1After months of ongoing negotiations, Senate Finance Committee chair Max Baucus (D-MT) released a 220-page draft bill today that lays out the committee’s priorities moving forward. The short title of the bill is the America’s Health Future Act.
The bill draft, for the most part, follows the framework released last week, does not include a public option and is projected to cost $865 billion over 10 years.
The Congressional Budget Office estimates the fully paid for package will increase health coverage and reduce federal deficit within 10 years.
According to a released statement, coverage provisions include:
- Creates health care affordability tax credits to help low and middle income families purchase insurance in the private market.
- Provides tax credits for small businesses to help them offer insurance to their employees.
- Allows people who like the coverage they have today the choice to keep it.
- Reforms the insurance market to end discrimination based on pre-existing conditions and health status .
- Eliminates yearly and lifetime limits on the amount of coverage plans provide.
- Creates Web-based insurance exchanges that would standardize health plan premiums and coverage information to make purchasing insurance easier.
- Gives consumers the choice of non-profit, consumer-owned and oriented plans.
- Standardizes Medicaid coverage for everyone under 133 percent of the federal poverty level.
Provisions included in the legislation to improve the quality of care, increase efficiency within the health care system, and lower health care costs would:
- Shift incentives in Medicare to reward better care, not just more care.
- Increase the number of primary care physicians in the system.
- Aggressively fight fraud, waste and abuse in Medicare.
- Encourage all of a patient’s physicians to coordinate care and reduce duplication and waste.
- Create incentives for health care providers to improve quality by using safer, more cost-effective health technology like electronic medical records.
- Increase health care research so physicians know what care works best for which patients.
Provisions included in the legislation to promote preventive health care and wellness would:
- Provide annual “wellness visits” for Medicare participants and their doctors to focus on prevention.
- Eliminate out-of-pocket costs for screening and prevention services in Medicare.
- Create incentives in Medicare and Medicaid for completing healthy lifestyle programs.
- Increase federal Medicaid funding for states that cover recommended preventive services and immunizations for enrollees at no extra cost.
- Provide free tobacco cessation services for pregnant women in Medicaid.
The Finance Committee will spend the next few weeks debating and amending the mark-up before it will be merged with the Senate Health, Education, Labor and Pension Committee’s bill , and finally make it to the Senate Floor for a vote.
The Chairman’s Mark can be viewed here.
Senate Finance Committee Chairman Max Baucus (D-MT) has released a document outlining a framework for health care reform which is likely to set the stage for draft legislation for committee consideration perhaps even yet this week.
The framework lays out several key priorities and is the result of ongoing negotiations in the Senate by the “Gang of Six” (key Democratic and Republican negotiators including Iowa Senator Charles Grassley) that has been working toward a bipartisan agreement.
One major development in the Senate’s version is that instead of a government-run public insurance option as found in the House bill, the framework rather creates a network of nonprofit cooperatives that would be charged with pooling individuals and negotiating with insurance companies and providers.
Other initiatives include the establishment of health insurance exchanges in 2010 and requiring health plans to report the amount of money they spend on items other than health care and require insurers to cover pre-existing medical conditions.
The report is broken down into seven sections:
- Immediate Relief For Families And Small Businesses
- Ensuring Affordable Health Coverage
- Promoting Disease Prevention And Wellness
- Improving The Quality And Efficiency Of Health Care
- Transparency And Program Integrity
- Fraud, Waste, And Abuse
- Revenue Provisions
Baucus is also proposing tax credits to help individuals who earn up to 300 percent of the federal poverty level, or $66,000 for a family of four, to purchase health care coverage. In addition, individuals who earn between 300 percent and 400 percent of the federal poverty level would be eligible for a premium credit as a flat percent of income.
The Finance Committee is continuing negotiations and several concepts from the framework are expected to be included in the bill draft the committee will mark-up in the coming weeks.
Click here to read the framework document.
by Scott McIntyre on Friday, September 11, 2009
Featuring hospital and health care headlines from the media and Web for September 5-11.
