The [AARP], which has been pushing for a health overhaul for more than a year, had withheld a formal endorsement of any of the healthcare bills being developed by congressional Democrats.

That endorsement was followed by an announcement at about 10 a.m. Pacific time from the American Medical Assn. in which the nation's largest doctors group voiced its support for the measure.

AARP Executive Vice President Nancy LeaMond said today that the group saw the House Democratic bill as the most promising proposal.

...

The AMA's support for the House bill comes ahead of a critical policymaking meeting of its House of Delegates in Houston that begins Saturday. The organization is being asked by some constituencies, at the eleventh hour, to back away from supporting healthcare reform.

"These bills go far beyond what is necessary to fix what is broken with our healthcare system, and they grant the federal government considerable new powers and authority, which could ultimately amount to a complete government takeover of healthcare, and which is anathema to doctors and patients," reads a resolution introduced by the American Assn. of Neurological Surgeons, the American Society of General Surgeons and the American Academy of Facial Plastic and Reconstructive Surgery. The resolution was also supported by AMA delegations from Georgia and Washington, D.C.

One of those states is Massachusetts, which passed health-care reform similar to the one contemplated at the federal level in mid-2006. The major aspects of this reform took place in 2007, notably the introduction of large subsidies for low-income populations, a merged nongroup and small group insurance market, and a mandate on individuals to purchase health insurance. And the results have been an enormous reduction in the cost of nongroup insurance in the state: The average individual premium in the state fell from $8,537 at the end of 2006 to $5,143 in mid-2009, a 40 percent reduction, while the rest of the nation was seeing a 14 percent increase.

• Why is a mandate necessary? [Those without coverage drive up costs for those with coverage]
  
• Will premiums go up or down? [They would go down]
  
• Will there be help? [Yes]
  
• What's affordable? [The House bill provides affordability tax credits for families of 4 up to $88,000]
• Has it been tried? [Yes, successfully]
  
• Which version is more affordable? [The House bill]
  

That's why the most important document House Democrats released when they unveiled their bill last week was a list of 14 benefits that would be created immediately.

These include insurance reforms to ban lifetime limits on coverage and an end to "rescissions," under which insurers abruptly nullify patients' policies after they file claims. One of the most popular reforms in the bill -- barring insurers from denying coverage to those with pre-existing conditions -- wouldn't take effect until later. So the House bill creates an interim high-risk pool to help those who need coverage in the meantime.

There are also particular benefits for Medicare recipients, including an immediate reduction in drug costs, and a very popular provision that would allow parents to keep their children on the family health plan through age 26.

Especially important are new investments in community health centers and in efforts to increase the number of primary care doctors. As millions more people get access to decent care, the system will have to provide more doctors, nurses and facilities to treat them.

"People will be excited about 2013," said Rep. George Miller, chairman of the House Education and Labor Committee, which shares jurisdiction on the health-care bill. "But there are enough benefits between now and then to keep them engaged and to keep them favorably disposed."

Readers of this paper will know that, for much of this year, Congress and President Obama have grappled with one of the most important and complicated issues affecting our nation's economy and our community: health insurance reform.

I am proud to announce that on Thursday we introduced revised legislation that addresses many concerns raised about reform and brings us closer than ever to delivering on the long-held promise of quality and affordable health care for each of us.

I am a principal co-author of the bill.

Since three House committees passed a bill this summer, we have worked hard to incorporate changes and improvements suggested by people from across the political spectrum. Our revised bill directly addresses the needs of American families. It will:

• Not increase the deficit.
• Curb out-of-control costs that are bankrupting families and employers.
• Strengthen Medicare for seniors, in part by closing the prescription drug "donut hole" and by making the program sustainable for years to come.
• Protect people against discriminatory insurance company practices. We eliminate so-called "pre-existing" condition denials, stop insurance companies from dropping coverage if you get sick, and establish yearly caps on what you will pay out-of-pocket.
• Keep premiums affordable and insurance companies honest by ensuring competition in the health care marketplace through inclusion of a public consumer option. People in California will be able to choose from multiple private options, such as Blue Shield, Kaiser Permanente and others, or choose a public plan that offers the best quality at the best price -- just as they do on Expedia.
• Offer affordability credits to ensure that low-income and middle-class families can pay for coverage, and ensure that small businesses can actually help cover their employees.

