Updates on health reform
Check out Barack Obama’s weekly address – this one is dedicated to health care reform. “We know there are those who will oppose reform no matter what…[who] use the same scare tactics that have stopped reform before because they profit from this relentless escalation in health care costs.” He then goes on to answer some FAQs – cost questions about the deepening of deficits (“I will not sign on to any health plan that adds to our deficits over the next decade…the reforms we make will help bring our deficits under control in the long term.”), the rationing of care and the ability to choose doctors (he keeps with the “if you like your doctor, you can keep your doctor” mantra). He ends by urging the House and the Senate to vote for reform and keep this process moving.
In other health reform news, Peter Orszag (the White House budget director) and Kathleen Sebelius (the Secretary of the Department of Health and Human Services) and other appointed and elected officials in the White House have been making firm statements about the timeline and the need for reform. The importance of the final being deficit neutral has been an important part of recent reform discussions; House legislation has been rated by the Congressional Budget Office at $239 billion over ten years.
Also, RH Reality Check outlines the amendments put forward by Steve Buyer (R-IN) proposing higher premiums for those who engage in unprotected sex. Wow. Check out this other article from the AFL-CIO website that cites our own Amy Allina from the National Women’s Health Network, and this article that makes the case for including immigrants in health care reform.
Committees pass health care reform bills
The Ways and Means Committee, one of the three committees in the House of Representatives working toward a health reform bill, has passed their version of the legislation. This comes after a few days of mark-up that featured the successful defeat of abortion-restricting amendments. Representatives Sam Johnson (R-TX) and Eric Cantor (R-VA) among others made attempts at restricting abortion coverage in the essential benefits package, meaning that basic health care plans would not include abortion. Also, the House Education and Labor Committee has passed their version of the bill. That means that we are passed the point the Clinton administration was fifteen years ago – this very well may happen!! (Also check out this article by Nancy Keenan about the Senate HELP Committee and the success they had in passing their version.)
In other good news, Washington DC is now able to use money to subsidize/fund abortions for women. Though this doesn’t apply to federal funds, it does allow the District to use locally-collected revenue for women in need. Though this passed, it is scary to see some of the opposition and the claims that they make.
John Stewart and Kathleen Sebelius talk about health care
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There was an interesting interview last night about health care on the Daily Show with Kathleen Sebelius, the Secretary of Health and Human Services. The entire episode was pretty funny, so definitely check it out here or above. Since the Daily Show is fine comedy television and not exactly the journalistic factual news media, we don’t expect it to carry the same responsibilities or weight that other serious news shows do. However, there were some things we thought it would be important to address. If John Stewart has these concerns, many other people probably do too.
First, it’s good to go over the basic ideas in the bill that they’re talking about. It is complex and we want to give a little peak into the important points. It is the Tri-Committee bill that came out of the House yesterday – a fairly progressive and large piece of legislation (a full 1,018 pages).
Most of the changes that would happen if this bill were to become law would happen in 2013. Some of those changes would be that all those below 133% of the federal poverty line would be eligible for Medicaid. There would be federal subsidies for all those from 133 – 400% of the federal poverty line. Those subsidies would aid individuals and families to buy into health care coverage through the health care exchange. There would be a requirement for health insurance for all legal residence, and non-compliance would result in monetary penalties that would depend on the income of the individual or family.
John Stewart stated that “I feel badly for the small businesses that have to shoulder the costs”, which is answered by another element of the bill: the pay-or-play policy for employers. This essentially means that employers would be required to either offer insurance to their employees and share in the payment of premiums, or pay the federal government 8% of their payroll. This is where John Stewart’s concern about small businesses comes in – those small businesses that have annual payrolls less than $250,000 would be exempt from this federal tax.
