Kaiser Daily Health Policy Report
House Eliminates Medicare 'Trigger' in Rules Package
AARP Unveils Legislative Priorities for New Congress, Including U.S. Health Care Overhaul
VA Secretary Nominee Shinseki Plans To Reopen Benefits to Thousands of 'Priority 8' Veterans
CNN Medical Correspondent Could Be Next U.S. Surgeon General, Serve in White House Office of Health Reform
Chronic Diseases, Out-of-Pocket Spending Increasing Among U.S. Residents, Study Finds
CMS Finalizes Medicare Rule That Aims To Stop Pharmacy Benefit Manager Practice That Inflates Drug Costs for Some Beneficiaries
Wegmans Food Markets To Offer No-Cost Generic Antibiotics Through March
Blue Shield of California To Reinstate Coverage for 678 Residents
Massachusetts Gov. Patrick Convenes Panel To Address Rising Health Care Costs
Hawaii To Offer Online Physician Appointments for Some Patients
Some Florida Residents Have Difficulty Finding Information About Plans in New Cover Florida Program
Opinion Pieces Address Health Care Reform Plans
Capitol Hill Watch
Senate Finance Committee Chair Expects Economic Stimulus Bill Will Include Subsidies To Help Laid-Off Workers Retain Health Coverage Under COBRA
[Jan 07, 2009]
Senate Finance Committee Chair Max Baucus (D-Mont.) on Tuesday said that the economic stimulus package likely will include subsidies to help recently laid-off workers pay to retain their health insurance through COBRA, the Boston Globe reports (Wangsness, Boston Globe, 1/7).
COBRA -- which allows recently laid-off workers to retain their group health insurance for as long as 18 months, provided that they pay the full cost of the premiums -- on average costs such workers 84% of their unemployment benefits, according to a report scheduled for release on Friday by Families USA. David Lemmon, a spokesperson for Families USA, said that the group has provided copies of the report to Baucus and the transition team of President-elect Barack Obama (Clarke, CQ Today, 1/6). According to Senate Democratic aides, the Congressional Budget Office has not determined the cost of the COBRA subsidies, and the percentage of the premiums that the subsidies would cover also remains undetermined (Boston Globe, 1/7). The COBRA subsidies would expire after two years, aides said (Weisman, Wall Street Journal, 1/7).
Aides said that the COBRA subsidies will account for part of the estimated $100 billion included in the stimulus package for health care provisions (Boston Globe, 1/7). Other health care provisions in the stimulus package likely will include an increase in federal Medicaid funds for states, an investment in health care information technology, and funds for medical research, prevention programs and community health centers (Frates, The Politico, 1/6). In addition, Obama has proposed a provision in the stimulus package that would allow workers who lose jobs that did not include health insurance to apply for Medicaid (Wall Street Journal, 1/7).
The Senate Finance Committee plans to hold a closed meeting Thursday to determine the level of support for health care and other provisions in the stimulus package (Rogers, The Politico, 1/7). Congressional committees likely will begin to hold hearings and markup sessions on the stimulus package as early as next week (CQ Today, 1/6). Comments
In a statement, Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) said of the COBRA subsidies, "Congress has a responsibility to help the victims of this crisis keep their health insurance even when they lose their jobs," adding, "The stimulus needs to include both job support and health support." Senate Budget Committee ranking member Judd Gregg (R-N.H.) said that he might support the COBRA subsidies, provided that they remain temporary (Boston Globe, 1/7).
However, House Budget Committee ranking member Paul Ryan (R-Wis.) said that the COBRA subsidies and additional federal Medicaid funds for states "aren't stimulus" and amount to "ideological accomplishments in the guise of economic stimulus" (Wall Street Journal, 1/7). Health Care Groups Seek Additional Medicaid Funds
In related news, a coalition of patient, hospital, physician and nursing home groups on Tuesday sent a letter to lawmakers asking for more than $125 billion in additional federal Medicaid funds for states, CQ HealthBeat reports.
The groups said that the stimulus bill should link matching funds to local government contributions to the portion of Medicaid funded by states, as well as "a robust maintenance of effort to protect against adverse changes in eligibility, benefits, provider payments or access to care."
