We've blogged a lot about how health reform fight moves to the state. But it continues in Congress as well. In particular, California's two Senators are continuing the fight for rate review.
Senator Feinstein had called on WellPoint/Anthem Blue Cross to drop plans for the rate hike on Californians (one that has been delayed pending an independent investigation for the California Department of Insurance) most recently during a speech on the floor of the U.S. Senate last Friday:
The Health Insurance Rate Authority Act of 2010, authored by Senator Feinstein and co-sponsored by Senator Boxer, would give the U.S. Secretary of Health and Human Services the authority to review and reject unfair premium rate increases in states where Insurance Commissioners do not have the authority or capability to do so. This is especially key for states like California, which do not have rate review, and important for the period between now and 2014, before the exchanges are functional and can use their negotiating power.
This bill is something that Senator Feinstein is looking to move, so stay tuned...
That's 51% in one year. Fifty-one percent -- even as Anthem Blue Cross of California, a subsidiary of WellPoint Inc. of Indianapolis, has refused to back down from a planned May 1 premium increase of up to 39%.
Braly's total compensation shot up to $13.1 million, from $8.7 million a year. earlier, according to a filing with the Securities and Exchange Commission. At least three other WellPoint executives got compensation increases of as much as 75%.
The hefty packages come as Anthem Blue Cross seeks double-digit rate increases for many of its 800,000 members who buy individual policies.
California customers of Anthem Blue Cross said they were shocked by the pay hike, the majority of which came in the form of $6.2 million in restricted stock, up from $2.4 million a year earlier. Braly also got a $1.5-million performance bonus, compared with $73,810 in 2008.
The Times report quotes customer Mark Weiss, a podiatrist whose Anthem policy will increase in cost by 35%, as saying, "It's unconscionable. How much more does somebody need?"
With federal health care reform on the horizon, we'll see how much longer they can get away with this.
Congressmember Doris Matsui was losing her voice while addressing nearly 100 supporters who gathered to express appreciation for her leadership on federal health reform on Thursday.
But that didn’t stop the Sacramento congresswoman from getting her message across to the crowd of folks who spent their lunch hour assembling at Trinity Cathedral to say “thanks!!” to one of federal health reforms key supporters.
The room stood to applaud Matsui several times during her remarks. Some wiped their eyes as the Democratic Congresswoman spoke poignantly about the importance of health reform in our nation’s history.
Calling it second-only to the passage of Social Security and Medicare, Matsui declared, “This is a victory for health care, civil rights, human rights and, ultimately, our democracy.”
In her role as a member of the House Energy and Commerce committee, where early versions of the legislation were shaped, Matsui’s commitment was key to ultimately turning a bill into the law of the land.
It was an informative program, with several community leaders and members--including Elizabeth Abbott of Health Access--speaking about various parts of the reform. But it was also touching.
To her supporters, who unveiled and presented Matsui with a handmade health care quilt featuring a patchwork of personal stories and messages of affirmation, the congresswoman, who won the 5th Congressional district after her late husband, Bob, held it for 26 years, offered her own thanks. She also made a point of thanking those whose fight for health care reform preceded hers, saying she was certain they were present in the chapel to help celebrate the historic reform.
We congratulate Dr. Donald Berwick for his pending nomination as the head of the Centers for Medicare and Medicaid Services (CMS). We've greatly appreciated his work to improve the quality of health care--and of the patient experience--and our interactions with him, most recently on winning standards for timely access to care.
Dr. Berwick has been clear that cost control and quality improvement are not in conflict. And he is clear that one way is to engage patients in medical decisions--not by shifting costs to consumers, but by informing them about their choices and explaining their options to them. That's a welcome distinction:
It was a beautiful day, but I mostly was on my couch, watching C-SPAN, and posting commentary on www.twitter.com/healthaccess. The Huffington Post condensed the full floor debate into ten minutes. Below is the video, and some of the quotes from the day, particularly from California Representatives.
* CA Rep Judy Chu talked about Eric, a young member of her staff... Getting chemo, he reached 24 and lost coverage under his parents' plan. He then was denied coverage based on pre-existing conditions. He only had coverage because of the job with the Congresswoman, but this plan would help him, and others like him. * CA Rep Doris Matsui described her constituents Tim's + Elizabeth's problem with the health system: "If it's not working for them, it's not working for me." * CA Rep Dennis Cardoza: "My wife has been a doctor for 30 yrs. She tells me every night of stories of patients who get sick, but denied coverage. My wife has to fight with insurers "to let her practice medicine the way she was trained at UC-Davis Med School." "My brother, who owns a small business, saw his premiums are going up 75%.""I am going to vote for this bill, and I am going to vote for it proudly.. "It is desperately needed, desperately long overdue." * CA Rep Henry Waxman: Health reform "builds on what works today.. and it reforms what doesn't. It fundamentally reforms the practices of insurers." * MI Rep John Dingell, after being introduced by Rep. Henry Waxman: "Today is a day that is going to rank with the day we passed the Civil Rights bill of 1964... and Social Security..." * CA Rep Eshoo: I am priviledged to be part of a Congress that votes for this "life affirming" health reform, which will "perfect the union." * CA Rep Mary Bono Mack's descriptions: "secret deals" "shell game" "does nothing"... She gave the impression she was opposed... * CA Rep Lois Capps highlighted prevention: after this bill, "no more co-pays for preventative screenings." * GA Rep John Lewis: "The American people need health care, and they need it now.. Answer the call of history, and pass health care." * CA Rep Mike Thompson: "I've worked for quality, affordable health care for all for years, since my first campaign." "In my district, 63,000 uninsured residents will have access to coverage" * CA Rep Devin Nunes: Health reform brings back "ghost of communism," and it "continues failed Soviet socialist experiment".. we should "say no to totalitarianism." * Vice Chair & CA Rep Xavier Becerra: "Today is a day of history. Today we accomplish what 100 years of Congresses could not." * MD Rep Van Hollen: "The day after this leg is signed by President Obama, Americans will see the world is not coming to an end." * CA Rep Lynn Woolsey: "The whole nation needs health reform but no one needs it more than women..." "..being a woman is a pre-existing condition"
Speaker Nancy Pelosi arrived to a standing ovation, to give a speech that journalist Marc Ambinder called "the best speech I've seen her give." She started by stating that we are honoring the vow of our founding fathers, from the Declaration of Independence, for "life, liberty and the pursuit of happiness." This reform will provide healthier lives, and more liberty to pursue happiness. "This is an American proposal..." she emphasized. Citing the linkage with student aid legislation, she said that health reform and education were two issues that were ultimately about opportunity for the American people. "One word: opportunity."
Speaker Pelosi made the link to the economy. "Imagine an economy where people can change jobs or start a business without worrying that they would lose their health coverage." She continued, "The best action to reduce deficit, to improve economy, to create jobs.. ...is to pass health reform." She praised the health reform for emphasizing prevention, wellness, and innovation.. It "will create 4 million jobs.. will save $1.3 trillion from the deficit."
Speaker Pelosi references her predecessor who said "all politics is local," by stating that in fact, especially with health reform, "politics is personal." She recounts, "I saw a grown man cry" when he couldn't pay his medical bills...
She refers to over 350 groups support of health reform: AARP, AMA, Catholic Health Assn, United Methodist Church, Voices for American's Children, and many others. She also pointed out that the bill includes over 200 Republican amendments, and after over a year of debate, it's time to pass it.
Referencing the late Senator Kennedy, Pelosi calls health reform the "great unfinished business" of our society and says the reform will establish health care "is a right and not a privilege."
