Guest Column by Guest Column byAffordable Health Care for All
In the wealthiest nation in the world, it is inconceivable that anyone could lack access to health care. Yet there are at least 47 million Americans - including 11 million children - who are uninsured. Health care for a family of four costs more than a minimum wage worker earns in a year. That's wrong and it creates a burden on both working Americans and the hospitals and doctors who treat them. It's clear that our system isn't working, and Americans are suffering as a result.
Affordable health care should be a right, not a privilege, and it is our moral responsibility to ensure that no American has to choose between receiving the care they need and putting food on the table. Our first priority must be to cover all children, no questions asked.
My Kids First Act, which I submitted to the Senate last year, would provide health coverage for every child in America through age 21. By requiring the federal government to take over Medicaid, states would be free to expand coverage for children above the poverty line. When passed, this proposal will save Massachusetts more than $219 million dollars a year, and states across the country will save over $6 billion a year. It's not only fiscally responsible; it's morally responsible.
Every American should have access to the same type of health care plan that Congress gives itself. If it's good enough for Members of Congress, then it's good enough for average Americans, and I would provide tax credits to make it affordable for those who fall through the cracks of our current system - the working class, small business owners and employees, and people between jobs.
I know this plan sounds expensive, but it could be easily paid for by repealing President Bush's tax cuts for those earning over $200,000. It's a matter of priorities. What is more important to us - ensuring affordable, quality health care for every American, or giving another tax break to those who need it least?
Affordable health care should be a right, not a privilege, and I will continue to fight in the Senate for health care for all.
Guest Column by A CALL TO ACTION . . .
It is the duty of the next President and the next Congress to reform America’s health care system. In 2009, Congress must take up and act on meaningful health reform legislation that achieves universal coverage while also addressing the underlying problems in our health system. The urgency of this task has become undeniable.
In preparing to act, I led the U.S. Senate Committee on Finance in holding nine hearings on health care reform this year, and hosted a day-long health summit in June 2008 to explore in greater depth the problems plaguing our health system. Additionally, I have spent a good deal of time talking to colleagues on both sides of the aisle and to stakeholders in the health care industry to get better perspectives on the issues that matter.
This “Call To Action” represents the next step. It is not intended to be a legislative proposal. Rather, it details my vision for both policy and the process in the upcoming health care reform debate. The plan contained outlined here addresses health care coverage, quality, and cost. Many components will require an initial investment but, over time, will vastly improve the quality of the health care Americans receive and reduce the cost of that health care, ultimately putting our system on a more sustainable path. It is my intention that after ten years the U.S. will spend no more on health care than is currently projected, but we will spend those resources more efficiently, and will provide better-quality coverage to all Americans.
The health system is so complex that any solution will demand time and attention to make sure we get it right. This plan is most certainly a work in progress. But the intention of this “Call to Action” is to encourage constructive input by policymakers, stakeholders, and health policy thought leaders to move us forward. I look forward to discussing this plan with President-Elect Obama, with my colleagues in Congress, and with stakeholders in the health care system, working collaboratively with all to enact an effective health reform law.
Americans who care deeply about the future of our health system and our economy must all take up the fight together for comprehensive health care reform. My door will be open throughout the debate, and I will seek partners with “can do” spirits and open minds. I believe — very strongly — that every American has a right to high-quality health care through affordable, portable, meaningful health coverage. And I believe that Americans cannot wait any longer.
Guest Column by HIT is the Key to Improving Healthcare System
Health information technology (HIT) is the key to improving quality, gaining efficiencies, and reducing cost in the U.S. healthcare system. That’s something that even people ranging from President Bush to Barack Obama can agree on.
There is no debate over whether we need such a HIT system in America. The debate is over the right role for government to foster the widespread adoption of such an interoperable, seamless HIT system. In this debate, it is vitally important to ensure that such a system has strong privacy protections and security requirements. Some might say let the private sector do it. I’d respond that we’ve tried that and it’s failed. Currently only 20-30% of hospitals and 10-20% of physician’s offices have comprehensive health information systems. Even where systems are in place, they operate in silos and do not provide the aggregate data needed to improve quality of care.
One reason for this failure is that private industry has spawned the development of unique proprietary systems. These systems may work well for the doctor’s office or hospital system that purchases it, but they are unable to perform outside of their own network and therefore fail to meet the need of integrating our disparate healthcare system. This lack of progress is costing US tax payers millions of dollars. Studies have indicated that widespread adoption of HIT could reduce healthcare spending by $80 million annually.
That’s why, in my mind, it is so important for the federal government to step into the arena of HIT. Not because I think government is better than the private sector. But, because I think that if our government has decided that a uniform, interoperable HIT system is a priority, we should step up to the plate to create the standards and help pay for its adoption. That’s precisely what the Health-e Information Technology Act that I introduced does.
With introduction of the Health-e Information Technology Act, I hope that we can move from the realm of private discussions to public endorsements. I am under no illusions that it will be easy to enact a bill like this. While the Congressional Budget Office has not yet provided a score for the legislation, we know that it will have significant costs. But down-payments are required to achieve yield on long-term investments. I am confident that a uniform HIT system will ultimately lead to dramatic improvements in the delivery system and reap great savings once it is in place.
We’ve been talking about this for decades. It is now time to act.
Rep. John D. Dingell (D-MI)
2009 Will Bring New Opportunities for Health Reform
In many ways, our health care system is the best in the world. Yet too many Americans do not have access to quality care, and many who have access still face financial ruin due to inadequate coverage. It’s nothing short of a disgrace that here, in the world’s wealthiest country, 47 million people are without health coverage. Nearly nine million of them are children. Most adults without health insurance are working full-time, but have jobs that do not provide insurance.
Unfortunately, for nearly eight years our President has done little to help the growing pool of uninsured and underinsured Americans. And this Administration has fought nearly every effort to improve or extend coverage for our youngest, oldest, poorest and most vulnerable.
In 1993, the last time our country launched a serious reform effort, health care spending was 14 percent of our GDP. Today it’s nearly 17 percent. Annual insurance premiums for a family of four now average more than $12,000. Half of all bankruptcies in our country are the result of medical expenses.
Our current health care system isn’t just morally indefensible, it's also economically untenable. Some of our largest corporations simply can’t compete with foreign companies based in countries with universal health care.
It’s been sixty years since President Truman issued the first call for a national health care plan. In 1942, my father, John Dingell, Sr., tried to answer Truman’s call by introducing the National Health Insurance Act in the House of Representatives. And I have carried on Pop’s work, opening each Congressional session by introducing a bill to provide every American with health insurance.
Though we have not moved forward as far or as quickly as I would have liked, we have made significant progress, chiefly by creating programs such as Medicare, Medicaid and SCHIP. These programs have allowed millions of Americans to enjoy better health and feel more financially secure.
In 2009, we must build on these efforts. Next year, there will be new opportunities for reform. Not only because we will have a new Administration, but also because support for comprehensive reform has become widespread, and a diverse group of business and health industry leaders are now calling for change.
Governor Edward Rendell (D-PA)
The Prescription for Pennsylvania
The health care crisis is a national problem, but we can and must take responsibility for a Pennsylvania solution. To increase the competitiveness of Pennsylvania businesses and the health and well-being of our residents, we need a "Prescription for Pennsylvania" that expands access to affordable health care coverage, improves the quality of care our residents receive and gets health care costs under control for employers and employees.
The cost of inaction is far greater than what it will take to improve health care for Pennsylvanians. Charges for uncompensated care for the uninsured, additional days of hospital care due to potentially avoidable hospital acquired infections, certain medical errors, readmissions for complications and infections and avoidable hospitalizations due to inadequate care for patients with chronic diseases total $7.6 billion per year. And there are other major cost drivers such as excessive use of emergency rooms for non-emergency care and lack of control over duplicative, expensive capital expenditures. Much of this is paid for through higher health insurance premiums by Pennsylvanians and Pennsylvania businesses.
