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.

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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.'

Health America makes executive changes - Tribune-Review/Pittsburgh Tribune-Review

Health America, a health care insurer with offices Downtown, saidFriday it has made three executive-level personnel changes.

Mary Louise Osborne was named chief operating officer,responsible for statewide operations for the insurer's Medicare,Medicaid and individual lines of business.

Dr. Robert S. Mirsky was named chief medical officer, workingwith the insurer's medical directors and staff to manage the healthplan's quality assurance activities.

Worrying about health: America's private health-care system costs too much and delivers too little. (American Survey) - The Economist (US)

COMFORTABLE, working American has little cause to complain- about the quality of health care he receives. The United States is brimful with highly paid doctors, one for every 400 citizens. These doctors have at hand the world's finest gadgetry, in liberal quantities: the rich western part of Germany has 0.7 open-heart surgical units per million people, and Canada 1.2, but America boasts 3.3. Best of all, for that working American, health care is nearly always a perk that comes with the job. That renders almost bearable the mass of form-filling that sprouts with each verruca.

Physician paradise, though, is fast becoming corporate hell. For 50 years a benign federal government has encouraged companies to provide health cover for their workers by exempting health benefits from income tax. Employers now pay for 85% of the 173m Americans covered by private health insurance. The cost of health, meanwhile, has ballooned. Annual spending per head on health care has risen, in constant dollars, from $950 in 1970 to $2,350 in 1989. For most businesses, health care is the second-biggest item of expenditure behind salaries. The cost, on average, is now equivalent to two-fifths of companies' post-tax profits.

Yet it is the tax break which, more than anything, contributes to America's climbing health costs. Since an employer pays for most of the benefits of his staff, they have little incentive to keep medical costs down. By the same token, hospitals and doctors, charging a fee for each service rendered (and fearing malpractice suits), have a duty to themselves not to skimp on treatment.

Both business and government have made attempts to control medical costs by, for instance, rationing the services provided to consumers. But often costs saved in one quarter have merely flowed to another. Health spending continues to grow by 5% a year in real terms. In 1980 health spending absorbed 9.3% of GDP; in 1989 it absorbed nearly 12%, or $604 billion. Canada spends only 8.7% of itS GDP on health, Britain 5.8%.

Employees are now learning that they are not immune to business's troubles. Last year four-fifths of all of America's labour disputes centred on medical benefits that companies were trying to cut. Thousands of (mostly small) businesses cannot, or choose not to, provide health cover for their workers-particularly in industries that insurers deem to be high-risk. These workers are usually too poor to buy their own insurance. As a result, the employed account for most of the 34m Americans (including dependants) who languish without medical insurance. A large but unknown number of other employees, particularly those with a history of high medical costs, want to change jobs but cannot, for fear of losing health insurance.

As with business, so with federal and state governments. Largely through the Medicare programme for the elderly and Medicaid for the poor, federal and state governments now pay for 42 cents of every dollar spent on health care (they also lose about $58 billion of revenues from those tax perks). indeed, the American government spends almost as much of GDP on health as the British government does (see chart on next page). This might have been expected to rein in costs. Yet spending on health as a share of all federal spending has risen from 10% in 1975 to nearly 15% today. Medicare costs, at an annual $100 billion, are soaring, largely because more old people are being kept alive longer with ever costlier technology. The Medicaid programme covers only two-fifths of those officially described as poor. Yet the Bush administration is bewildered that Medicaid costs are wildly exceeding predictions.

A Democratic stretcher-case or two

All of which has led some Democratic Party barons, headed by George Mitchell, the Senate majority leader, to think that they might have found an issue with which to shame the administration. Two kinds of reform are proposed.

The first is for America to adopt the Canadian system of health care. in this, though hospitals and doctors work largely in the private sector, universal access to medical care is paid for by the government out of taxation. This idea is popular among an unusual alliance of labour leaders and big companies-the ones that would like to be relieved of expensive commitments to past and present employees.

Last week four Democratic senators launched a bill to reform health care in a different manner. Under this bill businesses would have the choice of either insuring all employees or contributing to a payroll tax, from which government would provide coverage. This plan, supported by Mr Mitchell, has the advantage that it would not radically change the current mix of health-care finance-non-profit insurers, private insurers and health maintenance organisations (HMOS), which, for an annual fee, dispense health care to their clients through own-brand doctors and hospitals.

Yet both plans are flawed. Canada's system suffers from queues, shortages and ropey equipment. Canada's long border with America's swifter medical services acts as a safety valve to a system under pressure. Moreover, the Canadian government's monopoly over health spending has failed to curb costs. in the 20 years to 1987, Canada's real spending per person rose by 4.6% a year, compared with 4.4% in America.

Forcing business to foot the bill is even less feasible. The Mitchell plan envisages a tangle of subsidies for small and barely profitable businesses. The annual cost of these and other subsidies could be $60 billion or more. Given the current state of the budget, the money could not be found.

Neither proposal promises to restrain spending. One that does is being advanced by the Heritage Foundation, a conservative think-tank. This simply proposes that the link between tax breaks and employer-provided cover be abolished. In its place, tax credits would be given to families, varying according to income and health expenditure. in return families would, by law, be required to buy a minimum degree of health cover. Such a system would help to control costs by putting spending choices in the user's hands, allowing him to choose among current insurers and providers. It would also allow him to carry health cover from one place of work to the next.

If they were imaginative enough to see it, such a proposal-as well as being by far the simplest of the three-would have something to appeal to both Democrats and Republicans. By taking nearly $60 billion of tax breaks from the well-paid employees who now benefit most from them, and then spreading them as credits to the less well-paid, the Democrats could back a progressive tax reform. And giving more power to the consumer would dance well to the tune of 'empowerment' that the White House has been whistling of late.