And after that, the vote tally went up. Like a New Year's Eve countdown, but utterly more rare and consequential, the bill slowly but surely had over 216 votes.
This Saturday morning, the House Rules Committee will meet at 10am (7am Pacific).
Both Congresswoman Doris Matsui (D-Sacramento) and Congressman Dennis Cardoza (D-Stockton-Modesto-Fresno) serve on the powerful House Rules Committee, which will vote on the key "reconciliation" package, so that it is considered Sunday by the full House, alongside the health reform proposal passed in the Senate by supermajority late last year. The reform effort will not proceed without passage in the Rules Committee.
(A multi-ethnic, multi-generational range of organizations will react to the House Rules Committee vote this afternoon at a press conference at Sacramento State, hopefully thanking our area Representatives.)
The Rules Committee will also vote on what if any amendments go to the floor. Here's a list of proposed amendments. The vote today otherwise sets up a historic vote on the House floor for Sunday, expected around 2pm (11am Pacific), with some speeches and debate beforehand.
Speakers included Dolores Huerta (pictured), professor and radio talk show host Mark Martinez, Dr. Holly Spohn-Gross, Reverend Byrd Tetzlaff, and Katherine Ernst, who described her own experiences with a broken health care system.
But that's just the beginning of the strong show of support for health reform in the Central Valley. Today, Wednesday, March 17th, the Health Care for America Now! coalition will start running TV ads in the Central Valley, making a final case for health reform. The ads spotlight Anthem Blue Cross of California’s recent rate hikes – up to 39% on individual policy holders and 75% on small business owners.
The ad is part of a large national buy starting Tuesday and Wednesday in 17 districts nationwide. The $1.7 million ad buy runs Tuesday or Wednesday through Friday and is scheduled to coincide with the expectation of a vote on health care legislation by week’s end. Ads start running in 11 districts on Tuesday. Those are as follows: Jason Altmire (PA-04), John Boccieri (OH-16), Jim Costa (CA-20), Suzanne Kosmas (FL-24), Harry Mitchell (AZ-05), Scott Murphy (NY-20), Brad Ellsworth (IN-08), Earl Pomeroy (ND), Bill Foster (IL-14), Steve Driehaus (OH-01), and Alan Mollohan (WV-01).
* "It’s happening everywhere." * "Health insurance companies jacking up premiums. Crushing small businesses and working families across America." * "Right here in California, we’ve seen our rates go up by 10, 20, even 39 %, in just the past few weeks." * "Remember, if the insurance companies win, we lose." * "Tell Congressman Jim Costa. To keep standing up for us, not the insurance companies." * "Pass health insurance reform now. "
OK, it's not the big health reform bill, or even a comprehensive jobs bill, but it was a portion of a jobs package that would provide big benefits for health care in California.
One in a series of bills on jobs, this emergency relief package, the “American Workers, State and Business Relief Act,” was approved by a vote of 62-36. Much thanks to Senators Barbara Boxer and Dianne Feinstein for their support. It will go to the House of Representatives, who have passed their own version of a jobs bill, before it goes to the President for his signature.
The legislation, (H.R. 4213), has an extension of unemployment and benefits and contains several health-related provisions that are of particular importance to California, including: * Extending the COBRA subsidy from the earlier stimulus bill. For unemployed California families, the average monthly COBRA premium is $1,107. The COBRA premium assistance reduced this cost to $388 per month, and without this benefit, unemployed Californians could lose $720 a month. * Providing help to the state budget through a six month extension of the enhanced Federal Medical Assistance Percentage (FMAP) enacted under the American Recovery and Reinvestment Act, which otherwise would end on December 31, 2010. This extension through June 2011 would provide an increase of $1.5 to $2 billion in federal funding for California's 2010-11 budget. * Delaying a 21.2 percent cut in payments to physicians who treat California's 4,672,923 Medicare beneficiaries and many TRICARE enrollees in California.
The COBRA subsidy will be welcome for California, with our high unemployment rate. And the relief for our state budget is crucial, to help close our deficit and prevent much, much worse budget cuts. The House had passed these elements in other bills, but it's very good news that the Senate has finally acted.
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that states are able to claim enhanced funds for Medicare Part D drug payments. This should allow California to get $680 million additional money from the federal government.
This decision could mean an additional $160 million more if the enhanced Medicaid match--which the states get through December 2010 due to the American Recovery and Reinvestment Act--is extended by Congress for an extra six months. The House has passed such an extension in both its health reform bill and its jobs bill as well.
After some unfair and harsh statements, Governor Schwarzenegger struck an appreciative tone: “Today’s announcement shows that our bipartisan efforts for a more fair and equitable relationship with the federal government are paying off. Together, state legislative leaders and our Congressional delegation, especially Senators Feinstein and Boxer, have been working to bring California more of the federal dollars we are owed. These funds are important, and while we still have more work to do, I appreciate the commitment of the Obama Administration in responding to our requests for these much-needed funds that are owed to our state.”
This doesn't solve our state budget crisis, but it certainly helps.
BUDGET ACTION HEATS UP AT STATE & FEDERAL LEVEL * Chiang Tells Budget Committee of Cash Crisis, Urges "Credible" Action * Obama's Federal Budget Includes Health Reform and Help for California * Other Items: CBP Report on Growing Need for Services; Single-Payer Bill Advances
* Read Our Health Access Blog for updates on state budget, the latest in D.C. * Join Us on Facebook! Follow Us on Twitter!
ASSEMBLY BUDGET COMMITTEE REVIEWS THE BIG PICTURE: Budget Chair Noreen Evans (D) led committee members Wednesday in a sharply focused Q-and-A with State Controller John Chiang, Legislative Analyst Mac Taylor and representatives with the state Department of Finance.
Not since July 12, 2007, has California actually had cash on hand, Chiang said. Since that date, the Department of Finance has relied on "external borrowing and internal borrowing" from various special funds. In answer to lawmaker's queries, the controller said the state's finance department has identified 710 of the state's 1,000-plus special funds from which it can borrow internally.
Repeatedly, Chiang told legislators that California "needs credible and sustainable budget solutions" that do not include past-year gimmicks such as proposing to sell off the state compensation fund, or EdFund (the state's guarantor of student loans) or the state Lottery -- all of which were said by the administration to be worth far more money than they actually were, and attracted no buyers anyway.
Chiang was firm in telling the budget committee that members needed to make "tough choices" to buck up the state's economic and educational future, as well as to ensure its quality of life does not decline sharply. "We've lost 1 million jobs.... We need to decide what kind of state do we plan to have -- and if we are going to fund essential services, we really need to address the question of revenue."
Both Republicans and Democrats made remarks indicating they've had enough of cutting state services for taxpayers, the disabled, the elderly, and K-12 students as well as university-bound students. Assemblyman Jim Silva (R) said as a teacher he is tired of "seeing students are getting short-changed. I get my back up with I hear that California students are at a disadvantage in getting university educations."
Assemblywoman Diane Harkey (R) noted that she only joined the Legislature about a year ago, but already she'd been through three cycles of closing budget deficits. "We're not just in a budget problem. We are overloaded with debt." Others, including Democrats Jerry Hill and Robert Blumenfield, pointed out that some of the harsh health care service cuts that Gov. Arnold Schwarzenegger is championing will cost the state more money in the long-run as people seek care in emergency rooms or long-term care facilities.
Chiang said Wall Street financial experts do not consider the governor's demand for $6.9 billion from the federal government an intelligent answer to California's perennial deficit woes. "When the governor issued his '6.9 billion solution,' it was not viewed as a totally credible solution, leading Standard & Poors to downgrade California's rating from A to A-."
