Report: Bill would reduce senior care

health care reform

A plan to slash more than $500 billion from future Medicare spending -- one of the biggest sources of funding for President Obama's proposed overhaul of the nation's health-care system -- would sharply reduce benefits for some senior citizens and could jeopardize access to care for millions of others, according to a government evaluation released Saturday.

The report, requested by House Republicans, found that Medicare cuts contained in the health package approved by the House on Nov. 7 are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether.

Congress could intervene to avoid such an outcome, but "so doing would likely result in significantly smaller actual savings" than is currently projected, according to the analysis by the chief actuary for the agency that administers Medicare and Medicaid. That would wipe out a big chunk of the financing for the health-care reform package, which is projected to cost $1.05 trillion over the next decade.

More generally, the report questions whether the country's network of doctors and hospitals would be able to cope with the effects of a reform package expected to add more than 30 million people to the ranks of the insured, many of them through Medicaid, the public health program for the poor.

In the face of greatly increased demand for services, providers are likely to charge higher fees or take patients with better-paying private insurance over Medicaid recipients, "exacerbating existing access problems" in that program, according to the report from Richard S. Foster of the Centers for Medicare and Medicaid Services.

Though the report does not attempt to quantify that impact, Foster writes: "It is reasonable to expect that a significant portion of the increased demand for Medicaid would not be realized."

The report offers the clearest and most authoritative assessment to date of the effect that Democratic health reform proposals would have on Medicare and Medicaid, the nation's largest public health programs. It analyzes the House bill, but the Senate is also expected to rely on hundreds of billions of dollars in Medicare cuts to finance the package that Majority Leader Harry M. Reid (D-Nev.) hopes to take to the floor this week. Like the House, the Senate is expected to propose adding millions of people to Medicaid.

The Centers for Medicare and Medicaid Services administers the two health-care programs. Foster's office acts as an independent technical adviser, serving both the administration and Congress. In that sense, it is similar to the nonpartisan Congressional Budget Office, which also has questioned the sustainability of proposed Medicare cuts.

In its most recent analysis of the House bill, the CBO noted that Medicare spending per beneficiary would have to grow at roughly half the rate it has over the past two decades to meet the measure's savings targets, a dramatic reduction that many budget and health policy experts consider unrealistic.

"This report confirms what virtually every independent expert has been saying: [House] Speaker [Nancy] Pelosi's health-care bill will increase costs, not decrease them," said Rep. Dave Camp (Mich.), the senior Republican on the House Ways and Means Committee. "This is a stark warning to every Republican, Democrat and independent worried about the financial future of this nation."

Democrats focused Saturday on the positive aspects of the report, noting that Foster concludes that overall national spending on health care would increase by a little more than 1 percent over the next decade, even though millions of additional people would gain insurance. Out-of-pocket spending would decline more than $200 billion by 2019, with the government picking up much of that. The Medicare savings, if they materialized, would extend the life of that program by five years, meaning it would not begin to require cash infusions until 2022.

"The president has made it clear that health insurance reform will protect and strengthen Medicare," said White House spokeswoman Linda Douglass. "And he has also made clear that no guaranteed Medicare benefits will be cut."

Republicans argued that the report forecasts an increase in total health-care spending of more than $289 billion.

CEOs examine pros and cons of healthcare reform

health care reform

A recent report by the Business Roundtable , an association of chief executive officers of leading U.S. companies, indicates that key aspects of healthcare reform could slow the growth of healthcare costs, providing savings to companies and employees. However, the report also points out proposed reforms which would increase costs.

The report has been widely touted by Democrats who say the report shows their efforts will lower costs.

The report "underscores what experts and businesspeople have told us all along--comprehensive health insurance reform is one of the most important investments we can make in American competitiveness," said President Barack Obama in a statement.

According to the report, the right reforms could result in health care costs growing at the same rate as overall GDP – about 4 percent per year, a rate much lower than the current 10 percent per year growth rate

“This report shows that effective reforms can slow health care costs by as much as $3,000 per employee in 2019,” said Antonio M. Perez, Chair of Business Roundtable’s Consumer Health and Retirement Initiative and Chairman and CEO of Eastman Kodak Company. “Health care reform done right could reduce the growth rate of health care costs – not just for government, but for the private sector as well.”

According to the report, Heathcare reforms that would help cut costs include: • Delivery system reforms, such as value-based purchasing;

• Innovation centers that identify alternative methods of provider reimbursement;

• Accountable care organizations that realign financial incentives to improve the quality and the value of the care delivered;

• Financial penalties for failing to avoid preventable hospital re-admissions;

• Increased individual accountability for health care spending decisions, including health reimbursement arrangements and health savings accounts;

• Cost and quality of care data that is easier for patients and providers to access and use;

• Elimination of sharp regional variations in practice patterns;

• Promote wellness and prevention programs and expand financial incentives to participate in specific programs to reduce lifestyle related illness; and

• Insurance market reforms that promote competition and choice.

On the other hand, the report also notes several potential reforms which could increase costs, such as:

• Delayed or watered-down cost-saving efforts;

• Failure to implement a strong individual mandate to minimize cost increases in the health insurance exchange plans;

• Increases in the cost of health care to individuals from changes to consumer spending accounts or other actions that discourage consumer-engaged decision making; and

• Cost-shifting to the private sector from reductions in federal reimbursements to providers and from a public plan option, if included.

Michelle Obama urging healthcare reform

health care reform

NEW YORK, Nov. 14 (UPI) -- Michelle Obama talked up U.S. healthcare reform at a meeting of administration officials and advocates for reform, citing the needs of older women.

The first lady gave a 12-minute talk during the meeting Friday at the White House, Politico reported.

"Women are among those who will benefit most from health insurance reform ... . We are the healthcare system in so many ways," Obama said. "We are asked to bear much of the responsibility but we often face challenges when it comes to our own healthcare."

She called Medicare a "sacred part of the American safety net."