Our health care system is broken, and Pennsylvania's families and businesses are suffering the consequences. 767,000 Pennsylvania adults are forced to go without health insurance. For those who are covered, the cost of health care is rising far faster than wages. And despite the United States spending more on health care than all other developed countries and even with the extraordinary skills of Pennsylvania’s health care providers, residents of Pennsylvania are not consistently getting the quality of care they deserve.
Prescription for Pennsylvania is a realistic plan for meeting our urgent needs by:
Prescription for Pennsylvania will focus on patient safety by eliminating hospital-acquired infections - saving thousands of lives and billions of dollars each year - and targeting avoidable medical errors. The Prescription will promote a payment system that rewards wellness and does not pay for unnecessary or ineffective medical services. The plan will also improve the care received by the many Pennsylvanians suffering from chronic conditions such as heart disease, diabetes and asthma. And to help all Pennsylvanians stay healthy, the plan will support consumer incentives that reward healthy lifestyles. For more information, please visit www.RXforPA.com.
Rep. Phil Gingrey, MD (R-GA)
On May 7th, I introduced the Medicaid and SCHIP Abuse Prevention Act of 2008 (H.R. 5691). This legislation would eliminate the potential for individuals to fraud programs such as Medicaid and SCHIP, so that these programs can instead be used to benefit those truly in need. The Medicaid and SCHIP Abuse Prevention Act of 2008 will help ensure that these programs continue to be made available for the most vulnerable and needy in this country.
SCHIP and Medicaid were originally designed to be safety-net programs for those most in need in our society. However, these assistance programs for low-income Americans are now being hijacked, and their funds misused. By exploiting inadvertent loopholes in the statute, some states are allowing people to disregard significant portions of their income in order to appear poor on paper, even though their actual income is much higher.
For example, there is a state whose statutory upper limit for SCHIP is 200% of the Federal Poverty Level, which is $42,400. However, by using income disregards, this state allows people to enroll in SCHIP with incomes up to $74,200 per year, which is 350% of the FPL. Yet, nearly 25% of this state’s children – whose families make under 200% of the FPL – are uninsured, leading many to argue that by focusing on higher income families, the state is ignoring the very people it should be helping the most.
Disregarding whole blocks of income – a practice already being employed by as many as thirteen states – for the sole purpose of making an individual eligible for a government entitlement program is an egregious practice that manipulates the very intent of these programs. In order to ensure these programs serve children and individuals who ACTUALLY qualify as “low-income,” the Medicaid and SCHIP Abuse Prevention Act of 2008 will institute a gross income cap of 250% for SCHIP and Medicaid eligibility. This legislation will limit any income disregards to a maximum of $250 per month or $3000 per year.
Placing a firm eligibility cap on SCHIP and Medicaid is the best way to ensure that federal taxpayer dollars are spent on those most in need, and will not be diverted to people who already have the ability to purchase their own health insurance plan without taxpayer-funded assistance.
The bill’s original co-sponsors include: Rep. Feeney (R-FL), Rep. Walden (R-OR), Rep. Herger (R-CA), Rep. Bartlett (R-MD), Rep. Kingston (R-GA), Rep. Broun (R-GA), Rep. Miller (R-FL), Rep. Wilson (R-SC), Rep. Price of Georgia (R-GA), Rep. Westmoreland (R-GA), and Rep. Deal (R-GA).
Arizona Governor'Stimulus' and the States
The states are now in a precarious position. The economy is slowing down. Tax revenues are falling. And demand for expensive services – health care, food assistance and the like – is growing.
A slowing economy is never easy. But this year, the states' fiscal crunch is being made worse. That's because misguided policies put in place by Congress and the Bush administration have either forced states to spend money or driven away tax revenue.
Before anyone in Washington seriously contemplates a second "stimulus package" aimed at reviving the economy, I would offer two succinct pieces of advice: First, take a Hippocratic Oath to do no harm to state budgets. Second, ensure that Washington "pays its bills," just as we require of everyone else.
Let's start with doing no harm. The plain fact is that the first stimulus package violated this principle, and will result in nearly $2 billion in revenue loss to states. State taxes are based on the amount of federal taxes individuals and businesses pay. So when the stimulus package cut federal business taxes, it also cut state taxes and thereby cost us revenue.
Fortunately, Congress is considering bipartisan legislation in both the House and Senate that would provide new resources to help states.
Now, let's talk about Washington paying its bills. The Bush administration has perfected the nasty habit of cost-shifting to the states. Examples are plentiful:
Arizona's unpaid bill is nearing $500 million. As governor, I must enforce the law and pay to incarcerate these individuals. The federal government just shrugs its shoulders and walks away from its statutory obligation.
Even if you accept the Department of Homeland Security's suggestion that costs may be closer to $3.9 billion, this is a large unfunded liability. States are not in a position financially, nor inclined from a policy perspective, to bail out the federal government on Real ID.
Grants would have funded multijurisdictional drug and gang task forces, information sharing and technology, county jails, prosecutors, drug courts, juvenile delinquency and drug treatment programs. Now, states – as well as counties and municipalities – are on their own.
There are dozens more examples. Even if the federal government paid up on only a few of its debts mentioned here, Arizona would not be in deficit this year. It's that simple.
Rest assured, states will manage their economic challenges and balance their budgets as they have before – 49 of the 50 states are legally required to have balanced budgets. But Washington's failure to meet its obligations is forcing states to cut education, health care and other vital services. The federal government should accept its responsibility, do no harm and pay its bills. Once it does, we can work together to improve the quality of life for those we are privileged to represent.
New Hampshire Citizens Health Initiative to Develop Plan for Using Technology to Improve Health Care Quality, Affordability
This week I directed the Citizens Health Initiative to develop a plan for improving the state’s health information infrastructure to improve health care quality and affordability for New Hampshire citizens. Our goal is to keep New Hampshire one of the healthiest states in the nation, and make sure more of our citizens have access to quality health care, at a more affordable cost. Technology can help us reach that goal, by doing for the health care industry what it has done for virtually every other industry - improve quality and efficiency, which cuts down on errors and reduce costs.
As the use of healthcare technology grows, there is a risk of numerous potentially conflicting standards for health information technology in the health care community, which may make it difficult to appropriately share patient information and jeopardize the health care improvements that can come from the greater use of electronic medical records.
We want to make sure New Hampshire citizens get the maximum value from the increasing use of technology in health care. That is why I am asking the Citizens Health Initiative to bring people together now to make sure we develop common standards.
I issued an Executive Order directing the Citizens Health Initiative to work with hospitals, providers and businesses to further develop the state’s health information technology infrastructure in a way that will encourage common standards and coordinated efforts and ensure the privacy personal medial information is protected.
In 2005, I created the Citizens Health Initiative Citizens Health Initiative bringing together lawmakers, state government officials, business leaders, health care providers, workers, and insurance experts to address the state’s health care challenges.
This Executive Order directs the Citizens Health Initiative to convene working groups comprised of various stakeholders from across the state. The strategic plan will be delivered to the Governor by Dec. 1.
Through the work of the Citizens Health Initiative, New Hampshire has set the goal of being the first state in the nation to ensure all physicians have the ability to prescribe medications electronically, which will help lower costs and reduce errors.
The Citizens Health Initiative has worked with insurance companies to develop criteria for “pay-for-performance” standards putting the focus on preventative healthcare. The Initiative also has a Web site, www.nhhealthinfo.org, that allows employers to get the information they need to make informed decisions about employee health benefits.
Rep. Patrick Kennedy (D-RI)
New Legislation Expands Federal Neurotechnology Research and Development
I recently introduced legislation designed to unite and expand federal neurotechnology research and development efforts under a National Neurotechnology Initiative (NNTI). Using targeted funding increases, totaling less than 4 percent of the total brain and central nervous system research budget, the National Neurotechnology Initiative Act will ease bottlenecks, increase coordination, and result in critical treatments reaching patients faster.
The passage of mental health parity legislation in the House was an important step towards bringing greater attention to brain-related illness. It is important that we continue taking steps to better understand and ultimately develop treatments for all the various illnesses of the human brain. Key provisions of the legislation are outlined below (FY09 Authorization levels are in parentheses):
The brain is the most important component of the human body, and with so many Americans suffering from brain-related illnesses, it is crucial for us as a society to maximize our efforts and continue learning about the many facets of the brain, leading to a healthier life for all Americans.