"We're going to have to educate our students for new economies," Chiang said, "Your actions can make the difference in setting this generation on the right fiscal path. For too long, when people don't make tough choices, students, the aged, disabled and taxpayers all end up suffering."
Evans, the committee chair, said sub-committees will begin meeting next week to scrutinize details of the governor's budget proposal. Regarding an unprecedented Department of Finance letter requesting blanket authority to defer payments to various state creditors, Evans said "I will clean up my language from what I said when I first saw this request for the Department to have legislative authority. I'm extremely skeptical and I suggest you come back with an actual plan." Vice Chair Jim Nielsen (R) joined Republican colleagues in attempting to distance himself from the administration's request for open-ended authority to defer payments. "This is a breath-taking application," Nielsen said. "To just ask us to give you a blank check ... we can't afford that anymore."
PRESIDENT OBAMA PUTS FORWARD FEDERAL BUDGET PROPOSAL: Earlier this week, President Barack Obama released his proposed federal budget. The proposal attempts to balance short-term economic stimulus with long-term efforts at deficit reduction. In attempting to reducing the deficit by $1.25 trillion over 10 years, the proposal lets the Bush-era tax cuts expire, and prioritizes the passage of pending health reforms in Congress. To deal with the immediate recession, the budget proposes a variety of provisions, such as continuing COBRA subsidies to help the unemployed purchase health coverage. It would also extend enhanced Medicaid federal matching funds from the stimulus for six additional months to states, providing $25.5 billion nationally, and at least $1.5 billion to California in the budget year through June 2011.
The Office of Management and Budget has a specific fact sheet on the federal budget and California. Health Access has more about the federal budget on our blog.
CUTS PROPOSED AT TIME OF GROWING NEEDS: The cyclical, seemingly never-ending state budget grind has Gov. Arnold Schwarzenegger stuck in a rut, still swinging away with an ax at the safety net at the time it is needed most. That's the basic message that comes through from a report released Tuesday by the California Budget Project.
California has lost 1,000,000 jobs since the start of the recession, the report says. People need help, families need help, whole communities need help as they scramble against the tide of economic devastation. Cuts, the CBP says, will only further weaken the economy and could impede the national recovery.
The CBP report says that 100 prominent economists of all ideologies recently warned that,"It is economically preferable to raise taxes on those with high incomes than to cut state expenditures [during a recession] ... Steep state budget cuts will exacerbate the economic downturn."
The report noted that California now has 3.6 million more working-age individuals than 10 years ago, but is now down to approximately the same number of jobs as 10 years ago. More than one in five working-age Californians -- or 21.4 percent -- were either unemployed or underemployed in December 2009. (The calculation includes 354,000 jobless people who want and are able to work, but who are left uncounted in official statistics because they have not searched for work in the last month.)
As need grew, California unfortunately responded by cutting off programs -- suspending enrollment in Healthy Families, for example, even though the number of children whose low-income families bought coverage through the program increased steadily by nearly 100,000 kids from July 2007 to July 2009, the report says. To read it and view helpful charts and graphics, go to www.cbp.org.
SINGLE-PAYER, OTHER LEGISLATION STARTS TO MOVE AGAIN: With the new year, bills are starting to move again, including SB 810, the single-payer health reform bill authored by Democratic Senator Mark Leno of San Francisco. That bill looks to be headed to the Governor's desk again this year. It's onto the Assembly after passing the Senate last week, the last week a bill was eligible to pass out of its house of origin. While it still faces the barriers of a two-thirds vote for financing, and a probable gubernatorial veto regardless, it does keep a broad range of health reform options in the policy conversation, and highlights the deteriorating status quo of our health system. If anything, some advocates hope it will provide a lesson from state legislatures to their federal counterparts, that they should not quit just because of a setback.
For more information about anything in this update, contact its author, Cynthia Craft, at email@example.com.
Here's the Center for Budget and Policy Priorities' inital commentary, which states, "The President’s budget reflects both the short-term priority of boosting the economy and creating jobs and the longer-term priority of bringing deficits under control while meeting important national needs... The budget would reduce deficits by $1.25 trillion over 10 years, compared to what they would be by continuing current policies."
In the budget, President Obama reiterates that he is “committed to ensuring that every American has access to affordable health care,” and his FY 2011 budget proposal continues investments to this end in the health care of Californians. Specifically, California would receive $29.4 billion to provide health coverage to low-income families [Source: OMB factsheet]. In addition, other funding would be used to improve and increase the public health workforce, encourage health centers and providers to provide care to underserved populations, fund initiatives to achieve higher quality care at lower costs, and strengthen regional and local partnerships in rural areas.
STATE RELIEF FOR MEDI-CAL COSTS
Of particular note to those of us who deal with the state budget, there is some continued state relief through Medicaid.
Under the economic stimulus package (ARRA) passed last year, the federal matching rate for California’s Medi-Cal expenditures was increased from 50 percent to 61.6 percent. This totaled $1,991,907,534 for the two quarters from October 1, 2008 through March 31, 2009. In all, California was allotted $11.23 billion for the increased Medicaid match rate that is set to expire on December 31, 2010. [Source: http://www.statehealthfacts.org/]
President Obama’s FY 2011 budget proposal includes about $25.5 billion to extend the increased Medicaid matching rate for another six months until June 30, 2011 [Source: OMB]. This means California could receive an addition $2 billion to $3 billion in federal Medicaid relief under the President’s proposal, depending on actual expenditures and the formula for apportioning the grants to states.
This six-month extension of enhanced Medicaid matching funds is one of the requests for additional federal funding that Governor Schwarzenegger requested, and one that has also been included in other legislative vehicles, including health reform and jobs. However, Governor Schwarzenegger's state budget requested many other funding increases and policy changes, totaling nearly $7 billion. Given the political and procedural barriers in Washington, DC, some are more likely than others, but getting the enhanced Medicaid matching funds is a good first step.
We'll have more reports about health reform from DC through the week. But one message: this is *totally* doable.
There is a path for health reform. Some call it "two-step," others call it "Senate plus reconciliation." But it's the same path, and perhaps the only path: The House passes the Senate bill, and a package of improvements that would be passed by the Senate through a limited budget reconciliation process. This still takes two final floor votes, needing 218 votes in the House, and 51 in the Senate.
This is a situation where the best policy and best politics align.
We need comprehensive health reform, and failure to pass such a broad reform (or passing a dramatically scaled back version of reform) won't begin to solve basic issues: getting insurers to compete based on cost and quality, rather than avoiding sick people; having people pay for coverage based on what they can afford, rather than how sick they are.
But other options are also politically problematic. Small reforms and/or starting anew wouldn't work, would not provide the necessary political benefit, and would bring up all sorts of new issues, new opponents, and take much more time and effort.
That's the procedural path is clear. The only question is the political will.
Some have interpreted Speaker Nancy Pelosi's remarks as a signal that health reform is dead. Here's a transcript of some of her statements today, where she expresses the need and urgency for health reform. She's says her caucus can't pass the Senate bill as is. But it seems like it's a path for moving forward, but with changes. One way is to use the budget reconciliation process to make amendments. Read it for yourself:
PELOSI: Many of you have asked many questions about where we go from here. Let me congratulate the new Senator, Senator Brown from Massachusetts. While the results of the Massachusetts election may have diminished by one in the number of Senators in the Senate, last year this time there were 58 Senators, I remind you, 58 Democratic Senators, now there are 59. It has not diminished the need for affordable quality health care reform and for health care to be available to all Americans. As a right not a privilege.
