Kaiser Daily Health Policy Report
Senate, House Reach Agreement on Policy Framework for Mental Health Parity Legislation
House Energy and Commerce Committee Hopes To Vote on EHR Bill by August, Seeks To Make 'Privacy a Priority'
House Subcommittee Approves Six Veterans' Health Care Bills
House Panel Votes To Extend Health Coverage for College Students Who Take Medical Leave
NIH Fails To Oversee Grantees' Conflicts of Interest, Grassley Says
American Medical Association Apologizes for 'Past History of Racial Inequality' Toward Black Physicians
PhRMA Announces Revised Voluntary Guidelines To Prohibit Gifts to Physicians
Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
Recent Releases in Health Policy
Issue Brief Examines Effects of Tax Code on Health Insurance
Editorial, Opinion Piece, Letter to the Editor Address Health Care Issues in Presidential Election
Administration News
White House Renews Veto Threat of Medicare Physician Payment Bill Because of Medicare Advantage Cuts
[Jul 11, 2008]
President Bush intends to veto legislation (HR 6331) that would delay a 10.6% reduction to Medicare physician fees that was scheduled to take effect last week, despite the measure passing both chambers by veto-proof majorities, the Los Angeles Times reports (Gaouette, Los Angeles Times, 7/11). The Senate on Wednesday approved the measure after it failed to receive enough votes for cloture on June 26. CMS provided Congress with more time to act on blocking the fee reduction, freezing physician fee rates until July 15 through an administrative measure. The bill is similar to a measure (S 3101) proposed by Senate Finance Committee Chair Max Baucus (D-Mont.) that did not pass in the Senate (Kaiser Daily Health Policy Report, 7/10).
White House spokesperson Tony Fratto on Thursday said that Bush will veto the measure because it would reduce payments to providers of Medicare Advantage plans (Los Angeles Times, 7/11). "Taking choices away from seniors in order to pay for the reimbursement for physicians is the wrong way to pass this bill and to extend the reimbursements that we want to see physicians get," Fratto said (Freking, AP/Contra Costa Times, 7/10). Fratto in an e-mail wrote that he is unsure when Bush will take action on the measure (Edney, CongressDaily, 7/10).
Bush has opposed any reductions in payments to MA plans, which are paid on average 12% more than traditional Medicare, according to the Medicare Payment Advisory Commission (Lipman, Cox/Lexington Herald-Leader, 7/11). The measure would offset the 18-month delay to the reduction in physician fees by reducing payments to MA providers by about $13.5 billion over five years, the AP/Contra Costa Times reports. Administration officials estimate the bill would reduce MA plan enrollment to 12 million beneficiaries in five years, compared with the 14.3 million previously estimated. There currently are about nine million beneficiaries enrolled in MA plans, according to the AP/Times (AP/Contra Costa Times, 7/10).
Officials from the American Medical Association have said that 60% of physicians would limit the number of Medicare patients they will see if the fee cut goes into effect. In addition, military groups said the cut likely would affect active and retired service members' access to doctors because Tricare, the military health care system, bases its payment rates on Medicare's. James Rohack, president-elect of AMA, said, "If the president vetoes the bill, he's taking away the ability of patients to see their physicians, and the ultimate choice is whether a physician is able to see patients" (Los Angeles Times, 7/11).
Democrats Say Congress Would Override Veto
House Speaker Nancy Pelosi (D-Calif.) said that lawmakers "rest assured will make very sure that this bill becomes law through a veto override," should Bush veto it (Los Angeles Times, 7/11). If Bush vetoes the measure, the House would hold the first override vote, followed by the Senate. The House on June 24 passed the bill, 355-59, more than the two-thirds majority required for a veto override. The Senate on Wednesday passed the measure 69-30, after nine Republican senators who had previously voted against the measure switched their votes. In all, 18 Republicans voted for the bill, despite pressure from Bush to oppose the legislation (Armstrong, CQ Today, 7/10). "I can't imagine why the president would veto this bill because the writing is on the wall," Senate Majority Leader Harry Reid (D-Nev.) said (AP/Contra Costa Times, 7/10).
