Thursday, November 20, 2008

• Obama Appoints Former Sen. Daschle as HHS Secretary, Democratic Officials Say

 

Obama Appoints Former Sen. Daschle as HHS Secretary, Democratic Officials Say
[Nov 20, 2008]

      Former Senate Majority Leader Tom Daschle (D-S.D.) has accepted an offer from President-elect Barack Obama to become the new HHS secretary, according to Democratic officials, the AP/San Francisco Chronicle reports (Freking, AP/San Francisco Chronicle, 11/19). Obama likely will make an official announcement about the nomination of Daschle early next week, according to a Democratic official familiar with the process (Hook et al., "The Swamp," Chicago Tribune, 11/19). According to the AP/Chronicle, the "job is Daschle's barring an unforeseen problem as Obama's team reviews" his background.

Daschle, who lost his Senate seat in 2004, currently serves as a public policy adviser and member of the legislative and public policy group at the law firm Alston & Bird, but he is not a registered lobbyist (AP/San Francisco Chronicle, 11/19). "Daschle will likely face easy confirmation by his former Senate colleagues," Reuters reports (Smith, Reuters, 11/19).

Large Role
"Daschle could end up being the point man on any efforts to overhaul the country's health care delivery and insurance system, a tall order, health policy experts say, given the current economic situation," the New York Times' "The Caucus" reports (Cooper, "The Caucus," New York Times, 11/19). According to the Wall Street Journal, Daschle "is expected to play an important role in moving Mr. Obama's ambitious health care agenda through Congress" (Meckler/Weisman, Wall Street Journal, 11/20). "Daschle has positioned himself as Obama's central adviser on efforts to dramatically expand health care coverage next year, while at the same time lowering costs," according to the Washington Post's "44" (Connolly/Cillizza, "44," Washington Post, 11/19). Senate Democrats said that Daschle "would greatly help with efforts to overhaul the health care system next year," CQ Today reports (Wayne, CQ Today, 11/19).

On Wednesday, the Obama transition team announced that Daschle will lead a transition policy working group on health care (Cooper/Baker, New York Times, 11/20). According to the Times' "The Caucus," Daschle "was concerned that he not just be the head of a huge bureaucracy but a chief player on the subject he has literally written a book on" ("The Caucus," New York Times, 11/19).

Background
In February, Daschle wrote a book about health care policy titled "Critical: What We Can Do About the Health Care Crisis." In the book, Daschle proposed to establish a board modeled on the Federal Reserve Board to "offer a public framework within which a private health care system can operate more effectively and efficiently -- insulated from political pressure yet accountable to elected officials and the American people" (Goldstein, "Health Blog," Wall Street Journal, 11/19).

He serves as a senior fellow and a board member at the Center for American Progress. In addition, Daschle serves on the advisory boards of Intermedia Partners and BP America, as well as on the boards of CB Richard Ellis, Mascoma, Prime BioSolutions, The Freedom Forum, the Mayo Clinic, the LBJ Foundation, and the National Democratic Institute for International Affairs. Daschle also is a member of the Council on Foreign Relations (AP/San Francisco Chronicle, 11/19). He co-chaired the ONE Vote '08 campaign to address health care and poverty issues in developing nations (Rhee, "Political Intelligence," Boston Globe, 11/19).

Reaction From Lawmakers
House Rules Committee Chair Louise Slaughter (D-N.Y.) said that she hopes Daschle can "go down deep and clean out some of the 19th-century ideas at HHS" implemented by the Bush administration (Bellantoni, Washington Times, 11/20).

Daschle "knows health care, he knows the Congress and the rhythms of the Senate in particular," Senate Finance Committee Chair Max Baucus (D-Mont.) said (Talev, McClatchy/Philadelphia Inquirer, 11/20).

Sen. Ron Wyden (D-Ore.) said, "Tom Daschle sees this as a once-in-a-lifetime opportunity," adding, "On the premier domestic issue of our time, the president-elect sees Tom Daschle with the skills and abilities to bring people together and get this over the finish line" (Connolly, Washington Post, 11/20).

Republican National Committee spokesperson Alex Conant said, "Barack Obama is filling his administration with long-time Washington insiders. Since losing his Senate seat, Tom Daschle has worked for a major lobbying firm. For voters hoping to see new faces and fewer lobbyist connections in government, Daschle's nomination will be another disappointment. Obama promised to change America's health care system, but his nominee to be secretary is no change agent" ("The Swamp," Chicago Tribune, 11/19).

Additional Reaction
Kaiser Family Foundation President and CEO Drew Altman said, "You wouldn't appoint Tom Daschle to be secretary" of HHS "if you weren't serious about making health care reform a priority" (Hook/Levey, Baltimore Sun, 11/20).

