JUNE 10, 2005 -- Sens. Jeff Bingaman, D-N.M., and Mike DeWine, R-Ohio, have introduced legislation that would phase out the two-year period that disabled people currently must wait before they receive Medicare benefits.

In 1972, Congress expanded Medicare from a health care program for older Americans to one that also covers individuals with significant disabilities. At that time, it built in a 24-month waiting period during which disabled persons can receive Social Security Disability Insurance but not health benefits through Medicare.

Bingaman and DeWine's legislation eliminated the 24-month waiting period, phasing it out over 10 years. As it is phased out, the Secretary of Health and Human Services would be able to waive the waiting period for people with life-threatening illness, the lawmakers said in a news release.

"Of the estimated 400,000 uninsured disabled Americans in the waiting period at any given time, 16,000 of them will die awaiting Medicare coverage. Why are we denying Medicare coverage to those who need it most? It just doesn't make sense," Bingaman said.

JUNE 8, 2005 -- Will Michael Leavitt's signature achievement as secretary of the Department of Health and Human Services prove to be advancing adoption of health care information technology? Introduced at a Washington forum by medical information technology expert Brent James as "a techno-geek" and a hard worker with visionary plans for IT, Leavitt delivered another impassioned speech Wednesday advancing proposals unveiled earlier in the week to spur public and private sector collaboration in the field.

While Leavitt plays down his computer skills, noting that his recent attempts to change hardware in his laptop shut down his e-mail, the subject clearly captures his imagination. "This is a very big deal," Leavitt told the conference sponsored by the Agency for Healthcare Policy and Research. "It will affect every American."

Leavitt linked IT's power to cut health costs with the nation's continued ability to excel in the global economy. "We have learned to make machines work together. The question is whether we can make people work together," he said, referring to the importance of ensuring that doctors and hospitals actually use information technology.

Older ways of delivering care will have to be retooled, he said, adding, "There's no question that all of us will have to change." But Americans are up to challenge, he said. "This is the United States of America. I say we lead. I say we prosper."

Leavitt's personal interest in the field led him to take the job of chairman of the new advisory panel he announced Monday, the American Health Information Community (AHIC). And while Leavitt emphasized that it would be a mistake for government to take over the job of setting standards to ensure that various types of information technology are compatible, AHIC's work to foster adoption of interoperability standards will have a big impact. The panel will have 17 members, including representatives of the physician and hospital community, the insurance industry and federal agencies including Medicare, Medicaid, the Indian Health Service, and the Food and Drug Administration.

Leavitt also said that once interoperability standards coming out of AHIC are final—some could be ready within a year—the federal government will use them in its health programs. And he added that the "vast majority" of big private insurers are likely to do so as well.

The panel would produce "early deliverables"—for example, standards relating to prescription drug data, laboratory results, and computer systems that would track the emergence of a flu pandemic or a bioterror attack.

Leavitt said he knows standards aren't the whole story, suggesting that small health care practitioners might be able to get IT donations from insurers or hospitals if the "Stark law" is loosened. That legislation aims to prevent financial inducements to refer patients or order tests and services. Leavitt said he believes the administration has regulatory authority to more narrowly define the reach of the law, to foster not only electronic prescribing but also the adoption of other types of information technology.

JUNE 9, 2005 -- The chairman of the House Energy and Commerce Health Subcommittee laid out an ambitious legislative agenda for his panel on Thursday, citing Medicaid, medical malpractice, and patient safety as priorities.

Rep. Nathan Deal, R-Ga., said he anticipates an early September markup in his committee on a package of changes to the Medicaid program in order to meet the committee's responsibility under the fiscal 2006 congressional budget resolution (H Con Res 95) to cut $14.8 billion over five years, including anticipated savings of $10 billion from Medicaid.

Deal said he hopes the overhaul will authorize pilot programs to allow a limited number of states "to take it to the next level" and experiment with even more wide-ranging reforms than might be adopted in the current session of Congress.

He also aims to include "cash and counseling" language that would empower beneficiaries individually "to use their money and make choices with regard to their health care."

The overhaul plan also might include Medicaid health savings accounts "that would take it to a further personal involvement level." The accounts allot to individuals sums of money from which they pay for certain health care expenses and allow them to keep what they don't spend.

A former trial lawyer, Deal acknowledged the emotional toll medical malpractice can take on patients, but emphasized the need for an overhaul of the way such cases are handled. The House passed a bill last Congress that would have capped non-economic damages in malpractice lawsuits at $250,000, and Deal said he wanted to move legislation again this Congress. He said that he didn't expect the House version to be the final language of a malpractice bill, but wanted to work with the Senate, where the legislation has been stalled, to come up with a compromise.