According to CQ Today, "Vote-switchers in either chamber likely would be hammered by advocacy groups." Advocacy groups have said they would put more pressure on Republican lawmakers if either chamber fails to override a veto, CQ Today reports. Several groups over the Fourth of July recess aired advertisements targeting Republican senators who voted against the measure on June 26.
Republicans Confirm Veto Override Votes
Sen. Bob Corker (R-Tenn.), one of the nine Republicans who switched their votes, said he would vote to override a veto of the measure, spokesperson Laura Lefler said (CQ Today, 7/10). Corker and Sen. Lamar Alexander (R-Tenn.), who also switched his vote on Wednesday, dropped their opposition to the measure after Senate leadership pledged to take action on a Medicaid payment issue at Regional Medical Center at Memphis. Alexander said he has not yet decided whether he will vote to override a veto. Sen. Johnny Isakson (R-Ga.), who also changed his vote, said he would vote to override a veto (Young, The Hill, 7/10). The Dallas Morning News reports that Texas Sens. John Cornyn (R) and Kay Bailey Hutchinson (R) also said they would vote to override a veto. They both "reluctantly" switched their votes to ensure beneficiaries' access to physicians, according to the Morning News (Garrett, Dallas Morning News, 7/11). Sen. Mel Martinez (R-Fla.), who switched his vote on Wednesday, in a statement said, "The measure we moved forward today does not provide the kind of solution doctors deserve, but this is the only option to stop doctors in Florida from having their pay cut by 10.6%. It is also the only option to ensure that seniors continue to have uninterrupted access to health care" (Jaffe, Florida Health News, 7/10). Timing Issues
CQ Today reports that if Bush delays action on the bill past July 15, a date to which CMS has pushed back filing reimbursement forms, the cuts could go into effect, "infuriating doctors." According to CQ Today, advocacy groups already have begun pressuring Bush to "accept what they see as inevitable and quickly sign the bill," according to CQ Today. However, if Bush quickly vetoes the measure, it will give both chambers enough time to potentially override the veto (CQ Today, 7/10). Editorial, Opinion Piece
Two newspapers published an editorial and an opinion piece related to the Medicare bill. Summaries appear below.
- Houston Chronicle: A "shameless attempt" by Republicans to halt the Senate from voting on delaying a 10.6% reduction in Medicare physician fees "threatened to worsen an exodus of physicians from Medicare," according to a Chronicle editorial. According to the Chronicle, nearly 40% of physicians in Texas currently refuse to accept new Medicare patients. The Chronicle concludes, "Now that the crisis has been averted, Congress should get to work on comprehensive legislation that will devise a realistic formula for adjusting Medicare physician payments to the prevailing market and providing more incentives for doctors to stay with the program" (Houston Chronicle, 7/10).
- Paul Krugman, New York Times: Wednesday's vote was bigger than "the dramatic appearance on the Senate floor" of Sen. Edward Kennedy (D-Mass.), who is undergoing treatment for brain cancer, columnist Krugman writes in the Times, adding, "It was the first major health care victory that Democrats have won in a long time." Krugman continues that the vote "was enormously encouraging for advocates of universal health care." The vote "was really about ... the fight against creeping privatization," and Democrats "finally took a stand," Krugman writes. He writes that the vote shows that Democrats can use public support to secure Republican votes on health care-related issues, which could be used if presumptive Democratic presidential nominee Sen. Barack Obama (Ill.) wins the presidency and presents a universal health care plan to Congress. Through this tactic, Democrats can get the 60 votes needed in the Senate to override a filibuster, Krugman writes. He concludes, "A lot can still go wrong with this vision. But the odds of achieving universal health care, soon, look a lot higher than they did just a couple of weeks ago" (Krugman, New York Times, 7/11).
Capitol Hill Watch
Senate, House Reach Agreement on Policy Framework for Mental Health Parity Legislation
[Jul 11, 2008]
The House and Senate have reached an agreement on the policy framework for legislation that would require employers and health insurers to cover mental illnesses at the same level as physical illnesses, the Wall Street Journal reports. Under the agreement, the terms of which will be set this week, mental health benefits would be required to be on par with medical and surgical benefits, including treatments such as hospital stays, physician visits and cost sharing such as copayments, deductibles and out-of-pocket expenses. If a plan offers medical coverage for treatment outside its provider network, it must offer the same for mental health treatment.