MEDICAID MAY BE DISMANTLED BY CLINTO HEALTH CARE REFORM PAPERS SUGGEST NEW PROGRAM WOULD END SEGREGATION OF POOR.(Main) - Albany Times Union (Albany, NY)

Byline: ROBERT PEAR New York Times

As part of its health care plan, the Clinton administration is considering a proposal to dismantle the Medicaid program and integrate low-income people into the same networks of doctors, hospitals and private insurance companies that would serve more affluent people, administration officials say. But poor people would probably receive medical and social services beyond the standard package of health benefits to be guaranteed to all Americans, the officials said.

These might include additional dental care, transportation to a doctor's office and translation services for people who do not understand English. And the government would help pay the insurance premiums and other health costs of low-income people.

Confidential work papers from Hillary Rodham Clinton's Task Force on National Health Care Reform say that maintaining a separate Medicaid program 'would perpetuate segregation of the poor in the health care system, with the associated adverse implications for access to and quality of care.'

Today, the task force will hold its first public hearing. The group is considering numerous proposals, some being leaked to test public reaction. Whatever the group recommends to the President and he approves will also have to be approved by Congress.

How to care for the nation's 35.7 million poor people is one of the most important moral, political and policy questions facing the administration as it drafts a legislative proposal for sweeping changes in America's health care system.

Drew E. Altman, president of the Henry J. Kaiser Family Foundation, which is sponsoring a major study of Medicaid, said: 'There are really serious problems in putting Medicaid into the new system, but that's what we ought to do. A separate program for poor people will always be a poor program, underfunded and neglected.'

Altman, a former commissioner of Human Services in New Jersey, said he worried about how poor people, members of minorities and those with special medical needs would fare under the new system.

While no final decisions have been made, the shift of millions of people out of Medicaid and into the networks of doctors and hospitals would probably occur over several years.

Established in 1965 to finance health care for low-income people, Medicaid now provides care for more than 30 million people, including several million with incomes just over the official poverty level. It has become one of the fastest growing programs in the government. The federal government expects to spend nearly $80 billion on Medicaid in the current fiscal year, while the states plan to spend $60 billion.

But many people, in and out of the government, question whether the differing needs of poor people and the middle class can be adequately addressed within the same networks of doctors, hospitals and insurance companies.

Doctors say poor people are more likely to have special health needs and problems, ranging from AIDS to drug abuse, tuberculosis, diabetes, high blood pressure and birth defects.

Throughout the work papers of the task force, it is assumed that Medicaid recipients 'will be integrated fully or partially' into the new system, which the administration calls managed competition.

Under that system, huge consumer groups, known as health insurance purchasing cooperatives, would buy health care from large networks of doctors and hospitals. Advocates of this proposal say the buyers will command so much economic power in the medical marketplace that they can get high-quality care at reasonable prices.

In most states, Medicaid recipients can now generally go to any doctor or hospital that will accept them. The doctors and hospitals are typically paid for each service or procedure they perform. But many doctors take only limited numbers of Medicaid patients, and some doctors and private hospitals do not take any.

Under Clinton's plan, more people would be enrolled in health maintenance organizations and similar groups. Government agencies and employers would pay a fixed amount, set in advance, for each patient.

Rather than having unlimited freedom to use any doctor or hospital, consumers might have to go through one doctor, a 'case manager,' who would approve their use of specialists and hospitals.

Proposals for Medicaid do not imply any immediate changes in Medicare, the federal health insurance program for the elderly. But the task force's working papers show that the administration is considering changes in Medicare so it would eventually be compatible with the new health care system for people under 65.

Unpaid Medicaid bills ail health providers - Chicago Sun-Times

The situation that affects the Medicaid providers of this stateis unconscionable. The State of Illinois has not paid its billssince June, 1991. The Medicaid providers have continued to providetheir services. But, doomsday is imminent. Most of these providershave borrowed money to keep running; they all will soon reach theircredit limits. When that happens, the services will close.

I am on the board of directors of the Riverside Foundation, aresidential and day training facility in Lincolnshire for 96moderately and severely retarded adults. I know what our balancesheet looks like. I know just how stretched we are. I know that thebreaking point is not far off (within weeks). If we can't pay thestaff, buy food, provide medicine, wash sheets, repair plumbing, payrent, etc., we will have to close the doors. Where do the residentsgo?

The state Legislature has developed a voodoo-type plan thatdirects Medicaid providers to pay a tax - before they have any funds- that the state will then use to entice the federal government toreimburse the providers for all Medicaid expenses, plus a 'kicker.'And, in the process, the state gets to keep a little. Sounds great?

Hogwash!

The federal government has already closed that loophole. Theproviders must borrow funds to pay the tax - since the state isalready five to six months late in paying its bills. The increasedborrowing by the providers takes away opportunities to provide food,medicine and services to those in need. And, on top of everythingelse, who's going to trust the state at this point?

Something must be done now!

State of Illinois - pay your bills! Harvey L. Miller, corporate secretary, Quill Corp., Lincolnshire Bad policy

Regarding the CTA whistle blowers: They should have gotten amedal for guts in exposing dishonesty among the CTA workers.

Now, the rest of the employees will be kept in line so thedishonest ones can go on freely lining their pockets. No wonder ourfares are going up.

My heart goes out to the poor people who lost their jobs. Godhelp them! Bernice Wasielewska, Archer Heights Not Irish

Andrew Greeley ('Let Irish share in multicultural bounty,'column, Nov. 17) seems to think there are as many Irish in America asthere are blacks. He does not say where he got his numbers.

The term Irish should be used to describe people who have comehere from Ireland. It should not be applied to the children ofgrandchildren of such people unless they observe faithfully, overhere, the customs and folkways of that dear land across the sea. Andit should certainly not be applied to someone with an Irish nameinherited from some remote paternal ancestor.

In the 19th century, real, genuine Irish people were numerous inAmerica as a result of wholesale emigration from that most distressedcountry. They came here, and they made their mark. In our largercities, they were able to demonstrate a talent for politicalorganization that they never knew they had in the old country.

