The shame of health care in America - The Record (Bergen County, NJ)

MARY ELLEN SCHOONMAKER
The Record (Bergen County, NJ)
12-02-2004

The shame of health care in America
MARY ELLEN SCHOONMAKER
Date: 12-02-2004, Thursday
Section: OPINION
Edtion: All Editions.=.Two Star B. Two Star P. One Star B

THE UNITED STATES spends more on health care than any other nation, and our medical care is widely considered the best in the world. But it's not for everyone.

Top-notch specialized care in this country is only guaranteed to the rich and those with gold-standard health plans. Even the most basic care is only guaranteed to the poor and the elderly, through Medicare and Medicaid, and to the rapidly shrinking number of Americans lucky enough to be insured by an adequate and affordable plan.

Those with no insurance - even in doctor-drenched Bergen County, where there are 963 listings in the Physicians and Surgeons section of the Hackensack area Yellow Pages alone - take their chances.

In my last column, I asked uninsured North Jersey readers to describe their experiences. We need to hear more voices like these.

* A single 38-year-old construction worker, who does seasonal work that pays an hourly wage: 'It is impossible for me to afford individual health insurance coverage as I need to pay for rent, utilities and transportation to get me to the jobs. Even though blessed with good health for the most part, I ended up in the hospital emergency room last winter for 10 hours. I could not pay the extraordinary amount charged to me for my care.'

* A 56-year-old woman, who works for a lawyer in private practice, cannot afford health insurance and has not been to a doctor in more than three years: 'Forget about preventive medicine like mammograms. I cannot afford it. I'm not ashamed to say that when I needed an antibiotic I used my daughter's leftover dose. I often wonder what would happen to me if I needed surgery and a prolonged hospital stay.'

* A 63-year-old laid-off truck driver: 'I could have picked [insurance] up with COBRA at a cost of $725 a month. I never could understand why my single rate is the same as a family of five. Common sense shows there would be a greater need with the latter. It is a shame I have to take a gamble with my health.' (COBRA allows the unemployed to stay insured by paying the same monthly premium as their former employer.)

* A 29-year-old divorced woman who does facials at spas that do not offer insurance: 'I go to Planned Parenthood for my annual gynecological visit. When I get sick, my parents have to pay my doctor visits. I hate taking from them, but there is no alternative. I have something that should be looked at, but I am afraid. When and if I get insurance, I don't want them to say I am not eligible.'

* A 24-year-old home health aide who says she has had 'horrific experiences dealing with emergency rooms': 'One treated me like a drug seeker once the staff passed the word I was uninsured. I was treated so badly I promised myself I would be almost near death before I went to another ER. Last winter I visited an emergency room only because I had an infection for over two months. I was in so much pain the staff couldn't believe I waited so long.'

* A woman who was offered COBRA coverage for $1,200 a month but could not afford it and later had some temporary bare-bones coverage through her husband: 'I was hospitalized during this time with chest pains. I was in the hospital for a day and a half and had two outpatient procedures, and my bill was $31,000. The insurance paid just under $3,000.'

*

It's a well-kept secret that hospitals often charge far more than the actual cost of treatments - and often charge the uninsured far more than the insured for the same procedures. In a recent study, New Jersey ranked second behind California in the number of hospitals that charge the highest markups. Generally, patients with insurance don't pay the highest prices, since big insurers have the leverage to bargain for discount rates. But uninsured patients can sometimes end up paying bills for years or even going bankrupt.

The huge inequities are perhaps the most infuriating part of the American health care system. They mean that in Bergen County, one of the richest counties in the nation, some women with breast cancer will get state of the art treatment and access to the latest life-saving advances. And some women who can't afford it will go without the first and cheapest step, a mammogram - maybe until it's too late.

According to the Institute of Medicine, which advises the government on health policy, uninsured women with breast cancer have a 30 percent to 50 percent greater risk of death than women who are insured.

As of now, America's uninsured - 44 million people - equal the entire population of 14 states, as authors Donald Barlett and James Steele point out in their new book, 'Critical Condition.' They say no other industrialized nation would - or does - tolerate this injustice.

How much longer will we?

* * *

Mary Ellen Schoonmaker is a Record editorial writer. Contact her at schoonmaker@northjersey.com. Send comments about this column to oped@northjersey.com.

Health Debate Has America Feeling Dizzy - Chicago Sun-Times

Are you confused about the health care debate?

Are you a bit dizzy from trying to distinguish among the Clintonplan, the Cooper plan, the Senate Finance Committee plan, the HouseWays and Means Committee plan, the Mitchell plan, the Gephardt planand the Dole plan?

Of course you are. That's because we're confused as a peopleabout what we want, and how we think it should be paid for.

Here's one example, provided by Hillary Rodham Clinton. Thereports of her comments focused on the 'personal attack' shesupposedly made on Texas Sen. Phil Gramm. But the substantive pointshe made deserves examination.

How does Gramm feel, she asked, about government-mandatedpayroll deductions in order to support health care for an entireclass of Americans regardless of their economic need?

In fact, we have such a program. It's called Medicare. Itcovers every American over the age of 65. And it's almost impossibleto find a senator who will stand up and say this program should berepealed or drastically curtailed.

Medicare is one of the most costly 'entitlement' programs run bythe federal government. In hospital insurance alone, Medicare cost$67 billion in 1990; when the program was passed in 1965, costprojections for 1990 were estimated at $9 billion.

Could we cut the cost of Medicare? Sure - provided we werewilling to tell senior citizens: 'You can spend this amount of moneyfor health insurance, and no more.'

It's called 'rationing.' And given the clout of the seniorcitizens' lobby, the odds on enacting some form of rationing areabout the same as the chance that we will cede Oregon and Idaho toCanada.

At the same time, the specter of the government somehow gainingany more control over the nation's health care system is frighteningto millions of Americans.

In part, this is a product of the multimillion-dollaradvertising campaign; Harry and Louise have done their jobs.

In part, this fear is rooted in a belief that the governmentwill louse up anything it gets its hands on. This is exemplified bythe argument that a government-run health care system will combine'the efficiency of the Postal Service with the compassion of theInternal Revenue Service.'

What all this adds up to is a citizenry whose politicalschizophrenia was dramatically demonstrated by a recent NBC poll.

When asked if they favored cuts in 'entitlements' to cut federalspending, 61 percent of those polled said 'yes.'

But when asked if they favored cuts in 'government programs suchas Social Security, Medicare and Medicaid' - the three biggestentitlements - 66 percent of those polled said 'no.'

It is in this atmosphere, then, that the Senate health caredebate will take place: with the public favoring a health care planthat covers everyone, provides all the health care that we desire,preserves all the choice that most Americans have, and costs lessthan what we now pay.

Meanwhile, the rest of the industrialized world, which has hadsome form of government-supplied health care for decades, looks on inconfusion.

What's the Future of Health Care in America? - The Washington Post

What is about to happen-or not happen-to health care in America,at least for the next few years?

We're not going to see any quick, large-scale expansion offederal health benefits to replace private health insurance.

We're not going to see any broad replacement for the catastrophicMedicare benefits passed by Congress, then dropped like a hot potatowhen too many seniors objected to paying for them.

When we do see new federal benefits-when and if in the shortterm-there will have to be new taxes or premiums or payments in oneform or another.

In an attempt to control costs, more of us are going to begetting care quarterbacked by someone-or someones-who decide whatkind of care we may have, what kind of care is appropriate for us andwhat is not. This is called 'managed care.'

Doctors, hospitals and patients-us-will all be subject toincreasing 'incentives' to give or get care 'efficiently.' Translatethat into: Don't spend too much, or it'll come out of your pocket.

And those who argue for some broad new 'national health plan' tosolve health problems-including the problem of all the 30-somemillion Americans with no health insurance and millions more with badhealth insurance-had better not hold their breath. Any near-termprogress will be incremental, not sweeping.

These are my predictions after a meeting last week with thegovernment's chief payer for health care, Gail Wilensky, the newadministrator of the Health Care Financing Administration.

This Medicare-Medicaid agency currently spends $165 billion ayear paying for care for 55 million old or poor Americans. The waysit spends it and the rules it adopts tend to set the pattern for thenation's entire spending on health, now in the $650 billion ball parkand growing.

Wilensky is a health economist with wide experience in and out ofgovernment. Those who know her find her both realistic and humane, acombination she might find agonizing when trying to provide humanecare without new dollars. There are no perfect prophets, but she isin as good a position as any American to tell us what the Bushadministration and Congress may be able to agree upon in theforeseeable future, which-in today's climate-I'd define as maybe ayear.

Her statements in an hour-long session with a health reporters'group:

On medicare benefits: If they are increased, 'we should do it ona more thorough basis, not by a piecemeal addition of three or fourbenefits,' for example, the mammography benefit for older women lostwhen the catastrophic legislation was canceled. But 'until we solveother problems'-most outstandingly the problem of financing-newbenefits of any kind may have to be postponed.

On financing: As for the March 2 report of Congress's BipartisanCommission on Comprehensive Health Care, 'the Pepper Commission,'recommending an $86 billion program of health insurance for theuninsured and for long-term care, 'I'm troubled by the lack of afinancing scheme . . . While it's okay to say that is a problem oftax-writing committees to some extent,' they might have suggested afew ways.

