Health Insurance News

The Problem With Prevention
By Michelle Andrews - The New York Times

When politicians talk about prevention and health care, they are prone to sweeping statements about how preventive services not only keep people healthy but also save money. Just last Sunday, President Obama wrote in The Times:

Most importantly, we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies. There’s no reason we shouldn’t be catching diseases like breast cancer and prostate cancer on the front end. That makes sense, it saves lives, and it can also save money.

In a podcast on his Web site, Senator Tom Harkin, the Senate Health, Education, Labor and Pensions Committee point person on prevention, had this to say (MP3): “The full panoply of wellness and prevention provisions in our bill will result in countless tens of billions of dollars in annual savings.”

If only it were that simple. Nearly 40 percent of all deaths in the United States every year are a result of smoking, poor diet, lack of exercise or alcohol abuse. Preventing those behaviors or reducing their incidence is likely to save money. And one thing that everyone seems to agree on is that putting money toward community-based activities is a good thing, from widening sidewalks so people can get out and walk to getting fresh fruits and vegetables into grocery stores and healthy lunches into school cafeterias.

“You can’t rely on a clinical setting to help people stop smoking, lose weight and make healthier food choices,” said Dr. Steven Woolf, a professor of family medicine at Virginia Commonwealth University who has written extensively about preventive medicine.

But the picture is murkier for other preventive interventions. Very few actually save money. A study published in The American Journal of Preventive Medicine in 2006 examined 25 common preventive services and found that just a handful resulted in savings (PDF). These included childhood immunizations, offering to help smokers kick the habit and discussing daily aspirin use with people at risk for heart disease.

There are many reasons prevention doesn’t always save money, including how often a preventive service is performed and whether it is aimed at the appropriate population. Blood testing to screen for high cholesterol, for example, is a valuable preventive service, but unless it’s restricted to people at risk for heart disease, the costs outstrip the benefits.

Preventive screening for breast cancer or abdominal aortic aneurysms (both of which are covered in the House bills) often identifies potential abnormalities that lead to follow-up testing and treatment. But many of these abnormalities are false positives that might never have caused trouble in the first place, noted Dr. H. Gilbert Welch, professor of medicine at Dartmouth Medical School and author of the book “Should I Be Tested for Cancer? Maybe Not and Here’s Why.”. Treating them can increase risks to patients and raises costs.

“I’m not saying never do this, but it’s not a slam dunk,” Dr. Welch said.

The key is to invest in measures that provide the most bang for the prevention buck — high clinical value at a reasonable cost. “The right question to ask is whether it’s a cost-effective use of health dollars,” said Rob Gould, president of the Partnership for Prevention, a nonprofit that promotes preventive health.

Judged this way, certain preventive services, but not all, may be considered worthwhile, in that while they may not save money, their cost is considered reasonable for the years of sickness and the deaths that they help people avoid. By those criteria, effective prevention includes colorectal cancer screening for adults ages 50 and older, adult flu shots and screening for high blood pressure in appropriate patients.

But even widespread adoption of effective prevention measures carries financial risks, too. As the Congressional Budget Office noted in a health care budget options paper last December, “Discouraging smoking reduces spending … for smoking-related diseases, but the lower mortality rates that result … could increase federal spending for Social Security and Medicare.”

Sometimes you just can’t win for losing.

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Public Option — Here or History?
By Jane Norman, CQ Staff

Obama administration officials are insisting that the government-run public option in their health overhaul proposal is alive and well, despite remarks, comments and responses that hint otherwise.

Appearing Sunday on CNN’s “State of the Union,” Health and Human Services Secretary Kathleen Sebelius ’ commented that the initiative is “not the essential element” for providing consumers with choice and competition in insurance plans.

And on Aug. 15, at a town hall meeting in Grand Junction, Colo., President Obama brought an avalanche of headlines suggesting that the public option, a key but controversial element if the House bill (HR 3200), is ready to be junked by a White House facing falling poll numbers when it comes to health care.

Democrats, though, quickly lined up to show Obama just how difficult that might be, with defenders ranging all the way up to House Speaker Nancy Pelosi , D-Calif.

“A public option is the best option to lower costs, improve the quality of health care, ensure choice and expand coverage,” she said. “The public option brings real reform to lower costs over the 10-year period of the bill.”

In his Colorado appearance, Obama mentioned the public option while explaining the benefits the overhaul would have for those who already have insurance coverage. Polls have shown that many people are comfortable with the coverage they now have.

“The public option, whether we have it or we don’t have it, is not the entirety of health care reform. This is just one sliver of it. One aspect of it,” Obama said, as he explained how the overhaul could solve problems with insurers who deny coverage for pre-existing conditions or raise premiums.

White House officials said Monday the remarks by Sebelius and Obama were being taken out of context and misunderstood. “Nothing has changed,” said Linda Douglass, spokeswoman for the White House Office of Health Reform, in a statement. “The president has always said that what is essential is that health insurance reform must lower costs, ensure that there are affordable options for all Americans and it must increase choice and competition in the health insurance market. He believes the public option is the best way to achieve those goals.”

