HealthCareForAmericaNow

Some folks may have not yet noticed the "Steps to Win" section at the top of our site. It's a section of the site managed by our legislative team, and has the best information on the process by which we'll pass health care reform this year, broken down into six easy-to-understand steps.

For the last few months, we've been in step two, where committees in Congress that have control over health care have been holding hearings and drafting legislation. Now, with legislation set to be introduced in the Finance Committee in the Senate and the tri-committees in the House, and with HELP already marking up a bill, we're firmly in the third step towards passing health reform: Committees passing bills.

Here's what's going to happen:

Because health reform legislation is so complicated, five different committees – three in the House and two in the Senate – are entitled to have some say in the legislation. Each House and Senate committee in charge of different parts of health care reform has been holding hearings and drafting legislation. Committees consider their first draft, usually called the Chairman’s mark, in a process called "mark-up." During these committee meetings, members propose changes to the Chairman’s mark (amendments) and then vote on final approval in their committee. The committees may consider hundreds on amendments in the process.

Once each committee completes its process, the two Senate committees will combine their bills and work out any differences to bring one bill to the Senate floor. The same process will be happening among the committees working in the House. The committees involved in health care reform have pledged to work together to minimize differences and make this process easier.

And, because we're a campaign after all, here's what you can do to help this process:

• Call your Senators in support of a public option - Call your Senators in support of a strong public health insurance option, not "co-ops" or other proposals that won’t do all the things a strong public option can.
• Ask your Senators about the public option - Ask your Senators where they stand on the public health insurance option and what kind of public option they stand for.
• Sign the petition for a public option - Senators Leahy, Durbin, and Schumer have created a petition you can sign in support of a public health insurance option.
• Call your Members of Congress - This is by far the most important thing you can do. Members take calls from constituents very seriously, much more seriously than faxes or emails. Please take a moment and call, even if your Members of Congress are already supporting our efforts.
• Spread the word about our campaign - When President Bill Clinton tried to pass health care reform back in 1993, he didn't have a grassroots army behind him to hold Congress' feet to the fire and fend off opponents. That critical mistake eventually doomed his efforts. This time will be different, but we need your help to recruit your friends and family. Please send a message to anyone you know who supports President Obama and his promises of health care reform and ask them to join our campaign.
• Volunteer in your state - Health Care for America Now has grassroots offices in 42 states and grassroots supporters in all 50. Get involved in the effort in your state and in your community to help us pressure Congress and win quality, affordable health care for all in 2009.

So, hooray for progress! Things are indeed moving. A little historical note: If we make it pass step three onto the full House and Senate considering a bill for a vote, we'll have officially made it farther in the process than President Clinton did in the '90s. That'll be a real milestone.

Now, all we have to do is pass a bill out of committee, pass a bill out of both Houses of Congress, get them to agree on a bill, and have the President sign it - all while preserving our principles for health reform. Not easy, but we'll get there.

The HELP Committee has released their final version of a health care bill, including a public health insurance option and a provision for shared responsibility:

Democrats on a key Senate Committee outlined a revised and far less costly health care plan Wednesday night that includes a government-run insurance option and an annual fee on employers who do not offer coverage to their workers.The plan carries a 10-year price tag of slightly over $600 billion, and would lead toward an estimated 97 percent of all Americans having coverage, according to the Congressional Budget Office, Sens. Edward M. Kennedy and Chris Dodd said in a letter to other members of the Senate Health, Education, Labor and Pensions Committee. The AP obtained a copy.

By contrast, an earlier, incomplete proposal carried a price tag of roughly $1 trillion and would have left millions uninsured, CBO analysts said in mid-June.

You got that cost number right - $611 billion. If you'll remember, the last version of the HELP bill - without a public option or shared responsibility - came in at $1 trillion. Clearly, these changes saved money. (And remember when John Boehner, Republican leader in the House, said the public option would cost over $1 trillion? He's dead wrong.)