One of the biggest concerns I heard throughout this process was about the bill's cost. Let me be clear: Our reforms are fully paid for and will not increase the federal deficit. In fact, our revised bill will reduce the deficit by at least $30 billion over the next 10 years.

The nonpartisan Congressional Budget Office estimates the cost of our reforms at $894 billion. More than half of this cost will be offset through a combination of savings generated by making Medicare and Medi-Cal more efficient and implementing new technology, but we do not cut services for seniors or low-income individuals. We improve care for people served by these critical programs.

The rest of the bill's costs are paid for by a surcharge on the wealthiest 0.3 percent of U.S. households-- married couples earning over $1 million dollars and individuals earning more than half a million dollars annually.

For the past 70 years, Americans have battled hard for the right to quality, affordable health care. While we still have hard work ahead, next week the House will vote on our truly historic legislation and get us closer than ever to achieving what generations of Americans have been fighting for.

require insurers to allow young people through age 26 to remain on their parents’ policies. It would provide immediate help to people who have been uninsured for several months or denied coverage because of pre-existing conditions. It would speed elimination of a gap in drug coverage for Medicare beneficiaries (the so-called doughnut hole) and would give the government power to negotiate drug prices on behalf of Medicare beneficiaries, a promising way to reduce costs.

The bill would take a long stride toward universal coverage while remaining fiscally responsible.

• If people like their current plans, they will be able to keep them.
• For individuals who aren’t currently covered by their employer, and some small businesses, the proposal will establish a new Health Insurance Exchange where consumers can comparison shop from a menu of affordable, quality health care options that will include private plans, health co-ops, and a new public health insurance option. The public health insurance option will play on a level playing field with private insurers, spurring additional competition.
• This Exchange will create competition based on quality and price that leads to better coverage and care. Patients and doctors will have control over decisions about their health care, instead of insurance companies.

• Every American who receives coverage through the Exchange will have a plan that includes standardized, comprehensive and quality health care benefits.
• It will end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and strictly limit age rating.
• The proposal will also eliminate co-pays for preventive care, and cap out-of-pocket expensesto protects every American from bankruptcy.

• Guarantees that every child in America will have health care coverage that includes dental, hearing and vision benefits.
• Provides better preventive and wellness care. Every health care plan offered through the exchange and by employers after a grace period will cover preventive care at no cost to the patient.
• Increases the health care workforce to ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.
• Strengthens Medicare and Medicaid and closes the Medicare Part D ‘donut hole’ so that seniors and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.

• Employers can continue offering coverage to workers, and those who choose not to offer coverage contribute a fee of eight percent of payroll.
• All individuals will generally be required to get coverage, either through their employer or the exchange, or pay a penalty of 2.5 percent of income, subject to a hardship exemption.
• The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.

• Provides transparency in plans in the Health Exchange so that consumers have the clear, complete information, in plain English, needed to select the plan that best meets their needs.
• Establishes consumer advocacy offices as part of the Exchange in order to protect consumers, answer questions, and assist with any problems related to their plans.
• Simplifies paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all encounter a streamlined, less confusing, more consumer friendly system.
• Increases funding of efforts to reduce waste, fraud and abuse; creates enhanced oversight of Medicare and Medicaid programs.

• Pays for the entire cost of the legislation though a combination of savings achieved by making Medicare and Medicaid more efficient – without cutting seniors’ benefits in any way – and  revenue generated from placing a surcharge the top 0.3 percent of all households in the U.S.(married couples with adjusted gross income of over $1,000,000) and other tax measures.
• The Congressional Budget estimates the bill will reduce the deficit by at least $100 billion over ten years.
• Estimates also show the bill will slow the rate of growth of the Medicare program from 6.6 percent annually to 5.3 percent annually.

The states' reports suggest the biggest impact has been at schools. Twenty-three states that have reported school job numbers said more than 156,000 jobs had been created or saved.

Carol Bingham, director of fiscal policy for the California Department of Education, estimated the stimulus saved about 20,000 teaching positions. But she and others warn that precisely counting saved jobs has proved almost impossible. "It was intended to be a count. The way it was done, I think it's going to end up being an estimate," she said.

Indiana officials reported that the stimulus had created or saved about 13,000 school jobs. Asked whether he had any idea how many layoffs the plan had prevented, state Education Department spokesman Cam Savage replied: "I really don't."

