Speaker Nancy Pelosi will unveil a bill Thursday that falls short of the liberal vision of a public option — and the liberals, so far and somewhat surprisingly, are going along with that.
After months of public hand-wringing and strident proclamations in support of the strongest possible government-run health coverage, liberal Democrats are bowing to the reality that party leaders don’t have the votes.
So Pelosi will unveil a bill that creates a public option but one that would allow doctors and hospitals to negotiate rates with the government. Liberals wanted a bill tethered to Medicare rates.
In the end, most liberal lawmakers were willing to stand down in this months-long fight because Senate Majority Leader Harry Reid (D-Nev.) announced earlier this week that he would seek to include a public option in the Senate bill. Continue Reading
The Centers for Medicare & Medicaid Services' (CMS) Office of the Actuary recently released a memorandum estimating the financial and coverage effects of the America's Affordable Health Choices Act of 2009 (H.R. 3200) as approved by the House Ways and Means Committee.
According to the memorandum, the H.R. 3200 provisions expanding health insurance coverage (including Medicaid eligibility changes) are estimated to cost about $1 trillion through fiscal year 2019. However, the net savings from the Medicare, Medicaid and growth trend proposals are estimated to total $173 billion, leaving a net cost of $861 billion for the 2010 - 2019 period (before considering any Federal administrative expenses and income tax revenues from a surcharge on high-income individuals or families). Continue Reading Link to Memorandum
Excerpt: "...Post, it was reported that the SGR fix included in the House bill, H.R. 3200, was stripped out of the health care reform bill that passed in three House committees of jurisdiction. Leaders in the House are citing the $240..." Read More
Excerpt: "Over the longer term, H.R. 3200 will force further cutbacks in care as cost savings fail to materialize. Why am I so confident of this outcome? Because I heard the same promises,..." Read More
On October 15, 2009, the House Ways and Means Committee approved a procedural measure to send the America's Affordable Health Choices Act of 2009 (H.R. 3200) to the House Budget Committee with reconciliation instructions.
In a Press Release, House Ways and Means Committee Chairman, Charles Rangel, characterized today's action as "strictly procedural" and "necessary because there is a possibility that a handful of Senate Republicans could choose to engage in partisan tactics to stall this important health reform bill." Continue Reading
The House health reform bill (H.R. 3200)[1] includes a number of significant changes to the Medicare program that would enhance benefits and improve the quality of care, as well as shore up the program’s finances. Much of the discussion of Medicare in the health reform debate has focused, however, on various proposals to secure savings in that program, and a number of seniors appear to believe that Medicare “cuts” made in health reform would make them worse off — or at a minimum, that as Medicare beneficiaries, they would be no better off. [2]
Yet this is not the case. The Medicare provisions in the House health reform legislation would both strengthen Medicare’s financial footing and benefit most of the more-than-40 million seniors and people with disabilities whom Medicare covers.[3] For example, the bill would do the following:
By Joshua Holland, AlterNet.
So let's get past the fearmongering and look at some of the highlights of what's really in the more progressive legislation working its way through Congress. The proposals aren't perfect. As I've written before, in their current form, the bills fail the test of having a truly "robust" public insurance option, and as such has limited potential for cost savings.
But they are also substantial reforms that would go quite a way toward beefing up the health and economic security of a lot of American families if enacted.
The following breakdown is based on the legislation developed by three committees in the House of Representatives (HR 3200) and the Senate Health, Education, Labor and Pensions (HELP) Committee. A third piece of legislation is yet to emerge from the Senate Finance Committee. Reports suggest that the legislation coming out of Finance will be much more accommodating to the insurance industry and other corporate stakeholders
Read More
Asclepios - Your Weekly Medicare Consumer Advocacy Update - Medicare Rights Center
Opponents of health care reform continue to spread the false and malicious rumor that health care legislation would set up government “death panels” to decide whether older adults deserve life-sustaining treatment. Despite clear evidence that no such panels are authorized under any health reform bill, the rumor has not died. In fact, this falsehood has morphed from a fringe conspiracy theory and is now being mouthed by leading figures in the media.
Patients who face the diagnosis of a potentially fatal illness and their family members are ill-served by such fear-mongering. In reality, Medicare provides much more discretion to the doctor to decide the course of treatment in consultation with the patient than do private insurance companies. Take, for example, the treatment options available to a person with Medicare who has been diagnosed with cancer.