On the conference call announcing the measure, Senators Dodd, Brown, and Whitehouse said that all 13 HELP Democrats would be voting for this bill. That's right, every single one.

Richard Kirsch, our national campaign director, had this to say:

The HELP Committee’s bill will give Americans all across this country what they want - a choice of a strong public health insurance option that will provide lower costs and keep the insurance companies honest. The public health insurance option included in the HELP bill will be available on day one, giving Americans a new alternative to the private insurance industry. It will also encourage the delivery of better health care at a lower cost. The public health insurance option, combined with other key sections of the HELP Committee legislation, makes this bill a good prescription for health care reform. More specifically, the bill invests enough resources to make good, affordable health care available to middle-class families and includes strict rules to stop insurance company abuses.

We urge the Senate Finance Committee and the full Senate to follow Senator Kennedy and his fellow Democrats’ lead in giving everyone a choice of keeping their current health insurance coverage or selecting a new public health insurance option. That public health insurance option would be a real alternative to the private insurance companies that have failed to make health care affordable while regularly delaying and denying needed care.

I concur. The HELP Committee is standing up today and doing the right thing for the American people, and indeed, doing something they deeply support. Finance should follow suit.

NEWS

Key Senate Democrats trim cost of health care bill - Associated Press

Determined to advance President Barack Obama's health care agenda, key Senate Democrats are calling for a government-run insurance option to compete with private plans, as well as a $750-per-worker annual fee on larger companies that do not offer coverage to employees.

Washington Post sells access, $25,000+ - Politico

For $25,000 to $250,000, The Washington Post is offering lobbyists and association executives off-the-record, nonconfrontational access to "those powerful few" — Obama administration officials, members of Congress, and the paper’s own reporters and editors.

A Pitch on Health Care To Virginia And Beyond - Washington Post

President Obama offered a wonkish defense of his embattled health-care reform effort during an hour-long town hall meeting in Northern Virginia yesterday that featured seven questions, including one sent via Twitter and several from a handpicked audience of supporters.

AMA president: Group open to government-funded insurance - CNN

The new president of the American Medical Association, which represents the interests of the nation’s doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.

The New York Times writes on the tragic level of bankruptcies related to high medical costs. And they're not talking about people who lack insurance - they're talking about people who find out their insurance doesn't protect them:

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.

[...]

One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.

He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.

[...]

“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”

Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.

Mr. Yurdin learned the hard way.

At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.

He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.

In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there.

Aetna contends that it repeatedly informed Mr. Yurdin and the hospital of the restrictions in policy, which is known in the industry as a limited-benefit plan.

The company says such policies offer value by covering some hospital expenses, like surgeons’ fees or a stay in the intensive care unit. Aetna also says all of its policyholders receive significant discounts on the overall cost of hospital care. But Aetna also acknowledges that a limited-benefit plan was inappropriate in Mr. Yurdin’s case because his age and condition — an irregular heartbeat — made him likely to require more comprehensive coverage.

“Limited benefits aren’t right for everyone, and it clearly wasn’t right for Mr. Yurdin,” said Cynthia B. Michener, an Aetna spokeswoman.

Read more about Wendell Potter's testimony here and here.

As statistics show, stories like Larry Yurdin's are frighteningly common. Health Care for America Now discussed rates of medical-related bankruptcies in its report on the increasing unaffordability of health care, along with many other alarming numbers concerning exploding medical costs and stagnant wages.

Moreover, without serious health reform - including a public option - people like Larry will not find real protection against exorbitant medical costs. We need a public option to control costs and keep insurers honest. And we need a public option if we are to avoid the bleak future Jacob Hacker forecasts:

Look a little further down the road. It's been three years since the president signed [a bill without a public option]. Despite high hopes, the patchwork of federal and state insurance regulations created by the legislation isn't working. The worst abuses–such as revoking policies of people who thought they were covered after they've run up big medical bills–have largely ended. But private insurers continue to ration care in arbitrary ways that put their profits before patients, and many Americans still can't obtain or afford private insurance that promises them health security. The basic problem is that the regulations stand alone, without the auxiliary precaution of a public health plan whose mission is to improve the quality and cost-effectiveness of care.