Obama did not go into details about the Democratic bills or what she expects any legislation to look like once it has passed Congress.

The first lady has held similar meetings during recent weeks. Her staff said she will probably hold more, depending on what happens in Congress.

Letter: Most want reform, better health care

health care reform

A lot of Republicans (and many Democrats) have voiced their opposition to H.R. 3962, the Affordable Health Care for America Act. So, what is it about the bill that scares them so?

Is it that patients will no longer be denied coverage for “pre-existing conditions?” Is it that the bill will promote expansion of primary and preventive care, actions supported by leading physician organizations? Or, is it the fear of a government takeover if the public option becomes reality?

Given that the Congressional Budget Office estimates that only 2 percent of the insured will opt for the public option, that fear seems somewhat farfetched. Opponents of health care reform would like you to think that the current reform movement is the work of left-wing liberals. The facts speak otherwise.

The American Medical Association, the largest physician organization in the country, is a relatively conservative organization. In fact, it was the AMA that was instrumental in defeating health care reform in both the Truman and Clinton administrations. Yet, the AMA has announced its support for H.R. 3962.

“H.R. 3962 is not the perfect bill,” AMA President Dr. J. James Rohack said, “but it goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians.”

Several other physician groups, including the American College of Physicians and the American Academy of Family Physicians have endorsed H.R. 3962. As for the naysayers who claim that health care reform will undermine Medicare, the American Association of Retired Persons' endorsement of H.R. 3962 suggests otherwise. The health care reform movement is not the work of a radical fringe group. It is the dream of the most Americans and the majority of physicians. Let's make it work.

N.J. latest stop in health care tour

health care reform

House Speaker Nancy Pelosi and Rep. Rush Holt toured a Princeton hospital yesterday while stumping for health care reform legislation now before Congress.

"Improving quality of care, lowering costs, offering choice and putting the patient first," Pelosi said of the legislation as she stood with Holt (D-12 Dist.) in a press conference at the University Medical Center in Princeton.

Both Holt and Pelosi defended the public option of government-supported health insurance as providing an alternative to private insurers.

"This option offers strong competition in rates and strong competition in quality care. This will no doubt offer good value and a good price," said Holt, who has held public meetings on the health care reform with residents across his district.

Pelosi acknowledged that other, broader public options had been proposed, but said the alternative offer in the house form of the bill "was written by Ted Kennedy."

The California congresswoman has been traveling across the country -- appearing before students at Harvard University in Cambridge on Friday -- to promote the reform that has been a cornerstone of President Obama's administration.

Members of the House of Representatives passed their version of the bill Nov. 7 by a 220-215 vote. One Republican, Joseph Cao of Louisiana, voted for the bill; 39 Democrats voted against, including John Adler of New Jersey.

In addition to creating the so-called public option, the bill passed by the House would bar insurers from denying people coverage because of pre-existing conditions and set up health care "exchanges," or marketplaces, where consumers could easily shop for coverage.

Critics say the reforms could cost nearly $1 trillion over the next 10 years, but Pelosi yesterday said the house bill includes provisions to cover the costs.

Pelosi was quick to praise Holt for his work on the bill, along with fellow party members Rep. Frank Pallone (D-6th Dist.), and Rob Andrews (D-1st Dist.).

The Senate is now considering its own health care reform bill.

Tom Haydon may be reached

at thaydon@starledger.com or (732) 293-4928.

Health-care reform and abortion coverage: Questions and answers

health care reform

After the House passed its health-care bill last weekend, debate exploded over an amendment by Reps. Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.) that restricts abortion coverage.

Confusion was rampant all week, but on this both sides agree: The debate reflects the conflict between the rule banning federal funding for abortions and the expansion of the government's role in health care. Universal health care is a Democratic and liberal goal, but as long as the ban stands, increasing government support for those who lack insurance likely means more restricted coverage for abortions.

Richard Doerflinger of the U.S. Conference of Catholic Bishops has been trying to explain this irony to religious conservatives who worry "that when the federal government takes over health care, it'll be pro-death." In fact, he said, "When you expand the reach of federal funds, you expand the reach of federal policies" on abortion.

Here are answers to some questions about the amendment.

1. What is the status quo? Under the 33-year-old federal ban, there is no abortion coverage under Medicaid, the federal employee health benefits plan or the Tricare plan for military families, except where the life of the mother is endangered. Seventeen states use their own funds to provide abortion coverage for Medicaid recipients. A study co-authored by the Guttmacher Institute, which backs abortion rights, found that one in four women who would other get an abortion carry an unwanted pregnancy to term if they lack abortion coverage.

Abortion coverage is widespread among private insurance plans -- at least half of people with private coverage have abortion coverage, according to surveys by Guttmacher and the Kaiser Family Foundation. Guttmacher found that only 13 percent of abortions are billed directly to a private insurer, though many women bill their insurers separately. An abortion at 10 weeks costs $400, though it can be far more costly later on.

2. What does Stupak-Pitts say? Under the House bill, people without employer-provided coverage and small businesses would choose among private insurance plans and a government insurance plan, or "public option," offered in a new marketplace, or "exchange." As initially written, these plans would pay for abortions out of people's premiums, and not with any subsidies that would be extended to families who earn up to $88,000 annually.

Abortion rights opponents derided this as an accounting gimmick, and turned to Stupak-Pitts. It decrees that abortion may not be covered in the public option or in any of the exchange's private plans that take the subsidized customers. There is an exception if a woman's life is in danger or in cases of rape or incest.

Private plans could offer abortion coverage to those without subsidies, but that will be a small subset of the 30 million people expected in the exchange. Women could also buy a "rider" for abortion coverage, as is now done in a few states where employer-based plans are not allowed to cover abortion. Abortion rights supporters say relying on such riders is unrealistic and offensive, given that few women expect to have an abortion.

