Lawmakers were all over the airwaves Sunday following the Senate's procedural vote on the health care overhaul bill -- and like the chamber's vote, the rhetoric and the predictions for going forward lined up along predictable partisan lines.
Senate Democrats cleared the first major hurdle in their efforts to retool the health care system Saturday night, voting to adopt a motion and begin debating an overhaul plan assembled by Majority Leader Harry Reid, D-Nev.
The Senate voted along party lines, 60-39, to invoke cloture on a motion to proceed to the bill (HR 3590). It was the first of what will likely be several similar procedural votes that will have to be taken before the Senate can actually vote on passage of the measure.
Sen. Lamar Alexander of Tennessee said the Republicans' next goal is "to let the American people know what it does for them and to them, that it has higher premiums, higher taxes, Medicare cuts, puts 15 million more low-income Americans into a medical ghetto called Medicaid."
Alexander, who appeared on "Fox News Sunday," said once Americans become aware of the bill's onerous provisions, it "will collapse of its own weight. And we can get then started on going step by step toward reducing costs, which is what we've been trying to do ... And I think most people would be much more comfortable with us biting off what we could chew instead of this arrogance of thinking we can fix the whole system all at once."
Sen. Debbie Stabenow, D-Mich., appearing on the same program, was asked about certain lawmakers who voted yes Saturday but would vote against the bill on final passage if it contains provisions they cannot accept.
"We will keep working," she said. "We're working on a number of different options that will bring us together. And I believe at the end of the day we will be together because we know that we can't afford not to act, whether it's saving lives, saving money."
"Look, there are still many bumps in the road, discussions, arguments, disagreements. But I think, now, the wind is at our back. There's real momentum," said Sen. Charles E. Schumer on CBS's "Face the Nation," "... And now the time is to act. And, frankly, you know, there are a lot of people on the other side of the aisle who don't want health care. They haven't put together an alternative proposal that's out there on the Web the way our proposal is. And I think what Orrin Hatch [R-Utah] said is right. It's dilatory tactics."
Countering that argument on the same program was Sen. Jon Kyl, R-Ariz., who said "the American people, by public opinion surveys, have made it very clear they want this whole thing aired out. They would rather have us do it right than do it quickly. ... The reality is this is a huge issue affecting every American. And we do need to do it right. And the object is not to delay for delay's sake but rather to have an opportunity for everyone to see what's in it, to understand it, to know how much it costs and to know how it's going to impact their lives."
Senate Majority Whip Richard J. Durbin, D-Ill., appearing on NBC's "Meet the Press," said Saturday night's party-line vote to begin debate on the bill was "an amazing victory" for President Obama and Reid.
"We didn't have a Republican vote, but we are going to move forward after Thanksgiving," Durbin said on NBC's "Meet the Press." He said the bill "must" pass this year and urged Republicans to work with Democrats and not engage in a "filibuster-loaded debate where we don't get down to the basic issues."
Sen. Tom Coburn, R-Okla., said the "important thing is for the American people to understand that this bill doesn't fix what's wrong with health care. We're treating symptoms, not the disease, and it's really malpractice what we're doing."
The problem with U.S. health care, Coburn said on ABC's "This Week," "is that it costs too much... And there's nothing to address that. And one out of every three dollars that Americans spend today doesn't help anybody get well and doesn't keep anybody from getting sick. So why would we not want to go and fix the problems in health care, not the symptoms that all the politicians play around with, but the real problems?"
Monday, November 23, 2009
Children who lack continuity with a regular health care provider miss needed services
PORTLAND, Ore. — Low-income children who don't access health care from the same place or provider over the long term are significantly more likely to have unmet health care needs compared with those do, according to a new study published in the journal Pediatrics.
Studies like this are crucial to informing the financing and delivery of quality health care for children, the researchers report.
"In the current policy debates about health insurance reform, much of the focus has been on the importance of stable health insurance. This study confirmed that having a stable usual source of care is also an important factor in accessing needed health care," said Jennifer E. DeVoe, M.D., D.Phil., principal investigator and research professor in family medicine, Oregon Health & Science University School of Medicine.
Previous studies have shown that patients who maintain an ongoing relationship with a primary care facility or provider, also known as a "usual source of care," are more likely to use preventive health care, not use emergency services and have shorter hospital stays. In this study, DeVoe and colleagues expanded on that research by examining whether having a consistent place or person from whom to access regular health care over time affects low-income children's ability to access needed services.
To collect data, they created a statewide survey with questions adapted from several vetted national surveys and sent it to 8,636 families who were enrolled in Oregon's food stamp program at the end of January 2005. One focal child per family was randomly selected for each survey. The researchers received 2,681 completed responses and applied statistical weights to ensure that these responses were representative of the 84,087 households in the food stamp population.
The survey asked parents whether their child had experienced an "unmet need" in the previous 12 months, which the researchers defined as: an unmet medical need; an unmet prescription need; missed medication doses; delayed urgent care; no outpatient visits; and reports of problems obtaining necessary dental care or specialty care, and counseling.
Parents were also asked where they took their child for needed medical care. Children whose parents responded that their child received care at a community health center, private clinic or school-based clinic were considered to have a usual source of care. Those who reported no current usual source of care, or whose children received regular care only an emergency department or at an urgent care facility, were considered to have no usual source of care.
Based on these responses, the researchers report that 79 percent of the children who lacked a usual source of health care had an unmet need compared with 45 percent who reported having a usual source of care.
The researchers then compared their findings with a comparable national sample and found 67.5 percent of low-income children nationwide who lacked a usual source of care had an unmet need compared with 37 percent who reported having a usual source of care.
"A child without a usual source of care had at least two times the odds of experiencing an unmet need than a child with a usual source of care both in the Oregon population and in the national sample," DeVoe explained.
In addition, the researchers were interested in knowing whether children whose insurance changes had prompted a change in their usual source of care were more vulnerable to experiencing unmet need. They found that an estimated 23 percent of low-income children in Oregon had changed their usual source of care because of insurance reasons. Compared to children with a stable usual source of care, the group that had changed their usual source of care had 2.6 times the odds of experiencing unmet medical care needs.