Negotiators said the agreement would cost about $1.3 billion over five years and $3.4 billion over 10 years, mostly because of lost tax revenue. The plan would affect mental health coverage for 113 million people, including 82 million enrolled in federally regulated plans that are funded by employers and 31 million people who are enrolled in state-regulated health plans. The agreement contains elements of a Senate mental health parity bill that the Bush administration supports, as well as a broader House measure that the administration opposes.
The compromise won the support of business groups -- who were concerned such requirements would raise their health care costs -- because it wouldn't mandate coverage of specific mental health conditions or add liability risks under state laws, the Journal reports. Katie Strong, director of congressional and public affairs at the U.S. Chamber of Commerce, said, "Costs would be the biggest concern to employers, but we are hopeful the way it's drafted will not dramatically increase costs." Insurers could control costs using managed care tools, such as requiring members to see a doctor or therapist in their network or having doctors routinely show that continuing therapy sessions or other treatments are necessary, the Journal reports.
Neil Trautwein, vice president and employee-benefits policy counsel at the National Retail Foundation, said, "Time will tell what the ultimate cost will be," adding, "We definitely think it's in the greater interest of both employers and employees alike, and we think this is a responsible approach to extend mental health parity and mental health coverage." Karen Ignagni, president and CEO of American's Health Insurance Plans, said that the group supports the compromise legislation and that she does not believe the agreement would lead to insurers dropping coverage for behavioral health disorders or conditions (Zhang/Fuhrmans, Wall Street Journal, 7/11).
House Energy and Commerce Committee Hopes To Vote on EHR Bill by August, Seeks To Make 'Privacy a Priority'
[Jul 11, 2008]
House Energy and Commerce Committee ranking member Joe Barton (R-Texas) on Thursday said that committee leaders hope to vote on a bill (HR 6357) that would create a national electronic health record system and that the committee is committed to "making privacy a priority" within the legislation, CongressDaily reports. Speaking at a conference on privacy, Barton -- who introduced the bill with committee Chair John Dingell (D-Mich.) -- said the bill likely would have "the strongest privacy protection of any bill that's gone through the House or Senate in the last five or 10 years." Barton said that while discussions in the committee are focused on privacy protections, "the problem is determining what privacy is" in the legislative sense.
Privacy experts have requested specific language be included in the bill, according to CongressDaily. However, the language "is technically correct but not legislatively appropriate," Barton said. Barton added that he and Dingell have been "going round and round" with Health Subcommittee Chair Frank Pallone (D-N.J.) and ranking member Nathan Deal (R-Ga.) to what language to include. Senate Bill
A similar bill (S 1693), introduced in 2007 by Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) and ranking member Mike Enzi (R-Wyo.), also could progress soon, according to Democratic and Republican aides, CongressDaily reports.
However, a Kennedy spokesperson said a few outstanding concerns with the bill need to be addressed. Sen. Tom Coburn (R-Okla.) and other GOP lawmakers object to the $137 million authorization level.
In addition, Sen. Olympia Snowe (R-Maine) has said the bill should include provisions that require individuals who use or maintain the EHR system to alert authorities about patient data leaks and fine those who mishandle the data. The 18-member American Health Information Community advisory board -- led by HHS Secretary Mike Leavitt -- should have three consumer representatives instead of just one, Snowe said.
The Bush administration has voiced opposition to changing the board (Noyes, CongressDaily, 7/10).
House Subcommittee Approves Six Veterans' Health Care Bills
[Jul 11, 2008]
The House Veterans' Affairs Health Subcommittee on Thursday approved by voice vote six bills related to health care services administered by the Department of Veterans Affairs, CQ HealthBeat reports.
One of the bills (HR 1527), sponsored by Rep. Jerry Morgan (R-Kan.), would allow "highly rural" veterans to receive health services through outside providers. The bill defines highly rural as veterans seeking primary care who live more than 60 miles from the nearest veterans' facility; veterans seeking acute hospital care who live more than 120 miles from a facility; and those seeking tertiary care who live more than 240 miles from a facility. An amendment to the bill, which also was approved on Thursday, would establish a three-year pilot program to allow veterans enrolled in four of VA's 21 health care networks to receive outside health services. The bill does not include funding for the pilot program.