Whether the White House was really preparing to scrap the public option or just floating a trial balloon in the time-honored Washington fashion, the reaction from Democrats was swift.

Pelosi pointed out that the president stated in March that “the thinking on the public option has been that it gives consumers more choices and it helps keep the private sector honest, because there’s some competition out there.”

“We agree with the president that a public option will keep insurance companies honest and increase competition,” she said. “There is strong support in the House for a public option. In the House, all three of our bills contain a public option, as does the bill from the Senate HELP Committee.”

Rep. Raul M. Grijalva , D-Ariz., co-chairman of the 80-member House Progressive Caucus, said he and a majority of caucus members could not support a health care overhaul without the public option.

“The public option is central to health care reform,” he said. “… I look forward to working with my colleagues to develop comprehensive legislation that allows all Americans to choose the health care plan that’s right for them and their families. But I will not support any bill that does not include a public option.”

Jacki Schechner, a spokeswoman for Health Care for America Now, which has launched a major national campaign on behalf of change in the health system, said Obama has been very clear about the need for a public option and has been consistent in his support.

“I think there’s a media narrative that emerged that’s not 100 percent accurate,” she said. “It’s hard for me to tell what exactly their intentions are but I would say that [dropping the public option] would be a very, very bad idea.”

Former Democratic National Committee Chairman Howard Dean, appearing Monday on CBS’s “The Early Show,” said the public option is essential for House passage. “I don’t think it can pass without the public option,” he said. “There are too many people who understand, including the president himself, the public option is absolutely linked to reform.”

And John Sweeney, head of the AFL-CIO, said the public option is a must and “we will continue to relay that message forcefully to the Senate and the White House.” He said that “unfortunately, the usual suspects opposed to reform are trying to hijack the reform process and attack the public health insurance option because they are afraid of competition and they want to keep gouging working families.”

Insurance companies have been strongly opposed to the public option, saying it would destroy employer coverage and harm patient care, and didn’t seem distressed to hear of its possible demise.

“Unfortunately, the debate about a government-run plan has become a distraction and overshadows the many areas where there is broad consensus,” said Robert Zirkelbach of America’s Health Insurance Plans. “The same goals can be achieved by enacting insurance market reforms with a personal coverage requirement, expanding the safety net, providing one-stop-shopping for individuals and small businesses, and giving a helping hand to low and moderate income families to purchase coverage.”

Jacki Schechner, a spokeswoman for Health Care for America Now, which has launched a major national campaign on behalf of change in the health system, said Obama has been very clear about the need for a public option and has been consistent in his support.

“I think there’s a media narrative that emerged that’s not 100 percent accurate,” she said. “It’s hard for me to tell what exactly their intentions are but I would say that [dropping the public option] would be a very, very bad idea.”

Former Democratic National Committee Chairman Howard Dean, appearing Monday on CBS’s “The Early Show,” said the public option is essential for House passage. “I don’t think it can pass without the public option,” he said. “There are too many people who understand, including the president himself, the public option is absolutely linked to reform.”

And John Sweeney, head of the AFL-CIO, said the public option is a must and “we will continue to relay that message forcefully to the Senate and the White House.” He said that “unfortunately, the usual suspects opposed to reform are trying to hijack the reform process and attack the public health insurance option because they are afraid of competition and they want to keep gouging working families.”

Insurance companies have been strongly opposed to the public option, saying it would destroy employer coverage and harm patient care, and didn’t seem distressed to hear of its possible demise.

“Unfortunately, the debate about a government-run plan has become a distraction and overshadows the many areas where there is broad consensus,” said Robert Zirkelbach of America’s Health Insurance Plans. “The same goals can be achieved by enacting insurance market reforms with a personal coverage requirement, expanding the safety net, providing one-stop-shopping for individuals and small businesses, and giving a helping hand to low and moderate income families to purchase coverage.”

This story originally appeared in CQHealthbeat.

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Thousands Quit AARP Over Health Reform
Tens of Thousands Don’t Like the Health Care Overhaul

CBS News has learned that up to 60,000 people have cancelled their AARP memberships since July 1, angered over the group’s position on health care.

Elaine Guardiani has been with AARP for 14 years, and said, “I’m extremely disappointed in AARP.”

Retired nurse Dale Anderson has 12 years with AARP and said, “I don’t wanna be connected with AARP.”

Many are switching to the American Seniors Association, a group that calls itself the conservative alternative as CBS News Investigative Correspondent Sharyl Attkisson reports.

Last week alone, they added more than 5,000 new members. Our camera was there Friday when the mail came.

Letters were filled with cut-up AARP cards.

“I think that probably the seniors are most upset with cuts in Medicare,” said ASA President Stuart Barton.

The American Seniors Association is flat-out against President Obama’s plan, which calls for $313 billion dollars in Medicare cuts over ten years. The AARP is widely viewed as supporting the President.