• Guarantee that you will not be denied coverage based on a so-called pre-existing condition
• Limit out-of-pocket expenses to protect families from medical-related bankruptcy
• Make your insurance policy transparent so you know what you’re paying for
• Prevent insurance companies from dropping coverage when you get sick
• Prevent insurance companies from charging people different rates based on gender, health status, or occupation.

The bill, which passed 253 to 171, would allocate about $80 billion over the next decade for new loans, community colleges, school construction and early childhood programs without increasing taxes or adding to the deficit. How? Instead of paying bankers to provide loans for which they bear no real risk, the government would make the loans directly.

Liberals are always accused of spending money without worrying where it comes from, but in this case, costs are covered by making a government program more efficient -- yes, at the expense of bankers.

"We were paying these exorbitant subsidies to bankers who were taking government money, loaning it to somebody else, getting government guarantees that the loans would be paid back, and then taking all these profits," said Rep. George Miller (D-Calif.), the bill's champion. This, he told me, led Congress to ask itself: "Hey, chump, what is it you don't get about what's going on here?" The only knock on the proposal is ideological: that government is "taking over" the student loan program. But it's already a government program. The bill simply eliminates corporate welfare.

This is a classic case of how the Great Ideological Distortion Machine does its mischief: Instead of focusing on how the bill advances values typically regarded as "centrist" -- government efficiency, pay-as-you-go budgeting -- the banks' defenders bury the specifics behind abstract discussions of "big government." Yet I'd venture that middle-of-the-road Americans prefer that their tax money go toward education rather than to padding the profits of financial firms.

Over the past week, I've spoken with Democratic House members, most from highly contested districts, about what happened in their town halls. None would deny polls showing that the health-reform cause lost ground last month, but little of the probing civility that characterized so many of their forums was ever seen on television.

"I think the media coverage has done a disservice by falling for a trick that you'd think experienced media hands wouldn't fall for: of allowing loud voices to distort the debate," said Rep. Mary Jo Kilroy, whose district includes Columbus, Ohio.

At her town halls, she said, "I got serious questions, I got hostile questions, I got questions about how this would work, I got questions about how much it will cost. I also got a lot of comments from people who said it's important for their families and businesses to get health-care reform."

Rep. Frank Kratovil hails from a very conservative district that includes Maryland's Eastern Shore and says it didn't bother him that he was hung in effigy in July by a right-wing group. "As a former prosecutor, I consider that to be mild," he said with a chuckle. The episode, he added, was not at all typical of his town-hall meetings, where "most of the people were there to express legitimate concerns about the bill, wondering about how it was going to impact them" and wanting "to know the truth about some of the things that were being said about the bill."

The most disturbing account came from Rep. David Price of North Carolina, who spoke with a stringer for one of the television networks at a large town-hall meeting he held in Durham.

The stringer said he was one of 10 people around the country assigned to watch such encounters. Price said he was told flatly: "Your meeting doesn't get covered unless it blows up." As it happens, the Durham audience was broadly sympathetic to reform efforts. No "news" there.

Medicare beneficiaries would often have to pay higher premiums for prescription drug coverage, but many would see their total drug spending decline, so they would save money as a result of health legislation moving through the House, the Congressional Budget Office said in a recent report.

Premiums for drug coverage would rise an average of 5 percent in 2011, beyond the level expected under current law, and the increase would grow to 20 percent in 2019, the budget office said.

“However,” it said, “beneficiaries’ spending on prescription drugs apart from those premiums would fall, on average, as would their overall prescription drug spending (including both premiums and cost-sharing).”

The House bill would require drug companies to provide larger discounts, or rebates, on medications dispensed to low-income people enrolled in both Medicare and Medicaid. It would also require drug makers to provide 50 percent discounts on brand-name drugs in the doughnut hole, until the coverage gap was eliminated.

The budget office said premiums would increase, in part, because Medicare drug plans would have to provide additional coverage, paying some costs that beneficiaries now pay themselves.

“In return for those higher premiums,” Mr. Elmendorf said, “enrollees would receive greater protection against incurring high drug costs. As a result, beneficiaries’ spending on prescription drugs apart from the premiums would decrease, on average. That reduction in cost-sharing would outweigh the increase in premiums, again on average.”

This entirely voluntary plan — that's why it's called an "option" — would bring some cost control to health care by applying government's purchasing power as leverage against medical providers and insurance companies. Yet the idea is cynically cast as a "government takeover of health care" — rhetoric worthy of the Mad Hatter.