The other five bills were improved en bloc by voice vote. The bills include a measure (HR 6439), sponsored by Rep. Phil Hare (D-Ill.), that would extend mental health benefits to family members of veterans who seek non-service related treatment (Johnson, CQ HealthBeat, 7/10). In addition, the panel approved a measure (HR 6445) sponsored by Rep. Don Cazayoux (D-La.) that would prohibit hospitals and nursing homes from requiring copayments from catastrophically disabled veterans, such as those who are paralyzed or have neurological disorders (CongressDaily, 7/10).
The bills are expected to be marked up by the full committee on July 16 (CQ HealthBeat, 7/10).
House Panel Votes To Extend Health Coverage for College Students Who Take Medical Leave
[Jul 11, 2008]
The House Energy and Commerce Health Subcommittee on Wednesday by voice vote approved to extend a bill (HR 2851, S 400) that would allow college students who are forced to leave school for a serious illness to continue to receive health care benefits under their parents' health insurance policies, CongressDaily reports. The law would allow students who have certification from a physician of a serious ailment to qualify for coverage during a medical leave of up to one year. The panel also adopted an amendment, proposed by Subcommittee Chair Frank Pallone (D-N.J.), for the law to take effect one year after it is enacted.
Pallone said, "Students are forced into the difficult decision of continuing with a full-time course load while they try to seek treatment or withdrawing and losing health care eligibility," adding, "No American should be faced with such a choice" (Posner, CongressDaily, 7/9).
NIH Fails To Oversee Grantees' Conflicts of Interest, Grassley Says
[Jul 11, 2008]
NIH has failed to oversee conflicts of interest relating to almost $24 billion in annual funds the agency distributes to outside organizations for medical research, according to a recent letter by Sen. Chuck Grassley (R-Iowa) to the Senate Appropriations Committee, CQ HealthBeat reports.
NIH requires grantees of the extramural funds -- including non-government organizations and government agencies, such as CMS -- to collect and track information on money they receive from drug companies and device makers. However, reports show in several instances that such tracking does not take place, Grassley said. Grassley, the ranking Republican on the Senate Finance Committee, cited a report released in January by the HHS Office of Inspector General that found "NIH provided almost no oversight of its extramural funds."
NIH rules on disclosure need to "add teeth," Grassley said, adding that "researchers need to be put on notice that government grants come with obligations of financial disclosure."
NIH Director Elias Zerhouni said that the agency is conducting a full review of its "oversight of extramural institutions' financial conflicts of interest ... and has identified and is reviewing several areas for oversight enhancement." Zerhouni added, "I am hopeful that we can significantly enhance the identification and management of [financial conflicts of interest] to ensure that undisclosed, and therefore unmanaged, conflicts do not bias the design, conduct or reporting of NIH-supported research" (Parnass, CQ HealthBeat, 7/10).
Coverage & Access
American Medical Association Apologizes for 'Past History of Racial Inequality' Toward Black Physicians
[Jul 11, 2008]
The American Medical Association on Thursday issued an apology for more than 100 years of "racial inequality" toward black physicians and for the acceptance of racial segregation in the medical profession, the Wall Street Journal reports (Burton, Wall Street Journal, 7/11). In a statement posted on the AMA Web site, the group apologized for "its past history of racial inequality toward African-American physicians" and cited "its current efforts to increase the ranks of minority physicians and their participation in the AMA" (Kunerth, Orlando Sentinel, 7/11).
The apology accompanies a study and a commentary being published in the Journal of the American Medical Association. AMA acknowledges that, although the group has not engaged in racial inequality toward black physicians for decades, those past transgressions continue to affect medical care. The study emerged from the Commission to End Health Care Disparities, a work group co-chaired by AMA and the National Medical Association, a group that represents black physicians (Kay/Kohn, Baltimore Sun, 7/11).
According to the study, AMA from 1846 through the 1960s contributed to substandard care for black patients or segregated them to black hospitals; a lack of support for black physicians and for the Civil Rights Act; and exclusion of blacks from medical schools, hospital staffs and residency programs. The study concluded that past transgressions by AMA have contributed to the continued exclusion of blacks from the medical community. Blacks in 2006 accounted for 12.3% of the U.S. population but only 2.2% of physicians and medical students, according to the study (Wall Street Journal, 7/11). Implications
"The apology is among initiatives at the nation's largest doctors' group to reduce racial disparities in medicine and to recruit more blacks to become doctors and to join the AMA," the AP/Raleigh News & Observer reports (Tanner, AP/Raleigh News & Observer, 7/10). "There is still animosity among some black physicians toward the AMA for its refusal to accept blacks into its membership," according to the Orlando Sentinel (Orlando Sentinel, 7/11).