U. S. SenatorSenate Budget Places Priority on Veterans Health Care Needs
As a member of the Senate Budget Committee, earlier this month I announced the Senate passage of the Fiscal Year 2009 Budget Resolution, which for the second year in a row, will fully-fund veterans’ health care in order to make sure that our country keeps its promises to those who have served our country and will include two of my amendments that put veterans first. One amendment prevents the Bush Administration from doubling the cost of prescription drugs co-payments and implementing enrollment fees for our veterans.
The other amendment helps lay the groundwork to make the Department of Defense and Veterans Administration’s health record systems compatible, which means lower costs and improved care for those transitioning from active duty to veterans’ service.
Michigan is home to over 760,000 men and women who have worn the uniform in defense of our country. Our veterans have always been there for us and our country needs to be there for them. Providing the necessary funding for our veterans has been a long, hard fight, and the Senate’s Budget is a major step towards our goal. No one who has put their life on the line for their country should ever be forced to pay more for health care or fall through the cracks because there is a lack of resources.
My amendment rejects the Administration’s proposed increase in health care costs for veterans. Currently, many veterans have an $8 per prescription co-pay for each 30 day prescription. As of October 1, 2008, the President's Budget would increase the co-pay to $15. Veterans, who make more than $28,429 dollars but less than 80% of the community’s median income, would be subject to co-payment increases as well as enrollment fees. My amendment will help ensure that the brave men and women that have put their lives on the line in service to our country are not strapped with additional health care costs.
My Health IT amendment, included in the budget, will help pave the way to fund the Department of Defense and Veterans Administration's effort to make their electronic health records compatible. The Wounded Warrior Act, which passed last year, requires that these systems be compatible. This will help ensure that soldiers returning home from Iraq and Afghanistan do not fall through the cracks.
As a member of the Budget Committee, I have been an advocate for the needs of our nation’s veterans. Last year, veterans from across the country looked to Democrats to make their health care needs a priority, and we delivered. While the current administration has consistently under-funded the Veterans Administration, I have fought at every turn for full funding of veterans health care and to eliminate the year-to-year uncertainties in funding the needs of our nation’s heroes.
U.S. Senator Edward Kennedy (D-MA) Our Nation Depends on a Strong Primary Care System
The number of primary care physicians and other health professionals trained in the United States is shrinking, according to Government Accountability Office findings announced during a Senate Health, Education, Labor and Pensions Committee hearing last month. The nonpartisan research arm of Congress was asked to assess the state of primary care training in the United States.
The health of our nation depends on a strong primary care system. There are too many communities that lack affordable, quality primary care services. We must take the necessary steps to make sure that all Americans have access to primary care physicians and other providers. I look forward to working with my colleagues on this issue in our committee this year.
The number of U.S. medical school graduates enrolled in primary care residency programs -- such as family medicine, internal medicine and pediatrics -- fell to 22,146 in 2006 from 23,801 in 1995, according to the findings presented to the HELP Committee. Although the number of foreign-trained, primary care physicians went up.
In presenting the findings to the Committee, GAO Health Care Director A. Bruce Steinwald testified that there is “a growing recognition that greater use of primary care services and less reliance on specialty services can lead to better health outcomes at lower cost.”
U.S. Senator Michael Enzi (R-WY) Addressing Healthcare Workforce Issues for the Future
In my home state of Wyoming, one of our biggest challenges is providing timely access to health care providers. That kind of access has been hampered because Wyoming is currently facing a shortage of health care professionals – and I am not referring only to specialists. Clearly, that is a problem that needs to be addressed on more than one level.
To begin with, to have access to more health care professionals, we need more than a new, more effective grant program to increase their numbers. We need real reform of our medical system as a whole. I have introduced a Ten Step bill that will, when it is adopted, will greatly reduce the health professional crisis we are already seeing in states like Wyoming, Vermont, Alaska and Massachusetts.
We will be focusing on the training of health professionals, today, but I want to make it clear that work-force issues also include affordable medical insurance for patients, health information technology, better telehealth capabilities, and a liability environment for health care providers. Together, these foundations will help to make people feel more satisfied with their career choice, more fulfilled by the work they do, and ultimately attracted to not only begin, but pursue the call of medicine for many, many years.
That is necessary because Wyoming has a long list of health care needs. We do not have enough primary care physicians, dentists, physician assistants and nurse practitioners. That is in addition to our shortage of subspecialists.
Title VII of the Public Health Service Act is an important component of training our nation’s health care providers. Loan repayment, underrepresented minority programs, faculty training, and various other education programs are important programs that need to be continued. At the same time, we must coordinate the goals of the programs with the outcomes that we measure. We need to improve these programs and our health care delivery system. A few small tweaks are likely not sufficient. That would be like adding a new heel to an old shoe that we would be better off replacing with a new pair.
It seems to me it is also important that we may need to broaden training sites to include more ambulatory care sites in rural areas. Recent experience in Wyoming shows that with concentrated effort almost 2/3 of the family practice physicians who train in Wyoming will stay in Wyoming.
We need to establish a National Health Work Force Commission so that we can start addressing the shortages. I look forward to continuing the dialogue on this important topic and working with my colleagues on solutions that will place good and affordable health care within the reach of all Americans.
New Jersey AssemblymanHealth Information Technology Would Improve Quality of Health Care, Access to Patient Information
Governor Jon S. Corzine recently signed into law legislation I drafted to enhance the quality of health care delivered to New Jersey residents through a health information technology (HIT) system.
Improving access to health records for patients and medical practitioners would ensure that every patient receives the best care each and every time they seek medical attention. Our paramount goal should be to do all that we can to reduce medical errors that can threaten the health and safety of New Jersey medical patients. This health information sharing network will better coordinate the care of a patient among hospitals, emergency rooms, clinics, nursing homes, pharmacies, and health care professionals.
The “New Jersey Health Information Technology Promotion Act” (A-4044) will establish the state’s first electronic medical records infrastructure and create a Health Information Technology Commission to oversee the development, implementation and oversight of the program. The new law will advance the quality of health care for all New Jersey residents through a secure and integrated medical records system. The result is a comprehensive network to improve patient care, health policies and efficiency in research while cutting administrative costs and increasing our state’s emergency preparedness.
Health Information Technology can save New Jersey over three-quarters of a billion dollars. Electronic medical records also have the potential to cut-down on fraud and the misuse of New Jersey’s health care resources.
Thomas Edison State College released a 1994 healthcare information networks and technology study that showed that New Jersey could save as much as $760 million by migrating from paper-based systems to an electronic network.
The 19-member Health Information Technology Commission will be established within the Department of Health and Senior Services to oversee the creation and functions of a state-wide health information technology plan, with the assistance of the Department of Banking and Insurance, which will institute an Office for the Development, Implementation and Deployment of Electronic Health Information Technology, which shall be known as the “Office for e-HIT”. The commission would be charged with promoting the use of national standards for the state’s HIT system including security, privacy, data content, format, vocabulary and information transfer standards.
The commission will include:
The commission also would have access to assistance and services from any state agency as needed. The “New Jersey Health Information Technology Promotion Act” will take effect 180 days from the date of the Governor’s signing, January 13, 2008.
Assemblyman Herb Conaway (D-Burlington/Camden) is a practicing physician and Chairman of the Health and Senior Services Committee.
Rep. Steny Hoyer (D-MD) Working with Our Nation’s Providers
In almost every public poll that asks Americans what domestic issue most concerns them, health care is almost always listed among in the top three. As a matter of public policy, health care dominates the debate, both in the state of Maryland and in Washington.
There is much more that must be done to improve the way our nation provides health care services to its citizens. One of the greatest challenges before us is decreasing the massive rolls of the uninsured. Currently, there are more than 45 million Americans without health insurance coverage, 9 million of which are children. Quite simply, this is a national scandal.
It is simply unacceptable that in a country as prosperous as ours, 9 million children - one out of nine children - lack any covered access to health care services, while more than 20 million more who rely on Medicaid and the State Children's Health Insurance Program (SCHIP) endure considerable limitations to care.
