Finance Chair Sen. Baucus Introduces Health Care
Plan Involving Medicare, Medicaid
After a year of preparation by panel, Senator’s “Call
to Action” details policy options, goals for reform; draws backing of
Center for Medicare Advocacy
“American families – and our economy – are in
crisis over health care. We can’t get coverage to the 61 million who are
either uninsured or underinsured without a major overhaul of the system,
and there’s no way to really solve America’s economic troubles without
fixing health care for the long term." Sen. Max Baucus
Nov. 14, 2008 – Health care reform has not been a
high priority for many senior citizens, since they are already covered
by government plans - Medicare and/or Medicaid. A new plan introduced by
one of the most powerful members of the U.S. Senate would have some
impact on these programs, however, and seniors should stay informed.
Senate Finance Committee Chairman Max Baucus
(D-Mont.) two days ago unveiled his “Call to Action” for health care
reform in 2009, outlining “a path to quality, affordable health care for
all Americans.” The Baucus “white paper” details specific policy options
for consideration by the 111th Congress.
(Note: through out this news report and
summary of the plan, SeniorJournal.com has highlighted mentions of
Medicare and Medicaid in bold red type.)
The primary impact on Medicare in the Baucus plan
is to make health care coverage immediately available to Americans aged
55 to 64 through a Medicare
buy-in, and it would begin to phase-out the current two-year waiting
period for Medicare coverage
for individuals with disabilities.
Total
cost jumped $70 billion in one year to $943 billion: Medicare, Medicaid
more than half
Sept. 18, 2008 – A new government report shows the
less money an American has the more his or her hospital charges jumped
between 2005 and 2006. Hospital charges – what patients are billed for
their rooms, nursing care, diagnostic tests and other services – jumped
from $873 billion in 2005 to $943 billion in 2006, according to the
latest News and Numbers from the Agency for Healthcare Research and
Quality.
Read more...
The plan would also provide every American living
below the poverty level with access to
Medicaid. The Bauccus says this policy is consistent with the
original intent of Medicaid,
and it is the quickest and most cost-effective way to cover every
American living in poverty.
The Finance Committee oversees large portions of
the nation’s health care system, including Medicare, Medicaid, and the Children’s
Health Insurance Program, and also has jurisdiction over all tax policy
changes, including those affecting the health care system.
Judith Stein, Executive Director, Center for
Medicare Advocacy, responded to the proposal, saying, "The Center for
Medicare Advocacy is delighted to see Senator Baucus, a person with
knowledge and authority, propose a real effort to provide health
insurance for all Americans - and to do so by looking to the best of
Medicare."
"We particularly applaud the Senator's suggestions
to allow people between 55 and 65 to buy into Medicare as an interim
step, to eliminate the waiting period for people with disabilities, to
increase access to preventive services, and to ensure level payments
between private and public health plans. This proposal is a breath of
fresh air in its intention, realism, and creativity."
The importance of the committee and power of its
chairman, Sen. Baucus, makes this one of the most important health plans
on the table.
The main objectives of the Baucus plan, he says,
are to achieve universal coverage, reduce health care costs and improve
the quality of care our system provides.
Baucus says his vision for achieving these
objectives includes an individual responsibility to hold health
insurance – once quality, affordable care is accessible to all. His plan
seeks to reach that point through measures to shore up the
employer-based system, through a one-stop insurance marketplace for
individuals and businesses, and through limited expansions of public
programs.
The plan also includes a number of insurance
reforms to make the market work better for American health care
consumers, and delivery system reforms that emphasize better quality,
primary care for more patients, and a stronger focus on preventive care.
Baucus also suggests potential savings and efficiencies that can be
found in a remade health care system to reduce the cost of reform.
“American families – and our economy – are in
crisis over health care. We can’t get coverage to the 61 million who are
either uninsured or underinsured without a major overhaul of the system,
and there’s no way to really solve America’s economic troubles without
fixing health care for the long term. I believe the policy ideas in this
paper are the right way to start,” said Baucus.
“I’m following some basic principles to improve
access to care, to improve the quality of care, and to reduce costs. If
you are happy with the coverage you have, you can keep it. But the
system can work better and cost less for everyone, if leaders are
willing to work together for sound policy solutions. I am committed to
working with my colleagues here on Capitol Hill – Democrats and
Republicans – and to working with the incoming Obama Administration to
really move the ball forward on health reform. In human and economic
terms, there is really just no more time to waste.”
A detailed executive summary by Baucus’s office
follows below.
Baucus said he intends for the Finance Committee,
working with the Senate Committee on Health, Education, Labor, and
Pensions and other committees of jurisdiction, to introduce
comprehensive health reform legislation in the first half of 2009.
“Call To Action: Health Care Reform 2009”
Executive Summary by Sen. Baucus and Staff
“I’m following some basic principles to improve
access to care, to improve the quality of care, and to reduce costs. If
you are happy with the coverage you have, you can keep it. But the
system can work better and cost less for everyone, if leaders are
willing to work together for sound policy solutions.