Last week, Obama told a town meeting in Portsmouth, NH, “We have the AARP on board because they know this is a good deal for our seniors.”

The AARP called the President’s statements “inaccurate,” saying it hasn’t endorsed any plan or bill.

Some were left with the feeling that AARP was waffling.

“I feel they’re supporting it through the backdoor, and telling members that they’re not through the front door,” said Guardiani.

“AARP has not endorsed any plan at this point,” said Cheryl Matheis, AARP VP for Social Impact.

Yet the AARP’s Cheryl Matheis couldn’t find anything to quibble with, including the Medicare cuts which she says will not affect benefits.

“We haven’t seen provisions in legislation yet, so we’re going to reserve judgment until we see them,” said Matheis.

Meantime, the AARP’s image suffered with this town meeting already seen by hundreds of thousands on YouTube.

Faced with skeptical questions from the audience, the AARP representative ends the meeting abruptly. When the discussion continues, she pulls the plug on the microphone.

AARP says for a group with 40 million members that adds hundreds of thousands each month, losing 60 thousand is just a drop in the bucket. But to the much smaller American Seniors Association it’s a flood.

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Medicare Test Pays for Hospital Performance
By JANE ZHANG - The Wall Street Journal

WASHINGTON—A pilot project by Medicare that links hospital payments to the quality of care has helped prevent infections in pneumonia patients and cut death rates in heart-attack patients, according to data to be released Monday.

In the project, hospitals compete for cash incentives from Medicare, the government insurance program for the elderly and disabled. On Monday, Medicare officials are expected to announce that 225 hospitals will divide $12 million in bonuses; three poor performers will be penalized.

Some lawmakers see the experiment, which began in 2003, as a model as they debate ways to overhaul the nation’s health-care system.

In the four years ended Sept. 30, 2007, the hospitals saw about 4,700 fewer deaths among heart-attack patients than if they hadn’t been participating in the program, said Premier Inc., a health-information company that is Medicare’s contractor on the project. That was among more than 30 quality measures in which hospitals scored higher, Premier said. It said, for example, that 92.6% of the pneumonia patients during the period received antibiotics, flu vaccines or other recommended treatments to prevent acquiring other infections in the hospital, up from 69.3%.

The lesson is that “financial incentives can increase quality of care,” said Tim Love, director of the research office at the Centers for Medicare and Medicaid Services, the federal agency that manages Medicare.

Senate Finance Chairman Max Baucus (D., Mont.) has said he wanted to establish a hospital pay-for-performance program partly based on the Medicare pilot project. An aide said the committee hasn’t settled on any specifics yet as it drafts its proposal for health-care legislation. Lawmakers in the House are also discussing the idea.

The American Hospital Association supports the Medicare project, but Beth Feldpush, the group’s senior associate director for policy, urged caution in expanding the voluntary program nationwide, especially when hospitals are already suffering from the recession. “There are costs involved every time you beef up a program,” she said.

There are other caveats. The hospitals participating in the voluntary pilot project tend to be highly motivated, and their performance might not be a precise indicator of other hospitals’ performance under a similar system. Some hospitals and advocates have expressed concern that the bonuses Medicare hands out to top performers come from other health-care providers, instead of from additional federal funding. The bonus system means hospitals that maintain their existing quality of care but are ranked low on the list could lose some funding.

Doctors and hospital officials who participate in the project also say Medicare needs to overhaul its current payment system to control costs and boost quality across the board. The current fee-for-service payment system compensates doctors and hospitals more for providing more care, but it doesn’t pay for many measures aimed at improving quality of care, such as coordinating with other providers and visiting homes of patients with chronic illnesses. Hospitals say these measures cost money to implement.

“Quality is not without cost,” said Michael Goler, chief medical officer at the Cleveland County HealthCare System, whose hospital in Shelby, N.C., is a top performer in the Medicare project. “People are doing this because they feel this is the right thing to do, but they are doing that despite the economic burdens.”

The hospital, for example, hired 1 1/2 full-time-equivalent nurses to track quality data and also bought new beds that helped reduce infections. Its success in keeping heart-failure patients from returning to the hospital—readmission rates dropped 37% over three years—actually cost the hospital money because fewer admissions meant less reimbursement from Medicare, hospital officials said.

Write to Jane Zhang at Jane.Zhang@wsj.com

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Chances Dim for a Public Plan
White House Opens Door to Compromise on Government Role in Health Overhaul
By ELIZABETH WILLIAMSON and AUGUST COLE - The Wall Street Journal

The Obama administration gave its strongest signal yet that it would be willing to compromise on plans to expand the government’s direct role in health-insurance coverage as it fights a growing crescendo of opposition to its effort to overhaul health care.

Health and Human Services Secretary Kathleen Sebelius said Sunday that a new, government-run health-insurance program wasn’t the “essential element” of any overhaul plan.