On long-term care for the aged and disabled, a crying need in themind of many seniors: 'An issue we've got to deal with is to whatextent do we use private insurance, and what is the government'srole?' Whatever the role of government, 'I don't think it needs to bebudget-neutral'-translation, not exceeding the current budget-'at alltimes . . . I do assume that any kind of program to come out of thisadministration would have its own financing attached.'

But whether we think about long-term care or other new benefits,we have to realize we're dealing with an aging population, 'we'llhave to be cautious in bringing in new entitlement programs.'

And given the rapidly aging population-a population that iscertain to cost more to care for in sheer numbers-'it is a questionwhether we will be able to broaden benefits regardless of income.'

On the uninsured or underinsured employed: 'I have great concernabout mandating employers to provide benefits,' for fear of thwartingnew small-business activity and putting minimum-wage workers out of ajob. 'We're struggling now {in this administration} with finding away to encourage employers or to give them a push, without raisingsome of the problems of mandated insurance.'

On value for money: 'There are a lot of concerns that we are notgetting value for our money, that some health care may not benecessary or appropriate. I think if we could make people believethey are getting good value, they'd be substantially less concernedabout the money they're spending.' On oversight of the quality ofcare, on research to determine the best ways of care-much of itresearch just starting-'not enough people have been minding thestore.'

On managed care: 'I'm a strong advocate of managed care' in manyforms-various forms of HMOs and other prepaid health plans, and planswith 'incentives' for a more conservative, more cost-conscious use ofone's health plan.

'I'm not for coercing people into managed care. I think theyshould have options, and should be able to opt out of a plan.' But'I'm for such incentives as paying a higher deductible if you choosea more expensive plan, or paying a higher co-pay if you go out ofyour plan' for care.

'Managed care plans have particularly great potential for theelderly, who have so much chronic disease and often take severalmedications, some with adverse potential. This is far easier tocontrol in a managed system.'

On doctors' medical liability insurance and its high cost becauseof so many malpractice suits: 'This is one problem that has to besolved, particularly if there is to be sufficient participation ofobstetricians in Medicaid and other programs' to give prenatal careto needy and high-risk women.

On hospitals: 'When we look at nationwide hospital bed occupancyrunning about 60 percent-and when most people think an efficientoccupancy rate ought to be about 85 percent-it's a pretty good cluethat there may be a problem' of too many hospitals. 'I'm not forfederal regulation of occupancy rates. I am for financial pressuresand financial incentives to encourage efficiency.' And we may needto make exceptions to make sure some needed hospitals stay open.

On hospital mortality rates, published annually by HCFA in thepast few years but much criticized by hospitals for lack of validity:'We'll keep publishing them. I hope we can improve them.'

Wilensky is obviously a believer, as she has often said, in'incremental,' step-at-a-time improvements in the health system,rather than some sweeping change to a nationwide, government-paidsystem a` la Canada or Britain. This may be realistic in a time whena President pledges 'no new taxes,' when any new payment methods forhealth care, whether called 'taxes' or something else, will bedifficult to enact, and when the nation has many other needs besideshealth care.

She is also is a believer in controlling today's rapidlyescalating health costs by (1) managed care, which ideally restrictsthe care we get to that which is needed and of proved effectiveness;(2) financial incentives-or penalties-to encourage doctors, hospitalsand patients tobe cost-conscious about care; and (3) accelerated research to learnwhat kinds of care are really effective and should be provided.

Is it realistic to think these steps alone can control healthcosts? I fear not. I fear that, as time goes by, some of us mayhave to sometimes accept less care-effective but expensive care-thanwe'd like, a process that is already happening in underfundedinner-city hospitals like D.C. General Hospital.

But this is called 'rationing,' so I hope Wilensky is right.

REP. ALTMIRE VOTES TO PROTECT HEALTH CARE FOR AMERICA'S CHILDREN - US Fed News Service, Including US State News

Rep. Jason Altmire, D-Pa. (4th CD), has issued the following news release:

U.S. Representative Jason Altmire (PA-4) voted today in support of the bipartisan House-Senate compromise to reauthorize the State Children's Health Insurance Program (SCHIP). The $35 billion package would protect health care coverage for over 6 million children currently enrolled in the program and add up to 4 million more. Congressman Altmire strongly urged President Bush to withdraw his veto threat and to quickly sign the measure into law before the SCHIP program expires on September 30, 2007. Without an extension of SCHIP, health care coverage for 180,000 Pennsylvania children could be threatened.

'President Bush continues to ignore the stark reality faced by thousands of Pennsylvania's working families, families who work hard and play by the rules but are finding it increasingly difficult to afford health care coverage for their children,' said Congressman Altmire. 'Rather than joining us in our effort to ensure that every child has a healthy future, he stubbornly continues to push policies that would instead cut children from the health care rolls. I again call on the president to end the political gamesmanship with children's health care coverage and to work with Congress to solve the problem of providing 9 million uninsured children with health care.'

'One out of every eight American children - over 280,000 in Pennsylvania - are uninsured. Congress is doing its part, and now it's the president's turn,' continued Congressman Altmire. 'We must act now to extend the SCHIP program and protect the health care coverage of Pennsylvania's children.'

The State Children's Health Insurance Program Reauthorization Act of 2007 invests $35 billion over five years to strengthen and improve SCHIP. The bill ensures that the over 6 million children who currently participate in SCHIP will continue to receive health coverage and provides states with the resources to add up to 4 million additional children to the program. Further, the measure will also provide enrolled children with quality dental care and mental health services on par with medical and surgical benefits currently covered under SCHIP.

The House passed the State Children's Health Insurance Program Reauthorization Act today by a bipartisan vote of 265 to 159. Senate passage is expected later this week. The bill has been endorsed by AARP, America's Health Insurance Plans, Consumer Health Coalition, Families USA, Pennsylvania Partnerships for Children, and over 270 other organizations.

The Affordable Health Care For America Act ("AHCAA").(United States. Congress. House) - Mondaq Business Briefing

The U.S. House of Representatives moved closer to an overhaul of the nation's health care delivery system by passing the Affordable Health Care for America Act ('AHCAA' or the 'Act') late in the evening of November 7, 2009. Passage of AHCAA was not a foregone conclusion headed into the weekend. However, a visit to the Hill by President Obama and adoption of an amendment restricting public funding for abortions ultimately swayed a number of key Democrats who originally had opposed it to vote for the Act. The Act was approved by the House with a vote of 220-215.

The key provisions of the Act include employer mandates, individual mandates, a regulated health insurance marketplace, known as the 'Exchange,' a public health plan and various revenue generators to pay for the program. The key provisions of the Act are summarized below:

Employer Mandate--Play Or Pay. Starting in 2013, the Act will require employers to either provide health coverage (an 'offering employer') to employees and their eligible dependents or pay a federal payroll tax equal to 8% of all compensation paid to employees (certain small employers are exempt from this tax or are subject to a graduated tax rate). An offering employer generally must automatically enroll eligible employees in their employment-based health plan and offer the employees the option of selecting individual or family health coverage. Under the Act, employers must contribute 72.5% of the premium cost for individual and 65% of the premium cost for family coverage, for the lowest-cost qualified plan. Family coverage under AHCAA includes the employee's spouse and qualifying children. The Act also requires an offering employer to contribute to the Exchange for each employee who declines employer coverage but enters the 'Exchange' (described below) for insurance if the cost of the employer's insurance is greater than 12% of the employee's income. The contribution is generally 8% of the average salary for the employee. Small employers with annual payrolls at or below $500,000 are exempt from this requirement. The contribution phases up from 0-8% between an annual payroll of $500,000 and $750,000, at which point employers are subject to the full 8% contribution requirement.

Individual Mandates. Beginning in 2013, all individuals will be required to have acceptable health insurance coverage that meets or exceeds the qualifications of the federally-defined minimum benefit plan. The federal government will establish the baseline qualifications for coverage. Those who do not have this type of coverage will be required to pay a penalty equal to 2.5% of their income. Waivers are allowed for Native Americans, those with religious objections, dependents and individuals with a financial hardship, defined as premiums over 12% of income. Acceptable coverage generally includes grandfathered individual and employer plans, certain government coverage (e.g., Medicare, Medicaid, certain coverage provided to veterans, military employees, retirees and their families, and members of Indian tribes), and coverage obtained pursuant to the Exchange or an employer offer of coverage.

Health Insurance Exchange. AHCAA establishes a Health Insurance Exchange (to begin in 2013) (the 'Exchange') under the purview of the Health Choices Administration. The Exchange will be a regulated marketplace for individuals and small employers to comparison shop among private and public insurers, including new health insurance co-ops. The Commissioner of the Health Choices Administration is charged with establishing a process through which to obtain bids, negotiate and enter into contracts with qualified plans as well as to ensure that different levels of benefits are offered through the Exchange with appropriate oversight and enforcement. In Year One, individuals not enrolled in other acceptable coverage, as well as small employers with 25 or fewer employees, are allowed into the Exchange. In Year Two, employers with 50 and fewer employees are allowed into the Exchange. In Year Three, the Commissioner is, at a minimum, required to open the Exchange to employers with 100 and fewer employees, but is permitted from that year forward to expand employer participation as appropriate, with the goal of allowing all employers access to the Exchange. States may opt to operate the Exchange at the state level in lieu of participating in the national Exchange, provided an electing state follows the federal rules.