"I am committed to
working with my colleagues here on Capitol Hill – Democrats and
Republicans – and to working with the incoming Obama Administration to
really move the ball forward on health reform. In human and economic
terms, there is really just no more time to waste.”
Sen. Max
Baucus
The link between health care costs and the economy
is undeniable. Reforming the health care system is essential to
restoring America’s overall economy and the financial security of our
working families.
The case for reform is strong. The U.S. is the
only developed country that does not guarantee health coverage for all
its citizens, with 46 million uninsured and another 25 million
underinsured. As a result, families are struggling to keep up with
out-of-pocket costs for medical care. American businesses are straining
to absorb rising health care costs while staying competitive at home and
around the world. Despite high levels of spending on health care,
research documents poor quality of care received by patients in the U.S.
Studies show, for example, that adults receive recommended care for many
illnesses only 55 percent of the time. Children fare even worse.
Americans are acutely aware of problems in the
country’s health care system, and they are ready for change. They are
not alone. The nation’s health care stakeholders — consumers,
businesses, labor, providers, plans, manufacturers, and state and local
governments — are signaling that they are ready and willing to engage in
serious and comprehensive reform of a health system in crisis. They
recognize that the status quo of high costs, unacceptable numbers of the
uninsured and underinsured Americans, and far less than optimal quality
and value is unsustainable and intolerable. And, notably, the nation’s
economists concur that system reform is not only necessary to
rationalize our health care system, but to sustain our economy, our
ability to compete internationally and, over the long haul, to deal with
our long-term fiscal challenges.
A high-performing health care system would
guarantee all Americans affordable, quality coverage no matter their
age, health status, or medical history.
Today, the costs of care for the uninsured are
largely borne by those with insurance; providers charge higher prices to
patients with private coverage to make up for uncompensated care, and
these costs are passed on to consumers in the form of increased
premiums. Requiring all Americans to have health insurance will help end
the shifting of costs from the uninsured to the insured.
Covering all Americans would also ensure that the
insurance market functions effectively. Insurance works because
policyholders pay into their plans when healthy, and have their medical
bills paid when they are sick. If a significant portion of Americans
does not purchase coverage until sick, then premiums for all enrollees
will increase to cover insurer outlays, and the problem of unaffordable
coverage will persist. Finally, covering all Americans is essential to
effective prevention and wellness efforts and managing chronic
illnesses. Efforts to guard against and better manage illness are an
effective tool to improve health and contain costs but, without every
American in the system, those efforts will fall short of their full
potential.
In a high-performing health care system,
employers, individuals, health providers and plans, as well as
government would all bear responsibility and contribute to fulfilling
the goal of covering all Americans. Wellness and prevention would be
prioritized. And increased quality would result in lower costs so that
employers could afford to continue to offer health coverage and still
compete in a global marketplace. Our public health programs would be on
a more fiscally sustainable path. Ensuring that every American has
coverage would make health care truly portable, so that Americans are no
longer locked into a job based on a need to retain their health
coverage. This Call to Action outlines a vision for creating that
high-performing health care system.
Like a sturdy stool, the Call to Action has three
equally important legs:
(1) a policy that ensures meaningful coverage and
care to all Americans;
(2) an insistence that any such expansion be
coupled with an emphasis on higher quality, greater value, and — over
time — less costly care; and
(3) an absolute commitment to weed out waste,
eliminate overpayments, and design a sustainable financing system that
works for taxpayers as well as for the nation’s recipients and providers
of health care.
Ensuring Health Coverage for All Americans.
The Baucus plan would ensure that every individual
can access affordable coverage by creating a nationwide insurance pool
called the Health Insurance Exchange. Those who already have health
coverage could keep what they have. But for those who need affordable,
guaranteed coverage, the Exchange would be a marketplace where Americans
could easily compare and purchase the plans of their choice.
Private insurers offering coverage through the
Exchange would be precluded from discrimination based on pre-existing
conditions. Premium subsidies would be available to qualifying families
and small businesses. By making health care more affordable and
universally available to all Americans, the Baucus plan would take a
major step toward eliminating racial and ethnic health disparities.
Medicare
Buy-In and Medicaid for All in
Poverty
While the Exchange is being created, the Baucus
plan would make health care coverage immediately available to Americans
aged 55 to 64 through a Medicare
buy-in, and it would begin to phase-out the current two-year waiting
period for Medicare coverage
for individuals with disabilities.
The plan would provide every American living below
the poverty level with access to
Medicaid. This policy is consistent with the original intent
of Medicaid, and it is the
quickest and most cost-effective way to cover every American living in
poverty.
The Baucus plan would also ensure that all states
use the State Children’s Health Insurance Program (CHIP) to cover
children at or below 250 percent of the Federal poverty level, putting
help within reach for more needy children. Finally, recognizing that
America cannot keep its promise to provide care to Native Americans and
Alaska Natives with the current level of Indian Health Service (IHS)
funding, the Baucus plan calls for additional funding for IHS.