Robert Gibbs, the president’s press secretary, said President Barack Obama wants “choice and competition” in the insurance market. Mr. Obama “has, thus far, sided with the notion that can best be done through a public option,” or government-run plan, Mr. Gibbs said Sunday on CBS’s “Face the Nation.” However, he said the bottom line is simply that “what we have to have is choice and competition in the insurance market.”

A day earlier, President Obama defended the public option at a town-hall meeting in Grand Junction, Colo., while leaving the door open to alternative approaches that expand coverage and reduce costs, but don’t increase the federal deficit.

The public option, “whether we have it or we don’t have it, is not the entirety of health-care reform,” Mr. Obama said. “This is just one sliver of it, one aspect of it.”

The comments come after a bruising two weeks in which the president’s call for a public plan to “keep insurance companies honest” has been interpreted by Republican opponents and some members of the public as a push to drive private insurers out of the marketplace.

Insurance companies have fought a public plan, objecting specifically to one that would use the government’s buying power to negotiate rates. The worry is that hospitals and doctors would charge private companies more to make up for being underpaid by the government. Concerns have also been raised that insurers would be unable to compete with such a plan, and that the public option would be a precursor to national health care.

The implications for consumers of nonprofit health-insurance cooperatives, one alternative way to help individuals and small businesses get coverage, are unclear. Much will depend on how and how quickly the co-ops can organize — a daunting task that could involve setting up the equivalent of new insurers on a state or regional basis. The savings wrung from this extra competition could help cash-strapped patients, though it is unlikely that the co-ops would bring prices down as significantly as the government could.

Obama administration officials have indicated before that they could support a health-care overhaul without a government-run insurance option. “Nothing has changed. The president has always said that what is essential is that health-insurance reform must lower costs, ensure that there are affordable options for all Americans and it must increase choice and competition in the health-insurance market. He believes the public option is the best way to achieve those goals,” Linda Douglass, communications director for the White House’s health-reform office, said Sunday.

But as the debate over Mr. Obama’s ideas for a health-system overhaul grows more shrill, proponents have indicated willingness to drop some controversial elements in order to get a plan passed.

Aides to Senate Minority Leader Mitch McConnell (R., Ky.), an opponent of the public option, labeled Ms. Sebelius’s comments a “shift” on the issue in an email pointing out various occasions on which President Obama had said a health plan should include a public option.

Some liberal advocates interpreted the administration’s position as a shift in emphasis, but not away from the public option. Mr. Obama wants to “broaden the conversation so people understand that health-care insurance reform is bigger than just one element,” said Jacki Schechner, spokeswoman for Health Care for America Now, a grass-roots campaign for health-care reform.

Ms. Sebelius’s comments come as some senior Democrats in the Senate are urging the administration to give up on the idea of a public plan run directly by the government. The House has already passed a bill with a robust public option. But House Democrats might be reluctant to vote for a final bill that includes a government-funded plan — exposing themselves to attacks from the right — if the White House appears willing to bargain that away too quickly.

The insurers set to breathe the biggest sigh of relief if the public plan is dropped are Wellpoint Inc., which operates Blue Cross and Blue Shield plans in 14 states, and the dozens of other not-for-profit Blue plans across the country. They are currently the biggest sellers of individual health policies, the kind that would compete with new public or co-op plans. Companies such as Aetna Inc. and Cigna Corp. have less to lose from a public plan as they market mostly to employers.

Robert Laszewski, a consultant at Health Policy & Strategy Associates, said nonprofit co-ops aren’t necessarily an easy victory for insurers, though. If they don’t work down the road, and the government has to bail them out, they might be a precursor to a stronger government role in health care, he said.

He pointed out that the barriers to entry for new insurers are high: They need to set up information-technology infrastructure, build networks of providers and raise significant capital to hedge against catastrophic claims. A co-op that doesn’t navigate those challenges smoothly runs the risk of being shunned by potential customers.

America’s Health Insurance Plans, the lobbying group that represents the industry, is also cautious about the idea of co-ops, saying it hasn’t seen any details on how such a system would operate. Robert Zirkelbach, a spokesman for the group, said that reforms the insurers have proposed — such as accepting patients with pre-existing conditions — are enough to fix the health-care system. “If we do those things, a government-run plan — including a co-op — is not necessary,” he said.

—Avery Johnson and Vanessa Fuhrmans contributed to this article.
Write to Elizabeth Williamson at elizabeth.williamson@wsj.com and August Cole at august.cole@dowjones.com

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Reject White House effort to squelch health debate
By NEWT GINGRICH and NANCY DESMOND - Chron

Just months after Islamic terrorists flew planes into the World Trade Center and the Pentagon with the deadliest attack on American soil in U.S. history, Attorney General John Ashcroft attempted to establish a “TIPS” program in hopes of catching any future terrorists.

The Terrorism Information & Prevention System would have encouraged cable repair operators, telephone service technicians, meter readers and mail carriers to report suspicious activities to federal authorities. With loud objections by the American Civil Liberties Union and members of both parties, Congress adopted a homeland-security law that prohibited such a snitching program.

