> HEALTHCARE

Providing effective and affordable health care to our nation’s citizens is one of the greatest challenges facing the health profession, insurers, and our local, state, and federal governments. Congress is currently reviewing various health care proposals that will shape the health care industry in the future. The goal of these proposals, and the focus of this debate, is to increase affordability and choice, address barriers to accessing insurance, and to reduce the growing number of uninsured persons. While addressing these issues, we will work to improve not only the access of health care, but also the quality of health care.

While the government can play a role in providing and regulating health care, ultimately both consumers and providers should be free from excessive government interference with their health care choices. Instead of giving the government more power over health care, individual patients must be given more control, choice, and information to make their health care decisions. When individual patients have these choices, they will reward innovative providers and insurers who reduce costs and improve quality.

Providing quality care for all citizens must remain a priority for this Congress. Please know that I will continue to work with my Senate colleagues to reform our system of health care so that all Idahoans can receive the care they need.

Ambulatory Surgical Centers

Ambulatory surgical centers (ASC) play an important role in the nation’s health care delivery system by providing surgical services that do not require an overnight stay. The most prevalent surgical procedures performed in ASCs include cataract removal, upper gastrointestinal endoscopies, colonoscopies and epidural injections for back and bone pain. ASCs have experienced large growth in recent years, partially because they offer patients convenient locations, smaller out-of-pocket costs, the ability to schedule surgery more quickly and shorter wait times than hospital outpatient departments.

Since 1982, Medicare has paid for certain surgical procedures provided in ASCs. The Centers for Medicare and Medicaid Services (CMS) implemented the current ASC payment system in 1990. Payment rates are based on data from a 1986 survey of ASCs’ costs and charges, updated periodically using the consumer price index for all urban consumers. Because they are based on old cost data, these rates are no longer consistent with ASCs’ costs. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 mandated a new payment system for ASCs that incorporates a rational payment methodology. Since the new system is still years away, however, there is much reform needed now.

ASCs are also restricted in the variety of services they may offer to Medicare beneficiaries. Currently, CMS is required to establish and update a list of procedures that are appropriately performed in hospital outpatient settings but may also be safely performed in an ASC. Only those procedures on the list are eligible for Medicare payments. The current approach for deciding which procedures are eligible for Medicare payment often results in delays that keep innovative technology and services off the payment list. In addition, some of the criteria for adding procedures to the list may no longer be appropriate. A recent report by the Medicare Payment Advisory Commission suggests that reforming the current list would make it easier for beneficiaries to receive new surgical procedures in ASCs.

I introduced S. 1884 in order to provide necessary guidance to CMS in developing a new payment system. S. 1884 would direct that the new ASC reimbursement program be modeled after the methodology and payment rates applicable to surgical services furnished in hospital outpatient departments (HOPD). The legislation would eliminate the current ASC payment list and allow ASCs, with certain exceptions, to perform and receive payment for any surgical service that is covered as an HOPD service. Payment rates would be adjusted to a rate established to be 75 percent of the HOPD fee schedule amount for each covered service, and ASCs would receive pass-through payments for the additional costs of innovative medical devices, drugs and biologicals. In addition these payment rates would be adjusted by the same annual updates, area wage indices and other relevant adjustments applicable to HOPD payment rates. Finally, the beneficiary’s co-payment for services furnished in the ASCs would be 20 percent of the Medicare payment amount, as provided under current law.

I worked diligently to attach this legislation to S. 1932, the Deficit Reduction Omnibus Reconciliation Act. During recent negotiations on the Conference Report on this legislation, I won written assurance from Department of Health and Human Services (HHS) Secretary Michael Leavitt that his Department would perform two key steps concerning ASCs. First, HHS will update the ASC list by July 1, 2007 as required by law. Second, in 2008, concurrent with implementation of the new payment system as required by the MMA, Secretary Leavitt proposes to include all outpatient surgical procedures (except those that the Department finds would pose a significant safety risk when performed in an ASC, or would require an overnight stay) on the ASC list. These are positive steps forward.