The need for us to address health insurance reforms to end discrimination based on preexisting conditions, to stop rescissions, that when people are sick even though they have health insurance their policy has a rescission, to say that if you pay your premiums and do so on time and you get sick your plan will not -- your insurance will not be canceled. The list goes on and on. The idea of medical loss ratio that insurance companies should pay five percent of the premiums they collect on benefits. These and other issues to hold the insurance companies accountable. The McCarran-Ferguson, repealed McCarran-Ferguson exemption to the antitrust laws for the insurance company. As I say, these and other needs are still there.
There are still 30 million people in our country without health insurance. But the most important point I think is that the present system is unsustainable. We can not afford an upward spiral of cost. Families can't, businesses can't, our economy can't in terms of our international competitiveness, and certainly the Federal budget cannot. So we are going to have to continue to go in a forward direction to lower cost, to hold the insurance companies accountable, to make sure what we do is affordable to the middle class and to -- as we expand access to quality affordable health care. It is still a very exciting initiative, ranks right up there with Social Security and Medicare. And we are meeting with our Members on every level -- as a Caucus, in different groups of the Caucus, to hear how they perceive as the best way to go, how they would prefer to go forward, but we will go forward.
QUESTION: Madam Speaker, given the fact that there seems to be widespread unease in your Caucus about taking up the Senate bill and passing it and fixing it, is that option being discarded at this point?
PELOSI: Nothing is discarded, everything is on the table. You characterize it correctly; "unease" would be a gentle word in terms of the attitude of my colleagues toward certain provisions of the Senate bill. Let me remind you that over 80 percent of that bill, our two bills, are similar. So there are important initiatives in the Senate bill. But there are certain things that members just cannot support. For example, the Nebraska piece of it. And so what they would want to see fixed is that there be equity among states, more fairness, and that that policy shouldn't be made on the basis of one Senator, but on the basis of one country for -- to name one example. There has always been unrest in our Caucus about the excise tax on so called Cadillac benefits and so, you know, just to name a few.
So in its present form without any change, I don't think it is possible to pass the Senate bill in the House. There is some part of our Caucus that would say let's just take these pieces. We recognize health care has to be done -- health care reform has to be done, let's take some pieces of it and go forward. Others are saying let's just get it done and move on. But everybody recognizes that something needs to be done.
QUESTION: Madam Speaker, does that mean the Senate bill in its present form you will not pass?
PELOSI: I don't see the votes for it at this time, no. I mean, the Members have been very clear in our Caucus about the fact that they didn't like it before it had the Nebraska provision and some of the other provisions that are unpalatable to them. But there is a recognition that there is a foundation in that bill that is important. So one way or another, those areas of agreement that we have will have to be advanced, whether it is by passing the Senate bill with any changes that can be made or just taking pieces of the bill. But everything is on the table. In other words, what we are doing now is very calm, we have to get a bill passed. We know that, that is a predicate that we all subscribe to. We have to pass legislation.
QUESTION: But passing the Senate bill and then trying to fix it later is not an option?
PELOSI: There are some fundamentals in there that that make it problematic for our Members. And some Members say, and I respect this, some of the concerns that were expressed in Massachusetts were about certain provision of the Senate bill. We want obviously to hear and heed what was said there and what is said across the country. What was said in Massachusetts was not news to anyone, it was just expressed in an election. But it is hard it say, well, we don't like the special provision for [Nebraska] -- and that had a lot of resonance around the country, again most recently expressed in Massachusetts. So they don't see why something that wasn't even a fundamental part of the bill to begin with, that has been rejected by the American people is something they should be called upon to vote for. That doesn't sound like they heard the message of Massachusetts.
QUESTION: Just to be clear on that, you are ruling out passing the Senate bill unchanged, but are you not...
PELOSI: We are not ruling out anything. I am saying to you we are ruling out -- everything is on the table and everything, every decision that we have to make -- now we are legislating here now, so this may be more on the subject than you want to know. But in legislating, we have to know what our possibilities are, and that means in both Houses and with the White House. And every time you make a decision, you have to make a choice; you don't like this but is it better than that. I am saying to you right now that the Members -- in every meeting that we have had there would be nothing to give me any thought that that bill could pass right now the way it is.
QUESTION: You mentioned that as an option, the pieces. Given the unease among your Members about the Senate bill and trying to fix that, is that a more likely option?
PELOSI: Well, I don't think anybody disagrees with, "Let's pass the popular part of the bill," but some of that popular part of the bill is the engine that drives some of the rest of it. But again, we are not in a big rush; pause, reflect upon what our possibilities are, see what the support is in the Caucus. We have to always go where we can build consensus. So certainly there would be great consensus to take the most popular part of the bill and advance it, but I don't know what -- and that would be positive, but we have serious other structural things that have to be done, systemic changes that have to happen to again hold the insurance companies accountable. [Sound of clock chiming.] Have we, did we get a new clock? Or have we not been here at this time of day? Oh, it is 10 o'clock? It must be Eastern time, Western, some time, other time.
But again, however we achieve it we must arrive at accountability of the insurance companies, and I talked about that package earlier, any discrimination of preexisting conditions, no rescissions, stopping them from canceling policies even though people have paid their premiums but because they get sick their policies cancel. The list goes on, medical loss ratio, McCarran-Ferguson, repealing the exemption that they have to antitrust laws. Again in the Senate bill good language that talks about if the insurance companies raise rates in this next couple of years before the exchanges are established, then they would not be able to participate in the exchange. You know, those kinds of things -- accountability. Affordability is very important. Affordability for the middle class. That is one of the main purposes of bill is to make it affordable to the middle class. And so to the extent that any one of these initiatives, or the decision may be to proceed with the full bill, I don't know, but there isn't a market right now for proceeding with the full bill unless some changes are made in the Senate.
It was there that a 2006 reform got people talking again about health reform in a big way. (Maine and California got some attention in 2003 for reforms, but not as much.) The Massachusetts law was widely scrutinized (including by us at Health Access), either as a reform to emulate or to indicate what was missing.
So it is strange that the election in that state tomorrow for U.S. Senate matters so much. After all, Massachusetts voters already have had a very similar health reform for a couple of years, and have shown no sign of seeking to repeal it.
The concern is that if the Democrat loses, then supporters of health reform only have 59, rather than the needed supermajority of 60 votes. There may be other options, from trying to pass something before a new Senator is seated (there's been lots of lame duck sessions over the years), to simply having the House adopt the Senate bill as is (as Jon Cohn describes here). As Ezra Klein writes, there should be no question that the health reform push needs to go on, regardless of what happens.
As tweeted at @healthaccess and @sovernnation, Speaker Nancy Pelosi told KCBS today that she was not worried about Massachusetts Senate race, she was confident Coakley will win... and that they will pass health care "one way or another."
It was early morning Christmas Eve, 4am for those of watching from the West Coast. Vice President Joe Biden presided for the final vote of HR3590, the Senate's version of health reform. Senate Majority Leader Harry Reid gave appreciation to staff, and final arguments were given by both Republican Leader Mitch McConnell and Reid.
McConnell was defiant. He gave clear indication, that this fight is long fron over. "We will do everything in our power to stop it from becoming law."
Reid comments were touching, invoking Ted Kennedy and saying, perhaps hopefully, that "facts will always defeat fear." He asked the assembled to think of those who were just when Truman made his call to the U.S. Senate to pass health reform, and who because of inaction, became uninsured during their life. Those babies are now months away from Medicare. As Reid said, that's a gong time to wait, to get the commitment to provide health coverage.
