama cut Medicare by $716 billion is misleading.

In the debate, Romney said 10 times that Obama was paying for his health care package by taking the money from Medicare recipients’ pockets, cutting $716 billion out of the program.

“To balance the additional cost of Obamacare is, in my opinion, a mistake,” Romney said. In his closing statement, he promised to restore that amount.

Dozens of bipartisan fact-checkers say that number, often repeated by the Romney/Ryan campaign, is misleading.

Where does it come from? It’s the figure mentioned in a letter from the Congressional Budget Office sent to House Speaker John Boehner in July. Boehner had asked for an analysis from the CBO if Congress could repeal Obamacare, something Romney said he would do if elected. “Spending for Medicare would increase by an estimated $716 billion” over the next decade, the analysis said.

That means Medicare would cost the government more. Obama’s health legislation does not mean people will see cuts to their benefits. Hospitals and health care providers will, but that’s what they agreed to in exchange for the Affordable Care Act’s mandate that people have health insurance. If more people have health insurance, hospitals will have to care for fewer of the uninsured. Uninsured patients cost significantly more to care for than patients who are insured.

It is unclear what impact the cuts would have on the Medicare program. Romney argues providers will accept fewer Medicaid patients. In the debate he said, “Some 15% of hospitals and nursing homes say they won’t take any more Medicare patients under that scenario (Obamacare).”

Medicare’s own independent actuary, which it uses to analyze changes in the program, has warned that these planned cuts to pay providers’ bills will force some doctors to stop accepting Medicare patients.

5. The Cleveland and Mayo Clinics do it better.

The candidates agreed during the debate that more needs to be done to control the cost of health care.

Obama praised the Cleveland Clinic as a model for new ways of controlling the cost of care. “They actually provide great care cheaper than average,” he said. “And the reason they do is because they do some smart things.”

One approach he highlighted was the collaborative approach of the clinic’s doctors. Instead of each doctor ordering a different test, they meet and decide as a team how to approach the patient’s problem. This prevents duplication. The team of doctors also provides preventive care.

Obama has held the clinic up as a model throughout his time in office. He visited it in 2009. It is a top-ranked teaching hospital that attracts patients from around the world. An analysis done by the Dartmouth Atlas of Health Care found that the Cleveland Clinic did treat Medicare patients for tens of thousands of dollars less than many other medical centers.

One of the big differences between the Cleveland Clinic and other hospitals is that it and other multi-specialty clinics like the Mayo Clinic in Minnesota employ their own doctors and can create these teams. In most traditional hospitals, doctors are independent private practitioners who are left to making their own choices.

Because Cleveland Clinic’s doctors are paid fixed salaries, there is less incentive to do unnecessary tests or procedures compared to a doctor who works on a fee-for-service basis.

As of right now, Medicare acts a lot like those traditional hospitals do, Thorpe said. “If you take the typical patient who is chronically ill, they will be overweight or obese, they suffer from bad cholesterol, hypertension, asthma and diabetes — that means they take 10 to 15 medications and there is no team-based care,” he said.

“Going to separate doctors with their own plans is expensive. These integrated group plans work well and the ongoing preventive care they provide — working with doctors, nutritionists, nurses, nurse practitioners and the rest — ultimately save on costs.”

Popularity: 21% [?]

John Roberts Saves Obamacare

By Walter Shapiro

In his White House memoir, “Courage and Consequence,” Karl Rove recalls being the lone non-lawyer among the group of George W. Bush aides who initially interviewed John Roberts for the Supreme Court in 2005. Rove asked Roberts to go back in history to name the justice whom he most revered. Roberts’ answer, Robert Jackson, intrigued and reassured Rove. When appointed in 1941, Jackson was serving as Franklin Roosevelt’s attorney general and had been expected to be a pro-New Deal rubber-stamp on the court. But, as Rove put it, Jackson “instead demonstrated a fidelity to the Constitution that Roberts admired.”

Thursday, in a jaw-dropping turnabout worthy of Justice Jackson, Roberts provided the swing vote in a 5-to-4 decision that upheld the constitutionality of almost all of Obamacare, the president’s signature legislative achievement. While an army of armchair court watchers expected Justice Anthony Kennedy to determine the fate of the Affordable Care Act (a recent Time cover called him “The Decider”), it was Roberts who took his fidelity to the Constitution in an ideologically surprising direction. Kennedy voted with three other conservative justices to overturn the health insurance mandate at the heart of the law.

Constitutional law seminars and unlicensed political psychologists will spend years speculating about Roberts’ motivations in joining the liberal bloc in probably the most important Supreme Court decision since Bush v. Gore in 2000. While we may wait decades to know for certain, it does seem plausible that Roberts may have been partly triggered by a desire to prevent the court from being seen as overtly political. Polls showing public respect for the Supreme Court at a quarter-century low reflect the growing view that the justices pursue partisan agendas.

One of the most important passages in Roberts’ majority decision was the chief justice’s assertion: “We do not consider whether the act embodied sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenge provisions.”

In short, if you want a national referendum on the health-care law, then the proper arena is the 2012 campaign—and not the inner sanctums of the Supreme Court.

The majority opinion in the health care case points up the inadequacy of the political clichés used in the heat of an election year to describe the Supreme Court. Phrases like “strict constructionist” and “not making law from the bench” do not clarify complex Supreme Court opinions like Thursday’s ruling. Romney’s campaign website declares, “As president, Mitt will nominate judges in the mold of Chief Justice Roberts and Justices Scalia, Thomas and Alito.” There’s only one problem with this formulation: Roberts went in one direction and Scalia, Thomas and Alito went in the opposite on the constitutionality of the health care bill.

Obama’s own ability at prophecy is limited, as well. In 2005, the former constitutional law professor declared in a Senate address that he was opposing Roberts’ nomination to the Supreme Court because “I ultimately have to give more weight to his deeds and overarching political philosophy … than to the assuring words he provided me in our meeting.”

While Obama has sharply disagreed with major decisions of the Roberts Court (particularly the anything-goes Citizen United ruling on campaign finance), it is tempting to wonder if the president now feels that he misjudged the man who saved his legislative legacy.

It is almost part of the job description of a president that he will make, at least, one blunder when picking Supreme Court justices. Harry Truman called one of his nominees, Tom Clark, a “damn fool from Texas.” When George H.W. Bush tapped New Hampshire jurist David Souter in 1990, the president never expected that he would be reinforcing the court’s liberal wing. Now it is Roberts who has refused to stay in his pre-determined ideological cubbyhole.

With four current justices over the age of 70, it is likely that whoever is elected president this November will get an opportunity to put his stamp on the Supreme Court. But the potential for Lucy-and-the-football surprises endures. About the only ways a president can achieve some measure of certainty about the court are either to nominate fire-breathing ideologues like Antonin Scalia or political cronies like Abe Fortas, who kept open a back channel to Lyndon Johnson during his brief tenure as a justice. But even the Scalia precedent no longer works, because anyone with a sharply articulated judicial philosophy probably could not make it through today’s hyper-partisan Senate.

As for the health care law, its major provisions remain on schedule to take effect in 2014. Even a President Romney may it difficult to reverse history, as he would have to face down a filibuster threat by Senate Democrats to get a repeal bill through Congress. (There are, however, administrative gambits that Romney could use to eviscerate Obamacare if Congress proves balky.) That’s why the Supreme Court seemed like such a beguiling short cut for conservatives who loathe Obamacare.

It’s also why back in 2005 Karl Rove may have badly misinterpreted John Roberts’ stated intention to be an independent jurist like Robert Jackson.

Walter Shapiro’s Yahoo! News column examines what we know about the character and personalities of the 2012 candidates. Shapiro, who is covering his ninth presidential campaign, is also a special correspondent for the New Republic.

Popularity: 71% [?]

Supreme Court appears willing to let most of health care law stand

Washington (CNN) — The heart of the health care law championed by President Barack Obama may be in judicial trouble, but the Supreme Court appeared very inclined Wednesday to keep the rest of the sweeping reform legislation intact.

On the final day of its marathon public debate over the 2010 Affordable Care Act, the justices tackled what would happen if they ruled against the constitutionality of the individual mandate, the key funding mechanism of the law.

At issue Wednesday morning was whether the entire law’s 450 or so provisions would have to be scrapped if the individual mandate were found unconstitutional.

A separate session is scheduled for Wednesday afternoon on whether states would be “coerced” by the federal government to expand their share of Medicaid costs and administration by the risk of losing that funding if they refuse.

Even though the health care law’s “individual mandate”– requiring most Americans to have health insurance beginning in 2014 or face a financial penalty– appeared to be on shaky legal ground, few on the court seemed eager to take the drastic step and invalidate the rest of the landmark legislation.

“There are so many things in the act,” said Justice Ruth Bader Ginsburg, including many provisions not directly related to market reforms such as Native American health care. “Why make Congress redo that? Who should we stop and start from scratch?”

Added Justice Elena Kagan. “Half a loaf is better than no loaf,” meaning some provisions would survive.

And the court appeared in no mood to pick and choose.

“You want us to go through 2,700 pages” of the law, asked Justice Antonin Scalia. “Is this not totally unrealistic … to go through one by one and decide each one?”

Justice Anthony Kennedy said he was reluctant to take on this “awesome exercise of judicial power,” at the expense of congressional discretion.

Supreme Court, health care and one little girl

This week’s hearings are among the most politically charged and closely watched in years, with dueling protests and news conferences outside the court building every day on what is likely to be a central issue of the November presidential election.

With the legal survival of the individual mandate in constitutional jeopardy, the question of “severability” — whether the rest of the law can stand if one part is invalidated — has become more important.

All of this may be moot. If the court decides the mandate is constitutional — even in a narrowly tailored way — they will not even bother to take up the severability question presented Wednesday.

In the morning arguments, the clearly divided court expressed concern over whether Congress would have passed the broad reform package without the key funding mechanism — the mandate– firmly in place. However, several of the justices seemed ready to let lawmakers eventually sort out the specific funding questions with or without the mandate.

After the end of six hours of arguments spread over three days, the nine-member bench will retreat from the public spotlight and get to the real task before them.

They will likely gather as a group in a closed-door conference over the next few days and actually decide on the four health care appeals. Going one-by-one in order of seniority, they will all be thinking of the number five — which is how many votes it will take to achieve a majority.

Two families, two viewpoints on health care reform

Once the tallies are sorted out, opinions will be assigned to individuals to craft over the next three months. What the court says in these written opinions — how it interprets the Constitution — will be far more important than what they said in the oral arguments this week.

The rulings may be in essence how legislators, individual Americans and history will judge these justices.

Wednesday’s cases gave the administration another chance to regain the rhetorical offensive and defend the entire law’s validity. Many legal observers concluded the Obama administration’s solicitor general, Donald Verrilli Jr., did little to boost the individual mandate’s constitutionality in two hours of intense arguments Tuesday.

The questioning of Verrilli’s performance was so widespread that the White House issued a statement Wednesday defending him.

“Mr. Verrilli is an extraordinarily talented advocate who possesses a sharp mind, keen judgment, and unquestionable integrity,” said the statement by White House Counsel Kathryn Ruemmler. “He ably and skillfully represented the United States before the Supreme Court yesterday, and we have every confidence that he will continue to do so.”

Wednesday’s first argument dealt with severability, but most court watchers think of it as the “domino effect” issue — if the individual mandate section is ruled unconstitutional, must the entire law collapse as well?

A federal judge in Florida had so ruled in February 2011, saying: “Because the individual mandate is unconstitutional and not severable, the entire act must be declared void.”

However, a federal appeals court subsequently overruled on the severability question while upholding the individual mandate’s unconstitutionality.

Opponents of the law say the individual mandate is crucial to its overall impact, since it is the main funding mechanism for the expansion of a range of other programs. This might be the one question on which the justices will ultimately agree in favor of the government.

The high court and election-year blockbusters

Then comes the Medicaid “coercion” question, which can be seen as the” national policy implications” issue.

Separate lawsuits by 28 Republican-led states say the new law’s significant expansion of the social safety net unconstitutionally “coerces” state governments.

Medicaid is administered by the states with a combination of federal and state money. It currently required coverage only for poor children and their parents or caretakers, adults with disabilities and poor individuals 65 or older. The “coercion” issue was surprisingly added to the health care debate by the Supreme Court justices.

Both sides of the issue agree that what the high court decides on Medicaid could have broad implications for the regulatory ability of the federal government to set long-term national policy goals in areas such as the environment, education and the workplace.

Some states have long complained their autonomy is being eroded by creeping federal intervention on spending matters.

Article 1 of the Constitution gives Congress the power to “lay and collect … taxes to pay the debts and provide for the common defense and general welfare of the United States” and to “regulate commerce … among the several states.”

Such authority has long been broadly interpreted, including when imposing conditions on recipients, be they individuals or states. No federal court has ever ruled states have been unlawfully coerced when they accept conditions or strings attached to federal funds. The Supreme Court in 1987 affirmed that congressional discretion.

Starting in 2014, the health care law’s Medicaid changes would make millions of additional Americans eligible for benefits by raising the income cap for qualification. That would include all adults up to 133% of the federal poverty line.

The tricky point is that states are not forced to agree to the law’s incremental Medicaid increases, spread out over six years. The states could instead abandon their participation in the program, but they say that would be a financial, social and political catastrophe — one which they cannot realistically accept.

Supporters of the health care law say the Medicaid issue involves political motivations rather than real policy concerns.

“These arguments aren’t based on Medicaid’s health outcomes among children or seniors,” Dr. L. Toni Lewis, the health care chair of the Service Employers International Union, said at a news conference Wednesday. “They aren’t based on testimony from those who have received services from Medicaid. They aren’t even based on data that shows how well Medicaid controls costs compared to private insurance. That’s because the challenge to Medicaid in the Supreme Court isn’t based on what’s good for our health. It’s just based on politics and posturing.”

Through this issue, the long-standing fight over “federalism” and the leverage the national government wields over states might soon reach epic levels with a high court decision either strengthening or limiting congressional authority on this and potentially a host of other regulatory areas.

