Healthcare
"Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection." --Harry Truman, 1945
The Need for Reform
There is no denying that our healthcare system is in dire need of reform. Claire knows the soaring cost of medical care is crippling our economy, bankrupting our nation's families and becoming an unsustainable financial burden for American employers. The United States spends more money per person on healthcare than any other country in the world, double that of our neighbor Canada. Despite this spending the U.S. ranks 38th in life expectancy worldwide, 33rd in child mortality, and out of over 200 countries we rank as the 29th worst in terms of the prevalence of diabetes. Americans clearly aren't getting a good value for their healthcare spending and Claire wanted to act to make sure that America was second best to no one. In addition to the high cost of healthcare to businesses and individuals is the high cost of healthcare to our federal government. Almost one quarter of all federal spending right now is on healthcare expenses related to Medicare and Medicaid. Anyone who is concerned about our long-term debt, as Claire is, knows that we must reform and control the spiraling costs of our current system.
In the last eight years, healthcare premiums have grown four times faster than wages. There are nearly 46 million uninsured Americans, and more than 451,000 of those individuals are Missourians. The recent economic downturn has highlighted the need for a healthcare system overhaul. Every year, more and more businesses are unable to afford health insurance benefits for employees, and Claire has heard from many recently laid-off workers who have lost health coverage for their entire family. Claire believes Americans should have access to care and protections in place to secure stable health coverage.
Reforming our nation's healthcare system was first debated during the administration of Teddy Roosevelt almost 100 years ago. Even Missouri's own Harry Truman tried unsuccessfully to pass reform. Recognizing the continued need for reform, Congress began considering possible healthcare legislation in the summer of 2009. The process slowly evolved over the course of the summer and fall and, like other legislators, Claire heard from literally thousands upon thousands of Missourians. She conducted ten open town halls in August 2009 and heard arguments both for and against reforming our healthcare system; many promoted doing nothing and others wanted to go much further, calling for the creation of a single-payer government-run system.
In the end it was clear to Claire that doing nothing was simply not an option. In November of 2009 the two Senate committees responsible for crafting healthcare legislation, the Finance Committee and the Health, Education, Labor, and Pensions (HELP) Committee, merged their respective bills and introduced H.R. 3590, The Patient Protection and Affordable Care Act. The bill was debated for over a month on the floor of the Senate. Ultimately Claire joined a supermajority of senators in passing the bill by a vote of 60-39 on Christmas Eve. The Senate bill was later passed by the House of Representatives in March of 2010, and that bill, along with a subsequent "fixer" bill, was signed by President Obama and is now law.
What is in the new law?
First, the law bars insurance companies from refusing coverage to people with preexisting conditions. This prohibition starts immediately for children and will take effect for adults in 2014. To provide immediate relief to adults, the law sets aside $5 billion to help states create high risk pool insurance policies and offer reduced premiums for those who have been denied coverage due to preexisting conditions. Missouri's high risk pool insurance, also known as Missouri Health Insurance Pool or MHIP, will be a recipient of part of this money. In addition to help those with preexisting conditions, there is also help for young adults just getting started in their careers. Starting in 2010 young people can stay on their parent's health insurance plan until their 26th birthday if they do not have access to their own employer-sponsored coverage.
The new law also provides benefits to small businesses who want to provide health insurance to their employees but have not been able to afford it. The law provides tax credits to employers with fewer than 25 employees whose average salary is less than $50,000 per year and who pay at least 50% of their employees' health insurance premiums. From 2010 through 2013 employers can claim a tax credit for up to 35% of their contribution toward employee premiums. This value jumps to 50% in 2014 and 2015. Further information on employer responsibility and small business tax credits can be found by clicking here.
In 2014 each state will have access to an insurance exchange where uninsured Americans can shop for affordable insurance and choose from a variety of plans. These exchanges are not a form of government insurance, but rather are comparable to sites like OrbitzTM or TravelocityTM. On the exchanges private insurance companies will be able to offer their insurance and customers will be able to compare policies and prices on an apples-to-apples basis. Not only will individuals be better able to compare prices between private carriers, the exchange will also allow businesses with less than 50 employees (up to 100 at a state's discretion) and individuals to pool their risk and have the same kind of purchasing leverage that previously only large companies had. Missourians are not required to use the exchange. In fact, just as before reform, most Missourians will continue to get their insurance through their employer. The only people required by law to purchase their insurance through the exchange are members of Congress and their staffs.