Earlier this year, for example, a 12-year old boy from Prince George's County – Deamonte Driver – died from a brain infection caused by an abscessed tooth. His Medicaid coverage had lapsed and he was denied access to basic dental services.
Cases like Deamonte's are precisely why the 110th Congress has made reauthorization of the State Children's Health Insurance Program (SCHIP) a top priority. Unfortunately, President Bush's budget request for SCHIP failed to keep pace with inflation, preventing millions of children from getting coverage and putting even greater strain on states' coffers.
Clearly, Maryland's doctors are the on the front line in the effort to ensure the health and well-being of our residents, particularly our elderly. That is why I am committed to working with physician groups to ensure that Medicare fairly reimburses physicians for their services. Some data show that Maryland ranks in the bottom quartile for reimbursement payments to doctors and health care providers. And, since 2002 the "sustainable growth rate" (SGR) that governs annual updates in Medicare has called for reductions in payment rates. Cuts of 40 percent are anticipated over the next eight years.
Certainly, we must reexamine the SGR, but doing so will require significant investments, which must be balanced with other national priorities. But as we work to get our fiscal house back in order at the federal level and reverse years of irresponsible budget and tax decisions, we must take steps to ensure that physicians can afford to serve our nation's elderly and needy.
The key point to remember as we look to make improvements in our health care system is that investing a few dollars up front will save many more later on. Investments for immunizations, obesity prevention, smoking cessation, and research - just to name a few - will help us reduce patient care and hospital costs and prevent the government from having to spend more later on mandatory costs in Medicaid and Medicare.
Unfortunately, the Bush Administration has pushed spending levels over the years that have eroded our health care safety net. For example, the Administration proposed only a 1.6 percent increase in discretionary health programs for Fiscal Year 2008.
Surely, in the days and months ahead, Congress will work to make improvements to our health care system so that you - our front-line providers of health services – can provide quality care to all those in need.
I look forward to working with the medical community to implement necessary reforms, so that the United States – which has the most professional, dedicated and knowledgeable providers in the world – can address our shortcomings and fulfill our promise to the American people.
Congressman Steny H. Hoyer represents Maryland's 5th Congressional District and serves as the House Majority Leader in the 110th Congress
House Speaker Nancy Pelosi (D-CA) Affordable Health Care is Critical
Access to quality, affordable health care is critical to the well being of America, today and in the future. Central to this is addressing the needs of the 46 million uninsured Americans, strengthening the Medicare system, providing health insurance to our low-income children, funding cutting-edge research into cures for diseases, and giving patients the clout to challenge the decisions of health insurers. Only through action on these critical issues can we meet the pressing health care concerns of our nation.
A top priority of the new Democratic-led Congress is providing health care for our nation’s children. On September 25th, the House voted overwhelmingly to pass the final agreement reauthorizing the successful Children’s Health Insurance Program (SCHIP) for five years. The Children’s Health Insurance Program provides health coverage to American children whose parents do not qualify for Medicaid, but can not afford private insurance. This bill will bring health coverage to approximately ten million children in need – preserving coverage for all 6.6 million children currently covered by SCHIP, and reaching millions more low-income, uninsured American children in the next five years.
On October 3rd, President Bush vetoed this legislation. On October 18th, House Republicans sustained President Bush’s veto of the Children’s Health Insurance Program Reauthorization Act of 2007, H.R. 976. House Democrats will continue to insist on insuring the full 10 million children covered by this bill.
Eighty-six percent of children covered by the SCHIP program are in working families that are unable to obtain or afford private health insurance for their children. The program is crucial for both our children in our country’s rural and urban areas. In rural areas, one in three children has health care coverage through SCHIP or Medicaid. In urban areas, it is one in four. SCHIP has also had a dramatic effect in reducing the number of uninsured minority children. After SCHIP was enacted, the number of uninsured African American children dropped from 20 percent to 12 percent; the number of uninsured Latino children dropped from 30 percent to 21 percent, and the number of uninsured Asian American children dropped from 18 percent to 8 percent. Additionally, health care through SCHIP is cost effective. It costs only $3.34 dollars a day to cover a child under SCHIP, according to the Congressional Budget Office.
The passage of the SCHIP reauthorization is a bipartisan victory for America’s families and children. The reauthorization of SCHIP program presents an historic opportunity to put an end to the morally unacceptable fact that nine million American children live every day without insurance.
Medicare for Seniors
Congress is working to maintain Medicare’s commitment to insure our seniors and reverse harmful cuts proposed by the Bush Administration. We are working to prevent the scheduled 10 percent cut to physician payments, and create a path to a better payment system for physicians. Unless Congress acts with updates to reflect the increasing cost of running a medical practice, physicians in Medicare will receive a 10 percent reduction in fees and an estimated 5 percent patient reduction each year.
Congress will also enhance Medicare benefits for vulnerable populations, strengthening programs that provide financial assistance to low-income Medicare beneficiaries for premiums, cost-sharing, and prescription drug costs. Enhancing and simplifying eligibility and enrollment in these programs will help more beneficiaries afford health care services without being forced to choose between food and medical care. Our health care legislation will additionally invest in rural health care. Currently, rural patients and doctors face real problems with Medicare Advantage private plans. Rural doctors often receive far lower rates in these plans as compared to traditional Medicare. Investing in traditional fee-for-service Medicare is the top priority for rural America.
Expanding Health Care for the Uninsured
It is a disgrace that there are 46.6 million Americans without health insurance. In July, Congress is considering legislation that takes steps to address this problem—funding several initiatives that would provide access to health care for more than 2 million uninsured Americans. The legislation provides $200 million, or 10 percent more than 2007 and the President’s request for community health centers, enabling these centers to serve an additional 1 million uninsured Americans. It also provides $75 million for a new initiative of state health access grants—providing start-up grants to states that are ready with plans to expand health care coverage to targeted groups. It also includes $50 million for an initiative to assist states in providing high-risk insurance pools to support affordable insurance for almost 200,000 people who are medically high-risk.
Strengthening Life-Saving Medical Research
Medical research at National Institutes of Health offers hope to millions of American families—with groundbreaking research into diseases such as cancer, diabetes, Alzheimer’s, and Parkinson’s. And yet the Republican-led Congress has been shortchanging NIH for years. Between 2003 and 2006, the number of new and competing research grants that NIH could support actually dropped by 12 percent. For Fiscal Year 2008, the President proposed a cut of $279 million below 2007. Instead, this Democratic legislation being considered in July provides an increase of $750 million over 2007 and $1 billion over the President—allowing NIH to support another 545 new and competing research grants.
Military and Veterans’ Health Care
As part of the Emergency Supplemental funding measure signed into law in May, Congress is expanding and improving health care for the brave men and women who have given their all to keeping our country safe and secure. They deserve the best possible treatment. The legislation includes funding for Post Traumatic Stress Disorder and Traumatic Brain Injury care and research, for preventing health care fee increases for our troops, and for addressing the problems at Walter Reed Hospital. It will address the backlog in maintaining VA health care facilities, allow hiring of additional personnel for the administration of the VA health care system, fund mental health care for veterans, and speed up the processing of claims of veterans returning from Iraq and Afghanistan.
Rep.
Lois Capps, RN
(D-CA) Appropriate Nurse Staffing Levels Improve Patient Care
For the sake of our patients and our nurses we have to do a better job of ensuring there are enough nurses on staff to provide quality patient care. It comes as no surprise that when there aren’t enough nurses on the job there is an increased chance of medical errors. The Registered Nurse Safe Staffing Act (HR 4138) would require health care facilities to work with nursing staff to implement a system that ensures appropriate nurse staffing levels are present to promote quality patient care.
The strain on overworked nurses leads to burnout, greater stress on the job and more nurses leaving the profession. We all want patients to have the best possible care and nurse staffing practices that promote a safe and healthy work environment are a key element in reaching that goal. This legislation encourages nurses and hospitals to work together to make sure the right number of nurses are there to provide the excellent care that each and every patient deserves.