There are people today in certain lines of work, such aspolitics or the selling of used cars, who think it is helpful to callthemselves Irish. Their claims to the label are often dubious andsometimes quite imaginary, but they do no harm. Pseudo-Irish arewith us in abundance but should not be confused with the genuinearticle. John McIntyre, Downers Grove Wrong numbers

I'm writing in response to 'The new blue collars: City trainsstudents for manufacturing' (news story, Nov. 17). The figuresquoted to the reporter by the Economic Development Commission ofChicago misrepresented the precision metalworking industry, and Iwish to clarify the information regarding wages.

The Tooling & Manufacturing Association trains apprenticesthrough its apprentice-related theory program toward certification astool and die makers, moldmakers, precision machinists and precisionsheetmetal-modelmakers. Experienced precision metalworkers typicallyearn between $35,000 to $50,000 annually. Overtime is unquestionablycommon, with the work week averaging 45 to 50 hours.

Even at the intern level, aspiring precession metalworkers canexpect to earn nearly $20,000 during the first year. The news storystated an entry level metalworker can earn $16,000 to $32,000. Inorder for an entry level metalworker to earn $32,000, he or she wouldhave to possess a degree in engineering. After five years oftraining, some toolmakers will earn $35,000, but that depends ontheir responsibilities and skills.

The news story also stated a metalworker can earn as much as$70,000 a year, excluding overtime. This is grossly exaggerated.For a metalworker to earn $70,000 a year, he or she would have towork a 70-hour week, with time-and-a-half at $16 per hour. Topmetalworkers earn $20 an hour, which is $41,600 annually.

Indeed, there is a shortage of skilled technologists in themetalworking industry, not just in Chicago and Illinois, but alsoacross the nation. Despite good pay and job security, the industrycannot attract enough qualified applicants. Therefore, as many as1,500 to 2,000 jobs a year are going unfilled. Keith A. Miller, manager, communications and public affairs, Tooling and Manufacturing Association, Park Ridge Senseless losses

Your Nov. 20 edition had a picture of a Cooper's hawk thatkilled itself by flying into a Loop skyscraper. Sadly, Chicago'sdowntown area is built on a migratory bird path. Though thisbeautiful hawk is newsworthy, hundreds of small migratory birds meettheir death on the mirrored glass windows of Loop buildings everyspring and fall during the migration.

The birds see their reflection and think they are flying towardanother one of their kind, when it is actually their own destructionthey are about to meet. In most cases a simple hawk silhouette wouldfrighten these birds off and save their lives. Most of them aremembers of dwindling species that may ultimately face extinction astheir habitat continues to be depleted or destroyed.

It is not often that a huge hawk loses its life by striking abuilding, but certainly not unheard of. What saddens me is that Loopskyscrapers are a poignant examples of man's inability to cohabitatewith nature. We build these steel and glass giants but make noprovisions for the birds who have used this air space for centuries.Why can't the new survive without killing the old?

Further generations, maybe hundreds of years from now, willcertainly look back and wonder why we could not have spent two bucksfor a silhouette or, with all our ingenuity, come up with anothersolution so that our descendants could also witness the beauty of abird winging its way overhead toward destinations beyond the horizon. Buzz Alpert, Loop Serious problem

There is a serious problem in the African American community.It is not the problem of poor medical care, housing, gang wars ordrugs. The problem is 'outsiders' in control of all the businesseswithin the African American community.

I, personally, find it hard to accept or adjust to this insult.

There is truly something seriously wrong when an outside groupof people composes the majority of owners within any community.

But the biggest problem is that we - yes, us the AfricanAmericans - have adjusted and accepted this insult.

There is no outrage from our political representatives, churchleaders, educators, parents, etc.

Some of us even believe it's OK and, worse yet, believe we can'tand don't want to own or manage the businesses in our communities.

Please! Anyone and everyone, leaders and followers, show somevision and bring about a change. As consumers, we must be selective.

If you find yourself absolutely and completely surrounded byoutsiders, at least insist on employment, fair prices and qualityservice from these outsiders. Gwendolyn M. Carter, Douglas Curtail curfew

I have strong feelings against the new curfew laws that might bepassed. This law will affect many people who have nothing to do withgangs, drugs or violence.

Even though violence in Chicago has gone up, I think this lawshould apply only to the reputed gang members and drug dealers andthose known to help them.

This law would open doors for police to harass minorities. Thislaw would basically roll out the red carpet for police to harassyoung people.

I read that under this law, police would be able to disperse agroup (if you can even call it a group) of two people, even if theyare not engaged in any act of violence what so ever. This is notfair! Cesar Torres, West Town Right moves

We may perceive Donald (Trump) as a wild and carefree playboy,but I believe him to be a truthful playboy.

While blowing his trumpet the other day, Trump noted that thisso called recession is a depression. Who should know better, GeorgeBush?

George Bush, like Herbie Hoover will not admit how bad thingsare.

Yep, folks, listen to me! Prosperity is just around the corner.I see a chicken in every pot and a car in every garage. But some ofus don't have a pot or a garage.

Is it possible that George Bush, the world leader, is tired ofbeing president of the United States? If that is so, he's making allthe right moves.

We'll be thinking of you George, next year at the polls - yeah,sure we will! Chuck Robertson, Springfield, Wis. Unfair changes

Mr. Firemen, Mr. Policeman, retire early! We will give you$1,000 a month and you will pay $55 for family health insurance.That was 10 years ago.

STATEMENT BY STEVEN B. LARSEN, J.D. DEPUTY ADMINISTRATOR AND DIRECTOR CENTER FOR CONSUMER INFORMATION AND INSURANCE OVERSIGHT CENTERS FOR MEDICARE AND MEDICAID SERVICES ON EXPANDING HEALTH CARE OPTIONS: ALLOWING AMERICANS TO PURCHASE AFFORDABLE COVERAGE ACROSS STATE LINES. - States News Service

WASHINGTON, DC -- The following information was released by the U.S. Department of Health & Human Services:

Statement by

Steven B. Larsen, J.D.