Ron Pollack, executive director of Families USA, said, "Sen. Daschle has a deep commitment to securing high-quality, affordable health care for everyone in our nation," adding, "His new leadership position confirms that the incoming Obama administration has made health care reform a top and early priority for action in 2009" (AP/San Francisco Chronicle, 11/19).

AARP Executive Vice President Nancy LeaMond said, "Senator Daschle would bring a wealth of experience to HHS as the new Congress and administration begin their work to solve our health care crisis" (Reuters, 11/19).

Former Rep. John Porter (R-Ill.), chair of Research! America, said of Daschle, "He'll do an outstanding job" (AP/San Francisco Chronicle, 11/19).

Broadcast Coverage

• ABC's "World News Tonight" on Wednesday reported on the Daschle nomination (Stark et al., "World News Tonight," ABC, 11/19).
  
  
• CNN's "CNN Newsroom" on Wednesday reported on the Daschle nomination (Henry, "CNN Newsroom," CNN, 11/19).
  
  
• CNN's "Lou Dobbs Tonight" on Wednesday reported on possible ties between Daschle and the pharmaceutical industry (Dobbs, "Lou Dobbs Tonight," CNN, 11/19). A transcript of the show is available online.
  
  
• CNN's "Situation Room" on Wednesday reported on the Daschle nomination (Blitzer, "Situation Room," CNN, 11/19). A transcript of the show is available online.
  
  
• Fox News' "Special Report with Brit Hume" on Wednesday reported on the Daschle nomination (Angle, "Special Report with Brit Hume," Fox News, 11/19).
  
  
• NPR's "Day to Day" on Wednesday reported on the Daschle nomination (Brand/Elving, "Day to Day," 11/19).
  
  
• NPR's "Morning Edition" on Thursday reported on the Daschle nomination (Rovner/Inskeep, "Morning Edition," NPR, 11/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

Senate Leaders Hold Closed-Door Meeting To Discuss Health Care Overhaul Legislation
[Nov 20, 2008]

      Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) and Senate Finance Committee Chair Max Baucus (D-Mont.) in a Wednesday meeting that included other Senate leaders discussed plans for health care overhaul legislation to be proposed next year, CongressDaily reports (CongressDaily, 11/19). Baucus after the meeting said, "All are dedicated toward getting meaningful health care reform enacted in this next year" (Herszenhorn, "The Caucus," New York Times, 11/19).

Baucus said, "We all agreed that there has not been a better time in modern American health care to" overhaul the nation's health system. He added, "I think we have to move very quickly to seize the opportunity and build momentum because it's difficult to anticipate what else is going to come up next year that will involve the Congress." Baucus last week announced details of his universal health care proposal. Kennedy, who announced plans this week for drafting health care legislation, did not speak with reporters. Also present at the meeting were Senate Banking Committee Chair and second-ranking Democrat on the HELP Committee Chris Dodd (D-Conn.), HELP Committee ranking member Mike Enzi (R-Wyo.), Sen. Orrin Hatch (R-Utah), Sen. John Rockefeller (D-W.Va.); and Finance Committee ranking member Chuck Grassley (R-Iowa).

Pay-Go
Kennedy and Baucus both have said that a health care overhaul bill likely would not include offsets for its full cost. Grassley on Wednesday said, "I think that for a lot of us, [pay-go] is a big issue," referring to rules that all measures passed include funding offsets. Baucus said, "You have to invest in order to reap long-term savings," adding, "That's understood by senators; that's understood by outside groups. I talked to [Congressional Budget Office Director] Peter Orszag ... [and] that's understood clearly by him" (Armstrong, CQ Today, 11/19).

House Majority Leader Steny Hoyer (D-Md.) on Tuesday said that while a health care system overhaul could increase the national deficit in the short-term, in the long-term it would stop adding to the deficit, according to The Hill. "Hoyer's comments are notable because he is considered the chief advocate of the [Blue Dog Coalition] and the pay-go policy in the House Democratic leadership," The Hill reports. Hoyer said, "Our objective is going to be (to) have a pay-go compliant policy over the longer term," but that "may not be possible in the short term, given where we are." He noted that addressing health care problems and inefficiencies could reduce costs and limit the impact of an overhaul on the deficit. In addition, Hoyer said, "When it comes to health care, we can no longer think of entitlement reform and expanded access as two separate issues" (Soraghan, The Hill, 11/18).

At a Finance Committee hearing on Wednesday, Baucus said a health care system overhaul "must be part of any successful economic recovery plan." He said, "Health care costs and the economy are linked: The key challenges of our health care system are high costs, low quality and insufficient access," factors that affect family budgets, competitiveness of U.S. businesses abroad and government spending (Carey, CQ CQ HealthBeat, 11/19).