Today over 83% of all non-elderly Americans are covered by insurance of some sort. Many of those who remain uninsured cite cost as a key reason. The new law contains a requirement that all citizens carry insurance, so in addition to increasing availability and competition of private insurance through the exchanges, this law also provides for subsidies for people with modest means so that they can meet this requirement. Those without insurance often seek treatment in emergency rooms where they are guaranteed treatment, but that treatment comes at a high cost. Estimates are the average family pays an extra $1,000 per year in premiums to pay for the uncompensated care used by the uninsured. This hidden cost of care for Missourians needed to be ended.
Medicare Reforms to Better Serve our Nation's Seniors
Medicare has been the foundation of health insurance for our nation's seniors since 1965 and has provided a crucial health care safety net for nearly 45 million elderly Americans. Claire knows how important Medicare is for seniors living on a fixed income, and she is committed to strengthening this vital benefit program. However, federal entitlement programs, such as Medicare, will not be able to survive if the burgeoning health care costs are not addressed. Before reform it was estimated that Medicare would run out of money by 2017, and there was growing concern the federal government would not be able to keep pace with the aging baby-boomer demand for medical services.
This new law implements important changes to reduce waste and fraud in Medicare and strengthen its long-term prospects. Medicare has traditionally paid for each procedure separately, setting up an incentive to order multiple tests or procedures rather than finding the most effective diagnosis and treatment method. This law begins making changes to reimburse providers for quality and efficiency rather than just quantity. The law also cuts billions of dollars of unnecessary subsidies to private insurance companies that have been contracted out to provide Medicare benefits in place of the government through the Medicare Advantage program. Importantly, the law does not cut any Medicare guaranteed benefits, just the overpayments that have wasted billions of dollars from the Medicare trust fund. Lastly, the Centers for Medicare and Medicaid Services (CMS) have also been granted enhanced fraud fighting capabilities to fight some of the billions of dollars wasted annually on fraudulent claims.
Prescription Drug Affordability
Seniors and people with disabilities have the right to receive the drugs they need at prices they can afford and under the terms of coverage that they have been promised. Claire is dedicated to providing all Medicare beneficiaries access to comprehensive and affordable prescription drug coverage and strongly supports proposals which would allow Medicare to use its bulk purchasing power to negotiate with drug companies for lower prices.
Most seniors now take part in Medicare Part D to provide their access to drug benefits. While popular, seniors face difficulties in paying for medication when they reach the "Doughnut Hole" where they must pay 100% of the costs of drugs. The new law shrinks the doughnut hole by $500 and in 2010 seniors who reach this coverage gap will be eligible for a $250 rebate to help with drug costs. Additionally, starting in 2011 name-brand drug manufacturers are required to offer seniors a 50% discount on drugs when they are in the doughnut hole. Further changes will eventually eliminate the doughnut hole by 2020.
As long as strict safety standards are met, Claire also believes Americans should have the ability to re-import less expensive medicines from other countries. Claire voted in favor of an amendment that was offered to the healthcare reform legislation that would have allowed drug importation, but the amendment failed to get the necessary votes. Claire continues to support legislation waiving current limits on the importation of prescription drugs and establishing registration conditions for importers and exporters.
Revoking Insurance Antitrust Protections
The health insurance industry is currently protected by an exemption to antitrust laws which Claire has repeatedly worked to remove. She cosponsored a bill with Sen. Leahy (S.1681), "The Health Insurance Industry Antitrust Enforcement Act of 2009" and again cosponsored the same legislative language when it was offered as an amendment (SA 2795) to H.R. 3590, the health reform bill. The amendment was never voted on and neither has the free-standing bill, but Claire has asked that the issue be brought to the floor.