The groups that signed the letter included the American Academy of Pediatrics, the American Hospital Association, the American Academy of Family Physicians, the American Health Care Association and the National Association for Home Care and Hospice (Reichard, CQ HealthBeat, 1/6). Opinion Piece
"As with the practice of medicine, the application of economic stimulus is as much art as it is science," and "it's imperative to get a clear idea of how proposals for new spending on health care" and other provisions "would work and why they should be part of this package," Washington Post columnist Ruth Marcus writes.
She writes, "Much of what the Obama team proposes is more -- much more -- of the same," such as "giving states extra money for Medicaid," adding, "By contrast, launching a new 'green energy' plan or a program to computerize health records, is a newer, more complicated endeavor, one that calls for more consideration than up-or-down vote on the floor." According to Marcus, "It is incumbent on Obama's advisers to explain how these programs would contribute to the recovery." In addition, lawmakers "need to consider whether they are passing a temporary stimulus or paving the way for permanent spending," according to Marcus.
She writes, "The next several weeks will be a test, for the new Congress as much as for the new administration," because the nation "cannot afford a 111th Congress as gridlocked as the 110th," adding, "Nor should it settle for a rubber-stamp Democratic Congress doing the bidding of the new Democratic president" (Marcus, Washington Post, 1/7). Broadcast Coverage
 NBC's "Nightly News" on Tuesday reported on efforts to overhaul the U.S. health care system amid a worsening economy, as well as health care provisions expected to be included in the stimulus bill. The segment includes comments from Kaiser Family Foundation President and CEO Drew Altman; Karen Ignagni, president and CEO of America's Health Insurance Plans; Obama; and Ron Pollack, executive director of Families USA. The segment is part of a series of special reports titled "America's Agenda" (Bazell, "Nightly News," NBC, 1/6).
House Eliminates Medicare 'Trigger' in Rules Package
[Jan 07, 2009]
The House on Tuesday voted 242-181 to approve an operating rules package (H Res 5) that eliminates the Medicare trigger, which requires the president to submit a plan to contain Medicare costs if they reach a certain level, CQ Today reports. The trigger was approved as part of the 2003 Medicare law. Under the law, if 45% or more of the program's funding comes from general tax revenues for two consecutive years, the president must submit to Congress legislation that would slow spending over a seven-year period and make the program financially stable. The trigger went into effect for the first time last year.
A one-line item included in the rules package states that the Medicare trigger "shall not apply." In a release accompanying the package, House Majority Leader Steny Hoyer (D-Md.) said the trigger is "an ideologically driven target based on a misleading measure of Medicare's financial health." Hoyer's office said that eliminating the trigger "will allow Congress to consider all options for improving Medicare financing to provide a balanced and equitable solution" (Armstrong, CQ Today, 1/6).
AARP Unveils Legislative Priorities for New Congress, Including U.S. Health Care Overhaul
[Jan 07, 2009]
AARP officials on Tuesday released a list of legislative priorities for health care for the 111th Congress as part of a "characteristically sweeping agenda that focuses on the recession and on health care reform," The Hill reports.
Among the priorities, AARP, which has more than 40 million members ages 50 and older, seeks as much as $50 billion in additional federal Medicaid funds for states as part of an economic stimulus package. AARP also wants lawmakers to prohibit states that take the additional Medicaid funds from reducing long-term care services. In addition, AARP seeks provisions in the stimulus package that would extend unemployment benefits, maintain nutrition programs, allocate as much as $50 billion to develop a national electronic health record system and encourage more participation in the nursing field.