A study published in the New England Journal of Medicine in May of 2002 found that higher levels of nursing care correlate with better patient care and outcomes in hospitals. Another study in 2002 by the Joint Commission on the Accreditation of Healthcare Organization (JCAHO) found that nearly one‑quarter of all unanticipated events that result in death, injury or permanent loss of function result from inadequate nurse staffing levels. And research published in the October 23, 2002 Journal of the American Medical Association concluded that a patient's overall risk of death rose roughly 7 percent for each additional patient above four on a nurse’s workload.
Appropriate staffing is the number one concern of nurses today and is critical to the delivery of quality patient care. Proper staffing levels allow nurses the time they need to make patient assessments, complete nursing tasks, respond to health care emergencies, and provide the level of care that their patients deserve. Proper staffing levels also increase nurse satisfaction and reduce staff turnover, an important priority given today’s nursing shortage and the projected shortfalls in the future.
Maryland Governor Martin O’Malley Last week, I announced a new healthcare proposal that would extend medical coverage to more than 100,000 uninsured Marylanders – including poor adults and children. Maryland currently has almost 800,000 residents who are uninsured, and ranks among the lowest states in Medicaid eligibility. As members of the General Assembly come together to address the fiscal challenges of our State, I hope they will also focus on what is possible to improve the quality, access, and affordability of healthcare in our State.
Right now, in Maryland there are almost 800,000 people living without health insurance. In many cases, healthcare is too expensive and out of reach for Maryland families, and when its available healthcare quality is not what it should be. We can and must do better.
My healthcare proposal which was introduced during the special session this week, would:
Encourage wellness and prevention by lowering out-of-pocket costs in exchange for enrollees’ commitment of personal responsibility.
I also signed an Executive Order establishing the Maryland Health Quality and Cost Council to coordinate best practices of the private and public sector to improve healthcare in our State. The Maryland Health Quality and Cost Council will be chaired by Lieutenant Governor Anthony Brown, and shall:
I have also asked the Maryland Healthcare Commission to move forward as quickly as possible to create a Health Information Exchange that allows patients and providers to share vital information on a real time basis. Information technology has tremendous potential for improving quality of care and eliminating many unnecessary costs.
Kansas Gov. Kathleen Sebelius Healthcare: Make Your Voice Heard
Health care affects people more directly than any issue I've worked on during my time in public service. We are all patients at some point in our lives, and we all know people who have benefited from the amazing medical treatments that are available today.
But we also all likely have friends or family members who fought endless battles with an insurance company, or neighbors who have no insurance at all and who were brought to the brink of financial ruin by a health problem.
Now, Kansans have two opportunities to make their voices heard in the national discussion on the health care crisis and how to solve it. The first involves comprehensive health care reform in Kansas. The Kansas Health Policy Authority – a bipartisan group created to oversee health care in our state – is touring Kansas, listening to the stories of patients, providers, families and business leaders.
You can be a part of this discussion by going to www.khpa.ks.gov and offering your stories or your suggestions for how to improve health care in Kansas. Your input will help shape the reform plan that is presented to me and the Legislature later this year, and which will set us on the path to coverage for all Kansans.
At the same time, I also hope you'll contribute to a national debate on health care for children – a debate that's taking place right now.
Congress needs to take action soon in order to continue a program that provides health insurance to tens of thousands of Kansas children. As part of this debate, there are proposals being offered that would expand the number of low-income children who receive health care, and therefore have a healthier start on life.
I am joining other governors across the country in urging our congressional delegation to support an expansion in health insurance for children. We know that if a child is healthy, they will have a better start towards a successful life. I encourage you to contact Senators Brownback and Roberts, and your Congressional representative to add your voice to the discussion.
We can solve the health care crisis, but only if you make your opinions known to the people elected to represent you.
Together, we can create a future where every Kansan has access to affordable, quality health care, and I look forward to working with you to make that future a reality.
Rep. Anna G. Eshoo (D-CA) New House Legislation Accelerates the Adoption of HIT
We live in the Information Age, but healthcare, one of the most information-intensive segments of our economy remains mired in a pen-and-paper past. We can buy airline tickets online, we can check our bank accounts from anywhere in the world, and
we send pictures of new babies and grandchildren to friends and family via e-mail or instant messages. The healthcare industry, however, remains dangerously disconnected. Patients' medical histories are largely disaggregated among the various physicians who have treated them, and are often inaccessible to a new doctor or even to the patients themselves.
Such an inefficient healthcare information system creates unnecessary risks and costs. It's time to look at healthcare in a new way, focusing on overall health and not simply disease. We need to move toward a model of integrated care by providing ways for a patient's physicians to coordinate their care, and promote the modernization of our nation's healthcare system.
Health information technology (HIT) promises to revolutionize the healthcare delivery system and have a powerful effect on enhancing patient safety, reducing medical errors, improving the quality of care, and reducing healthcare costs. The deployment of HIT and the adoption of important patient tools such as electronic health records (EHRs) have been slow and have not kept pace with the advances of technology in nearly every other aspect of our lives.
To accelerate the adoption of HIT and create market conditions and incentives which will encourage investment in this critical technology, I'm introducing the Promotion of Health Information Technology Act. This legislation builds on the excellent work of Senators Kennedy and Enzi and will promote HIT in the federal government and throughout the healthcare sector.
Any meaningful HIT legislation must establish a process for the rapid formulation and implementation of standards to facilitate the exchange of interoperable health data and create incentives to ensure that these technologies are actually adopted. The Promotion of Health Information Technology Act establishes a streamlined process for the adoption of HIT interoperability standards and requires the federal government to abide by the standards it sets.
The legislation establishes a permanent position within HHS with broad responsibility to facilitate the exchange of interoperable health information and coordination of the government's own health IT activities and procurement. It also creates a permanent public-private advisory body to recommend or endorse appropriate HIT interoperability standards with definitive timeframes for adoption and updates. Broadly accepted interoperability standards are vital to the development of IT systems that can communicate and share information.
Under my legislation all federal HIT procurement must comply with the standards endorsed by the interoperability standards body. In addition, all agencies that collect health data electronically for purposes of quality reporting, health surveillance and other purposes must comply with endorsed standards. For HIT to gain a foothold in the healthcare marketplace, it is essential for the federal government to utilize its purchasing power in healthcare to ensure the United States is rapidly adopting these innovative technologies.
The Promotion of Health Information Technology Act also provides important protections for patients and their sensitive medical information. The bill establishes an ongoing system for certification of Electronic Health Records products by third-party entities and guarantees that individuals will have the right to inspect and obtain a copy of their EHRs and amend any inaccurate or fraudulent information. It also clarifies that operators of health information electronic databases like Google Health, Revolution Health, and WebMD are deemed to be covered entities under HIPAA. The use of non-identifiable health data for public health and research purposes is permitted with appropriate patient approval.
The bill establishes a process for the development of reports by ``Health Quality Organizations'' on federal healthcare data to advance healthcare research, enhance consumer education and awareness, and provide the public with reports on national, regional, and provider-and supplier-specific performance.
Finally, to provide resources for the adoption of HIT nationwide the Promotion of Health Information Technology Act authorizes funding for grant programs to assist state and local governments adopt HIT and promote adoption within their states. It also establishes a grant program for regional health information exchanges and a competitive grant program for private sector healthcare providers, with a preference for providers that use the ``Medical Home'' patient care model, which allows patients to have a single point of care and a medical provider to coordinate care through the use of HIT. The legislation also provides incentives for utilizing broadband to deliver HIT in underserved areas and funding of academic curricula to train qualified Health IT professionals.
The power of HIT to transform American healthcare is clear, but without aggressive action by the Congress to promote and adopt HIT, we will not see the benefits of these innovative technologies for years to come. The Promotion of Health Information
Technology Act will ensure that the federal government fosters the development and implementation of advanced Health IT networks and technologies in our country.
Maine Governor Health care is a basic human right, and universal health insurance coverage is my goal for every man, woman and child in Maine.
This is a great challenge. Health care is an issue so important and complicated that to truly provide universal insurance, a national solution is needed.