Iowa Headlines
Hospital project in Denison moves ahead
Crawford County Memorial Hospital officials are moving ahead with plans for a new hospital in Denison, at a price tag several million dollars less than expected. Earlier this year, rough estimates were in the $38 million range. Now, the total project, including site acquisition, grading, construction, parking lot paving, landscaping, equipment and supplies installation, and financing and interest fees, is expected to cost $31 million. (September 11, 2009, Tim Gallagher, Sioux City Journal)
Mercy, Finley provide $11 million in uncompensated care, benefits
Medical care without pay grew last year in Dubuque. Mercy Medical Center-Dubuque and The Finley Hospital combined to provide more than $11 million in uncompensated charity care and other community benefits in 2008, according to figures released by the facilities. (September 5, 2009, Erik Hogstrom, Dubuque Telegraph Herald)
Insurance Out of Reach for Hard-Working Iowan
Bankrupted by crippling medical bills, for a year Cindy Ramer could not afford to put a headstone over her husband’s final resting place. Truth is, she hasn’t been able to afford a tombstone since Jim Ramer died from a heart attack in 2005. She eventually asked her bank to tack on the expense to a larger loan. The bank agreed. (September 7, 2009, Mason City Globe Gazette/Associated Press)
Physicians mixed on health reform bills
Pledging to care for others means doctors and nurses keep their doors open for the sick and the hurt, even if the resources aren’t available to pay for the treatment. It is with that pledge in mind that doctors are weighing the health care reform discussion taking place in living rooms, restaurants and in Congress. There’s little doubt medical professionals believe reform is needed. It’s the method to reach that goal that varies dramatically. (September 6, 2009, Christinia Crippes, Burlington Hawkeye)
U.S. Headlines
Better care, pay less: Some communities find a way
Around the country are hospitals and health systems like the hospitals in Cedar Rapids, Iowa that President Barack Obama calls “islands of excellence,” places quietly trying innovative changes to improve patient care at below-average prices. (September 8, 2009, Lauran Neergaard, Associated Press)
Speech Marks Turning Point in Debate
President Obama’s speech to Congress marked a clear turning-point in the health care debate, and Democrats in Congress will now try to capitalize on the momentum. From a policy standpoint, Mr. Obama’s speech strongly affirmed that Senator Max Baucus, the Montana Democrat who has led the only effort to fashion a bipartisan compromise on health care, is in the driver’s seat. (September 10, 2009, David M. Herszenhorn, New York Times)
How to bargain hunt for health care
When Bridget and Scott Bear were expecting their first child, they wanted to know what it would cost so they could set aside enough money in their health savings account. The Omaha, Nebraska, couple went to Alegent Health’s Web site and found the My Cost function, entered their insurance information and learned the hospital charges would be around $2,500, Bridget Bear said. (September 10, 2009, Davis S. Martin, CNN)
Data Fuel Regional Fight on Medicare Spending
For years, health policy experts have said health care spending is much higher in New York City and Boston because doctors and hospitals there provide more services, practicing medicine in a more intensive way. But new numbers are adding fuel to a raging debate over what Congress should do to reduce geographic disparities in Medicare spending. The debate involves a combustible mix of health policy and money. (September 7, 2009, Robert Pear, New York Times)
Hospital CEOs manage staff time, inventory to cut costs
Criticism came from almost every corner leading up to Obama’s speech before Congress on Wednesday night, yet many hospital CEOs aren’t complaining, at least not publicly. They say that the hospitals they run are rife with inefficiency and that they are optimistic that the $155 billion in savings is do-able with the help of business disciplines, such as the Toyota Production System, lean manufacturing and Six Sigma. (September 10, 2009, Des Jones, USA Today)
“Death Panels” Born in Heartland Hospital
In La Crosse, Wisconsin, Gundersen Lutheran has long been a pioneer in ensuring that the care provided to patients in their final months complies with their wishes. More recently, it has taken the lead in seeking to have Medicare compensate physicians for advising patients on end-of-life planning. (September 5, 2009, Alec MacGillis, Washington Post)
Designers create symbols to show way in hospitals
Hospitals can be tough to navigate, especially for immigrants who speak little or no English. So students at four colleges have designed a series of navigation symbols—from a large white tooth to show dental services, to a head with gears inside depicting mental health services—as a way to help guide immigrants through the daunting mazes of hospital hallways and buildings. (September 5, 2009, Lisa Cornwell, San Jose Mercury News/Associated Press)
by Dan Royer on Thursday, September 10, 2009
Story County Medical Center, known as @storymedical on Twitter, is a full-service primary care hospital that has served Story County residents since 1951.