Dingell, Waxman
House Democrats on Thursday voted 137 to 122 name House Oversight and Government Reform Committee Chair Henry Waxman (D-Calif.) as chair of the House Energy and Commerce Committee, over current Chair John Dingell (D-Mich.), New York Times reports (Broder [1], New York Times, 11/20). After the House Democratic Steering and Policy Committee on Wednesday voted 25 to 22 to nominate Waxman as chair of the committee, the final vote went to the full Democratic Caucus (Bendavid, Wall Street Journal, 11/20). According to the Times, Waxman "has a long record of leadership on health care issues" (Broder [1], New York Times, 11/20).

Waxman in a statement said he was "running for the chairmanship ... because we have a once-in-a-generation opportunity to advance health care, achieve energy independence and tackle climate change" (Broder [2], New York Times, 11/20).

Opinion Piece, Letter to the Editor
The Washington Post on Wednesday published an opinion piece and on Thursday published a responding letter to the editor focusing on the race for House Energy and Commerce Committee chair. Summaries appear below.

• Harold Meyerson: The two reasons Waxman "would be the better" Energy and Commerce chair are that "he is probably the House's most accomplished legislator in three issues that are high on the agendas of the nation and President-elect Obama: universal health care, global warming and enhanced consumer protections," and he "is a legislative genius," columnist Meyerson writes in the Post. He continues that Waxman "steer[ed] to passage the bills that gave rise to the generic drug industry, required uniform nutrition labels on food, heightened standards of care at nursing homes, created screening programs for breast and cervical cancer, provided health care for people with HIV/AIDS" and "expanded Medicaid coverage to the poor." In addition, Meyerson writes, "In the midst of the Reagan era's cutbacks, Waxman expanded the number of working poor eligible for Medicaid a stunning 24 times" and "consistently won key Republican backing for these regulatory and programmatic expansions." He concludes, "Obama needs an ally on the Hill who can craft bills and obtain votes for the change he's pledged to deliver. He needs a master legislator. He needs Henry Waxman (Meyerson, Washington Post, 11/19).
  
  
• Rep. Baron Hill (D-Ind.): "I feel obligated to clear up a few things" regarding the Meyerson piece, which "was riddled with falsehoods -- chiefly the assertion that Rep. John Dingell has not been an effective legislator" during his time as chair of the energy and commerce panel, Hill writes in a Post letter to the editor. He adds that Dingell's "proposals reflect what voters have demanded: more jobs, better health care and a green future." According to Hill, "Dingell is committed to achieving these goals while promoting economic recovery and protecting our Democratic majority -- which is essential for seeing quick results." With "Dingell's leadership, we can ... achieve the consensus necessary to implement sound policy solutions and signal to Americans that we heard their call for change." The letter continues, "Meyerson was correct, however, that Barack Obama 'needs an ally on the Hill who can craft bills and obtain votes for the change he's pledged to deliver,'" and Obama "has this in Chairman Dingell" (Hill, Washington Post, 11/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

Sens. Baucus, Grassley Release Draft Bill To Link Medicare Payments for Inpatient Hospital Care to Quality
[Nov 20, 2008]

      Senate Finance Committee Chair Max Baucus (D-Mont.) and ranking member Chuck Grassley (R-Iowa) on Wednesday released a draft bill that would link Medicare reimbursement levels for inpatient hospital care to the quality of care, rather than the number of services provided, CQ HealthBeat reports. Under the legislation, the new policy would begin in fiscal year 2012 and take full effect in FY 2016. Medicare reimbursement levels would increase from 1% to 2% during that time. The legislation would base quality standards on a list of measures established by several medical organizations, such as the National Quality Forum (Carey, CQ HealthBeat, 11/19). According to CongressDaily, the lawmakers likely will seek to attach the bill to larger health care reform or Medicare legislation (Edney, CongressDaily, 11/20).

In a news release, Baucus and Grassley said that the bill "would re-focus the Medicare program on quality care, which will result in improved patient care and could lower costs throughout the entire health care system" (CQ HealthBeat, 11/19). Grassley said, "Medicare's payment system is set up to reward volume rather than quality," adding, "The value-based purchasing initiative we've been pursuing would reverse those incentives in order to improve quality and reduce costs" (CongressDaily, 11/20).