Public Health Insurance Option. Under the Act, a national public plan will be established in 2013 to compete with private insurers in the Exchange. The public option will operate on a 'level playing field' with private insurers, offering the same benefits, abiding by the same insurance market reforms, following provider network requirements and other consumer protections. The Secretary of Health and Human Services will administer the public option and negotiate rates for providers that participate in it. The public health insurance option is provided startup administrative funding, but is required to amortize these costs into future premiums as the option must be self-sustaining - i.e., financed through premiums - after the initial funding. Significantly, providers are presumed to be participants in the public option unless they opt out of participation.

Revenue Generation. The Act contains various provisions meant to generate revenue to pay for the expanded health care coverage called for under AHCAA. Revenue generators under the Act include:

Distributions From FSAs, HRAs, And HSAs For Medicine Qualify Only If For Prescribed Drugs Or Insulin. The Act limits nontaxable reimbursements from health flexible spending accounts, health reimbursement arrangements, and health savings accounts to medicines and drugs prescribed by a medical provider, or insulin. Over-the-counter drugs will no longer be reimbursable through these arrangements under the Act.

Limitation On Health Flexible Spending Arrangements Under Cafeteria Plans. The Act limits salary reduction contributions to health flexible spending arrangements to $2,500 (indexed to the consumer price index).

Increase In Penalty For Nonqualified Distributions From Health Savings Accounts. The Act increases the 10 % penalty on distributions from health savings accounts that are not used to pay for health-related expenditures to 20 %.

Denial Of Deduction For Federal Subsidies For Prescription Drug Plans Which Have Been Excluded From Gross Income. Certain employers are eligible for Federal subsidies with respect to prescription drug benefits provided to retirees, and the subsidies are excluded from gross income. The Act eliminates the ability of employers to deduct expenses for which they are subsidized.

Surcharge On High Income Individuals. The Act levies a 5.4 % tax on modified adjusted gross income in excess of $1 million in the case of a joint return ($500,000 in the case of other returns).

Excise Tax On Medical Devices. The Act establishes a 2.5 % excise tax on medical devices sold for use in the U.S. The excise tax does not apply to exported devices and does not apply to retail sales of devices.

AHCAA grew out of H.R. 3200 (aka America's Affordable Health Choices Act of 2009) and contains a series of compromises and new provisions not found within the predecessor act. The chart below illustrates key differences between AHCAA and H.R. 3200:

> The Senate will now take up deliberations regarding national health care reform. After the House bill passed, key Senators went on record as opposing prominent components of the Act, including the 'public plan.' However, Senate Majority Leader Harry Reid has indicated he supports a public option, which includes the ability for states to 'opt out' if they can provide a reasonable alternative. Additionally, there are key differences between AHCCA and competing bills currently pending in the Senate, including the Health, Education, Labor and Pensions Committee's (HELP's) American Health Care Choices Act, and the Finance Committee's American Health Future Act. The American Health Future Act, for example, does not embrace the 'Play or Pay' approach adopted in the Act with respect to an employer mandate. Rather, the Finance Committee bill provides that, starting in 2013, employers with more than 50 employees who do not offer health care coverage to an employee must reimburse the government for each full-time employee (30 or more hours a week) who receives a 'health care affordability tax credit,' equal to the average national Exchange credit, and a penalty of up to $400 per number of employees. While the Senate's current proposed bills do not include the AHCCA's surtax on high wage earners, the Finance Committee bill includes an excise tax on high-cost insurance plans. This so-called 'Cadillac Tax,' which would again begin in 2013 (after the next presidential election), would be a nondeductible excise tax of 40% on premiums in excess of $8,000 for group health individual coverage and $21,000 for group health family coverage.

If these and other differences cannot be addressed in the Senate version of health care reform, the Act and whatever Senate legislation is passed, if any, will be sent to a joint committee for reconciliation. The reconciled bill would then need to be passed by both the House and the Senate.

In short, there is still a long way to go before we will know all of the requirements of health care reform. It is impossible for anyone to predict what will ultimately appear in a bill that would be sent to the President for his signature. We will continue to issue Client Alerts addressing key issues under the Act and Senate legislation, as well as updating our clients to new developments in this area of the law. In the meantime, please feel free to contact your Proskauer attorney or any member of our Health Care Reform Task Force.

www.proskauer.com

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Health care in America. (Capitol Corridors) (column) - The National Public Accountant

Health Care in America

The debate over the nation's health care situation recently has intensified in earnest here in Washington. The Senate's Democratic leadership has unveiled a plan which it believes will help to solve the health care crisis. As this article is penned, the Republicans are framing their response. The media have labeled health care 'the issue of the '90s.' A great deal is at stake for all Americans, but especially for small businesses and their advisors.

The scope of the health care crisis is staggering. The twin problems of access and cost have taken a heavy toll on the nation's economy. Some 37 million Americans have no health insurance coverage at all; three-fourths of these individuals are working men and women. The price of insurance premiums has grown by double digits each year for the past several years. In a development surprising some business leaders, more and more Americans of every political persuasion are throwing up their hands in desperation and looking to Washington for a solution. The Democrats think they've found the answer in HealthAmerica, their new initiative.

The legislation seeks to assure every American basic health insurance coverage, either through a plan provided by an employer or through a federal-state public insurance program called AmeriCare. Except for long-term care services, AmeriCare would replace Medicaid. The Democrats maintain their plan couples universal health insurance coverage with a comprehensive cost-control program and with provisions to reflect the special needs of small business.

The crux of the plan is what has been dubbed 'play-or-pay.' Employers would be offered a choice of providing coverage meeting specified minimum standards for employees and their families or making a contribution to the public plan. Proponents of HealthAmerica estimate that the contribution would work out to about 8% of payroll. However, the Small Business Administration estimates that current actual health care costs for small business average approximately 12% of payroll. One must ask how the government proposes to provide coverage for one-third less than the private sector does.

For employers choosing to 'play,' employees may be required to pay up to 20% of premium costs. The plan would be required to cover all employees who work more than 17 hours per week and their families. One of the problems still to be ironed out is family coverage for dual-career families.

For those not covered by employment-based insurance, including those whose employers choose to 'pay,' AmeriCare coverage would provide access to the same health care benefits. AmeriCare would be administered by the states, subject to national standards for eligibility, reimbursement and coverage.

Individuals below the poverty line will pay no premium. Those between 100% and 200% of poverty would pay on a sliding scale. Those above 200% of poverty would be charged based on ability to pay.

Of course, the reason the government is feeling pressed to get into the health care business is that the private sector can't afford it anymore. It's tough to imagine the public sector would fare any better without some change, so cost containment measures are included in the bill. The cost containment strategy is organized around steps to reduce unnecessary and ineffective care, to reduce the excessive costs of the pluralistic payment system and to limit unrestrained price and volume increases by providers. The first goal is a little nebulous. The second would be achieved through standardized claim forms. The last item, however, really gets to the heart of the health care crisis - cost.

In order to rein in costs, an independent agency along the lines of the Federal Reserve Board would be established to set national health expenditure goals, in total and by sector of the health care industry. Advisory goals would also be established by state and region. The board would then convene providers (e.g., hospitals, doctors, et. al.) and purchasers (i.e., insurance companies) to conduct negotiations on rates and other methods of achieving expenditure goals. Negotiated rates would be binding.

The states would also be required to establish insurance consortia. It is hoped that, through these consortia, enough economic pressure would be brought to bear on providers to encourage them to negotiate in earnest. However, the bill stops short of actually mandating prices for health care services.

In order to make this medicine a little easier for small business to swallow, several incentives have been included in the legislation. First, the applicability of the law to small business would be phased in over a five-year period. Next, Section 162(1) of the Internal Revenue Code (deduction of health insurance costs for self-employed persons) would be made permanent and expanded to 100%. Finally, very small businesses with low profit margins would receive a tax credit to cover up to 25% of the program's costs.

The Democrats' proposal has received generally favorable reviews, from being labeled an 'important first step' to qualified support. Again, it must be pointed out that this support cuts across traditional ideological boundaries. Moreover, it appears that the Republican response will not include universal coverage. Although it would be premature to comment on a plan that has not even been formally announced, this fact, if true, would seriously damage any proposal's credibility.

Nevertheless, certain important questions about HealthAmerica remain to be answered. Particularly: 1. How can small business be certain

that the 8% figure won't

quickly turn into 12% or even

15% as costs rise and the level of

required health care services is

sought to be expanded? 2. Why are the plan's proponents

mandating coverage, but not

mandating prices? If the consensus

has emerged that the

marketplace must be usurped,

why do so only on one side of the

equation? 3. As with all 'revenue-negative'

legislation in Washington these

days, where will the money come

from to finance the government's

end of this deal?

A competitive vision for health care in America - Dynamic Chiropractic

The 13th century Italian poet Dante observed, 'A great flame follows a little spark.'

Thomas Jefferson said, 'The greatest threat to freedom is the expansion of government power.'

In no other profession is government more involved than in health care in the 21st century.

The Policy Argument

The policy argument against choice in health care runs something like this: Since 90 percent of Americans are in a third-party payment system, we must devote all our energies to 'fixing' that system. We must also fight freedom of choice with regard to doctors outside of managed care networks, because choice brings competition, and competition will increase costs.