He pointed to recent changes in Georgia law that provide for a higher cap and allow physicians to apologize and not have the apology used against them at trial. Republicans pressing for malpractice award caps argue that high awards are driving up prices of health care because of insurance costs and the practice of defensive medicine.

One way to get at the malpractice problem, Deal said, was to get legislation through Congress that aims to reduce medical errors in the first place. Both chambers last year passed versions of legislation that would establish databases of medical errors to track trends and avoid mistakes in the future. A conference meeting never took place in the 108th, and Deal said there are "hopeful signs the legislation can come forward before August."

Deal spoke at a health care conference sponsored by Congressional Quarterly.

JUNE 6, 2005 -- Amid growing criticism of the Bush administration's handling of what it hopes will be a major remake of the federal–state Medicaid program later this year, the nation's governors are stepping forward to exert more influence over the process.

National Governors Association Chairman Mark Warner and Vice Chairman Mike Huckabee plan to detail an ambitious set of revisions at a Senate Finance Committee hearing tentatively set for June 15 while at the same time saying they won't be a part of the administration's proposed Medicaid overhaul commission.

"Given that the NGA Medicaid Working Group has completed much of its work and will be releasing its preliminary recommendations later this month, the members thought it would be most effective to continue their work as an independent bipartisan group," NGA said June 1.

The announcement foils a plan by the administration to include governors among the 15 voting members it plans to appoint to the commission, which would report by Sept. 1 on how to cut $10 billion from Medicaid spending growth over five years.

At the same time, a key House Republican objected that the proposed commission fails to include members of Congress as voting members.
The success of the panel's recommendations hinges on the level of congressional participation, Rep. Heather A. Wilson, R-N.M., said in May 27 letter to HHS Secretary Michael O. Leavitt. Wilson also voiced doubt about whether the commission, to be appointed solely by the administration, would have sufficient balance. "For this commission to have credibility, it must be truly bipartisan," she said.

Wilson also expressed concern that the proposed commission charter would give Leavitt the power to close meetings and to approve the agenda prior to each meeting. "It is difficult to imagine a topic under discussion pertaining to the Medicaid program which would call for an exception to the sunshine laws," Wilson wrote. "The independence of the work of the commission will be important to giving it credibility."

Democratic leaders announced May 26 that they would decline an opportunity to appoint four non-voting members to the commission.

Meanwhile, an interim set of policy recommendations announced June 1 by Warner, the Democratic governor of Virginia, and Huckabee, the Republican governor of Arkansas, reflects at least some level of bipartisan support for overhauling Medicaid.

How much bipartisan support is unclear, however, since the full NGA won't decide whether to embrace the policy changes until its summer meeting. And one of the major recommendations backed by the NGA's working group on Medicaid, requiring beneficiaries to pay more out-of-pocket costs, drew fire from a liberal think tank on grounds that it would cause the poor and frail to forego badly needed care.

The NGA interim policy advocates changes not only to Medicaid, but also proposals to cover Americans who likely otherwise would be dumped onto the program as businesses hit by rising health costs drop health coverage. And it aims to give a big boost to the spread of information technology. Here are the highlights:

• Prescription drugs: Policy changes should include increased rebates from manufacturers, changes in the average wholesale price (AWP) reimbursement system, and "tiered, enforceable" co-payments for beneficiaries. "The current system is flawed and must be replaced," the policy says. "The goal of reducing both state and federal expenditures will require policy changes that impact all segments of the pharmaceutical marketplace."
  
  
• Cost-sharing: Medicaid cost-sharing provisions should be modified to allow states to use "personal responsibility" to improve health care delivery. As with the State Children's Health Insurance Program (SCHIP), states should have the power to add "enforceable" premiums, deductibles, and co-payments to Medicaid.
  
  "As in SCHIP, there should be financial protections to ensure the beneficiaries would not be required to pay more than 5 percent of total household income (no matter how many family members are enrolled in Medicaid) as a critical balance to this proposal. For higher-income households (for example, those above 150 percent of the federal poverty level), a 7.5 percent cap should be applied."
  
  
• Benefit cuts: Billed as benefit "flexibility," the interim policy says that Medicaid populations range from relatively healthy families to the very frail and very sick.
  
  "The types of services and supports needed by these populations are quite different, yet the Medicaid benefits package remains 'one-size-fits-all.' Many states have found that the flexibility built into the SCHIP program allows for greater efficiencies without compromising quality of care." Flexibility to vary benefits would allow "more targeted services while managing the program in a way that prevents sweeping cuts in the future."
  