AARP also seeks a number of Medicare reforms, such as a system that bases reimbursements to health care providers on quality, a reduction or elimination of the asset test for prescription drug benefit subsidies and a proposal to allow the federal government to negotiate directly with pharmaceutical companies on prices for medications (Young, The Hill, 1/6). Other priorities for AARP include efforts to reduce health care costs and improve quality; encourage increased use of comparative effectiveness research on medications and medical devices; promote chronic care coordination, disease management and prevention initiatives; and expand Medicaid and SCHIP (Carey, CQ HealthBeat, 1/6). Comments
AARP CEO Bill Novelli said, "This is not the time for business as usual," adding, "It is time to demonstrate bold leadership, to take our agenda to the people and our nation's leaders, to demand change and to work hard to bring about that change" (The Hill, 1/6). Novelli cited the need for health care reform to address the increased cost of Medicare and other entitlement programs. "The way to deal with entitlements is to first of all deal with health care," he said (Kivlan, CongressDaily, 1/6).
John Rother, executive vice president for policy and strategy at ARRP, added, "The economic crisis is promoting the need for health reform because more people are at risk."
Nancy LeaMond, executive vice president for social impact at AARP and director of Divided We Fail, said, "The economy's effect on people who are in the work force, near-retirees, and retirees is drastic; the time for solutions is now" (The Hill, 1/6). Survey
In related news, AARP on Tuesday released a survey that examined the effect of the current economic recession on the health care decisions of U.S. adults. The survey, conducted in December 2008, included responses from 1,097 adults ages 45 and older.
According to the survey, 55% of adults have concerns about their ability to pay their health care bills over the next year. In addition, more than 80% of adults said that they strongly or somewhat agree that the federal government should provide financial assistance to residents who lose their jobs to allow them to maintain their health insurance or purchase affordable coverage during the recession, the survey found (CQ HealthBeat, 1/6).
VA Secretary Nominee Shinseki Plans To Reopen Benefits to Thousands of 'Priority 8' Veterans
[Jan 07, 2009]
Department of Veterans Affairs Secretary-nominee Eric Shinseki on Monday said that, if confirmed, he would expand VA health coverage to about 265,000 middle-income veterans who had been denied the benefits since 2003, the AP/Boston Globe reports (Xen, AP/Boston Globe, 1/6). At a House panel briefing on Monday, lawmakers said that the fiscal 2009 VA spending bill includes $375 million to increase VA health coverage of "Priority 8" veterans with incomes of more than $30,000 annually. Priority 8 indicates those veterans with the least urgent need for care. The funding provision aims to increase enrollment of these veterans by 10%. In January 2003, new Priority 8 veterans were blocked from joining the program if their incomes exceeded $30,000 annually.
VA told members of the House Appropriations Military, Construction, Veterans Affairs and Related Agencies Subcommittee that funding will be formally disbursed to VA hospitals and clinics later this month in order to have the new enrollment plan in place by June. In the meantime, VA will work with the White House Office of Management and Budget to develop a regulatory authority and propose it as a rule in the Federal Register. As the regulatory authority is developed, enrollment will be modified to include veterans whose income exceeds the current maximum amount by 10% or less, according to CQ Today (Johnson, CQ Today, 1/6).
Shinseki in a written disclosure obtained by the Associated Press also said he plans to reduce to six months the wait experienced by veterans applying for disability benefits, in part by switching to "an integrated, all-electronic claims processing system." He said his first goal will be to achieve VA's strategic goal of reducing the average wait to 145 days. He also wrote that he would order an "independent, thorough" review to ensure that VA will not delay outlays of millions of dollars in new benefits in August. At least 520,000 veterans are expected to receive these payments, up from about 250,000 annually. Shinseki said, "If confirmed, I would focus on these issues and the development of a credible and adequate 2010 budget request during my first 90 days in office," adding that VA funding issues in the past created "significant management difficulties" that led to delays in medical care (AP/Boston Globe, 1/6).
Election 2008
CNN Medical Correspondent Could Be Next U.S. Surgeon General, Serve in White House Office of Health Reform
[Jan 07, 2009]
CNN on Tuesday confirmed that its chief medical correspondent and neurosurgeon Sanjay Gupta has been chosen by President-elect Barack Obama to be the next U.S. Surgeon General, pending Senate approval, the New York Times reports (Harris, New York Times, 1/7). The surgeon general serves as the nation's "chief health educator" by providing the public with medical information on how to improve health and reduce risk of injury and illness, according to the Atlanta Journal-Constitution (Schneider, Atlanta Journal-Constitution, 1/6). The position also is responsible for commanding the 6,000-member U.S. Public Health Service Commissioned Corps, a group of scientists and emergency responders who address a broad range of health emergencies (Hall/Sternberg, USA Today, 1/7).
