Health Reform

Tinker Ready hosts an excellent Halloween edition of Health Wonk Review over at Boston Health News. This week's edition features our colleague Joanne Kenen's discussion of oreos, carrot cake, and the biggest public health challenge of our time with Dr. David Kessler. Check it out!

This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say about allowing states to opt out of a public health insurance option.

The public plan debate marches on this week as we discuss whether or not states should be allowed to “opt-out” of the public health insurance plan. Allowing states to choose not to provide the public health insurance plan as an option in their markets has its virtues. It establishes the infrastructure necessary to create a public health insurance plan nationwide, but it also makes the decision ultimately a state judgment. This may be a safer way to go for those who worry about government expansion.

While we do not know the details of what kind of public plan states would be able to “opt-out” of, we suspect the center of gravity is closer to a level playing field approach, such as that proposed by Senator Schumer (where the plan would have to negotiate payment rates with providers) as opposed to the version supported by progressive Democrats in the House (where the plan would administer prices based at least in part on Medicare rates). If the level-playing field approach is in fact adopted, assertions that the plan would simply “underpay providers” rather than “driving real reforms that bring down costs and improve quality” are unfounded.

H.R. 3962, the Affordable Health Care for America Act, is available online. All 1990 pages of it.

UPDATE: Politico's Live Pulse has the supporting documents:

• 11-page detailed summary.
• Topline changes
• Implementation timeline
• Immediate investments
• Section by section summary

We often get so caught up following the politics of health reform that we forget how incredibly important reform will be for real people. It's also easy to forget that members of Congress, and the First Family, no less, have had their own confrontations with the health care system -- and that they might actually be able to relate to John and Jane Q. Public.

In a quick, five-minute video message aimed at American women, First Lady Michelle Obama makes health reform a little more personal -- as both a mother and a woman -- and divulges a medical scare that she and the President experienced two years back with their daughter, Sasha. They knew something was terribly wrong, and they were able to quickly get an appointment with their family pediatrician. The doctor expressed concern that Sasha might have meningitis and risked deafness -- possibly even death. He sent the family straight to the Emergency Room. But the Obama's were lucky -- and they know it.

"That moment in our lives flashes through my mind when we talk about health-care reform," Obama explains. "How if we hadn't had insurance, if we couldn't afford a doctor, we might have waited until it was too late."

But the First Lady promises us that with health reform, "every family will have the same peace of mind as we've had."

There has been a lot of attention lately on what health reform can do for women. We have retold (here and here) several painful stories and explained how the nuances of the health insurance industry disproportionately affect women. For example, gender rating, pre-existing conditions and coverage gaps. Michelle Obama's video, part of a week-long celebration of women leading up to Maria Shriver's annual Women's Conference, features Roxi Griffin (both a lung and breast cancer survivor) and Health and Human Services Secretary Kathleen Sebelius. Watch the full video:

House Leadership will unveil its merged health reform bill at 10:30 a.m. today at the West Front of the U.S. Capitol Building. The Affordable Health Care for America Act should be posted on the House Rules Committee website at 10:00 a.m. We'll have more thoughts later, but early details on the legislation formed from the Tri-Committee bills are as follows:

• Coverage: The bill is expected to lower the ranks of the uninsured by 35 to 36 million. As expected, the bill contains sweeping changes to the health insurance market, such as guaranteed issue, community rating, and an end to the practice of exclusions based on pre-existing conditions. It requires all Americans to purchase insurance, provides subsidies to make insurance affordable and establishes insurance exchanges to create a new marketplace for consumers.
• Cost: The bill will come in under President Obama's target of $900 billion over ten years. The bill is deficit neutral running surpluses in the first half of the 10-year  budget window, but deficits in the second. Democrats in the House say they expect the bill to be budget neutral in the second 10 years as well.
• Public Plan: The bill will contain a public plan with negotiated rates. The move is seen as compromise to help appease concerns of some of the moderate and conservative Democrats in the House.
• Medicaid: The bill expands Medicaid eligibility to 150 percent of the federal poverty level for all adults -- an increase from previous drafts which had set eligibility at 133 percent of FPL.
• Financing: The bill is funded largely savings from changes in Medicaid and Medicare and a a 5.4 percent surtax on individual making more than $500,000 and couples making more than $1 million -- an increase from the original thresholds. The fix to the sustainable growth rate formula has been carved out and will be introduced separately. There is also an 2.5 percent tax on medical device makers and an increase in the cuts faced by drugmakers.