Sometimes, the best option for treating cancer is to use a drug that was approved by the Food and Drug Administration for the treatment of another type of cancer or for cancer at a later, more serious, stage. Such “off-label” drug use is widely accepted in the medical community. Medicare will cover such off-label cancer treatments if there is support in reference compendia that review the research on safety and efficacy or, during a review of the specific case, when studies published in respected, peer-reviewed journals (reviewed by expert doctors) support the use.
The flexibility that is built into the legal standard for Medicare coverage is essential to ensure access to life-sustaining cancer treatments. Last year, Congress extended this legal standard for cancer treatments to drugs purchased at a pharmacy under the Part D drug benefit. (Previously, it had applied only to drugs covered under Part B—mostly chemotherapy received in the doctor’s office.) The legislative change was included in the Medicare Improvements to Patients and Providers Act, which passed over a veto by then-President Bush, 70-26, with 21 Republicans voting for the bill.
Many state laws require private insurance companies to use the same standard to decide whether they will cover cancer treatments. Health reform legislation being considered in the House of Representatives, as well as legislation passed by the Senate Health, Education, Labor and Pensions Committee preserves those benefit mandates.
Of course, the question of coverage mandates for Medicare or private insurance is irrelevant to people who have no insurance, or who have insurance that leaves them paying the lion’s share of treatment costs. For the uninsured and underinsured, a cancer diagnosis often means bankruptcy or going without treatment. By setting minimum standards for health benefits (including an out-of-pocket limit), helping low- and moderate-income people afford their premiums, and preventing insurers from denying coverage based on pre-existing conditions (like a history of cancer), health reform legislation extends to all Americans the health security that people with Medicare enjoy.
As the example of cancer shows, ensuring access to life-sustaining treatment is complicated. Securing legal or regulatory mandates is just the first step; real access is often secured only when patients and advocates fight for what they need. If the energy now being devoted to spreading false rumors about government “death panels” were redirected to securing comprehensive, affordable health coverage for all Americans, including those with life-threatening conditions, we would all be better off.
Medical Record
“[Health reform legislation] gives actually people with Medicare more options, more information, more choices, as the president said, and puts them more in control at the end of life or beforehand as they plan for that kind of care. So the mischaracterization of this has really been used to scare seniors and to drum up anti-reform efforts. And it's really a good thing overall, providing seniors and people with disabilities on Medicare more options and choices.” (Medicare Rights Center President Joseph Baker on NewsHour with Jim Lehrer, August 2009)
“Medicare beneficiaries are less likely to report not getting needed services. Twelve percent of elderly Medicare beneficiaries reported going without care, such as prescribed medications or recommended tests, because of cost restraints. Of individuals with employer-based plans, 26 percent reported experiencing these cost/access issues.” (Meeting Enrollees' Needs: How Do Medicare and Employer Coverage Stack Up?,Commonwealth Fund, May 2009)
“The provisions contained in the off-label laws in 19 states require that, in order for certain drugs to be covered, they must be recognized for treatment of the specific type of cancer or indication by either standard reference compendia or medical/peer-reviewed literature.” (State Laws Requiring Third-Part Reimbursment for Off-Label Use of Prescription Drugs for Cancer Treatment, National Cancer Institute, June 2002)
“More than two years after it first filed an appeal, the Medicare Rights Center has secured coverage under the Medicare Part D prescription drug benefit for a New York woman’s ovarian cancer treatment. . . .The victory, handed down in an April 20, 2009 decision by the Part D independent review entity, follows passage last summer of the Medicare Improvements for Patients and Providers Act (MIPPA). (Medicare Rights Center Secures Coverage for New York Woman’s Cancer Treatment, Medicare Rights Center, April 2009)
Rep. Earl Blumenauer [D-OR3]:
H.R. 3200, health care reform, does have a simple solution to empower people and their families. Yet, this carefully crafted provision has been attacked by some opponents of reform, for example, Betsy McCaughey in The Wall Street Journal claiming wildly that somehow this would be mandatory, that it would be done by a government assigned physician, with the threat of coercing senior citizens.
A simple reading of the provision shows that that's simply not the case. Like all other Medicare provisions, it would be voluntary. It would by the physician of one's choice. There's nothing mandatory about it.
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Mr. Speaker, we are on the verge of something very significant in this body and in this Congress. I am proud to join my colleagues from the Ways and Means Committee here tonight to talk about the prospects of health care reform in this country.
I heard the other day that it was in 1912 that President Teddy Roosevelt first talked about proposing a national health care system for the United States. Today, we're still the only industrialized nation that doesn't have health care for all of its citizens. We believe it's time, almost 100 years later, to try and get this accomplished for the American people.
