Scientists & Engineers for America

Health Care Legislation in the 111th Congress

Worldwide, the United States has the highest health-related costs while its citizens receive the lowest quality care among industrialzed nations. Facing increasing costs, President Obama and congressional Democrats are hoping to pass major health care reform during the 111th congress.

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Contents

[edit] Current Status

[edit] Health Care in the United States

Currently, health care costs in the US are skyrocketing at increasing rates. In 2007, the United States spent approximately $2.2 trillion on health care, which is about 16.2% of the GDP or close to twice the average of other developed nations. [1] From 1996 to 2006, health care costs doubled and are expected to rise to 25% of the GDP in 2025 and 49% of the GDP in 2082. [2] Since 2000, premiums of employer-sponsored health insurance have more than doubled at a rate 4 times faster than cumulative wage increases. [3] [4] In 2008, the average cost of an employer-based family insurance policy was $12,800, which is almost equivalent to the annual earnings of a full-time minimium wage paying job. [5]


Due to these rising health care costs, millions of Americans do not have access to health care or receive inadequate coverage. [6] In 2007 and 2008, one in every three Americans under the age of 65 or approximately 87 million people did not have insurance with more than 80% of the uninsured comprised of working families. [7] Because Americans remain untreated, this leads to a decrease in workplace productivity and a large risk of illness and death, which costs $65- $135 billion per year. [8] [9] [10] However, as the uninsured receive health care coverage, they obtain access to effective clinical services, which leads to improvement in their health. [11]


In addition, the quality of health care in the United States remains behind those of other developed countries in many categories despite increasing costs. [12] In a report detailing our national scorecard on US Health System Performance by the Commonwealth Fund, the US achieved an overall score of 65 out of a possible 100 in 37 performance indicators. For instance, hospitals on average do not meet the recommended targets for treating heart attacks effectively. [13] In addition, close to 98,000 Americans die each year as a result of medical errors, which is more than car accidents, breast cancer, and AIDS. [14]

[edit] Public Option Health Care

President Obama has proposed making it mandatory for every individual to purchase health care and providing a public option for health care, a government-sponsored insurance program that will compete with private insurers. The public option is a large part of the Democrats’ health care reform proposals that are working their way through Congress. The public option proposal has met with some criticism, especially from Republican lawmakers, who say that it will result in too much federal intervention in health care. [15]


Some opponents of the proposal feel that the public option for health care is a move towards Canadian-style government-run health care, [16] while supporters hope this new government program will be able to provide coverage for the approximately 46 million people in the United States with no insurance. In addition, they argue that a public insurance option would put pressure on private insurance agencies to cut costs and improve the overall quality of their services. Many Republicans have expressed concerns that a government-run insurance program would have an unfair advantage and would drive insurance companies out of business. They argue that this could potentially lead to a monopoly of the health insurance industry by the public option, which could decrease the quality of care and benefits for patients.


According to a recent CBS News/New York Times poll, 72% of Americans support a government-sponsored health care plan to compete with private insurers. However, many Americans are concerned that government involvement in their own health care plans will compromise the quality of care. The poll also reveals that at first many Americans are willing to pay more in taxes for universal health care coverage, but are hesitant once they learn of the actual dollar amount increase in their taxes to help pay for the new program. [17]

[edit] Developments Off of the Floor

July 14th, 2009.

The American Hospital Association, is taking steps toward health care reform. If this bill goes through, the AHA will agree to give over $100 billion in Medicare and Medicaid payments for 10 years to help reform the system. Ultimately, the AHA is beginning to make major changes to the system, such as the elimination of unnecessary readmissions. The overall goal is to cover more than 40 million Americans. [18]


June 19th, 2009.

The economic benefits of change.

White House Council of Economic Advisers Chairwoman Christina Romer today presented an agency report that shows the significant economic benefits of halting the healthcare costs increments.[19]

Romer testified before the House Budget Committee and pointed out that slowing the health care cost increments would be translated as income for a family of four as much as $2600 in 2020 and $10000 a decade later. Budget panel ranking member Paul Ryan agreed with Romer on the necessity to halt health care cost but remain skeptical about the outcome as he stressed that it would be insufficient to assume system reformation will yield the desired results since any savings would be "swallowed up by spending increases".

Romer told House Budget Chairman John Spratt, it would take between 5 to 10 years for health information technology improvements to exhibit significant savings and that expanding coverage to include the uninsured would effectively raise labor supply.

"With full health insurance coverage, some people who would not be able to work because of disability would be able to get health care that prevents or effectively treats the disability," she said and added "We find the benefits of coverage to the uninsured are very large and substantially greater than the costs," claiming that net benefits of expanding coverage is potentially $100 billion on annual basis.