3. What does it mean for women? For women who do not have health insurance, gaining subsidized coverage will mean they will be much better off overall, while still lacking abortion coverage. But there are many women who now have coverage on the individual market that is overpriced and low-quality but does cover abortion. Their subsidized coverage under the legislation will be superior in general, but they will lose their abortion coverage, unless they buy a rider. Abortion opponents note this outcome is no different than when Democrats now push to expand Medicaid in the 33 states without abortion coverage.

The impact is less clear for women buying coverage on the exchange without subsidies. This will include higher-income women and those working for small businesses, who likely will not qualify for subsidies since their employers will be helping pay. For these women, the availability of a plan covering abortion will depend on whether insurers decide to offer a plan that is open to only some people and differs from other plans only in covering abortion -- not the easiest distinction to market.

Such a plan could also upset the balance envisioned for the exchange, with costs shared across plans; the plan would draw members unlike any other -- wealthier and with more women of child-bearing age.

Some higher-income women may choose to go without abortion coverage, on the assumption that they could pay for it out of pocket. But they could then find themselves facing the high cost of an abortion with complications.

4. Are there broader implications? Abortion rights advocates worry abortion foes will apply the amendment to other federal funds in the bill, such as tax credits for small businesses or subsidies for companies with early-retiree plans. But the amendment's supporters say this is not their intent. Abortion rights advocates also worry that as insurers introduce plans on the exchange without abortion coverage, they will for convenience's sake drop it from their employer-provided plans. Abortion opponents counter that insurers customize many of their plans today.

Most notably, larger businesses will eventually be able to join the exchange, and more people may come to the exchange on their own if their employers drop coverage outright. As the exchange grows in size, the abortion restrictions will apply to more people -- though the market for plans limited to the non-subsidized customers will also grow.

5. Will the amendment stick? Many Senate Democrats hope to pass language closer to the original House language, paying for abortions out of premium funds. Separating private and public funds in the exchange's plans, abortion rights supporters say, is no less an accounting scheme than the Catholic Church's segregation of federal funds it gets for school costs from its religious operations, a comparison abortion foes reject. Forty House Democrats now say they will reject a final bill with the amendment.

But at least one Senate Democrat, Nebraska's Ben Nelson, wants the amendment. And Democrats are struggling to find language that is less restrictive and yet satisfies the two dozen House Democrats who voted for the bill but want assurance that it truly upholds the federal ban.

President Obama has said he wants the bill to uphold the status quo on federal funding and abortion, but also said that he thought Stupak-Pitts went too far -- leaving him in the same bind as many fellow Democrats.

Rep. Obey: Health care reform his hardest fight

health care reform

WAUSAU, Wis. - The Wisconsin representative who has served 40 years in Congress says passing the health care reform bill has been the most difficult legislative fight of his career.

Democrat Dave Obey of Wausau says the House passage of the reforms designed to hold down health care costs and extend coverage to millions of Americans is among the four greatest accomplishments of Congress since the beginning of the 20th century. He likened it to the passage of legislation on civil rights, Social Security and Medicare.

Health care reform legislation must still pass the Senate.

The House bill Obey voted for narrowly passed the House and includes a government-run "public option" insurance plan.

The 71-year-old Obey is the dean of Wisconsin's congressional delegation and was first elected in 1969.

Congresswoman Dahlkemper discusses health-care reform

health care reform

U.S. Rep. Kathy Dahlkemper, of Erie, might have put her political life on the line -- or enhanced it -- with her vote on health-care reform a week ago.

The House narrowly passed the bill, 220-215, and it included several amendments offered by Dahlkemper, D-3rd Dist.

Dahlkemper, who is anti-abortion, co-sponsored an amendment that would maintain the federal law that prohibits federal funds from being used to pay for abortions except in cases of rape, incest or to save the life of the mother.

Her other measures include grants for communities to work on childhood obesity; a pilot project providing incentives for people to stop smoking, lose weight and make other healthy lifestyle choices; and a proposal that would allow children to stay on their parents' health-care plan until age 27.

The Affordable Health Care for America Act would cover another 36 million people by 2019, leaving just 4 percent of the population without coverage. The nonpartisan Congressional Budget Office says about 17 percent are without insurance now.

But it comes with a huge price tag -- as much as $1.2 trillion over 10 years. Dahlkemper said the cost might not be that high, but she said savings would occur over the long term through prevention, early diagnosis of illnesses and other ways.

The Erie Times-News interviewed Dahlkemper about the vote as the issue moves to the Senate.

1Why was it important for you to vote for the health-care reform bill?

As I have gone around the district over the last two years now, since I announced in October 2007 that I was running for Congress, health care has been one of the main issues that people have discussed with me. The cost of health care and the inability of some people to access health care has been an issue of great concern to the people that I represent. So I believe we have a broken system that is unsustainable, and if we do not do reform now, we will continue to go down a road to a less healthy society at a much greater cost.


2Was it the most important vote you've cast during your brief time in the House?

Yes, it was. It affects every constituent in my district and it will, I believe, make a major difference in their lives in a positive way.

3What are the biggest misconceptions about the bill?

I think the biggest misconception is that it's some kind of government takeover of health care. All of our health providers will remain in private or nonprofit hands. There still will be private insurers covering the majority of our citizens, and the individuals, along with their doctors, will make health-care decisions. The other misconception is that somehow it's bad for seniors, and yet Medicare will be strengthened by this legislation.


4What else do you believe has been misunderstood?

There's an area that's been misunderstood and that's the (government-run) public option. I like to call the public option the generic option. For those people who are uninsured, when we open up the health-insurance exchange in 2013, an individual will be able to go into that exchange and be able to choose between the typical insurance carriers in our region, and they're also going to have an additional choice, and that's the public option. Now, the individual is going to choose, and no one else. They can choose the public option or a familiar name such as Blue Cross-Blue Shield, UPMC or HealthAmerica. The reason we need the public option is that it will help to give competition that will then drive down the cost. Many areas only have one or two insurance companies that really control the market.