To no surprise at this point, all Democratic and Independent Senators voted in support, including our California Senators @Barbara_Boxer and Dianne Feinstein. All Republicans in attendance (Sen. Bunning was not present) voting no. They only needed 50 votes (plus Vice President Biden) for this final vote but got the 60 that allowed the vote to take place. There was applause in the gallery, including from Senator Kennedy's widow, who was in attendance, and Congressman John Dingell--two figures who indicated the long legislative history of attempts in this area. Many Senators gathered afterwards with handshakes and hugs.
Readers of this blog probably already have links to the early morning commentary of Jon Cohn and Ezra Klein. But if not, they are worth reading. Talking Points Memo has other response from across the political spectrum. There wass lots of commentary on the blogs and on Twitter, even by allies in California like @CPEHN, @CALPIRG_mike, and others, sometimes with the whimsical hashtag #cspanatdawn
The most important responses, however, are those of the members of the House of Representatives that have to negotiate with the Senate for a final bill. The three chairmen of the three main House Committees, including Californians George Miller and Henry Waxman, released this statement that suggests their positioning, pointing to similarities and differences:
“We commend our colleagues in the Senate for this crucial vote, which brings health reform closer to reality than at any time in the past 70 years. While there are clear differences between the bills passed by the Senate and the House, both bills will bring peace of mind and fundamental health care coverage to millions of Americans who are currently uninsured.
“Both bills will slow the growth of out-of-control health care costs and reduce the deficit by over $100 billion in the first ten years – and by much more in the second decade. Both bills will make unprecedented reforms to the insurance industry to hold insurers accountable and protect consumers from delays or denials of care based on pre-existing conditions, from rescissions, and from exorbitant out-of-pocket expenses that bankrupt far too many Americans. Both bills will protect and expand peoples’ choices of doctors and health plans. And both bills will offer relief to small businesses getting crushed by spiraling health costs.
“Now that the Senate has cleared this critical legislation, we look forward to working with them and the White House to reconcile and further improve our bills. We are committed to producing a final bill that incorporates the best reforms for middle-class families, small businesses, seniors and our fiscal health, stays true to the values of our members and delivers on the changes the American people desperately need.”
Finally, here's yesterday's statement, from Politico, from two other California Congresswomen, Lynn Woolsey, the chair of the Congressional Progressive Caucus, and Barbara Lee, chair of the Congressional Black Caucus, on what they are seeking in the final negotiations.
"Now that the Senate is poised to pass its version of a health care reform bill, it is time to turn to reconciling it with the House legislation... For Congress to achieve true health care reform we must have a meaningful conference process that integrates both bills into the best possible piece of legislation for the American people."
They list top prioirities:
"A public option — If the bill requires people to buy health insurance, there must be a public option to bring down costs by providing lower-cost competition to private insurers and choice to consumers."
"Affordability protections — The legislation must protect lower and middle-income individuals by ensuring that subsidies make coverage affordable and that Medicaid patients have access to primary care physicians."
"Tighter market regulations — New regulations must keep premiums reasonable and end abusive practices. Insurance companies should no longer be exempt from anti-trust laws and any premium increases must be reviewed before they take effect."
“Employer mandates — If individuals are required to buy insurance, employers should be required to provide it."
“Tax surcharges — Health care reform should be financed by tax surcharges on the wealthy not excise taxes on health insurance plans offered to many workers and union members.
The final product will be better than the Senate bill, and I think by more than what the conventional wisdom suggests. For political and policy reasons, the House will not simply take what the Senate has passed. And while there are some specific areas where it will be hard to revisit hard-fought compromises, there's still leaves lots of room for refinement and improvement. The pressure will be the timetable to get this done quickly.
But California advocates are especially important here, to communicate and advocate and organize with our key Congressional delegation what our priorities are for the final negotiations. We can't disengage now--or at the very least, we need to get right back to work after the holiday break!
"With passage by the Senate, the nation has moved one big step closer to comprehensive health care reform. Health Care for America Now will work to get the strongest bill to the President's desk, one that provides good, affordable coverage to all and holds insurance companies accountable. To realize the promise of reform, we need to be sure that employers are required to help pay for good coverage for their workers, that premiums are affordable to families, that we do not tax benefits, that we enact tough insurance regulations, and that we offer the choice of a public health insurance option. We will urge President Obama to work with leaders in both houses of Congress to agree on legislation that meets these goals, guaranteeing good health coverage we can count on."
Word has come that the federal government will permit, for a limited time, California to take advantage existing federal rules to implement AB1422 (Bass) which would help to fund the Healthy Families program.
This is a great relief. Until now, we heard very discouraging words from those in DC about the prospects for approval of federal matching funds through the extension of the gross premiums tax to Medi-Cal managed care plans.
As you may recall, the health coverage of almost a million children was put at risk as a result of the budget adopted by the Legislature and the further line item vetoes by the Governor back in July. AB1422 was a last ditch effort supported by both the insurers and the advocates to find a way to end the waiting lists and avoid disenrollment of hundreds of thousands of children in the midst of the great economic downturn.
When we learned of the difficulties at the federal level, in a matter of days, an impressive coalition of 20 California groups signed a letter of support for the implementation of AB1422 for Obama Administration.
The federal Centers for Medicare and Medicaid Services will pursue a formal rule making process that is likely completed in June 2011 or later.
Nobody wants a lump of coal in their stocking, least of all the children of California---and in the land of sunshine and oranges, every kid should have health care—and now a million of them will have that chance.
The report, by the consumer health organization Families USA and co-released by the statewide health consumer coalition Health Access California, states that the subsidies – which were started last March by the American Recovery and Reinvestment Act (ARRA), but were made available for only nine months – have enabled millions of laid-off workers and dependents to afford so-called “COBRA” premiums needed to continue health coverage from their previous employer.
Under the ARRA, the federal subsidies pay 65 percent of the cost of COBRA premiums. In California, the federal subsidies for COBRA family coverage average $720 per month.
Without subsidies, the report finds, COBRA premiums for family health coverage will cost laid-off California workers, on average, $1,107 per month – 82.1 percent of the average ($1,349) monthly Unemployment Insurance checks they receive.
For the first recipients, who began receiving subsidies in March, the subsidies will expire on November 30. For those who started receiving subsidies after March, the expiration will be nine months after their start-up date.
For millions of laid-off workers and their families, the federal COBRA subsidies have been described as a health-coverage lifeline. Health advocates are arguing that new jobs legislation extends those subsidies.
Health and consumer advocates noted that pending health reform legislation would provide a permanent source of help to laid off workers. The health reform bills pending in Congress would enable laid-off workers and their families to obtain health coverage through a newly created marketplace, called an “exchange,” and families with low incomes would receive tax-credit subsidies to help pay the premiums.
Health advocates are urging Congress to extend the COBRA subsidy as a much-needed measure in the present to protect recently laid-off workers and their families. But, they say, this issue shows the dire need for health reform moving forward, so nobody loses health coverage when he or she switches jobs or becomes unemployed looking for work.
The Congressional Budget Office and Joint Tax Committee estimated that approximately 7 million adults and dependent children would receive the COBRA subsidy in 2009. The Treasury Department is compiling data about how many workers received the subsidy, but a count of the people benefiting from the subsidy is not yet available.
The data for the Families USA report were derived from federal sources in the Departments of Labor and Health and Human Services. A more detailed description of the sources of the data is set forth in the report’s methodology section.
Fresh from voting to begin debate on health reform, California Senator Dianne Feinstein was on NBC's Meet The Press this morning. (We tweeted her comments at @healthaccess on Twitter.)