But as we just learned in the latest Census data released last month, the rate of the uninsured in the nation has climbed, this includes more children who are without health insurance.
Absent a national solution, with health care costs continuing to climb, states have had to go it alone. But Maine has led the way.
In the latest Census data, Maine tied for first in the nation in health insurance coverage. Through Dirigo Health Reforms, we are addressing underlying costs in the health care system while working to improve the quality of care and providing more insurance options in the health care marketplace.
We announced this week that DirigoChoice will now be offered through Harvard Pilgrim, a nonprofit insurance company. This new partnership is a better financial arrangement for Dirigo and helps bring competition back to the health insurance marketplace in Maine.
We have expanded coverage through Medicaid and through innovative efforts that ensure people don’t go without the health care they need, but that they get it by better managing and tightening the controls in the Medicaid program.
Also, in the recent State Legislative session, we achieved legislation to require insurers and allow employers to extend a child’s insurance coverage on a parent’s plan until the age of 25, regardless of whether or not the child is in school.
Much of our success in keeping our rate of uninsured low has been through the use of the tool known as the State Children’s Health Insurance Plan (SCHIP). I was very pleased to be part of its creation at the federal-state partnership, being established in 1997. I was in my second term as a 2nd District Congressman from Maine.
This program has lived up to its promise. It is a unique program providing states with precious funding, and with the flexibility to craft their own effective programs.
Maine’s program is one of the most successful in the country.
In fact, 93% of children in Maine have health insurance. Even when talking about the hardest group of kids to insure – the poor and near-poor, children of working families – the very group designed for Children’s Health Insurance to cover – Maine’s has reached a successful coverage rate of 88%.
More than 13,000 Maine children have health care because of this program. But now, Maine and other states’ good faith efforts to extend affordable insurance to children are being threatened.
As I expressed in a letter to President Bush almost a year ago, pulling back coverage to our children is unacceptable. Funding for this program is one of the best investments we can make to ensure that our children grow and develop healthy, reduce chronic disease instances and costs, and attend school better equipped to learn.
Simply put, future success of Maine’s efforts to provide quality affordable health care to Maine children depends on the federal government continuing to meet its responsibility to this program. Luckily, Congress is moving in to reauthorize the Children’s Health Insurance Program in a way that keeps the promise made ten years ago.Both the current House and Senate versions of the reauthorization would enable Maine to continue the health insurance program for children.
Both bills would give Maine and other states the tools to expand that coverage. I want to extend my thanks to our Congressional Delegation: to Senator Snowe and Senator Collins; Congressman Allen and Congressman Michaud – for their strong support of Children’s Health Insurance Programs. Their voices have been loud and clear through this debate.
Working with my Administration and other governors, they have rejected the White House’s attempts to curtail insurance to low and moderate income families. Along with our Delegation in Washington, D.C., Children’s Health Insurance Programs has strong support in Maine from the Maine Legislature, the Maine Children's Alliance, Maine Equal Justice Partners, Maine hospitals, Maine physicians, among many others in the State of Maine, because they all know there’s nothing more important than protecting the health and welfare of the children of the State of Maine.
Governor Joe Manchin IIITechnology Will Help Control Costs and Improve Health Care
I am very excited about the promise that information technology holds for improving the health of West Virginians. In just as much as modern information technology has made it easier for us to bank online, conduct research, find a phone number or get the biography of our local council members, or to purchase items from around the globe, it can revolutionize the way we provide quality health care to our residents.
By more effectively using technology, such as electronic medical records, the health care community can directly improve the quality of care it provides its patients and can save millions of dollars and countless hours that free up valuable time and resources that could be better used to improve patient care.
Soon after I took office, I challenged state government and the health care community to work together to make West Virginia a national model for implementing health information technology and adopting electronic medical records. I’m pleased to say that since then, we’ve put in place a leadership team that is making real headway not just in West Virginia, but that’s also drawing attention on a national level.
In 2006, I introduced and signed Senate Bill 170, which created the West Virginia Health Information Network (WVHIN). The network is a public-private partnership of consumers, physicians, medical facilities and business leaders, led by WVU School of Medicine neurosurgeon Dr. Julian Bailes. The WVHIN board is making plans for appropriate statewide sharing of medical information and resources for doctors and consumers. Of course, maintaining privacy will be paramount.
The WVHIN is looking at how our state’s various electronic medical records systems are set up, and how we can plan and build a robust, interoperable and affordable system. This work will take strong partnerships so that together we can understand our needs, maintain high quality and control costs. The result: better and more efficient health care for our citizens.
I’m really proud of the progress the network is making, including applying for federal funding and grants that, among other accomplishments, will make us part of the national health information network. The network is competing in two national projects and going after others. Their efforts are garnering national attention and West Virginia is being called a leader in this field.
We want to become a nationwide model for health information exchange and I applaud everyone involved for their efforts toward that goal. It’s important for us to realize the impact information technology has had on productivity and efficiency in other businesses. If we make the right investments in information technology for health care in West Virginia, we can make great advancements in medical quality, safety, health promotion and savings right here in the Mountain State.
U.S. Rep. Jesse Jackson, Jr. (D-IL) Mending the Health Care Breach
Shamefully, the health care system in this country is broken, leaving too many Americans stranded and trapped in the cracks. I introduced The Minority Health Improvement and Health Disparity Elimination Act, which amends many of the breaches in the system.
The bill provides education and training, increases healthcare quality and access, expands research and data collection and improves leadership and collaboration within the federal government. Among its specific aims, the legislation reauthorizes and strengthens the National Center for Minority Health and Health Disparities at the National Institutes of Health (NIH); establishes an internet clearinghouse at the Office of Minority Health to provide culturally appropriate resources; establishes grants to promote positive health behaviors as well as to improve access to care; provides scholarships to minorities who make a mid-career change to a health profession; and requires the development and implementation of a national action plan to improve minority health and eliminate health disparities.
Too many racial and ethnic minorities have less access and fewer options in health care. And, when they do receive care, it is often infrequent, inadequate or inferior. To eliminate the disparity, this legislation directs the attention, summons the resources, and implements a plan within our government. It makes important steps to ensuring that all Americans have an opportunity to see a doctor and get a clean bill of health.
The bill was introduced with 56 original co-sponsors, with an equal number of Democrats and Republicans signing on to it. The legislation also is supported by leading national organizations and institutions, including the American Heart Association, American Public Health Association, Harvard Medical School, Meharry Medical College, National Association of Community Health Centers, Campaign for Tobacco Free Kids, National Council of La Raza, NAACP and the National Medical Association. In June, Senator Edward Kennedy introduced the companion bill in the U.S. Senate.
I am committed to improving and extending access to health care in our country. I believe that health care is a human right, to which all Americans should be entitled under the U.S. Constitution.
Guest Column by Healthcare is a Basic Right for All Americans
All Americans, regardless of age, ethnicity, or background, deserve access to affordable health care. More than 46 million Americans, including 9 million children, are without health insurance and must rely on hospitals and clinics to provide their basic health care needs. Millions more have inadequate insurance and face rising health care costs. As a nation, we must ensure that access to health insurance is a basic right for all by instituting a universal requirement for health insurance with the federal government providing options to individuals and assistance to those who cannot afford adequate coverage.
I introduced a universal health care bill that would require all Americans to enroll in a health care plan. The legislation builds on our current health care system, but would require individuals who do not have coverage to enroll in a “qualified” health plan. The measure is similar to many state laws that require motorists to purchase auto insurance.
The Universal Health Coverage Act would require Americans to have “qualified health coverage” such as Medicare, Medicaid, SCHIP, veterans’ health care, federal health employee benefits, Indian Health Service or any other qualified health coverage as defined by their state of residence.
This legislation provides a simple, straight-forward solution that will ensure that all Americans have health insurance. It directs the Secretary of Health and Human Services to work with the National Association of Insurance Commissioners (NAIC) to develop three low-cost options for individuals below 400% of federal poverty level (FPL). The FPL is currently defined as approximately $20,000 a year for a family of four. That standard was selected because the vast majority of working families with incomes above that level have access to employer-based health insurance.