The bill "includes all the right pieces of the puzzle, but as it evolves, it needs to be more specific," Chip Kahn, president of the Federation of American Hospitals, said, adding, "We really need to have everyone understand their roles" (CQ HealthBeat, 11/19). He said, "If the purpose of this is improvement, then you should have the payment connected to the areas that have improvements" (CongressDaily, 11/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

AHIP, BCBS Say They Support Guaranteed Coverage for People With Pre-Existing Health Conditions, as Long as All Individuals Are Required To Obtain Coverage
[Nov 20, 2008]

      America's Health Insurance Plans and the Blue Cross Blue Shield Association in separate announcements on Wednesday said that they would support guaranteed health coverage for people with pre-existing health conditions, as long as lawmakers also approve an enforceable requirement that all U.S. residents obtain coverage, the New York Times reports.

Some congressional lawmakers on Wednesday said that they want to pass health care legislation next year that is in line with the health care proposal of President-elect Barack Obama. According to the Times, "The new position taken by the insurance industry -- the industry that helped sink President Bill Clinton's plan for universal health coverage in 1994 -- could ease the way for passage of such legislation" (Pear, New York Times, 11/20). Both of the industry's proposals are included in a health care overhaul plan released last week by Senate Finance Committee Chair Max Baucus (D-Mont.) (CongressDaily, 11/19). Obama's proposal would require insurers to cover people with pre-existing conditions but initially would apply the coverage requirement only to children.

The insurers said that unless a coverage requirement is adopted, people will wait until they become sick to purchase insurance. Alissa Fox, a BCBS vice president, said, "Insurance works best when everyone is in the pool. You need healthy people in the insurance pool to help pay for sicker individuals who are much more motivated to buy coverage." Donald Hamm, president of Assurant Health and a member of AHIP's board, said, "In the individual market, people can choose whether or not to apply for coverage," adding, "If they know they can obtain coverage at any time, many will wait until they get sick to apply for it. That increases the price for everyone."

The new policy statements do not offer recommendations for how to enforce a coverage requirement or how to regulate insurance prices or premiums. Hamm said that the group might offer recommendations for creating "a fair and appropriate rating structure" (New York Times, 11/20). The insurers also said that premiums should be kept stable through a "broadly funded reimbursement mechanism that spreads cost for the highest-risk individuals" (Bloomberg/Boston Globe, 11/20). Karen Ignagni, president and CEO of AHIP, said, "We hope this will be a contribution to help members of Congress fashion their proposal," adding, "We're going to provide all the technical background that we have assembled, all the experience we've assembled at the state level, and we're going to work very hard with members of Congress" (Freking, AP/Philadelphia Inquirer, 11/20).

Advocates, Industry Offer Recommendations
Health care advocates and industry leaders have begun to offer recommendations for health care reform legislation that they expect President-elect Barack Obama and Congress to address next year, the Wall Street Journal reports. According to the Journal, in a "stark contrast" to health care reform efforts in the 1990s, a "wide variety of interests groups are rooting for it to succeed rather than plotting to kill it" (Meckler, Wall Street Journal, 11/20).

Health Care for American NOW! on Tuesday launched a television advertisement that asked Obama to meet his campaign promises on health care despite the current economic downturn (Rhee, "Political Intelligence," Boston Globe, 11/18).

In addition, some large pharmaceutical companies have begun "crafting plans to expand health insurance coverage and cut the escalating costs of care," Reuters reports (Richwine/Pierson, Reuters, 11/19). On Wednesday, leaders of labor unions during a seminar sponsored by the Connecticut Health Advancement and Research Trust discussed the need for health care reform (Holahan, Harford Courant, 11/20).

CNN's "Lou Dobbs Tonight" on Wednesday examined the differences between the health care proposals announced by Obama and lawmakers and the effect that those plans might have for U.S. residents (Pilgrim, "Lou Dobbs Tonight," CNN, 11/19).

Editorials

• Christian Science Monitor: "Nearly all the great issues facing Obama involve science or technology as part of the solution," a Monitor editorial states. According to the editorial, "Obama has pledged to 'restore integrity' to U.S. science policy by making decisions informed by the best available evidence," as well as increase funding for scientific research. In addition, Obama will "need to deal with the promise and perils of biotechnology and nanotechnology," among other issues, the editorial states. The editorial concludes that his science adviser should "sift through the blizzard of data and ensure that the president has before him viable choices based on sound science" (Christian Science Monitor, 11/20).
  
  
• Wall Street Journal: "Now liberals think the political moment has finally arrived to achieve ... government-run health care," based on the health care reform proposal released by Senate Finance Committee Chair Max Baucus (D-Mont.) last week and the selection of the "very liberal former Senate warhorse" Tom Daschle to become the new HHS secretary, a Journal editorial states. According to the editorial, "the reality is that the Baucus-Obama plan would be extraordinarily expensive as it slowly but relentlessly grew the government's share of health spending." The editorial concludes, "Either Senator Baucus and President-elect Obama are making promises that can't possibly be kept. Or they're not being honest about their plans for U.S. health care" (Wall Street Journal, 11/20).