5Your vote angered conservatives on the one side and abortion-rights liberals on the other. Are you worried that this vote could hurt your re-election chances in 2010?

I actually believe that this vote will help my re-election for 2010 because I think as people understand the legislation better, they will see we'll have an improvement in our health-care system, and it will help bring security and stability to that health-care system.

6What do the polls tell you Americans are saying about this health-care bill, and do you pay much attention to those polls?

Certainly, I look at the polls in general and I try to listen to my constituents more than anything. But polls are only as good as the pollster who is doing it. I look at the number of uninsured, for example, in my district and there are 29,000 uninsured in my district, and that's a lot, and there's many more underinsured. One of the best things with this legislation is the insurance reform. We're going to end discrimination for pre-existing conditions. No longer will your insurance company be able to deny you coverage for these pre-existing conditions or remove you from your insurance because you get sick.


7How soon would you expect the Senate to vote on a health-care reform bill? Will it be before the end of the year? Or will the bill be delayed long enough that it runs into the midterm elections and nothing gets done?

I really am optimistic that the Senate will get its bill passed out of the Senate sometime in the next few weeks, and then it will go to (House-Senate) conference and we'll have a chance to vote on a final bill before the Christmas holiday. Our calendar now has us in session up to the 23rd of December. That's very unusual. Normally, Congress is there very little in the whole month of December.


8Is that because of the health-care bill?

I'm sure it is.


9If the Senate approves a bill, how different do you think the final product will be? There's already talk about a revolt from House Democrats on the abortion restrictions.

Obviously, there's many different issues that will have to be dealt with, and compromises will have to be made. That includes the exact form of the public option ... how the bill is paid for, along with many smaller issues throughout the bill.


10Are changes over the abortion restrictions a deal breaker for you?

We had a very strong vote on the abortion funding issue in the House. And I think it's important for the people to understand that we aren't changing the law and we are not changing the ability of a woman to get an abortion. We are restricting in the bill the ability of using public funds to pay for an abortion. Since 1976, when the Hyde Amendment was placed on federal funding for abortion, there has been no federal funding for abortion. So this amendment just keeps the status quo of what's been in place since 1976, but it does not change the law at all.

Will Reid work to reconcile to get health care bill passed?

health care reform

Voters are shouting at Democrats to head back toward the political center, but they keep plunging on left — to the point where I wouldn’t put it past Majority Leader Harry Reid (Nev.) to blow up the Senate in order to pass a health care reform bill.

Even though polls and the Nov. 3 election returns indicate increasing disapproval of Democratic management, House leaders plowed ahead with government-heavy health care reform, barely passing it.

The Democrats’ logic, as stated by pollster Mark Mellman at a recent breakfast with reporters is, “We gotta get things done if we want to win in 2010.”

That argument was reinforced by former President Bill Clinton in a meeting with Senate Democrats on Tuesday, where he attributed Democrats’ loss of their congressional majority in 1994 to failure to pass his health care reform measure.

In the Senate, Reid says he’s determined to pass a health care bill by the Christmas recess.

Details of the of bill that he’s drafting are still secret, but he’s announced it will include a government-run public-insurance option — a swerve to the left from the measure approved by the Senate Finance Committee, which contains a non-profit cooperatives plan.

Reid’s spokesman, Jim Manley, says his boss “is working tirelessly” to collect 60 votes for his health care reform bill in order to pass it under “regular order,” but increasingly that looks next to impossible.

As a result, there’s increasing speculation, notably among health lobbyists, that Reid will opt to bulldoze reform through under budget reconciliation rules — requiring only 51 votes — and risk all-out rebellion from Republicans.

Manley says reconciliation “is always an option, but it’s not what we’re looking at now.”

And there are lots of reasons why Reid doesn’t want to go that route apart from the fact that Republicans likely would shut down all other Senate business in protest.

For one thing, as former Senate Republican staffer Bill Hoagland told me in an interview, Reid’s bill would have to be subjected to a “Byrd bath” to identify purely policy provisions that do not meet budget reconciliation standards.

Under the rule named for former Appropriations Chairman Robert Byrd, D-W.Va., Hoagland said, any line item in the bill that has no budget effects is subject to being stricken — such as authorization of prevention and wellness measures.

Hoagland said he’s not certain whether insurance reforms such as guaranteed issue and elimination of annual caps on coverage — considered a vital part of health care reform — would pass Byrd muster.

A public insurance plan probably could be scored as saving money and would pass muster.

So, besides incurring GOP wrath, Reid’s bill would risk being significantly narrowed if he tried to push it through on reconciliation.

Moreover, trying to pass a measure affecting every citizen and one-sixth of the U.S. economy on the basis of a bare majority would be attacked — and not just by Republicans — as blatant disregard for popular opinion.

Polls increasingly indicate that more voters oppose “Obamacare” than support it — by 10 points according to a Nov. 1 Ipsos/McClatchy poll and 8 points in a Nov. 3 CNN poll.

On the other hand, it’s looking increasingly impossible for Reid to round up 60 votes to pass health care reform — especially by the end of the year. Resorting to reconciliation may be his only option.

To get 60 votes, Reid needs all 58 Democrats and both of the Senate’s Independents to vote with him. He’d like one or two Republicans, too.

But a government-run health care plan — especially a “robust” one like that approved by the House and by the Senate Health, Education, Labor and Pensions Committee — surely will be opposed by all Republicans, plus Sen. Joe Lieberman, Ind.-Conn., and up to five Democrats.

Lieberman said he will filibuster any public option, and he’s likely to be joined by Sen. Ben Nelson, D-Neb.

In addition, Reid has problems over abortion language — with Sen. Bob Casey, D-Pa., likely to insist on restrictive language supported by the Roman Catholic Church, while several female senators adamantly oppose it.

And Sen. Dianne Feinstein, D-Calif., reportedly is balking because the bill may reduce Medicare reimbursement rates for California hospitals.