The cases argued Wednesday were National Federation of Business v. Sebelius (11-393) and Florida v. Department of Health and Human Services (11-400).

Popularity: 2% [?]

Health Care Reform – What Would YOU do?

Regardless of where you fall on the political spectrum, you have to admit that these are historical times.

As more patients come into a health system already under stress, they encounter higher premiums. Higher premiums are tough to swallow especially when unemployment rates are hovering around 9 percent (10-12% some states) and the economy is unpredictable. The Obama administration recently channeled $109 million in an attempt to fight against “unreasonable” increases. The grant comes on the heels of a provision in the health care law affecting rate review. The provision requires health insurers who want to increase their rates by 10 percent or more in the individual and small group market to justify the increases in writing.

Whatever the reason for increases in medical costs, one thing remains certain – we cannot continue down the same road. So whether or not you are in favor of or against the health care reform bill, do you think you have ideas that could help solve the world’s health care issue?

Please share your thoughts and stories.

Popularity: 3% [?]

Nearly Half of Private Company CEOs Believe Healthcare Reform May Have a Notable Financial Impact on Their Business

Download image PwC’s Private Company Trendsetter Barometer tracks the business issues and standard industry practices of leading privately held US businesses. It incorporates the views of 224 CEOs/CFOs: 125 from companies in the product sector and 99 in the service sector, averaging $256.7 million in enterprise revenue/sales, and including large, $300 million-plus private companies.

NEW YORK, Oct. 14 /PRNewswire-USNewswire/ — As private company CEOs review the provisions of the federal Patient Protection and Affordable Care Act (the “Act”), nearly half (47%) of executives surveyed for PwC’s Private Company Trendsetter Barometer say the Act may have a notable financial impact on their business. However, nearly one-third (31%) of respondents believe it’s “too soon to tell” how the Act’s provisions will impact their companies. Twenty percent don’t anticipate a notable financial impact; 2% were unreported. Companies that don’t anticipate a notable financial impact are forecasting above-average revenue growth, compared with the other companies surveyed.

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Although the majority of Trendsetter CEOs (70%) have begun reviewing their healthcare benefit plans in light of the Act, 55% have not yet determined what changes need to be made to their companies’ plans. Only 15% have started to take action.

“In helping our clients assess the effect that healthcare reform will have on their organizations, we’ve been looking at their overall healthcare benefit packages to evaluate whether they’re in compliance with the Act, as well as considering strategies for managing the expected increase in healthcare costs,” says Ken Esch, a partner in PwC’s Private Company Services practice. “In light of current economic conditions, it’s imperative that companies begin assessing their healthcare plans and cost-containment strategies soon rather than later.”

Overall Impact Unclear

When asked which of the Act’s provisions were likely to have a moderate or significant overall impact on their company (including an impact on costs, benefits, strategy, operations, systems, employee recruitment, wellness programs, etc.), Trendsetter CEOs’ responses varied a good deal. “Although we’re seeing CEOs begin to review their options and healthcare strategy, on the whole they’re uncertain about how significant an impact the provisions will have on their organization,” says Esch.

This is evident, for instance, in the Trendsetter CEOs’ response to the Act’s tax provisions. Although a fair number of private companies expect the tax provisions (starting in 2013) to have a moderate to significant effect on their business (31 percent say this about the Medicare tax increase and 26 percent about the net investment income tax), the overall response to those provisions was mixed.

“This is an interesting time for Trendsetter CEOs, when you consider they’ll be implementing new healthcare requirements in tandem with increasing tax rates,” says Esch. “It’s possible this could create a cash flow issue as CEOs look to continue reinvesting in their business. Every company is different, of course, but we’re seeing clients consider accelerating income or deferring deductions now at the lower tax rate, which should provide a permanent tax benefit when rates go up.”

Popularity: 2% [?]

U.S. to hospitals: Clean up your act

By Parija Kavilanz, senior writer

NEW YORK ( — The new health law puts the nation’s hospitals on strict notice.

Either they improve the safety and quality of care for patients or the government will hit them where it hurts the most — their revenue.

The legislation contains dozens of provisions, including fining hospitals, to reduce medical errors, hospital-borne infections and costly preventable readmissions.

Those three issues alone drain billions of dollars annually from the health care system.

Industry watchers and consumer advocates say the measures were sorely needed and will go a long way to protect patients and enhance efficiency in the system.

But for hospitals, the new law could present a tough challenge.

Preventable readmissions: These cost the health care system about $25 billion every year, according to consulting firm PricewaterhouseCoopers.

To tackle the problem, beginning in 2012, the Department of Health and Human Services (HHS) will publish each hospital’s readmission track record.

Experts say high readmission rates — when patients return within 30 days of discharge — indicate hospitals aren’t adequately addressing patient issues or they’re discharging them prematurely.

In 2012, Medicare will stop paying hospitals for preventable readmissions tied to health conditions such as heart failure or pneumonia. In 2014, HHS will expand that policy to cover four additional health conditions.

Medical harm: The second penalty for hospitals is tied to hospital-acquired conditions stemming from medical errors or infections.

Here, the government has set a carrot-or-stick approach.

For instance, the government currently gives hospitals an incentive payment for simply reporting their performance on things like patient satisfaction and care quality tied to treatment of conditions such as heart failure, pneumonia and hospital-borne infections.

That’s changing.

Under the legislation, hospitals won’t be paid for just reporting their performance, but beginning in 2012, will be paid commensurate to their score. Higher scoring hospitals will receive higher payment and vice versa.

In 2015, HHS will also start reporting each hospital’s record for medical errors and infections pertaining to Medicare patients.

About 15 million instances of injury or harm as a result of a medical treatment occur every year in the United States, according to non-profit group the Institute for Health Care Improvement.

These include more than than 30,000 people who die annually from catheter-related blood stream infections, according to consumer advocacy group Consumers Union’s Safe Patient Project.

In 2015, Medicare will reduce its payments by 1% to hospitals with the highest rate of medical errors and infections. The government will also no longer pay hospitals for treatment when a Medicaid patient is harmed during a hospital stay.

Doctors: A tough job just got tougher
A medium-sized general hospital could lose upward of $1 million a year from these penalties at a time when all providers are struggling to keep up with escalating health care costs.

“That’s real money,” said Brad Bowman, director with PricewaterhouseCoopers’ health care advisory practice.

On top of that, Bowman warned of an even bigger risk to hospitals — a tainted reputation.

“Think about a town with three or four hospitals,” said Bowman. “Once the local press has access to hospitals’ detailed quality and performance scores, consider the impact a story about a poor-performing hospital can have on its business.”

It will be many times more than the dollars lost to penalties, he said. “Guess what? People will now say ‘Don’t take me to hospital D but to hospital A.’”

For its part, hospitals’ main trade group, the American Hospital Association (AHA), said it is supportive of some provisions but concerned about others.

“The penalties are intended to send a strong message from Congress that they want hospitals to be efficient and keep patients safe,” said Nancy Foster, AHA’s vice president of quality and patient safety. “That’s exactly what our members are working hard to do.”

Regarding readmissions, Foster said the government has to be “strategic” about how to bring down what it labels “preventive” readmissions.

“You don’t want a fear of penalties preventing hospitals from readmitting people who may need to come back soon after they were released,” Foster said, adding that many times, patients’ economic status prevents them from properly following post-hospital care and thus landing them back in a hospital.

“We’re eagerly awaiting regulations that improve these provisions to make sure these types of cases are thought about,” she said.

If regulations aren’t sensitive to people’s social issues, she warned that the measures could frequently punish hospitals that cater to the disadvantaged population.

Michael Young, CEO of Atlanta-based Grady Memorial, one of the largest public hospitals in the nation, said Foster makes a valid point.

As many as 95% of Grady’s patients are in the low income bracket and 40% of those don’t have insurance, which forced the hospital to provide $300 million in “free care” last year.

“When these patients can’t pay for things like home nurse care and readmissions go up, it’s the hospital that’s getting blamed under these measures,” he said.

“The legislation is a step in the right direction but the penalties are a legitimate concern,” Young said. “For public hospitals, the next five years will be a tremendous challenge.”

A victory for consumers
From a consumer perspective, PWC’s Bowman said the law is a big win.

“Up until this point, consumers have had so little information on health care providers,” he said. “You can get more information easily on a company’s stock in India than on a hospital down the street.”

The law, he said, cracks this door open so that consumers can make more informed choices about providers.

Lisa McGiffert with Consumers Union Safe Patient Project, agreed. “These measures put us on a path to improving care because when you change their payment structure, the behavior in hospitals improves.”

And even though most of these measures affect public insurance payments, McGiffert is hopeful of a knock-on effect on private insurance payments as well.

“As Medicare goes, typically so do other private insurers,” she said. “Medicare by virtue of being the largest insurance program in the country is considered the trendsetter for insurers and providers.”

Popularity: 4% [?]

Health overhaul likely to strain doctor shortage


WASHINGTON – Better beat the crowd and find a doctor.

Primary care physicians already are in short supply in parts of the country, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.

The new law goes beyond offering coverage to the uninsured, with steps to improve the quality of care for the average person and help keep us well instead of today’s seek-care-after-you’re-sick culture. To benefit, you’ll need a regular health provider.

Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.

A growing movement to change how primary care is practiced may do more to help with the influx. Instead of the traditional 10-minutes-with-the-doc-style office, a “medical home” would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most.

“A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months,” says Dr. Sam Jones of Fairfax Family Practice Centers, a large Virginia group of 10 primary care offices outside the nation’s capital that is morphing into this medical home model.

“We think it’s the right thing to do. We were going to do this regardless of what happens with health care reform,” adds Jones. His office, in affiliation with Virginia Commonwealth University, also provides hands-on residency training to beginning doctors in this kind of care.

Only 30 percent of U.S. doctors practice primary care. The government says 65 million people live in areas designated as having a shortage of primary care physicians, places already in need of more than 16,600 additional providers to fill the gaps. Among other steps, the new law provides a 10 percent bonus from Medicare for primary care doctors serving in those areas.

Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last fall reported just over half of internists and 40 percent of family and general practitioners weren’t accepting new patients, an increase in recent years as the state implemented nearly universal coverage.

Nationally, the big surge for primary care won’t start until 2014, when the bulk of the 32 million uninsured starts coming online.

Sooner will come some catch-up demand, as group health plans and Medicare end co-payments for important preventive care measures such as colon cancer screenings or cholesterol checks. Even the insured increasingly put off such steps as the economy worsened, meaning doctors may see a blip in diagnoses as those people return, says Dr. Lori Heim, president of the American Academy of Family Physicians.

That’s one of the first steps in the new law’s emphasis on wellness care over sickness care, with policies that encourage trying programs like the “patient-centered medical home” that Jones’ practice is putting in place in suburban Virginia.

It’s not easy to switch from the reactive — “George, it’s your first visit to check your diabetes in two years!” — to the proactive approach of getting George in on time.

First Jones’ practice adopted an electronic medical record, to keep patients’ information up to date and help them coordinate necessary specialist visits while decreasing redundancies.

Then came a patient registry so the team can start tracking who needs what testing or follow-up and make sure patients get it on time.

Rolling out next is a custom Web-based service named My Preventive Care that lets the practice’s patients link to their electronic medical record, answer some lifestyle and risk questions, and receive an individually tailored list of wellness steps to consider.

Say Don’s cholesterol test, scheduled after his yearly checkup, came back borderline high. That new lab result will show up, with discussion of diet, exercise and medication options to lower it in light of his other risk factors. He might try some on his own, or call up the doctor — who also gets an electronic copy — for a more in-depth discussion.

“It prevents things from falling through the cracks,” says Dr. Alex Krist, a Fairfax Family Practice physician and VCU associate professor who designed and tested the computer program with a $1.2 million federal grant. In a small study of test-users, preventive services such as cancer screenings and cholesterol checks increased between 3 percent and 12 percent.

Pilot tests of medical homes, through the American Academy of Family Physicians and Medicare, are under way around the country. Initial results suggest they can improve quality, but it’s not clear if they save money.

Primary care can’t do it alone. Broader changes are needed to decrease the financial incentives that spur too much specialist-driven care, says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

“What we need is not just a medical home, but a medical neighborhood.”


Popularity: 2% [?]

Obama’s Health Care Reform Bill Passed

Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle. “This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction,” Obama said shortly after the historic vote. “This is what change looks like.” With Democrats chanting the signature line of the Obama presidential campaign – “Yes we can!” – the House voted 219-212 to send a sweeping overhaul of the nation’s health care system to be signed into law. “We tonight will make history for our country and progress for the American people,” Speaker Nancy Pelosi declared shortly before the vote. “Today we have the opportunity to complete the great unfinished business of our country.”

The Democrats passed the bill without a single Republican vote – and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor. “If we pass this bill, there will be no turning back,” warned minority leader John Boehner. “It will be the last straw for the American people.”

Suspense about the outcome continued until the final hours of the debate. Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure. That only came after President Obama promised to sign an executive order reaffirming that the bill would maintain a “consistency with longstanding restrictions on the use of federal funds for abortion.” In reality, that executive order was more a symbolic move than an actual concession; the bill’s supporters have insisted all along that it does nothing to change the current federal policy, known as the Hyde Amendment, which has been in effect since 1976.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation. Such changes would be filibuster-proof in the Senate, though that process could still drag on a while if Republicans choose to draw it out with objections and amendments. Even so, it will be an anticlimax to Sunday’s historic House vote, which will send the underlying Senate bill to President Obama’s desk for signature.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, “Kill the bill.” It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival – especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House. The crowd was stoked by regular appearances that lawmakers made on a balcony overlooking the protesters. “It’s interesting how many faces they recognize,” said Republican Congressman Steve King of Iowa. Republicans flashed handwritten signs with the word No on them, sending the crowd into rapture.