"Although this study confirms the importance of a stable usual source of care, our findings do warn against any notion that having a regular source of care can substitute for stabilizing the U.S. insurance system. Financial and structural reforms are both needed to ensure better access to health care for low-income children" said DeVoe.
Studies like this are crucial to informing the financing and delivery of quality health care for children, the researchers report.
"In the current policy debates about health insurance reform, much of the focus has been on the importance of stable health insurance. This study confirmed that having a stable usual source of care is also an important factor in accessing needed health care," said Jennifer E. DeVoe, M.D., D.Phil., principal investigator and research professor in family medicine, Oregon Health & Science University School of Medicine.
Previous studies have shown that patients who maintain an ongoing relationship with a primary care facility or provider, also known as a "usual source of care," are more likely to use preventive health care, not use emergency services and have shorter hospital stays. In this study, DeVoe and colleagues expanded on that research by examining whether having a consistent place or person from whom to access regular health care over time affects low-income children's ability to access needed services.
To collect data, they created a statewide survey with questions adapted from several vetted national surveys and sent it to 8,636 families who were enrolled in Oregon's food stamp program at the end of January 2005. One focal child per family was randomly selected for each survey. The researchers received 2,681 completed responses and applied statistical weights to ensure that these responses were representative of the 84,087 households in the food stamp population.
The survey asked parents whether their child had experienced an "unmet need" in the previous 12 months, which the researchers defined as: an unmet medical need; an unmet prescription need; missed medication doses; delayed urgent care; no outpatient visits; and reports of problems obtaining necessary dental care or specialty care, and counseling.
Parents were also asked where they took their child for needed medical care. Children whose parents responded that their child received care at a community health center, private clinic or school-based clinic were considered to have a usual source of care. Those who reported no current usual source of care, or whose children received regular care only an emergency department or at an urgent care facility, were considered to have no usual source of care.
Based on these responses, the researchers report that 79 percent of the children who lacked a usual source of health care had an unmet need compared with 45 percent who reported having a usual source of care.
The researchers then compared their findings with a comparable national sample and found 67.5 percent of low-income children nationwide who lacked a usual source of care had an unmet need compared with 37 percent who reported having a usual source of care.
"A child without a usual source of care had at least two times the odds of experiencing an unmet need than a child with a usual source of care both in the Oregon population and in the national sample," DeVoe explained.
In addition, the researchers were interested in knowing whether children whose insurance changes had prompted a change in their usual source of care were more vulnerable to experiencing unmet need. They found that an estimated 23 percent of low-income children in Oregon had changed their usual source of care because of insurance reasons. Compared to children with a stable usual source of care, the group that had changed their usual source of care had 2.6 times the odds of experiencing unmet medical care needs.
"Although this study confirms the importance of a stable usual source of care, our findings do warn against any notion that having a regular source of care can substitute for stabilizing the U.S. insurance system. Financial and structural reforms are both needed to ensure better access to health care for low-income children" said DeVoe.
Health care fight swells lobbying
WASHINGTON — Companies and groups hiring lobbying firms on health issues nearly doubled this year as special interests rushed to shape the massive revamp of the nation's health care system now in its final stretch before Congress.
About 1,000 organizations have hired lobbyists since January, compared with 505 during the same period in 2008, according to a USA TODAY analysis of congressional records compiled by the non-partisan CQ MoneyLine.
Overall, health care lobbying has increased, exceeding $422 million during the first ninth months of the year, according to the Center for Responsive Politics, which tracks money in politics. That's more than any other industry and a nearly 10% jump over the same period in 2008. The center's Dave Levinthal said the frenzy of new lobbying activity makes financial sense. "If lobbying didn't work, people wouldn't do it," he said.
The vast scope of the health care legislation, which cleared a major hurdle Saturday when the Senate voted 60-39 to begin debating it, has spurred some to lobby for the first time. Gaylord Hospital in Wallingford, Conn., a 137-bed long-term care facility, decided it needed professional help after scrambling last year – aided by state lawmakers – to avoid losing Medicare payments, said Janine Epright, hospital chief financial officer.
"It was an eye-opener," she said of the Medicare fight. "We realized that we didn't have enough pull individually or as an industry to drive the process" in Washington. Epright said the non-profit hospital will spend about $50,000 on lobbying.
Others are beefing up their lobbying presence. Language Line Services, which has spent $90,000 on federal lobbying since 2007, hired a second firm this year as it pushed to boost federal funding for medical translation services. The firm, which employs 8,000 translators, says interpreters can reduce medical errors for patients who don't speak English.
The lobbyists arranged meetings between company executives and House staffers, said Marty Conroy of Language Line. The health bill passed by the House this month would require Medicaid to match up to 75% of translation costs, up from 50%.
The American Beverage Association hired a fifth lobbying firm this year as it worked to kill a proposed federal excise tax on sugary drinks to help pay for the bill. The group spent $7.3 million on lobbying during a three-month period, federal records show. That included $5 million on advertising to fight the tax, spokesman Kevin Keane said.
About 1,000 organizations have hired lobbyists since January, compared with 505 during the same period in 2008, according to a USA TODAY analysis of congressional records compiled by the non-partisan CQ MoneyLine.
Overall, health care lobbying has increased, exceeding $422 million during the first ninth months of the year, according to the Center for Responsive Politics, which tracks money in politics. That's more than any other industry and a nearly 10% jump over the same period in 2008. The center's Dave Levinthal said the frenzy of new lobbying activity makes financial sense. "If lobbying didn't work, people wouldn't do it," he said.
The vast scope of the health care legislation, which cleared a major hurdle Saturday when the Senate voted 60-39 to begin debating it, has spurred some to lobby for the first time. Gaylord Hospital in Wallingford, Conn., a 137-bed long-term care facility, decided it needed professional help after scrambling last year – aided by state lawmakers – to avoid losing Medicare payments, said Janine Epright, hospital chief financial officer.
"It was an eye-opener," she said of the Medicare fight. "We realized that we didn't have enough pull individually or as an industry to drive the process" in Washington. Epright said the non-profit hospital will spend about $50,000 on lobbying.