Matthew Wynia, head of historical inquiry and director of the Institute for Ethics at AMA, said, "If we wanted to do anything credible in the area of health disparities, we had to take responsibility for any role the association had to play in segregation in the medical profession" (Baltimore Sun, 7/11). He added, "I wouldn't be shocked if this led to similar work by other groups" (Wall Street Journal, 7/11). Reaction
NMA President Nelson Adams said, "We applaud the AMA for coming forward with information that is not pretty," adding, "It represents a time to celebrate where we are" (Baltimore Sun, 7/11). Nedra Joyner, head of the board of trustees at NMA, said, "These persistent, race-based health disparities have led to a precipitous decline in the health of African-Americans when compared to their white counterparts and the population as a whole" (Orlando Sentinel, 7/11).
Levi Watkins -- a cardiologist at Johns Hopkins Hospital, associate dean of the Hopkins medical school and the first black student at the Vanderbilt School of Medicine -- said, "I'm grateful for the apology. But the time for apologies is long since past." He added, "Right now I would like apologetic action" to address racial discrimination in the medical community and racial disparities in health care (Baltimore Sun, 7/11).
 The apology is available online.
The study and commentary also are available online.
 NPR's "Day to Day" on Thursday included coverage of the apology with comments from Adams ("Day to Day," NPR, 7/10). PBS' "NewsHour with Jim Lehrer" on Thursday also included coverage of the apology (Brown, "NewsHour with Jim Lehrer," PBS, 7/10).
Prescription Drugs
PhRMA Announces Revised Voluntary Guidelines To Prohibit Gifts to Physicians
[Jul 11, 2008]
Pharmaceutical Research and Manufacturers of America on Thursday released revised voluntary marketing guidelines that ban gifts from pharmaceutical companies to physicians, Bloomberg/Indianapolis Star reports (Bloomberg/Indianapolis Star, 7/11). In addition, under the guidelines, pharmaceutical companies can no longer provide physicians with meals at restaurants and entertainment or recreation. According to the guidelines, pharmaceutical company sales representatives should focus on efforts to inform physicians about products and discuss related scientific and educational information (Seaman, AP/Philadelphia Inquirer, 7/11). The guidelines also require increased disclosure of speakers or consultants financed by pharmaceutical companies (Cohen, Newark Star-Ledger, 7/11).
"We are ... concerned that our interactions with health care professionals not be perceived as inappropriate by patients or the public at large," PhRMA said in a statement (AP/Philadelphia Inquirer, 7/11). PhRMA President Billy Tauzin said, "These are critically important changes to help build more trust and credibility and help benefit patients" (Newark Star-Ledger, 7/11). He added, "This updated code fortifies our companies' commitment to ensure their medicines are marketed in a manner that benefits patients and enhances the practice of medicine" (Tansey, San Francisco Chronicle, 7/11).
Tauzin said that all member companies have endorsed the guidelines and that PhRMA will certify their compliance publicly on the group Web site. He added that, although PhRMA will not impose penalties for violations of the guidelines, media scrutiny and industry competition will encourage compliance (Reichard, CQ HealthBeat, 7/10). Allowable Practices
According to the Baltimore Sun, the guidelines target practices that "are already losing favor" and will "eliminate only a small fraction of the estimated $20 billion" that pharmaceutical companies spend annually on marketing to physicians (Rockoff, Baltimore Sun, 7/11). For example, the guidelines allow pharmaceutical companies to continue to pay physicians for speaking appearances or consulting arrangements (Lazar, Boston Globe, 7/11).