On top of all that, if Reid goes the “regular option” route, Republicans are promising “weeks and weeks” of debate on “hundreds” of amendments — practically guaranteeing that health care can’t be passed this year.

If President Barack Obama, Speaker Nancy Pelosi and Reid and other Senate leaders were looking at the Nov. 3 election results and most every poll, they’d pull back, limit the scope and cost of health care reform and abandon the public option.

They might even incorporate some Republican ideas to make their measure bipartisan.

Local conditions surely dominated in the Virginia and New Jersey gubernatorial races, but Republicans won largely because independent voters who supported Obama in 2008 supported the GOP in 2009.

And almost every poll indicates that Obama’s approval ratings are plummeting — as is approval for most of his policies.

On Nov. 3, Gallup reported that Obama’s overall approval rating had dropped from 67 percent in February to 51 percent recently and that his drop in the period from June to September “was the highest such drop in Gallup’s history of tracking first-term presidents.”

On Nov. 4, Gallup reported that, by 54 percent to 34 percent, voters view Obama’s policies as “mostly liberal” rather than “mostly moderate,” whereas more Americans now regard themselves as conservative (40 percent) than moderate (36 percent) or liberal (20 percent.)

In 2008, Obama won by carrying 52 percent of the independent vote. According to a Fox News poll, his support among independents in January was 64 percent. As of mid-October, it was 42 percent.

For sure, the public has no great regard for the Republican Party, especially congressional Republicans.

A late-October Wall Street Journal poll showed approval for the GOP at 25 percent, and a Washington Post/ABC poll showed confidence in congressional Republicans at 19 percent.

Yet, on Wednesday, Gallup reported that the GOP had a 4-point lead in the 2010 generic ballot — and that, by 22 points, independents said they would vote for GOP candidates for Congress rather than Democrats.

All this is surely a warning to Democrats to pull back and rethink. But to Democrats, it seems to mean charge left. If Reid is hearing that message, he may push the Senate over a cliff.

Morton Kondracke is exec-utive editor of Roll Call, the newspaper of Capitol Hill.

Whoa! We need logical health care reform

health care reform

Why are our president and Congress so hell bent on passing a health care bill immediately? What's wrong with taking time to correct ills that will impact a bill of this magnitude and complexity? Why not have bills that plan our way to a good bill?

A few programs that could bring down the price of the proposed bill and have a smaller impact on our federal budget and society are:

1. A program assisting high school graduates seeking medical careers and timed so that more doctors and professionals are available when the bill is passed. This would alleviate wait times for care.

2. An acceptable program to computerize all medical records in the country.

3. A bill for medical tort reform, addressing the number of cases and settlement amounts. The bill should address the medical insurance charged doctors and monitor a decrease in medical costs.

4. A program to address fraud and overcharges in Medicare and Medicaid.

5. A plan to address preventative medicine. For example, an obesity plan would include measures to help people lose weight and monitor their progress. A Time magazine article claimed that Medicare has gone up $178 billion because of obesity.

6. An agreeable immigration bill acceptable to the majority of Americans that would provide a more accurate account of how many people would be picked up in the health care bill.

There are a number of other areas that could be tied to programs pointing to a future trigger coinciding with the passage of a good health care plan. What's wrong with government planning and passing a number of programs aimed at making a big one successful?

We need commonsense politicians with insight, patience, and perseverance to plan and pass laws that will not bankrupt our country.

State Republicans pan health care bill

health care reform

State Republican leaders are protesting the congressional health care reform plan, arguing that reform will hurt the state's budget.

Flanked by about 15 legislative leaders, former Health and Human Services commissioner John Stephen told the press yesterday that the health care reform bill just passed by the U.S. House "will be devastating to state budgets." The bill must still pass the U.S. Senate, and Stephen urged the state's senators to vote against it.

"This will lead New Hampshire down the road of a sales or income tax," Stephen said. "These are called unfunded mandates, and we can't afford them."

The state has about 142,500 uninsured residents. Stephen said the bill will force states to expand efforts to enroll people in Medicaid who are eligible for coverage but have chosen not to sign up. That could cost $434 million over the next 10 years. Stephen estimated the state will pay an additional $111 million over six years, beginning in 2015, to pay for expanded Medicaid coverage for healthy adults making up to 150 percent of the federal poverty limit. The bill would also restructure the "disproportionate share hospital" program, which reimburses states for charitable care, which could cost the state $157 million in 2017 and slightly more in the following years.

In total, Stephen argued that the state could lose $1.2 billion under the House bill. The state would also be prohibited from reducing Medicaid eligibility or benefits.

"It's the largest program in the state budget and it couldn't be effectively managed by the commissioner and the department," Stephen said. "It's an unacceptable overreach of the federal government."

State Sen. Jeb Bradley, a Wolfeboro Republican, said he has sponsored legislation that would preclude the state from paying extra Medicaid expenses mandated by the federal government, unless the state Legislature authorized those expenses. It is unclear whether the state has the ability to challenge the federal government that way. Bradley also introduced legislation to allow New Hampshire residents to buy health insurance across state lines.

Other speakers who opposed the bill included Republican U.S. Congressional candidates Jennifer Horn, Frank Guinta and Bob Bestani. "Under cover of dark, (House Speaker Nancy) Pelosi, (U.S. Rep. Paul) Hodes, and Congress voted to socialize health care in America," said Horn, who is running for the 2nd District seat.

Hodes has said the legislation will help small businesses. But Horn said small businesses would be hurt by a fine levied on those who do not provide health insurance. "It will hurt everyone its supposed to help," Horn said.

Guinta, who is running against Bestani for the 1st Congressional District's Republican nomination, said the bill would downshift costs from the federal government to the states. "$1.2 billion over 10 years is an unacceptable unfunded mandate," he said.

House Republican Leader Sherm Packard called the House bill the "groundwork for a total federal takeover of the system," while Rep. Andrew Renzullo called it a "financial and medical disaster."