Democrats also got into the act. Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, “God bless America. We’re glad you’re here.” She also flashed two fingers in a mischievous V for victory. The response? “Someone flipped a third finger,” she said.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down. There was also the distraction of March Madness to pass the hours. One aide said of Obama: “He’s in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket.” At one point during the afternoon, the Commander in Chief ordered his health care czar, Nancy-Ann DeParle, to take a break and go out for a run.

With passage of the legislation, Obama has achieved the signature domestic goal of his presidency, and the most sweeping piece of social legislation since the 1960s Great Society initiatives that saw the passage of Medicare and Medicaid. Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama’s bill comes as close to that target as anyone has. The bill would provide health coverage to an estimated 32 million additional Americans, meaning 95% of those who are legally in this country would have health insurance, up from 83% today.

The bill also promises to rein in health costs by reorienting the practice of medicine, making it more efficient, with health care providers rewarded on how well they treat their patients, rather than how much care they give them. Whether it actually achieves that latter ambition, however, is far more uncertain.

In the early years, most Americans will see only minor changes in the health care system. It will almost immediately end some insurance-company practices, such as denying coverage to children with pre-existing conditions. And dependent children under the age of 26 would be allowed to remain on their parents’ policies if they cannot get health insurance elsewhere. Adults with pre-existing conditions would also be able to buy coverage through expanded high-risk pools.

Beginning in 2014, more far-reaching measures will begin to take effect. States would be required to set up new “exchanges,” or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers. Government subsidies would be available to those earning up to 400% of poverty. Employers with 50 or more workers who do not offer coverage would be fined, and for the first time, most people would be required to obtain health coverage – either at work, or by purchasing it on their own – or pay a penalty.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

But while the bill is headed toward becoming law, the fighting over it isn’t going away anytime soon. Republicans have already issued notice that they plan to campaign in this fall’s midterm elections on a pledge to repeal it. There will be constitutional challenges. And in dozens of states, legislatures are considering measures that would attempt to exempt their citizens from some of its provisions, including the requirement that individuals purchase insurance.

By KAREN TUMULTY / WASHINGTON Karen Tumulty / Washington

Popularity: 3% [?]

Obama Delays Asia Trip as Dems Wrangle Health Care Votes

Sources Say ‘Dramatic’ Developments in Late Negotiations but Vote Count Unclear
WASHINGTON, March 12, 2010—

Speaking volumes about how Democrats lack the votes to pass health care overhaul legislation, President Obama has decided to delay next week’s trip to Indonesia and Australia.

The president was due to leave Thursday, which is the deadline that the White House gave Congress to finish negotiations and pass a bill.

But the White House has confirmed that Obama will leave three days later on Sunday, March 21, and without his wife and daughters as originally planned.

White House officials and congressional Democratic sources expressed confidence that the compromise House-Senate legislation will ultimately pass, but as of now, House Speaker Nancy Pelosi, D-Calif., does not have the votes.

“We’ll take whatever time is required forus to pass the legislation,” Pelosi told reporters today.

She needs 216 votes — a majority of the House’s 431 members — to pass the Senate bill and changes to it. Anti-abortion Democrats, led by Rep. Bart Stupak, D- Mich., have said they will not support the Senate bill because it has less restrictive language on abortion than the House bill.

Democratic congressional leaders had asked the president to delay his trip until after the health care overhaul vote so he could make a personal appeal to House Democrats to vote for legislation that has consumed so much of his presidency.

“I’m delighted the President will be here for the passage of the bill. It’s going to be historic,” Pelosi said.

Meanwhile, Senate Majority Leader Harry Reid, a key figure in the ongoing negotiations, is facing a personal health care crisis of his own.

Reid’s wife and daughter are recovering from a car accident Thursday that left the women hospitalized in serious condition.

Democrats Await CBO Score to Move Ahead
DemocSen. Reid’s wife, Landra, 69, suffered a broken nose, back and neck. Daughter Lana Reid Barringer, 48, has a neck injury and facial lacerations. Both are “conscious, can feel their extremities, and according to doctors, their injuries are nonlife threatening,” a Reid spokesman said.

The incident put Democrats’ intense legislative negotiations temporarily on hold Thursday as Reid rushed to the hospital to be by their sides. But Reid soon after returned to the Capitol; one sign that negotiations among House and Senate Democrats have become make-or-break.

“If Nancy Pelosi had the votes, they’d have already voted on this,” conservative commentator Laura Ingraham said on “Good Morning America” today. “Obviously, the president, he’s put it all on the line here. It’s not going to be good for Democrats, no matter what they do.”

But Democrats insisted they have the will and the votes to pass a bill soon.

“We’re in the home stretch,” Democratic strategist Donna Brazille told ABC News’ George Stephanopoulos. “There’s no question the Democrats will round up the votes.”

The White House had set a deadline for the House to pass the Senate bill by March 18, when the president was originally scheduled to leave for an overseas trip to Indonesia and Australia.

The White House has since backed off its deadline.

“Our hope is to get this done as soon as possible,” White House press secretary Robert Gibbs said Thursday. “If it … takes a couple extra days after a year, it takes a couple of extra days.”

One reason for the delay is the eagerly anticipated Congressional Budget Office score on how much the health care bill now before the House will cost. Its release is expected any day.

The Congressional Budget Office issued an updated cost estimate of the health care bill that passed the Senate Dec. 24, but that estimate didn’t include the changes being negotiated with the White House. The updated estimate was up slightly, from $871 billion to $875 billion over 10 years. And the total deficit reduction went from $132 billion to $118 billion.

‘Full Speed Ahead’ for Reid Despite Personal Matter
After congressional Democrats broke from their meeting Thursday night, White House chief of staff Rahm Emanuel told reporters, “It was a very good meeting. A lot of decisions were made. We’re getting towards the end.”

Sources described “dramatic” developments in the closed-door meetings in the past 24 hours.

As for whether Reid’s personal situation will affect the process ahead, many people close to the senator say that’s unlikely.

“This won’t slow him down, although he may have to spend quite a bit of time with his wife here in the next few days,” Sen. Mark Pryor, D-Ark., said “It’s going to be a full speed ahead for him for sure.”

The House budget committee may begin writing the “fixes” to the Senate bill Monday.

ABC News’ Devin Dwyer contributed to this report.

Popularity: 1% [?]

Obama health care reconciliation: save your outrage for the unconstitutional filibuster

By Tom De Luca
Wed Mar 3, 1:14 pm ET
New York – The debate over healthcare reform should have been about doctors, patients, insurance and drug companies, and coverage. Instead, much of the attention has been focused on a preexisting condition.

A filibuster allows a senator to delay or defeat legislation through endless talk – or merely the threat of it. That gives the minority breathtaking power to cause gridlock and discredit the majority by stopping it from pursuing the program it was elected on. That is exactly what 41 Senate Republicans are doing to 59 Democrats right now.

The filibuster has become so potent a political weapon that President Obama is reportedly approving the use of the controversial “reconciliation” process to pass healthcare reform. Under this method, Democrats could turn the reform bill into law with a simple majority of senators instead of the 60 now needed to end a filibuster. Critics are calling reconciliation an “abuse of power,” “undemocratic,” and “the nuclear option.” The real undemocratic abuse of power, however, is the present way in which the filibuster is used.

While the use of a simple majority through reconciliation to pass legislation would restore constitutional sanity to the Senate, it does not go far enough. The Senate should rewrite the filibuster rule entirely. Full and thorough debate should be preserved, but the unconstitutional practice of requiring supermajorities to pass important legislation must be ended. 

Many of us first learned about the filibuster in “Mr. Smith Goes to Washington.”

In that classic film, the filibuster is our quintessential American hero Sen. Jefferson Smith’s last hope of stopping corruption and symbolically saving the American republic.

In the real world of American politics today, however, the filibuster has become the weapon of choice to thwart a democratically elected majority on important legislation. Once rare, it’s now used routinely. Filibusters used to be hard work. Senators had to actually stand and talk in the Senate 24/7 until they literally dropped. Now they merely need to threaten a filibuster to stop legislation from ever coming to a vote.

This usurpation is more than an unheroic partisan power grab. It is an unconstitutional change in which the entire Senate – and both parties – are complicitous.

The Framers were explicit about those rare cases, such as constitutional amendments, in which supermajorities are required. They fashioned a document that assumed the majority rule principle for legislation, and based important arguments for the constitution’s ratification on that assumption.

In “The Federalist No. 10,” James Madison defended the newly proposed constitution on the grounds that it created the kind of republic that could prevent factions from undermining liberty. He was most worried by the abusive potential of a majority faction and prescribed, not supermajority rule, but a large and strong republic supplemented by federalism and separation of powers.

Minority factions could be more easily handled, he believed, by simply applying the “republican principle” of majority rule, enabling “the majority to defeat [the minority’s] sinister views by regular vote.”

The filibuster also upends the Great Compromise of 1787 that gave us a bicameral legislature. Small-population states wanted congressional representation based on state equality, while large-population states wanted to base it on the number of inhabitants in a state (or the amount of taxes it contributed).

The deal was to have both: a Senate and a House of Representatives. In granting an extraconstitutional veto to a minority faction of senators, the filibuster increases their (and their states’) power relative to that of other senators (and states). It also upsets the balance of power with the House and its members. The filibuster undermines the state equality and proportionality principles at the same time.Â

Debates over when “extraordinary majorities” would be required were part of the horse-trading that led to final agreement on the constitution. Southern states, for example, depended on agricultural exports and some wanted a legislative supermajority to be required for passage of laws that affected navigation, something the New England shipping states opposed. They traded this demand away for a 20-year guarantee of continuance of the slave trade and a ban on export taxes. Because sectional and state interests played an important role in these deals and compromises, it is inconceivable that the back door would have been left open for supermajorities to sneak in.

Article I, Section 5 offers filibuster-defenders one slim reed to grasp: that “Each House may determine the rules of its proceedings.” However, it also says that each senator shall have “one vote” and that “a majority of each [House] shall constitute a quorum to do business.” The filibuster both deviates from the equality of power idea intrinsic to the “one vote” principle, and changes the meaning of the words “to do business” – unless they were intended by the Founders to mean “do nothing but talk.”

The filibuster “rule” is in reality not a rule at all. It is a structural change to the meaning of the Constitution itself, something even a unanimous Senate is not empowered to do. Its defenders should ask themselves this question: If the filibuster “rule” were written into the constitution’s draft, would the constitution have been ratified? Without a new round of debates and compromises, the answer is no.

As the president of the Senate, Vice President Joe Biden should rule unconstitutional any use of the filibuster to block major legislation. As a political matter, such a move would be highly controversial, but as a constitutional matter, it merely restores the Framers’ intent regarding using majority votes to move legislation in each house of congress – something conservatives should support. After all, the status quo distorts the Constitution. And it robs the vice president of the only real power he has: to cast the tiebreaking vote when the Senate is “equally divided,” an impossibility if the meaningful vote is the one that requires 60 senators to end debate.

If Mr. Biden takes this step and gets attacked, it would be a perfect time to treat his Senate colleagues to a filibuster of his own, by reading to them, in its entirety, “The Federalist No. 51,” which explains how to avoid excessive concentration of power: “Ambition must be made to counteract ambition,” Madison wrote. “The interest of the man must be connected with the constitutional rights of the place.” In protecting his own power from Senate usurpation, Biden would also be fulfilling Madison’s constitutional plan. Mr. Smith would be very proud. But not as proud as Madison.

Tom De Luca, a professor of political science at Fordham University, is coauthor of “Liars! Cheaters! Evildoers! Demonization and the End of Civil Debate in American Politics.”

Popularity: 2% [?]

Two Fatal Flaws in Health Reform Resuscitation

iStock_000002494056SmallBy Bernadine Healy, MD

Salvage efforts are underway for the president’s health reform package, put into a stall by the recent surprise election of Republican Sen. Scott Brown in Massachusetts, which disrupted the one-vote margin that would have passed the legislation last month. On the one hand, President Obama seems conciliatory; a proposed televised summit in late February would allow key members from both sides of the aisle to hear from those who have different ideas. On the other, he does not seem willing to scrap the health reform bills that were a year in the making and would radically restructure both the financing and delivery of healthcare. Last week, Secretary of Health and Human Services Kathleen Sebelius delivered the message that the administration would not budge from its comprehensive approach to lowering costs and covering the uninsured, since the “pieces of the puzzle are too closely tied to one another.”

She has a point there. The Obama­care puzzle, a centrally driven plan that requires at least a trillion dollars to succeed, counts on a combination of taxation, fines, penalties, and cost savings; a reallocation of major resources within the current health system; and a willingness among doctors and patients to accede to substantial new government controls. Regardless of how workable the administration’s grand design appears to be on paper—about 4,000 pages of paper—it will fail if all of these big puzzle pieces are not in place. Most obviously, are the needed resources there for the tapping? There are at least two giant reasons that I think the puzzle is now imploding on its own, and neither has anything to do with political partisanship. And no televised show of hand-holding will make one whit of difference.

The first fatal flaw: leaning on Medicare. Obamacare counts heavily on its ability to drain off money from Medicare—which, by the administration’s own accounting, is slated to go into bankruptcy in seven years even as it is. It seems like a heavy dose of voodoo eco­nomics to expect that this program, with its ranks just starting a big swell because of aging baby boomers, has the capacity, no less the will, to cough up half a trillion dollars to pay for half of the cost of health reform. Much has been made of the savings to be found in ending fraud and abuse, but success there would in no way be sufficient to prevent a hike in Medicare payroll taxes on working Americans (who would not be pleased), higher Medicare premiums for beneficiaries, and a big bite out of the medical care our elders now receive.

Health reform proposes to save lots of government money by keeping seriously and chronically ill old folks from being readmitted to the hospital too frequently, a major source of Medicare expenditure. Sounds good, but it is easier said than done, both medically and ethically. Political pundits who would have you think that a hospital admission should cure the disease and that a readmission is a sign of doctor or hospital failure know little about the nature of the formidable degenerative diseases that affect the hearts and lungs, bones and brains, and immune systems of the elderly. Patients who can be tuned up with a few days in the hospital and return home better, even if it’s more than once, are not candidates for hospice. Where else are they to turn? Washington is threatening to cut reimbursement to the doctors and hospitals with higher readmission rates, or label them as poor performers, without analyzing the circumstances. It won’t work.