The dirty secret of our health care system is that it already is dependent on government or, more precisely, government waste. More than 46% of all medical service in the USA, about $1 trillion annually, is paid for directly by taxpayers. Private insurers cover 42%, and the remainder is paid out of pocket. In addition to what government pays directly, it pumps in more than $200 billion a year in tax subsidies.

If Washington does nothing, this government role will only get a lot bigger as the population ages, providers hike prices and private coverage becomes increasingly unaffordable.

The Washington Post debunked one of the leading myths being peddled by health reform opponents this morning. They took on the misleading claims about end-of-life discussions being forced euthanasia.

Washington Post says:

THE DEBATE over health reform has veered into a peripheral and misleading discussion of whether it includes a scheme to pressure senior citizens into pulling the plug. The most extreme misrepresentation has "death panels," as former Alaska governor Sarah Palin colorfully put it, deciding who is too old or too disabled to merit treatment. This is a distorted interpretation, to say the least. The debate threatens sensible policy on end-of-life discussions and in the separate realm of reforming the health-care system.

 

First: It makes sense for everyone to think about end-of-life issues, and the earlier in life the better. If you want every last heroic measure to be tried to extend your life, you can say so. If you have a different vision, you can spell that out. You will be doing your relatives and yourself a favor if you express yourself while you are still healthy. You can always change your mind.

The Washington Post goes on to discuss the need for end-of-life planning and the cost saving benefits of it. Learn more about the misinformation campaign against the America’s Health Choices Act.

Today’s LA Times editorial called for Americans to refuse the status quo in health care. They explain how while most of cable news has been covering town hall protests recently, while there are daily stories that have gone unnoticed but reveal the need for real health reform.  

LA Times says:

It's too bad the television cameras haven't been trained instead on the Forum in Inglewood, where the Remote Area Medical Foundation opened a temporary clinic this week. The scene makes a compelling case for a health care overhaul, putting a human face on the dry statistics about uninsured and underinsured Americans. People started lining up Monday for a chance to be treated Tuesday by volunteer doctors, dentists, nurses and other health care providers. About 1,500 people were seen that first day; after hundreds more camped out overnight, the clinic ran at full capacity again on Wednesday. It's scheduled to stay eight days before heading to its next stop, a reservation in Utah.

 

The turnout in Inglewood was huge despite the lack of publicity about the clinic, indicating how great the need is for more primary care. These are the people whose first stop for treatment tends to be the emergency room, often after a routine problem has festered long enough to become a complex (and expensive) one. Expanding health insurance to cover this group wouldn't be cheap, but it's a prerequisite to the changes in delivery and payment that will help improve care and control costs.

Remote Area Medical's experience here also illustrates one of the best features of our health care system: the humanitarianism of its professionals. But unless the system is reformed to bring basic health care services to all Americans, far too many will continue to depend on the kindness of strangers.

 

We encourage you to continue read the remainder of the LA Times editorial and learn more about the America’s Health Choices Act.

In this morning’s USA Today editorial, they take on myths that continue to surface about health care reform. On July 31, U.S. Reps. Chris Van Hollen (D-MD) and George Miller (D-CA) released a statement exposing the campaign of misinformation on health care.

USA Today says:

There's an old proverb that says a lie can travel halfway around the world while the truth is still getting its boots on. That's surely true when the lie instills deep personal fears, and lies appear to be in full sprint as the nation's health care debate goes local.

Some August town hall meetings around the country have degenerated into furious shouting matches, driven by outrageous misinformation borne of many sources.

The Internet spreads anonymous chain e-mails to a public that is both vulnerable and gullible. Groups with a financial or ideological interest give the rumors a boost. Talk radio provides an echo chamber for the demonizers. Most outrageously, political leaders who know better and could oppose legislation in a more credible way, engage in their own hyperbole or simply remain silent. One Republican senator, South Carolina's Jim DeMint, simply bypassed the substance of the discussion, saying it was a chance to "break" a popular Democratic president. He has plenty of company that isn't quite as blunt.

We encourage you to continue reading the USA Today editorial and learn more about the America’s Health Choices Act.

• Page 22 of H.R. 3200 requests a study, not an audit, of the effects to which rating rules are likely to cause adverse selection in the large group market and employer self insurance market insurance market. This does not require an audit of ALL employers that self insure

• Nothing in the bill infringes upon you and your doctor’s ability to make medical decisions.  The National Health Benefits Advisory Council is not a “government committee” but is made up of providers, consumer representatives, employers, labor, health insurance issuers, independent experts and representatives of government agencies.  They will make recommendations about minimum standards of care and covered benefits that insurance companies have to offer- ensuring that everyone has a health plan that provides them with adequate coverage. 

