The Cost of Doing Nothing

The Robert Woods Johnson Foundation released a report today projecting what would happen to the states within ten years if health care reform fails.

This important study exemplifies the failure of the status quo. In workplaces across Texas, because of skyrocketing insurance rates, you don't get a pay-raise, you simply get to keep your insurance. And the coverage provided to you is not as good as it was previously; the net result being that you pay more to get less.

The failure of reform will hurt Americans' pocketbooks and will crush state and local budgets. According to the study, the number of uninsured residents will increase if reform is not enacted. Additionally, the number of employers offering coverage will drop, out-of-pockets costs will skyrocket, and spending by states on public programs will drastically increase. These costs will likely be passed along to Texas businesses and taxpayers. Click here to read the full report from the Robert Woods Johnson Foundation.

An article in today's Houston Chronicle, Cost higher if health reform fails, study says, details the report's Texas specific findings. It found middle-income working families would be hardest hit:

"The study, which estimates how coverage and cost trends would change from now to 2019 if health care isn't reformed, found out-of-pocket expenses could increase by more than 35 percent in every state. . . . The effects in Texas within 10 years include:

• As many as 8.3 million residents would be uninsured, up from 6 million this year.
• The average resident's health care spending would increase as much as 81 percent.
• Employers' premiums would increase as much as 121 percent.
• Medicaid/Children's Health Insurance Program spending would increase as much as 117 percent.
• Uncompensated care would increase by as much as 138 percent."

Our families, businesses, and state and local governments cannot afford the status quo.

Update on Legislation

Yesterday, the Senate Finance committee took up a series of amendments to their version of the health care plan. Senators Jay Rockefeller and Chuck Schumer offered amendments to the bill that would have created a public option, and both were voted down. Senator Schumer noted during the debate that this was but one step in the legislative process, as the four other versions of the bill (one in the Senate and three in the House) all contain a version of the public option. Click here to read a summary from the Washington Post on yesterday's debate.

As the legislation makes it's way through the process, I will continue to update you on it's status.

Paying More and Getting Less

The 47 million uninsured Americans have often been at the center of the debate on health care reform. Less often talked about are the approximately 25 million underinsured Americans who have insurance with very limited coverage and spend a large share of their income on medical expenses. In 2008, an alarming 1.6 million Texans spent more than 25 percent of their income on health related costs, while another 5.3 million spent more than 10 percent.

A lack of adequate insurance coverage affects Americans at every income level, not just low-income individuals. Many Americans with insurance pay high deductibles, high out-of-pocket costs, and have annual and lifetime limits on health benefits. This problem has been exasperated by the current economic climate and rapidly increasing health care costs. More employers are no longer offering health coverage and many are changing to plans that offer less adequate benefits and require workers to pay more in costs.

Often it takes a catastrophic illness or event, like getting diagnosed with cancer, for a family to realize the huge flaws with the insurance status quo. According to a recent survey, 25 percent of individuals with cancer report using up all or most of their savings as a result of the financial burden of treating cancer. Treatment is so costly, that many patients delay treatment, having a devastating effect on their health. In Texas, 10 percent of people have diabetes and 28 percent have high blood pressure. Health insurance companies often use the presence of chronic conditions like cancer, diabetes, and high blood pressure to charge higher premiums and deny coverage.

Many individuals with insurance face the same problems as those who lack coverage altogether. More than half of underinsured individuals delay medical care because of costs, and 45 percent of the underinsured have difficulty paying medical bills.

In 2007, 62 percent of personal bankruptcies were caused by medical problems. The large majority of those filers - 78 percent- had health insurance when their illness started. Most of these individuals had gone to college and were from middle-income families.

National Public Radio interviewed an underinsured family whose 2008 medical costs totaled 45 percent of their income. Click here to read and listen to the full NPR story that details the struggles of an underinsured family in America.

Federal health insurance reform will increase stability and security for Americans with insurance and will lower the cost of health care for our families, our businesses, and our government. Health insurance reform will prevent any insurance company from denying coverage based on pre-existing conditions, will limit out-of-pocket costs, and would ban annual and lifetime limits on benefits.

Houstonians Need Health Coverage

On Saturday, 2,000 uninsured Houstonians visited Reliant Center to receive much needed free medical attention. The health clinic was hosted by the National Association of Free Clinics and Dr. Mehmet Oz, who chose Houston as a site because 1 in 3 Harris County residents are uninsured. Individuals attending included many who lost their insurance once they lost their jobs and those who could no longer afford their rising insurance premiums or deductibles. Dr. Oz called the current health crisis facing America, which has left millions of Americans without health care, a "national catastrophe." For more information, read yesterday's Houston Chronicle article, which includes a short video, here.