The Nevada-based hospital began using several social networking sites in July of this year as a way to help promote the opening of their new facility, Story Medical – South Campus.
One Web site the hospital is using in particular is Twitter, a popular service that allows users to send short messages to one another in a public forum.
Among the messages Story Medical is sending (known as tweets to Twitter users) related to the opening of their new facility and the services the hospital offers, they have also been sending at least one update per day tagged with #dailymedterm.
“As someone who doesn’t have a medical background, I knew that a lot of our patients weren’t familiar with many of the medical terms that physicians use every day. I thought the #dailymedterm would be a fun way to educate people.” – Ashley Moore, Ancillary Services Assistant at Story County Medical Center
This method of tagging tweets is called using a hashtag, which allows other messages using that same tag to be grouped together. When a user does a search for that hashtag on Twitter, #dailymedterm in this case, they have the opportunity to only view updates that include that term.
Although Story Medical started the hashtag, there are no rules that say others cannot participate. In fact, the #dailymedterm hashtag could be an opportunity for other Twitter users to ask questions about medical terms and what they mean. With other users suggesting terms, the process could become even more interactive.
I’ve seen a number of users commenting on how much they enjoy the #dailymedterm and think it is exactly the type of unique approach to Twitter that more organizations should be thinking about.
Congratulations Story Medical! Keep up the good work.
by Scott McIntyre on Friday, September 4, 2009
Charles Grassley
Iowa Senator Charles Grassley heard a clear, unified message from the state’s hospital leaders at a meeting in Des Moines this week: stay at the health care reform negotiation table and fight to fix geographic variation in Medicare payment. Grassley, who is one of six key Senators negotiating language for that chamber’s reform bill, said he is committed to including that fix in the final bill and will “be at the table until I am pushed away.”
At the same meeting, the American Hospital Association (AHA) backed the IHA-formulated plan to address Medicare geographic variation through value-based purchasing.
Meeting with more than 30 hospital CEOs and other executives at Des Moines University, Grassley told the group he wants to understand the priorities of Iowa hospitals. “I appreciate the help we get from AHA and the work they do, but I am much more interested in how you folks see it,” Grassley said. “I want to be able to gauge the progress of addressing your ideas.”
Over the course of the hour-long discussion, Grassley heard several concerns related to health care reform and its impact on Iowa hospitals, including the need to address Medicare payment issues for “tweener” hospitals through a low-volume adjustment and reauthorization of the Medicare Dependent Hospital program. Grassley said Iowa hospitals have done a great job of keeping the “tweener” issue in the forefront, noting that he now had the names of the impacted hospitals memorized.
The meeting with IHA members was one of the last for Grassley before he returns to Washington, D.C. to resume work on the health care reform legislation. Having spent most of August hearing the concerns of Iowans at well-attended town-hall meetings, Grassley said his faith in grass-roots democracy has been revived. He also noted he consistently heard from hospital representatives at those forums.
“For the most part, Iowans can be proud of how they conducted themselves at those meetings,” Grassley said. “A lot of what we saw on the media didn’t reflect what I saw here in Iowa.”
Developing more specific proposals and finalizing legislation will be difficult over the next three months, said Grassley, who reiterated his commitment to a bipartisan bill. “There are a lot of unknowns out there,” he said. “Maybe we’ll know after the president speaks next week,” he added, referring to President Obama’s speech on health reform before a joint session of Congress on September 9.
The last time a president addressed a joint session of Congress that wasn’t a State of the Union or the traditional first address by a new president was when President George W. Bush spoke about the war on terrorism following the 9/11 attacks.
Have thoughts about the health care reform debate and how it is impacting Iowa? Leave your comments below.