• This is a misreading of the text.  This section limits the amount of out-of-pocket costs you will face to $5,000 for an individual and $10,000 (indexed to CPI) for a family for a basic package of care.  This ensures you have access to affordable care and won’t go bankrupt paying for it.

• The Health Choices Commissioner is charged with ensuring insurance plans are meeting regulations and minimum standards as well as administering affordability credits and monitoring the exchange.  Nothing in this section or in the larger bill permits the Health Choices Commissioner to choose your benefits for you

• This is blatantly false.  This section prohibits insurance companies from discriminating against persons when issuing coverage, and has nothing to do with government subsidized coverage to illegal immigrants.  The bill explicitly states that no Federal payments will be used for affordability credits for illegal immigrants.  (P. 143, sec. 246). 

• This section says nothing about a National ID health card, or accessing your personal financial information.  This section promotes administrative simplification- for example being able to look up your insurance coverage and determine how much you will pay and which provider your insurance will accept, at the point of service.  This saves money and gives you, the consumer, information about what you will owe at the front end, rather than being denied or getting a surprise bill from your insurance company weeks after your treatment.
  

• This section encourages the development of standards to encourage electronic payments between providers and insurance companies.  Administrative simplification measures like these save billions of dollars.  Nothing will give the government access to your bank account.

• This section provides a limited reimbursement for participating employment-based private plans for part of the cost of providing health benefits to retirees (age 55-64) and their families.  People who have been forced into early retirement in this age group do not qualify for Medicare and this will help them stay on their employer provided, private insurance plan if their employer wants to participate.  Participation is voluntary. This is for all early retirees, and no language targets the provision towards unions or acorn.

• The bill imposes new regulations on private health care plans that will force them to end unethical practices such as rescissions or denying coverage based on pre-existing conditions.  The Exchange will improve the quality of coverage and increase the affordability of private insurers in the Exchange.
  

• Insurance companies in the Exchange will have to offer a basic benefit packages in every service area.  This package will include basic care such as hospitalization, physician visits, medical equipment, mental health, preventative care, maternity and well baby care, and drugs – services that anyone would expect a real insurance policy to cover.  Private insurers may offer a higher tier of coverage with more benefits that are not mandated by the government if they choose.
  

• No, this determines the minimum standards insurance companies must offer coverage for- it has nothing to do with rationing.  Private plans can offer extra benefits like dental or vision coverage for adults, or other non-covered benefits that are not included in the basic level plan.

• The bill requires plans in the Exchange to offer culturally and linguistic appropriate services.  The U.S. is a diverse country culturally and linguistically.  Many legal residents and citizens of the U.S. speak other languages, and implying that everyone of a different culture in the U.S. is here illegally is intolerant and incorrect.  The bill explicitly states that it will not subsidize coverage for illegal immigrants.  (P. 143, sec. 246). 

• The Health Choices Commissioner will conduct outreach and enrollment activities to educate Exchange-eligible individuals and businesses about enrollment in the new Exchange, which includes many private plans along with the public option.  This includes a toll-free hotline, maintenance of a website, creation of outreach materials, and community locations for enrollment.
  

• This section has nothing to do with seniors or Medicare. It describes the minimum benefits insurance plans must offer under the Exchange.

• Protects your access to the doctor of your choice—incenting more family doctors to enter the profession and more doctors to practice in rural areas—and allowing all Americans to keep their current doctor.
• Phases in completely filling in the “donut hole” in the Medicare prescription drug benefit (where drug costs are not reimbursed at certain levels), potentially savings seniors thousands of dollars a year.
• Eliminates co-payments and deductibles for preventive services under Medicare.
• Limits cost-sharing requirements in Medicare Advantage plans to the amount charged for the same services in traditional Medicare coverage.
• Improves the low-income subsidy programs in Medicare, such as by increasing asset limits for programs that help Medicare beneficiaries pay premiums and cost-sharing.
• Computerizes medical records so seniors won’t have to take the same test over and over or relay their entire medical history every time they see a new provider.
• Starts rewarding doctors for the quality, not just the quantity, of care they provide.
• Extends solvency of Medicare by 5 years or more.