Whether or not costs can be reduced under health reform may depend largely on how willing Congress is to impose controls on the U.S. health care system. These controls would, of course, be largely financial. On May 26, Karen Davis of the Commonwealth Fund suggested the following mandatory system:
“To ensure the promised savings are realized, policymakers should consider incorporating into health reform expenditure targets that hold increases to 1.5 percentage points below baseline projections. As several analysts have pointed out, reducing the annual growth rate in national health expenditures by 1.5 percent means that the entire health care industry can still expect sustained revenue increases over the coming decade. Moreover, if cost reduction targets are incorporated into larger payment reform efforts that reward quality and value, ample opportunities for revenue growth will exist for efficient and innovative insurers and providers.”
However, as Ms. Davis suggests, controls also should incorporate non-financial factors. In a recent New Yorker article, Atul Gawande envisions a reformed system that includes “rewarding doctors and hospitals if they band together to form … accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers—whether public or private—would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don’t form these organizations.”
Sounds good on paper, and in fact the idea that medical care providers should collaborate and share information to produce a standard of quality care that likely will be less expensive that the current system is a part of almost every comprehensive health reform proposal.
Nonetheless, compelling a system to change its practices is much tougher that agreeing that the change is a good idea. In this case, one practical problem may be antitrust laws.
As noted in a May 27 New York Times article, U.S. antitrust laws could affect health care industry groups' efforts to work together to rein in health care costs
Many of the plans being considered by the health care industry would require greater cooperation across health care providers, according to the New York Times. Robert Leibenluft, a former Federal Trade Commission official, said, "Any agreement among competitors with regard to prices or price increases -- even if they set a maximum -- would raise legal concerns."
In a letter to the Senate Finance Committee, the American Hospital Association wrote that uncertainty regarding the enforcement of antitrust laws "makes it difficult for a hospital and doctors to collaborate to improve care" and reduce costs. AMA has asked Congress to amend antitrust laws to allow physicians to collectively negotiate with insurers over fees and other concerns, but FTC repeatedly has designated the practice illegal price-fixing.
The American Medical Association notes in a 2008 White Paper that health care reform such as improvements in health information technology “requires a level of physician investment and network integration that pose significant barriers to implementation….At the same time, the emergence of new quality improvement initiatives and reimbursement mechanisms such as “pay for performance” place a premium on physicians’ ability to collect and share data. For physicians, who still practice predominantly in small groups, network arrangements provide one way of achieving the economies of scale necessary to participate in these initiatives.”
According to the AMA, Federal Trade Commission and Department of Justice enforcement policies “still casts a suspicious eye on physician collaboration through network arrangements.”
The AMA concludes that “meaningful health system reform should remove obstacles that prevent physicians from forming networks that can jointly negotiate with health plans for the purposes of participating in quality improvement … Joint contracting through a network would further enable physicians to invest in and sustain systems that are likely to reduce errors, improve care coordination, and improve quality”
More than 30 years ago, physicians and hospitals, faced with rising costs they were unable to contain, ceded control of the health care system to the federal government and the insurance industry. Giving back some of that control to those successful medical providers who now know how to provide low-cost, high quality medical care would be a step in the right direction toward health reform.
Friday, May 29, 2009
Thursday, May 28, 2009
HSAs don’t (and won’t) slay health care cost dragon
The Patients' Choice Act, which Republicans introduced last week, contains provisions addressing health savings accounts (HSAs). As you may recall, HSAs were created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L. 108-173) and were available starting in January 2004.
Individuals participating in high deductible health plans (HDHPs) are allowed to make tax-free contributions to an HSA to fund lifetime medical needs. An HDHP is a health plan that assesses an annual deductible of at least $1,150 for individuals and $2,300 for families. Currently, contributions to HSAs are limited to $3,000 for self-only coverage and $5,950 for family coverage. To avoid taxation and penalties, distributions from HSAs must be used to pay for qualified medical expenses. Distributions generally cannot be made for expenses for insurance premiums.
How many people have HSAs? The number of individuals covered by health savings account/high-deductible health plans (HSA/HDHPs) increased to 8 million as of January 2009, according to a study of U.S. health insurance carriers from America's Health Insurance Plans' (AHIP) Center for Policy Research. The May 2009 report, January 2009 Census Shows 8 Million People Covered By HSA/High-Deductible Health Plans, noted that this number has increased from 6.1 million in January 2008 and 3.2 million in January 2006.
Enrollment in HSA/HDHPs in the group market rose to nearly 6.2 million, up from 4.6 million in 2008, according to AHIP. Enrollment in the small group market, which is defined as coverage through employers with 50 or fewer employees, rose 34% to 2.4 million enrollees in 2009. Annual deductibles in the small group market averaged $2,091 for individual coverage and $3,764 for family coverage, while premiums averaged $3,449 for individual coverage and $9,036 for family coverage.
Annual contributions. The Republican proposal would allow health insurance premiums to be paid with HSAs without a tax penalty and also would increase the amount of money HSA owners may annually contribute to their accounts. That seems logical because right now contributions for self-only coverage are limited to $3,000 but premiums averaged $3,449 (in the small group market), according to the AHIP study.
But a separate AHIP study, which looked at the financial activity in HSAs, found that during calendar year 2007, account holders residing in areas with median incomes between $25,000 and $50,000 experienced average HSA inflows (personal deposits, employer contributions, and interest earnings) of $1,401. For account holders with median incomes between $75,000 and $100,000, average HSA inflows in 2007 were $2,083.
Hmm . . . something is not adding up. I’m not great at math, but I’m pretty sure both $1,401 and $2,083 are less than $3,449. So, that means that if HSAs were allowed to be used to pay premiums, these folks wouldn’t even have enough in their accounts to cover the cost of such premiums, not to mention other qualified medical expenses. Thus, raising the annual contribution limit won’t help those who already aren’t contributing the maximum amount.
As one critic of the proposal notes, “people with less income to contribute to an HSA may lack sufficient funds in their accounts to cover their health care needs. This short-sighted remedy fails to address the real affordability challenges faced by Americans . . . .”
Individuals participating in high deductible health plans (HDHPs) are allowed to make tax-free contributions to an HSA to fund lifetime medical needs. An HDHP is a health plan that assesses an annual deductible of at least $1,150 for individuals and $2,300 for families. Currently, contributions to HSAs are limited to $3,000 for self-only coverage and $5,950 for family coverage. To avoid taxation and penalties, distributions from HSAs must be used to pay for qualified medical expenses. Distributions generally cannot be made for expenses for insurance premiums.
How many people have HSAs? The number of individuals covered by health savings account/high-deductible health plans (HSA/HDHPs) increased to 8 million as of January 2009, according to a study of U.S. health insurance carriers from America's Health Insurance Plans' (AHIP) Center for Policy Research. The May 2009 report, January 2009 Census Shows 8 Million People Covered By HSA/High-Deductible Health Plans, noted that this number has increased from 6.1 million in January 2008 and 3.2 million in January 2006.
Enrollment in HSA/HDHPs in the group market rose to nearly 6.2 million, up from 4.6 million in 2008, according to AHIP. Enrollment in the small group market, which is defined as coverage through employers with 50 or fewer employees, rose 34% to 2.4 million enrollees in 2009. Annual deductibles in the small group market averaged $2,091 for individual coverage and $3,764 for family coverage, while premiums averaged $3,449 for individual coverage and $9,036 for family coverage.
Annual contributions. The Republican proposal would allow health insurance premiums to be paid with HSAs without a tax penalty and also would increase the amount of money HSA owners may annually contribute to their accounts. That seems logical because right now contributions for self-only coverage are limited to $3,000 but premiums averaged $3,449 (in the small group market), according to the AHIP study.
But a separate AHIP study, which looked at the financial activity in HSAs, found that during calendar year 2007, account holders residing in areas with median incomes between $25,000 and $50,000 experienced average HSA inflows (personal deposits, employer contributions, and interest earnings) of $1,401. For account holders with median incomes between $75,000 and $100,000, average HSA inflows in 2007 were $2,083.
Hmm . . . something is not adding up. I’m not great at math, but I’m pretty sure both $1,401 and $2,083 are less than $3,449. So, that means that if HSAs were allowed to be used to pay premiums, these folks wouldn’t even have enough in their accounts to cover the cost of such premiums, not to mention other qualified medical expenses. Thus, raising the annual contribution limit won’t help those who already aren’t contributing the maximum amount.
As one critic of the proposal notes, “people with less income to contribute to an HSA may lack sufficient funds in their accounts to cover their health care needs. This short-sighted remedy fails to address the real affordability challenges faced by Americans . . . .”
Wednesday, May 27, 2009
SFC still on track for mid-June mark-up of health reform bill, Baucus says
The Senate Finance Committee appears to be on track to meet its self-imposed mid-June deadline for marking up a healthcare reform bill. On May 21, SFC Chairman Max Baucus (D-MT) offered up odds of 75 to 80 percent that a bipartisan bill will emerge from his committee next month.
Is Baucus overly optimistic about the prospects of health reform this year? There have certainly been many attempts at healthcare reform in the past, most notably, healthcare reform measures advocated by President Bill Clinton in the 1990s. However, attempts to reform our healthcare system go back to the New Deal.
What's different this time? Health reform may be a boring topic to some, but, this time, people do seem to be paying attention. More importantly, this time, the American public appears to be supportive of efforts to reform healthcare, despite the tough economy (or maybe because of the difficult economy?)
Of course, the devil is in the details. Public support can evaporate in an instant. Big issues—such as how to pay for health reform and whether to include a government-financed public plan option, just to name a few—remain. So far, support for health care reform this year seems to be holding but "it ain't over til it's over," as Yogi Berra said. You can rest assured that we’ll be following the latest health reform developments for you—whenever it ends.
Is Baucus overly optimistic about the prospects of health reform this year? There have certainly been many attempts at healthcare reform in the past, most notably, healthcare reform measures advocated by President Bill Clinton in the 1990s. However, attempts to reform our healthcare system go back to the New Deal.
