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October 29, 2007

Washington Health Policy Week in Review Archive aa830c9c-1ef0-4909-95dc-43bf49d5d1dc

Newsletter Article


Biden Unveils Health Care Plan

By Mary Agnes Carey, CQ HealthBeat Associate Editor

October 23, 2007 -- Democratic Presidential Candidate Sen. Joseph R. Biden Jr. of Delaware unveiled a health care plan Tuesday that he said would provide health insurance for all children, provide more coverage options for adults, and focus on disease prevention and modernizing the nation's health care system.

Biden's plan, announced in Des Moines, Iowa, would permit uninsured Americans to buy into an insurance program similar to the one that provides health care benefits to federal employees and members of Congress, with people paying on a sliding scale based on income. Biden's proposal also would allow people between the ages of 55 and 64 to buy into the Medicare program, with the federal government providing a subsidy to low-income individuals.

The State Children's Health Insurance Program (SCHIP) would be expanded to children in families with incomes of at least 300 percent of the federal poverty level, or $61,950 for a family of four, and coverage would be extended to at least age 21. Biden's plan also would have the federal government cover 75 percent of the cost of catastrophic health costs for cases exceeding $50,000 per individual.

In a statement, Biden said if he were elected, he would convene a meeting, within the first 90 days of his administration, with all players involved in health care in hopes of making coverage both universal and affordable. "Getting this done will require the kind of experience and leadership that comes from years of success corralling bipartisan support for numerous issues," he said. "I have that experience and it will prove invaluable when I am president."

Separately on Tuesday, five Democratic presidential health care advisors debated their candidates' health care plans at a Congressional Quarterly Presidential Forum sponsored by the Partnership To Fight Chronic Disease and held at The George Washington University.

Other elements of Biden's plan would:

  • Eliminate co-payments for physicals, vaccinations, vision and hearing screenings, and preventative dental checkups for children of all income levels.
  • Prohibit employers and insurers from collecting or using genetic discrimination when making decisions about hiring or providing health care coverage, including the cost of a policy.
  • Invest at least $1 billion yearly to help hospitals, physicians, and other health care providers move to electronic health records systems.
  • Add 100,000 new nurses to the workforce in the next five years and establish scholarship and loan repayment programs to encourage people to join the public health workforce.

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GOP Advisors Emphasize Affordable Coverage as Health Overhaul Goal

By John Reichard, CQ HealthBeat Editor

October 25, 2007 -- Advisors to GOP presidential hopefuls played up affordable health insurance as the goal of their bosses' health overhaul plans at a Washington forum Thursday, with none spontaneously volunteering universal coverage as a priority.

Lanhee J. Chen, domestic policy director for the campaign of Mitt Romney, did say in response to a question about 90 minutes into the event that the former Massachusetts governor would like to cover every American during his presidency, but advisors to Arizona Sen. John McCain and former New York Mayor Rudolph Giuliani focused on cost control and tax code changes as priorities. They did say, however, that every American should have access to affordable coverage.

The remarks at Congressional Quarterly's Presidential Forum, sponsored by the Partnership to Fight Chronic Disease, contrasted with those made earlier in the week by Democratic presidential advisors, who were much more apt to name universal coverage as a goal. But there were some areas of overlap, with advisors on both sides of the aisle saying that competition among insurers would help restrain rising costs and that tax revisions would help pay for coverage.

But Giuliani advisor Don Moran said there is a bright line dividing the parties, with Democrats favoring centralized governmental solutions and Republicans urging market-based solutions. Giuliani's goal is to "reinvigorate the role of private insurance markets in health care," said Moran, a consultant who served as executive associate director for budget and legislation at the White House Office of Management and Budget from 1982 to 1985.

Democrats espouse the use of new or existing insurance "exchanges" or "marts" as the arena for competition, with tight regulations to ensure that people with costly illnesses have access to affordable insurance. GOP advisors at the forum acknowledged the need for regulatory changes, but were more vague about what they should be. Nevertheless, they rejected the Democratic charge that Republicans just want to give the uninsured tax deductions or credits to buy coverage on the "individual" market without making regulatory changes that would allow people with costly medical conditions to actually find affordable coverage. In the individual market, a single person or family buys coverage alone and not as part of a larger pool.

"There's nothing about the current insurance market that everybody should embrace and love," said McCain advisor Douglas Holtz-Eakin, former director of the Congressional Budget Office. "The current individual market is not a good place to live."

Added Chen: "We recognize the market is broken."