I am committed to ensuring that Medicare payment rates are accurate and fair, in order to ensure beneficiary access to convenient, quality services.

Cancer

The issue of cancer research and care is very important and personal to me. In November 1999, I was diagnosed with prostate cancer following a routine physical exam. I was fortunate to undergo successful prostate removal surgery in January 2000. Since my prostate cancer surgery five years ago, I have encouraged the public to be vigilant about their health. This includes regular check-ups and preventative care. I followed my own advice and have had PSA tests and other recommended tests every three to six months since that time. In early 2004, my doctors detected a slight rise in PSA. On the advice of my doctors, I underwent radiation treatment. I have now completed treatment and continue to have regular check-ups.

As a prostate cancer survivor, I know how important it is to help provide Idahoans with information about cancer. Early detection is the key to successfully fighting many forms of cancer. For that reason, beginning in 2001, I began to sponsor the Mike Crapo Health Awareness Booths at regional fairs in Idaho. In partnership with local physicians, labs and other sponsors, the booths provide cancer screening tests and cholesterol checks. This year booths were set up at four regional fairs in Idaho—the Western Idaho Fair in Boise, Eastern Idaho State Fair in Blackfoot, Twin Falls County Fair in Filer and the North Idaho Fair and Rodeo in Coeur d’Alene. Since creation of the booths, thousands of individuals have received PSA (prostate specific antigen) tests, mammograms and cholesterol screenings at the fair. I have heard from numerous Idahoans who credit those tests as saving their lives. Some men have undergone treatment for prostate cancer as a result, while others have adjusted their lifestyles to accommodate high cholesterol readings. I look forward to continuing to work on this important effort.

I have also been a strong supporter of funding for the National Institutes of Health (NIH). As you may know, the NIH is the focal point for federal health research. An agency of the Department of Health and Human Services, it supports more than 50,000 scientists working at 2,000 institutions across the United States and conducts biomedical and behavioral research and research training at its own facilities. NIH consists of twenty-five institutes and centers, each of which focuses on particular diseases or research areas in human health, including cancer. In the past six years, Congress has more than doubled the NIH budget from $13.7 billion in Fiscal Year (FY) 1998 to $28 billion in FY 2004, including over $5.4 billion in cancer research funding.

Caring for Americans struck by illness or living with disabilities is one of the greatest challenges facing the health profession, insurers and local, state and federal governments. I recognize the burden placed upon cancer patients and their families to pay for the expensive regimen of treatments this disease requires. Because more than half of all cancer diagnoses occur in individuals over sixty-four years old, a large number of cancer patients are dependent financially upon Medicare to provide treatment. Clearly, the Medicare program must assist elderly Americans suffering with cancer to bear the cost of battling this disease.

Please rest assured, as cancer research and funding issues are considered in Congress, I will continue to carefully consider the needs of health care professionals and cancer patients in Idaho, and that I remain committed to increasing funding for medical research so we can find cures for deadly diseases and other medical problems.

COPD Caucus

I formed the Congressional COPD Caucus in January of 2004 to raise awareness of COPD and the threat it poses to our families and communities. It is estimated that over 16 million Americans suffer from COPD. I view the COPD Caucus as a way to accomplish a number of objectives that address the unique challenges and opportunities of COPD communities.

At present, I am working closely with the American Lung Association, the American Thoracic Society, the American College of Chest Physicians, the American Association for Homecare and others to build a cohesive message addressing the needs of COPD patients. Please be assured I will continue to work with my colleagues to promote public awareness of COPD.

Medicare Part D

All Americans are deeply affected by the growing costs of healthcare, particularly the cost of prescription drugs. Those most affected are often senior citizens. As America continues to lead the world in the research and development of new drugs that improve and extend lives, we must do more to make access to those drugs affordable.

The Medicare Prescription Drug and Modernization Act, enacted in late 2003, was an important step in achieving this goal. The legislation creates a new voluntary prescription drug benefit available to all Medicare beneficiaries. Those who want to stay with their current coverage may do so, and employers are encouraged to continue their retiree coverage through financial assistance. Low income beneficiaries will receive extra help in obtaining their medications.