In addition to responsibilities with CNN, which include hosting a weekend program called "House Call with Dr. Sanjay Gupta," Gupta is an assistant professor of neurosurgery at Emory University School of Medicine, as well as a neurosurgeon at Emory University Hospital and associate chief of neurosurgery at Grady Health System (Neergaard, AP/Tucson Citizen, 1/7).
Gupta also has been offered the lead role in the new White House Office of Health Reform, which would give him "twin duties that could make him the most influential surgeon general in history," the Washington Post reports. The Obama transition team refused to comment on the matter, noting its policy of not discussing appointments publicly before they are finalized. Gupta also declined to comment but did not deny plans to accept the position, according to the Post (Connolly/Kurt, Washington Post, 1/7). According to people at CNN and members of the Obama transition team, Gupta likely will make a decision on whether to accept the position in the next few days (New York Times, 1/7). Gupta, if nominated, will be subject to confirmation hearings before the Senate Health, Education, Labor and Pensions Committee (Armstrong, CQ Today, 1/6). Comments
Joseph Heyman, chair of the American Medical Association's board, said, "If chosen, Dr. Gupta's communication skills and medical knowledge could be a boon to the new administration's health system reform efforts" (AP/Tucson Citizen, 1/7). Former assistant Surgeon General Susan Blumenthal said the selection of Gupta represents a "returning to a communicator model" for the post (Washington Post, 1/7).
Gerard Farrell, head of the public health service's Commissioner Officers Association, said members were "disappointed" in the selection of Gupta, adding, "Dr. Gupta is certainly a well-respected neurosurgeon and accomplished media journalist, but I'm not aware of any particular in-depth public health experience." Farrell said the group would prefer that the surgeon general be chosen from its membership (USA Today, 1/7). Broadcast Coverage
 NPR's "All Things Considered" on Tuesday reported on Obama's choice of Gupta as surgeon general (Rovner/Block, "All Things Considered," NPR, 1/6).
Coverage & Access
Chronic Diseases, Out-of-Pocket Spending Increasing Among U.S. Residents, Study Finds
[Jan 07, 2009]
The percentage of U.S. residents who have chronic diseases has increased in recent years, and the trend has led to a large rise in out-of-pocket medical costs, according to a study published on Tuesday in the journal Health Affairs, Reuters/Boston Globe reports. For the study, Kathryn Paez of Social & Scientific Systems and colleagues examined nationally representative government surveys that included responses from about 32,000 residents in 2005 and about 22,000 residents in 1996.
The study found that in 2005 about 44% of residents had at least one chronic condition -- such as diabetes, high blood pressure, high cholesterol, cancer, arthritis, heart failure and others -- compared with 41% in 1996. In addition, the study found in 2005 that 13% of residents had three or more chronic diseases, compared with 7% in 1996. The study also found that average annual out-of-pocket medical costs rose to $741 in 2005 from $427 per resident in 1996, a 39% increase after adjustment for inflation.
According to the study, Medicare beneficiaries who had three or more chronic conditions had average annual out-of-pocket medical costs of $2,588 in 2005 (Dunham, Reuters/Boston Globe, 1/6).
 The study is available online.
American Public Media's "Marketplace" on Tuesday reported on the study. The segment featured comments from study author Kathy Paez and a 30-year-old urban planner with two chronic illnesses who pays $250 a month for physician visits and prescription drugs despite having health insurance (Grech, "Marketplace," American Public Media, 1/6).
Medicare
CMS Finalizes Medicare Rule That Aims To Stop Pharmacy Benefit Manager Practice That Inflates Drug Costs for Some Beneficiaries
[Jan 07, 2009]
CMS officials on Tuesday said that the agency has finalized a new rule that will restrict an approach used by pharmacy benefit managers that inflates prescription drug costs for some Medicare beneficiaries, the Wall Street Journal reports.