It is certainly true that most Americans currently receive health care either paid by the government (Medicare or Medicaid) or their employers (HMOs or managed-care plans), but this is precisely why we should embrace choice rather than reject it. A system that can command (and indeed, enforce) a 90-percent market share is a monopoly, and as everyone knows, monopolies produce bad products at high prices. Why? When there is no competition, customers have no alternatives; when there are no alternatives, customers have to accept whatever a monopoly decides to produce, and pay whatever a monopoly decides to charge.

This is exactly the dismal record of the government's long-standing monopoly in health care. Medicare costs almost 10 times its initial projected costs. The government calls this 'cost overruns,' which gives it a reason to tax more and get even more control over the people. But overall health care has not improved. People are not getting better care at a cheaper cost. The government blames doctors and patients - it is great at pointing the finger, but the public should stop looking where the government is pointing and start looking at the government itself.

More government is not the solution to our problems. We are told if we just keep plugging away at failed solutions - if we spend more money, hire more healthcare managers and administrators, and create more government commissions and regulators - we will get different results.

In the meantime, what happens to the patient? To defenders of the status quo, the primary concern is not what happens to the patient if he or she is forced to stay in the system, but rather, what happens to the system if corporate bureaucrats or government bureaucrats lose control and the patient is free to leave. By this reasoning, no matter how bad the situation gets, we must not help the patient to leave, lest in leaving, he makes a bad situation worse. Does this make any sense at all?

Does the patient exist to serve the system, or does the system exist to serve the patient? Even if the policy argument were not morally bankrupt, it runs counter to settled economic truths. Long before the Sherman Antitrust Act (a flawed, but popular piece of legislation) was passed in 1890, Americans recognized that monopolies stifle innovation and defraud the customer. The solution has never been to increase the power of the monopoly; the only remedy that has worked consistently is to encourage competition.

The Historical Argument

Competition may be deeply ingrained in our nation, but according to opponents of choice, so is government health care. This is the historical argument against choice, which alleges that America was founded on a system in which government was given the primary responsibility for delivering health care to the people. In other words, government health care constitutes the very underpinnings of our republic, and reflects our founding fathers' deepest aspirations.

The problem with this argument is that it is false. The government delivery system we have come to know as Medicare wasn't established until 150 years after America was founded. The system it forcibly replaced - the system of health care in our country was founded on - was characterized above all by diversity, competition and choice. People could choose from different private practitioners, while competition spurred innovation and expanded services. This approach wasn't perfect, but it worked well, and it was improving steadily. Not only did it produce some of the greatest doctors in history, it also produced a system of health care that led to technological breakthroughs and expanded methods of health-care delivery.

The Civic Argument

Such revelations don't seem to faze the anti-choice crowd. Its members simply 'step over' history and move on to the civic argument against choice. They admit that the free-market approach to health care may have worked in a more homogenous society, but quickly add that in today's diverse culture, we need government health care to promote standards of care and uniform guidelines that are acceptable to everyone.

Conflicts began immediately after the creation of uniform standards of health care. There are over 150 different guidelines just for the treatment of back pain. Which one is correct? Health care is an inexact science, and even if it were exact, there would still be human error. Doctors have to learn how to document all patient records to specific practice guidelines developed by the government and different HMO standards. Fees for services are set according to a uniform standard, rather than the expertise or experience of individual practitioners. Look at the recent battles involving HMOs that denied care for basic procedures that used to be standard. HMO profits are paramount to patient care; a 'one size fits all' policy is developed, and patients who fall between the cracks with complicated cases are just out of luck. The question becomes not whether health care is rationed, but who decides what is rationed? The decisions are made not between patient and doctor, but by corporate or government bureaucrats.

By claiming to deliver what families need, rather than giving them the power to pursue what they want, the government health system needlessly tramples individual rights and creates unnecessary conflict.

The Legal Argument

Why not enable patients to pursue the health care they want? According to the final argument against choice, it is against the law. Patients are caught in a 'catch-22' situation. The same people in government health programs argue that the law prevents them from using a fraction of their tax dollars to leave the system.

Since some patients may flee to doctors outside their network, we are told this represents an unconstitutional establishment or tax-supported health care. In a competitive system, patients would receive the money and do their own choosing. It is almost as if advocates of the government's monopoly in health care have discounted patients for so long, they have forgotten they even exist.

Freedom Is What Matters

The last weapons in the government's health-care-monopoly arsenal are fear and prejudice, disguised as concern for the welfare of the disadvantaged. Thus, its leaders insinuate (in politically correct terms, of course) that poor and minority patients won't make good decisions when it comes to their own health care. This argument underestimates the fundamental value that makes this country great. In America, we must place our faith in freedom and the ability of ordinary, often humble people to make the best decisions, by their own lights, for themselves and their families.

[Author Affiliation]

Allen Unruh, DC President, South Dakota Chiropractic Association

[Author Affiliation]

Quality, not quantity; Frugal health care in America.(Private firms take baby steps to curb American health-care costs)(Geisinger Health Systems, Intermountain Healthcare, Blue Cross Blue Shield) - The Economist (US)

Relax, your grandchildren will pay

Private firms are taking baby steps to curb soaring health costs

ABOVE a valley in Pennsylvania sits an old hospital that gives an optimistic hint about the future of American health care. Geisinger Health Systems was founded in 1915 but is as adaptable and creative as a start-up. It has invented new ways to offer services: it provides heart surgery, for example, at a fixed price and with a warranty. (If there are complications within 90 days, you pay nothing to fix them.)

Geisinger is changing the way it delivers primary care, co-ordinating teams of doctors and nurses to keep more people healthy for less money. Barack Obama sometimes praises the organisation in speeches. His health reform includes a programme to promote a model much like it. Alas, Geisinger's chief executive, Glenn Steele, is one of many hospital bosses who think the new programme will not work.

America spends far more on health care than other countries, such as Britain (see page

). The waste is staggering (see chart). The main problem is loopy incentives. Under 'fee-for-service' arrangements, the more tests, scans and pokes with gloved hands a hospital or clinic provides, the more it is paid. Mr Obama's health reform included only a few small nudges to change this.

Topmost among them is a plan for Medicare to reward 'accountable care organisations' (ACOs) for keeping people healthy, rather than lavishing treatment on them. The plan seems sensible enough. But it has provoked uproar in every corner of the health industry. This month the Centres for Medicare and Medicaid Services (CMS), the body that oversees government health schemes for the old and the poor, was barraged with irate letters about it.

An entrenched system is hard to change. Hospitals currently have little incentive to keep patients healthy. On the contrary, fitter patients would mean lower volumes and smaller margins, says Michael Nugent of Navigant Consulting, an expert on ACOs. Nevertheless, the current system is clearly unsustainable.

Wonks have buzzed about ACOs for years. In 2005 CMS began a pilot with ten health systems, including Geisinger, to reward them for improving the quality of care while lowering costs. America is dotted with examples of reform. Utah's Intermountain Healthcare is a hospital system with its own health plan. Clever use of data has helped to streamline care: a new protocol for delivering babies has reduced the number of unplanned caesarean sections and saved about $50m a year.

Insurers are experimenting with reform as well. Aetna, Humana and Wellpoint are testing new payment models. In Massachusetts, Blue Cross Blue Shield has created an 'alternative quality contract' that gives hospitals a fixed budget for a patient, with additional rewards for improving the quality of care. In the programme's first year hospitals cut the number of unnecessary emergency-room visits by 22%.

'The train is moving in the right direction,' says Mark McClellan, a former head of CMS who has championed ACOs. Real progress, however, requires change in the public sector. Medicare, the public health programme for the old, provides a whopping 35% of American hospitals' revenue.

CMS's proposed rule for ACOs would allow doctors, hospitals and other health providers to form networks to co-ordinate Medicare patients' care. CMS would reward ACOs that save money, relative to a predetermined benchmark, while meeting certain standards of quality.

Alas, the regulations are a mess. 'The ACO policy is an example of why the government is not always a great change agent,' sighs Chip Kahn, president of the Federation of American Hospitals. The insurance lobby frets that the rules will prompt hospitals to merge, reducing competition and driving up prices. The American Hospital Association says that the rewards for saving money are too low and the risks too high. The rules include 65 quality measures, more than twice the number in CMS's earlier, smaller pilot. 'I was very disappointed with their over-specificity,' says Geisinger's Dr Steele. Advocates for ACOs, such as Dr McClellan, hope that the final rules will be different.

CMS is likely to make at least some changes to the programme. 'I'm delighted to have the feedback,' says Donald Berwick, CMS's boss. Last month Dr Berwick unveiled a few new enticements for ACOs, such as more flexible rules for experienced hospitals such as Intermountain. But it is unlikely that the ACO programme will be in place by January, as originally planned.

SIRES' STATEMENT ON AFFORDABLE HEALTH CARE FOR AMERICA ACT. - States News Service

WASHINGTON -- The following information was released by the office of New Jersey Rep. Albio Sires:

After thoughtful consideration of H.R. 3962, the Affordable Health Care for America Act, I stand here today in strong support of this legislation. Beyond the expansion of coverage that this bill will bring to 115,000 of my constituents, it will reduce health care spending and our national deficit over time, as well as create new job opportunities within the health care sector.