Others are beefing up their lobbying presence. Language Line Services, which has spent $90,000 on federal lobbying since 2007, hired a second firm this year as it pushed to boost federal funding for medical translation services. The firm, which employs 8,000 translators, says interpreters can reduce medical errors for patients who don't speak English.
The lobbyists arranged meetings between company executives and House staffers, said Marty Conroy of Language Line. The health bill passed by the House this month would require Medicaid to match up to 75% of translation costs, up from 50%.
The American Beverage Association hired a fifth lobbying firm this year as it worked to kill a proposed federal excise tax on sugary drinks to help pay for the bill. The group spent $7.3 million on lobbying during a three-month period, federal records show. That included $5 million on advertising to fight the tax, spokesman Kevin Keane said.
Senate Democrats at odds over health care bill
WASHINGTON – Moderate Senate Democrats threatened Sunday to scuttle health-care legislation if their demands aren't met, while more liberal members warned their party leaders not to bend.
The dispute among Democrats foretells of a rowdy floor debate next month on legislation that would extend health care coverage to roughly 31 million Americans. Republicans have already made clear they aren't supporting the bill.
Final passage is in jeopardy, even after the chamber's historic 60-39 vote Saturday night to begin debate.
"I don't want a big-government, Washington-run operation that would undermine the ... private insurance that 200 million Americans now have," said Sen. Ben Nelson, a conservative Nebraska Democrat.
Nelson and three other moderates — Democratic Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas and Connecticut independent Joe Lieberman — agreed to open debate despite expressing reservations on the measure. Each of them has warned that they might not support the final bill.
One major sticking point is a provision that would allow Americans to buy a federal-run insurance plan if their state allows it. Moderates say they worry the so-called public option will become a huge and costly entitlement program and that other requirements in the bill could cripple businesses.
"I don't want to fix the problems in our health care system in a way that creates more of an economic crisis," said Lieberman.
The sway held by such a small group of senators has annoyed their more liberal colleagues, who could vote against a final bill if it becomes too watered down.
Sen. Sherrod Brown, D-Ohio, said he didn't think rank-and-file Democrats would feel compelled to go that far. At the same time, Brown warned Democratic leaders not to make too many concessions.
"I don't want four Democratic senators dictating to the other 56 of us and to the rest of the country — when the public option has this much support — that (a public option is) not going to be in it," said Brown.
The Senate bill would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their work force. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions.
Congressional budget analysts put the legislation's cost at $979 billion over a decade and say it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.
The House approved its version of the bill earlier this month on a near party-line vote of 220-215.
Sen. Dick Durbin of Illinois, the No. 2 Democrat in the Senate, said the health care bill must be passed by the end of the year so that President Barack Obama and lawmakers can shift their attention to the economy and improving employment rates.
Such a timeline also would enable Obama to claim victory on a major domestic priority when he delivers his State of the Union speech in January.
But with one-third of Senate seats up for election in 2010, politics will factor heavily into the outcome of the debate on health care.
Sen. Michael Bennet, a junior Democrat who will be seeking his first full term next year in Colorado, where many districts lean conservative, said he would support the health care overhaul even if doing so means losing his seat.
"The thing that our working families need more than anything else is to end these double-digit cost increases that they're having every single year with health insurance," Bennet said.
Democratic Sen. Chuck Schumer of New York said he believes there are enough votes to include a public insurance option in the bill as long as states are allowed to opt out. To do so, all 58 Democrats and independent Sens. Lieberman and Bernie Sanders of Vermont would have to support it.
Sanders issued a statement Sunday saying, "I strongly suspect that there are a number of senators, including myself, who would not support final passage without a strong public option."
Lieberman and Nelson have said they object to the public option. On Sunday, Nelson said he is open to negotiating the provision; he said he would prefer allowing states to opt into the program, instead of having to remove themselves.
Senate GOP leader Mitch McConnell said the lingering reservations by moderate Democrats indicate that the party's leaders have gone too far. On Saturday, no Republican voted to begin debate on the bill, which they said would cripple industry and drive up costs for the average American.
"I believe there are a number of Democratic senators who do care what the American people think and are not interested in this sort of arrogant approach that everybody sort of shut up and sit down, get out of the way, we know what's best for you," said McConnell.
Brown, Bennet and McConnell appeared on CNN's "State of the Union." Lieberman appeared on NBC's "Meet the Press." Nelson appeared on ABC's "This Week."
The dispute among Democrats foretells of a rowdy floor debate next month on legislation that would extend health care coverage to roughly 31 million Americans. Republicans have already made clear they aren't supporting the bill.
Final passage is in jeopardy, even after the chamber's historic 60-39 vote Saturday night to begin debate.
"I don't want a big-government, Washington-run operation that would undermine the ... private insurance that 200 million Americans now have," said Sen. Ben Nelson, a conservative Nebraska Democrat.
Nelson and three other moderates — Democratic Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas and Connecticut independent Joe Lieberman — agreed to open debate despite expressing reservations on the measure. Each of them has warned that they might not support the final bill.
One major sticking point is a provision that would allow Americans to buy a federal-run insurance plan if their state allows it. Moderates say they worry the so-called public option will become a huge and costly entitlement program and that other requirements in the bill could cripple businesses.
"I don't want to fix the problems in our health care system in a way that creates more of an economic crisis," said Lieberman.
The sway held by such a small group of senators has annoyed their more liberal colleagues, who could vote against a final bill if it becomes too watered down.
Sen. Sherrod Brown, D-Ohio, said he didn't think rank-and-file Democrats would feel compelled to go that far. At the same time, Brown warned Democratic leaders not to make too many concessions.
"I don't want four Democratic senators dictating to the other 56 of us and to the rest of the country — when the public option has this much support — that (a public option is) not going to be in it," said Brown.
The Senate bill would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their work force. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions.
Congressional budget analysts put the legislation's cost at $979 billion over a decade and say it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.
The House approved its version of the bill earlier this month on a near party-line vote of 220-215.