What's different this time? Health reform may be a boring topic to some, but, this time, people do seem to be paying attention. More importantly, this time, the American public appears to be supportive of efforts to reform healthcare, despite the tough economy (or maybe because of the difficult economy?)
Of course, the devil is in the details. Public support can evaporate in an instant. Big issues—such as how to pay for health reform and whether to include a government-financed public plan option, just to name a few—remain. So far, support for health care reform this year seems to be holding but "it ain't over til it's over," as Yogi Berra said. You can rest assured that we’ll be following the latest health reform developments for you—whenever it ends.
Tuesday, May 26, 2009
Cutting Medical Errors Could Help Finance Coverage Expansion
Senators Max Baucus and Chuck Grassley recently announced potential sources of financing for health reform. Yet, one fairly obvious source of funds, health care quality improvement with reduction in preventable medical errors, gets insufficient attention. These savings can be achieved only with the full cooperation of the professional medical establishment.
Ten years after the Institute of Medicine (IOM) released “To Err Is Human,” its report on the toll of preventable medical errors on patients and the economy, there has been little, if any, progress in efforts to improve the quality of medical care and reduce medical errors. Two reports released in April and May by two non-profit organizations, The Leapfrog Group and Consumers Union, reached this conclusion.
In its 1999 report, the IOM estimated that as many as 98,000 Americans die each year due to preventable medical errors and that these errors cost the United States anywhere from $17 billion to $29 billion a year. At that time, the IOM recommended a number of reforms to the health care system to improve patient safety. The IOM called for a measurable improvement in patient safety, stating that it would be “irresponsible to expect anything less than a 50 percent reduction in errors over five years.”
How many uninsured people in the U.S. do you suppose we could cover with $17 bullion to $29 billion a year?
Yes, various medical professional groups, including the American Hospital Association and the American Medical Association, sent a letter to President Barack Obama pledging that "we will do our part to achieve your Administration's goal of decreasing by 1.5 percentage points the annual health care spending growth rate --saving $2 trillion or more. This represents more than a 20% reduction in the projected rate of growth. We believe this approach can be highly successful and can help the nation to achieve the reform goals we all share." Included in the groups’ cost containment strategy were reforms recommended in the 1999 IOM report such as implementation of electronic health records and quality improvement. Encouraging, isn’t it? Not so fast. Just a few days after the medical groups’ offer was publicly announced, the AHA backtracked saying that what they really meant was that they were going to try really hard to save money, but they were making no promises.
The Consumers Union report gives the country a “failing grade on progress in select [IOM] recommendations” that Consumers Union believes are necessary to “create a health-care system free of preventable harm.” Lack of progress on implementing those “select recommendations” includes these:
Few hospitals have adopted well-known electronic prescribing and dispensing systems to prevent medication errors, and the Food and Drug Administration rarely intervenes to avoid confusion among similarly-named drugs. A 2008 survey of American Hospital Association members found that just 17% had a computerized order entry system for prescriptions and medication administration; 38% had either a partial system of plans for a system, but nearly half (45%) had no plans to implement such a system.
Medical error and hospital-acquired infections reporting is not systematic, publicly distributed, or validated, thus avoiding medical provider accountability.
No national entity is empowered to coordinate and track patient safety improvements which makes it impossible to determine progress.
Physicians and other health professionals are not expected to demonstrate competency in patient safety practices.
“The U.S. health-care system needs nationwide mandatory, validated and public reporting of preventable health care-acquired infections and medical errors,” Consumers Union wrote. “The FDA, doctors, hospitals, and drug manufacturers must establish better practices at every stage of the treatment process to track and prevent harm from medication errors. Professional standards regarding patient safety should ensure competent care….public reporting of preventable medical harm is today perhaps the only effective accountability measure we have…As the nation begins to reform our health-care system, we have an opportunity to take effective and accountable action to make health care safer for all Americans,” the Consumers Union report concluded.
Leapfrog’s Hospital Survey for 2008 also finds little progress in efforts to reduce preventable medical errors. “As the Obama administration and Congress consider health reform options, it is clear we have a long way to go to achieve hospital quality and cost-effectiveness worthy of the nation’s $2.3 trillion annual investment,” said Leapfrog CEO Leah Binder. “According to our data, a majority oif hospitals have significant safety and efficiency deficits….As the President has often stated, a reformed high value health care system needs to be cost-effective”.
Two-thirds of hospitals do not have in place all of the recommended policies to prevent common hospital-acquired infections and 75% do not fully meet the standards for 13 evidence-based safety practices (including hand washing, for heaven’s sake; how hard or costly is that practice to implement?).
I don’t know about you, but the more I learn about the deficient patient safety practices of our health care system, the more I want to avoid it. How’s that for a cost-saving measure?!
Ten years after the Institute of Medicine (IOM) released “To Err Is Human,” its report on the toll of preventable medical errors on patients and the economy, there has been little, if any, progress in efforts to improve the quality of medical care and reduce medical errors. Two reports released in April and May by two non-profit organizations, The Leapfrog Group and Consumers Union, reached this conclusion.
In its 1999 report, the IOM estimated that as many as 98,000 Americans die each year due to preventable medical errors and that these errors cost the United States anywhere from $17 billion to $29 billion a year. At that time, the IOM recommended a number of reforms to the health care system to improve patient safety. The IOM called for a measurable improvement in patient safety, stating that it would be “irresponsible to expect anything less than a 50 percent reduction in errors over five years.”
How many uninsured people in the U.S. do you suppose we could cover with $17 bullion to $29 billion a year?
Yes, various medical professional groups, including the American Hospital Association and the American Medical Association, sent a letter to President Barack Obama pledging that "we will do our part to achieve your Administration's goal of decreasing by 1.5 percentage points the annual health care spending growth rate --saving $2 trillion or more. This represents more than a 20% reduction in the projected rate of growth. We believe this approach can be highly successful and can help the nation to achieve the reform goals we all share." Included in the groups’ cost containment strategy were reforms recommended in the 1999 IOM report such as implementation of electronic health records and quality improvement. Encouraging, isn’t it? Not so fast. Just a few days after the medical groups’ offer was publicly announced, the AHA backtracked saying that what they really meant was that they were going to try really hard to save money, but they were making no promises.
The Consumers Union report gives the country a “failing grade on progress in select [IOM] recommendations” that Consumers Union believes are necessary to “create a health-care system free of preventable harm.” Lack of progress on implementing those “select recommendations” includes these:
Few hospitals have adopted well-known electronic prescribing and dispensing systems to prevent medication errors, and the Food and Drug Administration rarely intervenes to avoid confusion among similarly-named drugs. A 2008 survey of American Hospital Association members found that just 17% had a computerized order entry system for prescriptions and medication administration; 38% had either a partial system of plans for a system, but nearly half (45%) had no plans to implement such a system.
Medical error and hospital-acquired infections reporting is not systematic, publicly distributed, or validated, thus avoiding medical provider accountability.
No national entity is empowered to coordinate and track patient safety improvements which makes it impossible to determine progress.
Physicians and other health professionals are not expected to demonstrate competency in patient safety practices.
“The U.S. health-care system needs nationwide mandatory, validated and public reporting of preventable health care-acquired infections and medical errors,” Consumers Union wrote. “The FDA, doctors, hospitals, and drug manufacturers must establish better practices at every stage of the treatment process to track and prevent harm from medication errors. Professional standards regarding patient safety should ensure competent care….public reporting of preventable medical harm is today perhaps the only effective accountability measure we have…As the nation begins to reform our health-care system, we have an opportunity to take effective and accountable action to make health care safer for all Americans,” the Consumers Union report concluded.
Leapfrog’s Hospital Survey for 2008 also finds little progress in efforts to reduce preventable medical errors. “As the Obama administration and Congress consider health reform options, it is clear we have a long way to go to achieve hospital quality and cost-effectiveness worthy of the nation’s $2.3 trillion annual investment,” said Leapfrog CEO Leah Binder. “According to our data, a majority oif hospitals have significant safety and efficiency deficits….As the President has often stated, a reformed high value health care system needs to be cost-effective”.
Two-thirds of hospitals do not have in place all of the recommended policies to prevent common hospital-acquired infections and 75% do not fully meet the standards for 13 evidence-based safety practices (including hand washing, for heaven’s sake; how hard or costly is that practice to implement?).
I don’t know about you, but the more I learn about the deficient patient safety practices of our health care system, the more I want to avoid it. How’s that for a cost-saving measure?!
Friday, May 22, 2009
Health Reform Chasm Between Democrats, Republicans As Wide, And Deep, As Expected
On May 20, Sens. Tom Coburn (Okla.) and Richard Burr (N.C.) and Reps. Paul Ryan (Wis.) and Devin Nunes (Cal.) introduced the Patients’ Choice Act of 2009 (S. 1099, H.R. 2520), the first legislative proposal from Republicans trying to provide an alternative to the upcoming health reform proposals from Senate and House Democrats.
No surprises here, but a confirmation that the Democrats wan to guarantee health care coverage through legislation, while Republicans want to encourage coverage through expansion of the existing free market system.
The major provisions in the Republican legislation have no chance of being enacted. Among other things, the Patients’ Choice Act proposes the following:
--Encourage, but do not require employers or employees to have health insurance coverage. Democrats will compel coverage in one form or another, either immediately or in stages.
--Replace the current tax exclusion for employer-provided health coverage with an income-related, refundable tax credit.. The “Medi-Choice” rebate would be worth about $2,300 for individuals and about $5,700 for families. Democrats may modify the tax exclusion but will not eliminate it.
--Create voluntary state health insurance exchanges with the following characteristics:
One-stop marketplace for health insurance. Individuals could choose the plan that best meets their needs through a state exchange.
Plans offering coverage through an exchange would have to meet the same statutory standard used for the health benefits given to Members of Congress.
A state exchange would require all participating insurers to offer coverage to any individual— regardless of patient age or health history.