Another source of money is slated to come from ending Medicare Advantage, a popular but costlier option that covers 10 million elderly in privately managed healthcare organizations that provide pharmaceuticals and impose small or no copayments. Though the savings here are sure to be realized, they come at the risk of citi­zen discontent. Especially so when some elders, namely Floridians, are exempt. Who was the hero who saved Advantage for the 1 million elderly in the Sunshine State? It was their own Sen. Bill Nelson, who made that loophole the price for his health reform “Aye” vote.

The second seed of destruction: counting on Medicaid. The current plan to cover half of the uninsured by putting them into Medicaid has special appeal to federal budgeteers, since the states would be forced to kick in as much as 50 percent of the expense. But Medicaid is already literally bankrupting many states, which unlike the federal government have no way to print money. This new unfunded federal requirement would inevitably mean higher state income taxes that, yes, would hit the middle class despite the president’s promise otherwise.

On this point, give a tip of the hat to the other Nelson, the unrelated Sen. Ben Nelson of Nebraska, who got the bill passed even as he struck a special—and a bit tacky—deal to protect his state. Stridently opposed to the health bill up until the 11th hour, Nelson finally traded his 60th and winning vote in return for a promise that the feds would pay for Nebraska’s portion of Medicaid costs related to health reform in perpetuity. This did not sit well with other governors. Indeed, in his January State of the State address, California’s Gov. Arnold Schwarzenegger went ballistic about reform that would dump huge costs on states already struggling to pay their bills. Once a supporter, he called health reform a “trough of bribes, deals, and loopholes” and challenged the state’s congressional delegation “to fight for the same sweetheart deal Senator Nelson of Nebraska got for the Cornhusker State.”

If the federal government were to make the Nebraska deal with every state, reform would add billions more to the federal deficit, and the president by his own promise would have to veto the bill. But if the “I’ll vote for the law as long as I don’t have to follow it” approach is what carries health reform to his desk, he should by his own conscience consider using his veto pen.

Clearly, fixing the Obamacare mess will take time, if it’s possible at all. But one bipartisan effort that’s worth tackling and is doable right away is targeted insurance regulation. Let’s begin creating a health reform puzzle with this key piece: a system with no denials of access; no cherry-picking of the healthy over the sick; and, rather than one-size-fits-all coverage, an open market where people can search anywhere across the country to find the best policy at the best price for their own needs. Such change would cause insurers to compete to win the trust of, and lower the premiums for, their “covered lives” in order to keep their business. That would be real change.

Popularity: 4% [?]

Health Insurers Post Record Profits

Health Insurers Post Record Profits

Health Insurers Post Record Profits

Insurance Firms Rake in Profits as They Cut Patients, Advocacy Group Says


MedPage Today Staff Writer
Feb. 12, 2010—

In the midst of a deep economic recession, America’s health insurance companies increased their profits by 56 percent in 2009, a year that saw 2.7 million people lose their private coverage.

The nation’s five largest for-profit insurers closed 2009 with a combined profit of $12.2 billion, according to a report by the advocacy group Health Care for American Now (HCAN).

“The outsized earnings are a vivid reminder that without comprehensive national health care reform, the gatekeepers of our broken health insurance system always will put the short-term interests of Wall Street before the needs of millions of patients and a national economy plagued by joblessness,” the report said.

A spokesman for the nation’s health insurers said their profits are reasonable and represent only a small part overall increase in health insurance costs.

The HCAN report attributed this year’s profits largely to insurers’ dropping coverage of 2.7 million people, who then moved onto public insurance plans such as Medicaid.

Under questioning from reporters, Richard Kirsch, national campaign manager for HCAN, conceded that insurance companies don’t bear all the blame for eliminating people from their rolls. He said the recession induced many employers to cut back on benefits, including health plans. Also, many who were laid off lost their insurance coverage and were forced to enroll in Medicaid.

Even so, insurance companies have also offloaded their most expensive patients by cancelling their policies and raising premiums drastically, Kirsch asserted in a Thursday press call.

Among the report’s findings on specific insurance companies:

 - Wellpoint increased profits 91 percent from 2008 while it chopped 3.9 percent of its total enrollment.

 - United Health’s profit increased 28 percent from 2008, while enrollment dropped by 3.4 percent.

 - Cigna’s profit increased 346 percent and enrollment dropped 5.5 percent.

 - Humana’s profit increased by 61 percent while enrollment decreased by 1.7 percent.

 - Aetna was the only company with a drop in profit and a gain in enrollment. The company’s profit declined by 8 percent from 2008, and enrollment grew by 7 percent.

Lawmakers and critics who took part in the HCAN call said they were disgusted by the notion of insurance companies profiting while unemployment rates soar and more than 40 million people lack health insurance.

“How did they accomplish this feat in the midst of a sharp economic downturn that reduced wealth across the board?” asked Rep. Rosa DeLauro (D-Conn.). “Easy. They delayed payments to doctors, hospitals, patients. They raised premiums, increased co-pays and deductibles.”

California’s largest insurer, Blue Cross, announced last week that it will raise premiums 30 percent to 39 percent for many of its 800,000 customers.

“Without reform, we’re going to continue to see double-digit rate increases,” Kirsch said. “Without requiring that everyone’s covered, without regulating insurance companies, and without subsidies for people to make it more affordable, the data this year will continue unabated,” Kirsch said.

The health care bills being considered in Congress would impose regulations on insurance companies, prohibiting them from denying insurance or cancelling policies based on a pre-existing health condition. Both bills would also require insurance companies to spend money from premiums on health care, not on administrative costs.

Insurance companies agreed to the deal because of a provision that would require most Americans to buy health insurance, which would increase their customer base.

Some say the health care reform movement stalled with the election of Republican Scott Brown to Sen. Edward Kennedy’s old Massachusetts Senate seat, and President Barack Obama is holding a televised health care summit on Feb. 25 in hopes of bringing Republicans and Democrats together on some kind of agreement.

A spokesman for the insurance industry said health insurance profits “are well below other industries in the health care sector.”

“For every dollar spent on health care in America, less than one penny goes towards health plan profits,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans (AHIP). He argued that in 2009, it was spending on hospitals, physicians and prescription drugs that “continued to soar.”

Indeed, a recent report by the Centers for Medicare and Medicaid Service (CMS) found that health spending grew 5.7 percent, reaching $2.5 trillion in 2009, even though the overall economy declined by 1 percent. The report pointed to increased spending on hospitals, doctors, and medications as major drivers in the rising cost of health care.

Copyright © 2010 ABC News Internet Ventures

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Health Reform: Let’s Work on Drug Costs and Premiums

Pills & billsBy Bernadine Healy M.D.,

Posted: February 2, 2010

In his State of the Union address, President Obama vowed not to “walk away” from healthcare reform, though he was clearly chastened by the upset in Massachusetts that had swept Republican Scott Brown into the Senate, depriving Obama, at the 11th hour, of a signed bill before the speech. The legislation barely made it through each chamber, and the 60-vote victory on Christmas Eve in the Senate came without a vote to spare. The president did not reveal how he would move forward, but his rescue options are sorely limited. Still, whatever path he chooses, the walk provides a totally unexpected opportunity for the country: the chance to go back and make changes that would not have been possible before Massachusetts voters weighed in.

There are really only two paths forward, and both will take time. In the faster (and perhaps too clever) way, the House would pass the Senate bill untouched and send it to the president, bypassing the need for a final Senate vote that includes Brown. Secret negotiations are underway at both ends of Pennsylvania Avenue to modify the 2,700-page Senate monster to the House’s liking—but any changes can be voted on only after the president signs the bill into law. The post-facto recasting would use a political gimmick, a process called reconciliation, that applies to budget issues and requires a simple majority vote (51 percent) rather than the supermajority (60 percent) often needed to pass controversial legislation in the Senate. If the House balks at this feat of legislative engineering, Congress will have to take a deep breath, step back, and fashion a more bipartisan bill.

Both scenarios mean that healthcare reform could still be made far more respectful of patients’ individual choices and their pocketbooks—not just the federal purse. Let me suggest two big-ticket areas that badly need attention: prescription drug costs and insurance premiums. Both must be affordable, or a central goal of reform—ready healthcare for all—will never be achieved.

Pharmaceuticals: In the United States, medicines in exactly the same doses commonly run three to four times, and in some cases 10 times, prices in other places on the planet with drug-safety and approval systems like our own. The issue became hot in 2003, when older folks were caught boarding buses to Canada to buy their drugs at huge discounts. Rather than being cheered on by Uncle Sam for saving healthcare dollars, the renegades were threatened with confiscation of their “illegal” purchases. The federal government refused to relax the Food and Drug Administration’s rules against citizens’ importing drugs, even those obtained from perfectly legitimate pharmacies. And the consumers’ revolt was vigorously opposed—surprise, surprise—by the drug companies, which lobbied heavily to continue to soak American taxpayers under the guise of safety. A bill to allow such drug imports, cosponsored by none other than Barack Obama when he was in the Senate, was roundly defeated.

 Shortly after he was inaugurated, Obama vowed to bring down the cost of drugs by making it possible for Americans to fill prescriptions outside the country. It did not take long, however, for the special interests to entice him to cave. In a stunning surprise, given his legislative record and earlier promises, Obama made a backroom deal with the pharmaceutical lobby. Big Pharma would support Obamacare and even contribute $80 billion to the healthcare reform effort. The president would quash efforts in support of the citizen revolt.

Then, in mid-December, in one of the few bipartisan moves related to health reform, a majority of senators voted to amend the bill to allow Americans to buy drugs from Canada, Europe, Australia, New Zealand, and Japan. How could they not do so? The Congressional Budget Office had just estimated that the amendment would save the government almost $20 billion, and Democratic Sen. Byron Dorgan of North Dakota, who sponsored the bill, said it would lower patients’ costs by $80 billion. The amendment did not get the 60 votes necessary to be added to the health reform bill, but a reconciliation strategy that needs only 51 votes, or a new bill fashioned from scratch, could and should get the gray panthers a win after all. Health reformers ought to place value on healthy competition, which, if allowed to flourish, can lower costs to individuals as well as to the U.S. Treasury.

Insurance reform: In the same spirit of allowing competition and consumer choice to thrive, the way health insurance is sold should be addressed. The current system bears no resemblance to an open market where people can shop for the best policy for themselves and their families at the best price, as they can, say, for car insurance. Now, patients have little leverage. Those with health risks can be rejected out of hand, existing coverage can be canceled, and claims can be denied for little or no reason. Outlawing such abuses is the one part of the current healthcare reform legislation that has strong bipartisan support. And this is an imperative that cannot be walked away from.

But even then, a nagging problem remains: People don’t feel insurers are working for them, although the companies manage lots of their money and weigh in on their health. This could get worse, since a keystone of health reform—the individual mandate—would force people to buy coverage restricted to that sold through either a government-run exchange or an employer. Only the federal government would define the “essential” coverage every American must have and would set up the rules of the exchange.

Instead, to preserve patient choice while trimming cost, we need multiple nationwide exchanges, public and private, that will foster competition among insurers, expand choices, and lower prices by helping patients to be smart consumers. Rather than being forced to buy a one-size-fits-all, comprehensive, government-approved policy, for example, most young people could get insurance for thousands of dollars less by choosing a scaled-back, high-deductible cata­strophic plan that brings access to discounted ­prices for preventive and primary care.

Face it: Since most of the uninsured fall into the relatively healthy under-40 group, the current bills will force tens of millions of Americans to overpay for coverage, a juicy deal for insurers but not for anyone else. A bonus to allowing high-deductible plans is that they force people to think about the cost of their care and, much as those elders did when they boarded buses to cross the border to get cheaper drugs, to search for ways to save. We cannot ignore the power of the people to make their own wise decisions. Let’s give them an incentive to do so, and we’ll develop a generation of prudent healthcare consumers. 

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‘Wellness’ Provision in Health Care Bill Meets Protest

DoctorAdvocate Groups Say Incentives For Wellness May Hurt The Poor and Elderly
By EMILY P. WALKER MedPage TodayWashington Correspondent
WASHINGTON, Jan. 10, 2010—
Incentives within the U.S. Senate health care bill designed to encourage healthy lifestyles unfairly target the poor, elderly, overweight and disabled, and could be exploited by insurance companies for financial gain, advocacy groups claim.

Dozens of health, justice, and disability organizations have signed a letter urging senators to remove a provision in the health care reform bill that would allow insurers to provide reimbursements or incentives to workers who meet certain fitness goals laid out in workplace wellness programs.

In rewarding healthy people for making good choices, those who don’t meet fitness goals would be unfairly penalized, the groups said.

“It’s indistinguishable from medical underwriting,” Sue Nelson, vice president for federal advocacy of the American Heart Association (AHA), told reporters during a Thursday call.

“This is a loophole that [insurance companies] will drive right through on day one,” added Andrew Kurz, former chief financial officer of Wisconsin Blue Cross-Blue Shield. “This can lead to huge differences in premiums.”

Under the existing Health Insurance Portability and Accountability Act, group health insurance plans can’t discriminate based on an individual’s health status by varying insurance premiums.

But the law does allow insurers to provide incentives tied to voluntary “wellness programs,” either solely for participating in a workplace wellness program, or for meeting certain health and fitness benchmarks, such as reaching a certain body mass index target.

Those incentives can take the form of extra reimbursements, but they can’t top more than 20 percent of the employer’s cost of covering the employee.

The Senate bill would raise that figure to 30 percent, so an individual who doesn’t meet the wellness goals could hypothetically be paying up to $1,410 more in annual premiums than an employee who met wellness goals.

The amount could be raised to 50 percent, with government approval. People with medical conditions that preclude participation would be offered an alternative program, the bill says.