Sen. Dick Durbin of Illinois, the No. 2 Democrat in the Senate, said the health care bill must be passed by the end of the year so that President Barack Obama and lawmakers can shift their attention to the economy and improving employment rates.
Such a timeline also would enable Obama to claim victory on a major domestic priority when he delivers his State of the Union speech in January.
But with one-third of Senate seats up for election in 2010, politics will factor heavily into the outcome of the debate on health care.
Sen. Michael Bennet, a junior Democrat who will be seeking his first full term next year in Colorado, where many districts lean conservative, said he would support the health care overhaul even if doing so means losing his seat.
"The thing that our working families need more than anything else is to end these double-digit cost increases that they're having every single year with health insurance," Bennet said.
Democratic Sen. Chuck Schumer of New York said he believes there are enough votes to include a public insurance option in the bill as long as states are allowed to opt out. To do so, all 58 Democrats and independent Sens. Lieberman and Bernie Sanders of Vermont would have to support it.
Sanders issued a statement Sunday saying, "I strongly suspect that there are a number of senators, including myself, who would not support final passage without a strong public option."
Lieberman and Nelson have said they object to the public option. On Sunday, Nelson said he is open to negotiating the provision; he said he would prefer allowing states to opt into the program, instead of having to remove themselves.
Senate GOP leader Mitch McConnell said the lingering reservations by moderate Democrats indicate that the party's leaders have gone too far. On Saturday, no Republican voted to begin debate on the bill, which they said would cripple industry and drive up costs for the average American.
"I believe there are a number of Democratic senators who do care what the American people think and are not interested in this sort of arrogant approach that everybody sort of shut up and sit down, get out of the way, we know what's best for you," said McConnell.
Brown, Bennet and McConnell appeared on CNN's "State of the Union." Lieberman appeared on NBC's "Meet the Press." Nelson appeared on ABC's "This Week."
New baseline of opinion on health care
CULPEPER, Va. — On the day President Clinton went on national television in 1993 to prescribe his remedy for the nation's ailing health care system, emergency room director Michael Bost was too busy treating uninsured patients to believe change would mean improvement.
Sixteen years later, Bost has seen enough physical and financial suffering to convince him that major change is needed. He has watched his sons grow up and become uninsured, bringing their children to emergency rooms and paying hospital bills in installments. He has seen thousands of uninsured patients face the trauma of illness and destitution.
"What I see every day in the ER is magnified 10 times worse than what we experienced back in the '70s," says Bost, 59, now an emergency room physician in Fishersville, Va. "Not only does it hurt them physically, but it hurts them financially."
In Culpeper and across the nation, the years since Clinton's failed effort have seen the cost of medical services nearly double and softened some of the skepticism voiced by Americans in 1993 and 1994. The percentage who say Congress should pass comprehensive legislation, rather than dealing with health care incrementally over several years, has increased by 10 points, USA TODAY/Gallup Polls show.
That could help President Obama and Democrats in Congress as the Senate begins debate next week on an $848 billion plan that would fundamentally revamp the nation's health care system — the first such effort in 15 years. Unlike Clinton's plan, which would have created a new government regulatory system to monitor premiums and benefits, Obama's builds more on the current private insurance system. And unlike Clinton, Obama got most of the affected interest groups — doctors, hospitals, drugmakers, even insurers — to acknowledge that the system needs to be fixed.
To gauge how Americans' views have changed since 1993, USA TODAY spoke to many of the same people from Maine to Washington that the paper's reporters interviewed during Clinton's effort.
Here in Culpeper, a town of 16,000 with a median household income of $44,000 and a history of voting for both Democrats and Republicans, nothing tells the story better than Mort Chiles' path last year from private medical practice to chief medical officer at Culpeper Regional Hospital. He had planned on retiring last July at 60 but decided to keep working — in part to get health insurance through his employer.
On the day of Clinton's September 1993 speech, Chiles doubted Americans would give up any of the expensive care they were used to. Today he's ready to give it a try because the present system, he says, isn't sustainable.
"At some point, there has to be some limit on what we think we can do in health care," he says.
Health care costs, combined with the economic downturn, have caused Don Shuman to cut his small payroll from seven people in 1993 to just three today.
Then, "the economy was rocking and rolling. We were making money hand over fist," says Shuman, who has run Shuman Builders since 1974. His workers had excellent health benefits, he says. As a result, he opposed the Clinton plan, fearing it could lead to higher costs and fewer benefits.
Now, he has been forced to switch carriers and increase deductibles and co-payments, yet he's paying $6,600 a month.
"Change is inevitable, and this is the closest that we've ever come," says Shuman, 66. "If we don't do anything at all, we've missed an opportunity."
'Times have greatly changed'
Personal experiences with the health care system since 1993 have convinced many people that something has to be done.
Lynne Brauser ran a general store in Bradford, Pa., in 1994 and worried that a redesigned health care system would force her to pay her three employees' insurance premiums. "I don't believe Clinton's plan," she said then.
Since then, her husband had a serious illness requiring three months in the hospital, and the couple's insurance paid most of the costs — something she says the uninsured deserve. She also worked as a registered nurse and saw how the uninsured get care today — in the emergency room.
"Times have greatly changed," Brauser, 60, says. "I honestly think that we do need some type of change."
It took a death in the family to convince Judy Grabinski of Rockham, S.D., that insurance coverage should be expanded. The last time Congress considered it, her mother-in-law, Sharon Grabinski, was an uninsured cook in Faulkton, S.D., with diabetes and Raynaud's disease, which reduced circulation to her hands and feet.
In 1994, Sharon Grabinski succumbed to uterine cancer. If the types of low-income subsidies under consideration at the time had been available earlier, Judy Grabinski says, they could have helped pay for regular checkups.
"Some type of reform should be done," Judy Grabinski, 41, says. "Screening should maybe be available for all people."
Barely 12 hours after Clinton unveiled his plan in 1993, Rhonda Yeagerwas treated to a personal sales job by then-Treasury secretary Lloyd Bentsen on the concrete production floor at Philadelphia's Stockwell Rubber. She didn't buy it.