Earlier this year, Senator Feinstein’s comments on health reform were noncommittal and even skeptical. She had a website post that indicated her “concerns” with health reform. But as she’s focused on the problem and the solution, she has become more convinced of the urgency of the need, as she stated the urgency of the problem: "The time has come to really see that people who have no insurance can get insurance."
She also seems to have more appreciation for the solution proposed. Always a moderate at heart, she described the bill as “incremental,” in a positive way. "The good part about this bill is that it is structured so it is phased in, so over time we can watch it, we can change it." She cited that some help comes early, like small business tax credits, and coverage for those denied for pre-existing condition,. Other changes, like setting up the exchange and the public option, come online in 2014, and she seemed comforted that it would give us time for adjustments if needed.
As she indicated in a new health reform statement on her website last month, Senator Feinstein was clearly influenced by the T.R. Reid book that compared health systems from around the world. A conclusion of the book is that while several countries have different systems, the U.S. stands out, and not in a good way. As Senator Feinstein said on Meet the Press, "America has serious problems with respect to health care. Virtually every other developed country has a better system than we do. Ours is costly, in places it is ineffective, it's deeply troubled."
But then Feinstein went further, showing that her centrism is not incompatible with a strong critique of insurance companies and our current for-profit system: "No developed country on Earth has a huge for-profit medical insurance industry that we have: 480% profit in 8 years. Premiums skyrocketing." She described that she had five California Daughters of Charity hospitals come to her, and talk about how they face a 17% in premium hike for their 6,000 workers, yet only got back 5% in rate reimbursement. The premium increase wiped out their operating capital for 2009. She argued strongly for a public health insurance option, and for a rate regulation authority.
She also pushed back against the wild falsehoods by the opposition. "I looked at the Republican talking points on the 2.5 trillion figure that is their cost [for health reform]. There's no substantiation for that... What [the CBO] does say: The deficit savings is $170 billion."
Senator Feinstein did Californians right with her vote to move health reform forward, and in her comments on health reform this morning.
Earlier tonight, the U.S. Senate voted on a "motion to proceed" to begin debate on a historic comprehensive health reform proposal, by a vote of 60-39. (All Democrats and Independents voting yes, all Republicans voting no, with GOP Senator George Voinovich not present.)
We thank California Senators Boxer and Feinstein for voting to move forward on the debate for desperately needed comprehensive health reform. Given the extent of California's health crisis, we need to move this bill, and work on the Senate floor to make it better.
The bill would provide stability and security for those who have coverage, and that would extend affordable coverage to those who don't. Californians are concerned that coverage won't be there for them when they need it, and this bill provides our families with much needed security from financial ruin.
Californians have a particular interest in this debate. Californians are more likely to be uninsured, face a higher cost-of-living, are at greater risk to be denied for coverage for pre-existing conditions, and are less likely to be offered on-the-job coverage.The Senate bill would provide crucial financial assistance to small businesses and low- and moderate-income families, expand our safety net, provide key consumer protections against insurance company abuses, and provide the choice of a public health insurance option.
There are areas where we will push to improve the bill, closer to where the House bill is in affordability, inclusivity, and employer responsibility. We need to do better to ensure affordable and meaningful coverage both in terms of what low- and moderate-income families pay in premiums, and in out-of-pocket costs. We need to do better secure on-the-job coverage for working families. We need to remove unnecessary paperwork and prohibitions for people to use the new health insurance exchange. But despite these details, this is a good framework for moving forward.
What we needed tonight was to move the bill foward. We are proud that California's Senators did the right thing for our state. We look forward to them taking quick action so that this legislation can become final law.
Lots going on today. At 2pm Pacific, Senate Majority Leader Reid will unveil the new, combined version of a health reform proposal to his Democratic Senate colleagues, thus starting weeks of debate on the measure. The drama is whether all 60 Democratic-caucusing Senators will vote to allow such a debate to take place, in order to prevent a Republican filibuster. It's an important next step in getting health reform passed.
Back here in California, health reform will be front and center in its own way. At 1:30pm, the Senate Health Committee, chaired by Senator Elaine Alquist, will hold an informational hearing on "Redesigning California's Medi-Cal Program: Examining the Potential for Cost Savings and Program Improvements."
As we have reported before, California's Medi-Cal waiver agreement with the federal government is up for renewal next year. A new waiver would set the rules for the program, which now covers 7 million Californians, mostly low-income children, parents, seniors, and people with disabilities, for the next five years.
Those next five years would take us into the full implementation of health reform, should any of the pending proposals in Congress pass. The waiver process poses a challenge, since consumer advocates are always wary of changes that might undermine patients' rights or access to care. But it can be a significant opportunity to increase access to care and coverage and transition Medi-Cal to a newly reformed system.
Today, with Senate debate on health care reform gearing up for action, former Congressman Richard Lehman, of the Central Valley town of Sanger, had words of support for his House successors, U.S. Rep Dennis Cardoza and U.S. Rep Jim Costa.
"One can demonstrate true leadership and advocate for your district, as Costa and Cardoza have done, and try to address the difficult challenges facing us. Costa and Cardoza have demonstrated once again their choice to take the political hard road and advocate for one of the poorest regions of the country and try to improve our health care system."
Representatives Costa and Cardoza were the subject of major efforts to urge them to support health reform, as among the last to commit to vote for the reform. They did vote for the bill, and there were lots of reasons for them to do so. Health reform will be a major assist to the Central Valley, which needs the help.
It's a clean, inviting informational graphic that depicts dozens of factors and events that helped shape the system of health care delivery in the United States. A simple rollover of the mouse gives greater detail to the events on the timeline -- and as a bonus, cites New England Journal of Medicine articles on the events as far back as 1916. We recommend it.
Health Access California, as part of Health Care for America Now (HCAN) – the nation’s largest health care campaign – launched a new television ad today to publicly thank Representative Jerry McNerney (CA-D) for his historic ‘yes’ vote on the House of Representatives’ health care bill – the Affordable Health Care for America Act (H.R. 3962).
The ad titled “About More” will air for a week on San Francisco Bay Area cable. The ad is one of more than twenty airing nationwide to show appreciation to Members of Congress who have done the right thing in voting ‘yes’ to pass health care legislation through the House and to emphasize the importance of Members continuing to hold strong as health insurance lobbyists and other opponents of meaningful reform are sure to ramp up their attacks in the coming weeks.
California HCAN partners visited Congressman McNerney’s office (and those of several other health reform-supporting Representatives) on Monday morning at 11am to deliver chocolates and a “health care hero” media to make sure Rep. McNerney knows how much his constituents appreciate his voting to make quality care affordable to families and businesses in Nevada and to let her know they will continue to stand with her until health care reform gets signed into law.
“We’re very proud of Congressman McNerney and all the Democrats in the California delegation for standing up to the health insurance industry and other special interests and doing what’s right for California. His historic vote to pass health care legislation through the House means we are one step closer to having good health care we can afford,” said Anthony Wright, executive director, Health Access California. “With his vote, Congressman McNerney has said yes to lower health care costs, yes to a guarantee of good, affordable coverage, yes to stopping health insurance companies from denying care, and yes to the real choice and competition we’ll get with a new national public health insurance option.”
Here's a television advertisement starting to run today by Health Care for America Now! in the district of Rep. Jerry McNerney, thanking him for voting for the historic health reform bill this weekend.
Small floating SUPER: For Congressman Jerry McNerney, it’s about more than just health care.
Small business owners happily running their business. SUPER: Helping small businesses SUPER: Growing the economy
Skyscrapers. SUPER: Taking on insurance companies.