First, the bill is estimated to provide affordable health coverage to 96 percent of all Americans. For people that like their current plans, they will be able to keep it, but for those individuals who are not currently covered by their employers and for those small businesses who can not currently afford health care coverage for their employees, a new Health Insurance Exchange will be created. Here consumers will be able to comparison shop from a menu of affordable, quality health care options, including private plans, health co-ops, and a new public health insurance option. Financed by its own premiums, the public option will operate on a level playing field with private insurers to spur additional competition. The Exchange will lead to improved coverage and care by creating competition based on better quality and prices.

Additionally, to ensure coverage is affordable for all Americans, affordability credits would be provided to qualified individuals in the Exchange; tax credits for up to 50 percent would be available for certain small businesses who acquire insurance; and Medicaid would be expanded to cover individuals with incomes up to 150 percent to the federal poverty level.

Second, this legislation will be entirely paid for, while not adding a dime to the deficit, rather reducing the deficit over the next two decades. It will also put Medicare and Medicaid on the path to a more fiscally sound future, so seniors and low-income Americans can continue to receive quality health care benefits for years to come.

Third, this bill makes tremendous investments in our nation's health workforce, especially in the field of primary care. Under this legislation, existing scholarship, loan repayment, and training grant programs are strengthened to address the need for primary care, nursing, and public health professionals. The primary care workforce is also enhanced by expanding the National Health Service Corps and creating a new primary care loan program. Additionally, a new generation of public health workers will be trained through a new loan repayment and scholarship program modeled on the National Health Service Corp. These investments will come at a critical time as there will be an increased need for primary care professionals due to the influx of new patients caused by increasing access to coverage and care.

Finally, this bill will create high quality research opportunities and jobs. By including the framework for allowing biosimilar competition created by the Energy and Commerce Committee, a new class of medicines will flourish to help lower costs and bring competition in prescription drugs. As this provision requires much research and testing to ensure patient safety, more high paying, highly skilled jobs will increase in New Jersey as the biosimilar industry grows. It is imperative that we keep this research and these jobs in this country. We cannot allow these research opportunities to leave this country, and I intend to work with the Secretary of HHS and the Commissioner of the FDA to ensure they stay in the United States.

AHIP STATEMENT ON AFFORDABLE HEALTH CARE FOR AMERICA ACT. - States News Service

WASHINGTON -- The following information was released by America's Health Insurance Plans:

Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP), released the following statement today in response to the Affordable Health Care for America Act:

'The promise of health care reform has been that if you like your current coverage, you can keep it. We are concerned that this proposal will break this promise by increasing health care costs for families and employers across the country and significantly disrupting the quality coverage on which millions of Americans rely today.

'The lack of system-wide cost containment is a missed opportunity. Without a greater focus on health care costs, families and employers will not be able to afford coverage and health care costs will rise at a rate much faster than the overall economy is able to sustain.

'We share the concerns that doctors, hospitals, employers, and patients have all raised about the significant disruption a new government-run plan would have on the current health care system. A new government-run plan would bankrupt hospitals, dismantle employer coverage, exacerbate cost-shifting from Medicare and Medicaid, and ultimately increase the federal deficit.

'Estimates show that a government-run plan would cause millions of people to lose their current coverage. Moreover, massive Medicare Advantage cuts would cause millions of seniors to lose their Medicare Advantage coverage altogether, while millions more would face benefit cuts and higher out-of-pocket costs.

'Health plans strongly support comprehensive, bipartisan health care reform and have proposed sweeping insurance market reforms and new consumer protections to ensure that every American has guaranteed access to affordable health care coverage. Experience in the states has shown that insurance market reforms must be paired with an effective personal coverage requirement for these reforms to work. While this legislation recognizes the key linkage of market reforms and a personal coverage requirement, more needs to be done to ensure coverage is affordable and our health care system is sustainable.

REP. CHU'S STATEMENT ON PASSAGE OF H.R. 3962, AFFORDABLE HEALTH CARE FOR AMERICA ACT. - States News Service

WASHINGTON, DC -- The following information was released by the office of California Rep. Judy Chu:

Rep. Judy Chu, D-CA32, issued the following statement today on the passage of the House version of the health care reform bill, H.R. 3962, the Affordable Health Care for America Act of 2009:

'With today's passage of H.R. 3962, America has never been closer to truly reforming our broken health care system,' said Rep. Chu. 'The magnitude of this accomplishment cannot be overstated: for six decades, Congress and a number of presidential administrations have tried - and failed - in this monumental task. So President Obama and our Leaders in Congress deserve great credit for bringing us this far, and I am honored and humbled to have been a part of the debate over what I truly consider to be the most important piece of legislation of this century.

'I believe the ultimate goal of health care reform is to provide stable and affordable health care for every American while preserving what works in today's system, expanding choice, and containing costs. The Affordable Health Care for America Act accomplishes those goals by creating a public health insurance option that would compete on a level playing field with private insurers within the Health Insurance Exchange. It protects Americans from being discriminated against by insurance companies due to gender or pre-existing conditions. And it opens up the health insurance system to tens of millions of individuals who currently cannot afford it, which is particularly important in areas of our country such as my own District, where fully one-third of residents are uninsured.

'A bill of this size and complexity can never be perfect, As a long-time supporter of a robust public option, I would have preferred a stronger government plan with the power to better negotiate rates and help keep overall premiums down. I am also disappointed that under H.R. 3962, legal immigrants will still have to wait five years before being able to access Medicaid or Medicare benefits. But faced with the choice of reform or continuing the status quo, I felt that I had to support reform, and this bill goes a long way toward reforming our system for the better.

'We now await news from the Senate as it moves forward with its own version of the health care reform bill. I will work hard to encourage our colleagues in the other chamber to preserve the most important components included in the House bill, particularly the public option. I also urge our Senators to incorporate that aspect of the House bill that ensured that our states are provided with adequate federal funding to cover the expansion of Medicaid to individuals and families to 150 percent of the poverty level,

REP. REYES ISSUES STATEMENT ON HOUSE PASSAGE OF AFFORDABLE HEALTH CARE FOR AMERICA ACT - US Fed News Service, Including US State News

WASHINGTON, Nov. 7 -- Rep. Silvestre Reyes, D-Texas (16th CD), issued the following news release:

Congressman Silvestre Reyes today released the statement below following the passage of H.R. 3962, the Affordable Health Care for America Act:

'This is a momentous occasion for the American people, particularly for the hundreds of thousands of El Pasoans who have unjustly struggled without health insurance in the world's wealthiest nation. The Affordable Health Care for America Act, as passed by the House, will dramatically improve the quality of life for so many families in our community, who will finally have access to quality affordable health coverage.

'I am particularly pleased this legislation incorporates a provision that I, along with Majority Leader Steny Hoyer, and others worked to include that will support the development of our medical school. The measure will allocate $100 million each year through fiscal year 2015 to the Department of Health and Human Services to help develop medical schools in federally-designated health professional shortage areas for construction, equipment, curriculum and faculty development. This is an exciting opportunity for our community.

'The House passage of the Affordable Health Care for America Act is one of the most significant legislative victories for the people of El Paso. Our community has one of the highest concentrations of America's uninsured population, with over 230,000 residents without health coverage, one in three people. Texas has the highest rate of children and adults without health insurance in the entire nation. The status quo is unacceptable, and we can no longer afford to pass this growing problem to future generations.

'While our community is spending a greater share of property taxes to pay for individuals without health coverage, insurance companies have continued to engage in practices that protect their bottom lines. For too long, insurers have been the gatekeepers to our health care system, with the power to dictate who receives health coverage and who does not. Americans with pre-existing conditions and serious illnesses are too often denied coverage or are dropped from their existing insurance plans for developing a serious illness or reaching their cap on coverage, and are denied access to the medical care they need.

'When people lack access to quality affordable preventative care, they end up in our emergency rooms for ailments that could have been treated by a family doctor or seek treatment for conditions that should have been diagnosed earlier. When these patients fail to pay their medical bills from publically-financed hospitals such as University Medical Center, local property taxes are used to cover these expenses. Since 1998, El Paso property tax payers have spent over $400 million to pay for treatment and services for those patients who could not afford to pay their medical bills.

'The Affordable Health Care for America Act will dramatically reduce the number of people without insurance in El Paso. First, it prohibits insurance companies from denying coverage due to 'pre-existing conditions.' It requires that every American obtain health coverage, and provides 'affordability credits' to individuals and families with incomes up to 400 percent of the federal poverty level (currently $43,430 for individuals and $88,200 for a family of four).

'The legislation also requires that most employers provide coverage. It includes exemptions for small businesses with payrolls of less than $500,000 and offers generous tax credits for those small businesses that elect to provide coverage for their employees. The bill creates an 'insurance exchange,' that will offer affordable health insurance plans for individuals without employer-provided or government-provided insurance (such as Medicaid and Medicare). This exchange will include a public option to encourage competition with private insurers to keep prices low for consumers.

'This bill also brings much needed relief and peace of mind for those who do have insurance coverage, as all Americans will no longer have to worry about the possibility of financial ruin due to a serious illness. It caps annual out-of-pocket expenses at $10,000 for families and $5,000 for individuals, and prohibits insurance companies from imposing lifetime limits on an individual's coverage.

'Our local community leaders have expressed their support for health insurance reform, and both the City and the County have passed unanimous resolutions in support of reform. The Affordable Health Care for America Act is endorsed by over 300 national organizations and associations, including the AARP, the American Medical Association, the American Cancer Society, the American Heart Association, the Consumers Union, the Catholic Health Association, and many other medical professional organizations.