Meanwhile, it has been reported that a merged health insurance reform bill will emerge from the Senate Finance and Health, Education, Labor and Pensions committees and hit the Senate floor in mid-October. I will be there with my colleagues from the Progressive States Network to ensure passage of legislation that will insure millions of Americans and bring security and stability to those who are insured. I promise to keep you up to date as this important issue continues to progress.

County Level Data on Uninsured in Texas

Earlier this week I shared with you a story from the Houston Chronicle about new Census data that shows one in three adults in Harris County are without health insurance.

Today I wanted to forward your way an analysis of that data from Texas' state demographer, Dr. Karl Eschbach, that breaks down county by county the percentages of people without health insurance in Texas, which you can find by clicking here.

Dr. Eschbach also has created some Texas maps that reflect this new data, which you can find by clicking here (this data is based on the American Community Survey, which only covers counties with a population greater than 20,000, so it does not cover every county in Texas).

This sobering data only further emphasizes the need for health insurance reform; I am in Washington, D.C. this week working on health insurance reform as part of the White House Working Group of State Legislators for Health Reform, and promise to continue providing updates on this issue as they develop.

Update on Baucus Health Care Legislation

Yesterday, in Washington D.C., the Senate Finance Committee began the mark-up process on Chairman Max Baucus' health-care legislation. The modifications focus largely on making care more affordable for low- and middle-income Americans by increasing the Health Care Affordability Tax Credit, lowering the penalties for people who fail to meet the individual requirement to have health insurance and increasing the High Cost Insurance Excise Tax threshold for people whose basic health care is more expensive.

Some of the changes include:

• Easing the financial burden on families with income up to four times the federal poverty level. Families with income up to four times the federal poverty level would contribute on a sliding scale, between 2 and 12 percent of their income to their insurance premium.
• Americans making less than 133% of the federal poverty level would qualify for Medicaid.
• Reducing out-of-pocket limits for families between 200 and 300 percent of the poverty level to $7,973 annually.
• Lowering the amount by which insurance companies could vary premiums based on age.
• Making it easier for people who cannot afford the insurance offered by their employer to receive tax credits in a health insurance exchange.
• Ensuring the federal government pays for costs of expanding Medicaid in states with the largest populations of people who are on Medicaid.

Click here to view a complete list of modifications made so far to America's Healthy Futures Act of 2009.

Please remember that as the process continues, changes and modifications will continue to be made, and that this legislation is in no way a finished product.

This week, I am in Washington, D.C. working on health insurance reform as part of President Obama's State Legislators for Health Reform and promise to continue sending you updates on this issue as they develop.

Newsclips on Health Care and Other Issues

Below are some items in today's news that I thought you would find interesting. - Garnet

In the News

• Houston Chronicle: One in three adults in Harris County lacked health insurance in 2008 while Texas continued to have the highest rate of uninsured residents in the nation, the Census Bureau reported Monday.

• Houston Chronicle: Columnist Lisa Falkenberg interviews me for a column in which she notes that "[w]e may soon have to come up with a different word to describe 'other' in this fondue pot of a city. We're all minorities now. The latest numbers to tally Houston's journey of growth and diversification came Monday in estimates from the American Community Survey, a U.S. Census snapshot for 2008. They show whites, who made up 63 percent of Harris County's population in 1980, now are just 36 percent of the population."

Third Ward Featured on NPR's Morning Edition Tomorrow

I wanted to let you know that tomorrow morning National Public Radio's Morning Edition will be running a story (for which I was interviewed) on efforts in Third Ward to preserve the character of the neighborhood and mitigate gentrification.

It's one of several stories Steve Inskeep of Morning Edition is doing in Houston as part of his series "The Urban Frontier." Mr. Inskeep came to Houston to interview me after reading an article in Governing Magazine (which you can read by clicking here) about my efforts to mitigate gentrification in Third Ward. We spent four hours driving around the neighborhood, talking about the historical significance of the area and significance of the people who live there as well.

The first story aired this morning, which you can read and hear by clicking here. I hope you'll tune in to 88.7 FM tomorrow morning, from 5-9 am, to listen to the story.