"I think we're all going to get smacked," Yeager said after Bentsen's pitch.
Since then, Yeager's father was diagnosed with Parkinson's disease, and neither Medicare nor his private supplemental policy pays for his full $479 monthly drug bill. Then she was diagnosed with lupus, a chronic autoimmune disease that is causing numbness in her legs, and the costs for medical tests and treatments are mounting.
"We're just going completely broke with the co-payments," says Yeager, 43, who still works at Stockwell, as a finisher.
"At this time, everybody is heading for trouble in terms of medical coverage," she says. "I see it getting worse."
For most of those who date back to Clinton's effort, cost was the big concern then and now.
Maryan Kearney noticed it in 1993 when son John's birth cost the family three times as much as her son Robbie's birth 11 years earlier. She notices it today because her father was billed $8,000 for eight hours in the emergency room with stomach pain, her 27-year-old son struggles to pay his premiums on the individual market, and another son can't afford insurance at all.
"Things have gotten very far out of hand," says Kearney, 53, a dental hygienist in Culpeper. "I don't know how we're ever going to fix it."
It cost David Cousens $546 a month to insure his family in 1993, when his lobsters were bringing in $2.70 a pound. Today, he's paying about $1,200 a month for health insurance. Lobsters? Just $2.50 a pound.
That's the main reason why Cousens, president of the Maine Lobstermen's Association, has shed the hesitation he voiced to Hillary Rodham Clinton during a Boston forum in 1993 and now supports Obama's efforts. It's not the only reason. He wishes he could afford to provide coverage for his one employee. And he regrets that his two children, ages 27 and 23, can't afford it, either.
"I think we need to get it done," says Cousens, 51, of South Thomaston. "Is it going to be perfect? No way. But it's got to be better than what we have now."
'Each one of us is at risk'
In 1993, Eugene Wigglesworthhad five auto repair shops in Vancouver, Wash., and a message for President Clinton. "Call me," he said at the time. "Get back in touch with the people making the jobs."
Sixteen years later, his opposition to changing the health care system has subsided. He and his wife just switched carriers for their Medicare supplemental policy. The old policy was going from $121 to $175 a month and dropping his sole medication.
"I think it's absolutely essential that we get health care reform," says Wigglesworth, 66. "There's just no getting around it now."
Illinois family physician Arvind Goyalread the entire Clinton plan in 1993 and determined that it would "destroy the practice of medicine as we know it." He brought his concerns to the American Medical Association.
Since then, Goyal informally polled his doctors at Northwest Community Hospital in Arlington Heights, Ill., where he chaired the family medicine department. Faced with reduced reimbursements, liability insurance premiums and overhead costs, he found, 30% of them had dropped health insurance for themselves, their families or employees.
"That amazed me," says Goyal, now 61. "These people would be at tremendous risk if they were hospitalized."
With 10% unemployment nationally, Goyal says, "our employer-based system is not protecting us. Each one of us is at risk."
Can government help?
Despite complaints about medical care and rising costs, some of those who opposed Clinton in 1993 see a repeat performance from Obama.
Richard Lee ran his own business, Gayheart's Drugstore, in Culpeper in 1993. Clinton's plan, he said then, would have meant higher insurance costs and more paperwork. Since then, Lee sold the business because insurance reimbursements were late and inadequate. He became the pharmacist at Culpeper's Safeway, a company that has taken costs into its own hands by offering lower premiums to employees who are in good health and offering generic drugs for $4 per month.
"The insurance companies and the drug companies are driving the health care system, and that's not the way it should be," Lee, 55, says. But with reform, he says, "the cost is going to climb."
Dorothy Crone didn't hesitate when she learned Democrats planned to cut Medicare to help pay for their plan. She ran out and got the surgeries she needed.
"I'd advise anybody nearing their 70s, if they have to get any work done, they better get it done while they can," she says.
Crone, a former small businesswoman from Horseshoe Bend, Ark., complained to her congresswoman about the Clinton plan in 1994. Today she's more convinced that government is the problem. "When has anything that the government does saved money?" she says.
Kentucky accountant Kenneth Wolfecomputes the tax burden for small businesses for a living. In 1993, it didn't take him long to predict that Clinton's health care plan would force some of them out of business.
When it comes to Obama's plan, Wolfe, 63, hasn't changed his mind. Still, he's convinced the current system doesn't work. Wolfe pays about $15,000 a year to insure himself, his wife and son, plus co-payments. He wants a high-deductible plan that isn't offered in Kentucky but in Ohio, within "rock-throwing distance" of his Park Hills home.
For Wolfe and many others, the need for cost controls remains paramount. He recalls going to the hospital for a small outpatient procedure and asking what it would cost. "You'd have thought I just landed from Mars," he says. "She said, 'Nobody's ever asked that before.'
Sixteen years later, Bost has seen enough physical and financial suffering to convince him that major change is needed. He has watched his sons grow up and become uninsured, bringing their children to emergency rooms and paying hospital bills in installments. He has seen thousands of uninsured patients face the trauma of illness and destitution.
"What I see every day in the ER is magnified 10 times worse than what we experienced back in the '70s," says Bost, 59, now an emergency room physician in Fishersville, Va. "Not only does it hurt them physically, but it hurts them financially."
In Culpeper and across the nation, the years since Clinton's failed effort have seen the cost of medical services nearly double and softened some of the skepticism voiced by Americans in 1993 and 1994. The percentage who say Congress should pass comprehensive legislation, rather than dealing with health care incrementally over several years, has increased by 10 points, USA TODAY/Gallup Polls show.
That could help President Obama and Democrats in Congress as the Senate begins debate next week on an $848 billion plan that would fundamentally revamp the nation's health care system — the first such effort in 15 years. Unlike Clinton's plan, which would have created a new government regulatory system to monitor premiums and benefits, Obama's builds more on the current private insurance system. And unlike Clinton, Obama got most of the affected interest groups — doctors, hospitals, drugmakers, even insurers — to acknowledge that the system needs to be fixed.
To gauge how Americans' views have changed since 1993, USA TODAY spoke to many of the same people from Maine to Washington that the paper's reporters interviewed during Clinton's effort.