Fast forward to 2009 and the health care debate and the tables have turned. American safety isn’t the issue but our health, something almost synonymous with our well being. The White House is encouraging an electronic snitching program for the entire country, asking people to report friends and neighbors to flag@whitehouse.gov if they suspect someone is spreading “fishy” information concerning health care reform.

This time, however, we don’t hear a peep out of those champions of free speech, the ACLU. The current administration, which has so proudly defended the rights of terrorists and noncitizens in Guantanamo Bay, shows no remorse in how this policy may be trampling over the Bill of Rights and suppressing the free speech of our honest citizens who have a right to speak their conscience.

The issue of health care ignites passion because it is so personal and determines how long we will live and our quality of life. Without good health, life is just not the same. Ask anyone with disabilities or chronic conditions such as diabetes or arthritis. If you don’t feel good, life isn’t good.

Medical advances have also taken us to the edge of a personalized health system. With DNA samples, physicians can determine whether someone is predisposed to a variety of diseases such as breast cancer, Alzheimer’s or Parkinson’s. With a government-run health program — as is being pushed in Washington — we will see less personalized treatment and more one-size-fits all medicine that will have fewer success rates.

To ask the country to report friends and neighbors who raise questions about whether they will lose their current health care (the best in the world), be forced into a government program, have their benefits reduced when they reach their golden years or be forced into counseling about end of life issues is the antithesis of the type of individual involvement we need. In addition, it flies in the face of our basic constitutional rights.

Sen. John Cornyn, R-Texas, sent a letter with some key questions to the president last week that earned little media coverage. His points included:

• • How do you intend to use the names, e-mail address, IP addresses and identities of citizens who are reported to have engaged in “fishy” speech?

• • What action do you intend to take against citizens who have been reported for engaging in “fishy” speech?

A mere seven years ago this nation almost allowed a snitch program for suspected terrorists in the aftermath of the bloodiest day on our nation’s soil but then decided against it. Yet now, little is being said about a program where Americans are encouraged to report their neighbor for raising questions about whether their dialysis will be covered when they are forced into a public plan because high taxes forced their company to drop their private insurance.

Americans need to keep voicing their questions and concerns about health care, and their involvement in the dialogue should be encouraged, not discouraged.

If our goal is better health at lower cost for every American, empowering individual Americans beats government-run, bureaucratic health care every time.

Gingrich, the former speaker of the U.S. House of Representatives, is the founder of the Center for Health Transformation. Desmond is president and CEO of the Center.

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Town halls too heated for some
By Kathy Kiely, USA TODAY

WASHINGTON — The contentious health care debate is forcing some Congress members to rethink an August tradition: town-hall-style meetings.
Eager to avoid the kind of shouting — and, in some cases shoving — confrontations that have turned the health care debate into a cable television and YouTube sensation, some lawmakers are opting out of the free-wheeling forums.

“I’m not going to give people a stage to perform,” Rep. Silvestre Reyes, D-Texas, told the El Paso Times. Like a number of his Democratic colleagues, he’s holding telephone town halls instead.

Others, such as Illinois Sen. Dick Durbin, the No. 2 Senate Democrat, are hosting smaller roundtables with community leaders. “I won’t be doing sucker-punch town-hall meetings,” Durbin said.

Much of the hostility has come from opponents of President Obama’s health care plan. But his critics aren’t the only ones forcing lawmakers to change schedules.

Local officials canceled a meeting to discuss plans for a visitors’ center in Longview, Wash., after Obama’s campaign group, Organizing for America, urged members to show support at the meeting for Sens. Patty Murray and Maria Cantwell and Rep. Brian Baird, all Democrats, on health care.

In a letter, Mayor Kurt Anagnostou and City Manager Bob Gregory fretted about paying $2,600 in police overtime to control an estimated crowd of 900. “We are concerned about our ability to provide adequate security,” they wrote county officials.

Capitol Hill police are working overtime to ensure that the lawmakers who are holding town meetings remain secure. Senate Sergeant-at-Arms Terrance Gainer says it’s the busiest August in memory. “It’s not a budget-buster — yet,” he said.

Brendan Daly of House Speaker Nancy Pelosi’s office says lawmakers are not letting protesters deter them. Since early August, House Democrats have held more than 500 health care events, he said. “They like to be able to speak firsthand to their constituents, and they will continue to do so,” he said.

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AARP wields its power in health care debate
Obama quickly retracts claim

By Jennifer Haberkorn - The Washington Times

If there is anyone or anything President Obama cannot afford to offend in his battle to overhaul the nation’s health care system, it is the powerful seniors lobby, AARP.

Perhaps that is why the White House was so quick to backpedal Wednesday after Mr. Obama mistakenly claimed that the organization, with its tens of millions of politically active members, had already signed on to his plan.

Mr. Obama drew a forceful rejoinder from the group, the nation’s largest organization for retirees, when he said during a town-hall meeting Tuesday in New Hampshire that it was endorsing his health care reform proposal.