Would you pay $4,000 for a knee brace, shoulder brace, and a heating pad? Would you pay for physical therapy for an imaginary person? How about two knee braces for a patient with only one leg? Probably not -- which is exactly why federal prosecutors are cracking down on fraud and abuse in Medicare and Medicaid.

How much of health care spending consists of fraud and abuse? And what can we do to stop it? These questions were the focus of a Senate Judiciary Committee hearing, "Effective Strategies for Preventing Health Care Fraud."

Deputy HHS Secretary Bill Corr and Assistant Attorney General Tony West testified about their departments' joint task force on health care fraud. The National Health Care Anti-Fraud Association estimates that fraud makes up about three percent of total health care expenditures (more than $60 billion a year). Other estimates go even higher.

We were tempted to say that providing all Americans with affordable health care is not as hard as landing on the moon... but then we remembered that we have landed on the moon...

Sen. Joe Lieberman (I-CT) may not be, to use Harry Reid's own words, "the least of Harry Reid's problems."

After all, Reid does have to worry about a couple of other guys and gals (from Roland '"no-leverage-point"  Burris to Blanche "tough race in 2010" Lincoln). But Lieberman's comments about possibly joining a Republican filibuster of health reform with a public plan certainly got everyone talking today, and he's been on our minds too. Earlier this month, while all eyes were on Maine Republican Olympia Snowe, who cast her ambivalent "aye" vote for the Senate Finance bill, anyone listening to the radio might have noticed that Joe Lieberman was making a lot of worrisome noises.

"In a health-care debate characterized by partisan bickering," Alexi Mostrous of the Washington Post writes, "most lawmakers agree on one thing: American medicine needs to go digital." But how how we make sure it goes digital -- evenly?  In other words, how can we use technology to eliminate health disparities -- not enlarge them?

As we have written before, there is significant evidence that the widespread (and smart) adoption of health information technology will help improve the safety, efficiency and effectiveness of the U.S. health care system. It can also eventually save money or "bend the cost curve." As such, Obama's American Recovery and Reinvestment Act of 2009 (the stimulus bill) made a roughly $30 billion net investment toward Health IT adoption by physicians and hospitals.

But the administration also wants to make sure that health IT reduces -- not deepens -- health disparities. That means making sure the health IT funds benefit the rural, uninsured and underserved populations. 

Senate Majority Leader Harry Reid's decision to include a public plan with state opt-out in the Senate bill may have made the headlines this week, but Christina Romer's remarks Monday may tell us more about what's next for health reform

Speaking at the Center for American Progress, the chair of the Council of Economic Advisers highlighted the importance of health reform to our nation's fiscal future. (Full text of her remarks here). In particular, Romer gave a strong endorsement of the excise high value health insurance plans:

Getting professionals to work together can be hard. Take Washington's football team, for example. All the players are paid by the same owner. Yet they can't seem to get a win.

USA Today/Kaiser Health News featured a story this week on how to get physicians and hospitals to work together. Featuring Tulsa, Oklahoma's Hillcrest Medical Center, the story explores the new Medicare Acute Care Episode (ACE) Demonstration Project and its effect on providers and patients. Hillcrest, a for-profit hospital owned by the Ardent chain, receives a global or "bundled" payment for certain Medicare services. Then -- in line with previously negotiated arrangements -- it pays physicians from the global payment funds. The idea is to encourage coordination of care between physicians and hospitals, which (due to a relic of history) traditionally recieve not only separate payments but from separate Medicare funding streams (part A for hospitals, B for doctors).