PBMs negotiate prescription drug prices with pharmacies and reimburse them for medication purchased by patients, after which health insurers pay PBMs for administration of claims. Under the so-called lock-in approach, health insurers pay PBMs a set amount for claims regardless of the amount that they reimburse pharmacies for prescription drugs. The amount that health insurers pay PBMs for claims often exceeds the amount that they reimburse pharmacies for prescription drugs. PBMs in most cases do not disclose the amount of the difference, which the companies retain. The approach can cause Medicare beneficiaries to reach the so-called "doughnut hole" coverage gap earlier.
The new rule, which will take effect on Jan. 1, 2010, will not ban the use of the approach. However, under the rule, CMS will use the amount that PBMs reimburse pharmacies for prescription drugs, rather than the amount that health insurers pay PBMs for claims, to determine medication costs for Medicare beneficiaries.
Acting CMS Administrator Kerry Weems said that the rule will "reduce what (patients) pay at the pharmacy counter." PBM Express Scripts raised concerns that the rule "will lead to higher costs and fewer competitive plan design choices over the long term" (Rubenstein, Wall Street Journal, 1/7).
Prescription Drugs
Wegmans Food Markets To Offer No-Cost Generic Antibiotics Through March
[Jan 07, 2009]
Wegmans Food Markets starting on Wednesday will fill generic oral antibiotics, such as amoxicillin and cephalexin, at no cost through March 31, the Baltimore Sun reports (Walker, Baltimore Sun, 1/7). The program will run at all of the chain's 72 stores nationwide and will cover up to a 14-day supply of nine generic antibiotics that otherwise would cost between $8.99 and $13.99 without insurance. Colleen Wegman, president of Wegmans, said the company might offer the benefits permanently if the program is successful over the next three months. Wegman estimated that the program would save consumers about $1 million (Wang, Rochester Democrat and Chronicle, 1/7). Giant Food stores and stores of its sister chain Stop & Shop last week began offering no-cost generic antibiotics to customers with prescriptions for three months (Kaiser Daily Health Policy Report, 1/5).
However, some physicians are concerned that no-cost antibiotics could encourage excessive use of the drugs. Thomas Campbell, Highland Family Medicine physician and chair of family medicine at the University of Rochester Medical Center, said patients might pressure their physicians to prescribe antibiotics after learning of the program. According to Campbell, antibiotics already are over-prescribed for upper respiratory and other infections and can cause rashes, fungal infections or life-threatening allergies. In addition, outbreaks of drug resistant bacterial infections such as MRSA are linked to overprescribed antibiotics. "While I think the intent to save people money is laudable, I think Wegmans chose the wrong class of medications to offer for free," Campbell said (Rochester Democrat and Chronicle, 1/7).
Health Care Marketplace
Blue Shield of California To Reinstate Coverage for 678 Residents
[Jan 07, 2009]
Blue Shield of California on Tuesday said it will reinstate coverage for 678 state residents whose health insurance was improperly canceled between Jan. 1, 2004, and May 31, 2008, after they got sick, the Los Angeles Times reports. Blue Shield also said it will reimburse out-of-pocket medical expenses for people whose coverage was rescinded during that time. As a result, the state has dropped its case against the insurer and will not pursue $12.6 million in proposed fines.
The agreement comes more than one year after state Insurance Commissioner Steve Poizner accused Blue Shield of 1,262 violations of laws and regulations that resulted in the recession of hundreds of policies, the Times reports. Poizner said that he hoped the settlement would "put an end to rescission practices that were hurting consumers." He added, "Canceling someone's insurance can have devastating medical, emotional and financial impacts. I will continue to take action against those insurers who do not live up to their agreements."
Under the agreement, consumers must waive their right to sue Blue Shield before they can obtain medical reimbursement. Blue Shield also agreed to simplify its applications and improve its underwriting process. The Department of Managed Health Care reached similar agreements last year with other insurers in California, including Kaiser Permanente and Health Net, that also were accused of improperly rescinding coverage (Girion, Los Angeles Times, 1/7).
Please note: The Kaiser Family Foundation is not associated with Kaiser Foundation Health Plan, Kaiser Permanente or Kaiser Industries.