Senate Finance Committee Chairman Introduces America's Health Future Act

Today, Senator Max Baucus (D-Montana), Chairman of the Senate Finance Committee, introduced health legislation to lower costs and provide quality, affordable health coverage to millions of Americans. This legislation would insure more than 30 million Americans, expand Medicaid, and would make it easier for working families to purchase health insurance.

Specific provisions in the bill would:

• Create health care affordability tax credits to help low and middle income families purchase insurance in the private market;
• Provide tax credits for small businesses to help them offer insurance to their employees;
• Allow people who like the coverage they have today the choice to keep it;
• Reform the insurance market to end discrimination based on pre-existing conditions and health status ;
• Eliminate yearly and lifetime limits on the amount of coverage plans provide;
• Create web-based insurance exchanges that would standardize health plan premiums and coverage information to make purchasing insurance easier;
• Give consumers the choice of non-profit, consumer owned and oriented plans (CO-OP);
• Standardize Medicaid coverage for everyone under 133 percent of the federal poverty level.

Health insurance reform cannot wait. New numbers released by the Department of Health and Human Services show that the number of uninsured increased from 39.8 million in 2001 to 46.3 million in 2008. In today's dismal economy, even more Americans are losing their insurance when they lose their jobs. Even individuals who have health insurance are struggling. In Texas, workers have seen their insurance premiums rise from $6,638 to $12,271, a 91.6 percent increase which far outpaces the 19.7 percent increase in wages.

Health insurance reform will provide quality, affordable options to individuals without insurance, and give security and stability to those who already do.

I will continue to keep you up to date on this issue at it progresses.

I'm in Washington Working to End Health Care Status Quo

Today I am in Washington, D.C., meeting with members of Congress on the best way to move forward with real health reform. As I've spoken with these Representatives, I've stressed that the time to act on health care reform is now. I'm heartened by the response, and after sitting down and working with members in Washington I am more committed than ever to ending the health care status quo.

For decades, Washington has allowed partisan point-scoring and special interest lobbying to crush reform. But the health care crisis facing American families isn't a Democratic issue or a Republican issue – it's a moral issue.

I've stressed in my meetings with members of Congress that President Obama's health insurance reform plan addresses three simple goals: If you have health insurance, it will give you more security and stability. If you don't have insurance it will give you quality, affordable options. And it will lower the cost of health care for our families, our businesses, and our government.

Also today, two new reports reiterate what many of you already know: that the health care status quo is unsustainable and that it's time for the kind of health insurance reform President Obama has proposed.

A new study published in the New England Journal of Medicine has found that more than 60% of doctors agree that health insurance reform should include a public option alongside private insurers to introduce choice and competition to the insurance market.

The new report from the Kaiser Family Foundation and Health Research and Educational Trust indicates that premiums for employer-sponsored health insurance have continued to rise.

Key findings from the Employer Health Benefits survey include:

• The average cost of a family policy in 2009 increased to $13,375. On average, employees pay $3,515 and employers pay $9,860.
• In the past ten years, health insurance premiums have increased by 131 percent in total, far outpacing wages or inflation, which have risen 38 percent and 28 percent respectively.

You can read the full report by visiting www.kff.org.

It's also worth noting that, in addition to doctors, a strong majority of Americans also favor the type of public option proposed by President Obama.

Opposition's Game Plan to Kill Federal Health Reform Legislation

At a time when thoughtful discourse is necessary, conservative organizations are encouraging inefficient and disruptive behavior in an effort to quash health reform. The documents below are examples of the opposition's game plan to tear down efforts that would lower health care costs and improve health care for all Americans.

• An RNC polling memo by Republican Strategist Alex Castellanos
• Frank Luntz' 10 rules for stopping health care reform
• A "Rocking the Town Halls" political action memo by Right Principles

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Below, please find examples of the opposition's methods in action. To download the below documents as PDF documents, click here and here.

Frank Luntz HealthCare Messaging: A Case Study

Background: Dr. Frank Luntz is a renowned pollster and messaging consultant for conservatives. In late May 2009, he released a set of ten rules for healthcare opponents, titling it "The Language of Healthcare 2009". The detailed rules in a 28 page memo are to be used to bring down healthcare reform. The rules and talking points have been used by Congressmen, political professionals, and other opponents of reform. The below press release is an example of Luntz' messaging.