The advisors said insurance could be made more affordable with regulatory changes that would make it easier for Americans in one state to shop for better insurance deals in another state, using the Internet, for example. However, they conceded that doing so might require a new way to conduct regulatory oversight of such sales. "You're going to have greater federal involvement—there's no way around that," said Holtz-Eakin. But both Moran and Chen expressed reservations about a greater federal role.

Holtz-Eakin wasn't skittish about downplaying coverage as the needed focus of a major health care overhaul. It's more important to tackle the issue of rising costs, he said, by changing payments to reward higher quality and lower cost care and better management of chronic diseases. "The focus has to be on changing the practice of medicine in the U.S.," he said. "John McCain has decided to take this as the premier problem" in domestic politics, Holtz-Eakin added.

Part of tackling the cost problem should be reining in the costs of Medicare, in part by scaling back the Medicare prescription drug benefit to target it to low-income people, he said. Holtz-Eakin suggested that coverage can be a greater focus once costs are under better control. He added that a healthy dose of individual responsibility is also needed, with McCain favoring stronger messages to people to take better charge of their own health.

Chen emphasized the importance of coverage more than his fellow panelists. As governor of Massachusetts, Romney developed a track record on health care, reforming insurance markets to expand access to care, Chen said. "I'm just glad to see on the Republican side that we're all embracing the notion of expanding access to health insurance," Chen said. He suggested that without insurance coverage, people are less likely to get access to medical advice emphasizing the importance of exercise and preventive care.

But Chen joined his colleagues in arguing for a less centralized approach to overhauling health. He said states should lead the way in widening coverage and lowering costs, and be given regulatory flexibility and greater control over Medicaid in order to do so.

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Health IT: Just What the Doctor Ordered?

By Mary Agnes Carey, CQ HealthBeat Associate Editor

October 26, 2007 -- A new report released Friday urges Congress to take several steps to help increase the use of health care information technology (IT) among health care providers and their patients.

The study, prepared by the Information Technology & Innovation Foundation, states that Congress should pass legislation to promote the use of electronic health records and national health data standards, as well as create a legal framework for health record data banks. Lawmakers should also leverage federal resources to ensure access to health record data banks and require medical practices to disclose patient health information electronically upon request, the report concludes.

Legislation that would provide new leadership, funding, and organization at the national level to promote health information technology include a bill (S 1693) co-sponsored by Sen. Edward M. Kennedy, D-Mass, and Sen Michael B. Enzi, R-Wyo., and a House measure (HR 3800) sponsored by Anna G. Eshoo, D-Calif., the report states.

The findings, presented during a forum held with the group Health IT Now!, a coalition whose membership includes the National Alliance on Mental Illness, the National Association of Manufacturers, and other health care and business groups, noted that both the federal government and private industry have a role to play in the adoption of health information technology and electronic health records. Barriers to greater use of both of these items include providers' reluctance to make long-term investments in such technology because they do not often reap the benefits of it. Medical privacy advocates have also expressed concern that existing patient privacy protections are insufficient, the report notes.

In a related development, the top official for the nation's Blue Cross and Blue Shield plans has asked Congress to require physicians to use electronic prescribing in Medicare by 2010.

Some new funding for health information technology is included in legislation (HR 3043) the Senate passed earlier this week which provides fiscal 2008 funding for the departments of Labor, Health and Human Services (HHS) and Education, and for some independent agencies such as the Social Security Administration. The Labor-HHS measure includes about $61 million to fund the Office of National Coordinator for Health Information Technology, with about $13.3 million coming from the Department of Health and Human Services, and $48 million funded under a separate account under the Public Health Service Act.

In a letter sent Wednesday to Capitol Hill, Blue Cross and Blue Shield president and CEO Scott P. Serota said that the "e-prescribing" would improve health care quality and safety for Medicare beneficiaries and should be included in any Medicare package lawmakers produced this year, with an exemption for small providers with fewer than 10 full-time employees.

Serota wrote that electronic prescribing can reduce preventable medication errors that the Institute of Medicine has found that preventable medication errors harm a estimated 1.5 million Americans each year. "E-prescribing is a powerful tool to eliminate problems with handwriting legibility and to alert providers in real time to adverse drug-to-drug interactions and allergic reactions," he wrote.

Serota added that for one Blue Cross and Blue Shield plan that has covered one million e-prescriptions since 2006, one-third received potential drug interaction warnings and more than 50,000 adverse drug events may have been prevented through e-prescribing. Fewer than one physician in five uses e-prescribing, he wrote.

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House Passes New Children's Health Bill Despite GOP Protests

By Alex Wayne, CQ Staff

October 25, 2007 -- The House passed its third children's health insurance bill of the year Thursday, a measure intended to draw more Republican supporters and overcome a threatened veto. It didn't.