“Such exorbitant penalties undermine a fundamental goal of healthcare reform — the creation of a system in which no one can be charged more based on their health status,” said the letter, signed by representatives of groups including the American Heart Association, AARP, the American Diabetes Association, and the National Disability Rights Network.

The basic idea sounds intuitive and hardly controversial: Reward people for being healthy.

“Weight gain and unhealthy lifestyles that focus on smoking and lack of exercise have sky-rocketed our healthcare costs,” said the sponsor of the provision, Sen. John Ensign (R-Nev.), in a statement when the Finance Committee adopted his amendment in a bipartisan vote.

“These costs could be lowered by focusing on what makes us healthy — through weight loss programs, smoking cessation, and preventive care. Voluntary employee participation in these areas should naturally be reflected in lower healthcare costs,” he said.

However, it’s not so cut-and-dry, advocacy groups contend. Employers could first raise premiums for workers across-the-board, and then lower premiums for employees that meet certain goals, such as having low cholesterol or reaching a certain body mass index.

Those who are unable to meet such goals would be forced to pay a high premium that could well be unaffordable.

“Attainment incentives provide welcome rewards for employees who manage to comply but may be unfair for those who struggle, particularly if they fail,” wrote Harald Schmidt of the Harvard School of Public Health in a recent “Perspective” published in the New England Journal of Medicine. “In some cases, the incentives are really sticks dressed up as carrots.”

“This is not workplace wellness, this is cost-shifting,” added AHA’s Nelson, arguing that costs would likely move from healthy employees to sick employees, and from employers to employees.

Schmidt said the incentive programs would unfairly penalize lower-paid workers, who are more likely to be unhealthy.

Advocates say it’s unfair to expect the same level of exercise and diet from a law school graduate who has a gym in his condo and a single mother who works two jobs, can’t afford a gym membership, and lives in an area with a limited supply of healthy foods.

“It’s really important to ask what is the motivation behind these programs,” Schmidt told reporters. “Is it really to make people more healthy or to reduce costs? Or to do both? In the end, there is nothing wrong if we can achieve both, but we do have a problem if … it leads to unfairness and inequity.”

Sen. Tom Carper (D-Del.), a co-sponsor of the amendment said the provision contains “strong protections against discrimination” for employees.

“Companies using similar incentives have not only seen their employees’ health improve, but they have seen a significant decrease in healthcare costs,” Carper said in an e-mail.

During the health care reform debate, the grocery store chain Safeway was referenced countless times as a company that implemented a successful employee wellness program that helped workers quit smoking, lose weight, and eat healthily while saving the company money.

But critics say that because the Senate bill doesn’t include guidelines on what a workplace wellness program should look like, one might involve nothing more than testing cholesterol levels while ignoring fitness and motivational components, said Nelson.

Employers would have little incentive to spend money to install a workplace gym or hire smoking cessation counselors, she said.

Nelson said the AHA and other groups are working with congressional staff to remove the provision and instead have the final bill include the House language, which would merely set up pilot programs to test the idea.

A spokesperson for Senate Majority Leader Harry Reid declined to comment on whether the provision would be eliminated during conference, but said “differences will be negotiated with the House.”
Copyright © 2010 ABC News Internet Ventures

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Now That It’s Passed: What You Need to Know About the Senate Health Care Bill

iStock_000002125473SmallLegislation Clears First Hurdle; Debate Is Far From Over
ABC News Medical Unit
Dec. 25, 2009-

Now that the Senate’s $871 billion health care overhaul bill has passed, many may still have questions about the exact nature of the bill — and how it may affect their health choices in the decade to come.

To learn more, the ABC News Medical Unit reached out to some of the nation’s top experts in health care policy. More than a dozen replied. Below are some of their comments on the Senate bill, its potential impact and how it differs from the House bill.

What Will It Mean?
Health reform proponents overwhelmingly spoke out in favor of the bill though some noted that more remains to be done.

“It’s a start,” said Donald Kemper, chairman and CEO of Healthwise Incorporated. “It focuses on reducing the inequities, and that’s not a bad place to start.”

Karen Davis, president of the health care reform group the Commonwealth Fund, called the bill “another milestone on the way to historic and significant changes to the U.S. health care system.”

The Senate’s passage of the bill had its share of industry support as well.

“We applaud the Senate for taking an important and historic step toward expanding high-quality, affordable health care coverage and services to tens of millions of Americans, many of whom are struggling today financially,” said the Pharmaceutical Research and Manufacturers of America in a statement.

But not all were in favor of the bill.

“For the first time in our history, the federal government will tell you what type of insurance you have to have and effectively — where you will get it and even what price you have to pay,” said John Goodman of the conservative think tank National Center for Policy Analysis.

How Is It Different From the House Bill?
Of course, the Senate version of the health care reform bill is only one side of the story. Lawmakers will now begin the task of reconciling the Senate legislation with the House bill, which passed in November.

“The major unresolved issues that the conference committee will have to resolve are one, the sources of financing for the program, and two, the fate of the public option,” said Daniel Blumenthal, chair of the department of community health and preventive medicine at the Morehouse School of Medicine in Atlanta, Ga.

“[The House bill] has better premium and cost-sharing assistance for low-income families,” Davis said, adding that the House and Senate bills have different provisions on abortion coverage, which could also be a major point of contention.
Cost and Coverage
In its current form, the Senate bill asks for $871 billion over the next 10 years. What would Americans get for this sum? Uwe Reinhardt, professor of economics and public affairs at Princeton University in Princeton, N.J., said poorer families would be one group that would come out on the winning end.

“Starting somewhere between 2013-14, but no later than 2014, the bill will channel about $870 billion divided by roughly 6 years … $145 billion a year toward lower-income American families that would otherwise find themselves priced out of health insurance by the ever rising cost of coverage.”

In total, 31 million more Americans would ostensibly receive health coverage with the passage of the bill. But Republicans argue that the Senate health care bill would add an extra $1 trillion to the budget deficit a figure that differs from the nonpartisan Congressional Budget Office’s estimate that it would reduce the deficit by $132 billion over 10 years.

“Politics has caused compromises that may make the ‘victory’ hollow in that $1 trillion will not buy adequate truly affordable health care for a large segment of the population,” said Arthur Garson, dean of the school of medicine at the University of Virginia in Charlottesville.

What It Might Mean for Americans
Health care reform proponents lauded the fact that the bill would provide the same coverage to people regardless of pre-existing conditions.

“The industry will no longer be able to base the individual’s premiums on the individual’s health status,” Reinhardt said.

David Orentlichter, co-director of the Center for Law and Health, Indiana University, concurred. “Insurers will have to charge the same rates to all persons — with some freedom to charge higher rates based on age.”

Others noted that the legislation, if ultimately passed, will have other beneficial effects as well.

“New Medicare payment and quality reporting strategies will improve patient safety, cut medical errors, and increase the quality of care,” said Washington and Lee University law professor and health care expert Tim Jost.

But some expressed concern that the effort could have unintended consequences.

“Every one of these new regulations … will necessarily increase costs of insurance and raised premium costs — exactly what the Democratic leadership claims won’t happen,” said Richard Saltman, an international health expert at Emory University in Atlanta.

“Doctors will be forced to change how they make their medical decisions,” said Scott Gottlieb of the conservative think tank American Enterprise Institute. “The Centers for Medicare and Medicaid Services will be given the authority to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced.”

Going Forward: What It Means for Politics
If there is one matter upon which those from both sides agree, it is that the fierce fight over the direction of health care in the next decade will lead to lasting rifts between those in favor of the bill and those who are opposed to it.

“The nearly complete detachment of one of our main political parties from addressing the challenges of either coverage or cost control is also found nowhere else in the world,” noted Alan Sager, director of the Health Reform Program at the Boston University School of Public Health. And Saltman said the battle is “only the first chapter in a new phase of what will become an increasingly acrimonious and politically volatile period in our health system — one that many politicians on both sides of the political divide may soon wish had never begun.”
Copyright © 2009 ABC News Internet Ventures

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Senate health care bill to allow benefit caps, Democratic aides say

Washington (CNN) — The health care bill being negotiated in the Senate would allow caps on annual insurance benefits, reversing a previous version of the plan that would have prevented insurance companies from establishing such limits, according to three Democratic aides.

“We were trying to minimize premium impacts,” said Jim Manley, a spokesman for Senate Majority Leader Harry Reid, acknowledging the change.

The trade-off has drawn criticism from the American Cancer Society’s Cancer Action Network, a patient advocacy group.

“We were very surprised by this,” said Stephen Finan, the group’s senior policy director. Finan worries that cancer patients, who often require expensive procedures, could still face major financial losses if annual coverage benefits are capped too low.

Policymakers on Capitol Hill are defending the legislation.

“The provisions in the bill are a big improvement over the current system in which cancer patients have to fight for coverage and often don’t get the preventative services that catch cancers at an early stage. We hope to make the provisions even stronger in the bill Congress sends to the president,” a Democratic Senate aide, who declined to be identified, said about the change.

Aides say senators will continue to review the policy closely as the process moves forward.

“Ensuring affordable health care costs requires a balance between too much insurance market regulation and not enough,” said Erin Shields, an aide to Senate Finance Chairman Max Baucus, D-Montana. “That balance is what this bill aims to achieve, especially with regard to annual limits. Senators want to ensure this provision provides as much consumer protection as possible while keeping premiums affordable.”

CNN’s Ted Barrett, Ed Hornick, John Bonifield and Elizabeth Cohen contributed to this report.

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Lugar: Senate should put off health care debate

From CNN Associate Producer Martina Stewart

Washington (CNN) – The Ranking Republican on the Senate Foreign Relations Committee said Sunday that the Senate should set aside the impending debate on the health care reform bill and, instead, use the remainder of the year to focus on the appropriate strategy for the Afghanistan war, funding the war, and passing the appropriations bill necessary to keep the federal government running.

“I would just make this suggestion,” Republican Sen. Richard Lugar said Sunday on CNN’s State of the Union, “that in the three weeks of debate we still have ahead of us, we really ought to concentrate in the Congress on the war, on the overall strategy of our country and the cost of it. And we ought to be on the budget – passing appropriations bills in a proper way. . . . We may wish to discuss higher taxes to pay for [the war]. But we’re not going to do that debating health care in the Senate for three weeks through all sorts of strategies and so forth.”

“The war is terribly important,” Lugar continued, “Jobs and our economy are terribly important. So this may be an audacious suggestion, but I would suggest we put aside the health care debate until next year, the same way we put cap and trade and climate change [aside] and talk now about the essentials: the war and money.”

Democratic Sen. Jack Reed, who sits on the Senate Armed Services Committee, disagreed with Lugar.

“Absolutely not,” Reed replied when asked by CNN Chief National Correspondent John King whether the Senate put off debate on the health care reform bill until 2010.

“I think we’re in the midst of probably the most significant debate and conclusion with legislation that we’ve ever had,” Reed told King, “And the health care debate is essential to our economic future. There are – Businesses and individuals each year pay more and more for health care. It has become unaffordable. We have to go ahead and conclude this debate.

“To stop now would be stopping on the edge of, I think, significant reform, which is so important for the country. And frankly, it’s ironic, there’s – under the Bush administration, there was no serious debate about Afghanistan. That was relegated to the sidelines. There was no attempt to pay for it. And suddenly, now, that becomes a critical need that we put aside health care. I don’t think so.

I think we have to push forward. I think the president’s speech [Tuesday about Afghanistan] will be appropriate. I think the strategy we’ll analyze in the committees and I think we can go forward on both fronts and we have to.”

After months of deliberation, Obama is set to give a speech Tuesday evening that outlines his plans for the war in Afghanistan. Also this week, the full Senate is set to begin debate on a health care reform bill crafted by Senate Majority Leader Harry Reid, who managed to garner just enough votes to get the bill to the floor.

Popularity: 2% [?]

What do you think?

Should Healthcare Reform include coverage for Illegal Immigrants?

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AMA, AARP back House health care bill

Washington (CNN) — The push to overhaul health care received a major boost Thursday as the American Medical Association and AARP endorsed legislation drafted by top House Democrats.

The AARP, the nation’s largest organization of older Americans, is a nonpartisan group that advocates for people 50 and older. The AMA, historically an opponent of health care reform, is considered one the nation’s most influential doctors’ advocacy groups.

“I want to thank both organizations again for their support, and I urge Congress to listen to AARP, listen to the AMA and pass this reform for hundreds of millions of Americans who will benefit from it,” President Obama said at the White House.

The backing of those two groups comes as House Speaker Nancy Pelosi, D-California, oversees final changes to the $1.1 trillion health care bill. The measure likely will come to a final vote Saturday.

A 42-page manager’s amendment on the health care legislation posted Tuesday night made mostly technical changes in the nearly 2,000-page bill compiled from three Democratic proposals passed by three House committees.

By making the changes public Tuesday, House Democratic leaders could open floor debate on the bill Friday, while fulfilling their pledge to allow 72 hours of review before bringing the measure to the full chamber.

Pelosi insisted Thursday she will have the 218 votes necessary to pass the bill. Meanwhile, President Obama is set to huddle Friday with congressional Democrats on Capitol Hill to review the legislation.

In a statement, AARP CEO Barry Rand said, “We started this debate more than two years ago with the twin goals of making coverage affordable to our younger members and protecting Medicare for seniors.

“We can say with confidence that [the House bill] meets those goals with improved benefits for people in Medicare and needed health insurance market reforms to help ensure every American can purchase affordable health coverage.”

The AMA’s president, Dr. J. James Rohack, told reporters Thursday that the legislation is “not a perfect representation of our views” but is close enough to warrant his group’s support and keep the reform process moving forward.

Rohack said the bill needs to be accompanied by legislation reversing scheduled Medicare reimbursement payment reductions to physicians.

Responding to the AMA endorsement, Obama said the doctors’ group is “supporting reform because [its members have] seen firsthand what’s broken about our health care system,” Obama said.

“They would not be supporting it if they really believed that it would lead to government bureaucrats making decisions that are best left to doctors.”