  
• Asset transfers: Medicaid should increase penalties for "inappropriate" transfers of assets to qualify for long-term care benefits. Other changes should restrict the types of assets that can be transferred to qualify for coverage to encourage "reverse mortgages."
  
  Tax credits and deductions should be offered to encourage Americans to buy private long-term care coverage. The current ban should be dropped that allows so-called Partnership policies to be sold in only four states. The policies allow holders to preserve a larger share of personal assets while still qualifying for Medicaid long-term care benefits.
  
  
• Waivers: States should be able to obtain waivers to Medicaid regulations more easily. Also, more types of regulations should be eligible for waivers. In other cases, requirements to obtain waivers should be dropped altogether.
  
  
• Information technology: Congress should establish a "National Health Care Innovations Program" consisting of 10 to 15 state-led, large-scale pilot programs lasting 3-to-5 years. The pilot programs would test the ability of information technology to lower the costs and improve the quality of health care. "Some of these demonstrations would be for statewide provider networks while others would be for networks in major metropolitan areas. The financing of these demonstrations should not come at the expense of Medicaid funding."
  
  
• Judicial challenges: HHS should have to defend waivers it grants to states when challenged by the courts. HHS also should "work with states to define for the judiciary system that any state has a fundamental right to make basic operating decisions about optional categories" of Medicaid coverage.
  
  
• Private coverage expansion: Low-income uninsured Americans should be made eligible for a premium subsidy that could be paid directly to a health plan by the U.S. Treasury. Eligible workers should be able to combine payroll deductions with the tax credits to pay for coverage. The credit also could be used to buy into a state's SCHIP program.
  
  Small employers should be able to obtain tax credits for providing coverage to low-income workers. States should be able to designate a minimum benefits package the employer would have to provide to obtain the credit.
  
  The federal government should make grants to the states to set up purchasing pools to buy coverage. States should have the power to mandate that tax credit users, enrollees in Medicaid and SCHIP, and state employees be included in the pool along with small businesses.
  
  
• Reinsurance: A mechanism should be developed that would insure employers against the expense of very high-cost patients.
  
  
• Other recommendations: Less costly alternatives to nursing home care should be strengthened, including programs to provide long-term care in the home or elsewhere in the community. States should not face higher costs as a result of switching Medicaid beneficiaries to the Medicare prescription drug benefit starting in January.

The liberal Center on Budget and Policy Priorities released studies May 31 concluding that increased cost-sharing could mean less care and poorer health for low-income Americans. A Center literature review concluded that "increased co-payments cause low-income beneficiaries to cut back on essential care."

In addition, charging premiums for care leads to fewer people being covered by health insurance, the review concluded. "Increased cost-sharing also can trigger the subsequent use of more expensive forms of care, such as emergency room care or hospitalization," the Center said.

"The risks of increased cost-sharing are greatest for those with serious or chronic health conditions, such as diabetes, cancer, or mental illness, since they need the most health care services and thus would face more co-payment charges or the loss of more services," said the analysis by researcher Leighton Ku.

For example, a study published in January 2001 in the Journal of the American Medical Association found that welfare recipients in Quebec filled fewer prescriptions after co-payments were increased. "The co-payments led to a 78 percent increase in the occurrence of adverse events, including death, hospitalization, and nursing home admissions," the Center review said.

A second study by the group said out-of-pocket medical expenses for poor adult Medicaid beneficiaries who were not elderly or disabled grew 9.4 percent annually between 1997 and 2002, twice as fast as their incomes increased during that period. The beneficiaries spent more than three times as much of their income on health care as middle-class adults with private coverage.

"Some supporters of increased cost-sharing claim low-income Medicaid beneficiaries pay little or nothing and bear little responsibility for their health care," said Ku. "That is not accurate."

JUNE 8, 2005 -- Expanding public programs to cover low-income adults and children could help reduce the number of uninsured in many states, according to a recent study from Columbia University.

The report, published as a Web Exclusive by the journal Health Affairs, concludes that there is no one solution for expanding federal health coverage across all 50 states. What could reduce the uninsured rate by 20 percent in some states would have little effect in others.

Authors Sherry Glied and Douglas Gould compared the impact of five separate proposals, including President George W. Bush's proposed tax credit to low-income individuals and families. In states with high insurance premiums, Bush's plan would result in a 4.4 percent decline in uninsured rates, while in others the rate would decrease by up to 20.5 percent. Overall, the national uninsured rate would decrease by 1.7 percent.