State Watch
Massachusetts Gov. Patrick Convenes Panel To Address Rising Health Care Costs
[Jan 07, 2009]
Massachusetts Gov. Deval Patrick (D) on Monday "accelerated his administration's efforts to control spiraling statewide health care costs," and said that officials are considering regulations to block excessive insurance premiums, the Boston Globe reports. A recent investigation by the Globe's Spotlight Team found that an agreement between the former CEOs of Partners HealthCare and Blue Cross and Blue Shield of Massachusetts helped drive up health costs in the state. Following the investigation, Patrick on Monday convened a panel of senior administration officials to coordinate new and existing state cost containment efforts. He said that cost containment efforts should be developed by this summer and that he expects to file new legislation.
Patrick said, "The increases at this rate over time (are) just not sustainable, not for families, not to business, not for government," adding, "We have to get at cost containment because these kinds of premium increases and the unevenness in the way various providers are compensated for similar services have to be addressed in order to assure the long-term viability of this grand experiment" of the state's health insurance law. State Inspector General Gregory Sullivan said he wants providers and insurers to hold off signing new contracts until the Patrick administration has implemented new, as-yet-undetermined policies to limit premiums.
Partners and BCBS on Monday said they look forward to participating in Patrick's discussions. Partners spokesperson Rich Copp in a statement said that cost increases nationally "have been mirrored almost exactly" in Massachusetts. He added that Partners' latest contract with BCBS "resulted in rate increases well below those experienced in prior years." BCBS CEO Cleve Killingsworth "expressed support" for one of the administration's proposals that would base payments on medical outcomes rather than the quantity of procedures or visits (Bombardieri, Boston Globe, 1/6).
Hawaii To Offer Online Physician Appointments for Some Patients
[Jan 07, 2009]
The Hawaii Medical Service Association -- the state's BlueCross BlueShield licensee -- on Jan. 15 will launch American Well, a Web service that will allow patients to visit physicians online via webcam or text chat, the New York Times reports. Roy Schoenberg, co-founder and CEO of Boston-based American Well Systems, said the service is aimed at individuals seeking easier access to physicians because they are uninsured or do not want to wait for an appointment or travel to clinics.
Patients can use the service by logging on to participating health plans' Web sites. Doctors hold 10-minute appointments that can be lengthened for an additional fee. Doctors also can file prescriptions and view patients' medical histories through the system. American Well is working with HealthVault, Microsoft's electronic health records service, and Aetna subsidiary ActiveHealth Management, which scans patients' medical history for gaps in their previous care and notifies doctors during the online appointment. Hawaii Medical Service Association members will pay $10 to use the service and the insurer will provide the service to uninsured patients for a $45 fee. Insurers pay American Well a license fee per member and a transaction fee of about $2 each time a patient visits a doctor through the service.
Mike Stollar, vice president of marketing for the Hawaii Medical Service Association, said the system is well-suited for the state because the islands are remote, it takes time for people to travel among them and it is difficult to recruit physicians to rural areas. According to Schoenberg, American Well insurers in other states soon will offer the service.
Critics of the online appointments are concerned about the lack of a physical examination involved in the doctor and patient consultations, according to the Times. Critics also are concerned that low-income and uninsured people will not have access to broadband connections or webcams required for consultations (Cain Miller, New York Times, 1/6).
Some Florida Residents Have Difficulty Finding Information About Plans in New Cover Florida Program
[Jan 07, 2009]
Some Florida residents on Monday who tried to enroll in one of the health care plans available under the state's new Cover Florida program experienced difficulties finding information about the policies on the state's Web site, the South Florida Sun-Sentinel reports. The program launched on Monday. According to the Sun-Sentinel, the state Agency for Health Care Administration, which coordinates the program, was unable to publish contact or Web site information of the six insurance companies that were contracted to offer the policies (LaMendola, South Florida Sun-Sentinel, 1/6).