The House Tri-Committee bill provides a public plan that would be available through the insurance exchanges. The plan would be run by the Secretary of Health and Human Services and would pay Medicare rates plus 5% to practitioners (doctors and other health care providers). Also, providers would not be required to participate in the public plan in order to participate in Medicare. Another of John Stewart’s concerns was that companies, when faced with a possibly cheaper public health care option, would switch their plans to the public plan (therefore interfering with the Obama pledge that if you like your coverage you can keep it). Theoretically, by buying into the cheaper public plan, these companies would save money. Though Sebelius did state that competition and choice would help bring the cost down, we think this is a really important element of the public plan. When insurance companies see the public plan (which, according to Sebelius, would have lower overhead administrative costs) being cheaper, they will respond accordingly. This means bringing down everyone’s costs and ensuring better care.
John Stewart said something else important – that “there’s the cost issue and the moral issue”. Health care reform is very much a moral issue. Secretary Sebelius said that “what we have is unsustainable, unconscionable, and unacceptable” and that since this is “most personal service any of us will ever get”, reform needs to happen and everyone needs access to affordable, quality care. Sebelius ended by saying the whole basis of the system needs to be re-thought, that we need to “start to invest in prevention and wellness to make American kids healthier”. Amen to that. Hopefully some of this information clears up the concerns that many health insurance consumers have about the House bill.
Health Care for America Now comes out with a review of health care in New York
A report released by HCAN offers a bleak narrative of current and projected health care coverage in New York State. It shows the failures of the system: the fact that there are 2.6 million uninsured New Yorkers, and the rate of unemployment in New York is up after just 19 months from 4.6 to 7.7%. Health insurance premiums have increased 81% in New York from 2000 – 2007, and there are 1.3 million working non-elderly people that are not insured. HCAN also states that the cost of employer-sponsored health insurance is expected to grow at a rate of 7.4%, as compared with the expected 0.8% growth of income in the state.
In response to these alarming statistics, HCAN offers some solutions. Their recommendations to policy makers include providing regionally adjusted federal subsidies to those who qualify for private insurance. This adjustment would ensure that consumers have access to affordable health insurance costs of living are so variable. Also, HCAN recommends that individuals, employers, and the government share the costs to extend coverage to every person, and that the government does not tax hard-earned benefits.
The report says that benefit packages should be comprehensive and that there should be no annual or lifetime caps on benefits. The report goes into the more qualitative effects of health care costs on families and individuals, the damages being done to small businesses, and the heart breaking costs of a system that seems to do more harm than good. Over the past 9 years there has been a 120% increase in cost of health insurance but only a 29% increase in wages. The United States spends $2.5 trillion dollars per year within the health care system. Health Care for America Now insists that this is a problem that can and needs to be fixed as soon as possible.
Also take a look at this report done by Families USA that shows these same trends appearing across the country.
The HELP committee passes health care bill and the House committee releases language
The Senate Health, Education, Labor and Pensions Committee has passed America’s Affordable Health Choices Act on party lines 13 to 10. After twelve days of committee mark-up, the bill will now go on to the Senate floor for arguments. In other news, the House Tri-Committee (Education & Labor, Ways & Means, and Energy & Commerce) have released the finalized language of their bill. They’ll begin mark-up soon, and we’re still waiting on language from the Senate Finance Committee.
President Obama’s timeline looks to be out of reach
There has been much pessimistic talk over the past few days about the October goal of a health care bill on the President’s desk. A few things are leading to this conclusion made by pundits and politicians alike, including significant differences in opinion: Many have said that the fundamental disagreements between conservative and liberal members of congress are a bigger problem then we originally thought they would be. There are also three different committees working on this, and each has different leadership and different jurisdiction. However, Obama asserts that this will happen, and he has encouraged the Senate Finance Committee to release bill language soon. This poll shows “the difficult path ahead for the White House and Congress”. Money continues to be a big issue, as are those darned partisan politics. Check out the NPR piece about abortion and health care reform.
Women’s health is supported for one more day!