'The passage of this landmark legislation by the House of Representatives is an historic achievement and reflects the commitment and determined leadership of President Obama and the Democratic Congress to follow through on a key promise to help middle class families, who have endured years of rising medical costs. I commend my colleagues for their determination to pass this truly historic legislation that will lower health care costs for all Americans, and strengthen our country's financial future.'For more information please contact: Sarabjit Jagirdar, Email:- htsyndication@hindustantimes.com.

REYES STATEMENT ON HOUSE PASSAGE OF AFFORDABLE HEALTH CARE FOR AMERICA ACT. - States News Service

WASHINGTON -- The following information was released by the office of Texas Rep. Silvestre Reyes:

Congressman Silvestre Reyes today released the statement below following the passage of H.R. 3962, the Affordable Health Care for America Act:

'This is a momentous occasion for the American people, particularly for the hundreds of thousands of El Pasoans who have unjustly struggled without health insurance in the world's wealthiest nation. The Affordable Health Care for America Act, as passed by the House, will dramatically improve the quality of life for so many families in our community, who will finally have access to quality affordable health coverage.

'I am particularly pleased this legislation incorporates a provision that I, along with Majority Leader Steny Hoyer, and others worked to include that will support the development of our medical school. The measure will allocate $100 million each year through fiscal year 2015 to the Department of Health and Human Services to help develop medical schools in federally-designated health professional shortage areas for construction, equipment, curriculum and faculty development. This is an exciting opportunity for our community.

'The House passage of the Affordable Health Care for America Act is one of the most significant legislative victories for the people of El Paso. Our community has one of the highest concentrations of America's uninsured population, with over 230,000 residents without health coverage, one in three people. Texas has the highest rate of children and adults without health insurance in the entire nation. The status quo is unacceptable, and we can no longer afford to pass this growing problem to future generations.

'While our community is spending a greater share of property taxes to pay for individuals without health coverage, insurance companies have continued to engage in practices that protect their bottom lines. For too long, insurers have been the gatekeepers to our health care system, with the power to dictate who receives health coverage and who does not. Americans with pre-existing conditions and serious illnesses are too often denied coverage or are dropped from their existing insurance plans for developing a serious illness or reaching their cap on coverage, and are denied access to the medical care they need.

'When people lack access to quality affordable preventative care, they end up in our emergency rooms for ailments that could have been treated by a family doctor or seek treatment for conditions that should have been diagnosed earlier. When these patients fail to pay their medical bills from publically-financed hospitals such as University Medical Center, local property taxes are used to cover these expenses. Since 1998, El Paso property tax payers have spent over $400 million to pay for treatment and services for those patients who could not afford to pay their medical bills.

'The Affordable Health Care for America Act will dramatically reduce the number of people without insurance in El Paso. First, it prohibits insurance companies from denying coverage due to 'pre-existing conditions.' It requires that every American obtain health coverage, and provides 'affordability credits' to individuals and families with incomes up to 400 percent of the federal poverty level (currently $43,430 for individuals and $88,200 for a family of four).

'The legislation also requires that most employers provide coverage. It includes exemptions for small businesses with payrolls of less than $500,000 and offers generous tax credits for those small businesses that elect to provide coverage for their employees. The bill creates an 'insurance exchange,' that will offer affordable health insurance plans for individuals without employer-provided or government-provided insurance (such as Medicaid and Medicare). This exchange will include a public option to encourage competition with private insurers to keep prices low for consumers.

'This bill also brings much needed relief and peace of mind for those who do have insurance coverage, as all Americans will no longer have to worry about the possibility of financial ruin due to a serious illness. It caps annual out-of-pocket expenses at $10,000 for families and $5,000 for individuals, and prohibits insurance companies from imposing lifetime limits on an individual's coverage.

'Our local community leaders have expressed their support for health insurance reform, and both the City and the County have passed unanimous resolutions in support of reform. The Affordable Health Care for America Act is endorsed by over 300 national organizations and associations, including the AARP, the American Medical Association, the American Cancer Society, the American Heart Association, the Consumers Union, the Catholic Health Association, and many other medical professional organizations.

REP. DORIS MATSUI ON AFFORDABLE HEALTH CARE FOR AMERICA ACT. - States News Service

WASHINGTON -- The following information was released by the office of California Rep. Doris Matsui:

Today, Congresswoman Doris O. Matsui (CA-05) joined with her colleagues in the House of Representatives to announce historic legislation: the Affordable Health Care for America Act. This landmark reform package will reform our nation's health insurance system, make health coverage more affordable and accessible, and increase the quality of care for all Americans.

Today's announcement comes after several months of discussions between Rep. Matsui and her constituents about ways to improve our current system, feedback which she has used to work with her colleagues to strengthen earlier versions of health insurance legislation debated in Congress. Congresswoman Matsui issued the following statement today at the launch of the Affordable Health Care for America Act:

'The Affordable Health Care for America Act represents the views of the majority of my constituents in terms of making health insurance work for all consumers at a price they can afford. This is truly a consensus piece of legislation that will hold insurance companies accountable, empower patients and their doctors, and make quality insurance accessible for America's seniors and families. It is a stronger and more comprehensive bill because of the feedback and input that I have received from Sacramentans over the past year. Thanks to these conversations, the bill now includes important investments in Medicare, an expansion and strengthening of Medicaid, and a policy allowing young Americans to stay on their parents' health insurance plans while they transition into financial independence.

'The legislation blends the bills passed out of each of the three House committees with jurisdiction over health policy, including the Energy and Commerce Committee upon which I sit. It builds upon the strong foundations put forth in earlier drafts, and includes a number of policies and amendments I championed to invest in wellness and prevention, strengthen the public health system, provide more community-based resources for people with mental illness, and give seniors choice about where to receive health services. The Affordable Health Care for America Act also includes sweeping new regulations of the insurance industry, such as prohibiting companies from denying coverage to those with pre-existing conditions and making it illegal for insurance companies to rescind people's coverage. Finally, the package includes creation of a public health insurance option that will inject competition into the health insurance marketplace and guarantee that all Sacramentans has access to a comprehensive suite of health insurance benefits.

'We cannot afford not to enact the important protections for Sacramento's families that are included in this legislation. The cost of inaction is too great: the high cost of our current health insurance system is suffocating many of our local families and businesses. The Affordable Health Care for America Act makes important investments in the health and well-being of the American people, our seniors, our economy, and our future. I strongly support it and I look forward to its passage by the House of Representatives in coming days.'

The key components of the Affordable Health Care for America Act include:

INCREASING CHOICE AND COMPETITION: The bill will protect and improve consumers' choices.

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If people like their current plans, they will be able to keep them.

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For individuals who aren't currently covered by their employer, and some small businesses, the proposal will establish a new Health Insurance Exchange where consumers can comparison shop from a menu of affordable, quality health care options that will include private plans, health co-ops, and a new public health insurance option. The public health insurance option will play on a level playing field with private insurers, spurring additional competition.

*

This Exchange will create competition based on quality and price that leads to better coverage and care. Patients and doctors will have control over decisions about their health care, instead of insurance companies.

GIVING AMERICANS PEACE OF MIND: The legislation will ensure that Americans have portable, secure health care coverage - so that they won't lose care if their employer drops their plan or they lose their job.

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Every American who receives coverage through the Exchange will have a plan that includes standardized, comprehensive and quality health care benefits.

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It will end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and strictly limit age rating.

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The proposal will also eliminate co-pays for preventive care, and cap out-of-pocket expenses to protect every American from bankruptcy.

IMPROVING QUALITY OF CARE FOR EVERY AMERICAN: The legislation will ensure that Americans of all ages, from young children to retirees have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work.

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Guarantees that every child in America will have health care coverage that includes dental, hearing and vision benefits.

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Provides better preventive and wellness care. Every health care plan offered through the exchange and by employers after a grace period will cover preventive care at no cost to the patient.

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Increases the health care workforce to ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.

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Strengthens Medicare and Medicaid and closes the Medicare Part D 'donut hole' so that seniors and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.

ENSURING SHARED RESPONSIBILITY: The bill will ensure that individuals, employers, and the federal government share responsibility for a quality and affordable health care system.

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Employers can continue offering coverage to workers, and those who choose not offer coverage contribute a fee of eight percent of payroll.

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All individuals will generally be required to get coverage, either through their employer or the exchange, or pay a penalty of 2.5 percent of income, subject to a hardship exemption.

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The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.

PROTECTING CONSUMERS AND REDUCING WASTE, FRAUD, AND ABUSE: The legislation will put the interests of consumers first, protect them from problems in getting and keeping health care coverage, and reduce waste, fraud, and abuse.

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Provides transparency in plans in the Health Exchange so that consumers have the clear, complete information, in plain English, needed to select the plan that best meets their needs.

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Establishes consumer advocacy offices as part of the Exchange in order to protect consumers, answer questions, and assist with any problems related to their plans.

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Simplifies paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all encounter a streamlined, less confusing, more consumer friendly system.

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Increases funding of efforts to reduce waste, fraud and abuse; creates enhanced oversight of Medicare and Medicaid programs.