An exchange is almost a certain component to Democratic offerings—but it won’t be voluntary.
--Establish a non-profit, independent board to oversee prices and penalize insurance companies that cherry pick healthy patients while rewarding companies that seek patients with pre-existing conditions. Democrats will expand on existing comparative effectiveness research provisions and will provide overall limits on what insurers may change for health care coverage.
Probably the best example of the differences bewteen the Democrats and the Republicans is in provisions concerning health savings accounts (HSAs). Republicans The would allow health insurance premiums to be paid tax-free from an HSA as well as increasing the amount of tax-free dollars an individual can keep for their health care. They also would allow high-deductible health plans to cover preventive services, maintenance costs of chronic diseases, and concierge-style primary care services.
Democrats would like to restrict or even eliminate HSAs.
The gap between most Republicans and most Democrats is as wide as anticipated, and it now is even more likely that the Democrats will have to use the reconciliation process to pass health reform legislation.
Under the recently approved budget resolution, Congress has until October 15 to pass deficit-neutral health care reform legislation under the normal rules of the House and the Senate, which would in essence require a 60-vote majority in the Senate for passage that avoids a filibuster.
If reform is not passed by that date, deficit-neutral health care reform legislation could be attached to the budget reconciliation bill, which would require only simple majorities in the House and the Senate for passage.
No surprises here, but a confirmation that the Democrats wan to guarantee health care coverage through legislation, while Republicans want to encourage coverage through expansion of the existing free market system.
The major provisions in the Republican legislation have no chance of being enacted. Among other things, the Patients’ Choice Act proposes the following:
--Encourage, but do not require employers or employees to have health insurance coverage. Democrats will compel coverage in one form or another, either immediately or in stages.
--Replace the current tax exclusion for employer-provided health coverage with an income-related, refundable tax credit.. The “Medi-Choice” rebate would be worth about $2,300 for individuals and about $5,700 for families. Democrats may modify the tax exclusion but will not eliminate it.
--Create voluntary state health insurance exchanges with the following characteristics:
One-stop marketplace for health insurance. Individuals could choose the plan that best meets their needs through a state exchange.
Plans offering coverage through an exchange would have to meet the same statutory standard used for the health benefits given to Members of Congress.
A state exchange would require all participating insurers to offer coverage to any individual— regardless of patient age or health history.
An exchange is almost a certain component to Democratic offerings—but it won’t be voluntary.
--Establish a non-profit, independent board to oversee prices and penalize insurance companies that cherry pick healthy patients while rewarding companies that seek patients with pre-existing conditions. Democrats will expand on existing comparative effectiveness research provisions and will provide overall limits on what insurers may change for health care coverage.
Probably the best example of the differences bewteen the Democrats and the Republicans is in provisions concerning health savings accounts (HSAs). Republicans The would allow health insurance premiums to be paid tax-free from an HSA as well as increasing the amount of tax-free dollars an individual can keep for their health care. They also would allow high-deductible health plans to cover preventive services, maintenance costs of chronic diseases, and concierge-style primary care services.
Democrats would like to restrict or even eliminate HSAs.
The gap between most Republicans and most Democrats is as wide as anticipated, and it now is even more likely that the Democrats will have to use the reconciliation process to pass health reform legislation.
Under the recently approved budget resolution, Congress has until October 15 to pass deficit-neutral health care reform legislation under the normal rules of the House and the Senate, which would in essence require a 60-vote majority in the Senate for passage that avoids a filibuster.
If reform is not passed by that date, deficit-neutral health care reform legislation could be attached to the budget reconciliation bill, which would require only simple majorities in the House and the Senate for passage.
Thursday, May 21, 2009
After pomp and circumstance, quest for coverage begins
Young adults make up a significant segment of the uninsured population. Some of these folks lose coverage when they graduate from college because they no longer have dependent status pursuant to their parents’ health insurance coverage or their college health plan coverage ends. There’s also been a persistent belief that some young adults choose not to have coverage because they feel they are invincible and don’t need it. But at least one recent survey belies this belief.
In an online poll of 1,000 18-21 year olds conducted by the polling company™ inc. for UnitedHealthcare, 82 percent of young adults see health insurance as a necessity they cannot ignore. Yet more than half acknowledge that they lack information to make good decisions about coverage once they are no longer on their parents' or college plans.
The survey also found that 67 percent of young adults have not made any plans for health insurance coverage after they leave school, even though the overwhelming majority acknowledges the importance of coverage. In fact, 68 percent rank health benefits as important as salaries when choosing their jobs.
Graduates: welcome to the insurance world. This survey raises several issues. First, it’s good news that young adults (at least the ones in this survey) are recognizing the importance of health insurance. A night or two in the hospital or surgery for a broken limb could result in medical bills that haunt for years or lead to bankruptcy.
Second, the survey reminds us about some of the problems with employment-based insurance. In this economy, a lot of fresh college grads are going to have trouble getting jobs and, thus, getting health insurance. Even the grads who obtain jobs may find there is a significant waiting period before coverage begins. To bridge the gap, COBRA might be available based on previous coverage under a parent’s plan. But the premium subsidy generally won’t apply to these individuals, so the premiums are likely to be quite high.
Another problem related to employment-based coverage is dependent eligibility. As mentioned above, young adults who are covered under a parent’s plan often lose such coverage around age 25 (or age 18 if not a full-time student). Several states have addressed this issue by extending the dependent age limit for group plans (the most recent being Pennsylvania, which is set to extend the age limit to 30 for certain dependents). But that leaves out plans in states that have not extended the age limit and also parents’ coverage under self-insured plans, which are not subject to state rules.
The survey also raises the issue of obtaining individual coverage. As we know, there are obstacles to obtaining such a policy – cost, pre-existing condition exclusions, and gender rating, just to name a few.
Finally, the survey’s results on the lack of information highlight the importance of educating young (actually, all) adults about health care coverage options. If (when?) health care reform is passed, it will be more important than ever for us to be informed so that we can make good decisions about coverage. For that information, stay right here. We’ve got you covered.
In an online poll of 1,000 18-21 year olds conducted by the polling company™ inc. for UnitedHealthcare, 82 percent of young adults see health insurance as a necessity they cannot ignore. Yet more than half acknowledge that they lack information to make good decisions about coverage once they are no longer on their parents' or college plans.
The survey also found that 67 percent of young adults have not made any plans for health insurance coverage after they leave school, even though the overwhelming majority acknowledges the importance of coverage. In fact, 68 percent rank health benefits as important as salaries when choosing their jobs.
Graduates: welcome to the insurance world. This survey raises several issues. First, it’s good news that young adults (at least the ones in this survey) are recognizing the importance of health insurance. A night or two in the hospital or surgery for a broken limb could result in medical bills that haunt for years or lead to bankruptcy.
Second, the survey reminds us about some of the problems with employment-based insurance. In this economy, a lot of fresh college grads are going to have trouble getting jobs and, thus, getting health insurance. Even the grads who obtain jobs may find there is a significant waiting period before coverage begins. To bridge the gap, COBRA might be available based on previous coverage under a parent’s plan. But the premium subsidy generally won’t apply to these individuals, so the premiums are likely to be quite high.
Another problem related to employment-based coverage is dependent eligibility. As mentioned above, young adults who are covered under a parent’s plan often lose such coverage around age 25 (or age 18 if not a full-time student). Several states have addressed this issue by extending the dependent age limit for group plans (the most recent being Pennsylvania, which is set to extend the age limit to 30 for certain dependents). But that leaves out plans in states that have not extended the age limit and also parents’ coverage under self-insured plans, which are not subject to state rules.
The survey also raises the issue of obtaining individual coverage. As we know, there are obstacles to obtaining such a policy – cost, pre-existing condition exclusions, and gender rating, just to name a few.
Finally, the survey’s results on the lack of information highlight the importance of educating young (actually, all) adults about health care coverage options. If (when?) health care reform is passed, it will be more important than ever for us to be informed so that we can make good decisions about coverage. For that information, stay right here. We’ve got you covered.
Wednesday, May 20, 2009
Baucus/Grassley Lay Out Health Reform Financing Policy Options
Now things start to get interesting. On May 18, Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released a 41-page list of policy options that will be considered for financing this year’s health care reform proposals. The list offers plenty of ammunition for opponents.
At this stage, these financing policy options are those that are on the table. Nothing is definite yet so the proposals have an “everything but the kitchen sink” look about them. It is important to note that, while both Baucus and Grassley are jointly offering these proposals for discussion, not every option has the support of both Baucus and Grassley.
Health Systems Savings. The SFC will examine reducing geographic variation in medical spending, looking at why healthcare spending varies so much from region to region with no correlation to the quality of the medical care. Other financing topics in that area will include “means testing” for Medicare Part D premiums and attempting to make Medicare beneficiary contributions more predictable.
Tax Exclusion for Employer-Provided Coverage. Any changes to the employer-provided tax exclusion would likely be quite controversial. According to the SFC document, any such limits could be based on the value of the plan (such as the actuarial value of a benchmark plan) or the income of the insured (such as $200,000 for single filers or $400,000 for joint filers), or the limit could be a combination of both. Alternatively, the limit could be tied to a percentage of the value of the employer-provided health coverage. The SFC also notes that indexing of any amounts would be considered.
Besides direct health care costs, the SFC document points to indirect costs—health tax expenditures—as being the largest federal expenditure at $194.2 billion in 2008 alone. (Of this total, more than $132 billion is due to the tax exclusion for employer-provided health care.) Due to its cost, cutting, or at least limiting, the employer-provided health insurance tax exclusion will likely get serious consideration.
Other Health Care Related Revenue Raisers. Quite a few interesting options on the table here, too, including increasing the 7.5 percent AGI threshold for itemized deductions for medical expenses. Various modifications to Health Savings Accounts (HSAs) and limiting or repealing flexible spending arrangements (FSAs) and the Health Reimbursement Arrangements (HRAs) would also be addressed in upcoming months.