Opinion Pieces

• Elizabeth Carpenter/Sarah Axeen, Philadelphia Inquirer: "While there is no question that the next administration needs to take immediate action to stabilize our financial and housing markets, there is a compelling economic case for keeping health care reform at the top of the agenda," Carpenter and Axeen, who work on health care policy at the New America Foundation, write in an Inquirer opinion piece. They write, "Our economy cannot recover if Americans need to spend a large and increasing share of their income on health insurance," adding, "We know that the uninsured get sick unnecessarily, stay sick longer and are less productive in the workplace." They continue that while there is a "compelling moral case" for reforming the health care system, "making sure every American has quality health coverage is also an economic imperative." Carpenter and Axeen conclude, "The economic and social costs of failing to reform our health system are high," adding, "We must reform our nation's health care system -- not despite our economic crisis, but precisely because of the impact it has on U.S. workers and businesses" (Carpenter/Axeen, Philadelphia Inquirer, 11/20).
  
  
• John Merline, USA Today: President-elect Barack Obama's vow to cut health insurance premiums by $2,500 a year is "one campaign promise [he] is virtually guaranteed to break" because the math that the campaign used to come up with that number was "fuzzy," Merline, a former editorial writer for USA Today, writes in an opinion piece. Even if Obama is able to reduce health care spending by $81 billion through efforts aimed at improving disease management and care coordination, "he'd still be hard-pressed to deliver those premium cuts, because other parts of his plan would almost certainly drive up costs," Merline writes. He concludes, "Obama's promise that he can deliver more health care to more people while painlessly cutting costs is just not possible. At least, not in the real world" (Merline, USA Today, 11/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

Children With Serious Mental Health Programs Do Not Receive Adequate Care in One in Five States, Survey Finds
[Nov 20, 2008]

      Children with serious mental health problems do not receive adequate care in more than one in five states, according to a survey released on Thursday, USA Today reports. The survey, conducted by Janice Cooper of the National Center for Children in Poverty at Columbia University, included responses from state and local officials, as well as others involved with mental health care for children.

The survey found that most children who receive care through public mental health programs are in low-income families or foster care. According to the survey, many states support school-based mental health programs, but such programs are not consistent. In addition, although some states require or promote care that studies have proven effective as treatments for specific mental health problems, most do not have such requirements, the survey found. The survey also found that some federal and state policies prohibit Medicaid reimbursements for preventive or early mental health care for children. The states that reported the highest-quality public mental health programs for children included Washington state, Ohio, New York, Vermont and Maine, according to the survey.

Cooper said that the current economic downturn likely will shift more children to public mental health programs as states reduce spending for such programs.

Darcy Gruttadaro, children's issues director at the National Alliance on Mental Illness, said that, although many states have public mental health programs for children, "they often have long waiting lists, ... so families just can't get good care for their kids."

Michael Hogan, commissioner of the New York State Office of Mental Health, said, "We know what to do," adding, "Our failure to address these problems early is costing us time, it's costing us money, and frankly, it's costing us children's lives" (Elias, USA Today, 11/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

State Budget Shortfalls Force Cuts in Home Care for Low-Income Elderly, People With Disabilities
[Nov 20, 2008]

      At least 15 states facing widening budget shortfalls are cutting funding for services for low-income elderly residents and people with disabilities, mostly for programs that allow low-income "shut-ins" to receive personal care in their own homes, according to the Center on Budget and Policy Priorities, the Wall Street Journal reports. In recent years, Medicaid has encouraged home-based care because nursing homes cost more per person, the Journal reports. In 2006, Medicaid spent about $47 billion on nursing home care compared with $15 billion on home- and community-based care.

The Journal reports that while home-based services for the elderly and disabled "are just one of the areas facing cuts, ... the cuts hit hard because the population is especially vulnerable." JoAnn Lamphere, director of state government relations at AARP, said, "We are beginning to see serious cuts and we are expecting those cuts to get worse."

According to the Journal, the cuts are "exacerbating the already long waiting lists for home care support services in many states," such as Florida, where the waiting list for one home and community care service doubled to 8,505 people in the year ending July 2008. Florida Medicaid Director Dyke Snipes said, "We are going to be facing a tight year," adding, "It wouldn't surprise me if the list is increasing." A class-action lawsuit against Florida alleges that the state "unnecessarily" puts people with disabilities in nursing homes because it does not allocate enough resources for community-based care.