In early October 2005, information on individual plans became available to all Medicare beneficiaries. This information can be obtained in a variety of ways. In early October 2005, the Centers for Medicare and Medicaid Services (CMS), the federal entity in charge of implementing the prescription drug benefit, sent informative booklets to all Medicare beneficiaries informing them of the available plans in their area and the way to sign up for a plan. In addition, a toll-free helpline, 1-800-MEDICARE, has been set up to answer questions from Medicare beneficiaries. Those beneficiaries with access to the Internet may search for plans according to price, drug requirements, and pharmacy preferences at www.medicare.gov. Beneficiaries needing personal assistance can call their local State Health Insurance Program (SHIP) or local office on aging. In Idaho, beneficiaries may reach the SHIP office toll free at 1-800-247-4422. The Idaho Administration on Aging may be reached at 208-334-3833. The Idaho Department of Health and Welfare can also provide assistance with drug plan enrollment at 208-334-5747. Finally, it is important for the families and friends of Medicare beneficiaries to also examine the new offerings. The advice of loved ones is invaluable in this process and can help beneficiaries select the appropriate plan. Links: Centers for Medicare and Medicaid Services: http://www.cms.hhs.gov/ Idaho Senior Health Insurance Benefits Advisors (SHIBA): http://www.doi.state.id.us/shiba/shwelcome.aspx

Mike Crapo Health Awareness Booths As a prostate cancer survivor, I know how important it is to help provide Idahoans with information about cancer. Early detection is the key to successfully fighting many forms of cancer. For that reason, beginning in 2001, I began to sponsor the Mike Crapo Health Awareness Booths at regional fairs in Idaho. In partnership with local physicians, labs and other sponsors, the booths provide cancer screening tests and cholesterol checks. This year booths were set up at four regional fairs in Idaho—the Western Idaho Fair in Boise, Eastern Idaho State Fair in Blackfoot, Twin Falls County Fair in Filer and the North Idaho Fair and Rodeo in Coeur d’Alene. Since creation of the booths, thousands of individuals have received PSA (prostate specific antigen) tests, mammograms and cholesterol screenings at the fair. I have heard from numerous Idahoans who credit those tests as saving their lives. Some men have undergone treatment for prostate cancer as a result, while others have adjusted their lifestyles to accommodate high cholesterol readings. I look forward to continuing to work on this important effort.

Pulmonary Rehab

I recognize the importance of pulmonary rehabilitation for the million of individuals suffering from Chronic Obstructive Pulmonary Disorder (COPD). It is estimated that over 16 million Americans suffer from COPD. I formed the Congressional COPD Caucus in January 2004 to raise awareness of COPD and the threat it poses to our families and communities. I view this Caucus as a way to accomplish a number of objectives that address the unique challenges and opportunities of COPD communities.

In view of the benefits of pulmonary rehabilitation, I recently introduced S. 1440, the Pulmonary and Cardiac Rehabilitation Act. This legislation would formally establish pulmonary rehabilitation as a specific Medicare benefit category. Although Medicare has been paying for various pulmonary rehabilitation services since the early 1980s, it has never developed a national coverage policy to guide its contractors. Therefore, Medicare intermediaries have established their own coverage policies for pulmonary rehabilitation, resulting in inconsistent coverage as well as nonexistent coverage in some regions of the country. Rehabilitation is a well-documented, proven therapy for certain patients with moderate to severe COPD. I look forward to guiding this legislation into law.

At present, I continue working closely with the American Lung Association, the American Thoracic Society, the American College of Chest Physicians, the American Association for Homecare and others to build a cohesive message addressing many COPD issues, including enhanced pulmonary rehabilitation under Medicare.

Stem Cell Research

I recognize the significant medical breakthroughs that may result from stem cell research and support federally funded research conducted within strict ethical guidelines like those promulgated by the National Institutes of Health (NIH). NIH’s guidelines are very clear. All of the existing stem cell lines that have been approved for government funding have been developed from excess embryos resulting from the invitro fertilization (IVF) process. The qualification process is complete and no other stem cell lines will be accepted for federal dollars. Essentially, the process for approval has three steps. Initially, the stem cell lines must have been derived from embryos that were in excess; in other words, these embryos were not going to be implanted for invitro fertilization and were not derived from abortions. Second, the donors did not receive financial compensation for the donation of these embryos. Finally, the donor had to give informed consent.