Meanwhile, House Republicans on Thursday continued to signal their opposition to the measure. GOP leaders held a rally on Capitol Hill along with “Tea Party” movement protesters and other activists to warn that the House legislation would translate into a full-blown government takeover of the health care system.

Rep. Michele Bachmann, R-Minnesota, told CNN’s “American Morning” on Thursday that Democrats had forgotten the lessons of August’s town hall meetings when angry conservatives criticized health care legislation.

“I think what we’re going to see is the town hall coming to Washington, D.C., just to remind members of Congress [that] we’re the ones we would like you to pay attention to, not lobbyists. And we don’t want the government to own our health care,” Bachmann said.

Speaking at Thursday’s opposition rally, actor John Ratzenberger, who played Cliff on the sitcom “Cheers,” slammed the Democratic bill as a form of socialism.

“These are Woodstock Democrats,” Ratzenberger said. “We have to remember where their philosophy comes. It doesn’t come from America. It comes from overseas. It comes from socialism. And socialism is a philosophy of failure.”

House Democrats have rejected an alternative $60 billion Republican plan as inadequate for meeting the goals of expanding health coverage to most of the nation’s 46 million uninsured while bringing down costs and ending controversial industry practices such as denying coverage for pre-existing conditions.

Pelosi’s bill would extend insurance coverage to 36 million uncovered Americans and guarantee that 96 percent of Americans have coverage, according to the Democratic leadership.

The claim is based on an analysis by the nonpartisan Congressional Budget Office.

Among other things, the bill would subsidize insurance for poorer Americans and create health insurance exchanges to make it easier for small groups and individuals to purchase coverage. It also would cap annual out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Pelosi’s office has said the bill would cut the federal deficit by roughly $30 billion over the next decade. The measure is financed through a combination of a tax surcharge on wealthy Americans and spending constraints in Medicare and Medicaid.

Specifically, individuals with annual incomes more than $500,000 — as well as families earning more than $1 million — would face a 5.4 percent income tax surcharge. Growth in Medicare expenditures would be cut by 1.3 percent annually.

The House bill also includes a government-run public option. Under the House plan, health care providers would be allowed to negotiate reimbursement rates with the federal government. Pelosi and other liberal Democrats had argued for a more “robust” public option that would tie reimbursement rates for providers and hospitals to Medicare rates plus a 5 percent increase. Several Democrats representing rural areas, however, killed the proposal after complaining that doctors and hospitals in their districts would be shortchanged under such a formula.

One thorny issue yet to be resolved among House Democrats is the bill’s final language on abortion. Rep. Bart Stupak, D-Michigan, has been pushing leaders to add stronger language prohibiting the use of federal money to pay for abortions under the health care overhaul.

Stupak has vowed that if he isn’t allowed a vote on the issue, a group of 40 anti-abortion Democrats will work to block the bill from getting to the House floor.

The House bill differs from legislation the Senate is considering in a number of critical ways. Senate Majority Leader Harry Reid, D-Nevada, also favors a public option but would allow individual states to opt out of the plan.

An $829 billion bill recently passed by the Senate Finance Committee does not include a tax surcharge on the wealthy but would impose a new tax on high-end health care policies, which critics have dubbed “Cadillac” plans. A large number of House Democrats are opposed to taxing those policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.

Individuals under the $829 billion Finance Committee plan would be required to purchase health insurance coverage or face a fine of up to $750. The House bill imposes a more stringent fine of up to 2.5 percent of an individual’s income. Both versions include a hardship exemption for poorer Americans.

The Finance Committee bill would require large companies to contribute to the health care costs of lower income workers if those workers received a government subsidy for insurance. The House legislation would require larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.

Democratic leaders in both chambers agree on establishing nonprofit health care cooperatives and stripping insurance companies of an anti-trust exemption that has been in place since the end of World War II.

Reid refused earlier this week to predict when the chamber would pass a health care bill, possibly signaling difficulty in generating support from his entire Democratic caucus.

CNN’s Dana Bash, Lisa Desjardins and Deirdre Walsh contributed to this report.

Popularity: 2% [?]

Shunned Illinois senator suddenly relevant

By LAURIE KELLMAN, Associated Press Writer, Yahoo! News

WASHINGTON – For Democrats determined to get a health care bill, Sen. Roland Burris is like the house guest who couldn’t be refused, won’t soon be leaving and poses a plausible threat of ruining holiday dinner.

Suddenly, he can no longer be ignored.

The Illinois Democrat, appointed by disgraced former Gov. Rod Blagojevich, says he’ll only vote for a bill to provide health care to millions more Americans as long as it allows the government to sell insurance in competition with private insurers.

And he says he won’t compromise.

“I would not support a bill that does not have a public option,” Burris, 72, said in a recent interview with The Associated Press. “That position will not change.”

Those words caught the attention of the very Democratic leaders who tried to keep Burris out of the Senate, suggested he resign and have shunned him in unprecedented fashion. Burris is not the only Democrat to insist on creation of a government-run health plan. But he is the one who has the least to lose by defying President Barack Obama and the Democrats who once turned him out in the cold rain.

It was early January and Blagojevich had appointed Burris, a former Illinois attorney general, to Obama’s former Senate seat — defying Democrats in Washington who had wanted someone without a tainted patron and with a better chance of winning election in 2010.

What happened next was a procession of ugly images, from Burris’ rain-swept news conference after Democrats turned him away from a swearing-in to Illinois Rep. Bobby Rush daring Democrats to block an accomplished lawyer who would be the chamber’s only black.

Bitterly, the Democrats seated Burris. But when it came out that Burris had admitted what he had denied under oath — that he’d unsuccessfully tried to raise money for Blagojevich — Majority Whip Richard Durbin, D-Ill., suggested that Burris resign. He refused.

A Senate ethics committee probe is pending into Burris’ statements. Democratic leaders, meanwhile, refused to support any effort by Burris to seek a full term, and he will leave the Senate in 2011.

Meanwhile, his relationship with the rest of his caucus has settled into one of mutual, if chilly, benefit.

It works this way: Burris stays mum about any bitterness he may feel about his reception, and he gets Obama’s Senate seat for two years. Democrats seat him, don’t speak of him and can count on his loyal vote at a time when all 58 Democrats and two independents must vote together to prevent Republican filibusters.

They’ve never needed 60 votes like they do on the yet-to-be-finalized health care bill. A disciplined grin shows that Burris knows it.

No, he says, he will not vote for any version of a government-run plan circulating in the Senate, other than the full-blown one from the Senate Health, Education, Labor and Pensions Committee.

He won’t vote, for example, for Republican Sen. Olympia Snowe’s idea to use the threat of a public option to force insurers to lower premiums by certain deadlines. He hasn’t seen the details of another idea, proposed by Sen. Tom Carper, D-Del., that would allow each state to decide whether to offer public coverage to compete with private insurers. The health committee’s proposal, he says, must be in the final bill to earn his vote.

“Yeah, that’s the one,” Burris said.

By definition, all 100 senators are relevant because any one can block Senate business unless there are 60 votes to override the objection. But Burris’ stated position on the public option means that Democrats can no longer take his vote for granted.

It’s too early to tell whether the public option, or some version of it, ends up in the final compromise between a committee of House and Senate lawmakers. First, each chamber must pass its version of a health care bill. House Democrats are insisting on the government-run plan; but in the Senate, the public option is less popular in both parties.

Every Democratic vote is important. And yet, Democratic leaders aren’t talking about Burris.

Instead, they’re talking confidently about having the votes for the biggest policy overhaul in a generation, a signature issue for Obama and the Democratic Party.

Finance Committee Chairman Max Baucus, D-Mont., said Burris’ demand alone makes him no different than other senators seeking this or that in the bill.

“I will do what I can to address the thises and thats,” Baucus said. “But my strong feeling is in the end, the need for health care reform is to get 60 votes (and) is going to trump the concerns that some might have.”

For his part, Burris says he’s just representing the wishes of his state. And he’s relentlessly loyal to the arrangement. His only acknowledgment of being treated differently than others is a reference to the “distractions” that marked his first weeks in office.

Ask him whether he feels badly treated by the leaders, and he’ll answer with a question:

“By whose standard?”

Go a couple more rounds, and he’ll elaborate, generally.

“I feel that I’ve had great opportunities here,” Burris said. “I feel like anytime I had a question that needed answered, anytime I needed something, there was certainly assistance there.”

Does he feel respected and listened-to? Burris pauses and looks puzzled.

“Yes. I’m a senator from Illinois representing 13 million people. I’m one of 100, and I speak on the floor, I preside over the Senate, I co-sponsor legislation,” he says. “I’m very busy, I’m very challenged, and I have one problem.”

He grins.

“I enjoy what I’m doing.”

Popularity: 2% [?]

Baucus Confident on Bipartisan Support for Health Care Bill

Senate Finance Committee Chairman Unveiled An $856 Billion Proposal
Sept. 16, 2009—

Senate Finance Committee Chairman Max Baucus today released a 10-year, $856 billion health care proposal, which is already being met with criticism on both sides of the political aisle.

The Montana Democrat dubbed his bill as balanced and fiscally responsible. At a news conference, Baucus expressed confidence that the final bill will get bipartisan support, despite his appearing without any fellow party members or Republicans.

“Everyone should understand it’s just the beginning, but it’s a good beginning. The choice is now on those on the other side of the aisle,” he said. “At the end of the day, there will be Republican support for this bill.”

The nonpartisan Congressional Budget Office estimates the Baucus bill would cost a total of $774 billion over 10 years. But the bill would, in effect, cost more than $800 billion, Finance committee staffers say, because of differences in scoring between the CBO and Finance committee. That would not account for the $900 billion in federal revenue raised by taxes on insurance companies, employers who don’t offer coverage and assumed cost savings in Medicare that are envisioned to pay for the bill and keep it deficit neutral.

The White House had little to say about the plan, except that it would provide momentum to the president’s goal of achieving health care overhaul in the near future.

“Last week, the president laid out his plan to bring stability and security to Americans who have insurance, and high-quality, high-quality, affordable coverage for those who don’t have insurance,” White House spokesman Reid Cherlin said. “The Senate Finance Committee [proposal] released by chairman Baucus is another boost of momentum for the president’s effort to reform the health system.”

Baucus’ Health Care Plan
Under Baucus’ plan, all Americans would be required to purchase health care or pay a fine if they don’t. It also includes provisions barring insurance companies from prohibiting care based on pre-existing conditions, and prevents practices such as charging more to people with more serious health problems. But, at the same time, the language in the bill suggests that those rules could be relaxed based on tobacco use, age and family composition. It would also place caps on yearly health care costs.

Baucus’ proposal includes a provision to create an insurance exchange system on the Internet, an idea President Obama also proposed last week during his joint address to Congress.

The “state-based Web portals, or ‘exchanges,’… would direct consumers purchasing plans on the individual market to every health coverage option available in their Zip codes,” according to the plan. “The exchanges would offer standardized health insurance enrollment applications, a standard format companies would use to present their insurance plans, and standardized marketing materials.”

Much to the chagrin of some Democratic lawmakers and liberal groups, the proposal does not include any language for a government-run insurance plan that would compete with the private sector. But it opens the way for health care cooperatives — member-owned, non-profit companies providing health insurance. All other bills produced in Congress so far — three in the House and one in the Senate — include a public option.

The proposal also outlines measures to improve and expand Medicaid. Baucus’ plan would make all parents, children, pregnant women and childless adults at or below 133 percent of the federal poverty level eligible for Medicaid. The plan would be paid for with $507 billion in cuts to government health programs and $349 billion in new taxes and fees.

“The Finance Committee has carefully worked through the details of health care reform to ensure this package works for patients, for health care providers and for our economy,” Baucus said in a statement. “We worked to build a balanced, common-sense package that ensures quality, affordable coverage and doesn’t add a dime to the deficit. Now, we can finally pass legislation that will rein in health care costs and deliver quality, affordable care to the American people.”

Under Baucus’ plan, illegal immigrants would not get insurance, a point that became increasingly contentious after South Carolina’s GOP Rep. Joe Wilson’s outburst during Obama’s speech last week.

Senate Majority Leader Harry Reid, D-Nev., said the Democrats are going to hold a special caucus Thursday to discuss the package put forward by the Finance Committee. Baucus’ bill will be voted on next week in the Finance committee before it goes on to the Senate floor.

Since returning from recess last week, the “gang of six” senators of the Finance committee have been working for hours behind closed doors to reach a bipartisan solution. Baucus had set today as his deadline for the bill, despite outcry from both his party members and the GOP. Some Democrats said they would not vote for the bill in its current form because it lacks a “public option,” a government-run insurance program that would compete with private insurance companies. Republicans say the plan is too costly.

Despite the differences, the bill that would pass the Senate Finance Committee has the best chance at bipartisanship. Bills proposed by three House committees and the Senate Committee on Health, Education and Labor led to backlash by conservatives and a rowdy recess for many Democratic lawmakers.

Democrats, Republicans Unhappy With Health Care Proposals
As some Democrats start the difficult task of rallying support in their own party for Baucus’ health care plan, Republicans are lining up against it. Even those who were involved in the negotiations with Baucus, including Sen. Olympia Snowe, R-Maine, and Sen. Charles Grassley, R-Iowa, say additional talks are needed before they can get on board.

“I believe the chairman’s legislation moves in the right direction away from a government-run system contained in bills that have passed other Congressional committees, but a number of issues still need to be addressed — including cost assumptions and ultimate affordability to both consumers and the government as well as ensuring appropriate competition in the health insurance exchange,” Snowe said in a statement.

Other GOP leaders are complaining that the plan would lead to a government takeover of health care in the United States but, at the same time, they are also raising alarm bells that the plan would cut benefits for seniors, who already receive government-run health care in the form of Medicare.

Senate Minority Leader Mitch McConnell, R-Ky., gave Baucus’ plan a thumbs down, saying that it will cut Medicare and set up government-run health care for others.