In addition, although the guidelines require pharmaceutical companies to establish annual limits on the amount paid to physicians who deliver educational lectures on their behalf, they do not specify the amount of such limits (Newark Star-Ledger, 7/11). The guidelines also allow pharmaceutical company sale representatives to continue to provide physicians with meals in their offices as they promote their products (Baltimore Sun, 7/11). Reaction
"The new code is a very important step forward for the industry and we welcome that," Association of American Medical Colleges chief scientific officer David Korn said. Sen. Herb Kohl (D-Wis.) said, "I'm encouraged by the industry's attempt to clean up its act." Sen. Chuck Grassley (R-Iowa) said that the guidelines will help increase oversight of pharmaceutical company marketing practices but added that Congress should pass a bill (S 2029) he has introduced to require drug and medical device companies to disclose to the public certain gifts and payments to physicians (CQ HealthBeat, 7/11).
However, Jerome Kassirer, a professor at Tufts University School of Medicine, said, "This announcement is a PR ploy. It really is a meaningless gesture" (Baltimore Sun, 7/11). Sidney Wolfe, director of the Health Research Group at Public Citizen, said of the guidelines, "They symbolically appear to cut out some small items but left huge items on the table such as buying lunch for everyone in a doctor's office" (Bloomberg/Indianapolis Star, 7/11). John Santa, director of the health ratings center at Consumer Reports, said, "It's best for consumers if there's competition around price and not competition around influence, reciprocity and advertisements, and I don't think we see that here" (Baltimore Sun, 7/11).
NPR's "Day to Day" on Thursday reported on guidelines (Brand, "Day to Day," NPR, 7/10).
Blog Watch
Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
[Jul 11, 2008]
While mainstream news coverage is still a primary source of information for the latest in policy debates and the health care marketplace, online blogs have become a significant part of the media landscape, often presenting new perspectives on policy issues and drawing attention to under-reported topics. To provide complete coverage of health policy issues, the Kaiser Daily Health Policy Report offers readers a window into the world of blogs in a roundup of health policy-related blog posts. "Blog Watch," published on Tuesdays and Fridays, tracks a wide range of blogs, providing a brief description and relevant links for highlighted posts.
Yuval Levin of The Corner points to a National Review Online article on the "pay-or-play" element of presumptive Democratic presidential nominee Sen. Barack Obama's (Ill.) health care plan, which he says "would create a serious new disincentive to hiring."
Louise from Colorado Health Insurance Insider discusses possible consequences of more people obtaining insurance through the individual market as an outcome of presumptive Republican presidential nominee Sen. John McCain's (Ariz.) health plan and notes that "the individual health insurance industry would be in more of a public spotlight and might be forced to make some modifications to allow coverage for more people, with more fair pricing."
Maggie Mahar from the Century Foundation's Health Beat Blog discusses how physicians who have stopped accepting private insurance run their practices and charge for services.
Sarah Arnquist of The Health Care Blog discusses challenges to providing health care in rural communities.
Jason Shafrin of the Healthcare Economist discusses a California HealthCare Foundation issue brief that examines standardized labeling of insurance policies, saying that "having some sort of standardized disclosure form could aid consumers in shopping for the best deal."
Suzanne Curry from Health Care for All's A Healthy Blog discusses a dialogue between economist Uwe Reinhardt and Ulla Schmidt, the German minister of health, at a Brandeis panel on Germany's efforts to implement an individual mandate similar to the one in Massachusetts. A webcast of the panel is available online at kaisernetwork.org.
Health Populi's Jane Sarasohn-Kahn discusses a new Health Affairs study that found enrollees in high-deductible, consumer-directed health plans were more likely to forgo medical care to save money and says policymakers and employer plan designs should take people's responses to growing financial risk into consideration.
Rep. Charles Boustany (R-La.) on The Hill's Congress Blog discusses recent legislation that would halt a Medicare physician fee cut, saying that "whether they like it or not, Congressional leaders must ultimately face the challenges facing the Medicare program."
Managed Care Matters' Joe Paduda discusses a panel at a Center for Studying Health System Change conference that discussed what health insurers are doing to prepare for health reform scenarios. Some insurers are expanding into the individual market, which Paduda says "may seem like good preparation for a possible McCain-type plan, [but] examining the results of Part D may be more instructive." A webcast of the conference is available online at kaisernetwork.org.
Paul Testa of the New America Foundation's New Health Dialogue examines Paul Krugman's column in the New York Times that discusses the link between problems in health care and the economy.