The program is available to all state residents who have been uninsured for six months. Residents who lost coverage by being laid off, divorced or widowed, or who exhausted their COBRA benefits, are exempt from the six month requirement. Two insurers -- United Healthcare in Florida and Blue Cross and Blue Shield of Florida -- are offering policies statewide, and four other insurers are offering coverage in specific regions of the state (Gentry, Florida Health News, 1/5).
Fernando Senra, a spokesperson for the agency, said that it expected to gather the information from the six companies and publish it online soon. Randy Kammer, vice president of regulatory affairs and public policy at BCBS, said that technical problems were delaying the Web site for its Cover Florida plans but that applicants for its plans would be insured by Thursday. United spokesperson Roger Rollman said that the company will not be ready to provide coverage to its uninsured applicants until March 1, although people were able to begin applying for coverage on Monday (South Florida Sun-Sentinel, 1/6).
Opinion
Opinion Pieces Address Health Care Reform Plans
[Jan 07, 2009]
Summaries of two opinion pieces that address issues related to health care reform appear below. - Rep. Tom Price (R-Ga.), Wall Street Journal: The "unwillingness" of the Republican party to reform "the terribly broken American health care system" has allowed "an emboldened Democratic Party well equipped to push a government-centered health care agenda," Price, a physician and newly appointed chair of the Republican Study Committee, writes in a Journal opinion piece. According to Price, "this is deeply disappointing ... because patient-centered health care is, at its core, conservative." According to Price, "Atop the list of worrisome ideas proposed by" former Senate Majority Leader Tom Daschle (D-S.D.) -- President-elect Barack Obama's nominee for HHS secretary -- "is the creation of an innocently termed 'Federal Health Advisory Board.'" The board "would offer recommendations to private insurers and create a single standard of care for all public programs, including which procedures doctors may perform, which drugs patients may take, and how many diagnostic machines hospitals really need," he writes. "In an overtly political ruse, Democrats will claim they are dictating nothing to private providers, while whipping noncompliant insurers in place through the tax code," Price writes, adding, "To be sure, this strategy seeks to eliminate private providers completely" as they would be "[f]orced into accepting rigid Washington rules and unsustainable financing mechanisms." Price writes, "If we fail to recognize the scope and scale of Democratic ambition on this issue, we will find ourselves with a permanent Washington bureaucracy prescribing patient care." He continues, "Our goal, however, must not be confined to defeating a Democratic proposal," but "[i]nstead, we must advocate for a positive approach to health care reform that does not sacrifice patient care to achieve its goals." He writes that the GOP "must fundamentally reform the tax code so that it makes sense for all people to have health insurance," which "may be readily accomplished through the adoption of tax equity for the purchase of insurance, active pooling mechanisms for increased purchasing power, and focused use of tax deductions and credits." The GOP also "must transform our health care model to one that is owned and controlled by patients," he adds. Price concludes, "A historic debate about American health care is fast approaching," adding, "We are not doomed to a Washington-run bureaucratic health care system, so long as Republicans push for the right remedy for health care and return to being the party of solutions" (Price, Wall Street Journal, 1/7).
- Michael Gerson, Washington Post: "Obama can expect a serious fight" from Republicans over his health care reform plan because it could result in a "predominately publicly run health care" system, Gerson, a senior fellow at the Council on Foreign Relations, writes in a Post opinion piece. Under Obama's plan, "all but the smallest businesses" would be required "to provide health coverage to employees -- or pay a tax." He continues, "[Obama] would also create a government-run insurance plan similar to Medicare that would compete with private companies to cover the uninsured." According to Gerson, "The problem is" that "[b]ecause government can impose price controls, it can make the public option cheaper." He adds, "Companies, tired of dealing with complicated health care burdens, would have an incentive to drop employees from coverage, and uncovered individuals would have an incentive to join the public system -- achieving universal nationalization of health care by small steps." Gerson writes that government-administered health care "is an ideological red line for Republicans." Gerson notes that "[n]ot even the most compassionate conservative is going to accept government control of 16% of the economy." However, "If Obama's proposal demonstrates genuine neutrality between public and private health options -- empowering individuals to make a free choice -- it could gain significant Republican support," according to Gerson (Gerson, Washington Post, 1/7).
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