Federal reform update

With the Senate Finance Committee wrapping up its work early Friday morning, the Senate and House are now both poised to begin floor debates on health reform legislation (Source: “House, Senate Leaders Prepare for Floor Debate on Health Care,” Washington Post, Oct. 2, 2009).

Although Finance Committee Chair Sen. Max Baucus (D-Mont.) delayed a committee vote on the overall bill until this week, he said he has enough votes that he expects it to pass.

The committee is expected to reconvene for a final vote today or tomorrow. Senate Majority Leader Harry Reid (D-Nev.) then plans to merge the package with a measure approved by the Senate Health Committee and begin debate before the full Senate shortly after Columbus Day. The House also expects to begin action in mid-October.

Meanwhile, Obama Administration officials have continued to work behind the scenes to encourage for the inclusion of a public insurance option in the final Senate legislation (Source: “Obama quietly tries to shore up Senate support for public option,” Los Angeles Times, Oct. 5, 2009). The measure that goes to the floor will be an blend of the bills passed by the Finance and Health committees. The Health Committee bill contains a government insuance plan while the Finance Committee version does not. 

Study: States likely to pay more without reform
A new Robert Wood Johnson study estimates that without federal health reform, over the next 10 years the number of people without insurance could increase by more than 30 percent in 29 states (Source: “Without US healthcare plan, states could pay more,” Forbes/Reuters, Sept. 30, 2009).

Using their Health Insurance Policy Simulation Model, researchers from the Urban Institute estimate that under a worst-case scenario, the number of uninsured would increase by at least 10 percent in every state and businesses in every state would see their premiums increase—more than doubling in 27 states. And even in the best case scenario, employers in 46 states would see premiums increase by more than 60 percent, according to the Robert Wood Johnson Foundation report.

In Ohio, the report finds that under a worst-case scenario, the percentage of non-elderly Ohioans with employer-sponsored insurance would drop to 54.9 percent by 2019 and the percentage of uninsured would grow to 17.4 percent. And under a best-case scenario, employer-sponsored coverage would drop to 59.5 percent and the uninsured rate would grow to 14.9 percent. The study estimates that currently 61.4 percent of Ohioans have employer-sponsored coverage and 13.7 percent are uninsured.

U.S. trails other weathy nations in preventable deaths, study finds
Findings from a study published earlier this year that shows the U.S. lagging behind other industrialized nations in preventable deaths has gotten some renewed attention on Capitol Hill recently(Source: “U.S. Losing Ground on Preventable Deaths,” Washington Post, Oct. 6, 2009).

The Commonweath Fund study, which was published in the journal Health Affairs in January, found that despite spending $2.4 trillion a year on medical care, the United States trails other wealthy nations when it comes to preventable deaths

"All of these countries have much lower costs than we do," said Sen. Kent Conrad, (D.-N.D.), who during a Senate Finance Committee hearing last week pointed to a chart showing the United States in last place. "And they have higher quality outcomes than ours." 

Mark Pearson, head of the health division at the Organization for Economic Cooperation and Development, which analyzes data from dozens of countries, said the findings are further evidence that there is very little middle ground when evaluating the U.S. health care system.

"Where it's good, it's very, very good, and where it's bad, it's horrid," he said.

Report finds Massachusetts employers not dropping coverage
A new study concludes that in the first two years after Massachusetts’ landmark health reform legislation passed requiring employers to provide coverage or face penalties, access to employer coverage has increased and the quality of coverage has improved, according to a survey of workers (Source: “Massachusetts Health Reform: Employer Coverage From Employees' Perspective,” Health Affairs, Oct. 1, 2009).

However, premiums and out-of-pocket costs for employees of smaller firms have increased between the 2006 implementation of health reforms and the fall of 2008, when employees were surveyed for the study.

Contrary to concerns that quality of care has suffered since reform was enacted, employees reported higher satisfaction with care after reform. “Despite these increasing costs of coverage, however, workers in small firms, like their counterparts in larger firms, report continued satisfaction with their employer-sponsored health plans,” according the report.

Health Affairs also has published a policy brief examining whether federal reform should include an individual mandate. The report is titled, “Individual Responsibility: Should Congress require that most Americans have health insurance — and that they be subject to penalties if they don’t?”

Cleveland Clinic’s Cosgrove: Reform must go beyond coverage
Cleveland Clinic Chief Executive and President Delos “Toby” Cosgrove told a gathering in Washington last week that insurance and payment reform will not do enough to curb the unsustainable growth of medical costs (Source: “Doctor: U.S. Needs to Control ‘Tsunami of Obesity,’” CBS News, Oct. 1, 2009).

Current health care legislation "is about insurance reform and payment reform," Cosgrove said. "It is not health care reform."

Cosgrove said that bending the cost curve will require changing the delivery of care and reducing the disease burden in the United States. Of particular concern for Cosgrove is the combination of aging Baby Boomers and the increased availability of high-cost treatments.

"Add to that the situation where we maybe bring another 40 million people under coverage, you're going to see a continuing escalation of health care we're not going to be able to sustain at the present time," Cosgrove said. "We've got to figure out a way to do it more efficiently -- that's going to require doctors to be integrated with hospitals, and hospitals to be integrated with hospitals."