Yesterday in the Senate Health, Education, Labor, and Pensions Committee a variety of anti-choice anti-women’s health amendments were defeated. There were amendments proposed that would (if passed) restrict women’s access to health care through parental notification, prohibiting abortion coverage in private plans included in the exchange, and by expanding provider refusal clauses. Read more from RH Reality Check.
Reform talk over the past few days
The Senate Health, Education, Labor, and Pensions Committee commenced mark-up for the tenth day yesterday. Most amendments were Republican-sponsored and didn’t gather enough votes to pass. However, there was one small victory in an amendment put forward by Barbara Mikulski (D-MD), co-sponsored by Tom Harkin and Chris Dodd (who unfortunately was absent from mark-up yesterday because he was attending his sister’s funeral. Our thoughts are with the Dodd family). The amendment established funding for community women’s health centers. There was some discussion – John McCain (R-AZ) was upset about the lack of Congressional Budget Office scoring on the amendment, and Orrin Hatch (R-UT) and Bob Casey (D-PA) were both concerned about the broadness of the bill and the possible inclusion of abortion coverage. Hatch inquired about whether Mikluski would be willing to change her amendment to explicitly exclude abortion, and she said, politely, she was not willing to do that.
Phew.
In other reform news, taxing benefits looks like it won’t happen, and tax increases for the wealthy look like they might happen. The issue, of course, is still financing this bill. The group of Blue Dog conservative Democrats in the House of Representatives have voiced concerns over financing, so the House Tri-Committee bill will not be released today, but hopefully on Monday of next week. And out of all of this rubbish is the reality that the timetable for health care is slipping (some say due to explicitly obstructionist Republican members of these committees).
Women and health care coverage: the importance of continuity
An article from The American Prospect from a few days ago addressed the inequities in continuous health care coverage for women. Since women have fewer opportunities for employer-provided health insurance, straight women often depend on their partner’s health insurance to cover them. This makes women much more vulnerable to losing their health insurance due to relationship or family issues that disrupt the relationship that provides them coverage. Dana Goldstein makes the case in this article that “[women who experienced health disruptions] had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of the cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.”
This highlights the importance of providing women with health insurance that they choose, on their terms, and controlled by them. Women need self-determinations in all areas of life, and health insurance is an important piece of the puzzle.
The NEJM gives solutions
Yesterday the New England Journal of Medicine released an article written by Michael Porter that outlines the solution to health care reform. He breaks it up into a series of steps before and after reform.
In the face of a significant aging population in this country and the development of new medical technologies, Porter makes the case for an increased value-based system of health provision where “the central focus [is] increasing value for patients – the health outcomes achieved per dollar spent”. He states that “achieving and maintaining good health is inherently less costly than dealing with poor health” and that the two goals should be universal coverage and a complete restructuring of the care delivery system. His suggestions for doing this are as follows:
1. Changing the basis of health insurance competition: companies should do well when they take care of their patients. This seams obvious, but right now insurance companies benefit when they provide lots of care, not necessarily the best care. Porter also suggests the removal of things like gender and age ratings and discrimination against individuals with preexisting conditions. In addition, health plans should be required to report the outcomes of health care they cover. All of these things point back to the basic premise of a value-based system.
2. Porter asserts that employers should be kept in the system because they depend on the performance of their employees, so they are interested in keeping them healthy.
3. Fix the burden that has been put on individuals who have no access to employer-based coverage.
4. Porter makes the case for larger pools that will spread out costs.
5. Financial support for individuals of lower-incomes will help them get health insurance and therefore stay healthy.
6. Everyone should be required to purchase health insurance so as to spread out the costs and everyone is included.
Porter also emphasizes the importance of measuring and disseminating health outcomes so everyone knows which health providers offer the best care. Preventive services are essential to the change in attitude about health care. Consumers need to be encouraged to address health concerns before they become health emergencies. A better reimbursement system would benefit everyone, as would electronic medical records that help measure outcomes.
Check out the full article here, and let us know what you think!
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