In addition, Alabama ended homemaker services for approximately 1,200 disabled and elderly adults to save $2 million, leaving social workers and local officials trying to find help for those now without subsidized home care, the Journal reports (Shishkin, Wall Street Journal, 11/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

Average Annual Deductible for Individual Employer-Sponsored PPO Now Over $1,000, According to Survey
[Nov 20, 2008]

      The increasing cost of health care in the U.S. has prompted more U.S. employers to shift a larger portion of the expenses to their workers, pushing the average annual PPO deductible in 2008 for a single worker to more than $1,000, according to a study released on Wednesday by Mercer , the Los Angeles Times reports (Girion, Los Angeles Times, 11/20). The study was based on an annual survey of about 2,900 businesses nationwide that had at least 10 employees (Boulton, Milwaukee Journal Sentinel, 11/19).

The study found that the mean deductible for a traditional health plan increased from $859 last year to $1,001 this year, an increase of about 17%, because a large number of employers, especially those with fewer than 500 workers, raised their deductibles (Rubenstein, Wall Street Journal, 11/20). The study found that nearly half of all employers nationwide in 2000 offered health plans that did not require workers to pay a deductible, but in 2008, four in five businesses required a deductible, in addition to an average monthly premium of $124 for individuals under PPO plans (Raabe, Denver Post, 11/20). According to the Journal, from 2000 to 2007 the median deductible had stayed consistent at $500. Deductibles typically are raised in increments of $500, $1,000 or $1,500 (Wall Street Journal, 11/20).

The Denver Post reports that businesses have been able to maintain their annual cost increases at about 6% over the last four years by charging employees higher monthly premiums and deductibles. Health benefit costs for U.S. employees averaged $8,482 per employee, an increase of 6.3% on average, according to the Post (Denver Post, 11/20). Blaine Bos, the chief analyst for the survey, said, "Raising the deductible has become the fallback for employers faced with cost increases they can't handle," adding, "It's the easiest way to reduce cost without taking more out of every employee's paycheck" (Yee, Minneapolis Star Tribune, 11/19).

Laura Baker, a consultant for Mercer, said that companies are expecting further increases in 2009. "Historically, downturns in the economy have often correlated with higher medical trends," Baker said (Los Angeles Times, 11/20). However, Chris Watts, head of Mercer's health and benefits consulting office in Denver, said, "But these are different times, and history may not repeat itself," adding, "Higher employee cost-sharing -- like a $1,000 deductible -- could prevent that spike in utilization that we've seen in other recessions" (Denver Post, 11/20).

Small Businesses Experience Biggest Deductible Increases
A separate employer survey by the Kaiser Family Foundation and the Health Research and Education Trust found that businesses with three to 199 workers had experienced the largest increase in deductibles, with at least one in three workers paying a minimum of $1,000 for single PPO coverage (Los Angeles Times, 11/20). The study also projected potential increases in employee deductibles, copayments and other fees in 2009, the Raleigh News & Observer reports (Wolf, Raleigh News & Observer, 11/20).

Survey co-author Gary Claxton, a Kaiser Family Foundation vice president and director of the Foundation's Health Care Marketplace Project -- said deductibles likely would continue to increase over the next couple of years. "When unemployment goes up, workers just have less ability to push for good benefits," he said (Wall Street Journal, 11/20). He said that a deductible "discourages people from using services," adding, "The more cost-sharing there is, the more it's going to be discouraged. And when they are already worried economically, that's got to amplify the effect" (Los Angeles Times, 11/20).

The Mercer study is available online.

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

About 34M Unpaid Caregivers Performed $375B Worth of Aid in 2007, AARP Reports
[Nov 20, 2008]

      About 34 million caregivers provided unpaid help to family and friends last year valued at an estimated $375 billion, an increase from $350 billion in 2006, according to a report released on Thursday by AARP, the Wall Street Journal reports.

The estimate, derived from five nationally representative surveys, was based on the caregivers providing an average of 21 hours per week of care at $10.10 per hour to adults with limitations on daily activities, up from $9.63 per hour in 2006, according to the Journal. AARP noted that 34 million is the estimated number of caregivers in the U.S. at any given time, but that 52 million adults provided unpaid care at some point during 2007. According to the report, the typical caregiver is a 46-year-old woman who works outside the home and provides more than 20 hours weekly of unpaid care to her mother, including daily chores and health-related tasks, such as administering medications. According to Elinor Ginzler, AARP's senior vice president for livable communities, 37% of caregivers reduce their working hours or quit their job to provide care. In addition, caregivers to people ages 50 or older on average spent $5,531 out-of-pocket, while long-distance caregivers spent $8,728 out-of-pocket on average, the report found. The report also found that caregivers are at risk of becoming ill themselves because of chronic stress, depending on the intensity of the assistance they provide.