Now, a little earlier, my colleague from Texas--my colleague, friend and classmate from college--talked about polls that are out this week that indicate that the American people have somehow turned against the President in his quest to provide health care reform in this country. But what he didn't mention was the other part of that poll, which said, once people understand what H.R. 3200 does, they overwhelmingly support it.
By Roxana Tiron
Six high-profile veterans groups are raising objections to the House healthcare reform bill, warning House Speaker Nancy Pelosi (D-Calif.) that it could jeopardize the care of millions of veterans.
Citing “grave concerns,” the groups are urging Pelosi to modify the House bill. If changes are not made, the veterans groups say they will actively oppose the measure.
Read More
Asclepios -- Your Weekly Medicare Consumer Advocacy Update from the Medicare Rights Center -- July 30, 2009 • Volume 9, Issue 30
The opponents of health reform will say anything to stop it, no matter how untrue. The latest falsehood alleges that the America’s Affordable Health Choices Act of 2009 (HR 3200) would require older adults to obtain counseling “that will tell them how to end their life sooner,” in the words of Betsy McCaughey, an employee of the conservative Hudson Institute. Representative Virginia Foxx, Republican of North Carolina, went a step further, implying that the House Democrats’ health reform bill would “put seniors in the position of being put to death by their government.”
These falsehoods are designed to scare older adults and gin up opposition to health reform. In fact, HR 3200 provides Medicare coverage for a consultation with a doctor—not a government official—in which the patient can express her preferences regarding end-of-life care. The patient is not required to have this consultation, and there is no mandate for the patient to complete an advance directive (such as a living will) or forego aggressive treatment of a life-threatening illness.
In fact, HR 3200 makes substantial improvements to Medicare. The bill would phase out the Part D “doughnut hole,” the built-in gap in Medicare drug coverage that requires older adults and people with disabilities to pay the full price for their prescriptions while still paying the premiums for the drug plan. Although it would take until 2023 to fully close the doughnut hole, people with Medicare will benefit immediately as the gap is narrowed with each passing year. The enhanced coverage is paid for by securing lower prices for prescription drugs covered under Medicare Part D. In addition, brand-name drugs for people who are in the doughnut hole would be subject to a mandatory 50 percent discount.
The real threat to the lives of older adults and people with disabilities comes when they cannot afford to buy the medicines they need to treat a serious illness. That is happening right now when people enter the doughnut hole. Closing the doughnut hole is the right thing to do, and we need to pass health reform to make that happen. Please write your senators and representatives and tell them to Remember Medicare and pass health reform.
The Kaiser Family Foundation today issued several new resources related to the national debate about comprehensive health reform:
• How Might a Reform Plan Be Financed? examines the challenges of paying for a major reform plan, including a look at some of the options under consideration by Congressional leaders. The brief explains the various approaches being discussed to finance the likely costs of the health reform plans under consideration. It is part of the Foundation's series of Explaining Health Care Reform briefs.
• Key Questions about Changes for Medicaid and Low-Income Individuals: American's Affordable Health Choices Act of 2009 summarizes the Medicaid and Children's Health Insurance Program provisions included in H.R.3200, America's Affordable Health Choices Act, otherwise known as the Tri-Committee bill. It also looks at some key questions about the legislation's provisions affecting low-income individuals.
• Summary of Key Medicare Provisions in H.R. 3200, America's Affordable Health Choices Act of 2009 provides a detailed look at the provisions in the House Tri-Committee bill that affect the Medicare program, including breakouts of the savings and new spending included in the bill.
In addition, the Foundation has updated its interactive side-by-side health reform comparison tool to reflect changes to the Senate Health, Education, Labor and Pensions Committee proposal. The online tool allows users to compare any of 11 different plans, including the House Tri-Committee legislation and the Senate Finance Committee policy options.
All these resources are available through the Foundation's health reform gateway page, which provides a centralized source for key information and analysis about national health reform efforts now being considered by Congress. The gateway also includes original policy and public-opinion research, columns from Kaiser President Drew Altman, and relevant news summaries produced by Kaiser Health News, an editorially independent health policy news service established by the Foundation.
from MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center
People with Medicare would gain new access to low-income programs in H.R.3200, America’s Affordable Health Care Act of 2009, which was introduced by senior Democratic leaders in the House this month. Among other provisions, the legislation would increase access to Medicare Savings Programs (MSPs) and Extra Help, which help pay medical and prescription drug costs for people with Medicare who live below, or just above, the federal poverty level ($10,830 for an individual/$14,570 for a couple in 2009).
The legislation would raise the asset limit for people with Medicare to be eligible to receive Extra Help to $17,000 for an individual/$34,000 for a couple. This is the same limit that determines eligibility for MSPs, and is an increase from $12,510/$25,010 in 2009 for Extra Help.