The vote on passage of the latest version (HR 3963) was 265–142, with 43 Republicans voting "yes." A previous, bipartisan measure (HR 976) that President Bush vetoed passed the House Sept. 25 by 265–159, with 45 Republican votes.

The House fell 13 votes short of overriding Bush's veto Oct. 18.

Both the vetoed bill and the latest one are less generous than the original expansion of the State Children's Health Insurance Program, or SCHIP, passed Aug. 1 by the House (HR 3162).

Renewed Veto Threat
The White House said in a statement that Bush would veto the new bill because it "has not addressed in a meaningful way" the objections that led him to veto HR 976.

Democrats said they had rectified all the major Republican complaints about the vetoed legislation—that it could allow enrollment of some relatively well-to-do families, illegal immigrants and adults in a program intended for children.

"So those who vote against today's legislation can only be voting against the government providing health care to poor children who have no other means of obtaining medical care," said Pete Stark, D-Calif., the chairman of the Ways and Means Subcommittee on Health. "That's the only reason to vote against this."

Republicans insisted that their opposition is more substantial. "Republicans like kids, and not just medium-rare with a side of fries," said Rep. Thaddeus McCotter, R-Mich.

Both bills would expand SCHIP by about $35 billion over the next five years, to $60 billion. Under each, the expansion would be financed by a tobacco tax increase, including a 61-cent increase in the cigarette tax, to $1 per pack.

In most areas, the two bills are identical, and some of the changes Democrats touted in the new bill are cosmetic—one reason Democrats did not make gains among Republicans in Thursday's vote.

"In our cursory examination of the bill, at least, it doesn't appear to have changed very much," said Rep. Jim McCrery of Louisiana, the senior Republican on the Ways and Means Committee.

Republicans members also complained they did not have enough time to read the legislation, which Democratic leaders rushed through the Rules Committee late the night before. They also protested the rule for debate, which bars amendments. And they said it was unfair to force a floor vote when many Southern California members had flown home to be with constituents who are struggling to cope with devastating wildfires. They asked Democrats to postpone a vote on the bill until next week, but were rebuffed.

"I do not believe the absences of either party's members will impact on the outcome of this vote," said Majority Leader Steny H. Hoyer, D-Md.

With the current authorization for the State Children's Health Insurance Program due to lapse Nov. 16, he insisted it was vital to send the new bill to the Senate this week, so the notoriously slow-moving chamber can pass it and a final version can be sent to the president before then.

Republicans forced repeated procedural votes, delaying progress toward passage.

The Bills Compared
Among those objections Bush and House Republicans lodged against the vetoed bill was that it would cause millions of families to leave or forgo private insurance to join taxpayer-funded SCHIP or Medicaid, a phenomenon called "crowd-out."

The new bill contains no substantive new provisions to prevent families from dropping private insurance to enroll in SCHIP. Instead, it offers states an incentive to help low-income people with private insurance pay their premiums: If they do, the states might collect bonuses from the government. That provision has no projected effect on crowd-out—CBO estimates that both the new bill and the old bill would cause about 2 million families to leave or forgo private insurance to enroll in public programs.

In the most substantive change from the vetoed bill, the new measure would limit eligibility for SCHIP to families earning no more than three times the federal poverty level—about $62,000 for a family of four. But Republicans noted that states could evade that cap by disregarding some income—such as money parents spend on housing or transportation—for the purpose of calculating eligibility.

The new bill would result in slightly fewer children enrolling in SCHIP than under the previous bill, and slightly more enrolling in Medicaid. The vetoed bill would have allowed bonuses to states for increasing enrollment in both SCHIP and Medicaid; under the new bill, states will only receive the bonuses for enrolling more children in Medicaid.

The new bill is slightly more costly than the earlier bill—$35.4 billion over five years, versus $34.9 billion for the earlier bill, according to the Congressional Budget Office. Either bill would add about 5.8 million people to SCHIP and Medicaid, CBO estimates.

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Lawmakers Introduce Bill to Allow Medicare-Run Drug Benefit

By Mary Agnes Carey, CQ HealthBeat Associate Editor

October 24, 2007 -- House and Senate Democrats have introduced legislation that would allow Medicare beneficiaries to receive prescription drug coverage administered by the Medicare program rather than by private insurers.

The bill (HR 3932, S 2219) would permit the Medicare program to negotiate drug prices with pharmaceutical manufacturers and provide consumers with information about the safety and effectiveness of drugs.