Expanding the eligibility for State Children's Health Insurance Programs (SCHIP) in families below 300 percent of the federal poverty level could decrease uninsured rates by 18 percent in some states, but do little in states that have already expanded eligibility. Further expanding coverage to these children's parents would have up to a 4.7 percent impact.

Broadening eligibility for Medicaid to include adults 133 percent below the poverty line would create significant reductions in the most states, with the highest reduction at 10.3 percent. And though these adults are already covered in some states, the researchers say federal funding for this insurance proposal could ease state budget problems.

"The message is that there is no single solution that will work for all the uninsured, so we need a variety of solutions. In some states the problem of the uninsured is related to the high cost of health insurance, and in other states it is more closely linked to high rates of poverty among the uninsured," said a statement from Glied, professor in the Department of Health Policy and Management of Columbia's Mailman School of Public Health. "Federal policies to increase health insurance coverage would be more effective if they took into account the variety of economic structures, insurance markets, and the situations of uninsured individuals across states."

In terms of capturing the greatest group of those uninsured nationally, expanding SCHIP is most effective, with 11.5 percent of Americans currently uninsured gaining coverage under the proposal. The president's plan is second, giving insurance to 11 percent, and expanding Medicaid would cover 5.2 percent of the uninsured population.

The article was published with support from The Commonwealth Fund, a private foundation supporting independent research on health and social issues.

JUNE 8, 2005 -- To help cover the cost of treatment for the nation's ballooning number of uninsured, premiums for family health insurance provided by private employers will increase by an average of $922 this year, according to a report released Wednesday.

Issued by the consumer organization Families USA, the study found that by 2010, health insurance premiums for families who are insured through their private employers would, on average, increase by $1,502. In addition, the study indicated that health insurance premiums for individuals are, on average, $341 higher in 2005 and would increase by an average of $532 by 2010.

The report—described as the first to quantify the dollar impact on private health insurance premiums when doctors and hospitals provide treatment to the uninsured—also showed that the cost of health care provided to people without health insurance that is not paid out of pocket by the uninsured would exceed $43 billion nationally in 2005. That figure, according to the study, would soar to more than $60 billion by 2010.

"I think the bottom line message here is that these costs of the uninsured certainly affect everyone," said Ron Pollack, executive director of Families USA.

Stressing that the large and increasing number of uninsured Americans was no longer just an "altruistic concern" because of its wide-reaching impact, Pollack highlighted the importance of Medicaid as a safety net. He added that cuts to Medicaid could lead to an increase in the nation's uninsured population, thus compounding the cost issue highlighted by the report.

Sen. Gordon H. Smith, R-Ore., who said he was working on bipartisan legislation with Sen. Ron Wyden, D-Ore., that would provide catastrophic coverage for uninsured Americans, agreed it was high time to find a "rational way in which to provide medicine in this country."

The owner of a frozen food company, Smith indicated he knew firsthand how difficult it was for a small business to provide adequate health care to its employees.

"In short, we're asking so much of our small businesses and workers today, we simply must address this in Congress today," Smith said.

Failure to find a viable solution could result in an increase in the number of the uninsured and a slowing down of the economy, Smith added.

According to the report, New Mexico, West Virginia, Oklahoma, Montana, Texas, and Arkansas will see family insurance premiums increase by at least $1,500 in 2005.

The study found that the number of uninsured would increase from approximately 48 million in 2005 to about 53 million in 2010, with California projected to top the list in terms of actual numbers. New Mexico, meanwhile, was projected to have the highest percentage of uninsured in 2010, according to the report.

Democratic Kansas Gov. Kathleen Sebelius, a former insurance commissioner, urged business owners to become involved in the dialogue about health insurance issues on both the state and federal levels.

Linking bankruptcy and health matters, Sebelius said she knew of many small-business owners and farmers who were living in fear of high health care costs.

A separate study by The Commonwealth Fund found that American employers spend an estimated $31 billion to cover the health care costs of workers employed elsewhere.

The private foundation found that of the 35.9 million workers who do not have health insurance from their own employers, about 16 million are covered by others through dependent coverage.

While another 3.7 million are covered by public programs, the foundation said 3.2 million are privately insured and 13 million are uninsured.

Speaking on the Senate floor early Wednesday afternoon, Sen. Edward M. Kennedy, D-Mass., referenced the Families USA report while commenting on the pending confirmation vote on Janice Rogers Brown, President Bush's pick to serve as judge on the U.S. Court of Appeals for the District of Columbia Circuit.

"Don't we think that's a national problem? Don't you think that's something we should be discussing in the United States Senate?" Kennedy asked his colleagues after mentioning that health insurance would continue to go up as more Americans lost their health insurance.