Those with chronic conditions or nearing retirement age who are self-employed or work for small businesses are hit hardest. A 59-year-old self-employed man with diabetes, or a 48-year-old single mother with breast cancer who works at a small retailer–these are the sort of people who will fall through the cracks without a public plan available in all parts of the nation. They may qualify for a "hardship exemption" so that they are not compelled to buy insurance under the reform legislation's "individual mandate." But not being forced to buy insurance they can't afford is a poor substitute for having access to a public plan they can afford.

Hardworking Americans facing financial and personal ruin over high medical costs deserve a better future than that. And they deserve a better deal than the one Larry Yurdin got from his insurer and from his society. We need a public option to help turn our current system - a nightmare for so many - into a system that provides people with real choices.

If all questions were created equal, you might think that Americans were badly divided on health care reform. According to CNN, only "a bare majority of Americans support President Obama's health care plan."

But when pollsters ask Americans point blank if they want a strong public health insurance plan option as part of health reform, a large - not a "bare" - majority of us say yes.

Just today, Quinnipiac released polling results that showed that support was as high as ever. When Quinnipiac asked, "Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?" 69% said they support the public option.

Need more? When the Washington Post and ABC asked, "Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?" 62% said they support the idea.

And when the Wall Street Journal and NBC asked, "In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance––extremely important, quite important, not that important, or not at all important?" 76% said it was extremely or quite important (.pdf).

A variety of other polls, asking similar questions, have found similar levels of support for the public option.

So what's the deal with CNN? Their poll, it turns out, asks a very different question, which is why it gets a different answer. When CNN asked, "From everything you have heard or read so far, do you favor or oppose Barack Obama's plan to reform health care?" 51% said they supported it, while 45% said they opposed it. Rasmussen, asking roughly the same question, gets a similar answer: 50% say they support "Barack Obama's plan," while 45% say they oppose it.

I'm no pollster, but I'm not surprised that levels of support change based on whether the pollster explains the policy they are asking about or simply associates it with a political figure.

It's more valuable to ask about attitudes toward specific policies. President Obama will not single-handedly determine the shape of health reform. Congress is the body that will take primary responsibility for drafting, amending, and ultimately passing legislation. Many individuals - Edward Kennedy, Max Baucus, Christopher Dodd, and Nancy Pelosi, to name a few - will have a profound impact on the final bill. That's why we need to know how Americans feel about the proposals being made, not the people who propose them.

I am concerned that media narratives about public opinion will become distorted as a result of polls like CNN's, and that observers - or ordinary Americans - will look at polls and say, "Well, we see 76% support for the public option here, but only 50% there. So who knows what Americans really want?"

But I am even more concerned that opponents of health reform will exploit confusion over polls to alarm members of Congress and weaken legislation. "Look at how divided Americans are over the public option," a crafty spinmeister might say. "The President's honeymoon is over, and support for health reform is dropping." If opponents of reform succeed in tying the issue to a person (see "Hillarycare"), they've laid the groundwork for some nasty attacks on reform proposals.

Americans tend to balk at the idea that one powerful individual could reorganize the health system in our country. That's why we all have to keep in mind that the reform proposals on the table have been shaped and supported by many qualified leaders and thinkers, from the President to the Democratic leadership in Congress to intellectuals like Jacob Hacker and analysts in a broad array of major think tanks like the Center for American Progress, the Economic Policy Institute, and the Campaign for America's Future.

The public option is a good proposal, and a necessary one, and that's why Americans support it when you explain it to them in a straightforward manner. So don't let polls that ask different questions trick you into thinking the forces of reform are losing ground. On the contrary, we're gaining steam - and Congress will pay attention.