"Under current law, Medicare beneficiaries are stuck with confusing, costly plans designed by insurance and drug companies. What seniors deserve is an affordable, straightforward drug benefit," one of the bill's cosponsors, Senate Majority Whip Richard J. Durbin, D-Ill., said in a statement. "This legislation will give them the choice of a drug plan operated directly by Medicare—just like all other Medicare benefits—and require the administration to negotiate on behalf of seniors to bring down the exorbitant costs of needed medications." Durbin, along with House sponsors Rep. Marion Berry, D-Ark., and Rep. Jan. Schakowsky, D-Ill., introduced similar legislation last year.

The bill's introduction Tuesday coincided with the release of a report from the Medicare Rights Center and Consumers Union that concludes a Medicare-administered prescription drug plan would give seniors a plan that is less expensive and easier to understand than those offered by the private sector.

"We know that the private insurance companies aren't getting the best deals for consumers on prescription drugs," Consumers Union senior policy analyst Bill Vaughan said in a statement.

Medicare Rights Center President Robert M. Hayes said a Medicare-administered drug benefit "would benefit consumer's health and pocketbooks and bring down the program's cost for taxpayers." He added that many beneficiaries are unable to get the drugs they need due to the "confusing and exploitative marketplace that dominates the for-profit drug offerings from private insurance companies."

Centers for Medicare and Medicaid Services Spokesman Jeff Nelligan said the Medicare drug program has been a "solid success" because "fierce competition and wise consumer choices have resulted in reduced costs and enhanced savings." He said that beneficiaries are saving an average of $1,200 annually on their drug costs and the program is coming in 30 percent—or nearly $190 billion—under initial estimates.

In their report, Consumers Union and the Medicare Rights Center said the current Medicare drug program is unnecessarily expensive, has coverage gaps, and leaves seniors vulnerable to marketing fraud because the number of plans offering such divergent benefit packages. The groups recommend a national evidence-based formulary for a Medicare-administered drug plan that would help guide doctors and patients on the best medicines to use and establish "a fair and efficient drug appeals system," which they said does not currently exist in the Medicare drug program.

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Universal Coverage Not Universally Supported

By Lydia Gensheimer, CQ Staff

October 26, 2007 -- As universal health plans gain traction—through plans offered by Democratic presidential candidates and state-led initiatives—a panel on Friday examined the correlation between health care access and the quality of health care provided through universal coverage.

The forum, which was sponsored by The Alliance for Health Reform, focused on state coverage initiatives to examine the effects of a trend towards universal coverage.

Sara Collins, assistant vice president for the Program on the Future of Health Insurance at The Commonwealth Fund, cited a recent report produced by The Commonwealth Fund which highlights the positive correlation between high rates of insurance and high quality of care.

"Health insurance coverage is the most important determinant of access to health care," Collins said.

The Commonwealth Fund supports a mixed private and public approach to universal care.

However, Tom Miller, a resident fellow at the American Enterprise Institute, criticized the view that universal coverage would result in better access and quality of health care. He cautioned the audience to "curb your enthusiasm" for universal coverage.

Miller presented a chart which compared states' rankings on health care access to their rankings on the number of residents with "healthy lives." Miller concluded that there is no correlation between access to health care and the general health of residents. Miller said, then, that states need different tools—besides money—to implement changes in health care.

Miller's fellow panelists, meanwhile, briefed the audience on the progress of state health initiatives that support universal coverage.

Sarah Iselin, commissioner of the Division of Health Care Finance and Policy for Massachusetts, praised the progress that has been made in Massachusetts since the state committed to a universal coverage plan a year and a half ago. Iselin said the state has 56,000 new Medicaid enrollees and 127,000 residents newly enrolled in Commonwealth Care.

Massachusetts, Iselin said, was able to implement a successful plan in part because the state began with a broad Medicaid program, a highly regulated insurance market, and a relatively small number of uninsured—only six to seven percent of its population was uninsured before the state adopted its plan for universal care. By contrast, over 20 percent of California's population does not have health insurance.

Miller compared Massachusetts' situation to when "you start on third base and hit a triple," and he cautioned that the costs of Massachusetts' plan may undermine its effectiveness.

"Where is the containment, where is the sustainability?" Miller said.

Iselin said polls have indicated that the "public is on board" in Massachusetts, and the state is still working on getting the word out about the relatively new plan.

Ann Torregrossa, deputy director and director of policy for the Pennsylvania's Government's Office of Health Care Reform, described Pennsylvania's plan for universal coverage, Prescription for Pennsylvania. The plan is based on an integrated approach based on quality, accessibility, cost, and affordability. Torresgrossa said Pennsylvania started with an approach to cover all children in the state, and is now working to cover all Pennsylvanians.

Democratic Governor Edward G. Rendell has been criss-crossing the state to promote the plan.

"The governor has finally realized that we can't wait for Washington," Torregrossa said.

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