Deputy Administrator and Director

Center for Consumer Information and Insurance Oversight

Centers For Medicare and Medicaid Services

on

Expanding Health Care Options: Allowing Americans To Purchase Affordable Coverage Across State Lines

before

Committee on Energy and Commerce, Subcommittee on Health

United States House of Representatives

Chairman Pitts, Ranking Member Pallone, and Members of the Subcommittee, thank you for the opportunity to discuss important health insurance reforms that promote choice, affordability, and options for American families. The Patient Protection and Affordable Care Act (P.L.111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), collectively referred to as the Affordable Care Act, ushered in a new era in American health care. The Affordable Care Act improves America's private health insurance system by instituting reforms that will help make affordable, high-quality insurance coverage accessible to millions of Americans, many of whom were not insured at the time of its passage.

As a former insurance commissioner, these issues are particularly important to me. For the past 14 months, my office, the Center for Consumer Information and Insurance Oversight (CCIIO) within the Centers for Medicare and Medicaid Services (CMS), has been steadily working to implement provisions of the Affordable Care Act that expand access to affordable coverage to millions of Americans, strengthen consumer protections, and help to end some of the worst insurance company abuses. These reforms create an important foundation of patients' rights in the private health insurance market, increase choices and options for families, and put Americans back in charge of their own health care. To date, we have already implemented several important private market reforms, including: eliminating pre-existing condition exclusions for children; prohibiting insurance companies from rescinding coverage and imposing lifetime dollar limits on coverage; and enabling many adult children to stay on their parent's insurance plan up to age 26.

The Affordable Care Act also established new programs that make health care more affordable and accessible, such as the Pre-Existing Condition Insurance Plan (PCIP) program and the Early Retiree Reinsurance Program, as a bridge to 2014 when all Americans will have access to affordable coverage choices. With the Affordable Care Act, our country is finally moving away from the broken health insurance system of the past to a new system that insures more Americans at more affordable rates with more benefits and protections. Because of the new protections and provisions in the law, many insurers will no longer be able to discriminate against the sick, limit coverage, and profit at the expense of America's families.

Selling Insurance Across State Lines

Thanks to the Affordable Care Act, today, Americans have many more health care choices. In 2014, State-based health insurance Exchanges will be in place, providing more options and better value for consumers and small businesses. Health insurance Exchanges, market reforms, and other policies contained in the Affordable Care Act create a health insurance market where health plans will have to compete on price and quality by providing consumers with easy-to-understand choices.

Selling insurance across State lines has long been proposed as an option to increase competition and choices in health insurance, but there are serious pitfalls with this approach when it is not coupled with adequate consumer protections. The Affordable Care Act allows health care to be sold across State lines when both States agree and consumer protections are maintained. Without the consumer protections included in the Affordable Care Act, we run the risk of creating an environment where there is a 'race to the bottom' in which insurers have an incentive to sell plans from the State with fewest consumer protections. Under section 1333, by July 1, 2013, the Secretary of HHS, in consultation with the National Association of Insurance Commissioners (NAIC), will issue regulations for the creation of health care choice compacts. Under these compacts, two or more States may agree to allow qualified health plans to sell insurance in their States. Plans will be subject to the laws and regulations of the State in which the plan was written or issued. Additionally, these plans must offer the same required by the consumer's State. Health care choice compacts are effective beginning January 1, 2016. These provisions ensure that interstate sale of health insurance is not a back-door attempt to disadvantage higher-risk individuals or preempt critical consumer protections.

Ensuring Coverage for More Americans

The Affordable Care Act ensures that more Americans have health insurance coverage through programs that are already helping young adults and people with chronic health problems receive the coverage they need. As a result of the Affordable Care Act, most insurance companies now must allow adult children to stay on a parent's plan until age 26 and may not deny children health insurance benefits or coverage because of a health problem. CCIIO has already implemented the Pre-Existing Conditions Insurance Plan (PCIP) program, which makes health coverage available to uninsured Americans who have been without coverage for over six months and have a pre-existing condition - providing a bridge to 2014 when affordable coverage options will be widely available without discrimination. Thousands of Americans who had been turned away by insurers because of their health history are now getting critical treatments and medicines thanks to PCIP.

Between February 1, 2011 and April 1, 2011, enrollment in PCIP has increased by nearly 50 percent, with over 18,000 individuals currently receiving coverage under this important program.[1] The PCIP program has provided invaluable help to people like Jerry Garner. Mr. Garner, a real estate agent from Gowen, Michigan who the New York Times recently featured, lost his health insurance after undergoing a kidney transplant. Because of his pre-existing condition, he was unable to obtain new insurance to cover the $2,000 monthly bills for the immunosuppressive medications that transplant patients must take to prevent rejection of a new organ. Mr. Garner signed up for Michigan's PCIP program and is now paying lower premiums than he did under his previous insurance and is receiving more comprehensive coverage. Mr. Garner's wife told the New York Times that the PCIP program 'was definitely an answered prayer.'[2]

Before the passage of the Affordable Care Act, many young adults who were enrolled in college or starting in the workforce in entry-level jobs could not maintain coverage under their parent's health plan. Young adults are more than twice as likely to be uninsured than older adults, making it harder for them to get the health care they need, and putting them at risk of going into debt from high medical bills. Now, thanks to the Affordable Care Act, most health plans that cover children must make coverage available to adult children up to age 26. Alexander Lataille, 23, of Laurel, Maryland is one of many young adults who have benefited from this provision. Alexander graduated from college last spring and was worried his insurance company would kick him off his parent's plan, especially since he has asthma. As a result of the Affordable Care Act, his insurance company allowed him to stay enrolled in his parent's plan, giving him peace of mind while he looked for full-time employment. 'It was a big relief,' Mr. Lataille told Kaiser Health News.[3] Because of the Affordable Care Act, over 600,000 young adults[4] have already signed up for their parent's health plan; we estimate that a total of 1.24 million young adults will gain coverage through this provision in 2011.