State Democrats accused Republicans of trying to block meaningful reform that would cover uninsured Granite Staters. "This is political theater," said Democratic spokesman Derek Richer. "All they've been doing is saying no, no, no."

Ned Helms, a former state Health and Human Services commissioner and co-chairman of President Obama's New Hampshire campaign, said health care is already hurting the state, with people losing their coverage and small businesses suffering from high insurance premiums.

"For (Republicans) to ignore the people in the state who don't have coverage, to ignore the fact businesses are begin pummeled with increasing premiums, to ignore the bill that has innovative ways to pay for health care . . . (to say) I think you ought to drop whole thing because maybe years from now it might hit the budget," Helms said. "These are people who can turn their back on reform of health care."

Helms said he finds it offensive that Stephen believes the U.S. "doesn't have the capacity to do what every industrialized country has done."

Helms said there are cushions in the bill to protect small businesses. And the bill will actually reduce the deficit, according to the Congressional Budget Office. "I think the country's ready, and I think we'll get it done," Helms said.

Bishop again attacks Kennedy over abortion stand in health-care reform

health care reform

PROVIDENCE –– Even as they agreed to postpone a planned face-to-face meeting that had been set for Thursday, Roman Catholic Bishop Thomas J. Tobin turned up the heat Monday on U.S. Rep. Patrick Kennedy over his “rejection” of church teaching on abortion, calling on him to enter into a process of conversion and repentance.

In a letter to Kennedy posted Monday on the Web site of the Diocese of Providence’s weekly newspaper, the bishop disputes Kennedy’s assertion that his disagreement with the hierarchy “on some issues” including abortion did not make him any less of a Catholic.

“Well, in fact, Congressman, in a way it does,” the bishop said in a letter issued just two days after Kennedy was among a group of minority lawmakers who attempted to block tough new restrictions on abortion that were added Saturday to the House’s health-care reform legislation.

“Although I wouldn’t chose those particular words, when someone rejects the teachings of the Church, especially on a grave matter, a life-and-death issue like abortion, it certainly does diminish their ecclesial communion,” the bishop declared.

Kennedy’s office did not respond yesterday to phone and e-mail requests for an interview on the bishop’s letter.

Bishop Tobin raised the question: What makes Kennedy think he’s Catholic? “Your baptism as an infant? Your family ties? Your cultural heritage?”

Being Catholic involves much more, he said, including acceptance of essential church teachings on matters of faith and morals, belonging to a parish community, weekly attendance at Mass and regular reception of the sacraments.

And support for abortion rights is not in the same category of those who struggle with sins of anger, pride, greed, impurity or dishonesty and then fail, the bishop declared.

“Your rejection of the Church’s teaching on abortion falls into a different category — it’s a deliberate and obstinate act of the will, a conscious decision that you’ve reaffirmed on many occasions.

“Sorry, you can’t chalk it up to ‘an imperfect humanity.’ Your position is unacceptable to the Church and scandalous to many of our members. It absolutely diminishes your communion with the church….

“I write these words not to embarrass you or to judge the state of your conscience or soul. That’s ultimately between you and God.

“But your description of your relationship with the Church is now a matter of public record and it needs to be challenged. I invite you, as your bishop and brother in Christ, to enter into a sincere process of discernment, conversion and repentance. It’s not too late to repair your relationship with the church, redeem your public image and emerge as an authentic ‘profile in courage,’ especially by defending the sanctity of human life for all people, including unborn children.”

Michael Guilfoyle, director of communications for the diocese, said the planned meeting between the bishop and congressman, originally set for Thursday, was postponed by mutual agreement after their staffs agreed that the meeting was not as urgent now that the House voted on the abortion provision in the health-care legislation. He said Bishop Tobin still looks forward to a meeting with Kennedy in the near future.

The abortion provision, which prohibits women insured under the public option or who obtain federal health insurance tax credits from purchasing abortion insurance, passed the House Saturday on a 240 to 194 vote. Rhode Island’s other Democratic congressman, U.S. Rep. James Langevin, voted for the amendment and Kennedy voted against it.

The health-care bill passed on a 220-215 vote.

Matheson's vote on health care reform saddens Dems

health care reform

Rep. Jim Matheson's vote Saturday against the House health care reform bill has some Utah Democrats talking up an intraparty challenge against the centrist "blue dog."

But a glance at the district's demographics may quickly discourage serious rivalry from the left.

On Sunday, state Sen. Scott McCoy, D-Salt Lake City, floated the following question on Facebook: "So is it time for me to form an exploratory "McCoy for Congress" committee given Jim Matheson's vote against the health care reform bill?"

That query brought several dozen responses, many urging the congenial -- and openly gay -- Democrat to seriously consider such a run.

"It reflects that a lot of people are upset and disappointed that Jim didn't vote for the bill," McCoy said Monday. "I join in that disappointment. This is one of the most important bills out there."

But McCoy said he has no plans to go after Matheson's seat in 2010.

"I'm flattered," McCoy said of the social-network support. "But you have to think about the composition of the whole district. Right now it's a tough row to hoe."

When congressional boundaries were readjusted after the 2000 census, the conservative Wall Street Journal editorial page pointed to Utah's 2nd Congressional District as one of the country's worst examples of gerrymandering. The new district lumped liberal Salt Lake City with a large swath of conservative southern Utah.

"Scott McCoy is a terrific senator representing his district in Salt Lake County," said Democrat Bill Keshlear, former state party spokesman. "But I don't know of any road map that would lead him to win in Escalante, Vernal or Kanab."

One Utah Democrat drew a distinction between Matheson's stance and that of the GOP.

"His position hasn't been the Republican party 'no way, no how,'" said Todd Taylor, executive director of the state Democratic Party. "Jim had five changes he was interested in."

Still, Utah Dems are "thrilled" with the bill's passage.

"It's a huge deal," Taylor said, "and nothing Jim did obstructed it."