Example is a recent press release from the Texas Medical Association (TMA). From TMA president William H. Fleming III, MD, regarding H.R. 3200, “America’s Affordable Health Care Choices Act of 2009,” Congressional legislation to reform America’s health care system. Analysis added in parenthesized bold, italics.

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The physicians of the Texas Medical Association believe our health care system is broken and needs reform. (Acknowledge the crisis or suffer the consequences, Luntz Rule #2)

However, we have concerns about the current House proposal, H.R. 3200, ‘America’s Affordable Health Care Choices Act of 2009.’ While it addresses some of health care’s ailments, it leaves gaping wounds which do not serve Texas patients well. (Humanize approach by mentioning patients, Luntz Rule #1)

“As physicians, our primary goal is to improve the health of our patients. We believe that patients and their physicians must be free to make choices that best fit their individual health care needs. This legislation severely limits those choices. (Protection of personalized doctor-patient relationship, One-size-does-not-fit-all, Luntz Rule #7)

“Therefore, TMA cannot support a proposal to create another government-payer health plan while existing government-payer plans, such Medicare, Medicaid, and the military health care program, TRICARE, are failing patients. (Arguments against Democrats must center around government, Luntz Rule#4)

We are deeply troubled there is no fix to the flawed Medicare funding formula, which limits seniors’ ability to see a doctor when they need to; and the absence of medical liability reforms, which provide greater access to care to Texas patients. We remain extremely concerned that the ‘public option’ will soon become the controlling payer in all health care (One-size-does-not-fit-all, Luntz Rule #7), resulting in an unworkable government price-setting scheme (Government waste and abuse, Luntz Rule #8) like we now see in Medicare. TMA physicians also are concerned that this plan limits at which hospitals patients can receive care. (Stress healthcare denial from government run healthcare plans, Luntz Rule #5)

“TMA physicians will continue to review and analyze H.R. 3200, and pledge to work with Congressional leaders and the Obama administration in crafting legislation that truly would improve health care ― the patient-physician relationship ― in the United States and Texas. As physicians, it is our ethical duty to provide leadership on these public policy decisions. (Not enough to say you are against, say you are working for solution, Luntz Rule #10)

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Delay, Delay, Delay - Common political strategy to 'kill bills without saying so'

"The Republican Party is trying to kill health care reform, and anyone in politics knows delay delay delay is one good way to do it"
-Garnet Coleman, Houston Chronicle, 7/30/2009

"The typical Washington bureaucratic game of, if you don't have a better alternative, just delay in the hope that that kills something, is partly what is playing out here…But there are those who are advocating delay just as a desperation move to try to kill this."
-White House budget director Peter Orszag, CNN 7/19/09

Republican, Conservative Groups Push Delay Effort

"The Republican National Committee will engage in every activity we can to slow down this mad rush while promoting sensible alternatives that address health care costs and preserve quality"
-RNC Internal Healthcare memo, 7/21/09 page 8

"Even voters who support a ‘public plan’ think Obama and Congress are moving too fast, with reckless speed, risking a huge part of our economy and our health care, when they don’t know what reform would really bring. If we slow this sausage-making process down, we can defeat it, and advance real reform that will actually help..”
-RNC Polling memo by Alex Castellanos 7/13/2009

"We can throw sand in the gears of the government-run health care scheme…Let's rededicate outselves by derailing the plan to give the federal government more power over our health care."
-Dick Armey, Freedomworks Healthcare Opposition Kit

"Throw the kitchen sink at the legislation now on the table, drive a stake through its heart, and kill it."
-Conservative Columnist William Kristol, 7/20/09

"Let's do it smart, not fast,"
-Former Bush Chief of Staff Andy Card, 7/21/2009

"[GOP Senators John McCain and Mitch] McConnell called for Congress "to step back, start over and think about incremental changes" to the health care system"
-GOP senators seek go-slow approach on health care, AP 9/1/2009

Health Care Leaders Echo the Message

"Believing that President Obama and Congress must slow down and get health system reform right, the Texas Medical Association has launched the "Me and My Doctor, We Know Best" patient-physician action campaign."
-Texas Medical Association front page website, www.texmed.org

"The priority should be, let's get it right, not let's get it done fast."
-Dan Wolterman, CEO, Memorial Hermann Health Care System, Houston Chron 7/29/09

"Texas Medical Center leaders Monday sent a message to Congress as it tries to reform America's troubled health care system: slow down…Two said the process ought to take years, perhaps involving a series of bills." -Texas Medical Center leaders, Houston Chron, 7/29/09