In the future, more people will obtain coverage or more comprehensive benefits or realize lower health insurance premiums because of the critical protections of the Affordable Care Act. The Congressional Budget Office estimates that by 2019, 24 million people will gain insurance coverage through the new health insurance Exchanges.[5] These Exchanges will create affordable, quality insurance options for many Americans who previously did not have health insurance coverage, had inadequate coverage, or were at risk of losing the coverage they had. The Exchanges will make purchasing private health coverage easier by providing eligible consumers and small businesses with 'one-stop-shopping' to compare and select from a range of affordable plans.

Additional Consumer Protections and Resources

The Affordable Care Act gives millions of Americans important new health insurance protections. The Affordable Care Act also prohibits most insurers from discriminating against patients with health conditions like cancer and diabetes. About one in 12 Americans suffer from diabetes,[6] and nearly one in 25 Americans has cancer.[7] The Affordable Care Act helps ensure these Americans have access to care. Before passage of the Affordable Care Act, tens of thousands of people were denied insurance each year because of an illness or condition. Today, most plans cannot deny coverage to children because of a pre-existing condition. Up to 72,000 uninsured children are expected to gain coverage through this provision.[8] In 2014, most insurance companies cannot discriminate against someone because of a pre-existing condition.

We have also prohibited insurance company rescissions, so most insurers can no longer cancel coverage when individuals get sick just because they made a mistake with their application paperwork. We have put an end to lifetime dollar limits on essential benefits - limits that in the past often meant coverage was gone when people needed it most. Patients in non-grandfathered health plans now have greater freedom to choose their own doctor and to go to the nearest emergency room when they are injured or face a life-threatening health situation. By 2014, annual dollar limits on essential benefits will also mostly be a thing of the past. Americans are already benefiting from new rules that require coverage of preventive services; important early detection services like mammograms and colonoscopies must now be available to Americans in new plans without expensive co-pays or deductibles.

Consumers today have unprecedented access to critically important information about insurance options and public programs available to them on a geographic basis. During the past several months, www.HealthCare.gov has had millions of visitors and the information housed in this on-line tool continues to grow rapidly. Visitors can get easy-to-understand information in English and Spanish about the coverage options available to them, their protections, and their rights as health care consumers.

Affordable Coverage for All Americans

The Affordable Care Act makes coverage more affordable by holding insurers accountable for the premiums they charge consumers and helping employers maintain or offer health benefits. Significant health insurance premium hikes proposed by insurers will be publicly available on the internet and will be subject to a review. States will receive $250 million in grants to bolster their own rate review process. For the first time, insurers will be held accountable for how premium dollars are spent. The new medical loss ratio (MLR) protections implemented last year ensure that insurers spend at least 80 or 85 percent (depending on the market) of premium dollars on actual health care services and quality improvement efforts - not marketing and CEO bonuses. Insurance companies that do not meet the standard will have two choices: reduce premiums or send cash rebates to their customers. Recognizing State flexibility, the law allows for a temporary adjustment to the individual market MLR standard if a State requests it and demonstrates that the 80 percent MLR standard may destabilize its individual insurance market. We are already seeing indications that the MLR and rate review policies are causing insurance companies to think twice about their premium increases and, in some cases, mitigate annual premium hikes. For example, more than 15,000 Aetna customers in Connecticut may see their health insurance premiums drop by between five and 19.5 percent due to, in part, the new MLR policy. [9]

The Affordable Care Act also provides new programs and tax credits to assist employers that offer health benefits to their workers. More than 5,000 businesses, State and local governments, and employee trusts are participating in a new program under the Affordable Care Act[10] that helps employers retain retiree coverage for Americans 55 to 64 years of age. Also, more than 4 million small businesses have been notified that they may be eligible for tax relief to help provide insurance coverage to their workers.[11]

Americans will see additional savings from the health insurance Exchanges that begin by 2014. Beginning in 2014, State-based health insurance Exchanges will improve access to affordable, quality insurance options for Americans who previously had no health insurance coverage or inadequate coverage. The Exchanges will make purchasing private health insurance coverage easier by providing individuals, families, and small businesses with 'one-stop shopping' where they will be able to compare a range of plans. Eligible individuals will also have new premium tax credits and cost-sharing reductions available to them to make coverage more affordable. By increasing competition between insurance companies and allowing individuals and small businesses to band together to purchase insurance, Exchanges will help to lower health care costs for consumers.

Moving Forward

Through new coverage options and consumer protections, the Affordable Care Act has already improved America's health care system for millions of Americans. And every day we move forward to full implementation of the law, when all Americans will have access to quality, affordable health insurance free of restrictions due to pre-existing conditions or benefit caps. In the meantime, I look forward to continuing to implement provisions of the Affordable Care Act, while considering stakeholders' ideas and input.

[1] 'State by State Enrollment in the Pre-Existing Condition Insurance Plan, as of March 31, 2011.' Link here.

[2] Walecia Konrad, 'Pre-existing Condition? Now, a Health Policy May Not Be Impossible.' The New York Times, March 18, 2011, link here.

[3] Phil Galewitz, 'At Least 600,000 Young Adults Join Parents' Health Plans Under New Law.' Kaiser Health News, May 3, 2011, link here.

[4] Phil Galewitz, 'At Least 600,000 Young Adults Join Parents' Health Plans Under New Law.' Kaiser Health News, May 3, 2011, link here.

[5] CBO's March 2011 Baseline: Health Insurance Exchanges. Link, here.

[6] 'Data from the 2011 National Diabetes Fact Sheet.' January 26, 2011, link here.