However, I also have reservations. I do not support such research when it involves the purposeful creation and destruction of human embryos. Additionally, I do not condone using federal dollars to fund programs that harvest living embryos solely for the purpose of research. The significant amount of medical information that can be gained from this research must be balanced with the responsibility to the unborn of our society.

On August 9, 2001, President George W. Bush made a statement to the nation regarding federal funding for stem cell research. In his statement, he said, “I have concluded that we should allow federal funds to be used for research on … existing stem cell lines, where the life and death decision has already been made.” In other words, federal funding can be used for embryonic stem cell research if the embryo has already been destroyed. However, President Bush’s decision also prohibits the further destruction of living embryos for the purpose of stem cell research. As of the third quarter of 2004, there were 22 human embryonic stem cell lines that federally supported researchers can utilize for research. The research potential created by these cells is impossible to ignore. Since these cells are no longer compatible with creating life, President Bush has decided to allow federal funds to contribute to research on these existing lines, while prohibiting federal dollars from being spent on any other embryonic stem cell research. President Bush’s decision marks the first time federal funding has been made available for human embryonic stem cell research.

It is important to point out that stem cell research of any kind is currently legal in the United States. Private entities continue to carry out promising research in the field, without restriction or encumbrance from the government. The current debate focuses on the use of taxpayer dollars to subsidize this research.

I recognize the significant medical breakthroughs that may result from stem cell research and support federally funded research conducted within strict ethical guidelines like those promulgated by the National Institutes of Health (NIH). NIH's guidelines are very clear. All of the existing stem cell lines that have been approved for government funding have been developed from excess embryos resulting from the invitro fertilization (IVF) process. The qualification process is complete and no other stem cell lines will be accepted for federal dollars. Essentially, the process for approval has three steps. Initially, the stem cell lines must have been derived from embryos that were in excess; in other words, these embryos were not going to be implanted for invitro fertilization and were not derived from abortions. Second, the donors did not receive financial compensation for the donation of these embryos. Finally, the donor had to give informed consent. For more information on the National Institute of Health please visit their website at: http://stemcells.nih.gov/index.asp

However, I also have reservations. I do not support such research when it involves the purposeful creation and destruction of human embryos. Additionally, I do not condone using federal dollars to fund programs that harvest living embryos solely for the purpose of research. The significant amount of medical information that can be gained from this research must be balanced with the responsibility to the unborn of our society.

The Senate approved three bills regarding stem cell research. One bill, H.R. 810, the Stem Cell Research Enhancement Act, which passed the House of Representatives allows federal funding for research on embryonic stem cell lines, regardless of the date on which the stem cell line was created. I voted against this bill.

The Second bill is S. 2754, the Alternative Pluripotent Stem Cell Therapies Enhancement Act, which was introduced by Senator Rick Santorum (R-Pennsylvania). This measure would develop techniques for the isolation, derivation, production, or testing of stem cells that are capable of producing almost all cell types but are not derived from a human embryo.

The final bill expected to be considered is S. 3504, the Fetus Farming Prohibition Act of 2006, also introduced by Senator Santorum. This bill would make it illegal to perform research on embryos from "fetal farms." Fetal farms are where human embryos are gestated in a non-human uterus or from human pregnancies created specifically for the purpose of research.

I have serious concerns with any legislation that would federally fund the destruction of embryos for research. A number of alternatives to the study of embryonic stem cells have developed, and measures have been introduced in Congress to address these promising discoveries.