White House press secretary Robert Gibbs acknowledged the error Wednesday but said Mr. Obama was not trying to mislead anyone.

That the AARP so forcefully knocked down the claim of support shows the group is wary of being used as a political football. Leaders on both sides of the debate are well aware that seniors have the power to help push through a health care bill or block it entirely.

“We knew [the health care debate] would get to this position, that it would be very difficult, with partisan politics and … misinformation,” AARP spokesman Jim Dau said.

AARP has supported the concept of overhauling the system and has endorsed an $80 billion White House deal with pharmaceutical drug manufacturers that will save seniors money under Medicare Part D, but it has not expressed support for any of the specific pieces of legislation making their way through Congress.

“AARP’s decision to put daylight between them and the president, coupled with the activity of seniors at these town-hall meetings, indicates that the supporters of health care reform haven’t sold it well enough yet,” said David Di Martino, a Democratic media consultant at Blue Line Strategic Communications.

“Because of their depth of knowledge and participation rate in political debates, [seniors] usually have the loudest voice, figuratively, and in this case it seems literally as well.”

Senior citizens, the largest consumers of health care and recipients of the Medicare government health care program, are increasingly questioning the health care reform plans on Capitol Hill. Polling shows that in general, seniors, who are also more likely to be Republican, aren’t likely to support the reform plan. A CNN/Opinion Research Corp. poll released last week found that the majority of voters older than 50 oppose a health care overhaul, while voters younger than 50 support it.

As the most active voters - people older than 50 represented about half of all voters in 2008 - seniors have flooded lawmakers and advocacy group with demands for support or opposition, or clarification of several measures being used to drive the debate. In particular, they have shown concern that the House health care bill would encourage euthanasia, ration care or lead to socialized medicine, arguments put out by conservative groups.

Democrats and liberal-leaning organizations have been quick to try to knock down such claims, calling them smear campaigns by opponents of health care reform.

But the conservative 60 Plus Association said its top concern is the provision in the House bill that would provide voluntary counseling for end-of-life care, a move they say could encourage euthanasia.

“If you want to assuage seniors, take that out [of the bill],” said Jim Martin, president of 60 Plus, which started a nearly $2 million television advertising campaign against the reform plan last month.

The group says it has seen a large increase in member activity over health care. AARP also has reported a spike in the number of calls in recent days seeking information or demanding action.

The group has spent much of its work in recent weeks trying to correct misleading information, Mr. Dau said.

AARP and the seniors it says it represents haven’t always seen eye to eye. In the 1980s, the organization backed a catastrophic care program for Medicare, but an outcry from senior citizens forced Congress to repeal the program and dealt a black eye for the AARP.

But AARP remains among the most powerful interests in Washington. Its support helped Republicans add a prescription drug component to Medicare in 2003, and its opposition helped Democrats block President Bush’s efforts to overhaul Social Security in 2005.

On Tuesday, Mr. Obama said AARP, which claims about 40 million members, is “endorsing” his reform plans.

“AARP would not be endorsing a bill if it was undermining Medicare, OK?” Mr. Obama said at a town-hall meeting in Portsmouth.

AARP’s chief operating officer, Tom Nelson, quickly rebutted the president.

“Indications that we have endorsed any of the major health care reform bills currently under consideration in Congress are inaccurate,” Mr. Nelson said.

White House officials said privately that the president spoke accurately in general terms because AARP does support the reform effort but that he crossed a line when he used the word “endorse.”

A Quinnipiac University Poll conducted July 27 to Aug. 3 found that 39 percent of respondents older than 55 thought the president’s health care plan would improve the quality of health care in the nation. Among those ages 18 to 34 who were surveyed, 46 percent said they thought the plan would improve quality.

Jon Ward contributed to this report.

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For Lawmakers, Health-Plan Anger Keeps Coming
By DAVID STOUT - The New York Times

WASHINGTON — Lawmakers ran into fresh anger and skepticism on Wednesday as they fielded questions from constituents worried about changes in the health care system, and about a lot of other things having to do with government.

The queries hurled at legislators from the Atlantic Seaboard to the nation’s midsection reflected deep-seated fears, a general suspicion of government and, in some cases, a lack of knowledge on the part of the questioners.

“Why does the government want to rush into this bill when many don’t want it?” Senator Ben Cardin, Democrat of Maryland, was asked at a “town meeting” in Hagerstown. “Why are you rushing this?”

Calmly, the senator replied in a snippet shown on CNN, “We’ve got to take as much time as we need to get it right.” And he added, “The status quo is unacceptable.”

The senator was too polite (or intent on survival) to correct his questioner by pointing out that there is not one bill yet, but rather several proposals working their way through five committees in both houses of Congress, and that to talk of “the government” as a single entity makes no sense, at least in this context, because of the divisions between Republicans and Democrats, House and Senate, Capitol Hill and the White House.

Mr. Cardin had to raise his voice slightly to speak over shouts from the audience. “I’m not going to vote for any bill that adds to the national debt,” he said at one point.