Those who fail to enroll for any coverage for a continuous period greater than 60 days would be required to pay a tax equal to the average monthly premium amount for qualified coverage as defined by the state in which they reside. Funds collected by this tax would then be used to automatically enroll them in a state-approved plan.
The proposal is based on the principle of personal responsibility: namely, that those who have the financial ability to afford health insurance must be required to have it. It also maintains the current employer-based system and protects government-sponsored health programs.
As a member of the Senate Small Business Committee, I am working to help small businesses provide affordable health insurance for their employees. On the Senate Budget Committee, I have worked to ensure that critical health care programs such as Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP) are priorities in the federal budget.
Children are our greatest resource and we have a special obligation to take care of them. I am an original cosponsor of the Keep Children Covered Act, S. 401, to increase funding for SCHIP which provides millions of American children with health insurance. I have also cosponsored the Children's Dental Health Improvement Act, S. 739, to require states to include dental health coverage for children in their SCHIP programs.
Medicare is a critical element in providing health coverage for seniors and the disabled. I have introduced the Preserving Medicare for All Act, S. 137, to guarantee a universally available, defined prescription drug benefit plan for seniors through Medicare. The bill also would fix Medicare Part D drug coverage and allow the federal government to negotiate lower prices for prescription drugs.
We must continue to fund research for new treatments and actively encourage people to get preventative health care and testing. Stem cells hold the promise of great advances in medicine. I have cosponsored the Stem Cell Research Enhancement, S. 5, and consistently have voted to allocate more federal funds for embryonic stem cell research.
In the House, I successfully fought to expand Medicare to provide coverage for cancer patients so they could enroll in clinical trials. As the lead Democratic sponsor of the Medicare Cancer Clinical Trial Coverage Act, I was able to establish a project whereby Medicare beneficiaries with cancer would be covered for patient care costs, including hospital and physician fees.
Great advances have been made in women's health and we must now build on this success and ensure that women are able to get the care they need. I have cosponsored the Prevention First Act, S.21, a comprehensive bill designed to increase access to reproductive health services, with an emphasis on education and prevention of unintended pregnancies. We have the most sophisticated health care in the world, but our system lacks adequate access.
Guest Column by Eliminating Health Disparities
For the past few Congresses, the Congressional Black Caucus (CBC) has made confronting health disparities one of its major initiatives. We have been champions for access to affordable healthcare, meaningful coverage for prescription medications for every American, and increased representation of African Americans across all health care professions.
The healthcare statistics are staggering in the African American community.
These problems are just the tip of the iceberg. Today, 50 million Americans have no health insurance, including more than 8 million children. Eight out of 10 uninsured Americans either work or are in working families. Sadly, many of those that are uninsured and underinsured are African American.
Being uninsured means going without needed care. It means minor illnesses become major ones because care is delayed. Tragically, it also means that one significant medical expense can wipe out a family's life savings. There are millions of working, uninsured Americans who go to bed every night worrying what will happen to them and their families if a major illness or injury strikes.
In my home state of Ohio there are currently 1,362,000 uninsured an increase of 18,000 people since 2003. We have also seen the strain on many of the local hospitals in my district when people are forced to use emergency rooms as their source of primary care.
The problem is getting worse. As the price of health care continues to rise, fewer individuals and families can afford to pay for coverage. Fewer small businesses are able to provide coverage for their employees, and those that do are struggling to hold on to the coverage they offer. It is a problem that affects all of us and we cannot sit idly by while the people of this country continue to go without health insurance.
We must begin to move forward on a bipartisan basis to expand access to affordable, quality and reliable health coverage for America’s families. Additionally, members of the CBC are putting forth legislation that addresses specific health issues that affect the African American community.
Earlier this year, I introduced the Uterine Fibroid Research and Education Act, which would double federal funding for uterine fibroid research and fund a public education campaign on the condition. Senator Barbara Mikulski (D-MD) introduced companion legislation in the Senate. Congresswoman Tubbs Jones and Senator Mikulski introduced identical legislation in the 109th Congress, but neither received a floor vote.
Uterine fibroids are non-cancerous tumors that form within a woman’s uterine lining. It is estimated that three in every four American women have uterine fibroids, with one in four women seeking medical care for the condition. African American women are three to nine times more likely to develop uterine fibroids. Historically, hysterectomy has been one of the few treatments available.
Right now, hysterectomy is the most common treatment for uterine fibroids, accounting for 200,000, or 30percent of all hysterectomies in the United States. This legislation will help us develop new and better ways to treat or even cure uterine fibroids.
This is just one of the many pieces of health legislation that the CBC is working on. I encourage you to contact your member of Congress and ask them to support these pieces a legislation. Our society must be one that seeks to bridge the divide between the Haves and the Have-Nots and ensure that all Americans have an equal opportunity to live a healthy and happy life.
Guest Column by Reliable, Unbiased Comparative Information
Can Control Health Spending
All too often physicians and patients struggle to understand when a new product, diagnostic test or surgical procedure will be most helpful, or how to choose among existing courses of treatment. Comparative clinical effectiveness means comparing the relative value of different clinical treatments, including drugs, devices, tests, procedures, bandages, pills and anything else you want to take and try to get a comparative ranking.
Given the dearth of good information on comparative clinical
effectiveness, it’s hardly surprising that GAO and MedPAC find dramatic variation in the use of medical services across regions, providers and specialties. Even worse, researchers find that areas with the highest use of some services aren’t necessarily linked to higher quality care or better outcomes. To the contrary, beneficiaries may be put at greater risk when they are subjected to more -- and more complicated -- tests and treatments.
As Medicare’s Board of Directors, Congress needs to ensure that
Medicare resources are being used effectively and efficiently to provide high quality care and achieve the best possible outcomes. Getting reliable, unbiased comparative information is our best shot at controlling health spending while improving care and access. Even if Dr.Orszag won’t give us savings immediately for our efforts, we can
identify ways we can get the information we need to achieve this
important goal, and lay the groundwork for a more efficient, effective system.
Health policy experts across the political spectrum advocate that
comparative information is sorely needed for the public good. They argue that greater investment in comparative effectiveness research is critical to assuring high-quality care and reducing unnecessary
expenditures. Better information about the relative strengths and
weaknesses of various products, procedures and services will help
physicians and patients make wise decisions and will help public and
private payers equitably manage rising health care costs.
Many countries have already made major investments to provide this information to physicians, patients, and policy makers. It’s high time that we do the same!
Many of my colleagues urge that we should “pay for performance.” We already do that – providers perform, and we pay. It’s just that we pay the same whether the service is done on the right people at the right time -- or the wrong people at the wrong time! We really have to know what the effective and appropriate services are before we can know how to reward the care that achieves the best outcomes.
Various authorities both within and outside government have called for a substantial national investment in comparative effectiveness information, and have identified issues and options to help us determine optimal financing and governance for this activity. My personal preference is to move toward a system that is accountable, yet independent, and free from both industry and political influence. Let me repeat that, free from both industry and political influence. Both clinicians and patients need to be confident that this work has been done in the best interest of the patient. To me that points to a government-led effort.
Garth N. Graham, MD, MPH
Office of Minority Health: Using E-learning Tools to Improve the Health Status of Minority Populations
The United States is acknowledged worldwide for leading medical technologies. But, even with the greatest technologies, we are not able to serve the needs of our patients if we are unable to communicate effectively with them.
Nearly one in five Americans speaks a language other than English in their home. If we cannot accurately diagnose or treat a patient due to a lack of language/cultural understanding, we run the risk of misdiagnosis, losing valuable time in the fight to maintain health. A national dialogue about the minority healthcare divide speaks to these issues and how we can improve healthcare for all Americans.
At the Office of Minority Health, U.S. Department of Health and Human Services, we have leveraged e-learning as a powerful tool (www.thinkculturalhealth.org) to improve the healthcare of minority populations of the nation and promote cultural competence. Our distance learning courses are based on streaming multimedia clinical vignettes that reflect clinical practices and illustrate clinical encounters in a readily understandable format.
With the growing popularity of these courses, we leverage content delivery networks and content management systems to insure effective delivery of the rich instructional content based on the latest research in the field of cultural competence. Our learners benefit from accredited online testing and certification, as well as content updates made possible by the flexibility of the web.