Modifying the FICA tax exception for students and extending the Medicare payroll tax to all state and local government employees also will be considered.
Lifestyle-Related Revenue Measures. No surprise here. The SFC will be considering enacting a sugar-sweetened beverage excise tax. This could apply to nondiet soft drinks, energy and sports drinks, iced teas and coffees, and flavored milk and dairy drinks. Diet drinks would be exempted from this tax.
Administration Proposals. Revenue raising measures proposed by the Obama Administration will also be considered by the SFC.
What next? A lot of options to consider? As they say up in Minnesota, you betcha. It should prove to be an interesting next few months.
At this stage, these financing policy options are those that are on the table. Nothing is definite yet so the proposals have an “everything but the kitchen sink” look about them. It is important to note that, while both Baucus and Grassley are jointly offering these proposals for discussion, not every option has the support of both Baucus and Grassley.
Health Systems Savings. The SFC will examine reducing geographic variation in medical spending, looking at why healthcare spending varies so much from region to region with no correlation to the quality of the medical care. Other financing topics in that area will include “means testing” for Medicare Part D premiums and attempting to make Medicare beneficiary contributions more predictable.
Tax Exclusion for Employer-Provided Coverage. Any changes to the employer-provided tax exclusion would likely be quite controversial. According to the SFC document, any such limits could be based on the value of the plan (such as the actuarial value of a benchmark plan) or the income of the insured (such as $200,000 for single filers or $400,000 for joint filers), or the limit could be a combination of both. Alternatively, the limit could be tied to a percentage of the value of the employer-provided health coverage. The SFC also notes that indexing of any amounts would be considered.
Besides direct health care costs, the SFC document points to indirect costs—health tax expenditures—as being the largest federal expenditure at $194.2 billion in 2008 alone. (Of this total, more than $132 billion is due to the tax exclusion for employer-provided health care.) Due to its cost, cutting, or at least limiting, the employer-provided health insurance tax exclusion will likely get serious consideration.
Other Health Care Related Revenue Raisers. Quite a few interesting options on the table here, too, including increasing the 7.5 percent AGI threshold for itemized deductions for medical expenses. Various modifications to Health Savings Accounts (HSAs) and limiting or repealing flexible spending arrangements (FSAs) and the Health Reimbursement Arrangements (HRAs) would also be addressed in upcoming months.
Modifying the FICA tax exception for students and extending the Medicare payroll tax to all state and local government employees also will be considered.
Lifestyle-Related Revenue Measures. No surprise here. The SFC will be considering enacting a sugar-sweetened beverage excise tax. This could apply to nondiet soft drinks, energy and sports drinks, iced teas and coffees, and flavored milk and dairy drinks. Diet drinks would be exempted from this tax.
Administration Proposals. Revenue raising measures proposed by the Obama Administration will also be considered by the SFC.
What next? A lot of options to consider? As they say up in Minnesota, you betcha. It should prove to be an interesting next few months.
Tuesday, May 19, 2009
Medicare: A Successful Working Public Health Plan
One of the key issues in the current health reform discussion is whether to make available to employers and to individuals younger than age 65 a public plan based on Medicare. Opponents to a public plan claim it will pose unfair competition to private insurance plans. In previous posts we discussed public plan proposals and how a public plan might be constructed in a fair competitive way.
A new report from The Commonwealth Fund compares the experience of Medicare beneficiaries with that of individuals with employer-sponsored insurance. Medicare beneficiaries gave their plan’s performance much higher marks than did individuals with employer coverage.
More specifically, the Commonwealth Fund found that Americans with Medicare coverage report fewer problems getting medical treatment, less financial hardship due to medical bills, and higher satisfaction with their coverage, than do individuals with employer-sponsored coverage. Thus, a Medicare-type public plan would be a desirable option for working-age adults, the report concluded. The study used data from a health insurance survey conducted in 2007 to “explore the ability of different sources of coverage to fulfill the two main purposes of health insurance: assuring access to care when needed, and protecting against financial hardship from medical bills.”
The Commonwealth Fund attributes Medicare beneficiaries’ high level of satisfaction to beneficiaries’ perceptions that the value of the benefits far outweighs their own premium contributions, and that their coverage is secure, that is, that once beneficiaries obtain coverage they are not at risk of losing it. In contrast, individuals with employer coverage fear losing the coverage should they lose their jobs, or that their employers will restrict benefits and implement higher employee premiums or cost share. The study also raised concerns about documented deterioration in employer coverage between 2001 and 2007.
“Offering a choice of a Medicare-sponsored public plan with benefits similar to private employer or federal employee plans would build on Medicare’s wide provider network and experience in making accessible care available to enrollees at lower cost,” the Commonwealth Fund report commented. “Such an option would be particularly attractive to older adults seeking secure coverage that does not depend on health status.” An earlier survey of older adults ages 50-64 showed that nearly three-fourths were interested in becoming eligible for Medicare, including 68% of those covered by employer plans.
The report concluded that: “Providing a Medicare-sponsored option to the nonelderly could increase the continuity of coverage and bolster confidence that people will be able to get and afford health care when they need it. Most importantly, building on Medicare as an option for working-age adults could contribute to greater competition between public and private coverage sources, making both more responsive to the needs of the enrollees.” President Obama and Kathleen Sebelius, the new Secretary of the Department of Health and Human Services and former Kansas insurance commissioner, agree.
If Medicare, our only widely-available public health plan, works well for elderly folks who are sicker and poorer than younger working adults, why couldn’t it also work well for younger folks?
A new report from The Commonwealth Fund compares the experience of Medicare beneficiaries with that of individuals with employer-sponsored insurance. Medicare beneficiaries gave their plan’s performance much higher marks than did individuals with employer coverage.
More specifically, the Commonwealth Fund found that Americans with Medicare coverage report fewer problems getting medical treatment, less financial hardship due to medical bills, and higher satisfaction with their coverage, than do individuals with employer-sponsored coverage. Thus, a Medicare-type public plan would be a desirable option for working-age adults, the report concluded. The study used data from a health insurance survey conducted in 2007 to “explore the ability of different sources of coverage to fulfill the two main purposes of health insurance: assuring access to care when needed, and protecting against financial hardship from medical bills.”
The Commonwealth Fund attributes Medicare beneficiaries’ high level of satisfaction to beneficiaries’ perceptions that the value of the benefits far outweighs their own premium contributions, and that their coverage is secure, that is, that once beneficiaries obtain coverage they are not at risk of losing it. In contrast, individuals with employer coverage fear losing the coverage should they lose their jobs, or that their employers will restrict benefits and implement higher employee premiums or cost share. The study also raised concerns about documented deterioration in employer coverage between 2001 and 2007.
“Offering a choice of a Medicare-sponsored public plan with benefits similar to private employer or federal employee plans would build on Medicare’s wide provider network and experience in making accessible care available to enrollees at lower cost,” the Commonwealth Fund report commented. “Such an option would be particularly attractive to older adults seeking secure coverage that does not depend on health status.” An earlier survey of older adults ages 50-64 showed that nearly three-fourths were interested in becoming eligible for Medicare, including 68% of those covered by employer plans.
The report concluded that: “Providing a Medicare-sponsored option to the nonelderly could increase the continuity of coverage and bolster confidence that people will be able to get and afford health care when they need it. Most importantly, building on Medicare as an option for working-age adults could contribute to greater competition between public and private coverage sources, making both more responsive to the needs of the enrollees.” President Obama and Kathleen Sebelius, the new Secretary of the Department of Health and Human Services and former Kansas insurance commissioner, agree.
If Medicare, our only widely-available public health plan, works well for elderly folks who are sicker and poorer than younger working adults, why couldn’t it also work well for younger folks?
Monday, May 18, 2009
HHS 2010 budget: Cost control is the message of the day
As others have observed, in recent days the Obama Administration has emphasized cost control, rather than universal coverage, as a key rationale for its health care reform plans. It may prove to be a politically savvy communications strategy. Ever increasing costs is an issue that affects the significant segment of Americans who are otherwise reasonably happy with their health insurance coverage.
The emphasis on cost control as the key message is also apparent in the Department of Health and Human Services’ rollout of its budget for 2010. “This budget sends a clear message that we can’t afford to wait any longer if we want to get health care costs under control and improve our fiscal outlook,” said Secretary Kathleen Sebelius, according to an agency press release.
The 2010 budget establishes a health care reserve fund of $635 billion over 10 years to finance health reform that, according to HHS, brings down costs, improves quality, and assures coverage for all Americans. Funding for this reserve fund will come from “new revenue” (more on that in a moment) and from savings from Medicare and Medicaid.
The Medicare savings will come in part from more dollars spent on the Medicare Integrity Program, anti-fraud program run by HHS. “The President’s budget lays out funding for anti-fraud efforts over five years that we estimate could save $2.7 billion by improving overall oversight and stopping fraud and abuse within the Medicare Advantage and Medicare prescription drug programs,” according to Sebelius.
But HHS concedes savings won’t be enough to finance the reserve fund. The balance will come from “new revenue.” What new revenue? HHS doesn’t elaborate, but that little phrase is often synonymous with “new taxes,” a topic typically less popular with the average voter than cost savings. With some predicting passage of House and Senate versions of reform legislation by August, it will be interesting to observe how the Obama team continues to morph its message of the day.
The emphasis on cost control as the key message is also apparent in the Department of Health and Human Services’ rollout of its budget for 2010. “This budget sends a clear message that we can’t afford to wait any longer if we want to get health care costs under control and improve our fiscal outlook,” said Secretary Kathleen Sebelius, according to an agency press release.
The 2010 budget establishes a health care reserve fund of $635 billion over 10 years to finance health reform that, according to HHS, brings down costs, improves quality, and assures coverage for all Americans. Funding for this reserve fund will come from “new revenue” (more on that in a moment) and from savings from Medicare and Medicaid.