[7] 'Cancer Prevalence: How Many People Have Cancer?' October 7, 2010, link here.

[8] 'Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patients Protections.' (OCIIO-9994-IFC), link here.

[9] Arielle Levin Becker, 'As Federal Health Reforms Take Effect, Aetna Proposes Rate Cuts.' The Connecticut Mirror. May 11, 2011, link, here.

[10] Progress Report on the Early Retiree Reinsurance Program, March 31, 2011. Link, here.

SEN. GRASSLEY ISSUES STATEMENT ON MEDICARE, MEDICAID, AND SCHIP INDIAN HEALTH CARE IMPROVEMENT ACT OF 2006 - US Fed News Service, Including US State News

At a hearing of the Senate Finance Committee, Sen. Charles Grassley made the following opening remarks:

Our first mark before us today is the Medicare, Medicaid, and SCHIP Indian Health Care Improvement Act of 2006. This bill encompasses the provisions of the Indian Health Care Improvement Act, S.1057, reported by the Indian Affairs Committee on March 16, that are in the jurisdiction of the Finance Committee. This legislation today helps us keep our commitment to provide quality health care to Indians. The legislation we are considering today would allow the tribes to be able to use money from Medicare and Medicaid to maximize improvement of the care provided to Indians. This legislation provides for increased outreach for Indian tribes to assist Indians in applying for Medicaid or SCHIP. This legislation also provides relief for Indians from Medicaid cost-sharing or premiums if that Indian comes to Medicaid by contract or referral. This is a fair and balanced policy as those Indians would not be subject to cost-sharing or premiums if their care was provided by an Indian Health provider.

This legislation creates incentives for Medicaid managed care plans that enroll Indians to include Indian Health providers in their networks. Indians have relationships with their health care providers and many prefer to receive services from an Indian Health provider. Under current law, if an Indian sees a provider not in the plan's network, that provider won't likely get paid except under certain circumstances. The Chairman's Mark helps fix that by requiring managed care plans that serve a large number of Indians to include Indian Health providers in their networks or to make alternative arrangements to make sure they're paid.

Finally, this legislation requires reporting of data on Indians served, the status of their health care, and efforts being made to upgrade facilities that may not be in compliance with Social Security Act requirements. This is valuable information that will aid us in insuring that we are providing quality care to Indians. I appreciate the efforts of Senator Baucus in helping us with this legislation as well as Senator McCain and Senator Dorgan. The work that has gone into today's markup has been a bipartisan process involving both committees. Their assistance has been invaluable.

Today we will also consider a bipartisan Chairman's Mark, the Improving Outcomes for Children Affected by Meth Act of 2006. This bill reauthorizes and improves the Promoting Safe and Stable Families program as well as the Mentoring of Children of Prisoners program. There is a long history of the Congress working productively on a bipartisan basis to improve child welfare. I am glad to report that this spirit of bipartisanship is alive and well on the Senate Finance Committee. The Senate Finance Committee has held two important hearings on child welfare. These are the first hearings the Senate Finance Committee has held on child welfare issues in nearly ten years. One of those hearings dealt specifically with the effects that methamphetamine addiction has had on America's child welfare system. I am persuaded that meth abuse and addiction have created a unique and pressing problem, notably in rural states like Iowa and Montana.

During these hearings, the committee also learned the terrible toll that methamphetamine addiction is taking on Native American Indians. I am also convinced that the meth epidemic has created an unsustainable strain on an already overburdened child welfare system in states and on Indian reservations. I am very pleased to have successfully worked on this legislation with Senator Baucus. I appreciated his thoughtful comments and questions during our hearings on meth abuse and child welfare. By marking up this legislation today, members of the Senate Finance Committee have the opportunity to help address the problems that the meth epidemic has created for state child welfare systems. We do this by directing $40 million a year toward grants for regional partnerships. These partnerships will increase the well-being of, and improve the permanency outcomes for, children affected by methamphetamine abuse and addiction.

These grants will improve collaboration and coordination among providers of services for children and families. The Secretary is directed to give consideration for receipt of these grants to rural areas that have a lack of capacity for access to comprehensive family treatment services. By emphasizing comprehensive family treatment, we are promoting a promising strategy for families to recover from meth addiction together.

Additionally, the mark before us expands the Mentoring of Children of Prisoners program, so that children in areas that have not been able to access these mentoring services may gain access to these important programs. The mark also increases and improves access for needed funding for Indian Tribes as well as increases states accountability.

Do not apply for Medicaid before you read this. (Health Insurance Portability and Accountability Act)(includes related information)(According to the Law)(Column) - Inside MS

Last August, Congress passed the Health Insurance Portability and Accountability Act (the Kassebaum-Kennedy Bill) which restricts the use of pre-existing condition exclusions in employer-sponsored group health insurance policies.

While providing valuable protection against employers who refuse to insure workers with MS, the bill also includes an important and little-noticed provision that may profoundly affect the availability of long-term care to Americans with severe disabilities.

In the United States, the primary payor for long-term services is Medicaid, a government program that serves as the health benefit component of state public assistance benefits. Medicaid is only available to eligible recipients who meet strict financial limitations. Those limitations are so rigorous that most recipients may have $2,000 or less in savings (not counting the value of a home -- assuming the spouse still lives in it).

People with disabilities without substantial private means usually have no other option for financing long-term care services.

Most must look to the Medicaid system. Therefore, many completely legal strategies have been developed by attorneys and financial planners to create or preserve Medicaid eligibility. One of these strategies is asset transfers -- signing away property and savings in order to meet Medicaid limits. At least one state study found that over half of its Medicaid nursing home beneficiaries had transferred assets shortly before applying for Medicaid.

In 1993, in order to deter an 'abuse' of the Medicaid system, Congress created several rules to discourage transfers. One was the imposition of a 'look back' period.