As for any implication that there is a “rush” to enact health-care legislation, President Obama may have been responsible for that, at least in part, by calling for final action before the House and Senate adjourned for August. And fixing health care, whose costs have been soaring, has been talked about for years, most notably in the failed attempt to enact sweeping changes early in the administration of President Bill Clinton.

Many hundreds of miles away on Wednesday, in Iowa, Senator Charles E. Grassley, perhaps the state’s most popular Republican, found it necessary to tell an audience at the Winterset Public Library that he is against any plan that “determines when you’re going to pull the plug on grandma,” against any plan that would provide government-funded care to people in the country illegally, and against end-of-life counseling when death is near.

Mr. Grassley was apparently reacting to groundless assertions that health-care legislation would call for “death panels” to determine who lives and dies (the AARP, the lobby for older Americans, calls such charges “lies”), and provide health coverage to illegal immigrants when none of the major proposals before Congress would do so.

“What we stand for is that the government is not going to take over our health-care system,” Mr. Grassley said, to cheers and applause. “What we stand for is to make sure that no bureaucrat gets between the doctor and the patient.”

Were he more professorial and condescending, Mr. Grassley might have pointed out that government already has a fairly big role in health care, as in Medicare, Medicaid and, to an extent, Social Security.

But the senator did not. In 2004, he proudly said that his constituents “don’t feel like Washington has gone to my head,” according to The Almanac of American Politics. He surely understands that older people, who worry almost reflexively about any hints at changes in Medicare or Social Security, vote in big numbers — whatever their gaps in knowledge and information — and that their ranks are growing.

Senator Arlen Specter, the Republican-turned-Democrat from Pennsylvania, endured another day of hostile, sometimes fact-defying questions at a town meeting in State College, Pa., The Associated Press reported.

“What’s up with all this?” one questioner said. “This is socialism.” Cheered on by some in the audience, the questioner persisted. “What about the money and speed of all this? If this is for the people, what’s the big hurry?”

The senator replied, “We’re slowing down. We’re taking our time to do it right.” (Mr. Specter could have pointed out that, whatever its virtues, the Senate is not designed for speed.)

Senator Claire McCaskill, a Democrat from Missouri, got an earful on Tuesday, being greeted by jeers at a health care session in her home state. “I don’t understand this rudeness,” she said at one point. “I honestly don’t get it.”

By Wednesday morning, Ms. McCaskill apparently did. “These people are frustrated, and they don’t trust government,” she said in an interview on MSNBC.

At the White House, President Obama’s chief spokesman, Robert Gibbs, was asked again on Wednesday if, perhaps, the administration had not done a good enough job explaining and selling the proposed health care overhaul. Mr. Gibbs suggested that the media bore some of the blame, for doing too many “X said this, Y said this” stories, without rooting out, and pointing out, unambiguous falsehoods.

But Jessica Yellin, CNN’s national political correspondent, commenting on Senator Cardin’s town meeting in Hagerstown, Md., pointed out what news people already know: when journalists cite outright misstatements by public officials, the American people “don’t seem to trust us.”

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As Congress leaves for recess, CBC keeps health care on the front burner
By: Pharoh Martin, NNPA National Correspondent
 
WASHINGTON (NNPA) — As members of Congress begin August recess, temporarily setting aside intense negotiations for a passable healthcare reform bill, the Congressional Black Caucus has vowed to continue pushing for specific provisions that its members feel are vital for African Americans.
 
The original House and Senate bills would significantly reduce the staggering number of uninsured Americans, of which are disparately Black. But it won’t be as effective if other provisions are not also included, CBC members argue.
 
The CBC and the Congressional Tri-Caucus, which also comprises the Congressional Hispanic Caucus and the Congressional Asian Pacific American Caucus, introduced a bill recently that outlines their priorities for healthcare reform for people of color.
 
They call for expanded data collection, improved healthcare workforce diversity efforts, comparative effectiveness research provisions for the disaggregation of data, community-centric prevention efforts that focus on reducing racial and ethnic health disparities, language and translation services throughout the health care system and a significant investment in community health centers and in community health workers.
 
With hopes that certain reform provisions from their Health Equity and Accountability Act of 2009 will make it into the final healthcare bill, CBC leaders – including Chairwoman Barbara Lee (D-Calif.) — wrote a letter to both President Obama and House Speaker Nancy Pelosi.
 
“We are very concerned about the current negotiations and feel that it is necessary to restate our strong position on several issues and provisions going forward,” the letter stated.
 
They are vehemently urging Congress to keep efforts that would correct health disparities and make improvements to Medicare and health services for children. They argued that additional cuts to the proposed bill that passed the three House committees will weaken the initiative itself.
 
“The Tri Com bill is budget neutral and we are concerned that efforts to cut more costs would mean cutting the vital services, like prevention and comparative effectiveness or disproportionate share,” the CBC wrote in the letter, which was also signed by co-chairs of the CBC Health and Wellness Taskforce Rep. Danny Davis (D-Ill.) and Rep. Donna Christensen. (D-V.I.).
 
