KAISER DAILY HEALTH POLICY REPORT
Friday, May 29, 2009

CAPITOL HILL WATCH

     Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) is circulating an outline of health care overhaul legislation that includes a requirement that all individuals obtain coverage and requires contributions from employers, the Washington Post reports. According to the Post, the legislation "closely resembles" the Massachusetts health insurance law enacted in 2006, the Post reports. According to the draft summary, the bill calls for a public, government-sponsored health insurance option that would compete with private insurers. The measure also would expand Medicaid eligibility, according to the Post. Kennedy spokesperson Anthony Coley said that the outline is not yet finalized. He said, "We are still actively negotiating with members" of the Senate HELP Committee.

According to a top White House official, Kennedy is expected to introduce his measure on Monday. A timetable released by Kennedy's office calls for Senate HELP Committee Democrats to meet June 2 (Connolly, Washington Post, 5/29). A bipartisan walk-through of Kennedy's bill is scheduled for June 5 and June 9. Hearings on the bill would then take place on June 10 or June 11. The mark up of the bill is scheduled from June 16 through June 25 (Bogardus, The Hill, 5/28). If Kennedy holds to the schedule, he will be ahead of other congressional Democrats, including Senate Finance Committee Chair Max Baucus (D-Mont.), on proposing overhaul legislation (Washington Post, 5/29). Coley said, "These are target dates that are not set in stone." Although Senate Democrats are hoping to pass health care reform legislation before the August recess, several senators have questioned whether that timeline is feasible (The Hill, 5/28).

Reform Supporters Call For Removal of Ad
In related health reform news, Democracy for America and the Service Employees International Union on Thursday demanded that Washington, D.C.'s NBC television affiliate refuse to air a 30-minute infomercial funded by Conservatives for Patients' Rights, Politico reports.

According to a letter from SEIU to NBC4, the ad, scheduled to run after "Meet the Press" on Sunday, "will be false, deceitful and a distortion." The union added that the station has a responsibility to pull the ad because it has a duty to protect the public from misleading advertising. In the letter, the union wrote that the conservative group has a history of running "demonstrably false" ads. According to Levana Layendecker, the online campaigns director for Health Care for America Now, CPR could face fines from the Federal Communications Commission if the ad is run, adding that it contains false statements.

CPR spokesperson Keith Appell said, "It's no surprise that they would try to block the public from seeing any information about the dangers of government-run health care," adding, "This program is full of compelling first-person accounts that every American should hear." He said that CPR stands by its ad. An NBC network spokesperson would not comment on the infomercial or the request, deferring questions to NBC4. The affiliate's general manger, Michael Jack, did not return a request for comment (Frates, Politico, 5/28).

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ADMINISTRATION NEWS

     The opportunity to enact health care reform legislation could be missed unless Congress passes it this year, President Obama on Thursday said to thousands of supporters in a phone call made from Air Force One, the AP/USA Today reports. In a call to members of his political organization, Organizing for America, Obama said, "If we don't get it done this year, we're not going to get it done," adding, "I think the status quo is unacceptable and that we've got to get it done this year."

Obama also said that any action on overhaul legislation could be delayed unless volunteers pressure lawmakers to support the administration's goals for health care reform (AP/USA Today, 5/28). Obama said, "Some of you are in states and districts where politicians are resistant to bringing about change, so we need you to get involved" (Zeleny, "The Caucus," New York Times, 5/28). Obama told volunteers that it was time to "remobilize" after their successful campaign to get him elected, adding that "we have gotten a lot of things done during our first four months. But health care, that's a big push" (AP/USA Today, 5/28).

David Plouffe, Obama's presidential campaign manager and head of Organizing for America, during the call said, "If the country stands with the president and if the country is demanding health care reform, [then] we'll get it done," adding, "Washington will not have any option but to follow us." He added, "You need to take ownership of this" ("The Caucus," New York Times, 5/28).

Organizing for America Campaign
The conference call was in preparation for the launch of Organizing for America's health care campaign, the AP/USA Today reports (AP/USA Today, 5/28). Organizing for America has scheduled grassroots organizing events beginning June 6, when Obama will release a video message about his principal goals for reform. The ideas generated at the events will be used to plan public service events that will be held on June 27. Mitch Stewart, executive director of Organizing for America, said, "Reforming [our] health care system is going to require each and every one [of] us to get involved" (Davis, "Washington Wire," Wall Street Journal, 5/28).

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COVERAGE & ACCESS

     Aetna, Cigna and Humana ranked highest nationally on criteria including speed of health claim payments and fewest claims denied, according to the 2009 PayerView Rankings, the Boston Globe reports. The rankings -- prepared by Athenahealth in collaboration with Physicians Practice management journal -- evaluated 172 national, regional and government payers in 40 states.

According to the data, insurers paid physicians an average 5.3% faster in 2008 and denied an average of 9% fewer medical claims compared with 2007 figures. On average, national health insurers paid physicians in 33 days and denied 9.2% of claims.