The Medicare savings will come in part from more dollars spent on the Medicare Integrity Program, anti-fraud program run by HHS. “The President’s budget lays out funding for anti-fraud efforts over five years that we estimate could save $2.7 billion by improving overall oversight and stopping fraud and abuse within the Medicare Advantage and Medicare prescription drug programs,” according to Sebelius.
But HHS concedes savings won’t be enough to finance the reserve fund. The balance will come from “new revenue.” What new revenue? HHS doesn’t elaborate, but that little phrase is often synonymous with “new taxes,” a topic typically less popular with the average voter than cost savings. With some predicting passage of House and Senate versions of reform legislation by August, it will be interesting to observe how the Obama team continues to morph its message of the day.
Friday, May 15, 2009
Achieving The Least Objectionable Results II: Channeling Willie Sutton
The Senate Finance Committee invited more than a dozen health care experts to discuss options for financing health care reform on May 12, and many of their comments reflected a quote attributed to the bank robber Willie Sutton when he was asked why he robbed banks. Willie is purported to have said, “Because that’s where the money is.”
The May 12 panelists emphasized four methods of providing funding for comprehensive health care reform:
--changing the employee tax exclusion for employer-provided health care;
--increasing taxes on alcohol, tobacco, and sugar consumption;
--reducing federal “safety net programs” such as that for uncompensated care; and
--reforming Medicare and other health care payments from a fee-for-service system to a value-based system.
At least for the first three items, this is where the money is, according to testimony from John Sheils, Vice President, The Lewin Group. These figures are for the 2010 to 2019 period and are estimates of the increases in federal revenues because of the specific changes described in the testimony:
--Limits on the Tax Exclusion for Employer Health Benefits: $757.1 billion
--Tobacco Tax : $358.8 billion
--Changing Federal Uncompensated Care Hospital Payments $239.2 billion
Tax Exclusion
Although the employer representatives at the Finance Committee hearing opposed limiting the tax exclusion, almost all others acknowledged this is one source that make up in large part for the new expenses of health care reform. The Democratic Chair of the Committee, Sen. Max Baucus, noted that “The current tax exclusion is not perfect. It is regressive. It often leads people to buy more health coverage than they need. We should look at ways to modify the current tax exclusion so that it provides the right incentives. And we should look at ways to make it fairer and more equitable for everyone.”
Sin Taxes
The allure of increases in taxes on such items as alcohol, tobacco, and sugar goes beyond revenue increases. Robert Greenstein, executive director, Center on Budget and Policy Priorities, conceded that taxes on alcohol and sugar-sweetened soda are regressive. He said, however, that the net effect of providing universal health coverage for “this part of the population would be a substantial gain in well-being. Low- and moderate-income households who reduced their consumption of unhealthy products as a result of changes in tax policy also would benefit from improved health outcomes.”
Uncompensated Care
According to Jonathan Gruber, professor of economics, Massachusetts Institute of Technology, “Hospitals in the U.S. currently spend over $30 billion per year on uncompensated care. Best estimates suggest that two-thirds of that amount is due to the uninsured. Thus, as we move towards universal coverage, there is a sizeable bonus to hospitals that could be recaptured to finance insurance subsidies; indeed, moving money from back-end care of the uninsured to up-front subsidies to insurance was the notion behind the Massachusetts reform.”
Value-Based Reimbursement System
Moving toward value based reimbursement, the one major item that so far has eluded a dollar amount of savings, also is the idea that holds the most promise for some.
Katherine Baicker, professor of health economics, Harvard School of Public Health, said, “Serious reforms would focus not exclusively on lowering costs, but on increasing the value that we get from health insurance and health care. Reforms that promoted higher-value insurance could both extend coverage so that more people benefit from the protections that insurance affords and ensure that those protections are secure for those who fall ill.”
Unfortunately, knowing how much this will save is elusive. In reviewing comparative effectiveness research, a key component to value-based reimbursement, the Congressional Budget Office noted that “it would probably be a decade or more before new research on comparative effectiveness had the potential to reduce health care spending in a substantial way.”
Nevertheless, look for value-based purchasing, along with the employer tax exclusion, “sin taxes,” and uncompensated care reductions to form the basis for health reform financing legislation. These are more “least objectionable results” that willform the basis of health reform compromise; and for the most part, this is“where the money is.”
The May 12 panelists emphasized four methods of providing funding for comprehensive health care reform:
--changing the employee tax exclusion for employer-provided health care;
--increasing taxes on alcohol, tobacco, and sugar consumption;
--reducing federal “safety net programs” such as that for uncompensated care; and
--reforming Medicare and other health care payments from a fee-for-service system to a value-based system.
At least for the first three items, this is where the money is, according to testimony from John Sheils, Vice President, The Lewin Group. These figures are for the 2010 to 2019 period and are estimates of the increases in federal revenues because of the specific changes described in the testimony:
--Limits on the Tax Exclusion for Employer Health Benefits: $757.1 billion
--Tobacco Tax : $358.8 billion
--Changing Federal Uncompensated Care Hospital Payments $239.2 billion
Tax Exclusion
Although the employer representatives at the Finance Committee hearing opposed limiting the tax exclusion, almost all others acknowledged this is one source that make up in large part for the new expenses of health care reform. The Democratic Chair of the Committee, Sen. Max Baucus, noted that “The current tax exclusion is not perfect. It is regressive. It often leads people to buy more health coverage than they need. We should look at ways to modify the current tax exclusion so that it provides the right incentives. And we should look at ways to make it fairer and more equitable for everyone.”
Sin Taxes
The allure of increases in taxes on such items as alcohol, tobacco, and sugar goes beyond revenue increases. Robert Greenstein, executive director, Center on Budget and Policy Priorities, conceded that taxes on alcohol and sugar-sweetened soda are regressive. He said, however, that the net effect of providing universal health coverage for “this part of the population would be a substantial gain in well-being. Low- and moderate-income households who reduced their consumption of unhealthy products as a result of changes in tax policy also would benefit from improved health outcomes.”
Uncompensated Care
According to Jonathan Gruber, professor of economics, Massachusetts Institute of Technology, “Hospitals in the U.S. currently spend over $30 billion per year on uncompensated care. Best estimates suggest that two-thirds of that amount is due to the uninsured. Thus, as we move towards universal coverage, there is a sizeable bonus to hospitals that could be recaptured to finance insurance subsidies; indeed, moving money from back-end care of the uninsured to up-front subsidies to insurance was the notion behind the Massachusetts reform.”
Value-Based Reimbursement System
Moving toward value based reimbursement, the one major item that so far has eluded a dollar amount of savings, also is the idea that holds the most promise for some.
Katherine Baicker, professor of health economics, Harvard School of Public Health, said, “Serious reforms would focus not exclusively on lowering costs, but on increasing the value that we get from health insurance and health care. Reforms that promoted higher-value insurance could both extend coverage so that more people benefit from the protections that insurance affords and ensure that those protections are secure for those who fall ill.”
Unfortunately, knowing how much this will save is elusive. In reviewing comparative effectiveness research, a key component to value-based reimbursement, the Congressional Budget Office noted that “it would probably be a decade or more before new research on comparative effectiveness had the potential to reduce health care spending in a substantial way.”
Nevertheless, look for value-based purchasing, along with the employer tax exclusion, “sin taxes,” and uncompensated care reductions to form the basis for health reform financing legislation. These are more “least objectionable results” that willform the basis of health reform compromise; and for the most part, this is“where the money is.”
Thursday, May 14, 2009
Eliminating gender rating is one small step for women, giant leap (possibly) for industry
Employment-based health insurance coverage is one of the focal points of the health care reform discussions. But what about the folks who don’t have such coverage? Other than being uninsured, the only option for many is to purchase coverage in the individual market. Buying coverage in the individual market can be difficult and costly, especially for women. That’s because most states permit insurers to use gender rating to charge women higher premiums than men for the same coverage. Insurers who practice gender rating charged 25-year-old women anywhere from 6% to 45% more than 25-year-old men and charged 40-year-old women from 4% to 48% more than 40-year-old men, according to a report by the National Women’s Law Center (NWLC).
Citing the report’s findings, Senator John Kerry (D-MA) has introduced legislation (S. 969) that would prevent insurers in the individual market from charging women more for health care coverage and from denying or limiting coverage based on their pregnancy status or delivery method. The bill also would ensure comprehensive maternity coverage.
Two-thirds of all American women aged 18 to 64 receive health insurance from their employer and are protected by federal and state laws that prevent them from charging employees different premiums or excluding maternity coverage, according to Senator Kerry’s press release on The Women's Health Insurance Fairness Act of 2009. The 5.7 million women who buy coverage in the individual insurance market rely on state regulation for fair treatment, but the vast majority of states provide few, if any, protections for women, the release states.
Another industry concession? On the same day that Senator Kerry introduced the legislation, America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni said during a Senate Finance Committee hearing that the industry would agree to stop charging women more for coverage if Congress requires all individuals to have coverage. Some are viewing this as the industry’s “latest concession” in its opposition to a public plan. A few weeks ago, the industry offered to ease its longstanding position on pre-existing conditions.
“Both Senator Kerry’s bill and the insurance industry’s willingness to eliminate gender rating equal a step in the right direction for women in health care reform. But we still have a long way to go,” Marcia D. Greenberger, Co-President of the NWLC said in a press release.
Citing the report’s findings, Senator John Kerry (D-MA) has introduced legislation (S. 969) that would prevent insurers in the individual market from charging women more for health care coverage and from denying or limiting coverage based on their pregnancy status or delivery method. The bill also would ensure comprehensive maternity coverage.
Two-thirds of all American women aged 18 to 64 receive health insurance from their employer and are protected by federal and state laws that prevent them from charging employees different premiums or excluding maternity coverage, according to Senator Kerry’s press release on The Women's Health Insurance Fairness Act of 2009. The 5.7 million women who buy coverage in the individual insurance market rely on state regulation for fair treatment, but the vast majority of states provide few, if any, protections for women, the release states.