Once affordable, high-quality, and meaningful
health insurance options are available to all Americans through their
employers or through the Exchange, individuals would have a
responsibility to have health coverage. This step is necessary for
insurance market reforms to function properly and to end the cost
shifting that occurs within the system. It is expected that the vast
majority of American employers would continue to provide coverage as a
competitive benefit to attract employees. Except for small firms,
employers that choose otherwise must contribute to a fund that would
help cover those who remain uninsured.
The Baucus plan would immediately refocus our
health care system toward prevention and wellness, rather than on
illness and treatment.
Those who are uninsured ― and therefore less likely
to receive preventive care and treatment for major conditions ― would be
given a “RightChoices” card that guarantees access to recommended
preventive care, including services like a health risk assessment,
physical exam, immunizations, and age and gender-appropriate cancer
screenings recommended by the U.S. Preventive Services Task Force.
Individuals without private coverage and not
eligible or enrolled in a public health coverage program, but whose
RightChoices screening detected and diagnosed one or more of the most
common, costly chronic conditions, would qualify to receive treatment on
a temporary basis until viable coverage options are available under the
Health Insurance Exchange.
No Cost for
Medicare, Medicaid Preventive
Services
Current Medicare,
Medicaid, and CHIP
beneficiaries would receive recommended preventive services with little
or no co-payment. Preventive services would be covered by all insurance
options offered through the Health Insurance Exchange.
Improving Health Care Quality and Value.
Recognizing that any attempt to cover the uninsured
and reduce health care spending must address the perverse incentives
fostered by current payment systems, the Baucus plan includes delivery
system reforms that would improve quality and, over time, lower costs.
The plan strengthens the role of primary care and chronic care
management. Primary care is the keystone of a high-performing health
care system. Increasing the supply and availability of primary care
practitioners by improving the value placed on their work is a necessary
step toward meaningful reform.
The plan would refocus payment incentives toward
quality and value. Today’s payment systems reward providers for
delivering more care rather than better care. A redefined health system
would realign payment incentives toward improving the quality of care
delivered to patients. Fixing the unstable and unsustainable Medicare physician payment
formula is a necessary step in this process. The plan would promote
accountability and coordination among providers by encouraging providers
in different settings — physician offices, inpatient hospitals,
post-acute care settings, and others — to collaborate and provide
patient-centered care in a way that would improve quality and save
money.
To facilitate the proposed delivery system reforms,
the Baucus plan would improve the health care infrastructure by
investing in new comparative effectiveness research and health
information technology (IT). Health IT is needed for quality reporting
and improvement and to give providers ready access to better evidence
and other clinical decision-support tools.
Reinvesting in the training of a twenty-first
century health care workforce is necessary for many delivery system
reform goals to be realized. Achieving Greater Efficiency and
Sustainable Financing. The U.S. spends $2.3 trillion per year on health
care, and economists warn that rising health care costs represent a
serious threat to our long-term fiscal security.
According to the Congressional Budget Office, up to
one-third of that spending — more than $700 billion — does not improve
Americans’ health outcomes. Excess spending must be eliminated and
dollars put to better use, not only to correct the imbalances of the
current health care system, but to offset the high costs of much-needed
comprehensive reform. Beyond measures to refocus the system on primary
care, reward quality care, and invest in critical research and
technology, the Baucus plan would endorse direct steps in five
additional areas to curb excess health care spending.
● The plan would invest more to detect and
eliminate fraud, waste, and abuse in public programs.
● The plan would address overpayments to private
insurers in the Medicare
Advantage program.
● The plan would increase transparency of cost
and quality information and would require disclosure of payments and
incentives to providers by drug or device makers that may lead to biased
decision-making.
● The plan also considers careful reforms of
medical malpractice laws that could lower administrative costs and
health spending throughout the system, while ensuring that injured
patients are compensated fairly for their losses. Long-term care
services and supports are both a significant share of national health
expenditures and a driver of cost. Considering policies to shift the
focus from institutional care to services provided in the home and
community could improve the quality of care delivered and reduce costs.
● Finally, the plan would explore targeted
reforms of the tax code to make incentives more efficient, distribute
benefits more fairly, and promote smarter spending of health care
dollars by consumers themselves.
Conclusion
It is the duty of 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 coverage for all
Americans while also addressing the underlying problems in our health
system. The urgency of this task has become undeniable.
In the short term, health care reform would cost
taxpayers more than the government can achieve in savings from all
reforms and financing changes.
Congressional leaders and the public must be
realistic about the timeframe in which the fiscal success of reform is
measured. If we fail to act, however, we will double our current
national expenditure on health care from $2 trillion to $4 trillion,
continue to witness the plight of tens of millions of our citizens
without health insurance cost shifting to those who do, continue to
tolerate poor quality that leads to nearly 100,000 deaths a year, and
watch our businesses become less competitive and our nation go further
into debt. In short, we all must realize that the costs of inaction,
both in human and financial terms, will eventually be far greater than
any initial outlays.
We must choose to invest now in a health care
system that will richly repay the nation with greater health and
economic stability in the long term.
“American families – and our economy – are in
crisis over health care. We can’t get coverage to the 61 million who are
either uninsured or underinsured without a major overhaul of the system,
and there’s no way to really solve America’s economic troubles without
fixing health care for the long term." Sen. Max Baucus