August 17th, 2009.

Due to recent events ranging from disagreement over the public option all the way to angry mobs viciously interrupting town hall meetings, there is now some talk of the public option being dropped. This down side to this is that it will anger many who say that there can’t be a health care reform without the public option. The good side is that it will gain the votes of those who say that the public option is one small part of the legislation and win the trust of those who are afraid of a government takeover of health care. All in all, the talk of dropping the public option has been an upset to those who believe that it is an essential part of the reform. It has been a triumph for those who are either misinformed mobsters or those who just want to come to a substantial agreement that will get this bill passed. So far in the house there have been one hundred who have signed a letter stating that they will not vote for a bill without public option. There are also many in the senate that say they will not vote for a bill with the public option. [20]

[edit] House

July 14th, 2009

The Chairmen of House Energy & Commerce, Ways & Means, and Education & Labor Committees today unveiled their full draft for the health care reform, ‘‘America’s Affordable Health Choices Act of 2009’’. This bill will increase tax for the wealthy in order to gain the necessary $1 trillion to cover 95% of Americans as well as initiate a government run insurance program. [21]

Some key provisions include: [22]

Comparative Effectiveness Research— This reform creates a new center for comparative effectiveness research within the Agency for Healthcare Research and Quality (AHRQ) that would be overseen by a commission (see related developments below for more information). The center or commission would not mandate coverage, reimbursement policies, or focus only on clinical data. The Center would be able to request information and data from anywhere in the government, unchecked.

Gainsharing— This provision extends the duration of the gainsharing demonstration program established under the Deficit Reduction Act of 2005 until 2011, including additional funding of $1.6 million. Gainsharing involes two parties: hospitals and physicians. [23] Typically, arrangements have involved payments from hospitals to physicians for assistance in generating cost savings. Although these arrangements have the potential to foster efficiency and cohesiveness between physician groups and hospitals, they also raise important legal questions and potentially threaten clinical quality. Gainsharing also align incentives between parties with different economic interests.

Benefit Package/Coverage Decision-Making— This creates a “Health Benefits Advisory Committee” to advise on benefit standards for qualified health benefit plans that would participate in a “health insurance exchange.” This Committee can make recommendations on coverage of treatments, including items and services within benefit classes. In addition, the Secretary could propose to adopt those recommendations “subject to notice and comment rulemaking.” [24]

ACOs—Accountable Care Organizations or ACOs are a system where doctors would have a financial incentive to limit unnecessary tests and encourage patients to exercise more and eat better. [25] This new system would allow hospitals to benefit from keeping patients out of the hospital. Beginning January 1, 2012, the Secretary will begin to conduct a pilot program for testing over a period of 3-5 years different ACO payment incentive models to reduce the rate of growth in Medicare expenditures and to improve health outcomes. Qualifying ACOs would include a group of Medicare participating physicians and other physician organizational models at a minimum, but could also include other providers and suppliers of covered Medicare services. A qualifying group participating in an ACO does not have to be comprised solely of participating physicians. In addition, incentive payments would be available to providers if spending for beneficiaries is less than a target spending level or a target rate of growth.

Imaging— This provision will require the Secretary to adjust the practice expense equipment utilization assumption for imaging equipment from 50% to 75%. [26] Also it adjusts the procedure payment reduction for imaging procedures performed on contiguous body parts during a single session from 25% to 50% effective in 2011.

A complete version of the bill can be found at this link.


June 19th, 2009.

The Chairmen of House Energy & Commerce, Ways & Means, and Education & Labor Committees today unveiled their discussion draft for health care reform. The three committees with jurisdiction over health policy in the House have been working closely together to draw up a single bill that meet President Obama's desire of health care cost reduction, increasing consumer choices and protection as well as guaranteeing access to affordable and good quality health care for all Americans.

Please read:

Health Care Reform discussion draft in full text

Health Care Reform discussion draft summary

Health Care Reform for you

Why Health Care Reform is needed


July 29th, 2009.

Democrats and Republicans in the house have made an agreement which will let a vote take place in the house in September. The deal calls to lower the income surtax plan about 10 percent from $1 trillion so that a public option is considered. The deal also says that small businesses will not be required to give their employees health insurance. [27][28]

[edit] Senate

July 16th, 2009

The Senate Health, Education, Labor, and Pensions Committee passed The Affordable Health Choices Act today, representing the first time since the Clinton administration that a congressional committee has passed universal health care legislation. The legislation proceeded after a 13 to 10 vote along party lines, with Democrats voting in favor and Republicans voting against. Meanwhile, the Senate Finance Committee has been discussing ways to pay for the new legislation, which is likely to cost about $1 trillion dollars, including increasing fees levied on health insurance companies. The House is considering a similar bill, H.R. 3200: America’s Affordable Health Choices Act of 2009.[29][30]

July 23, 2009.