While nothing is finalized yet, Rep. Christensen, a medical doctor, said the new bill, as proposed, will include an expansion of Medicaid to young people that meet poverty guidelines.
 
“Those who meet 133 percent of poverty guidelines, which has been increased from before, will qualify for Medicaid,” the congresswomen said in an interview. “It has been expanded beyond just the elderly and the disabled.”
 
Christensen wanted Medicaid to become a part of the public plan because, she said, services are not covered in the same degree. For example, Medicaid covers some expensive procedures for children differently than the proposed public plan, and long-term care is not covered the same.
 
Christensen, the first female physician in the history of the U.S. Congress, pointed out that those whose incomes are not above 400 percent of poverty, which amounts to about $88,000 for a family, will qualify for subsidies if they purchase their coverage from an insurance exchange. This exchange is being considered to go along with the hotly contested public option.
 
Congresswoman Donna Edwards (D-MD) has also been fighting for the public option to be included in the final health care bill.
 
“[The] most significant part of the health care bill is the public option,” Edwards contends. “It’s a vital option for people who don’t have insurance.”
 
Edwards represents Maryland’s 4th District, home to the state’s affluent Montgomery and Prince George’s counties. Both Washington, D.C. suburban counties boast significant Black populations and are among the richest in the country. Yet, one-fifth of its residents are uninsured.
 
“The doctor would bill the public plan option like Medicare,” Edwards said, explaining how the public option would work.
 
The biggest healthcare concerns of her largely Black constituency are those related to accessing insurance, the amounts of co-payments, being denied for pre-existing conditions and sky-rocketing costs of premiums and deductibles.
 
“The U.S. healthcare system is one of the most expensive systems in the world. We spend $2.2 trillion per year on healthcare services and products, and yet approximately 46 million Americans are uninsured, 80 percent of whom are from working families,” Rep. Edwards wrote in an editorial, published in The Washington Informer.
 
“Almost half of all personal bankruptcies are attributed to medical debt. And, for the 80 percent of Americans who have health insurance, premiums, deductibles, and co-payments are skyrocketing; and we all pay for the flaws that leave millions uninsured and seeking care in expensive hospital emergency rooms. In fact, premiums rose 114 percent from 1999 to 2007, greatly outpacing incomes,” Edwards wrote.
 
She stated that a “robust public health insurance option modeled after Medicare must be available to compete alongside private insurers”.
 
The public plan that the Maryland congresswoman hoped for won’t be as robust as she likes because a deal to water it down was made with a group of conservative “Blue Dog” Democrats threatening to block passage of the bill over the cost.
 
Speaker Pelosi announced that the deal would lower the estimated cost of reforming healthcare by $100 billion dollars and bring the total cost to fewer than a trillion dollars over 10 years. Specifics of the compromise called for less subsidies for the uninsured and more lenient requirements for mandates for large employers to provide coverage for their workers.
 
Also, in an effort to balance the board for competing private insurers, the rates for the “public option” must be negotiated with doctors like the private industry has to do. If the compromised bill reaches the floor as negotiated, then it will likely infuriate progressives and will not be directly tied to Medicaid for which Christensen is lobbying.
 
“We do think that it makes sense to have a public option alongside the private option,” President Obama said at an AARP sponsored town hall event on health care. “So you could still choose a private insurer, but we’d also have a public plan that you could choose from that would be non-for-profit, wouldn’t have, hopefully, some of the same high administrative costs, and would be potentially more responsive to your needs at a lower cost. I think that helps keep the insurance companies honest because now they have somebody to compete with.”
 
The president engaged older Americans about their concerns about healthcare reform last week. In an hour-long forum, President Obama answered questions and cleared up misconceptions about components being legislated upon such as the bill’s affect on Medicare to a rumored clause that pertains to living wills.
 
“So the idea behind reform is: Number one, we reform the insurance companies so they can’t take advantage of you,” the president explained. “Number two, that we provide you a place to go to purchase insurance that is secure, that isn’t full of fine print that is actually going to deliver on what you pay for. Number three, we want to make sure that you’re getting a good bargain for your healthcare by reducing some of the unnecessary tests and costs that have raised rates.”
 
Following the town hall the Obama administration shifted their health care sales pitch strategy to stress security and stability. In an email campaign, the president focused on eight specific consumer protections in order to “create a new foundation for health care security.”
 
Some of these new provisions include non-discrimination for pre-existing conditions, exorbitant out-of-pocket expenses, deductibles or co-pays; no cost-sharing for preventive care, no dropping of coverage if a person becomes seriously ill and extending coverage for young adults.
 
“Over the next month there is going to be an avalanche of misinformation and scare tactics from those seeking to perpetuate the status quo,” Obama wrote in the email. “But we know the cost of doing nothing is too high. Healthcare costs will double over the next decade, millions more will become uninsured, and state and local governments will go bankrupt.”

This article was originally published in the August 10, 2009 print edition of The Louisiana Weekly newspaper.

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