On Monday, the National Republican Congressional Committee blasted Matheson for voting against the GOP health care alternative and trying to play both sides.

"Jim Matheson is so preoccupied with making the best political move for himself, that he ends up upsetting his constituents due to all the promises he breaks along the way," said NRCC spokeswoman Joanna Burgos.

Wayne Holland, who chairs the state Democratic Party, disputes that criticism, noting that Matheson ably represents a surprisingly diverse district larger than Pennsylvania.

"Jim has always been a candidate who cares about fiscal responsibility," Holland said. "That's a vote he had to take based on his constituents."

Plus, he enjoys the highest approval ratings among Utah's congressional delegation, Holland added.

"He knows how to win by big numbers -- and for that we're grateful."

cmckitrick@sltrib.com

Thomas Burr contributed to this story.

The Next Battleground in the Health Care Fight

health care reform

So now the battle turns to the Senate. Like Lincoln, President Obama needs a general who is not afraid to fight.

The Senate majority leader, Harry Reid, should let the Republicans filibuster. The longer they filibuster while people continue to die needlessly and go bankrupt for lack of health insurance, the more the protests across the nation will grow. Eventually the swell of support for real reform will make the reactionary tea party protests seem like, well, tea parties.

And any nominal Democrats tempted to support the insurance industry-backed effort to prevent this bill from coming to a floor vote should be put on notice: we are coming after you in your next election.

When the House passed its version of a health care reform bill on Saturday night, I saw the update on television while out celebrating the 27th birthday of a friend. Almost everyone in attendance was in their mid- to late 20s and college-educated and had voted for President Obama.

But we all had different insurance plans. Some were insured by their jobs; others by their unions; and some, recently unemployed or self-employed, were not insured at all.

And while we all celebrated the president’s and the House’s achievement, not a single one of us was able to answer two seemingly basic questions — how will this bill affect my current benefits, and how will this bill affect my current payments?

My friends and I support health care reform because we believe the current system is failing. But now that change may finally be coming, we want to know exactly what that change entails.

Congress must get health-care reform right

health care reform

The easiest way to understand the health reform debate is to compare it to a track meet, particularly a relay race. Speed is not the goal, however. Victory is getting across the finish line without dropping the baton.

First of all, it's a course that America must complete. Our current medical insurance system is increasingly unaffordable (both to families and the national budget) and mistreats tens of millions of Americans. Failure to finish the race will damage our country.

So when you criticize the athletes, think of what your strategy is for success.

The last time we tried reform, during the early years of the Clinton administration in 1993-94, the baton that the White House gave Congress turned out to be too heavy for Congress to handle. The race never really started; no key congressional committee in either the House or the Senate even voted on the Clinton proposal.

During this year's reform debate, Congress completed the first lap by putting together a bill in October that could be voted on by the House of Representatives. That was historic; it had never happened before.

The big news this past weekend was that the House of Representatives completed the second lap by passing the reform bill 220-215, handing the baton to the Senate to begin the third lap. We don't know yet how the Senate will run, but we will find out by the end of November or early December.

The Senate has a particularly difficult lap because it must get 60 votes, or a super-majority, to pass major legislation. A simple majority of 51 votes is not enough. This high hurdle means that the Senate usually prefers moderate legislation that can appeal to more people in more states.

If the Senate can pass a bill, then the crucial fourth lap will begin, probably in December. Under our Constitution, both the House and the Senate must agree on the same bill before it can be signed by the president to become law.

Today, the two legislative bodies have very different ideas of what makes good reform: The House approach helps the uninsured and underinsured in a more expensive and bureaucratic way than the likely Senate bill does.

I voted last week to allow the race to get to the third lap, believing that the Senate will produce a better bill. The alternative of dropping the baton is unacceptable, either for track meets or for good government. It would amount to a one-house veto.

Many people wanted the House to stop the race now by dropping the baton, but there are also people who watch NASCAR for the crashes. Many more people are hopeful that America will finally help families get a better deal on health insurance and health care. No one knows whether Congress will be able to make the eventual finish line after four laps. The vote was so close last week that the baton nearly slipped from our fingers. We're getting lots of advice because, just like with sports, every fan knows a lot more than the players or coaches. That's fair; Congress must do reform right because health care touches every life in the most profound way.

The ancient Hippocratic Oath says, "Do no harm," but that wisdom has never meant, "Do nothing." Citizens are right to be concerned about the eventual outcome of the debate, but they should resist those who are using scare tactics and misinformation.

I don't know whether Congress can succeed in finally passing a good bill, but I think America deserves the chance to see.

Obama's health care plan, health care reform bill gets an abortion jolt

health care reform

November 10: Obama's health care plan, health care reform bill gets an abortion jolt. Obama’s Health care reform bill is facing stiff opposition from members who think that abortion should be part of the healthcare bill so that women are able to utilize the full healthcare benefits and are not deprived from it.

Many members have said that they will vote against it when it comes for final voting.

Health reforms bill, President Obama’s top domestic priority, has been going through a heated debate for the last several months in the United States.

The bill is learnt to have gained popularity of late, thanks to a nonpartisan analyst. The analyst had pegged the cost of the bill at $ 892 billion, below Obama’s target of $ 900 billion.

The bill has been a bone of contention since it offers insurance coverage to all US citizens irrespective of any pre-existing conditions and will end the insurance companies’ practice of denying coverage for those affected with serious illness.

Republicans have vehemently opposed the bill labeling it a heavy-handed governmental intrusion into private sector.

Insurance companies also warn of hike in insurance costs and premium in case the bill is passed.

A Los Angeles Times report says, “The Senate legislation contains looser restrictions on abortion coverage than were approved by the House. But already at least one Democrat, Sen. Ben Nelson of Nebraska, has signaled that he may be willing to work with abortion rights opponents on developing language similar to the House's…"He wants to make sure the intent is the same" as the House amendment, said Jake Thompson, a spokesman for Nelson. "The final bill has to satisfy him that it doesn't support federal funding of abortions."