The Senate has delayed voting for the health care reform legislation. It is said that voting will not take place before the August 8th recess. The main reason for this delay is disagreement within the Senate, mostly about how to pay for what the bill calls for. What causes this delay is the disagreement over the high $544 billion income surtax on the wealthy to pay for the $1 trillion over 10 years. [31].


June 24, 2009

Senator Dodd announced on June 24 that the Health, Education, Labor and Pensions (HELP) Committee will have to continue marking up the bill after the July 4 recess. Dodd is chairing the markup while Senator Ted Kennedy is undergoing treatment for cancer. The Committee is waiting on scores (cost estimates) on a number of provisions from the Congressional Budget Office. The bill has been amended several times in committee markup, which began June 17, 2009.

July 28, 2009.

As much debate happens within the senate over the health care reform, three of the six senators debating the reform have deemed the public option unacceptable. Again, what causes the uncertainty and lack of compromise in the public option is the $1 trillion over 10 years plan and how to pay for the legislation. Although it may seem that there is much disagreement, progress has been made on the discussions of ending discrimination of patients with pre-existing conditions. It was eventually decided that the floor would need time to reach a decision and it is now apparent that the vote will not take place until after the summer recess. [32]

[edit] Related Developments

Comparative Effectiveness Research

In 2009, the American Recovery and Reinvestment Act invested $1.1 billion in federal initiatives to perform comparative effectiveness research (CER). [33] The US Department of Health and Human Services (HHS) committee defines CER as “the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions.” [34] The overall goal is to provide information to both patients and healthcare providers on the most effective medical treatment depending on each patient’s specific condition. In addition, this research will give clinicians and patients valid information to make decisions that will improve the performance of the U.S. health care system to help cut costs on redundant, unnecessary, or ineffective treatments. Specifically, the Federal Coordinating Council for Comparative Effectiveness Research will oversee the efforts of this research with 15 members (mostly physicians) that represent the Center for Disease Control (CDC), Centers for Medicaid & Medicare, Office of Applied Studies, HIV/AIDS Bureau, Health Resources and Services Administration, National Institute of Health (NIH), Food and Drug Administration (FDA), Department of Defense (DoD), Veterans Administration, Office of Minority Health, Office on Disability, and the Office of the National Coordinator. [35] To fund this research, the Recovery Act provided $300 million for the Agency for Healthcare Research and Quality, $400 million for the National Institutes of Health, and $400 million for the Secretary of Health and Human Services. However, the council will not make any recommendations on payment, coverage, or clinical treatment.