Here in Culpeper, a town of 16,000 with a median household income of $44,000 and a history of voting for both Democrats and Republicans, nothing tells the story better than Mort Chiles' path last year from private medical practice to chief medical officer at Culpeper Regional Hospital. He had planned on retiring last July at 60 but decided to keep working — in part to get health insurance through his employer.
On the day of Clinton's September 1993 speech, Chiles doubted Americans would give up any of the expensive care they were used to. Today he's ready to give it a try because the present system, he says, isn't sustainable.
"At some point, there has to be some limit on what we think we can do in health care," he says.
Health care costs, combined with the economic downturn, have caused Don Shuman to cut his small payroll from seven people in 1993 to just three today.
Then, "the economy was rocking and rolling. We were making money hand over fist," says Shuman, who has run Shuman Builders since 1974. His workers had excellent health benefits, he says. As a result, he opposed the Clinton plan, fearing it could lead to higher costs and fewer benefits.
Now, he has been forced to switch carriers and increase deductibles and co-payments, yet he's paying $6,600 a month.
"Change is inevitable, and this is the closest that we've ever come," says Shuman, 66. "If we don't do anything at all, we've missed an opportunity."
'Times have greatly changed'
Personal experiences with the health care system since 1993 have convinced many people that something has to be done.
Lynne Brauser ran a general store in Bradford, Pa., in 1994 and worried that a redesigned health care system would force her to pay her three employees' insurance premiums. "I don't believe Clinton's plan," she said then.
Since then, her husband had a serious illness requiring three months in the hospital, and the couple's insurance paid most of the costs — something she says the uninsured deserve. She also worked as a registered nurse and saw how the uninsured get care today — in the emergency room.
"Times have greatly changed," Brauser, 60, says. "I honestly think that we do need some type of change."
It took a death in the family to convince Judy Grabinski of Rockham, S.D., that insurance coverage should be expanded. The last time Congress considered it, her mother-in-law, Sharon Grabinski, was an uninsured cook in Faulkton, S.D., with diabetes and Raynaud's disease, which reduced circulation to her hands and feet.
In 1994, Sharon Grabinski succumbed to uterine cancer. If the types of low-income subsidies under consideration at the time had been available earlier, Judy Grabinski says, they could have helped pay for regular checkups.
"Some type of reform should be done," Judy Grabinski, 41, says. "Screening should maybe be available for all people."
Barely 12 hours after Clinton unveiled his plan in 1993, Rhonda Yeagerwas treated to a personal sales job by then-Treasury secretary Lloyd Bentsen on the concrete production floor at Philadelphia's Stockwell Rubber. She didn't buy it.
"I think we're all going to get smacked," Yeager said after Bentsen's pitch.
Since then, Yeager's father was diagnosed with Parkinson's disease, and neither Medicare nor his private supplemental policy pays for his full $479 monthly drug bill. Then she was diagnosed with lupus, a chronic autoimmune disease that is causing numbness in her legs, and the costs for medical tests and treatments are mounting.
"We're just going completely broke with the co-payments," says Yeager, 43, who still works at Stockwell, as a finisher.
"At this time, everybody is heading for trouble in terms of medical coverage," she says. "I see it getting worse."
For most of those who date back to Clinton's effort, cost was the big concern then and now.
Maryan Kearney noticed it in 1993 when son John's birth cost the family three times as much as her son Robbie's birth 11 years earlier. She notices it today because her father was billed $8,000 for eight hours in the emergency room with stomach pain, her 27-year-old son struggles to pay his premiums on the individual market, and another son can't afford insurance at all.
"Things have gotten very far out of hand," says Kearney, 53, a dental hygienist in Culpeper. "I don't know how we're ever going to fix it."
It cost David Cousens $546 a month to insure his family in 1993, when his lobsters were bringing in $2.70 a pound. Today, he's paying about $1,200 a month for health insurance. Lobsters? Just $2.50 a pound.
That's the main reason why Cousens, president of the Maine Lobstermen's Association, has shed the hesitation he voiced to Hillary Rodham Clinton during a Boston forum in 1993 and now supports Obama's efforts. It's not the only reason. He wishes he could afford to provide coverage for his one employee. And he regrets that his two children, ages 27 and 23, can't afford it, either.
"I think we need to get it done," says Cousens, 51, of South Thomaston. "Is it going to be perfect? No way. But it's got to be better than what we have now."
'Each one of us is at risk'
In 1993, Eugene Wigglesworthhad five auto repair shops in Vancouver, Wash., and a message for President Clinton. "Call me," he said at the time. "Get back in touch with the people making the jobs."
Sixteen years later, his opposition to changing the health care system has subsided. He and his wife just switched carriers for their Medicare supplemental policy. The old policy was going from $121 to $175 a month and dropping his sole medication.
"I think it's absolutely essential that we get health care reform," says Wigglesworth, 66. "There's just no getting around it now."
Illinois family physician Arvind Goyalread the entire Clinton plan in 1993 and determined that it would "destroy the practice of medicine as we know it." He brought his concerns to the American Medical Association.
Since then, Goyal informally polled his doctors at Northwest Community Hospital in Arlington Heights, Ill., where he chaired the family medicine department. Faced with reduced reimbursements, liability insurance premiums and overhead costs, he found, 30% of them had dropped health insurance for themselves, their families or employees.
"That amazed me," says Goyal, now 61. "These people would be at tremendous risk if they were hospitalized."
With 10% unemployment nationally, Goyal says, "our employer-based system is not protecting us. Each one of us is at risk."
Can government help?
Despite complaints about medical care and rising costs, some of those who opposed Clinton in 1993 see a repeat performance from Obama.
Richard Lee ran his own business, Gayheart's Drugstore, in Culpeper in 1993. Clinton's plan, he said then, would have meant higher insurance costs and more paperwork. Since then, Lee sold the business because insurance reimbursements were late and inadequate. He became the pharmacist at Culpeper's Safeway, a company that has taken costs into its own hands by offering lower premiums to employees who are in good health and offering generic drugs for $4 per month.