REDUCING THE DEFICIT AND ENSURING THE SOLVENCY OF MEDICARE AND MEDICAID. The legislation will be entirely paid for - it will not add a dime to the deficit. It will also put Medicare and Medicaid on the path to a more fiscally sound future, so seniors and low-income Americans can continue to receive the quality health care benefits for years to come.

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Pays for the entire cost of the legislation though a combination of savings achieved by making Medicare and Medicaid more efficient - without cutting seniors' benefits in any way - and revenue generated from placing a surcharge the top 0.3 percent of all households in the U.S.(married couples with adjusted gross income of over $1,000,000) and other tax measures.

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The Congressional Budget Office estimates the bill will reduce the deficit by at least $100 billion over ten years.

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AFFORDABLE HEALTH CARE FOR AMERICA ACT INTRODUCED IN CONGRESS. - States News Service

WASHINGTON -- The following information was released by the office of Washington Rep. Norman D. Dicks:

On October 29th, the Democratic Leadership introduced H.R. 3962, the Affordable Health Care for America Act, in the U.S. House of Representatives. H.R. 3962 blends and updates the three versions of previous bills passed by the House committees of jurisdiction in July. Since that time, Congress received an unprecedented amount of feedback from the American people through town halls, emails, phone calls and faxes. The feedback I received from my constituents was greatly appreciated, and while there were differences in the details, the majority were overwhelmingly supportive of the need to improve quality, expand coverage, and contain the rising costs of health insurance. This bill, which I intend to support, would accomplish these goals. Below you will find a summary of the key provisions in the bill, and links to more resources.

The key components of the Affordable health Care for America Act include:

Increasing choice and competition. The bill will protect and improve consumers' choices.

If people like their current plans, they will be able to keep them.

For individuals who aren't currently covered by their employer, and some small businesses, the proposal will establish a new Health Insurance Exchange where consumers can comparison shop from a menu of affordable, quality health care options that will include private plans, health co-ops, and a new public health insurance option. The public health insurance option will play on a level playing field with private insurers, spurring additional competition.

This Exchange will create competition based on quality and price that leads to better coverage and care. Patients and doctors will have control over decisions about their health care, instead of insurance companies.

Giving Americans peace of mind. The legislation will ensure that Americans have portable, secure health care coverage -- so that they won't lose care if their employer drops their plan or they lose their job.

Every American who receives coverage through the Exchange will have a plan that includes standardized, comprehensive and quality health care benefits.

It will end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and strictly limit age rating.

The proposal will also eliminate co-pays for preventive care, and cap out-of-pocket expensesto protects every American from bankruptcy.

Improving quality of care for every American. The legislation will ensure that Americans of all ages, from young children to retirees have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work.

Guarantees that every child in America will have health care coverage that includes dental, hearing and vision benefits.

Provides better preventive and wellness care. Every health care plan offered through the exchange and by employers after a grace period will cover preventive care at no cost to the patient.

Increases the health care workforce to ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.

Strengthens Medicare and Medicaid and closes the Medicare Part D 'donut hole' so that seniors and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.

Ensuring shared responsibility. The bill will ensure that individuals, employers, and the federal government share responsibility for a quality and affordable health care system.

Employers can continue offering coverage to workers, and those who choose not to offer coverage contribute a fee of eight percent of payroll.

All individuals will generally be required to get coverage, either through their employer or the exchange, or pay a penalty of 2.5 percent of income, subject to a hardship exemption.

The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.

Protecting consumers and reducing waste, fraud, and abuse. The legislation will put the interests of consumers first, protect them from problems in getting and keeping health care coverage, and reduce waste, fraud, and abuse.

Provides transparency in plans in the Health Exchange so that consumers have the clear, complete information, in plain English, needed to select the plan that best meets their needs.

Establishes consumer advocacy offices as part of the Exchange in order to protect consumers, answer questions, and assist with any problems related to their plans.

Simplifies paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all encounter a streamlined, less confusing, more consumer friendly system.

Increases funding of efforts to reduce waste, fraud and abuse; creates enhanced oversight of Medicare and Medicaid programs.

Reducing the deficit and ensuring the solvency of Medicare and Medicaid. The legislation will be entirely paid for -- it will not add a dime to the deficit. It will also put Medicare and Medicaid on the path to a more fiscally sound future, so seniors and low-income Americans can continue to receive the quality health care benefits for years to come.

Pays for the entire cost of the legislation though a combination of savings achieved by making Medicare and Medicaid more efficient -- without cutting seniors' benefits in any way -- and revenue generated from placing a surcharge the top 0.3 percent of all households in the U.S.(married couples with adjusted gross income of over $1,000,000) and other tax measures.

The Congressional Budget estimates the bill will reduce the deficit by at least $100 billion over ten years.

U.S. News & World Report/National Committee for Quality Assurance Ranks Great Lakes Health Plan among "America's Best Health Insurance Plans" for 2009-10. - Managed Care Weekly Digest

Great Lakes Health Plan (GLHP), part of AmeriChoice, is rated among the nation's Top 20 Medicaid health plans according to the 2009-10 U.S. News & World Report/National Committee for Quality Assurance (NCQA) survey of 'America's Best Health Insurance Plans.' Among Medicaid plans in the United States, GLHP ranks 19th , up from 21st in last year's study (see also AmeriChoice).

Each year, NCQA and U.S. News & World Report publish 'America's Best Health Insurance Plans,' which ranks the nation's commercial, Medicare and Medicaid health plans based on access to care, overall member satisfaction, prevention, treatment and overall quality score. NCQA is a private, nonprofit organization dedicated to improving health care quality.

'Great Lakes Health Plan's standing among the nation's best Medicaid health plans reflects our commitment to constantly improve and enhance the services we provide our members every day,' said David Livingston, GLHP president. 'In addition, GLHP received the NCQA's highest rating of 'Excellent' earlier this year. We are proud of the health care providers throughout Michigan who deliver such quality care and are honored to serve in a state with such highly recognized Medicaid plans.'

The 2009-2010 'America's Best Health Insurance Plans' survey also recognized three other Michigan Medicaid plans in the Top 20. The results are published online at http://health.usnews.com/sections/health/health-plans/index.html and will be featured in the December 2009 issue of U.S. News & World Report. About the study This collaborative study ranked the nation's commercial, Medicare and Medicaid health plans based on access to care (member's ability to get needed care, quickly contact health plan customer service), overall member satisfaction, prevention services (health screenings, prenatal care, childhood and adolescent immunizations, avoiding antibiotic overuse and well-child visits), treatment (how well the plan takes care of ongoing health problems), and overall quality score (a combination of the scores from the four main categories above and NCQA accreditation). 'America's Best Health Insurance Plans' is a trademark of U.S. News & World Report. About Great Lakes Health Plan Great Lakes Health Plan (GLHP) serves 204,000 people for Michigan Medicaid in 25 counties, including: Allegan, Berrien, Branch, Cass, Calhoun, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Monroe, Muskegon, Oakland, Oceana, Ottawa, Saginaw, Sanilac, St. Clair, St. Joseph, Tuscola, Van Buren, and Wayne. The health plan is a unit of AmeriChoice, the public sector health care business of UnitedHealth Group (NYSE: UNH). UnitedHealth Group is a diversified Fortune 50 health and well-being company. AmeriChoice serves 2.7 million people in government-sponsored health care programs in more than 20 states and the District of Columbia. For more information, visit www.americhoice.com.

Keywords: General Health, Health, Health Insurance, Health Policy, Insurance, Managed Care, Medicaid, Medicare, Medicare and Medicaid, Pediatrics, Professional Services, AmeriChoice.

WEEKLY ADDRESS: PRESIDENT OBAMA HIGHLIGHTS NEW TREASURY REPORT ON INSTABILITY OF HEALTH INSURANCE IN AMERICA. - States News Service

WASHINGTON -- The following information was released by the White House:

In this week's address, President Barack Obama highlighted a new report from the Treasury Department that found that about half of all Americans under 65 will lose their health coverage at some point over the next ten years. The report also found that Americans under 21 have more than a 50-percent chance of going uninsured at some point in that time. And more than one-third of Americans will go without coverage for longer than one year. The full Treasury report can be viewed HERE.

The full audio of the address is HERE. The video can be viewed online at www.whitehouse.gov.

Remarks of President Barack Obama

Weekly Address

The White House

September 12, 2009

On Wednesday, I addressed a joint session of Congress and the American people about why we need health insurance reform and what it will take to do it.

Since then, I've continued to hear from many Americans across the country about why this is so urgent and important.

I've heard from Americans who can't get health coverage; men and women who worry that one accident or illness could drive them into bankruptcy.

And I've heard from Americans with insurance who thought that 'the uninsured' always referred to someone else - but between skyrocketing costs and insurance company practices; they're beginning to worry that they could find themselves uninsured too.

It's an anxiety that's keeping more and more Americans awake at night. Over the last twelve months, nearly six million more Americans lost their health coverage - that's 17,000 men and women every single day. We're not just talking about Americans in poverty, either - we're talking about middle-class Americans. In other words, it can happen to anyone.

And based on a brand-new report from the Treasury Department, we can expect that about half of all Americans under 65 will lose their health coverage at some point over the next ten years. If you're under the age of 21 today, chances are more than half that you'll find yourself uninsured at some point in that time. And more than one-third of Americans will go without coverage for longer than one year.

I refuse to allow that future to happen. In the United States of America, no one should have to worry that they'll go without health insurance - not for one year, not for one month, not for one day. And once I sign my health reform plan into law - they won't.