Middle class couple looking over bills at kitchen table. SUPER: Making health care affordable.
Patient in waiting room looking worried. SUPER: No more denying coverage
Middle aged woman speaking with doctor in a doctor’s office. SUPER: Medical decisions in the hands of you and your doctor.
Still of Congressman w/ SUPER: Thank You Congressman McNerney for fighting for us. 1-877-264-4226
AUDIO TRANSCRIPT and DOCUMENTATION:
For Congressman Jerry McNerney, it’s about more than just health care.
Feel like you’re ready to buckle down and review the basics of the process here on out regarding health care reform in the comfort of your own home or office?
Like you ought to be taking this policy shift seriously, because everyone, including the President, describes it as history in the making? Something you’ll want to tell the grandkids about some day? There are plenty of blogs and news stories and informal conversations online, where you can pick up bits and pieces of the process of health care reform.
But if you want to feel like you’ve attended a real, buttoned-down, online university mini-course, try this one at Kaiser.edu.org, a project of the Kaiser Family Foundation. It’s got to be in the Ivy League of online overview slideshow/seminars.
Earlier tonight, the U.S. House of Representatives passed H.R.3962, a historic comprehensive health reform proposal, by a vote of 220-215.
We thank ALL of California's Democratic Congressional Representatives for voting for this desperately needed comprehensive health reform. Given California's health crisis, it's appropriate that the House of Representatives, led by Californians like Speaker Pelosi, Chairmen Miller, Waxman, and Stark, and many others, took the lead in crafting this historic bill.
The bill would provide stability and security for those who have coverage, and that would extend affordable coverage to those who don't. Californians are concerned that coverage won't be there for them when they need it, and this bill provides our families with much needed security from financial ruin.
Californians have a particular interest in this vote. California has more uninsured, a higher cost-of-living, more denials of coverage for pre-existing conditions, and fewer workers offered on-the-job coverage.The House bill would help people keep their on-the-job coverage and expand our safety net. It would provide consumer protections against insurance company abuses, and provide the choice of a public health insurance option.
This is the equivalent of passing Social Security or the minimum wage in the 1930s, or the passage of Medicare or civil rights legislation in the 1960s.
This is not the end of the process, but it moves the process forward. The Senate should take quick action the conference committee to meld the two bills can start its work can begin as soon as possible.
We will look to conference committee to change the one unfortunate development from today's debate, which was the adoption of the Stupak anti-abortion amendment. The main bill had already prohibited federal funds to be used for abortion. The amendment provides for an unwarranted extension that would place anti-abortion restrictions on private plans offered in the new health insurance exchange. While over 190 Democrats voted against the amendment, it's unfortunate that over 60 Democrats--including California Representatives Joe Baca, Dennis Cardoza, and Jim Costa--joined all Republicans in voting for this amendment. This issue needs to be fixed in conference.
Aside from the abortion issue, the House bill is a very good bill--and superior to the Senate versions, especially on key issues like affordability, employer responsibility, the public health insurance option, inclusivity, the bargaining power of the exchange, limits on out-of-pocket costs, financing, and several other issues.
So there's a lot of work to do, but let's remember the importance of this vote. It moves the process forward. And this process has now moved farther than any other previous effort in over 100 years of effort, with an entire body of Congress endorsing a proposal. Let's keep the focus on passing reform, while working to make the reform better.
As I write this, Speaker Nancy Pelosi spoke on the House floor. "This is an historic moment," and said, in a strong voice, "Today we will pass" health reform. "Today, we answer the call" of history. She talked of three pillars: Innovation, Competition, and Prevention. She talked about the benefits of reform for consumers, including that "there's a cap on what you pay in, but there's no cap on what you receive." She gave a long series of bullet points of what "no longer" will happen under the bill, with the biggest applause when she said, "No longer will being a woman be a pre-exisiting condition." At the end,Speaker Pelosi invokes Rep. John Dingell's long fight the health reform, as well as the quote from the late Senator Kennedy: "What is at stake is the character of our country."
There's been other poignant speeches by Californians, including Education and Labor Chairman George Miller's statement focusing on preventing financial insecurity for families. "We cannot ask American families to continue to live on the edge of insecurity..today, we deliver security... A small event, because of lack of healthcare, can explode into the life of a family, the life of a community. That's not going to happen again" under this bill.
Progressive Caucus Chair Rep. Lynn Woolsey explained how she worried about her three children's health when they were uninsured, and no mother will have to now.
The debate is expected to go into this evening.
There will be tough amendments on abortion and immigration before the day is done. * An amendment by Bart Stupak would limit abortion coverage for even *private* health coverage offered through the health insurance exchange. * A Republican amendment would limit undocument immigrants from *using their own money* to buy coverage in the health insurance exchange.
So if you can, keep calling your Congressmembers TODAY (Saturday) 1-877-264-4226.
Health Access California is opposed to the amendments, but strongly for the main bill, H.R. 3962.
Join the Frisco brigade for children's health care...
Thursday, November 05, 2009
One of the activist events rippling across the country is coming to San Francisco on Sunday -- and Champions for Children's Health is calling on people to participate to send a strong message to Congressional leaders that, when all is said and done in Washington, children should have equitable, accessible, affordable health care.
The event is the Champions for Children's Health Stroller Brigade, and participants will be pushing strollers en masse to demonstrate the need for kids' coverage. Supporters without strollers are welcome, too.
Folks should gather at San Francisco City Hall at 2 p.m. Sunday, November 8, to join in the brigade, which the Children's Defense Fund is organizing to send a strong message to Speaker Nancy Pelosi, Senator Barbara Boxer and Senator Diane Feinstein.
The message? Children need their leadership to ensure they are better off after health care reform is done.
As the vote near on the House health reform bill, it is easy to sink into the specifics of the bill, be obsessed by the debate on key details, and mourn amendments that we really wanted but that weren't included.
But we should look at this bill in its totality, and appreciate how signficant it is, and how much help it would provide if it passes. Here's my top ten reasons why this is an impressive bill:
1) Near-universal coverage for all, largely through group coverage with its efficiencies and purchasing power to get the best price. 2) The biggest expansion of Medicaid since its creation 40 years ago, completing a unfulfilled commitment for millions in and near poverty. 3) Sliding scale subsidies tied to income: Consumers will pay for coverage not based on how sick they are, but what they can afford. 4) The end of "junk" insurance, and bankruptcies due to medical bills, with a cap on out-of-pocket costs, and even no cost-sharing for preventative services. 5) Fair share financing that is progressive and pays for itself (in fact, it decreases the deficit), including an employer assessment as important as setting the minimum wage for pay back in the 1930s. 6) New consumer protections: New rules & oversight on insurers that include the abolition of underwriting and "pre-existing conditions," minimum benefit standards, limits on age-based rates and on premiums dollars going to administration and profit. 7) A public health insurance option to provide choice, competition, and offer a safe haven against private insurer abuses. 8) The tools for cost containment and quality improvement in health care generally, from health information technology to transparency of cost and quality to a strong emphasis on prevention. 9) More sustainability and improvements for existing programs--like filling the donut hole in Medicare and streamlining Medicaid paperwork. 10) Momentum to do more in the future, politically and policy-wise, in health care and beyond.
Yes, it still needs to be merged with the Senate, which shares many but unfortunately not all of these characteristics. But for the House of Representatives to pass this proposal, and move us closer to these multiple victories, would be a historic achievement.
The headlines from the elections last night was clearly about the two gubernatorial races, but there were other news as well.