Everybody, but mostly members of Congress, should read this article by Jacob Hacker and Rahul Rajkumar about what life would be like if we passed health reform - an individual mandate, an insurance exchange, and all that other great stuff - and not a public health insurance option.

That future is bleak. Insurers still control the markets, as they do now, and in fact, the giant insurance companies have grown. Hacker and Rajkumar predict we'll have a choice "basically between WellPoint and UnitedHealth–gargantuan for-profit insurers each about the size of Medicare." Sounds great, right?

Hacker and Rajkumar also pointed out a peculiar fact our geography and politics:

Ironically, the problem is worst in the rural areas of the country whose Democratic Senators–such as Kent Conrad of North Dakota and Finance Committee Chair Max Baucus of Montana–have been among the Democrats most willing to forsake the public health insurance plan. In these rural areas, one or two dominant insurers hold over 90 percent of the market. (In all of Montana, for example, one insurer has 75 percent of private enrollees.) For people in these parts of the nation, a real choice of health plans is as mythical as unicorns.

I would add that the overwhelming majority of rural voters support the choice of a public health insurance option [pdf]. They know what's best for them.

What if we passed a co-op plan? Not much:

Equally mythical, it soon becomes clear, are the consumer cooperatives that Conrad and Baucus had backed to attract Republican support. The reform legislation envisioned that these cooperatives would be chartered by the government and owned by consumers–the idea being that a democratically-controlled enterprise would be driven not by profit, but by serving the interests of its citizen-owners. But the cooperatives are almost impossible to get off the ground, just as similar consumer-oriented ventures have been in the past. Doctors largely boycott them, insurers undercut them, state politicians argue over them, and federal dollars are woefully insufficient to nurture them. It soon becomes clear that they represent little more than a fig leaf covering a lack of commitment to the basic aim of a public plan: having a tough competitor that forces large insurance companies to bring up their standards and bring down their prices.

All this means premiums remain high, as do provider rates and drug prices. Medical inflation keeps increasing. And guess who pays for that? Taxpayers, seeing as how people who can't afford the skyrocketing premiums get government subsidies to help them pay for their private health care. Needless to say, the plan isn't terribly popular.

Rationing of care by private insurers continues. This hits people's individual lives:

Those with chronic conditions or nearing retirement age who are self-employed or work for small businesses are hit hardest. A 59-year-old self-employed man with diabetes, or a 48-year-old single mother with breast cancer who works at a small retailer–these are the sort of people who will fall through the cracks without a public plan available in all parts of the nation. They may qualify for a "hardship exemption" so that they are not compelled to buy insurance under the reform legislation's "individual mandate." But not being forced to buy insurance they can't afford is a poor substitute for having access to a public plan they can afford.

These are the stakes before us. If we do reform right, with a public health insurance option, costs can come down, people will be covered, and none of this will come to pass. But if we remove just one element in the reform package, this idea of choice and competition, we'll end up with an unpopular and ineffective plan that does nothing to control costs and keeps us crushed within the status quo.

This is what makes health reform so hard - change just one piece of the whole plan and suddenly it doesn't work anymore.

Hacker and Rajkumar have another point to make on this idea of public/private competition:

This is a not a radical idea. In many areas of American commerce, private and government programs comfortably co-exist. FHA insured loans and non-FHA loans, Social Security and private pensions, public and private universities–all have long thrived side by side. Each side of the divide has strengths and weaknesses, but in every case the public sector is providing something the private sector cannot: A backup that's there if and when you need it; a benchmark for private providers; and a backstop to make sure costs don't spin out of control. Just as it is comforting to have Social Security in case your 401(k) evaporates or an FHA loan in case your credit score tanks, a new public plan provides an added level of protection against the vicissitudes of an unaccountable insurance market. A public plan is about competition as well as choice.