One source of stem cells is umbilical cord blood, also called "placental blood," which is the blood that remains in the umbilical cord and placenta following birth and after the cord is cut. The ability of cord blood stem cells to differentiate, or change into other types of cells in the body, is a new discovery that holds significant promise for improving the treatment of some of the most common diseases such as heart disease, stroke and Alzheimer's. Cord-blood stem cells are already used in the treatment of more than 60 different diseases, including leukemia, Fanconi anemia, sickle cell disease and thalassemia. In addition, research on adult stem cells has recently generated a great deal of excitement. Scientists have found adult stem cells in many more tissues than they once thought possible. Certain types of adult stem cells seem to have the ability to differentiate into a number of different cell types. If this differentiation of adult stem cells can be controlled in the laboratory, these cells may become the basis of therapies for many serious common diseases. A number of alternatives to the study of embryonic stem cells have developed, and measures have been introduced in Congress to address these promising discoveries. A measure has recently been passed by the House and Senate to establish a National Cord Blood Stem Cell Bank Network to prepare, store and distribute human umbilical cord blood stem cells for the treatment of patients and to support research using such cells. I support these valuable additions to the ongoing stem cell research being conducted by both public and private entities.

I understand the legitimate concerns raised by both proponents and opponents of embryonic stem cell research. Please be assured I will continue to carefully balance the need for productive medical research and the rights of the unborn.

Universal Health Care

Providing effective and affordable health care is one of the greatest challenges facing the health profession, insurers, and local, state, and federal governments. I understand the burden that high insurance and medical costs place on working families, and especially on seniors with fixed incomes. Our nation’s families should not be forced to forfeit vital necessities in order to afford adequate health care.

Congress continues to review various health care proposals that will shape the health care industry in the future. The goal of these proposals, and the focus of this debate, is to increase affordability and choice, address barriers to accessing insurance, and to stem or even reduce the growing number of uninsured persons. Congress must work to improve not only the access of health care, but also the quality of health care.

In order to address these issues, some lawmakers have advocated the creation of a single-payer healthcare system run by the federal government which would be mandatory for all Americans. I am opposed to such a system as it would certainly lower the quality of care that Americans enjoy. In Canada’s single-payer system, for example, patients must wait for months in order to receive certain types of surgery. In addition, such a system would be extremely costly, burdening American taxpayers and the economy with large costs and inevitable, significant tax increases. Without the beneficial effects of competition among insurers, or cost-cutting measures developed by the private sector, a government health care monopoly would likely lead to higher prices. The archaic, confusing and inaccurate formulas and policies used by Medicare to determine physician and hospital reimbursement levels serve as an example of the ramifications of adopting a universal, government-run healthcare system.

The best solution is to expand public-private partnerships that utilize the greater efficiency and existing infrastructure of private insurers to expand quality health care to the uninsured. One promising development in health insurance is the idea of health savings accounts (HSA). HSAs are a new method of paying for medical expenses not covered by insurance or other reimbursements. Authorized in November 2003 as part of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), HSAs allow eligible individuals to establish and fund a medical savings account when they have a qualifying high deductible health plan. Deductibles under qualifying HSAs are at least $1,000 for single and $2,000 for family coverage. The new accounts have tax advantages that can be significant such as deductible contributions and tax-exempt account earnings. In addition, account withdrawals used for medical expenses are not taxed. Unused balances may accumulate without limit. Instead of giving the government more power over health care, individual patients must be given more control, choice, and information to make their health care decisions. When individual patients have these choices, they will reward innovative insurers and providers who reduce costs and improve quality.

Providing quality health care for all citizens must remain a priority for this Congress. Please know that I will continue to work with my Senate colleagues to improve our system of health care.

Useful Links:

Mike on healthcare upgrades

Mike on stem cells

Mike's radio news conference on stem cell research

Henry J. Kaiser Family Foundation

The Henry J. Kaiser Family Foundation is a non-profit, private operating foundation focusing on the major health care issues facing the nation. The Foundation is an independent voice and source of facts and analysis for policymakers, the media, the health care community, and the general public.

Alliance for Health Reform

American Medical Association

Centers for Disease Control (CDC)

Mens Health Network

National Health Policy Forum

Pharmaceutical Research and Manufacturers of America

Congressional Heart and Stroke Coalition

Medicare Payment Advisory Commission

National Institutes of Health (NIH>

News Releases