Another industry concession? On the same day that Senator Kerry introduced the legislation, America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni said during a Senate Finance Committee hearing that the industry would agree to stop charging women more for coverage if Congress requires all individuals to have coverage. Some are viewing this as the industry’s “latest concession” in its opposition to a public plan. A few weeks ago, the industry offered to ease its longstanding position on pre-existing conditions.
“Both Senator Kerry’s bill and the insurance industry’s willingness to eliminate gender rating equal a step in the right direction for women in health care reform. But we still have a long way to go,” Marcia D. Greenberger, Co-President of the NWLC said in a press release.
Wednesday, May 13, 2009
“Cadillac health care coverage” can be a misnomer
Clearly, someone will need to pay for the expansion of health coverage for the uninsured. Besides the “don't tax my snacks” approach Tulay talked about on April 30th, another suggestion gaining favor in recent weeks is to tax those employees who have the most expensive employer-provided health coverage. The New York Times cites a Congressional estimate that taxing this so-called “Cadillac coverage” could result in revenues of $100 billion over five years. What’s not to like with that?
The problem is that, at times, “Cadillac coverage” is a misnomer. Some (many?) plans could be expensive for reasons that are totally unrelated to whether its benefits are “gold-plated” and overly generous. In fact, according to the Economic Policy Institute (EPI), taxing “Cadillac coverage” would hit two groups particularly hard—employees at small companies and those in higher risk employer pools, such as companies with a larger percentage of older employees. As the EPI says, the “high price may stem not from any bells and whistles in their coverage but from a fundamental inequity in the way that insurance for these groups is currently priced.”
Workers living in higher cost areas would also be hit especially hard by any proposals to tax “Cadillac coverage” as well. In those locales, the health care dollar does not go as far as it does in less expensive locations.
Nothing is final but, if Congress goes this route (and more and more seem to be coming on board with this approach), it needs to limit the tax to truly “Cadillac coverage” and not rope in those employees who have only “Chevrolet coverage.”
The problem is that, at times, “Cadillac coverage” is a misnomer. Some (many?) plans could be expensive for reasons that are totally unrelated to whether its benefits are “gold-plated” and overly generous. In fact, according to the Economic Policy Institute (EPI), taxing “Cadillac coverage” would hit two groups particularly hard—employees at small companies and those in higher risk employer pools, such as companies with a larger percentage of older employees. As the EPI says, the “high price may stem not from any bells and whistles in their coverage but from a fundamental inequity in the way that insurance for these groups is currently priced.”
Workers living in higher cost areas would also be hit especially hard by any proposals to tax “Cadillac coverage” as well. In those locales, the health care dollar does not go as far as it does in less expensive locations.
Nothing is final but, if Congress goes this route (and more and more seem to be coming on board with this approach), it needs to limit the tax to truly “Cadillac coverage” and not rope in those employees who have only “Chevrolet coverage.”
Tuesday, May 12, 2009
Comparative Effectiveness And Public Distrust Of Government
Are the medical treatments we get the best and most cost-effective ones for our medical conditions? In docs we trust. But are our doctors applying the best information possible? That’s often questionable, it turns out. In fact, nearly three-fourths of respondents to The Public and the Health Care Delivery System survey, conducted for the Kaiser Family Foundation and others, understood that clear scientific evidence of effectiveness is not always available. Many health care experts and payers have been asking for comparative effectiveness information to determine which treatments are worth the cost differential and which are not.
So, to better inform our medical treatment decisions, the American Recovery and Reinvestment Act of 2009 (ARRA) provides funds for a federal entity to organize comparative effectiveness research and to disseminate the results.
The dilemma is that many Americans mistrust government or insurers to tell them what treatments are most effective. More than half (56%) of the Kaiser survey respondents thought that insurers should pay for expensive treatments even if not proven most effective. Only 35% thought that those treatments should not be covered. More than half (55%) of respondents would prefer that a panel of experts from an independent scientific organization prepare comparative effectiveness research and reports. Yet only 41% would trust such information from a panel appointed by the federal government, the National Institutes of Health, or another governmental agency. The public does not realize that these agencies rely on research that is independently-performed by private, scientific organizations. And they fear that the information will be used to deny treatments.
Even former Senator Newt Gingrich, founder of the Center for Health Transformation, told the Midwest Business Group on Health annual conference in Chicago on May 8 that while he supports comparative effectiveness research, it should not be used by government to ration treatments. He supports investment in a scientific institute to study effectiveness of treatments, he said.
Most people seem to be unaware that there already are a number entities researching and disclosing the effectiveness of medical treatments and technologies. The entities, both federal and private, promote their research results not necessarily as a way to ration treatments or coverage, but to better inform treatment decisions. Among these entities are the following:
The Blue Cross and Blue Shield Association’s Technology Evaluation Center (TEC) Since 1985 the TEC has been appliying scientific criteria to assess medical technologies and effectiveness. Its clients include federal agencies, such as the Centers for Medicare and Medicaid, and private insurers such as Kaiser Permanente.
The CMS’ Council on Technology and Innovation (CTI)—Among other goals, CTI is dedicated to supporting improved medical decisions by patients and doctors, and promotion of better evidence development, which it deems critical to improve the quality of care for Medicare beneficiaries.
The U.S. Agency for Healthcare Research and Quality (AHRQ)--Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services. It is the nation's lead Federal agency for research on health care quality, costs, outcomes, and patient safety.
The Federal Coordinating Council for Comparative Effectiveness Research--A recently appointed group of, primarily, physicians working for government agencies, to carry out the research mandated in the ARRA. The Council is not expected to recommend clinical guidelines for payment, coverage or treatment. Instead, it will consider the needs of populations served by federal programs and opportunities to build and expand on current investments and priorities.
The ECRI Institute--For the past 40 years, this independent organization has been providing evidence-based healthcare research to help health care organizations select the safest, most effective medical devices, procedures, and drugs. Its Evidence-based Practice Center (EPC), used by the AHRQ and the Medicare Evidence Development and Coverage Advisory Committee, conducts comparative effectiveness reviews. The public has access to ECRI’s research findings through its Patient Safety Center.
Major medical centers across the U.S. also evaluate treatments.
There you have it. Treatment effectiveness review is ongoing. The question is, how will we use the information?
So, to better inform our medical treatment decisions, the American Recovery and Reinvestment Act of 2009 (ARRA) provides funds for a federal entity to organize comparative effectiveness research and to disseminate the results.
The dilemma is that many Americans mistrust government or insurers to tell them what treatments are most effective. More than half (56%) of the Kaiser survey respondents thought that insurers should pay for expensive treatments even if not proven most effective. Only 35% thought that those treatments should not be covered. More than half (55%) of respondents would prefer that a panel of experts from an independent scientific organization prepare comparative effectiveness research and reports. Yet only 41% would trust such information from a panel appointed by the federal government, the National Institutes of Health, or another governmental agency. The public does not realize that these agencies rely on research that is independently-performed by private, scientific organizations. And they fear that the information will be used to deny treatments.
Even former Senator Newt Gingrich, founder of the Center for Health Transformation, told the Midwest Business Group on Health annual conference in Chicago on May 8 that while he supports comparative effectiveness research, it should not be used by government to ration treatments. He supports investment in a scientific institute to study effectiveness of treatments, he said.
Most people seem to be unaware that there already are a number entities researching and disclosing the effectiveness of medical treatments and technologies. The entities, both federal and private, promote their research results not necessarily as a way to ration treatments or coverage, but to better inform treatment decisions. Among these entities are the following:
The Blue Cross and Blue Shield Association’s Technology Evaluation Center (TEC) Since 1985 the TEC has been appliying scientific criteria to assess medical technologies and effectiveness. Its clients include federal agencies, such as the Centers for Medicare and Medicaid, and private insurers such as Kaiser Permanente.
The CMS’ Council on Technology and Innovation (CTI)—Among other goals, CTI is dedicated to supporting improved medical decisions by patients and doctors, and promotion of better evidence development, which it deems critical to improve the quality of care for Medicare beneficiaries.
The U.S. Agency for Healthcare Research and Quality (AHRQ)--Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services. It is the nation's lead Federal agency for research on health care quality, costs, outcomes, and patient safety.
The Federal Coordinating Council for Comparative Effectiveness Research--A recently appointed group of, primarily, physicians working for government agencies, to carry out the research mandated in the ARRA. The Council is not expected to recommend clinical guidelines for payment, coverage or treatment. Instead, it will consider the needs of populations served by federal programs and opportunities to build and expand on current investments and priorities.
The ECRI Institute--For the past 40 years, this independent organization has been providing evidence-based healthcare research to help health care organizations select the safest, most effective medical devices, procedures, and drugs. Its Evidence-based Practice Center (EPC), used by the AHRQ and the Medicare Evidence Development and Coverage Advisory Committee, conducts comparative effectiveness reviews. The public has access to ECRI’s research findings through its Patient Safety Center.
Major medical centers across the U.S. also evaluate treatments.
There you have it. Treatment effectiveness review is ongoing. The question is, how will we use the information?
Monday, May 11, 2009
Ways and Means hearing: Sebelius “weighs” in, but does she “mean” business?
[OK, apologies for the horrible pun. But it’s Monday—groaners (and groaning) are in order.]
Fresh from her swearing in ceremony, Secretary of Health and Human Services Kathleen Sebelius testified before the House Ways and Means Committee last week as part of the Obama Administration’s continued efforts to drum up support for an overhaul of the health care system, including the (so far controversial) proposal to establish a public plan that would compete with private plans.
Fresh from her swearing in ceremony, Secretary of Health and Human Services Kathleen Sebelius testified before the House Ways and Means Committee last week as part of the Obama Administration’s continued efforts to drum up support for an overhaul of the health care system, including the (so far controversial) proposal to establish a public plan that would compete with private plans.
In her testimony, Sebelius argued that a public plan would bolster health care reform in a variety of ways: “Having an option for individuals; having a choice for the Americans who don’t currently have coverage; and having competition to drive the best practices, the best cost efficiencies, the best protocol; I think can be very positive in the long run.”