Jacob Goldstein from the Wall Street Journal's Health Blog discusses why cuts to Medicare physician fees will continue to be a political issue. Bob Laszewski of Health Care Policy and Marketplace Review writes that doctors should consider new solutions for reimbursement problems because another Medicare physician fee cut of 21% is scheduled for 2010. Laszewski calls the fragmentation of the U.S. health care system "the heart" of physician reimbursement problems and suggests medical homes and other similar approaches as ways to meet goals of containing health costs and improving quality.
Several blogs wrote about Health Care for America Now, which launched a $40 million national advertising campaign on Tuesday that calls for access to comprehensive, affordable health care in the U.S. A selection of posts is below:
Recent Releases in Health Policy
Issue Brief Examines Effects of Tax Code on Health Insurance
[Jul 11, 2008]
"Tax Subsidies for Health Insurance," Kaiser Family Foundation: The issue brief looks a the current tax treatment of health insurance, using examples of workers with different wage earnings to illustrate how the current tax code affects families depending on whether they have health coverage and whether that coverage is provided by an employer. The current subsidy for employer-based coverage -- which excludes the value of employer-sponsored health benefits from taxable income for workers -- costs the U.S. Treasury more than $200 billion in lost revenue per year. The brief illustrates that the current tax system generally provides a larger subsidy to higher-income families, since higher-income workers pay federal and state income taxes at a higher marginal tax rate than lower-income workers (Kaiser Family Foundation release, 7/10).
Opinion
Editorial, Opinion Piece, Letter to the Editor Address Health Care Issues in Presidential Election
[Jul 11, 2008]
Summaries of an editorial, opinion piece and letter to the editor about health care issues in the presidential election appear below. Editorial
Presumptive Democratic presidential nominee Sen. Barack Obama (Ill.) and presumptive Republican nominee Sen. John McCain (Ariz.) "both promise to keep America strong, free and prosperous," but "neither one offers many hints about how he will pay for those promises," a Wilmington News Journal editorial states. According to the editorial, Obama and McCain "are, at best, only giving lip service about reforming the costs of the nation's biggest entitlement programs: Social Security, Medicare and Medicaid." The editorial states, "Simply put, the nation can't afford either senator's promises" on health care and other issues, as "neither senator has addressed the far harder problems fixing Medicare and Medicaid, which threaten to eat up much more of the budget before the end of the next decade" (Wilmington News Journal, 7/9). Opinion Piece
"Some liberals fret that Barack Obama is tacking to the center," but the move is "overdue" and will continue "on core priorities like schools, taxes and health care," Matt Miller, host of the public radio program "Left, Right & Center," writes in a Wall Street Journal opinion piece. Miller recommends that Obama focus on three policy areas, including health savings accounts "done right. He writes, "Liberals sensibly reject 'consumer-directed health plans' loved by Republicans when these plans' high copays and deductibles put undue burdens on the sick and the poor," but "there's a simple way to structure such plans to address these concerns while still bringing consumer incentives to bear on runaway health costs." Miller adds, "The answer is to require such plans to limit the total medical costs a person can incur in a year to a reasonable percentage of income." According to Miller, by "calling for annual out-of-pocket maximums to be tied explicitly to earnings, Mr. Obama would forge a new 'third way' on health care and cast himself as an innovator not beholden to the far left view that market forces should play no role in health care at all" (Miller, Wall Street Journal, 7/11). Letter to the Editor
"Contrary to the assertion" a New York Times article, McCain's "health plan is neither 'radical' nor 'more fundamental than the universal coverage' plan proposed by Senator Barack Obama," Alan Cohen, a professor of health policy and management and executive director at the Boston University Health Policy Institute, writes in a New York Times letter to the editor. Cohen writes, "Granted, Mr. McCain's plan includes improvements to the current tax treatment of health benefits that would aid citizens who now buy insurance individually," but "his proposal to expand state high-risk pools is not a panacea." He adds, "It might benefit a relatively small percentage of Americans, whereas Senator Obama's plan would reach many more people and is more likely to address the key problems of access, cost and quality that plague our health care system." Cohen concludes, "Unfortunately, Senator McCain's prescription for system reform is merely a Band-Aid when nothing less than major reconstructive surgery is required" (Cohen, New York Times, 7/11).
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