My plan will provide more security and stability to those who have health insurance; offer quality, affordable choices to those who currently don't; and bring health care costs for our families, our businesses, and our government under control.

First of all, if you are among the hundreds of millions of Americans who already have insurance through your job, or Medicare, or Medicaid, or the VA, nothing in my plan will require you or your employer to change the coverage or the doctor you have.

What my plan will do is make the insurance you have work better for you. We'll make it illegal for insurance companies to deny you coverage because of a pre-existing condition, drop your coverage when you get sick, or water it down when you need it most. They'll no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or over a lifetime, and we will place a limit on how much you can be charged for out-of-pocket expenses - because no one should go broke just because they get sick.

Second, if you're one of the more than thirty million American citizens who can't get coverage, you'll finally have quality, affordable choices. If you lose your job, change your job, or start your own business, you will be able to get coverage.

And as I have said over and over again, I will not sign a plan that adds one dime to our deficits - period. This plan will be paid for. The middle-class will realize greater security, not higher taxes. And if we can successfully slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.

Affordable, quality care within reach for the tens of millions of Americans who don't have it today. Stability and security for the hundreds of millions who do. That's the reform we seek.

We have had a long and important debate. But now is the time for action. Because every day we wait, more Americans will lose their health care, their businesses, and their homes - but also the dreams they've worked for and the peace of mind they deserve. They are why we have to succeed.

The doctor octopus; Health insurance in America.(Far from curbing health insurers, Obamacare is making them bigger) - The Economist (US)

Obamacare is making health insurers bigger

THE future of Barack Obama's health law is uncertain. Its main provisions will not come into effect until 2014; the Supreme Court may strike it down before then. But America's insurers are already transforming. They were big before; now they are growing bigger. On October 24th Cigna, an insurer based in Connecticut, said it would pay $3.8 billion for HealthSpring, which offers services and insurance to the elderly. It is the latest deal to extend insurers' tentacles into new areas of health care. The question is whether they might actually improve it.

Good, cheap health care has long eluded America. Doctors are paid for each service, so they deliver as many as possible, necessary or not. Insurers protect margins by micromanaging claims and hiking premiums. These perverse incentives are addressed, faintly, by Obamacare. For example, there are pilots to reward hospitals for the quality rather than the quantity of their care. Mostly, however, the reform deals with the symptoms of muddled incentives: high premiums and poor access.

For insurers, reform holds opportunity and peril. From 2014 the law will require everyone to buy health insurance and offer subsidies to those who cannot afford it. As more people buy insurance, firms' revenues will more than double to $1.2 trillion by 2019, predicts the Boston Consulting Group. However, profits will be squeezed, thanks to a new tax, a minimum standard for benefits and new scrutiny of increases in premiums.

Faced with all this, insurers are keen to diversify. Many are hedging against a volatile private market by turning to the public one. More states are asking insurers to run Medicaid, the programme for the poor. HealthSpring will help Cigna tap the market for Medicare Advantage, private plans that use public money to cover the old. Humana, already a leader in public health programmes, has bought two Medicare firms this year (so far) and WellPoint has bought one. For these insurers, Medicare Advantage gives access to baby-boomers. It is also a testing ground for Mr Obama's new health 'exchanges', where consumers will be able to buy health insurance from 2014. Both are highly regulated markets that court consumers directly.

Insurers are spreading into new businesses. Last year Aetna bought a health information technology (IT) company. Humana recently bought a chain of clinics. Its new Medicare plans both provide care and pay for it. The thinking is that this will give Humana the means to keep more of its customers healthy. Others are doing the same.

UnitedHealth Group, the biggest health insurer, has been extending its reach for some time. Two non-insurance subsidiaries already account for 20% of its $94 billion annual revenue: OptumInsight, an IT business, and OptumHealth, which owns doctors' groups and provides services to help hospitals improve care. These ventures do not just create new revenue streams, argues Sheryl Skolnick of CRT Capital, a broker-dealer. They strengthen United's main business.

This is most obvious when OptumHealth buys a doctors' group. In August it announced that it would acquire Monarch HealthCare, in California. Bart Asner, Monarch's chief executive, predicts that Optum will help his doctors be more efficient, monitor patients' conditions and keep them healthier. United will enjoy revenue from owning Monarch. But as one of six insurers that contracts with Monarch, it will also benefit from patients' lower costs.

House health bill includes Medicaid relief for states; Expansion of coverage would come with $23.5 billion in aid - The Washington Post

Wedged in the House health-care bill is $23.5 billion that looksa lot more like new federal stimulus spending than anything to dowith national health-care reform.

The barely debated pot of money would allow Congress to continuepumping billions in new short-term aid to states to cover Medicaidcosts that have increased with rising unemployment in the past year.

The potential impact of the new spending became clear last weekwhen giddy state budget officials in capitals from Annapolis toSacramento penciled in the revenue, hoping that if health-carelegislation survives in the Senate, the states' bonus might squeakthrough.

Medicaid relief for states comprised one of the biggest pieces ofFebruary's $787 billion federal stimulus package, but that fundingwill run out next year, halfway through states' next round ofspending plans.

Under the Affordable Health Care for America Act, the federalgovernment would continue to pay a higher share of all Medicaidcosts -- 66 percent on average, up from 57 percent before thestimulus -- for an additional six months, and erase in one fellswoop a major chunk of states' projected shortfalls for the comingyear.

'It would be a huge help -- critical,' said Cindi Jones, chiefdeputy director of Virginia's Medicaid program, which quicklyestimated last week that it would receive an extra $360 million to$380 million next year under the bill. At a meeting last week of thenation's Medicaid directors, Jones said the group is unanimously infavor of the provision.

Said Steve Ford, the department's director of policy andresearch: 'We don't get bogged down in the terminology of what it is-- [more stimulus] or not. We've viewed it as our federal increase. . . which obviously helps the state.'

House Republicans, who had repeatedly blasted the cost of thebill, never directly attacked the additional state funding in thefinal floor debate leading up to the Nov. 7 vote, even as theycharged in other contexts in recent weeks that Democrats were tryingto increase federal spending without introducing a second stimuluspackage.

Only one Republican, Rep. Don Young (Alaska), issued a statementbefore the vote condemning the $23.5 billion, saying the fundingwould only delay the inevitable. In six months, he said, statesagain would not have enough to cover their Medicaid costs.

Chris Whatley, Washington director for the nonpartisan Council ofState Governments, said he sees an explicit political motive on thepart of those backing the House bill. 'It would force states toabsorb huge new Medicaid cost loads, and they want states to lookpast their immediate crisis and believe it's going to be okay. It'sa sugarcoating to help them swallow a very bitter pill.'

Two House Democrats who spoke on the condition of anonymity sothat they could freely discuss the provision in closed-doornegotiations, said the measure was designed to be a pragmaticsolution to the reality that states do not have the capacity to dealwith a reversion to regular Medicaid rates. Without another boost infunding to prop them up until their tax revenue rebounds, stateswould have to severely restrict access to Medicaid and otherservices for the poor or would have to cut programs, which couldnecessitate the layoffs of thousands of public employees and furtherdepress the economy.

The two said the provision, which was added to the bill lastmonth, also was part of a more complex set of final tradeoffs tocontrol the cost of the House measure after the chamber's Democraticleadership settled on a goal of extending Medicaid coverage toeveryone making up to 150 percent of the poverty rate.

The $23.5 billion in new short-term aid, they said, would partlyoffset other provisions that would require states to begin paying atiny fraction of the costs of new Medicaid enrollees in 2015, a yearearlier than in previous versions of the legislation. The finalHouse bill also would increase, to 9 percent, states' permanentshare of the costs for new enrollees.

'Call it stimulus if you want,' one of the Democrats said, 'butit's a recognition that it's a dire situation for states that haveto run a balanced budget.'

John Holahan, a Medicaid expert at the Urban Institute, said thatif it had not come up in the course of health-care legislation, itprobably was only a matter of time before Congress would have had toaddress the end of Medicaid stimulus funding.

'When we got into 2010, there was going to be a lot of talk abouta need for more stimulus. I guess maybe to avoid that they put it inhere,' Holahan said. 'It was going to come up somehow, we're goingto be looking at high unemployment and swollen Medicaid rolls beyond2010,' he said.

The provision, Section 1749 of the House measure, would extendthrough June 2011 an across-the-board 6.2 percent increase infederal Medicaid matching money, as well as additional percentage-point benefits that most states now qualify for because of highunemployment rates.

In Maryland, the measure would mean $384 million next year in newfunding, or enough to cover about 20 percent of the state'sprojected $1.9 billion shortfall.

Robin Rudowitz, a principal policy analyst for the KaiserCommission on Medicaid and the Uninsured, said it is unclear whetherthe six-month fix would be enough. 'Most states are not anticipatingtheir revenue to be back up to levels seen before the recession fora few more years,' she said. States may still be faced with'previously unthinkable Medicaid cuts when the funding ends.'

Raymond C. Scheppach, executive director of the NationalGovernors Association, said that even if the $23.5 billion survivesas part of the health-care overhaul, the six-month extension of thestimulus spending would still end too abruptly. 'It's sort of like acliff,' he said. States 'get the funding for two more quarters, butwe would prefer that it ratchet down over a couple more. The cliffis just moved back.'