“This partisan proposal cuts Medicare by nearly a half-trillion dollars, and puts massive new tax burdens on families and small businesses, to create yet another thousand-page, trillion-dollar government program,” McConnell said in a paper statement. “Only in Washington would anyone think that makes sense, especially in this economy.”

McConnell added that it’s just another “trillion-dollar” bill, although the Baucus bill is only $856 billion in its current form. As for Medicare cuts, the bill assumes those savings will be realized with greater efficiency.

Republicans are making a talking point of all the “thousand-page” bills Democrats want to pass, including the other health care bills and the stimulus package. The Baucus bill, as written, is only 223 pages long, but it will get longer when it’s translated into legal language.

But Republican opposition is not the only issue that supporters of Baucus’ plan will have to face. Even before the release of the proposal, Democrats expressed their disapproval with the lack of a public option in Baucus’ proposal.

“There is no way, in its present form, that I vote for it unless it changes in the amendment process by vast amounts,” Sen. Jay Rockefeller, D-W.V., said in a conference call with reporters Tuesday.

Others expressed concern about the proposed taxes on higher-end insurance plans, expected to rake in about $349 billion in new taxes and fees.

“They tax the sort of wealthiest benefit packages, and you’ve got some health insurance, you know — quite a bit of health insurance policies in America that during the next couple of years will top the $16,000 and $21,000 mark that exists in their bill that triggers taxation,” said Rep. Debbie Wasserman Schultz, D-Fla., on ABC News’ “Top Line.”

Democratic Oregon Sen. Ron Wyden said the plan would cost lower-income Americans too much and give many people too little choice of insurance plans.

“If the Baucus proposal passes,” Wyden said in an interview with the Washington Post. “They’re going to say, ‘Huh? Health-care security means I pay a whole lot more than I’m paying today or I get to be exempt from it, or I pay a penalty?’ They’re not going to say that meets the definition of health-care security.’”

ABC News’ Teddy Davis contributed to this report

Popularity: 1% [?]

Are health care co-ops a better alternative to public option?

WASHINGTON (CNN) — While a government-run public health care option irks conservatives, and even some fiscally minded Democrats, the idea of health care cooperatives has emerged as an option in the reform debate.

Small health care cooperatives have worked in a couple of markets. But whether the idea can be applied on a national scale is debatable.

Sen. Kent Conrad, chairman of the Senate Budget Committee, is pushing the co-op idea as an alternative to a government-sponsored insurance program that would compete with private insurers. He doesn’t think a government option will pass in the Senate.

Conrad, a North Dakota Democrat, told CNN’s “American Morning” on Tuesday that his model could attract 12 million members and “be the third-largest insurer in the country and be a very effective competitor [with private insurance companies].”

“If you believe competition helps drive down costs, then they would certainly contribute to holding down costs,” Conrad said.

But Tim Jost, a professor at Washington and Lee University, said that Conrad is not offering concrete statistics on how the plan will help reform health care.

“I have not seen anything, other than Sen. Conrad’s statements to the press, explaining how this is going to work,” he said. “He put out a couple of one-pagers early on, but he is talking about this actuarial data. Let’s make it public, let’s find out who the actuaries are.”

Co-ops are nonprofit organizations that aim to provide better coverage at a lower cost for their members. They put profits back into the system, so any money that is earned is used on patients and other costs. In addition, patients elect a governing board.

Cooperatives are already established in cities such as Minneapolis, Minnesota, and Seattle, Washington.

In order for a co-op to have reduced costs, analysts say, it needs to have tens of thousands of members. That could be a hard slog for the nonprofits because start-up costs would probably be in the millions. That may be where the federal government steps in — by adding seed money for the program.

That government infusion of money probably would put Democrats at odds with Republicans, who are worried about the rising federal deficit and an expanded role of government in health care. 

And the costs of a cooperative might not allow enough people to sign up, meaning that some of the nearly 46 million uninsured Americans wouldn’t be able to buy into the program. Other health reform alternatives, such as the public option, cost less for participants.

“Let’s see how they [Conrad and others] explain that they are going to get to 10 to 12 million members. … I can’t see how that’s going to happen,” Jost said.

Probably the biggest barrier, Jost said, is entering a new market and trying to establish a network.

“You have to go out there, you have to contract with hospitals, doctors, other providers of care. Well, the private insurers have their networks in place, and they often have what they call ‘most favored nations’ clauses, which provide that a provider cannot [offer] a lower rate than it does to the dominant insurer.”

The idea of co-ops appears to have received some support from the Obama administration.

A top White House aide told Bloomberg Television’s “Conversations with Judy Woodruff” that President Obama may accept nonprofit health insurance cooperatives in place of a new government-run plan.

“We would be interested in that” if certain conditions are met, said Nancy-Ann DeParle, director of the White House Office of Health Reform.

And the idea has gotten support from a key Republican senator.

Sen. Richard Shelby, R-Alabama, said on “Fox News Sunday” that co-ops are “a step in the right direction.”

“I don’t know if it will do everything people want, but we ought to look at it. I think it’s a far cry from the original proposals.”

But not everyone is so sure that co-ops will work to reduce health care costs across the board.

CNN Medical Correspondent Elizabeth Cohen, who spoke with top officials at both co-ops, said this type of model would not solve the problem of uninsured Americans.

“Will co-ops solve that? No. That is according to two folks who run co-ops [one in Seattle and one in Minneapolis]. … They said ‘we are not charities. You have to spend money and pay premiums to join our co-ops. And we don’t take everyone. We sometimes say no to people with pre-existing conditions,’ ” she said.

Co-ops also may not have the industry clout of the big insurance companies. 

“They [co-ops] would have some cost advantages over private plans — they wouldn’t have to make a profit — but they are going to be running on a very small scale, at least initially, and therefore they are going to have very high administrative costs proportionate to claims,” Jost said.

“But again, the big problem is how are they going to get providers to give them a better deal than the providers give the private insurers. They may not even be able to legally do that under their contracts with the commercial insurers,” he added.

CNN’s Dana Bash, Lesa Jansen and Chris Welch contributed to this report.

Popularity: 1% [?]

Basic Pros and Cons of Universal Health Care

The popular media is currently hotly debating the pros and cons of universal healthcare as President Obama ramps up his efforts to get his plan through Congress. Most Americans, however, know less about the issue than they should, even though more than 48 million of them have no health insurance and will thus be most directly affected by the implementation of a national system.

The major argument for a universal system can be found in the spiraling cost of health care in the United States, where insurance premiums continue to rise as do the costs of prescription medication and medical procedures — to the tune of about $2.5 trillion annually. In the current recession, providing health care benefits to employees is a burden many small businesses cannot bear. By the same token, workers who have lost their jobs are hardly in a position to pick up expensive private policies on their own.

Advocates for universal health care argue that such a system is inherently more efficient as it would encourage more preventive care, streamline record keeping for individual patients, and cut out on the repetitive mountains of paperwork that underpin even the most simple insurance claim. Proponents, however, are quick to counter with the real fact that there is no such thing as “free” health care. The services the government proposes providing will be paid for by taxes and no doubt by budget cuts in other areas, perhaps some as crucial as defense and education, thus shifting an unfair burden of cost onto healthy Americans who will be paying for their unhealthy counterparts while losing services in other sectors.

Given the government’s often muddled record of inefficiency, proponents also argue that the transition period from a private to a public system will be one filled with chaos and will, in the end, create an even larger bureaucracy than that already in place. Some estimates place the cost of implementing and supporting a universal health care system at as much as $1.5 trillion over the next decade, a figure far larger than the $634 billion set aside by the Obama administration to jump-start the system.

At the most basic levels, then, the “pro” argument is that the only way to reign in health care costs is to implement universal health care that encourages preventative medicine and levels the playing field of expense while improving record keeping and information sharing. The “con” argument is that such a system will raise taxes, force crucial budget cuts, limit consumer choice, and potentially encourage medical abuses as patients are more likely to access services they do not need because they are “free” for the taking. As is often the case, both sides have valid points, and in either scenario, the American consumer will continue to pay — either through higher taxes or through insurance premiums he may or may not be able to afford.

Given the enormous influence of the insurance and pharmaceutical companies and the significant profit loss a universal health care system would pose for them, the Obama administration faces a long, hard fight in Congress to get its package enacted into legislation and, provided they are successful, an even longer transitional period that will, most likely be fraught with mistakes and red tape. No matter how you shake out the scenarios, it seems that at least in the short term, it will be the American people who bear the greatest burden in either scenario.

Popularity: 21% [?]

Health Care Not a Right, Ron Paul Says…

President Obama is getting ready to push his health care reform plan in a prime time press conference tonight. He’s hoping to win over the American people as well as members of Congress who are skeptical about the plan.

Rep. Ron Paul (R-TX) has been a very vocal critic of the president’s plan. He spoke to Kiran Chetry on CNN’s “American Morning” Wednesday.

Ron Paul

Kiran Chetry: You’re a physician as well and I’m sure that you have a lot of thoughts on this issue as we debate health care. You oppose President Obama’s reform plan. You favor giving Americans control of their health care. Does it boil down to two different philosophies over who should get health care coverage? Do you believe not everyone can expect free or low cost health care?

Ron Paul: Yeah, I think there’s a lot to that. But I come from the viewpoint that the most important thing we do is preserve the doctor/patient relationship, which we do not. For the past 30 years or so we’ve had a lot of government involved. We have veterans care, we have Medicare, we have Medicaid and we also have a lot of people getting private insurance. People having private insurance are not all that unhappy. So what are we doing now or at least Obama is proposing that we turn the people that have service on insurance and make them join the governmental programs that everybody is unhappy about.

So it doesn’t make any sense. It’s a total failure to run anything by a bureaucracy. It always costs more and the services are always less favorable. So for us to pursue government solutions to a problem the government created sort of reminds me of the T.A.R.P. bailouts. You know what we do financially. So medical bailouts by more government when government created our managed care system of 35 years will only make things much worse.

Chetry: One of the things we’ve talked about is whether or not independents are backing this. There seems to be some eroding support because of concerns about whether or not we can afford it, whether or not the timing is right. Even though there is that apprehension right now about whether or not we can afford it most do agree that we need to do something about health care. Is there a Republican alternative out there that makes more sense in your opinion?

Paul: Oh, yeah. I think so. I think we should pursue the idea that the patient get control through the medical savings accounts and deductions so that you can deduct everything. The biggest problem is the misunderstanding about insurance. They talk about we need to give everybody insurance. You can’t give people insurance – you don’t expect from your car insurance to be able to buy gasoline and do all your repair bills and that’s not insurance. And this is not insurance either. Insurance would be major medical to take care of the big problems.

That is one of the basic problems. As far as costs goes, they’re estimating $1 trillion or $1.5 trillion in the midst of this crisis no wonder people are starting to wake up a little bit. Because the money just isn’t there. The one thing for sure, is if you look at every other previous program by government, if they proposed that say the prescription drug program would cost $49 billion, well, it might turn out to be $150 billion. It’s always much more so if they’re saying $1.5 trillion for this, be sure it’s going to cost two or three times that much.

Chetry: What do we do, though, about this problem with, you know, uninsured children, many people uninsured – the millions? Your state by the way, according to the United Health Foundation survey, ranks 46 out of 50 in terms of overall health. And one of the biggest challenges for your state right now is that there’s a high percentage of children in poverty and a big uninsured population. So, there you are opposing this, your state seems to be in dire straits when it comes to this situation. What’s the solution for Texas?

Paul: Well, one thing you have to do is say, why do people come up short and why is the cost so high? It’s inflation and it’s a government management of the health care system that is at fault. But even though I have my ideal system I would like to see with the government out completely because that would be a much better system, that’s not going to happen. I’m realistic. One thing we shouldn’t do is pay for it with money created out of thin air. So what I would do in a transition, I’ve talked about this a whole lot, is cut spending somewhere and take care of the very people you’re talking about. Because you don’t want to cut, under these conditions, medical care from poor people who have been dependent or the elderly.

But I would cut from overseas spending. I would cut from these trillions and trillions of dollars that we have spent over the years and bring our troops home so that we can finance it. A first, very, very minor step was done yesterday by cutting the F-22. I applaud Obama for that. We don’t need one system removed – we need to change our foreign policy. Then we could afford the health care that is necessary to tide us over until we have come to our senses and believe freedom can deliver medical care much better than a bureaucracy in government. You have to deal with the problem of inflation as well because that’s why people find that medical care costs too much.

Popularity: 2% [?]

Arizona Moves to Oppose Obama’s Expected Health Care Mandates

By Fred Lucas, Staff Writer

( – Voters in Arizona will decide next year whether residents will be subject to mandates in the pending health care reform that President Barack Obama and congressional Democrats are promoting.
At least five other states – Indiana, Minnesota, New Mexico, North Dakota and Wyoming – have considered proposals to take pre-emptive action against the pending federal mandates, but those proposals have either not made it out of committee, failed to get enough votes from one side of the legislature, or are still being crafted.
Only the Arizona Legislature introduced an initiative (HCR2014), which if passed, would amend the state constitution to codify that no resident would be required to participate in any public health care option. Arizonans will vote on the initiative in November 2010.
“HCR2014 is proactive and will protect patients’ fundamental rights,” Arizona State Rep. Nancy Barto, a Republican, said in a statement. “We are a front-line battle state to stop the momentum of this powerful government takeover of your health care decisions. Health care by lobbyists thwarts your rights and can be stopped here.”
The main issue is the core of the Obama health plan – a government run or “public option” – to compete with private health insurers. Some state lawmakers fear such legislation would force residents to buy into the public plan.
“The eyes of the nation will be on Arizona next year to see what happens,” Christie Herrera, director of the Health and Human Services Taskforce with the American Legislative Exchange Council, told “If this succeeds in Arizona, other states will take notice and push harder.”
The Obama administration insists that the public option will provide another choice for Americans who are not insured or are unhappy with their current insurance and will force private companies to be more competitive.
Critics of the plan say private firms could not compete with a public option – with unlimited government resources – and thus would go out of business, leaving what is tantamount to a single-payer system in place.
What happens in Arizona could spur other states to pass similar laws or constitutional amendments, said Wisconsin State Rep. Lea Vukmir, a Republican, who sponsored similar legislation in 2008 that passed the House but failed in the Senate. 