If any assets were transferred within 36 months of the Medicaid application (60 months if a trust was involved) the applicant was generally required to wait as many as 36 additional months to be eligible for Medicaid. The length of the period of ineligibility was based on the amount of the transfer.

The New Bill Raises the Stakes

Under the new law, the act of transferring assets is still not illegal, but applying for Medicaid during a 'look back' period is. It not only delays eligibility but may also result in a fine and/or imprisonment. The law now imposes criminal liability. In other words, applying for Medicaid during the period of ineligibility that follows transferring assets is now a criminal violation of the law -- not merely the grounds for temporary denial of Medicaid benefits. The bill provides for penalties of up to one year in jail and a fine of $ 10,000.

The purpose of the law is to prevent what Congress believed to be an abuse by middle- and upper-income people trying to go on public assistance. It was also intended to encourage purchase of private longterm-care insurance -- and, in fact, the same bill contains tax incentives for buying private insurance.

But the bill does nothing to make long-term care insurance policies available to people who are already ill or disabled. Nor has anything been done to alleviate the widespread tendency toward poverty and lack of reasonable private financing alternatives for non-elderly adults with chronic disabilities and illnesses.

Asset transfers are still completely legal. But the potential of criminal liability will chill the willingness of legal and financial advisors to suggest them. So this option is now even more difficult to find, understand, and wisely employ.

Plan Now

I advise people with multiple sclerosis to begin aggressive financial planning to develop private long-term-care strategies as soon as possible, regardless of their income.

In addition to accumulating cash, private strategies might include forming or joining a personal-assistance care cooperative*; developing independent living skills and creating a completely accessible environment to reduce the need for services; developing care resources through church or community groups; and purchasing stop-gap insurance coverage such as catastrophic excess major medical policies.

As it stands now, people who have transferred financial assets, need to plan on a 3-year waiting period (5 years if a trust was involved) before even filing a Medicaid application. The cost of being poor in America just went up.

* The author is currently involved in a pilot personal-care-assistance cooperative for herself and other residents of her apartment complex.

Molina Healthcare of Utah Medicaid Plan Recognized among 'America's Best'. - Health & Beauty Close-Up

HEALTH AND BEAUTY CLOSE-UP-13 November 2008-Molina Healthcare of Utah Medicaid Plan Recognized among 'America's Best'(C)2008 - CloseUpMedia - newsdesk@closeupmedia.com

Molina Healthcare announced that U.S.News and World Report has ranked Molina's subsidiary Medicaid health plan in Utah among 'America's Best Health Plans' in the magazine's annual report measuring the quality and performance of the nation's Medicaid health plans.

Molina's plans in New Mexico, Washington, Michigan, and California were also ranked among 186 Medicaid plan submissions.

It was noted in a release that this marks the fourth consecutive year that Molina's Medicaid plans have been included in 'America's Best Health Plans,' a report compiled in collaboration with the respected National Committee for Quality Assurance (NCQA), a private non-profit organization dedicated to improving health care quality.

'I am extremely pleased that our Utah health plan has made the list of America's best Medicaid managed care health plans for the fourth year in a row. It is a testament to our constant focus on quality care, patient access and partnership with our healthcare providers,' said J. Mario Molina., M.D., president and chief executive officer of Molina Healthcare

In the overall national ranking of Medicaid health plans, Molina Healthcare of Utah ranks No. 23, Molina Healthcare of New Mexico ranks No. 45, Molina Healthcare of Washington ranks No. 41, Molina Healthcare of Michigan ranks No. 37 and Molina Healthcare of California ranks No. 69.

'For plans that are listed among 'America's Best', quality is integrated into the culture of an organization from top to bottom,' said NCQA President Margaret E. O'Kane. 'America's Best Health Plans identifies those plans and helps consumers make informed decisions based on reliable data.'

Molina Healthcare is a multi-state managed care organization that arranges for the delivery of health care services to persons eligible for Medicaid, Medicare, and other government-sponsored programs for low-income families and individuals.

More Information:www.usnews.com/healthplans

((Comments on this story may be sent to health@closeupmedia.com))

Molina Healthcare of Utah Medicaid Plan Ranked among "America's Best".(Report) - Biotech Week

Molina Healthcare, Inc. (NYSE:MOH), announced that U.S.News and World Report has ranked Molina's subsidiary Medicaid health plan in Utah among 'America's Best Health Plans' in the magazine's annual report measuring the quality and performance of the nation's Medicaid health plans. Molina's plans in New Mexico, Washington, Michigan, and California were also ranked among 186 Medicaid plan submissions (see also Molina Healthcare, Inc.).

This marks the fourth consecutive year that Molina's Medicaid plans have been included in 'America's Best Health Plans,' a report compiled in collaboration with the respected National Committee for Quality Assurance (NCQA), a private non-profit organization dedicated to improving health care quality.

'I am extremely pleased that our Utah health plan has made the list of America's best Medicaid managed care health plans for the fourth year in a row. It is a testament to our constant focus on quality care, patient access and partnership with our healthcare providers,' said J. Mario Molina., M.D., president and chief executive officer of Molina Healthcare, Inc.

In the overall national ranking of Medicaid health plans, Molina Healthcare of Utah ranks No. 23, Molina Healthcare of New Mexico ranks No. 45, Molina Healthcare of Washington ranks No. 41, Molina Healthcare of Michigan ranks No. 37 and Molina Healthcare of California ranks No. 69.

'For plans that are listed among 'America's Best', quality is integrated into the culture of an organization from top to bottom,' said NCQA President Margaret E. O'Kane. 'America's Best Health Plans identifies those plans and helps consumers make informed decisions based on reliable data.'

More information on the U.S.News & World Report featured article, 'America's Best Health Plans,' and the complete report, which also includes ranking of Medicare, and commercial health plans throughout the United States, can be found at www.usnews.com/healthplans.

Keywords: Medicare and Medicaid, Health Policy, Managed Care, Marketing and Licensing Agreements, Medicaid, Molina Healthcare Inc.