Ginzler said the $375 billion included only conservative increases in the amount of family care and is based on increases in the elderly population and hourly rate. She added that additional "opportunity costs" of forgone paychecks, employer-sponsored health insurance and retirement benefits are not included in the estimate. "People are living longer with chronic conditions, and it is the family and friend that is the delivery system for this care," Ginzler said, adding, "We need policies that support these family members who are sacrificing not only time but dollars."

To support unpaid caregivers, AARP recommended employing workplace policies such as flex-time, telecommuting, referral services and support programs. The group also called for expanded funding to the federal National Family Caregiver Support Program. The program received $166 million for the current fiscal year, which AARP calculated is less than one-20th of 1% of the economic value that caregivers contribute (Greene, Wall Street Journal, 11/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

Michigan Attorney General Says Lawmakers Should Not Pass Health Insurance Legislation in Lame-Duck Session
[Nov 20, 2008]

      Michigan Attorney General Mike Cox (R) and consumer advocates on Tuesday asked the state Legislature to abandon plans to approve legislation in the upcoming lame-duck session that would allow Blue Cross Blue Shield of Michigan, the state's insurer of last resort, to restructure, the Detroit Free Press reports (Bell, Detroit Free Press, 11/18). Michigan lawmakers are working to consolidate two versions of the legislation, one approved last year by the state House and another approved in the spring by the state Senate (Rogers, Detroit News, 11/19).

Blue Cross officials say the legislation is needed because the company is experiencing unsustainable losses in the individual health insurance market. The company says that under current regulations, it must pay for hundreds of millions of dollars annually in uncompensated care. Blue Cross also seeks to increase its non-health insurance business through its Accident Fund subsidiary (Detroit Free Press, 11/18).

Cox, along with representatives from AARP and the Consumers Union, said that the legislation would increase costs for people who purchase individual health policies and allow the insurer to deny coverage for people with pre-existing health conditions (Detroit News, 11/19). In addition, Cox said the bill would allow the insurer to increase premium rates for individual policies without oversight from the attorney general's office or the state insurance commissioner (Detroit Free Press, 11/19).

Blue Cross spokesperson Andrew Hetzel said Cox's understanding of the legislation and a draft compromise bill that is being circulated among lawmakers is dated, the Detroit News reports. He said that the compromise package would continue state oversight of premium rate changes, as well as add consumer protections and require health insurers that reject people or deny coverage to pay into a fund that would be used to help keep insurance affordable (Detroit News, 11/19).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

Connecticut Attorney General Calls for Rebidding of State Health Insurance Programs, Governor Says Move Is Unnecessary
[Nov 20, 2008]

      Connecticut Attorney General Richard Blumenthal (D) on Monday recommended that the state Department of Social Services rebid contracts with managed care organizations for HUSKY and the Charter Oak health plan, but Gov. Jodi Rell (R) said that rebidding is not necessary, the New Haven Register reports (O'Leary, New Haven Register, 11/18). Rell on Friday overturned a plan that required physicians and hospitals participating in HUSKY for children to join the new Charter Oak health plan for uninsured adults.

Democrats in the General Assembly, activists for the uninsured and the majority of the state's congressional delegation were concerned that linking the two programs would put health care services for children at risk because of an inadequate network of health care providers. Physicians and hospitals have been slow to join Charter Oak because of concerns over reimbursement rates (Kaiser Daily Health Policy Report, 11/18).

According to Blumenthal, now that the two programs are delinked, the best way to ensure there is no breach of current contracts is to rebid them. Blumenthal said rebidding the programs could open the process to more people, provide more choices for state residents and possibly save the state money. Blumenthal, state health care advocate Kevin Lembo and state child advocate Jeanne Milstein recommended that the insurers stop enrolling people in the programs until contracts are rebid.

Rell said that because the insurers are still required to build their provider networks for Charter Oak, the contracts do not have to be rebid. She said that insurers "will now continue to market both HUSKY and Charter Oak and the only difference is they don't have to do them simultaneously" (New Haven Register, 11/18).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

New Medicaid Regulation Will Curb Abuse, Save Money, HHS Secretary Leavitt Writes in Letter to the Editor
[Nov 20, 2008]

      "I strongly disagree with your interpretation" of a Medicaid regulation announced last week that "clarifies" services covered under the program's outpatient hospital benefit, HHS Secretary Mike Leavitt writes in a New York Times letter to the editor dated Nov. 14, responding to a Nov. 12 Times editorial (Leavitt, New York Times, 11/20). Under the newly revised rule, outpatient hospital services do not include those that could be provided and covered outside a hospital. The Bush administration said the clarification was necessary because the provision under its current definition was vague and allowed states to overcharge CMS for medical claims (Kaiser Daily Health Policy Report, 11/10).