If the Obama administration’s “public option” becomes law before Arizonans vote in November 2010, their initiative would still allow the state the challenge the Obama plan.
Vukmir said that the Obama proposal could be unconstitutional, under the Tenth Amendment, which states, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”
“I’m a strong believer in the Constitution and the Tenth Amendment,” Vukmir told “The Tenth Amendment has been eroded by Congress and the Supreme Court for decades. We have to ask, does the Tenth Amendment have any meaning? We are supposed to have strong state governments and a weak central government. That has eroded away.”
Georgia State Sen. Judson Hill, a Republican, said that the Obama plan would put a big strain on state budgets and told that he would be interested in introducing similar legislation in the Georgia state house.
Medicaid and S-CHIP payments to states already make cutting costs untenable for states in lieu of a benefit cut or tax hike, Hill said.
He has introduced legislation to use state medical grants to go directly to patients as a sort of medical scholarship. (S-CHIP is the acronym for the State Children’s Health Insurance Program, run by the federal Health and Human Services, which provides matching funds to states that provide expanded health insurance programs for families with children in low- to moderate-income brackets.)
“I call them federal crack dollars,” said Hill. “States get addicted to health dollars sent by the U.S. government.”
Arizona’s Health Care Freedom Act, firstly, establishes the right of state residents to spend their own money to seek and receive health care and, secondly, the right to choose not to participate in any health care system of any type.
An advocacy group was started to campaign for the amendment.
“Protecting the rights of individuals to be in control of their health and health care must be a fundamental component of health care reform, so the Arizona legislature is to be congratulated for giving all Americans the opportunity to make certain our voices are heard,” said Dr. Eric Novack, chairman of the group Arizonans for Health Care Reform.


Popularity: 2% [?]

Universal Health Care is Near at Hand

By Richard C. Dillihunt
Guest column
Bangor Daily News

I have been a proponent of universal health care and single payer since retiring from the practice of surgery more than 10 years ago. During this decade I have never waffled on my conviction that our nation should transition to a system in which every citizen has an equal opportunity to obtain their health care from practitioners of their choice.

Further, I am convinced that the for-profit form of health care has morphed into an uncontrolled hierarchy of greed that has escaped from the normal restraints of personal ethics, compassion, empathy and basic unqualified concern for one an other without reservation. I feel that social justice should leap to the forefront of our decisions when an individual — any individual — has a health problem. Accordingly, it is obvious that universal health care has my support, and it is not surprising that polls of physicians, nurses and the general population concur.

Now, we have arrived at a point in the history of our nation where it is reasonable to say that universal health care is near at hand, and after trying practically everything else, the vast majority are convinced that a reform has arrived. Black, white, Republican, Democrat, Green, young, old, Catholic, Jew, Muslim, Asian, Native American, rich or poor — a modern melting pot has come to be, and we are all in it together. After a 10-year wait, I am delighted, the bus has arrived. I hope.

Single payer usually tags along when universal health care is the subject at hand. At times when being discussed, they are wed, and health care reform may be referred to as “universal single payer.” That’s too fast for many who look upon this as two separate entities. Not me, though. I believe we, as a nation, deserve both. I further believe that single payer will happen, and we need to work diligently to make this happen sooner, rather than later.

Another decade of waiting, with its stymieing of small business, its shameful financial effects on the middle class, its drain on state treasuries, its primary etiology in bankruptcy and its continuous release of wealth to special interests, cannot be tolerated by a nation already brought to its knees by mammoth fraud, greed and incom-petence. We cannot add health care to the list that includes Enron, banks, brokerages, insurance companies, a protracted automotive industry collapse, and stunning Ponzi schemes. We, as a nation, are on the ropes. The time has come to learn to say no. No more rip-offs. No more robbery. We have come to a fork in the road with a hairpin turn. We need to take the high road regardless of forks and turns, regardless of the consequences to those who have taken advantage of us. We cannot tolerate another hit.

Single payer is a great way to start. A great way to express the confidence we have in our federal government to do the right thing on our behalf. To show that we are tough at home as well as abroad. All we want is a fair and inexpensive accounting of expenditure of health care dollars. This is single payer, not socialized medi-cine.

When we hear criticism of the federal government, with critics saying they do not trust the government to run health care, then we simply should remind such skeptics that our federal government already administers and funds well over 50 percent of total health care expenditures by this nation. We should remind them and our-selves that the government already runs a stable of health care agencies which are national jewels, and include: Medicare, Medicaid, military medicine, Food and Drug Administration, National Institutes of Health, Centers for Disease Control and Prevention, Public Health Service, health care aid to the Third World, World Health Organization participation and aerospace medicine.

We are fortunate to have such a list — a list whose executives are employed by us and whose compensation is Main Street, not Wall Street. A list that could be enhanced enormously simply by adding single payer.


Richard C. Dillihunt, M.D., a retired general, vascular and transplant surgeon, lives in Portland.

Popularity: 9% [?]

Ever Wonder Just How Much That Sugery Cost?

Ever wonder how much it would cost to have knee surgery or any other type of surgery? 

Medical tourism is the practice of “outsourcing” healthcare services to an area outside of the patient’s home country.  Many common operations cost a fraction of what they might cost in the United States. 

As healthcare costs continue to rise, more and more patient’s are beginning to realize the potential cost savings!  Not sure I would be willing to leave the comforts of home, but I understand that some may not have the option…  

Medical Procedure       USA               Mexico       Cost Rica       India      Thailand   Korea

Angioplasty              Up to $57,000     $17,100      $14,000    $10,000     $9,000     $21,600
Heart Bypass            Up to $144,000    $21,100     $26,000    $10,000     $26,000   $26,000
Heart Valve Rep.      Up to $170,000    $31,000     $31,000     $3,000       $24,000    $38,000
Knee Replacement Up to $50,000       $11,500     $12,000    $9,000        $14,000   $19,800
Hip Resurfacing       Up to $30,000+    $13,400     $13,000    $10,000      $18,000   $22,900
Hip Replacement      Up to $43,000      $13,800     $13,000    $10,000      $16,000   $18,450
Special Fusion        Up to $100,000    $8,000       $16,000    $14,000      $13,000   $19,350
Face Lift                 Up to $15,000      $8,000       $6,500       $9,000       $8,600       $5,000
Breast Implants      Up to $10,000       $9,000       $4,000      $6,500       $5,700      $13,600
Rhino Plasty           Up to $8,000         $5,000       $6,000      $5,500       $5,400       $6,000
Lap Band/Bariatric  Up to $30,000       $9,200       $9,000      $9,500       $14,000    $11,500
Hysterectomy        Up to $15,000       $7,500       $6,000      $7,500       $7,000      $11,000
Dental Implant   Up to $2,000/10,000   $1,000       $1,100      $1,000       $1,000      $2,000

 *Prices are as of 2009 -  Prices are approximate and not actual prices and include estimated airfare for patient and companion.  Prices will vary based upon many factors including hospital, doctor’s experience, accreditation, currency exchange rates and more.  Not included are costs for meals, miscellaneous expenses and any hotel costs or tourism costs. 

Prices obtained from




Popularity: 2% [?]

To Improve Our Healthcare System


I have no figures to quote or studies to point to, just my innate sense that the un- & under-insured in our country may be using a disproportionate amount of health care dollars by accessing care for lower priority health issues at facilities designed to offer a higher level of care (i.e. accessing emergency rooms for colds).  I’m sure we’ve all heard the “common wisdom” that this is so.  Assuming that it is, it seems to me that it would reduce the cost of healthcare across the board if appropriate care could be provided in the appropriate setting by appropriate practitioners.

Another factor that I haven’t noticed being addressed is the shortage of key medical personnel, such as nurses, general practitioners, family doctors, obstetricians, dentists and others.  While these shortages affect everyone, they can be more significantly detrimental in underserved areas.

Additionally, it seems to me that having under- and un-insured individuals go for long periods of time without health care ultimately results in the care they eventually receive costing more and requiring longer periods of care.  To eliminate this, it would seemingly make sense to work to get them insured sooner rather than later.  In order to accomplish this, underwriting and financial access issues would need to be addressed. 

One last thought:  the development of medications and technologies to combat disease is universally beneficial.  Sharing the responsibility, costs and benefits universally would also seem to make sense and would, hopefully, accelerate the discovery of new treatments and cures.

To that end, I offer the following suggestions and ask for your thoughts in refining and expanding them:

 1.  Offer tax incentives to hospitals, clinics & urgent care centers who work in underserved areas a minimum of 30 hours/week.  The 30 hours to encompass a minimum of 1 hour before 7 AM and 1 hour after 7 PM at least 2 days/week and 3 hours on Saturday and Sunday.

 2.  For facilities opening in underserved areas willing to safely and appropriately renovate and/or remove and rebuild “blight” structures, Federal money should be made available to the local police department for the purpose of providing security.  The amount of money to be applied to be based on factors such as local population and crime rate in facility’s immediate vicinity.

 3.  Salaries paid to health care professionals (doctors, nurses, technicians) and limited to 2 administrators/site in underserved areas to be tax exempt for the first $100K (gross and unadjusted).

 4.  Create a federal insurance program (like the federal flood insurance program) for catastrophic illness (i.e. cancer, ESRD, Alzheimer’s, HIV) and require all health insurance carriers to contribute 1% of every policyholder’s premium to the program’s fund.  In years in which the carriers net profit exceeds 20% above the average net profit for the previous 5 years, they would be required to pay 10% of the net profit above 20% to the fund.  Upon confirmed diagnosis, the federal program would repay to the insurance carrier 75% of all care costs (including medications) paid on behalf of the insured.  Claims with any of the defined diagnosis codes denied would be subject to review by the same board that currently reviews Medicare claim denials.  GAO to do random financial and performance audits, with every carrier with audits performed a minimum of once every 5 years.  Deliberate fraud punishable by repayment to fund of 100% of monies paid for all patients from catastrophic fund for entire period of fraud plus a 10% penalty and posting of a bond equal to 33% of the amount of the fraud.  Said bond to be maintained for 5 years and to be released only upon completion of passing GAO audit.  Subsequent fraud would result in forfeiture of bond and loss of license in all states to sell health care coverage to Federal Employees and Medicare members for a period of 5 years.

 5.  Make health insurance premiums paid by individuals who do not qualify for coverage through an employer-sponsored plan 100% tax deductible up to an adjusted annual income of $200K with the deduction reduced by 10% for each $25K over $200,001.

 6.  Make payroll deducted employee health insurance contributions (including both fully and self funded plans) pre-tax for those whose adjusted income is less than $200K.

 7.  Reduce the threshold for claiming out of pocket medical costs as a tax deduction from 7% of adjusted income to 5% for adjusted incomes less than $200K.

 8.  Offer interest free scholarships in medical fields to highly qualified candidates where there is lower enrollment but a higher public need (i.e.:  nurses, family practitioners, obstetricians, general dentistry).

 9. Offer grants to cover 100% of tuition towards specific medical degrees in return for 2 year commitment to actively practice a minimum of 1300 hours/year in under-served areas (i.e.:  Indian reservations, low-income urban areas)

 10.  Standardize health insurance underwriting for specific chronic conditions on the condition they be certified by a physician to be under control for a minimum of 1 year with either diet/lifestyle change or medication at time of application (i.e.:  Type II diabetes, asthma, cholesterol, high blood pressure).  The rating factor applicable to these conditions when they meet the controlled criteria should be standardized (i.e.:  asthma +1.5%, Cholesterol +3.0%).

 11. Cancer survivors who have been certified to be in remission for a minimum of 5 years and have no other risk factors must be offered coverage with the pre-existing condition rated in the same manner as those conditions referred to in item 10.

 12.  Insured individuals who actively reduce their health risks (i.e. appropriate weight loss or gain, smoking cessation, reduced cholesterol, etc) may, at their discretion, request a review of their physical condition by their family/primary physician 2 months prior to the renewal of their policy to present to the insurer which is to be considered in determining renewal rates.  Significant, maintained health improvement should be “rewarded” with consideration when underwriting renewal rates (i.e.:  if rate increase would have been 8% consideration might allow for a reduction to a 6% or 7% rate increase). 

 13.  A public access website should be created using Medicare accumulated data showing a RANGE OF AVERAGE cost of care for the most common diagnoses and treatments by zip code (i.e. New patient office visit/consultation in zip code 60606:  $180 – $215).  (Although this information is more typically available to members of insurance plans through their secured websites, for uninsured individuals, gathering this information in order to make informed health care decisions is very difficult.)

 14. If medical procedures can be performed safely and more cost effectively overseas, allow 50% of travel exclusively for the performance of these procedures to be tax deductible if not covered by an insurer.  If the patient is insured, insurer must cover the procedure cost at the benefit level specified by the COC, assuming the procedure cost is a minimum of 25% less than if performed in-country:  i.e.:  if their in-country contracted rate for San Diego, CA for a hysterectomy is $1400 with the patient responsibility of 20%, the insurer would pay up to $1050 to the out-of-country provider with the patient paying 20% of the actual cost.  Insurance carrier has the right to ‘vet’ the out-of-country facility to ensure appropriate care and safety.  Insurance carriers would be permitted to negotiate contracts with out-of-country facilities and make a listing of “approved” facilities available upon request to insured’s.  Insurance carriers would NOT be permitted to pressure insured’s to receive care out-of-country.

 15. The US should seek to enter into an agreement with other like-minded countries to create an international fund (contributions to which would be pro-rated based on each country’s population) the purpose of which would be to subsidize pharmaceutical and scientific research into treatments and cures for cancer, HIV, Parkinson’s, Alzheimer’s, etc.  Distribution of funds to be determined by a board of independent, non-political scientists, medical professionals and representatives from organizations such as WHO, NIH, CDC, etc and their international counterparts.

Popularity: 4% [?]