This is exactly right. The idea that private industry can't ever compete with government is, as President Obama says, illogical, especially because the same people who say this say at the same time that government is too inefficient to run anything correctly.

As Hacker and Rajkumar make desperately clear, we need the public health insurance option. It's not negotiable. We need one available nationally on day one, accountable to voters and Congress, and able to set rates with providers. If we get something less, we don't get health reform.

NEWS

Health Care Deform - The New Republic

Afraid of the public option? This is what America will look like without it.

Insured, but Bankrupted by Health Crises - New York Times

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.

Wal-Mart Says It Backs a Mandate on Insurance - New York Times

Wal-Mart, the nation’s largest private employer, joined hands with a major labor union Tuesday to endorse the idea of requiring large companies to provide health insurance to their workers, a move that gives a boost to President Obama as he is pushing for health legislation on Capitol Hill.

Checking In With Wal-Mart's David Tovar - Kaiser Daily Health News

Wal-Mart Stores Inc., the nation’s largest private employer, has endorsed a health care overhaul that includes a requirement that employers make some financial contribution toward the health care of their workers. Yesterday, the Arkansas-based company released a letter (.pdf) to President Barack Obama jointly signed by the heads of the Service Employees International Union and the Center for American Progress, a liberal Washington think tank, that states: “We are for an employer mandate which is fair and broad in its coverage.” The letter does not provide details of how that requirement would work.

Senate health panel readies gov't insurance option - Associated Press

Senators on a key committee are putting the finishing touches on a government health insurance option that they hope will win broad support among Democrats and the public.

Pharmaceutical deal still has question marks - Politico

As details emerge of the pharmaceutical industry’s agreement to kick in $80 billion to help pay for health care reform, the deal is facing increasing skepticism from inside and outside the health care industry.

This is pretty much what I imagine goes on in the meetings of Conservatives for Patients Rights, or Patients United Now, or AHIP's Campaign for an American Solution, or Blue Cross Blue Shield's Get Health Reform Right. They're clueless.

Meet HAARM - Healthy Americans Against Reforming Medicine:

The front group "Get Health Reform Right," funded by the insurance industry, sent out their first "grassroots" email today. Here's what it says:

The healthcare reform debate is heating up in Washington and we all have a stake in the outcome.   Draft health reform legislation in the House of Representatives is now under consideration.  While this draft legislation takes some of the critical steps needed to transform our healthcare system and expand coverage, it also takes a huge leap in the wrong direction by creating a new government-run health plan.

We all agree that it is critically important to enact comprehensive healthcare reform this year, but legislation that includes a government-run health plan will actually undermine the goals of reform and have devastating consequences on our healthcare system.  Take action now and tell Congress to get health reform right.

More government bureaucracy will only create more problems, not solve the ones we have.  A new government health plan would use its built-in advantages to eventually take over the entire health insurance market, forcing out private plans and limiting consumers' choices.  Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan.  This is not the answer for improving our healthcare system.  Instead, Congress should build on the current employer-sponsored healthcare system that is already working for more than 160 million Americans.  Tell Congress to build on healthcare that’s working for most until it works for all.

Thank you for making your voice heard on this important issue.  With so much riding on healthcare reform, Congress needs to get health reform right for America.

Now, given that it's the insurance industry sending this message, I'm going to rewrite it so you can see what they really mean:

The healthcare reform debate is heating up in Washington and our profits have a stake in the outcome.   Draft health reform legislation in the House of Representatives is now under consideration.  While this draft legislation takes some of the critical steps needed to transform our healthcare system and expand coverage, it also forces us to compete and actually provide health insurance, or lose money. We don't like that.

We keep saying that it is critically important to enact comprehensive healthcare reform this year, but we're really worried that our CEOs won't be able to take that 2nd vacation this year if our profits get cut a couple percentage points. So we're going to tell people that offering them a choice of a public health insurance option somehow will cause them to lose health care. It's not true, but it sure is scary! And if we scare them enough, maybe they'll complain to their Members of Congress!