Leavitt picks heads of panel tasked with paring Medicaid.(Secretary of Health and Human Services Michael Leavitt) - Medical Device Week

Leavitt picks heads of panel tasked with paring Medicaid

By CHRISTOPHER DELPORTE

Medical Device Daily Washington Editor

WASHINGTON - Two former governors have been named to head a new Medicare reform panel, adding a little more fuel to an already controversial issue in statehouses nationwide - reducing the cost of Medicaid

Don Sundquist, former Republican governor of Tennessee, will chair the commission; Angus King, former Independent governor of Maine, will serve as vice-chair, Secretary of Health and Human Services Mike Leavitt reported on Friday.

The committee, made up of 13 voting members and 15 non-voting members, is charged with recommending ways to trim $10 billion in Medicaid spending in the next five years, as well as other possible reforms. Leavitt held open two voting-member slots to be added after September.

Plans for the panel were unveiled by Leavitt in May.

Medicaid, a joint federal and state program, insures more than 50 million of the poorest Americans, including children and nursing home residents. The program has a price tag of more than $320 billion annually.

'In Washington and state capitols across America, there is consensus that now is the time to reform and modernize Medicaid,' Leavitt said on Friday. He said he was looking forward to having 'a robust conversation in an open and bipartisan manner' with the commission's members.

'Together with Congress and the states, we will create a plan that will better help Medicaid fulfill its commitment to quality care in a way that is financially sustainable,' he added.

Opponents of cuts to Medicaid argue that federal and state policy experts should be given time to work out changes to the Medicaid system before Congress sets arbitrary spending limits on the program.

Despite HHS emphasis on a commission that includes leaders from 'both sides of the aisle,' many Democrats seem worried that the commission's findings will result in wholesale cuts along party lines rather than any real talk of reform.

The commission will submit two reports to HHS, with the first due on Sept. 1, and outlining recommendations for the $10 billion savings goal along with performance suggestions.

The second, longer-range report will be due on Dec. 31, 2006. It will make recommendations to maintain 'the long-term sustainability of Medicaid,' Leavitt said.

Up to now, both the House and the Senate have worked out their own federal budget resolutions, with the financing of the Medicare and Medicaid programs both the subject of much political wrangling concerning President George Bush's financial road map.

The White House's budget for FY06 includes revisions to Medicaid that are estimated to save $14 billion in five years and $60 billion in 10 years.

In April, the House approved a budget resolution with Medicaid savings of $15 billion to $20 billion. The Senate's version of the budget included no cuts to Medicaid, after senators approved an amendment to eliminate $14 billion in proposed cuts.

Budget resolutions are non-binding, but they set guidelines for congressional consideration as the budget process moves forward.

Voting members of the panel include three current or former Bush administration officials. Leaders from both parties were allowed to appoint four non-voting members. In protest, Democrats refused to name appointees.

In addition to representatives from other government departments and service bureaus, many of the members - especially the non-voting ones - are healthcare providers or they come from institutes and private industry.

Rep. Henry Waxman (D-California), who has been involved in crafting much of the current Medicaid law, was unimpressed with the makeup of the panel.

'Today's announcement confirms that the purpose of the commission is to rubber-stamp the administration's failed Medicaid policies,' the 31-year veteran in the House of Representatives told The New York Times.

The Centers for Medicare & Medicaid Services (CMS; Baltimore) did not return calls to clarify its role, if any, in the committee's activities.

Many states also recently have formed committees to examine how to reign in some of their Medicare costs.

Democrats in Maryland's legislature announced plans last week for hearings on the state's decision to terminate Medicaid benefits for nearly 4,000 legal immigrants, which they say may ultimately cost the healthcare system more than it saves.

In January, Gov. Robert Ehrlich Jr., a Republican, proposed eliminating $7 million in annual funding for coverage of pregnant women and children classified as permanent legal residents for fewer than five years. And Tennessee already has moved to drop patients from its Medicaid rolls.

Governors throughout the country have told Congress they need more money to cope with rising healthcare costs and growing populations.

In 2002, the Sundquist administration in Tennessee removed nearly 200,000 people from the Medicaid rolls. A federal judge ruled that the state had not accurately determined those eligible for benefits; it ordered a review that enabled 50,000 people to regain coverage.

The National Governors Association Center for Best Practices will act as an advisor to inform the commission on a range of issues affecting Medicaid.

Medicare coverage plans balloon upward

In other news from CMS, the agency approved 143 new Medicare Advantage coverage plans to provide services, which it said 'far exceeds' the number of plans that previously had been available.

With the addition of the new plans, Medicare beneficiaries in 49 states will have access to 428 health plans across the nation, including 41 plans completely new to the Medicare program and 66 new local preferred provider organizations (PPOs).

With these expansions, 73% of Medicare beneficiaries will have access to HMO plans, 52% will have access to PPO plans, and 80% will have access to private fee-for-service plans, CMS said.

The agency said the greater number of options will lead to increased cost savings, lower and 'more predictable' co-payments and deductibles than available in the traditional Medicare plan for Medicare-covered services, and a wider range of services.

The majority of beneficiaries in rural areas will have access to private fee-for-service plans, and nearly 20% of beneficiaries in rural areas will have access to HMOs or PPOs, most for the first time.

There are a little more than 5 million beneficiaries currently enrolled in Medicare Advantage health plans, with an average of 50,000 beneficiaries per month joining the plans since last year, CMS said.

For people on Medicare with special needs, such as those who are dually eligible for Medicare and Medicaid, living in institutions, or have severe or chronic or disabling conditions, the new Medicare law allows Medicare Advantage organizations to exclusively or disproportionately en-roll them into special needs plans (SNPs).

CMS has approved 48 SNPs to serve beneficiaries in 2005 and is reviewing more than 100 additional SNP applications that have been submitted to provide services in 2006.