We have made it part of our mission to make use of materials and approaches that appeal to the healthcare provider by providing content that is relevant to their particular specialty as well as being available ‘anywhere, anytime’ using the web as well as DVDs, streaming media, and other technologies which lessen the burden associated with maintaining knowledge and gaining new skills. In addition, we are anticipating more healthcare providers’ use of mobile devices such as smart phones and iPods- and we are working to provide content in formats that are compatible with these devices which can be used in concert with desktops – so that education can be accessible through the most convenient combination of devices. In the near future, as videoconferencing through the cell phone and interpretation services may arrive at the bedside, our efforts can be used to augment these solutions as well – providing a cultural context for medical decision making and communications between patients and their providers.
Techniques such as viral marketing have been very successful in spreading the word about cultural competency. Our user statistics indicate that 32% of our 11,500 users found out about our on-line courses through email invitations from their peers who had experienced the online materials. We also have made use of organic search engine placement, e-mail notifications, and links to the latest resources and legislative information to insure the highest levels of relevancy and credibility to our audiences.
With the increased interest in cultural competency, and rapidly growing number of users, we have transitioned from the limitations of in person training to mass training with very little cost associated with distribution. Our educational programs have been endorsed by the Centers for Medicare and Medicaid Services’ Quality Improvement Organizations, the American Nurses Association, and United Healthcare.
As with any successful e-learning initiative, we need to provide learner support services, such as automated help desk functionality. We also need to enable adaptive methods for individuals and institutions to participate in the course work.
With organizations such as the Healthcare Information Management Systems Society (HIMSS), catalyzing needed healthcare information technology infrastructure, we can provide critical ongoing education using innovative on-demand media. With greater availability of portable digital media devices, new web technologies can provide us with the opportunity to personalize content for individuals and institutions, as well as, multi-lingual dynamic, digital signage in public spaces. With audio and video conferencing now commonplace, mobile phones can facilitate the availability of interpreters 24/7 at the bedside. And, we can continue to further leverage all of these technologies to facilitate behavior change, improve healthcare, and enhance health outcomes of racially and ethnically diverse populations.
Rep. Bart Gordon (D-TN)
Putting the Technical Standards in Place to Usher in a Comprehensive EHR System
There is common agreement that the widespread use of Electronic Healthcare Records (EHRs) would improve patient care and decrease costs. Nonetheless, the ubiquitous use of information technology (such as in the case of EHRs) in the healthcare industry lags behind other sectors such as financial, manufacturing, and retail. There are a number of reasons why the widespread use of IT within the healthcare sector lags. However, one important component has been the lack of interoperable EHR systems that also ensure privacy and data security.
I believe that unless the technical standards are developed to ensure the interoperability, privacy, and security of EHRs, little will happen. Since assuming the chairmanship, I have held a series of roundtables with outside groups on what is slowing the adoption of EHRs. There was uniform consensus that interoperability, privacy, and security issues must be addressed if we wish to see the widespread usage of EHRs. While work on the development of technical standards has been initiated by the National Health Information Technology Coordinator, I am concerned about the pace and the scope of the work. As a result, I introduced H.R. 2406 to establish a Healthcare Information Enterprise Integration Initiative.
H.R. 2406 has three components: 1) to strengthen and reinforce ongoing technical standards work for EHRs; 2) to ensure that Federal agencies set a gold standard in the adoption, deployment and use of EHRs; and 3) to establish a research program to anticipate the next generation of information technologies. The provisions of the bill are based on the roundtables I held as well as recommendations made by the President's Information Technology Committee (PITAC) in their report, "Revolutionary Healthcare through Information Technology," and the National Academies report, "Building a Better Delivery System: A New Engineering/Healthcare Partnership."
One major element of this legislation is to provide a greater role for the National Institute of Standards and Technology (NIST) to work with the appropriate parties to develop standards and guidelines for EHRs. Why NIST? For more than 100 years, NIST has worked cooperatively with the standards-setting community and the private sector in the development of standards and measurement tools. In the IT field, NIST has worked cooperatively with the financial and banking sector, the e-business sector, and the manufacturing sector to ensure the interoperability, security, and integrity of their IT systems. In addition, NIST currently develops Federal Information Processing Standards (FIPS) for use by Federal agencies. Current FIPS address interoperability, data integrity, data security and privacy. Many of the challenges faced by those industries are similar to the ones faced by the healthcare sector. NIST is currently assisting the Department of Health and Human Services (HHS) in their health IT efforts. However, given NIST's successful track record in IT interoperability, privacy and security, they should play a leading role in any Federal efforts related to the technical aspects of EHRs. H.R. 2406 ensures this.
H.R. 2406 has three sections:
Healthcare Information Enterprise Integration Initiative - Builds upon the work already underway at NIST on electronic healthcare records and is complementary to the work underway at the Office of the National Coordinator for Health Information Technology. This section provides NIST with greater authority to work with both the user community and the technology community to develop the standards and tests required to ensure that a fully interoperable EHR system is developed. Building upon NIST expertise in information technology privacy and security, NIST will also address these important components in EHRs as well. The technical components of the program include standards and interoperability analysis; conformance testing and certification; security and privacy issues; management of electronic healthcare records; and usability and access to EHR information.
Federal Healthcare Information Technology Systems Infrastructure - Requires NIST to work with Federal agencies and the private sector to develop an interoperable system between agencies and their transaction partners. Elements of the program include development of guidelines for use by Federal agencies; development of testing procedures for conformance assessment; guidance for the protection of privacy of patient information and data security; and establishing a minimum level of interoperability criteria for transactions between Federal agencies. The Federal government currently operates the largest EHR system at the Department of Defense, the Veterans Administration and the Bureau of Indian Affairs. We need to ensure that Federal agencies serve as the gold standard for an interoperable, secure and private EHR system.
Research and Development Programs - Establishes a research program to anticipate the next generation of technologies. This section establishes industry/university partnerships to perform multi-disciplinary research in fields such as wireless networking of medical systems, voice recognition systems, and healthcare information management.
The goal of this legislation is to build upon and strengthen existing EHR efforts. Every month and year that goes by without a workable Electronic Healthcare Record system compromises patient care and increases healthcare costs. This legislation does not address all aspects of the complicated healthcare IT issue. However, it does address one critical element - the technical standards that would allow a comprehensive EHR system to be developed and used by the healthcare community.
U.S. Senator SheldonI have heard from countless Rhode Islanders who have struggled to pay for their health care and who live in fear of losing coverage on which they and their families depend. I have met nurses frustrated and heartbroken that they must spend so much time coping with the paperwork and so little time caring for patients. I have talked with families whose lives and health were shaken by terrifying medical errors, lost paperwork, missed diagnoses that should have been totally avoided.
I believe our current health care system is too complex and costs so much, yet so often does not provide patients with the quality of care they should have. It does not have to be this way. I have seen firsthand that we can make the system work better for everyone, we can cut costs, save lives, and improve the quality of the health care we receive, a critical step toward ensuring that all Americans have health care they can afford.
In Rhode Island, we have been working and experimenting for years to find solutions to many of these challenges. I have been privileged to be part of much of that work, most directly when I founded the Rhode Island Quality Institute to focus on quality reforms in health care.
The subject today is the issue of how the system itself runs, how it operates, put bluntly, how badly in America it runs. If we can reduce the cost of the underlying system by improving its performance, it will make solutions easier for financing our health care system and for finding a way to make sure every American gets health care coverage. Our health care system is a mess. The number of uninsured Americans is climbing and will soon reach 50 million. The annual cost of the system exceeds $2 trillion every year, and that number is expected soon to double. We spend more of our gross domestic product on health care than any other industrialized country in the world, 16 percent. That is double the European Union average.
There is today more health care in Ford cars than there is steel. There is more health care in Starbucks coffee than there are coffee beans. Worse still, for all this money we spend, we get a mediocre product. We have the best doctors, the best nurses, the best procedures and equipment, the best medical education in the world. Yet the system produces mediocre results. As m