The discussion draft of the legislation included a measure that would have made unnecessary for people who are enrolled in Extra Help to recertify each year. This provision was left out of the final version of the bill; CBO had estimated the provision would cost $25 billion. The total cost for raising the asset limit and making other improvements to low-income programs is now estimated at $11.9 billion over ten years.
The bill also extends the Qualified Individual (QI) program, which pays Part B premiums for individuals earning between 120 percent and 135 percent of the federal poverty level, for two years, at a cost of $1.4 billion. The program is now set to expire in December 2010. This is a change from the draft language of the legislation, in which the QI program would have been extended indefinitely.
from MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center
A provision that would have guaranteed access to supplemental “Medigap” coverage plans for people with Medicare under 65 was dropped from health reform legislation introduced in the House of Representatives. The provision had been part of an earlier discussion draft of the legislation.
Medigap plans help many people with Medicare pay Medicare’s cost-sharing. Older adults with Medicare have a guaranteed issue right to Medigap when they turn 65 and sign up for Part B, which means they cannot be denied coverage or charged a higher premium because of their medical condition. This helps older adults avoid catastrophic medical expenses. Federal law does not require insurance companies to sell Medigap plans to people under the age of 65. In absence of a federal requirement, only 29 states grant people with disabilities who have Medicare guaranteed issue rights to Medigap plans.
When the three House committees released the draft of their health care reform legislation, it had included a provision that would extend Medigap guaranteed issue rights to people eligible for Medicare because of a disability. The bill did not extend guaranteed issue rights to people who qualify for Medicare because they have end-stage renal disease.
This guaranteed issue provision was removed from the final version of the bill, H.R. 3200, America’s Health Choices Act, reportedly to bring the cost of the bill down. The Congressional Budget Office (CBO) estimated that extending Medigap guaranteed issue rights to people with disabilities would increase Medicare spending by $4.1 billion over ten years, as the enhanced coverage would allow people with disabilities greater access to health care.
Separately, Senator John Kerry, Democrat of Massachusetts, in a letter to Senator Max Baucus, Democrat of Montana, and Senator Chuck Grassley, Republican of Iowa, urges the leaders of the Senate Finance Committee to include provisions in their health care legislation that will extend guaranteed issue rights for Medigap to people with disabilities. He stated “Medigap plans provide vital assistance to Medicare beneficiaries in paying Medicare cost-sharing. Without supplemental coverage, the absence of an out-of-pocket limit in Medicare leaves beneficiaries vulnerable to catastrophic medical expenses.”
Asclepios - Your Weekly Medicare Consumer Advocacy Update from the Medicare Rights Center
Medicare’s Part D drug benefit has a built-in gap in coverage known as the “doughnut hole,” when coverage stops and consumers must pay the full cost for their medicine. The doughnut hole exists because the high cost of drugs made it too expensive for Congress to provide continuous drug coverage—the kind of drug coverage most Americans have through their employer-sponsored health plans. People with limited incomes can get coverage during the gap through a federal program called Extra Help, but for people with incomes or assets too high to qualify for this program, the effects of the gap on their health can be devastating. Here is what the studies show:
* 3.4 million people with Medicare fall into the doughnut hole.
* Over one-third of people with diabetes and hypertension fall into the gap.
* Over 60 percent of people with diabetes, hypertension, congestive heart failure and high cholesterol fall into the gap.
* Many people who fall into the gap skip doses or stop filling all their prescriptions, reducing their drug use on average by 14 percent.
* Use of both generic and brand-name medicines to prevent blood clots drops sharply once people hit the gap, and continues dropping with each month they are in the doughnut hole.
* One in ten people taking medicine to control diabetes stop taking their drugs when they hit the gap.
The statistics are grim, but there is hope. Health reform legislation—HR 3200, America’s Affordable Health Choices Act of 2009—now making its way through the House of Representatives would phase out the Part D doughnut hole. The bill requires price concessions from drug manufacturers and uses the savings to help Medicare gradually narrow the coverage gap until, in 2023, it disappears completely. For the short term, the legislation also requires brand-name drug manufacturers to provide a 50 percent discount to people who fall into the doughnut hole, the result of a deal reached with drug makers, the White House and the Senate Finance Committee. Together, both provisions result in savings to Medicare of nearly $30 billion over ten years.
Health reform legislation that passes Congress must include a plan to fully close the doughnut hole. Please write your senators and representatives and remind them to Remember People with Medicare in health reform and close the doughnut hole when they pass health reform.
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