"The insurance companies and the drug companies are driving the health care system, and that's not the way it should be," Lee, 55, says. But with reform, he says, "the cost is going to climb."
Dorothy Crone didn't hesitate when she learned Democrats planned to cut Medicare to help pay for their plan. She ran out and got the surgeries she needed.
"I'd advise anybody nearing their 70s, if they have to get any work done, they better get it done while they can," she says.
Crone, a former small businesswoman from Horseshoe Bend, Ark., complained to her congresswoman about the Clinton plan in 1994. Today she's more convinced that government is the problem. "When has anything that the government does saved money?" she says.
Kentucky accountant Kenneth Wolfecomputes the tax burden for small businesses for a living. In 1993, it didn't take him long to predict that Clinton's health care plan would force some of them out of business.
When it comes to Obama's plan, Wolfe, 63, hasn't changed his mind. Still, he's convinced the current system doesn't work. Wolfe pays about $15,000 a year to insure himself, his wife and son, plus co-payments. He wants a high-deductible plan that isn't offered in Kentucky but in Ohio, within "rock-throwing distance" of his Park Hills home.
For Wolfe and many others, the need for cost controls remains paramount. He recalls going to the hospital for a small outpatient procedure and asking what it would cost. "You'd have thought I just landed from Mars," he says. "She said, 'Nobody's ever asked that before.'
Health care reform may hurt hospital credit
NEW YORK (Reuters) – High-cost urban U.S. hospitals may face debt rating downgrades if large cuts to Medicare funding are implemented as part of U.S. health care reform, Moody's Investors Service said on Monday.
The U.S. Senate voted on Saturday to debate a reform bill two weeks after the House of Representatives passed its own version of a bill. Both bills seek to expand the number of insured patients, while reining in future health care costs.
"Achievement of these goals will affect hospitals in different ways, but cost control measures could be especially negative for the credit position of many high-cost urban hospitals even if the number of insured patients expands," Moody's said in a report.
The push to cut costs is driven by the rising costs of Medicare, the federal health care program for the elderly.
Research shows there are massive cost differences between hospitals in different regions. A recent report by Dartmouth College revealed costs per Medicare enrollee ranged from $5,300 to $16,000 in 2006.
Most of the 17 highest cost hospitals are in urban or densely populated areas, which tend to have a higher cost of living, higher poverty and unemployment levels, diverse populations with diverse health care needs and expensive research arms.
The cost differences also highlight the local nature of health care markets with most hospitals drawing more than 90 percent of patients from a 50-mile radius.
If reform involves large Medicare cuts, the best-placed hospitals are those that are part of multi-state systems that have economies of scale or those that gain the most new patients with health insurance.
"The most vulnerable hospitals will be stand-alone hospitals dependent on high cost referral practices and which do not gain many new paying patients," the agency said.
The U.S. Senate voted on Saturday to debate a reform bill two weeks after the House of Representatives passed its own version of a bill. Both bills seek to expand the number of insured patients, while reining in future health care costs.
"Achievement of these goals will affect hospitals in different ways, but cost control measures could be especially negative for the credit position of many high-cost urban hospitals even if the number of insured patients expands," Moody's said in a report.
The push to cut costs is driven by the rising costs of Medicare, the federal health care program for the elderly.
Research shows there are massive cost differences between hospitals in different regions. A recent report by Dartmouth College revealed costs per Medicare enrollee ranged from $5,300 to $16,000 in 2006.
Most of the 17 highest cost hospitals are in urban or densely populated areas, which tend to have a higher cost of living, higher poverty and unemployment levels, diverse populations with diverse health care needs and expensive research arms.
The cost differences also highlight the local nature of health care markets with most hospitals drawing more than 90 percent of patients from a 50-mile radius.
If reform involves large Medicare cuts, the best-placed hospitals are those that are part of multi-state systems that have economies of scale or those that gain the most new patients with health insurance.
"The most vulnerable hospitals will be stand-alone hospitals dependent on high cost referral practices and which do not gain many new paying patients," the agency said.
Schumer: Dems ready to go-it-alone on health care
WASHINGTON – A leading Senate Democrat said Monday his party is determined to push through a health care overhaul bill with or without Republican support because the "system is broken." "We prefer to go at it with Republicans if we can reach compromises in some areas," said Sen. Charles Schumer, D-N.Y. "But we're not going to not pass a bill."
Schumer dueled with Republican Sen. Kay Bailey Hutchison on a network morning news show in the wake of a key Senate vote Saturday night that advanced a 10-year, $959 billion health bill to full debate. Hutchison argued that "you're going to put taxes and mandates on business" that would be a drag on an economy still struggling to recover from recession.
Congressional Democrats are trying to resolve differences within their rank and file over abortion, taxes and letting the government sell health insurance as a competitor with private insurers. Those are all crucial policy questions, and House and Senate Democrats have taken conflicting approaches.
Appearing on NBC's "Today" show Monday, Schumer said, "We all know we have to give a little. ... If we don't do anything, that is the worst situation, and we have a good bill." He said lawmakers must come together because "the health care system is broken."
Schumer argued that Republican critics "haven't put any alternative on the floor."
Hutchison called it "a terrible idea at this time." She said that Republicans "have put alternatives on the floor," including individual tax credits that would not include cutting Medicare and permitting a government takeover of the health care system.
Hutchison is challenging incumbent Republican Rick Perry for Texas' governorship and is a near certain vote against any Democratic health care plan. However, Senate leaders hope to persuade moderate Sen. Olympia Snowe, R-Maine, who voted for a Democratic bill in the Finance Committee, to back final legislation.
The Democratic measures would leave 12 million or more eligible Americans uninsured. Many middle-class families who'd now be required to buy coverage would still find the premiums a stretch, even with government aid. A new federal fund to provide temporary coverage for people with health problems would quickly run out of cash.
For now, these bread-and-butter concerns take a back seat to more pressing issues for Democratic lawmakers trying to deliver on President Barack Obama's signature issue.