According to the Globe, the rankings reveal some of the obstacles that can result from the complexities and bureaucracy involved in the medical billing process, with each insurer operating in different ways. Jonathan Bush, chair and CEO of Athenahealth, said, "This is the biggest problem we have in health care -- the inability to close supply chains and to practically and tactically connect doctors with payers and patients," adding, "These connections are broken" (Weisman, Boston Globe, 5/28).

The rankings are available online.

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     Congressional lawmakers who are crafting a plan to overhaul the U.S. health care system might be able to look to state health insurance programs in Massachusetts and Tennessee for ideas, the AP/Minneapolis Star Tribune reports.

Health reform legislation modeled after Massachusetts' near-universal health insurance law "is likely to emerge" in Congress, "although details remain unsettled," the AP/Star Tribune reports. The plan also could include components of Tennessee's CoverTN program, which charges beneficiaries who smoke or are overweight higher premiums. Lawmakers in the Senate already have discussed a lifestyle tax funding mechanism, such as taxes on alcohol and sugary beverages. According to AP/Star Tribune, Massachusetts "chose to cover virtually everyone," while Tennessee "chose to get just a few more people bare-bones insurance at a budget price with limits on how much plans would pay for hospital stays."

Alan Weil of the National Academy for State Health Policy said, "The belief that we should all have health insurance coverage is broadly held," but "there are tremendous differences around the country in beliefs on how to achieve that goal." He added, "We learn from Massachusetts that a bold objective matters. If it can be sustained, that's terrific," and "[i]t would be nice if you had a southern state that had achieved universal coverage and did it in a different way, but we don't have that" (Johnson, AP/Minneapolis Star Tribune, 5/28).

American Public Media's "Marketplace" on Thursday reported on a study published in Health Affairs that looked at the Massachusetts program. The segment included comments from Jon Kingsdale, director of the Massachusetts Health Insurance Connector Authority, and University of North Carolina Health Care System CEO Bill Roper (Babin, "Marketplace," American Public Media, 5/28).

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STATE WATCH

     The Texas Senate on Wednesday voted to approve a bill that would boost enrollment in the state's version of CHIP, the Houston Chronicle reports. The bill, sponsored by state Sen. Kip Averitt (R), would raise the income eligibility threshold for the program to 200% of the federal poverty level for a family of four. Families' premiums, copayments and fees would not exceed 5% of their net income, under the bill (Elliott, Houston Chronicle, 5/28).

Supporters of the bill say that it could extend CHIP coverage to as many as 80,000 uninsured children statewide (AP/Fort Worth Star-Telegram, 5/28). The bill now moves back to the state House for approval. The House approved legislation last month that would have expanded CHIP to families with annual incomes up to $88,000. Averitt said the measure, which he attached to a House bill on disease screening for newborns, is similar to a bill that passed the Senate in March.

According to the Chronicle, the state budget being finalized this week includes $43 million to expand CHIP, which would draw down federal matching funds (Houston Chronicle, 5/28).

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     The Nevada Assembly last week voted to approve a bill (SB 229) that would authorize the Nevada Department of Health and Human Services to stop the exploitation of foreign physicians who have come to the state to provide care to residents in underserved areas, the Las Vegas Sun reports. The measure now goes to Gov. Jim Gibbons (R) for his approval (Allen, Las Vegas Sun, 5/28).

A September 2007 Sun investigation of the J-1 visa program found that some foreign physicians were forced by their sponsors to work up to 100 hours per week, and were being "cheated out of their salaries" and "diverted from the patients" in underserved areas whom they were supposed to help (Kaiser Daily Health Policy Report, 8/6/08).

The legislation would make violations of the J-1 program more clearly punishable under state law and prosecutable by the attorney general's office; charge J-1 physician sponsors a fee to cover the cost of enforcing the law; and protect whistle-blowers (Las Vegas Sun, 5/28).

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BLOG WATCH

     "Blog Watch" offers readers a roundup of health policy-related blog posts.

Bloggers are tentatively reacting to a report and blog post released by the Congressional Budget Office that summarizes the agency's approach to estimating the cost of any health overhaul bills. At issue is how CBO will count different stipulations of legislation -- like an individual mandate or a public plan -- and whether their conclusions will result in a heftier price tag. Douglas Elmendorf explained on the Director's Blog:

"In CBO's view, the key consideration is whether a proposal would be making health insurance an essentially governmental program, tightly controlled by the federal government with little choice available to those who offer and buy health insurance -- or whether the system would provide significant flexibility in terms of the types, prices, and number of private-sector sellers of insurance available to people. The former -- a governmental program -- belongs in the federal budget (including all premiums paid by individuals and firms to private insurers), but the latter -- a largely private-sector system -- does not."

Janet Adamy of the Wall Street Journal's Washington Wire notes that the report doesn't address the cost estimates of the scenarios. Alan Katz on his Health Care Reform Blog concludes, "the message is clear: the looser government's hand grips the new health care system the smaller its budgetary impact."