Since President Barack Obama took office at the White House this is being called by political pundits his first victory on domestic issues.

The bill, being opposed by the Republicans, allows the government to expand coverage to the Americans who lack it. Besides, it imposes tough new restrictions on the insurance industry.

The bill, that won by narrow margin of 220-215 vote, now goes to the Senate, who will debate on its future. There was jubilation among the Democrats. This epic legislation is being compared by Social Security in 1935 and Medicare 30 years later.

Before the voting a lot of back room maneuvering took place. The President taking initiative met those Democrats who were not sure of supporting the bill. He convinced them about the importance of such legislation. After the vote, he said: "I look forward to signing it into law by the end of the year.”

Another prominent leader to praise the passing of the bill was the 83-year-old Rep. John Dingell. The Michigan lawmaker is responsible for introducing national health insurance in every Congress since succeeding his father in 1955. He said: “It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it.”

Letter: Demand U.S. health care reform

health care reform

Health care reform is needed and needed now. Some think this is merely an option. The No. 1 issue on health care should be getting the heath care you need when you need it and at an affordable price, period. Health care should be a right, not a privilege.

The insurance industry, drug companies and health care administrators have been in charge of this process. They created the mess. Their No. 1 concern is profit, not your health. Always has been and always will be. Some seem to agree, that is the way it should be. They have had decades to find a solution. They failed, why? Because it is not in their interest. They don't see anything wrong with double digit premium increases and then denying coverage for sick people. I find it amazing they can find people who agree with them. But then they have been spending an average of $1.5 million a day lobbying for their interests. They try to scare you into opposing a public option.

This is the United States of America, we should be able to come up with a system that works for all of us. That means a public option is necessary if we don't want continued failure. Ever try dealing with an insurance company when you have a claim? Having insurance is supposed to give you peace of mind, not added stress. Today it doesn't work that way.

If you get your health care coverage through your job, health care premiums have risen 138 percent in the last decade and are predicted to double again in the next decade if nothing is done. Can your company afford $20,000 to $30,000 per year premiums? Can you? Many employers are dumping health care coverage for their employees and especially retirees. You could be next. Companies are moving operations overseas to escape these high costs. We have already given away too many of our good paying jobs. People die because they have no coverage. This is just plain wrong. We voted for change, now we should demand it.

Tom Stensberg

Chairman

Wisconsin River Valley Steelworkers Coalition

Wisconsin Rapids

Chad Stelmacher

President

USW Local 94

Wisconsin Rapids

Baucus Says He’ll Revise Plan, to Make Insurance More Affordable

health care insurance

WASHINGTON — The chairman of the Senate Finance Committee, Max Baucus, said Monday that he would modify his health care bill to provide more generous assistance to moderate-income Americans, to help them buy insurance.

In addition, Mr. Baucus said he would make changes to reduce the impact of a proposed tax on high-end health insurance policies.

Mr. Baucus, Democrat of Montana, disclosed his plans in an interview a day before the committee is to begin meeting to debate and vote on the sweeping legislation, which is intended to remake the nation’s health care system and guarantee insurance for millions of Americans.

Mr. Baucus said the changes showed that he had heard the criticism of his bill from colleagues, who asserted that many people would be required to buy insurance who could not afford it — even with federal subsidies to help defray the cost of premiums.

“Affordability — that, I think, is the primary concern,” Mr. Baucus said. “We want to make sure that if Americans have to buy insurance, it’s affordable.”

Mr. Baucus said he believed that the changes would “help smooth the way for passage” of the bill through the Finance Committee, where it has been criticized from both the left and the right.

The changes could add $28 billion to the 10-year cost of his bill, which was originally estimated at $774 billion by the Congressional Budget Office. The revised bill, though, could still meet President Obama’s stipulation that health care legislation not add to the federal budget deficit.

Under Mr. Baucus’s original plan, the government would provide subsidies on a sliding scale to help people pay premiums. People with income at the poverty level ($22,050 for a family of four) would have been expected to pay 3 percent of their annual income on premiums before subsidies would begin. People with incomes of 300 percent to 400 percent of the poverty level would have been expected to pay 13 percent of their income for premiums before being eligible for subsidies.

It was not immediately clear how much Mr. Baucus would increase the proposed subsidies. He said he wanted to reduce the maximum amount that moderate-income Americans would have to pay in premiums, under the legislation, to less than 12 percent of income.

The subsidies “will clearly be more generous,” he said. However, it was not clear if they would be as generous as those called for under bills approved in July by the Senate health committee and by three House committees.

Mr. Baucus, taking steps to win the support of lawmakers before the committee votes on the legislation, said he would also raise the threshold for expensive insurance plans that would be affected by a new tax. Under his original proposal, insurers would have to pay the tax on policies with premiums exceeding $8,000 a year for individuals and $21,000 for families.

In his revised proposal, “the limits would be higher, so there is less of an impact,” Mr. Baucus said, without giving details.

Senator Baucus said the changes reflected the fact that some people are charged high premiums because they have high-risk jobs, for example as police officers, firefighters or miners. In addition, he said he would address the concern that some health plans charge high premiums because they provide health benefits to retirees.

Senators John D. Rockefeller IV of West Virginia and Jeff Bingaman of New Mexico, both Democrats, have repeatedly raised questions about whether the subsidies for low-income people would be adequate.

Richard J. Kirsch, the national campaign manager of Health Care for America Now, a consumer group, said: “The tax credits in the original Baucus plan were so low they would make premiums unaffordable for many moderate- and middle-income people, who could also face high out-of-pocket costs. And if they don’t pay the premiums, they might have to pay a fine.”

A similar concern was expressed by health policy experts at the Center on Budget and Policy Priorities, a liberal-leaning research and advocacy group often cited by Democrats in Congress.

“Subsidies in the Baucus health reform plan would fall short of what is needed for many people to afford health care,”’ the center said in a study last week.