The House passed its health care bill 220-215 earlier this month. The Senate cleared the way Saturday for debate on legislation unveiled by Majority Leader Harry Reid, D-Nev. The bill, a compromise between two committee-passed versions, could undergo significant changes as senators amend it during weeks of arduous debate ahead.
Both bills would require all Americans to carry health insurance, with government help to make premiums more affordable. They would ban insurance companies from denying coverage or charging more to people with health problems. They would set up new insurance markets for those who now have the hardest time finding and keeping coverage — self-employed people and small businesses. Americans insured through big employer plans would gain new consumer protections but wouldn't face major changes. Seniors would get better prescription coverage.
"For the first time, we're going to allow American consumers to be involved in a buyers' market for health insurance," said Sen. Chris Dodd, D-Conn., one of the authors of the Senate bill. "This Congress is going to pass, and this president is going to sign, a national health care program for all Americans."
Before any signing ceremony, lawmakers must clear some tall hurdles.
On abortion funding, the House adopted strict limitations as the price for getting anti-abortion Democrats to vote for the final bill. Abortion rights supporters are backing Reid's approach in the Senate bill, which tries to preserve coverage for abortion while stipulating that federal dollars may not be used except in cases of rape, incest, or to save the life of the mother.
In the end, Reid may have to bend. Catholic bishops say they can't accept his approach because it would let federally subsidized plans cover abortion. They vow to oppose the health care bill unless, like the House, the Senate enacts stronger language. Democratic senators opposed to abortion are already threatening a battle.
On financing, the House relies mainly on an income tax hike for upper-earners to pay for expanded coverage. The Senate opted for a tax on high-cost insurance plans, a Medicare payroll tax hike on the wealthy and fees on medical industries. In polls, the House approach is more popular. The Obama administration has signaled it likes the Senate's insurance tax.
That leaves the controversy over a creating a government health plan to compete with the insurance industry. It has dominated the debate and remains unresolved.
Both House and Senate bills now provide for a government insurance plan, but Reid's bill would let states opt out. It's not clear that Reid has the votes. He may be able to get a compromise to allow a government plan only if, after a reasonable time, insurance companies fail to deliver lower premiums.
Resolving these policy issues would be a historic accomplishment for Democrats. But the bill could still leave consumers feeling a little cheated.
Schumer dueled with Republican Sen. Kay Bailey Hutchison on a network morning news show in the wake of a key Senate vote Saturday night that advanced a 10-year, $959 billion health bill to full debate. Hutchison argued that "you're going to put taxes and mandates on business" that would be a drag on an economy still struggling to recover from recession.
Congressional Democrats are trying to resolve differences within their rank and file over abortion, taxes and letting the government sell health insurance as a competitor with private insurers. Those are all crucial policy questions, and House and Senate Democrats have taken conflicting approaches.
Appearing on NBC's "Today" show Monday, Schumer said, "We all know we have to give a little. ... If we don't do anything, that is the worst situation, and we have a good bill." He said lawmakers must come together because "the health care system is broken."
Schumer argued that Republican critics "haven't put any alternative on the floor."
Hutchison called it "a terrible idea at this time." She said that Republicans "have put alternatives on the floor," including individual tax credits that would not include cutting Medicare and permitting a government takeover of the health care system.
Hutchison is challenging incumbent Republican Rick Perry for Texas' governorship and is a near certain vote against any Democratic health care plan. However, Senate leaders hope to persuade moderate Sen. Olympia Snowe, R-Maine, who voted for a Democratic bill in the Finance Committee, to back final legislation.
The Democratic measures would leave 12 million or more eligible Americans uninsured. Many middle-class families who'd now be required to buy coverage would still find the premiums a stretch, even with government aid. A new federal fund to provide temporary coverage for people with health problems would quickly run out of cash.
For now, these bread-and-butter concerns take a back seat to more pressing issues for Democratic lawmakers trying to deliver on President Barack Obama's signature issue.
The House passed its health care bill 220-215 earlier this month. The Senate cleared the way Saturday for debate on legislation unveiled by Majority Leader Harry Reid, D-Nev. The bill, a compromise between two committee-passed versions, could undergo significant changes as senators amend it during weeks of arduous debate ahead.
Both bills would require all Americans to carry health insurance, with government help to make premiums more affordable. They would ban insurance companies from denying coverage or charging more to people with health problems. They would set up new insurance markets for those who now have the hardest time finding and keeping coverage — self-employed people and small businesses. Americans insured through big employer plans would gain new consumer protections but wouldn't face major changes. Seniors would get better prescription coverage.
"For the first time, we're going to allow American consumers to be involved in a buyers' market for health insurance," said Sen. Chris Dodd, D-Conn., one of the authors of the Senate bill. "This Congress is going to pass, and this president is going to sign, a national health care program for all Americans."
Before any signing ceremony, lawmakers must clear some tall hurdles.
On abortion funding, the House adopted strict limitations as the price for getting anti-abortion Democrats to vote for the final bill. Abortion rights supporters are backing Reid's approach in the Senate bill, which tries to preserve coverage for abortion while stipulating that federal dollars may not be used except in cases of rape, incest, or to save the life of the mother.
In the end, Reid may have to bend. Catholic bishops say they can't accept his approach because it would let federally subsidized plans cover abortion. They vow to oppose the health care bill unless, like the House, the Senate enacts stronger language. Democratic senators opposed to abortion are already threatening a battle.
On financing, the House relies mainly on an income tax hike for upper-earners to pay for expanded coverage. The Senate opted for a tax on high-cost insurance plans, a Medicare payroll tax hike on the wealthy and fees on medical industries. In polls, the House approach is more popular. The Obama administration has signaled it likes the Senate's insurance tax.
That leaves the controversy over a creating a government health plan to compete with the insurance industry. It has dominated the debate and remains unresolved.
Both House and Senate bills now provide for a government insurance plan, but Reid's bill would let states opt out. It's not clear that Reid has the votes. He may be able to get a compromise to allow a government plan only if, after a reasonable time, insurance companies fail to deliver lower premiums.
Resolving these policy issues would be a historic accomplishment for Democrats. But the bill could still leave consumers feeling a little cheated.
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