[edit] Endnotes

  1. ↑ Organization for Economic Cooperation and Development. OECD Health Data 2008.
  2. ↑ P.R. Orszag, Growth in Health Care Costs: Statement Before the Committee on the Budget, United States Senate, (Washington, DC: Congressional Budget Office, Jan 31 2008), available at http://www.cbo.gov/doc.cfm?index=8948
  3. ↑ The Costs of Inaction Report on the Urgent Need for Health Reform. http://www.healthreform.gov/reports/inaction/
  4. ↑ Kaiser Family Foundation & Health Research and Educational Trust, Employer Health Benefits 2008 Annual Survey. (Menlo Park, CA: Kaiser Family Foundation, 2008). http://ehbs.kff.org/?page=abstract&id=1
  5. ↑ Kaiser Family Foundation & Health Research and Educational Trust, Employer Health Benefits 2008 Annual Survey. (Menlo Park, CA: Kaiser Family Foundation, 2008). http://ehbs.kff.org/?page=abstract&id=1
  6. ↑ http://www.healthreform.gov/reports/inaction/diminishing/index.html
  7. ↑ Families USA and The Lewin Group. Americans at Risk: One in Three Uninsured. http://www.familiesusa.org/assets/pdfs/americans-at-risk.pdf
  8. ↑ Institute of Medicine, Hidden Costs, Value Lost: Uninsurance in America. (Washington, DC: National Academies Press, June 2003).
  9. ↑ S. Dorn, "Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality" (Washington, DC: The Urban Institute, 2008)
  10. ↑ J. Hadley, "Insurance Coverage, Medical Care Use, and Short-Term Health Changes Following an Unintended Injury or the Onset of a Chronic Condition," JAMA 2007; 297 (10) : 1073-1084.
  11. ↑ Institute of Medicine, America's Uninsured Crisis: Consequences for Health and Health Care. (Washington, DC: National Academies Press, February 2009)
  12. ↑ The Commonwealth Fund. Why Not the Best? Results from a National Scorecard on U.S. Health System Performance. July 17, 2008. http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Jul/Why-Not-the-Best--Results-from-the-National-Scorecard-on-U-S--Health-System-Performance--2008.aspx.
  13. ↑ Agency for Healthcare Research and Quality. National Healthcare Quality Report 2007
  14. ↑ Agency for Healthcare Research and Quality. National Healthcare Quality Report 2007
  15. ↑ “Bill Moyers Journal: Assessing a “Public Option” for Health Care.” PBS. 10 July 2009. http://www.pbs.org/moyers/journal/blog/2009/07/assessing_a_public_option_for.html
  16. ↑ Levey, Noam. “Public debate over “public option” for health care.” Los Angeles Times 10 May 2009. http://articles.latimes.com/2009/may/10/nation/na-healthcare10
  17. ↑ “Poll: Most Back Public Health Care Option.” CBS News 20 June 2009. http://www.cbsnews.com/stories/2009/06/19/opinion/polls/main5098517.shtml
  18. ↑ "AHA : Advocacy Update : AHA Special Bulletin: House Leaders Release Reform Bill." American Hospital Association. 15 July 2009 <http://www.aha.org/aha/advocacy-update/2009/090714-bulletin.html>
  19. ↑ Leonatti,Andy."Romer stresses economic benefits of change".CongressDaily, June 19, 2009.http://www.nationaljournal.com/congressdaily/cdp_20090619_7010.php
  20. ↑ "The New York Times Log In." The New York Times - Breaking News, World News & Multimedia. Web. 18 Aug. 2009. http://www.nytimes.com/2009/08/18/health/policy/18talkshows.html?_r=1&scp=4&sq=health%20care%20reform&st=cse
  21. ↑ Herszenhorn, David M. "House Democrats to Unveil Health Care Bill - The Caucus Blog - NYTimes.com." Politics and Government - The Caucus Blog - NYTimes.com. 15 July 2009 <http://thecaucus.blogs.nytimes.com/2009/07/14/house-democrats-to-unveil-health-carebill/?scp=1&sq=health%20care%20legislation%20111th%20congress&st=cse>
  22. ↑ https://advamed.box.net/shared/static/fx5dj7o8y3.pdf
  23. ↑ http://findarticles.com/p/articles/mi_m3257/is_3_62/ai_n24925932/
  24. ↑ https://advamed.box.net/shared/static/fx5dj7o8y3.pdf
  25. ↑ http://www.kaiserhealthnews.org/Stories/2009/July/17/ACO.aspx
  26. ↑ https://advamed.box.net/shared/static/fx5dj7o8y3.pdf
  27. ↑ "Nightly Business Report . NBR Transcripts-July 29, 2009 |." PBS. Web. 29 July 2009. http://www.pbs.org/nbr/site/onair/transcripts/nbr_transcripts_090729/
  28. ↑ "Health care progress reported in Congress - White House- msnbc.com." Breaking News, Weather, Business, Health, Entertainment, Sports, Politics, Travel, Science, Technology, Local, US & World News- msnbc.com. Web. 29 July 2009. http://www.msnbc.msn.com/id/32202195/ns/politics-white_house/
  29. ↑ Connolly, Ceci and Lori Montgomery. "Senate Panel Advances Health-Care Overhaul." The Washington Post16 July 2009. http://www.washingtonpost.com/wp-dyn/content/article/2009/07/15/AR2009071500229.html
  30. ↑ Coley, Anthony. "In Historic Vote, HELP Committee Approves the Affordable Health Choices Act." Senate HELP Committee. 15 July 2009. http://help.senate.gov/Maj_press/2009_07_15_b.pdf
  31. ↑ "Reid: Senate Will Not Vote on Health Care Before Break - The Caucus Blog - NYTimes.com." Politics and Government - The Caucus Blog - NYTimes.com. 23. Web. <http://thecaucus.blogs.nytimes.com/2009/07/23/reid-senate-will-not-vote-on-health-care-before-break/'scp=1&sq=health%20care%20delay&st=cse>
  32. ↑ "The New York Times Log In." The New York Times - Breaking News, World News & Multimedia. Web. 29 July 2009. http://www.nytimes.com/2009/07/28/us/politics/28baucus.html?_r=1&scp=5&sq=health%20care%20reform&st=cse
  33. ↑ http://www.brookings.edu/events/2009/0609_health_care_cer.aspx
  34. ↑ Health and Human Services Draft Definition of CER: http://www.hhs.gov/recovery/programs/cer/draftdefinition.html
  35. ↑ http://www.hhs.gov/recovery/programs/os/cerbios.html
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