Transparency and the Health Reform Process
During the series of town hall meetings she held during August 2009, Claire heard from numerous Missourians about the confusion and misinformation surrounding certain proposals for health reform. Claire joined several of her Senate colleagues in sending a letter to Senate Majority Leader Harry Reid (D-NV) calling for greater transparency in crafting health care reform legislation, specifically requiring legislative text to be posted on a public website at least 72 hours prior to the first vote. Claire read the entire bill and reconciliation package prior to casting her vote and felt that the public should have the same opportunity. Thanks in part to Claire's effort the legislation was posted and votes were delayed to allow everyone more time to review legislative language.
Several "special deals" that never should have been included in the legislation marred the end of the process, and Claire, like much of the American public, was understandably upset at their insertion into the bill. Claire opposed these special deals and they were removed before the bill was passed. Overall, however, this was a long, open, and televised process. Debate on health care legislation began in committees in the summer of 2009 and continued for six months before the bill was approved in December. Archived footage of the Health Education Labor and Pensions (HELP) Committee meetings can be found by clicking here. Markups of the Finance portion of the bill can be accessed by clicking here. The month of floor debate can be found on c-span by clicking here.
Reduced Deficits through Healthcare Reform
Right now almost one quarter of all federal spending is dedicated to healthcare expenses and healthcare is the largest single federal expenditure behind defense and Social Security. Federal healthcare expenses are on the rise due to the twin pressures of increasing Medicare enrollees as Baby Boomers begin to retire along with persistent medical inflation that has been double the rate of general inflation. Without reform these pressures would increasingly contribute to deficit spending to cover the government's healthcare obligations. The new law attacks the basis of the hyperinflation by reforming payment practices to pay for quality rather than quantity and further reduces wasted subsidies to private Medicare contractors. Additionally, new fraud prevention efforts have been initiated to fight the billions of Medicare dollars annually lost to scams and fraud. These reforms combined are expected to save the federal government over a trillion dollars over the next two decades. The deficit-reduction effects of this law are a key reason for Claire's support. She only voted for this legislation once she knew it was not only paid for, but also reduced the burden on future generations.
Now, at the Six Month Mark: The Patient's Bill of Rights will:
· Ban discrimination against kids with pre-existing conditions - Up to 72,000 uninsured children are expected to gain coverage by banning insurance companies from refusing children coverage because of their pre-existing conditions.
· Ban insurance companies from dropping coverage - Insurance companies are banned from cutting off coverage because a consumer gets sick or makes a technical mistake on their application.
· Ban insurance companies from limiting coverage - Insurers can no longer put a lifetime limit on the dollar amount spent on coverage they provide because a patient is suffering from a serious or chronic disease.
· Ban insurance companies from limiting choice of doctors - Consumers will have the right to choose their own doctor within their insurer network and women will not be required to seek a referral to see an OB/GYN for covered services.
· Ban insurance companies from restricting emergency room care - Insurance companies can no longer limit which emergency room a patient goes to or charge more if a person goes to one out of their network.
· Guarantee a person the right to appeal - Patients will be guaranteed the right to appeal insurance company decisions to a third party if coverage is denied or treatment is restricted.
· Cover young adults on their parent's plan - Young adults will be allowed to remain on their parent's plan until their 26th birthday, unless they are offered coverage at work.
· Cover preventive care with no cost - Consumers will receive preventive care with no out-of-pocket cost. Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered, and insurance companies will be prohibited from charging deductibles, co-payments or co-insurance.
The Patient's Bill of Rights takes effect for health policy or plan years beginning on or after September 23, 2010. For more information, visit: http://www.healthcare.gov/
The Road Ahead
It would have been far easier to have kicked the can down the road, avoiding the tough decisions needed to reign in our spiraling healthcare costs, but the voters of Missouri sent Claire to Washington to deal with the tough issues and that is why she took action. The new laws are certainly not perfect, but they are a step forward. While everyone may not have been in agreement on provisions included in this new law, it is important now for Missourians to understand how this new law may affect them. The public has been bombarded with competing claims about what this law means, so Claire suggests that everyone visit a non-partisan website like the one sponsored by the Kaiser Family Foundation where the impacts of the new law are discussed.
Many myths have sprouted up with regards to the new law and they are debunked here: Healthcare Reform Top 10 Myths and Facts.