Health advocates across the nation can take some solace that TABOR (so-called "Taxpayor Bill of Rights") spending cap initiatives were defeated in Maine and Washington states. California voters have defeated spending caps twice in the past five years, and hopefully steam is running out of these artificial attempts to handcuff government's ability to meet the needs of its citizens.
In the House of Representatives, Speaker Nancy Pelosi will on Thursday have two more votes for the health reform proposal that is up for a vote Saturday or Monday. New York's 23rd district is sending new Congressman Owens, and California's 10th district has our newly minted Congressman John Garamendi.
Garamendi, Lt. Governor for one more day until he takes his seat, is a advocate for consumers and a verified health policy wonk, as a former Insurance Commissioner who was very active and influential in the health reform debates in the early 1990s. (Update: Ezra Klein and Jon Cohn have more on his health wonk ways.) Last year, he helped us launch the Health Care for America Now campaign in Los Angeles in July 2008 (see photo), and became then the first elected politician nationally to sign the HCAN Statement of Principles. It is totally appropriate that his first act in Congress will likely to be to vote for the historic health reform package.
We've been sending some real health care champions and experts to DC recently. Earlier this year, Congresswoman Judy Chu was elected, like Garamendi, to replace another Obama appointee, and arrived just in time to provide a historic vote. A fighter for health care as chari of the budget subcommittee on health when in the Assembly, she quickly filled former Rep. Hilda Solis' shoes on the U.S. House Education and Labor Committee as it passed health reform out of committee on her first day.
And last year, a San Francisco district elected Rep. Jackie Speier, who was a longtime chair of the Insurance Committee when in the state Senate, and co-author of SB2, the expansion of employer-based coverage that passed in 2003.
The seniority system of Congress suggests they won't necessarily be out front, but they will play a key role. It's heartwarming to know we have such good people who are so knowledgeable and passionate about health care entering Congress from California, augmenting the leadership of Californians like Speaker Pelosi, George Miller, Henry Waxman, Pete Stark, Xavier Becerra, Lois Capps, and others.
For this round of health reform and into the future, Californians will be the movers and shakers.
Before I joined Health Access in January 2006, I worked for the federal government in a variety of jobs. I began my career when I was hired to take applications for retirement, survivor's and disability insurance benefits for the Social Security Administration and ultimately worked in 17 Social Security offices across the U.S. I also served as the Regional Administrator for the Centers for Medicare and Medicaid Services (CMS), formerly HCFA, in San Francisco. The regional office was responsible for Medicare and Medicaid in the four western states (including California) and the Pacific Territories. While these programs are complex, they remain important and are widely respected.
Government programs have many detractors. All programs have coverage gaps and other flaws because of the compromises that arise out of the legislative process. In addition, agencies can have imperfect administration, due to inadequate funding or for other reasons. However, I had the good fortune to work on those programs (Social Security, Medicare, and Medicaid) that are esteemed by Congress and the public as National Treasures to this day. They are consistently admired as having a strong programmatic purpose, an unwavering commitment to beneficiaries, and consistent, professional, and relatively low-cost administration.
So, as we approach a new chapter in the current health care reform debate, it is interesting to look back at the legislative history leading up to the passage of Social Security and Medicare/Medicaid. Since our Congressional representatives all point to those programs as hallmarks of our social fabric and essential to our financial underpinnings, it is interesting to see if those revered programs passed Congress with virtually monolithic, or at least bi-partisan support. Not so much. The Social Security Act of 1935 passed with overwhelming Democratic support, but only 16 Republicans voted for it in the Senate. The Medicare/Medicaid legislation in 1965 similarly had broad support among Democrats in the Senate, but only 13 Republican Senators voted for its passage. While these programs remain part of our foundation, and few legislators would vote for their repeal today, they had little support across the political spectrum at the time they were signed into law.
However, as we attempt to build on their foundation for health care reform, no one remembers the fierce opposition those programs encountered, and the fairly one-sided and sometimes grudging support they received in their day. These days legislators from both political parties acknowledge the critical importance of these programs to the American people. So, let's hope as we re-examine our commitment to passing health care, we continue to go about the business of building on these National Treasures.
Lots of people followed the Senate Finance Committee debate today, which started with a debate on the public health insurance option, and ended with a debate on setting the minimum standards for the value of insurance.
Check out our Twitter feed at www.twitter.com/healthaccess for the blow-by-blow, often retweeting others who were also providing good coverage of the day's deliberations.
The focus was clearly the debate over the public option. Two amendments were extensively debated. Senator Rockefeller's amendment lost five Democratic votes. Senator Schumer's amendment lost three--those of Senator Baucus, Conrad, and Lincoln. In other for it to be accepted, we needed all but one Democrat to vote for the amendment.
Jonathan Cohn at The New Republic says it was predictable, and it was. But regardless of the outcome--either way it went, the fight over the public health insurance wasn't going to end today. Let's remember that of the five committees with jurisdiction on health reform, the other four committees all supported a plan with a public health insurance option. There are at least three other opportunities to improve the Senate Finance proposal, on issues like affordability, employer responsibility, and the public health insurance options, in multiple ways: * when the Senate Finance proposal is merged with the Senate HELP Committee proposal; * on the Senate floor through an amendment; * and in conference committee, when the differences between the Senate and House versions are worked out.
It's clear the public health insurance option doesn't just have the support of a majority of Americans, but a majority (51+) of the Senate. At this moment, it doesn't have 60 votes... which means that the opportunities are there, but it will be a challenge. We need to continue to express the need and urgency for health reform, while at the same time continuing our advocacy for the principles that are necessary.
Here's some reaction from Health Care for America Now!, the national coalition of 1000+ organizations which has been leading the fight for the public health insurance option, and which Health Access is proud to be the lead partner organization in California. Here's the statement by national campaign manager Richard Kirsch:
“Today, a vast majority – more than ¾ - of the Democrats on the Senate Finance Committee joined with all of the Democrats on the Senate HELP Committee to support giving us the choice of a strong public health insurance option. Now four of the five committees that have tackled health care legislation have included a public health insurance option, and the Senate Finance Committee as a whole has proven it’s out of step with the rest of Congress, the President, and a large majority of the American public. As Senators Schumer and Rockefeller said, the public health insurance option is clearly gaining momentum, and we are confident it will be in the final bill that lands on the President’s desk.
The Democratic Senators who spoke out in support of the public health insurance option today made it very clear they understand we cannot leave Americans out in the cold without real choice and competition and at the mercy of the private health insurance companies which will only continue to put their corporate profits before people’s health care needs.”
At least one White House official, Ms. DeParle, has gone so far as to make a house call. When Senator Dianne Feinstein, Democrat of California, expressed misgivings about how expanding Medicaid would affect California’s budget, Ms. DeParle gathered some charts and dropped in on a Saturday. They spent nearly three hours talking over coffee in Ms. Feinstein’s den.
That's not a small amount of outreach for a Senator not on a relevant Senate Committee. But when this gets to the floor, every vote will count.
Senator Feinstein has been equivocal in support of health care reform. While many have been disappointed in her lack of championing a public health insurance option, she has been fairly clear in being supportive of the general concept.
But on health reform in general, her tone has been more skeptical than supportive:
Some of the questions she raises are legitimate--from the need for affordability for California's families facing a high cost-of-living, to the impact on our budget to the need to protect our safety-net hospitals--and are appropriate for someone looking out for California's interests and specific needs. There are other concerns that are misguided--for example, the impact on the state budget is inflated--and other points that are contradictory. In another post, we'll go into the Senator's statement in a more detailed way.
It's good that the White House is walking the Senator through the specifics. It's up to Californians to make clear their support for health reform and their sense of urgency in the next few days and weeks.