A former Insurance Commissioner for the State of Kansas, Secretary Sebelius offered a tart response to warnings of the dangers of government involvement with health care. “I know there’s a lot of talk about not having bureaucrats make health decisions,” she said, “but I think it’s equally important not to have private insurance companies make health decisions, overruling protocol recommended by health providers.”
The public plan debate continues to draw much of the energy in the health reform debate (although after the hearing Chairman Rangel (D-NY) made some news of his own with his summary rejection of the taxation of employer-provided health care). Sebelius endorsed the public plan notion at the hearing, but the depth of the Obama Administration’s commitment to the idea remains to be seen. At least one long-time Washington pundit sees the public plan option as “a bargaining chip that will be cashed in” (i.e., eliminated) at the end of the day in order to gain support from Republicans and from moderate Democrats. We’ll see.
Friday, May 8, 2009
Achieving The Least Objectionable Results
Compromise solutions in health care reform debates also might be called the “least objectionable results.”
At a recent Congressional hearing on health care reform, conversations with a reasonable cross-section of health reformers suggests that there is a growing a list of these “least objectionable results” on coverage issues that are likely to find their ways into legislation this summer. In the April 5 roundtable at the Senate Finance Committee on “Expanding Health Care Coverage,” the following elements of health care reform had clear support:
At a recent Congressional hearing on health care reform, conversations with a reasonable cross-section of health reformers suggests that there is a growing a list of these “least objectionable results” on coverage issues that are likely to find their ways into legislation this summer. In the April 5 roundtable at the Senate Finance Committee on “Expanding Health Care Coverage,” the following elements of health care reform had clear support:
- Build on existing systems. On one hand, this is code for ignoring such options as a single payer system or the elimination of the employer-based tax exclusion for health care. On the other hand, this is code for the assumption that with employer and insurer (existing systems) buy-in, health reform legislation actually can be passed.
- Establish a health insurance exchange. Also referred to by its more descriptive Massachusetts name of “connector,” an exchange would provide one or more central marketplaces through which all could purchase health insurance under the same general rules. Whether an exchange would be run federally, or by the states or by both are issues of contention, but the majority of those who spoke on April 5 (and at other times at other committee hearings) like the exchange idea.
- Mandates. A majority at the April 5 hearing would support an individual mandate, although many will want pricing limits and subsidies for the poor built in before allowing such a mandate. And despite President Barack Obama’s support for an employer mandate and the surprising lack of complaints in Massachusetts (the only state with an employer mandate), there is considerable opposition to an employer mandate, even from those outside the employer community (including Len Nichols at the New America Foundation).
- Government Involvement In Coverage. There are three contenders for this—a new “public plan” run by the federal government that would compete with private plans; an expanded version of the Federal Employees Health Plan that would be available to all; and an expanded version of Medicaid that would provide coverage for the great majority of the poor and near poor. Everyone recognizes an inevitable increase in federal involvement, so the real fight will be over the form of involvement.
- Change in insurance-based rules. As long as everyone gets covered (see 3 above), say goodbye to preexisting conditions exclusions, rating by health status or gender, and limitations on guaranteed issue. That leaves intact underwriting possibilities for geography, age, and product type and the dangers of price escalations (a topic the Finance Committee will examine on May 12). Karen Ignagni of AHIP laid out these changes clearly in her testimony and in exchanges with Senators at the hearing.
For some who are new to the health reform debate, this might seem like a flimsy set of compromises, and there remain many detractors. At one end are those who would like to scuttle health reform in general; at the other end are those who believe a single-payer health system is the only real path to reform.
However, from the perspective of 60 years of past health reform failures, the amount of agreement so far is stunning. Next up is next Tuesday’s Finance Committee meeting, a Roundtable Discussion on “Financing Comprehensive Health Care Reform.” I’ll keep you posted on whether there might be some “least objectionable results” here.
Thursday, May 7, 2009
A lesson from Massachusetts
As the health care reform talks heat up, this is probably as good a time as any to sit back and look at the Massachusetts experience. Just over three years ago, Massachusetts passed a “near universal coverage” health care law. Critics on both sides predicted the measure would be expensive for individuals and for state government.
Well, it hasn’t exactly worked out that way, at least not so far. It is true that health costs have gone up in Massachusetts (as they have elsewhere) but the state’s health mandate is not what is driving health care cost increases there. Further, even though many more Massachusetts residents now have health insurance, employers, individuals, and the state government are paying roughly the same proportion of health care costs as was the case before the Massachusetts law took effect. This is important to note as “shared responsibility” between employers, state government, and individuals was a cornerstone of the 2006 Massachusetts law.
According to a recent report by the Center for Health Law and Economics at the University of Massachusetts Medical School, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, the bulk (60 percent) of health care cost increases in the state is due to either healthcare inflation (that was not related to the 2006 law) or to new enrollment in already-existing plans (31 percent). The report indicates that only about 8 percent of the increase is from the introduction of Commonwealth Care, and the remainder is due to the new Fair Share assessment that was levied on firms that do not make a “fair and reasonable” contribution toward the health costs of their workers, and the tax penalty for individuals who do not obtain health insurance if it is available and affordable.
Assuming that some sort of health reform passes this year at the national level, I wonder what people will be saying three years from now about our national health care reform experience.
Well, it hasn’t exactly worked out that way, at least not so far. It is true that health costs have gone up in Massachusetts (as they have elsewhere) but the state’s health mandate is not what is driving health care cost increases there. Further, even though many more Massachusetts residents now have health insurance, employers, individuals, and the state government are paying roughly the same proportion of health care costs as was the case before the Massachusetts law took effect. This is important to note as “shared responsibility” between employers, state government, and individuals was a cornerstone of the 2006 Massachusetts law.
According to a recent report by the Center for Health Law and Economics at the University of Massachusetts Medical School, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, the bulk (60 percent) of health care cost increases in the state is due to either healthcare inflation (that was not related to the 2006 law) or to new enrollment in already-existing plans (31 percent). The report indicates that only about 8 percent of the increase is from the introduction of Commonwealth Care, and the remainder is due to the new Fair Share assessment that was levied on firms that do not make a “fair and reasonable” contribution toward the health costs of their workers, and the tax penalty for individuals who do not obtain health insurance if it is available and affordable.
Assuming that some sort of health reform passes this year at the national level, I wonder what people will be saying three years from now about our national health care reform experience.
Wednesday, May 6, 2009
Schumer’s public plan compromise could propel health reform talks
One of the most contentious discussions in the current health reform debate is the issue of creating a government-run, public plan to compete with private health insurers. Critics contend that a public plan would drive private insurers out of business.
In an effort to map out middle ground, Senator Charles Schumer (D-NY) recently floated a proposal to require a new public plan to resemble private insurance. Specifically, Schumer says, the “public plan must be subject to the same regulations and requirements as all other plans” in the insurance market, thereby removing the public plan’s competitive advantages.
Besides staking out the middle ground, Schumer’s proposal could provide political cover to a small group of influential political moderates. Further, it would also shift the discussion from “should there be a public plan?” to “what form should the public plan take?”.
Of course, not everyone is happy with the Schumer proposal. Industry critics say that Schumer’s proposal to level the playing field between public and private insurers is impossible to accomplish.
The Schumer proposal leaves many questions unanswered but it could be just the thing to propel the health reform talks along towards the summertime goal. Is this a key turning point in the health care reform debate or just another detour in the long and winding road to health care reform? We'll have to wait and see.
In an effort to map out middle ground, Senator Charles Schumer (D-NY) recently floated a proposal to require a new public plan to resemble private insurance. Specifically, Schumer says, the “public plan must be subject to the same regulations and requirements as all other plans” in the insurance market, thereby removing the public plan’s competitive advantages.
Besides staking out the middle ground, Schumer’s proposal could provide political cover to a small group of influential political moderates. Further, it would also shift the discussion from “should there be a public plan?” to “what form should the public plan take?”.
Of course, not everyone is happy with the Schumer proposal. Industry critics say that Schumer’s proposal to level the playing field between public and private insurers is impossible to accomplish.
The Schumer proposal leaves many questions unanswered but it could be just the thing to propel the health reform talks along towards the summertime goal. Is this a key turning point in the health care reform debate or just another detour in the long and winding road to health care reform? We'll have to wait and see.
Tuesday, May 5, 2009
Altman's Law And Achieving Health Reform
"Health care reform is so daunting that even doing things right is no guarantee of success," remarked Julie Rovner, an NPR (National Public Radio) reporter, in a segment on health reform that aired on April 29. "It's a very heavy lift to pass meaningful health care reform," Ron Pollack of the consumer advocacy group Families USA told Ms. Rovner.
"What's been done so far is the easy part; the tough part is just hitting us," said Stuart Altman, a Brandeis University health economist and a veteran of health reform efforts. To implement comprehensive health care reform that will cover the 47 million uninsured will require new money, he added. Some estimate that the new money required for health reform will total $1.5 trillion over ten years.
One big reason for the difficulty of the health reform task is what Grace-Marie Turner of the Galen Institute, which supports less government involvement in health care, calls the "80-20 rule." The idea is that most of the public and health care interest groups are willing to go along with 80% of the agenda, she explained. "But 20% of the agenda, they simply can't accept." That 20% is different for every group.
And the problem is that for every interest group in favor of changing the health care system, their second choice is always the status quo, no change, added Mr. Altman. He calls this "Altman's law," a law that he says he wishes were repealed.
The "second choice," also the easier one, no doubt explains Rep. Charles Rangel's introduction for an April 29 House Ways and Means Committee hearing on Health Reform in the 21st Century: Employer-Sponsored Insurance: "Health reform efforts need to build on, and strengthen, employer-sponsored insurance, which provides coverage for approximately 160 million people in working families." Mr. Rangel called employer-sponsored health insurance, "a stable source of coverage for millions." I wonder how Mr. Rangel defines "stable"?