The editorial states that the "Bush administration has callously decided to reduce Medicaid payments to hospitals for their outpatient services," and the "impact on the poor and the hospitals that serve them could be severe." According to the editorial, hospital leaders and state Medicaid officials said the clarification might "force safety-net hospitals with huge Medicaid burdens to cut outpatient dental and vision care and various services for children, among other reductions," adding, "That could be a serious blow in many poor neighborhoods where there are few if any private practitioners willing to take Medicaid patients" (Kaiser Daily Health Policy Report, 11/12).

Leavitt writes, "This regulation seeks to restore accountability and transparency" to Medicaid, adding, "Hospitals can continue to provide Medicaid services in their outpatient clinics," and "state Medicaid programs can continue to adjust payments to recognize the needs of those facilities." He continues that HHS "recognizes that many hospitals are safety-net providers in areas where private practices are scarce," noting that "Medicaid will pay for these services appropriately, but not exorbitantly." The letter concludes, "Every dollar we save by paying prudently is a dollar that can cover even more eligible and deserving people" (New York Times, 11/20).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

 

Analysis Examines Cost of Employer-Sponsored Health Coverage; Report Looks at Medicare Part D Plan Changes; Issue Brief Examines Tax Treatment of Health Plans
[Nov 20, 2008]

     

• "Employer-Sponsored Health Insurance -- A Comparison of the Availability and Cost of Coverage for Workers in Small Firms and Large Firms," Kaiser Family Foundation: The analysis, part of the Foundation's online Snapshots: Health Care Costs series, highlights the differences in the availability and costs of health coverage for workers at small and large companies that might be relevant to any U.S. health care system reform effort. The analysis finds that companies with fewer than 200 employees are less likely to offer health coverage to workers than larger companies (62% vs. 99%). In addition, the analysis finds that even when workers at small businesses can receive coverage, they often face higher deductibles, contribute a larger share of their premium costs for family coverage and pay more medical expenses out-of-pocket than their counterparts at larger companies (Kaiser Family Foundation release, 11/19).
  
  
• "Musical Chairs: An Analysis of the Part D Annual Reassignment Process," National Senior Citizens Law Center: The analysis examines how changes to 2009 Medicare prescription drug benefit plans will force low-income beneficiaries to switch to new plans or face higher premiums or limited access to their medications. The analysis states that about 25% of beneficiaries receiving the low-income subsidy currently are enrolled in plans that are fully covered by the subsidy, but will not be in 2009 (National Senior Citizens Law Center release, November 2008).
  
  
• "Using Section 125-Premium-Only Plans to Expand Health Coverage," Mathematica Research Policy: The issue brief examines the IRS Section 125 employee health plans, which allow employees to pay for their health care insurance premium on a pretax basis, and how states are using the plans to expand access to health coverage. According to the brief, despite the potential tax-savings for low-income workers, many small firms do not offer these plans because they are not familiar with them or the tax treatment of employer-sponsored health plans in general (Mathematica release, 11/19).

Email this story to a friend	Link to this story.
Print this story.	Save this story in my saved links.

-------------------------------------------------------
EDITORIAL STAFF:
Jill Braden Balderas, managing editor, kaisernetwork.org
Allison Czapp, editor, Kaiser Daily Health Policy Report
Beth Liu, senior web writer, kaisernetwork.org
Kate Steadman, web writer, kaisernetwork.org
Simone Vozzolo, senior web producer, HealthCast
Amanda Wolfe, editor-in-chief, Kaiser Daily Reports
Francis Ying, web producer, HealthCast
Hayes Edwards, Julia Moss, Santosh Rao, Matt Wayt, Sherkiya Wedgeworth, Stephanie Woodrow, staff writers, Kaiser Daily Health Policy Report
Amy Moczynski, Michael Pogachar, copy editors, Kaiser Daily Reports
--------------------------------------------------------
SYNDICATION AND OUTREACH STAFF:
Shari Lewis, online communications associate, Kaiser Family Foundation
Sahar Neyazi, communications associate, Kaiser Family Foundation
Robin Sidel, communications officer, online activities, Kaiser Family Foundation
--------------------------------------------------------
Larry Levitt, editor-in-chief, kaisernetwork.org; vice president, Kaiser Family Foundation
--------------------------------------------------------
CONTACT INFORMATION:
For questions about kaisernetwork.org including calendar, Daily Reports or syndication/outreach, Contact Us
DAILY REPORTS PHONE: 202-266-5929, FAX: 202-266-5700; KAISER FAMILY FOUNDATION PHONE: 202-347-5270
To manage your email subscription: www.kaisernetwork.org/email
For questions about your email subscription: subscriptions@kff.org
The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
--------------------------------------------------------

About Us     Privacy Policy      Help      Site Map