If we actually had to compete, we couldn't pay our CEOs billions, and we would have to stop denying care for prexisting conditions. That would be a big problem - for us. And of course, though we've argued for years that government is so incompetent that it can't do anything, we're going to pretend that we're so vulnerable that we can't compete with government. Yes, we know this doesn't make sense, but we're going to say it anyway. If we make it sound scary enough, people might not realize they would love to choose to dump us if they could, and that most of them (76%) support giving us a bit of competition.

We hate competition, and so we're against health reform. And we're trying to scare you so you are, too.

Boo!

I don't expect anything better from the industry - they lie about everything else, why not lie about being grassroots.

Update: The Education and Labor Committee sends along this fact-check of the insurance industry's lies:

1. Government plan would use its built-in advantages to eventually take over the entire health insurance market, forcing out private plans and limiting consumers' choices.

The public health insurance option would be just one choice for consumers and families in a menu of private health insurance options called the national health insurance exchange. The public health insurance option would be required to follow the same rules as private insurers (level playing field). And, the public health insurance option would self-sustaining through premiums, not government subsidies.

If we are serious about real competition to help control costs, and most Americans agree, a public health insurance option must be one of many choices consumers will have. As studies have shown, many Americans have little or no choices in health plans in their region.

2. Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan.

No one will be forced into the public health option. If an employer drops their insurance coverage for their employees, those workers would have a choice of any plan in the health insurance exchange, including a public insurance option. In addition, the employer would then have to pay an 8 percent penalty, based on their payroll, for not covering its employees in order to assist low and moderate income employees to obtain insurance coverage that is right for them.

Some text for the HELP Committee's public health insurance option leaked last night. The language includes:

–HHS-based plan: The community health insurance option would be run by HHS. The government would pay for the first three months of claims as a way to capitalize it; this would be a loan to be repaid over time. For the first two years and longer if necessary, the option would also qualify for “risk corridor protections” which offset or reclaim excessive losses and gains which could result during the start-up period (identical to those in Medicare Part D). Subsequently, its premiums would be set to make it self sufficient. This would make the health insurance option quickly available in all areas of the country.

–Plays by the same rules: The option would be one of the Gateway choices. It would follow the same rules as private plans for defining benefits, protecting consumers, and setting premiums that are fair and based on local costs. The only difference between this option and others is that the Secretary would set the reserve requirements for this plan rather than states.

–Provider payments and participation:

• Negotiated rates within limits: The payment rates paid by the option would be no more than the local average private rates – but could be less. The Secretary would negotiate these rates.

• Input from Advisory Councils: Each State would create a Council of provider and consumers to recommend strategies for quality improvement and affordability. States would share in the savings that result.

• Purely voluntary: Health care providers would have the choice of participating in this plan; there would be no obligation to do so.

Why It Will Make Health Care Affordable:

–Pooled purchasing power: This health insurance option can pool the purchasing power of its enrollees nationwide to leverage lower prices to compete with private plans. Similar negotiation power has been used by states to get drug rebates in Medicaid beyond the statutory minimum. It has been used by large businesses to drive delivery system change. This negotiation would be backed by a ceiling of paying no more than average local rates.

–Flexibility and incentives to innovate: Unlike administered pricing, the negotiation for payment rates gives the Secretary the ability to quickly and aggressively promote payment policies that promote quality and best practices. In addition, the State Advisory Councils would tailor delivery system reform for the plan, with a financial bonus for success.

–Lower administrative overhead: The community health insurance option would not need to raise premiums to support shareholder profits, extensive marketing, and extra risk reserves required by require to protect enrollees from plan insolvency or mismanagement of funds.

This fulfills the broad requirements for a public option: Available everywhere and on day one, and accountable to Congress and the voters, as well as rate flexibility. Of course, things are still very much in flux and these details could all change, for better or for worse. But so far, so good.