"What's been done so far is the easy part; the tough part is just hitting us," said Stuart Altman, a Brandeis University health economist and a veteran of health reform efforts. To implement comprehensive health care reform that will cover the 47 million uninsured will require new money, he added. Some estimate that the new money required for health reform will total $1.5 trillion over ten years.
One big reason for the difficulty of the health reform task is what Grace-Marie Turner of the Galen Institute, which supports less government involvement in health care, calls the "80-20 rule." The idea is that most of the public and health care interest groups are willing to go along with 80% of the agenda, she explained. "But 20% of the agenda, they simply can't accept." That 20% is different for every group.
And the problem is that for every interest group in favor of changing the health care system, their second choice is always the status quo, no change, added Mr. Altman. He calls this "Altman's law," a law that he says he wishes were repealed.
The "second choice," also the easier one, no doubt explains Rep. Charles Rangel's introduction for an April 29 House Ways and Means Committee hearing on Health Reform in the 21st Century: Employer-Sponsored Insurance: "Health reform efforts need to build on, and strengthen, employer-sponsored insurance, which provides coverage for approximately 160 million people in working families." Mr. Rangel called employer-sponsored health insurance, "a stable source of coverage for millions." I wonder how Mr. Rangel defines "stable"?
Monday, May 4, 2009
What’s good for Medicare….
Will changes that are good for Medicare prove to be good for employer-provided health care as well? Well, whether changes are “good” or not would depend upon your point of view, but leading policy makers in the health care reform debate do believe that changes in the way health care is delivered to Medicare recipients will have an impact on health care delivery in the private sector. Thus, one premise of the Senate Finance Committee’s recently-released set of options for reshaping key aspects of the way health care is delivered in the United States is that “in many cases, changes to federal health programs like Medicare activate and pave the way for system-wide changes.”
The Medicare policy options released by Committee Chair Max Baucus (D-MT) and ranking member Charles Grassley (R-IA) served as a discussion point for a briefing on the proposals attended by members of Congress and other stakeholders. Striking an optimistic tone for the New York Times, Grassley said “I did not find a lot of dissension” at the briefing.
So, what does the new Medicare look like, as envisioned by Baucus and Grassley? Key points include:
--Providers should be reimbursed based on the quality of care that they provide, rather than on the volume of care they provide. To foster this shift toward outcomes-based reimbursement, a value-based purchasing program for hospitals would be established starting in 2012. In addition, financial incentives would be provided to encourage more primary care doctors to be part of the Medicare system.
--Long-term payment options include fostering the growth of provider collaboration in the care of each patient (with pilot programs focusing on the chronically ill).
--In the “health care infrastructure investments” area, policy proposals include extending health information technology incentives not included in the February stimulus package.
--Medicare Advantage programs would continue to play a part in health care delivery.
--Proposals to reduce fraud, waste and abuse in the Medicare system—estimated to be 3.6 percent, or $10.4 billion for 2008—round out the package of options.
Baucus and Grassley promise that the policy paper released last week is the first of three papers sketching potential reform options. Upcoming policy reports will discuss options for increasing health care coverage (currently scheduled for May 5) and for financing the health care overhaul.
In the meantime, the Senate Finance leaders are soliciting public comments on the Medicare options. Send your comments by May 15 to Health_Reform@finance-dem.senate.gov.
The Medicare policy options released by Committee Chair Max Baucus (D-MT) and ranking member Charles Grassley (R-IA) served as a discussion point for a briefing on the proposals attended by members of Congress and other stakeholders. Striking an optimistic tone for the New York Times, Grassley said “I did not find a lot of dissension” at the briefing.
So, what does the new Medicare look like, as envisioned by Baucus and Grassley? Key points include:
--Providers should be reimbursed based on the quality of care that they provide, rather than on the volume of care they provide. To foster this shift toward outcomes-based reimbursement, a value-based purchasing program for hospitals would be established starting in 2012. In addition, financial incentives would be provided to encourage more primary care doctors to be part of the Medicare system.
--Long-term payment options include fostering the growth of provider collaboration in the care of each patient (with pilot programs focusing on the chronically ill).
--In the “health care infrastructure investments” area, policy proposals include extending health information technology incentives not included in the February stimulus package.
--Medicare Advantage programs would continue to play a part in health care delivery.
--Proposals to reduce fraud, waste and abuse in the Medicare system—estimated to be 3.6 percent, or $10.4 billion for 2008—round out the package of options.
Baucus and Grassley promise that the policy paper released last week is the first of three papers sketching potential reform options. Upcoming policy reports will discuss options for increasing health care coverage (currently scheduled for May 5) and for financing the health care overhaul.
In the meantime, the Senate Finance leaders are soliciting public comments on the Medicare options. Send your comments by May 15 to Health_Reform@finance-dem.senate.gov.
Friday, May 1, 2009
A Few Interesting Connections
On April 29, 16 Democratic senators sent a letter to Sen. Max Baucus (Mont., chairman of the Finance Committee) and Sen. Edward Kennedy (Mass., the chairman of the Senate Committee on Health, Education, Labor, and Pensions) urging the two chairmen to include a public plan option as a "core component" of health care reform. The April 29 letter notes that "there is no reason to believe that private insurers alone will meet the public purpose of ensuring coverage for all Americans at an affordable price for taxpayers."
Senators who signed the letter include Sherrod Brown (Ohio), Jay Rockefeller (W.Va.), Dick Durbin (Ill.), Tom Harkin (Iowa), Daniel Inouye (Hawaii), Carl Levin (Mich.), Jeff Merkley (Ore.), Jack Reed (R.I.), Debbie Stabenow (Mich.), Bernie Sanders (Vt.), Bob Casey (Pa.), Jim Webb (Va.), Ted Kaufman (Del.), Kirsten Gillibrand (N.Y.), Sheldon Whitehouse (R.I.), and Charles Schumer (N.Y.)
A copy of the letter is available here.
Earlier this year, Democratic Sen. Ron Wyden (Ore.) and Republican Sen. Robert Bennett (Utah) introduced S. 391, the Healthy Americans Act, which would require individuals to purchase a health coverage and would provide a choice of a state health care plan or an employer-sponsored plan. Both plans choices would be regulated by the federal government and include standardized coverage. Cosponsors to S. 391 are Sen. Lamar Alexander (Tenn.); Sen. Maria Cantwell (Wash.); Sen. Mike Crapo (Idaho); Sen. Lindsey Graham (S.C.); Sen. Judd Gregg (N.H.); Sen. Daniel K. Inouye (Hawaii); Sen. Mary L. Landrieu, (La.); Sen. Joseph I. Lieberman (Conn.); Sen. Jeff Merkley (Ore); Sen. Bill Nelson (Fla.); Sen. Arlen Specter (Penn.); and Sen. Debbie Stabenow(Mich.).
Just a few interesting connections here:
First, three senators (Daniel K. Inouye (Hawaii), Jeff Merkley (Ore), and Debbie Stabenow (Mich.)) are cosponsors of S. 391 and signers of the April 29 letter. Possibly this means the Wyden/Bennett provisions will get more of a hearing when legislation is written.
Second, Sen. Joe Lieberman is a S.391 sponsor, but this universal coverage position is unlikely to influence Republicans.
Third, Sen. Arlen Specter, who just switched to the Democratic Party, is not immediately recognized as a health reform leader but also is a sponsor of S. 391.
With budget reconciliation as a vehicle for health reform now a distinct option if Congress cannot pass legislation before mid-October, the Senate may only need 51 votes for health reform to become reality. Look for the struggle to involve differences among Democrats and for Congressmen such as Mr. Wyden to exert more influence than otherwise would be possible.
Senators who signed the letter include Sherrod Brown (Ohio), Jay Rockefeller (W.Va.), Dick Durbin (Ill.), Tom Harkin (Iowa), Daniel Inouye (Hawaii), Carl Levin (Mich.), Jeff Merkley (Ore.), Jack Reed (R.I.), Debbie Stabenow (Mich.), Bernie Sanders (Vt.), Bob Casey (Pa.), Jim Webb (Va.), Ted Kaufman (Del.), Kirsten Gillibrand (N.Y.), Sheldon Whitehouse (R.I.), and Charles Schumer (N.Y.)
A copy of the letter is available here.
Earlier this year, Democratic Sen. Ron Wyden (Ore.) and Republican Sen. Robert Bennett (Utah) introduced S. 391, the Healthy Americans Act, which would require individuals to purchase a health coverage and would provide a choice of a state health care plan or an employer-sponsored plan. Both plans choices would be regulated by the federal government and include standardized coverage. Cosponsors to S. 391 are Sen. Lamar Alexander (Tenn.); Sen. Maria Cantwell (Wash.); Sen. Mike Crapo (Idaho); Sen. Lindsey Graham (S.C.); Sen. Judd Gregg (N.H.); Sen. Daniel K. Inouye (Hawaii); Sen. Mary L. Landrieu, (La.); Sen. Joseph I. Lieberman (Conn.); Sen. Jeff Merkley (Ore); Sen. Bill Nelson (Fla.); Sen. Arlen Specter (Penn.); and Sen. Debbie Stabenow(Mich.).
Just a few interesting connections here:
First, three senators (Daniel K. Inouye (Hawaii), Jeff Merkley (Ore), and Debbie Stabenow (Mich.)) are cosponsors of S. 391 and signers of the April 29 letter. Possibly this means the Wyden/Bennett provisions will get more of a hearing when legislation is written.
Second, Sen. Joe Lieberman is a S.391 sponsor, but this universal coverage position is unlikely to influence Republicans.
Third, Sen. Arlen Specter, who just switched to the Democratic Party, is not immediately recognized as a health reform leader but also is a sponsor of S. 391.
With budget reconciliation as a vehicle for health reform now a distinct option if Congress cannot pass legislation before mid-October, the Senate may only need 51 votes for health reform to become reality. Look for the struggle to involve differences among Democrats and for Congressmen such as Mr. Wyden to exert more influence than otherwise would be possible.
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