Liberal bloggers had a variety of reactions -- some found the report too vague, while others saw it as good news. The New Republic's Jonathan Cohn says, "you may need a Talmudic scholar to figure out what those implications are." Cohn continues, "Other passages in the briefing are [similarly] vexing and, for what it's worth, the reactions I've gotten from insiders familiar with the report have ranged from sighs of relief to statements not suitable for a family blog."

Ezra Klein agrees the report lacks specificity, but says, "Even so, I'm cheered by the simple existence of this ruling. The fact that CBO is explaining its thinking before legislation arrives [is] yet more evidence that CBO appears, insofar as it can, to be trying to help out on health reform. ... That's an important change from past years."

Interesting Elsewhere:

• Boston Health News' Tinker Ready hosts the latest edition of Health Wonk Review, a biweekly compendium of more than two dozen health policy, infrastructure, insurance, technology and managed care bloggers. A different participant's blog hosts each issue;
  
  
• Jacob Goldstein of the Wall Street Journal's Health Blog reports that the Supreme Court will hear Merck's appeal to a ruling over whether the pharmaceutical company misled shareholders on the safety data of the arthritis drug Vioxx;
  
  
• Huffington Post's Sam Stein reports that Sen. Max Baucus' (D-Mont.) chief of staff said Baucus is "fighting tooth and nail to include [a public plan option] in any final deal";
  
  
• The National Journal's Marilyn Werber Serafini solicits her experts' opinions: "When it comes to forming a winning message for health care reform, how should Democrats and Republicans in Congress (and President Obama) talk about it, and what should they absolutely stay away from? What messages will go over well with the public, and what could kill health reform?" Responders include Drew Altman, Karen Davis, C. Eugene Steuerle, Uwe Reinhardt, John Goodman and David Kendall;
  
  
• Uwe Reinhardt on the New York Times' Economix looks at the origin of employer-sponsored health insurance in the U.S.;
  
  
• Michael Miller of the Health Policy and Communications blog looks at a new National Journal "Insider's Poll" that asks experts, "What is your view of including a new public insurance plan in health care reform?"
  
  
• James Capretta of Diagnosis says the Patients' Choice Act "has been well-received among conservatives ... for good reason," although he disagrees with some liberal bloggers that the plan's structure is a sign that a Democratic plan's passage is "more likely";
  
  
• Bob Laszewski, referring to a New Yorker article by Atul Gawande on controlling health costs that profiles a Texas town, concludes, "When we have a health care bill that starts to change things in McAllen, Texas, then it will be worthy of the label, health care reform";
  
  
• Ray Ranthum on John Goodman's Health Policy Blog says the Senate Finance Committee "has proposed new changes to health savings accounts that could make them less attractive in the future."

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OPINION

• USA Today: It is "gratifying" that Republicans last week introduced a health care proposal because "the simple fact that it exists might improve chances" for bipartisan negotiations, a USA Today editorial states. According to the editorial, the plan -- which would replace the current tax exemption of employer-provided insurance with a refundable tax credit for all families and individuals, regardless of their employment status -- is "no cure-all," but is a "serious proposal that merits serious consideration." The editorial states, "For all those who say the Republican Party is out of ideas, on the issue of health coverage, at least, its proposal is bolder than what the Democrats have offered." However, the editorial notes that both Republicans and Democrats "have identified more groundbreaking ideas, and they are not entirely incompatible." The editorial concludes, "[L]et the debate begin. The only unacceptable approach is the status quo" (USA Today, 5/29).
  
  
• Wall Street Journal: The "emerging 180-degree turn by Democrats on taxes and health insurance is one for the record books," a Journal editorial states. According to the editorial, "Democrats have spent years arguing that proposals to equalize the tax treatment of health insurance are an outrage against the American people." However, "now Democrats need the money to finance $1.2 trillion or more for their new health insurance entitlement" and are considering taxing health insurance, according to the editorial. The editorial continues, "Democrats owe an apology" to Sen. John McCain (R-Ariz.), who favored taxing health benefits during his campaign and was "mauled" by liberals who criticized the idea as a tax hike on the middle class in "brutal" television ads. The editorial states, "Having told the country that this tax reform is really a tax increase, Democrats are opening themselves to the same attacks they leveled against Republicans." The editorial concludes that the only way Democrats can pay for their goal of "government-run health care" is "by taxing everything in sight, including your current health insurance" (Wall Street Journal, 5/29).

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RECENT RELEASES IN HEALTH POLICY

     "The Social Security COLA and Medicare Part B Premium: Questions, Answers and Issues," Kaiser Family Foundation Medicare Policy Project: The issue brief examines how Social Security recipients for the first time in 2010 are not expected to receive a cost-of-living adjustment, with no or a low COLA expected through 2012. The brief examines the relationship between the Social Security COLA and the Medicare Part B premium and the effect that such changes have on beneficiaries of both programs (Kaiser Family Foundation release, 5/27).

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Kaiser Daily Health Policy Report
The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a website of the Kaiser Family Foundation. (c) 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

For access to the Kaiser Family Foundation's policy research, analyses, reports and fact sheets, and media partnerships, visit the Foundation's main website at http://www.kff.org.