Wrap-up of the Bipartisan Summit and Intro to Reconciliation

The President's bipartisan healthcare summit has just wrapped up. What we saw today was the President and Congressional Democrats clearly lay out their vision and arguments for why the legislation they've passed should become law, and how it will help the American people. Unfortunately, for the most part, we heard the same song and a different verse from Congressional Republicans that simply want the President and proponents of health reform to give up.

Senator Cornyn put out a statement attacking the bill because of its cost to Texas. What he didn't note was that for every dollar the state will spend for Medicaid expansion, we'll receive $9 from the federal government to match it. Texas is clearly a winner under the President's plan, and we've reached the point where Senator Cornyn and his Republican obstructionist allies need to either lead or get out of the way.

The Congressional reconciliation process has made headlines lately as a possible track for Democrats to pass health care reform. Reconciliation is not a new concept, and it's not a "nuclear option". It's been used to pass significant legislation 21 times since 1981, 16 times by Republicans. President Bush used the budget reconciliation process to pass his 2001 and 2003 tax cuts and his Medicare Part D plan. This process was also used to pass COBRA- which lets individuals who lose their jobs continue employer sponsored coverage for 18 months- to enact most major Medicaid reforms, to pass the 1996 welfare reform, and to create the State Children's Health Insurance Program (CHIP).

Below, I've included an article from NPR that details the reconciliation process and some of the many instances it has been used to pass legislation.

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Health Care No Stranger To Reconciliation Process
by Julie Rovner
February 24, 2010

To reconcile or not to reconcile — when it comes to a health overhaul bill, that seems to be the biggest argument of the moment.

At issue is a process called budget reconciliation. By writing Obama's health care plan as a budget bill, Democrats can prevent a Republican filibuster in the Senate and advance the bill with a simple majority instead of the 60-vote supermajority they no longer have.

Not surprisingly, that has Republicans crying foul. Budget reconciliation, Sen. John Kyl (R-AZ) told reporters Tuesday, "was never designed for a large, comprehensive piece of legislation such as health care, as you all know. It's a budget exercise, and that's why some refer to it as the 'nuclear option.'"

"The use of expedited reconciliation process to push through more dramatic changes to a health care bill of such size, scope and magnitude is unprecedented," Sen. Orrin Hatch (R-UT) wrote in a letter to President Obama on Monday, urging him to renounce the possibility of trying to pass a bill using the procedure.

But health care and reconciliation actually have a lengthy history. "In fact, the way in which virtually all of health reform, with very, very limited exceptions, has happened over the past 30 years has been the reconciliation process," says Sara Rosenbaum, who chairs the Department of Health Policy at George Washington University.

For example, the law that lets people keep their employers' health insurance after they leave their jobs is called COBRA, not because it has anything to do with snakes, but because it was included as one fairly minor provision in a huge reconciliation bill, she says.

"The correct name is continuation benefits. And the only reason it's called COBRA is because it was contained in the Consolidated Omnibus Budget Reconciliation Act of 1985; and that is how we came up with the name COBRA," she says.

COBRA, which confusingly did not become law until 1986, was actually a much larger bill, including many nonhealth provisions and many other important health provisions as well (see chart). Among them was the so-called Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals that accept Medicare or Medicaid payments to at least screen patients who arrive for emergency treatment, regardless of their ability to pay.

Children's Health

But the budget reconciliation process has been used for more far-reaching health policy changes as well, says Rosenbaum. The expansion of health insurance coverage for low-income children is a prime example.

"In 1980, children who were living at less than half the poverty level in the United States could not get a Medicaid card in half the states if they had two parents at home," she says.

But via a series of budget reconciliation bills, beginning in 1984, Congress began expanding Medicaid coverage. In 1997, also in a budget reconciliation bill, it created the Children's Health Insurance Program, known as CHIP. Today, says Rosenbaum, who helped write many of the children's health provisions in those bills, Medicaid and CHIP together cover 1 in every 3 children in the United States.

"So literally we've changed everything about insurance coverage for children and families, and we've changed access to health care all across the United States all as a result of reconciliation," she says.

Medicare Changes

Budget reconciliation has also been an important tool for changing the Medicare program.

"Going back even close to 30 years, if you start say in 1982, the reconciliation bill that year added the hospice benefit, which is very important to people at the end of life," says Tricia Neuman, vice president and director of the Medicare Policy Project for the Kaiser Family Foundation.

Over the years, budget reconciliation bills added Medicare benefits for HMOs, for preventive care like cancer screenings; added protections for patients in nursing homes; and changed the way Medicare pays doctors and other health professionals.

Because the point of budget reconciliation was usually to cut the deficit, the huge Medicare program was nearly always on the chopping block. But there's another reason it became the bill of choice for other far-reaching changes.

"This happened primarily because it was the only train leaving the station, so if policymakers wanted to make a change in health policy, the only way to do it would be to amend a reconciliation bill, and that's really why it happened," says Neuman, a former congressional health policy staffer.

In fact, over the past three decades, the number of major health financing measures that were NOT passed via budget reconciliation can be counted on one hand. And one of those — the 1988 Medicare Catastrophic Coverage Act — was repealed the following year after a backlash by seniors who were asked to underwrite the measure themselves.

So using the process to try to pass a health overhaul bill might not be easy. But it won't be unprecedented.

Visits with Biden, Sebelius, Duncan and Others in DC

Yesterday afternoon I sat down with around 30 local and state officials from across the country at a three hour interactive briefing from senior White House staff, Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan. Afterwards, I attended a reception and dinner hosted by Vice President Joe Biden and his wife at the Vice President’s Residence.

The issue briefing on the administration’s policy priorities was wide ranging, but focused on a common theme: strengthening America in tough times and creating a foundation for the future. As we heard about health care, public health, strengthening our education systems, economic policy, job creation and urban and rural initiatives it was clear that to remain competitive on the world stage we must continue to move America forward and build strength during one of the worst recessions in our nation’s history.

Secretary Sebelius gave a presentation on health care, focusing specifically on public health. Health intervention, reducing obesity, the general health of our nation’s people – across the board these priorities are key to advancing our country and rebuilding our economy.

Secretary Duncan stressed that education is paramount for our nation, education systems must empower our children to become productive adults and good parents. We as a nation must ensure that they have the education to compete globally.

The two Cabinet Secretaries said we have to make sure we're building the best America possible because we're losing our competitive edge with other nations. Other countries have invested in their health care and education systems, meaning they’ve invested in their future. We must do the same.

We heard from the President’s Council on Economic Advisors. They’ve been busy over the last year, working hard to save the economy in our country. Obviously, rescuing our struggling economy has been the most important item on the agenda because this affects all individuals. As any of my colleagues in the Texas Legislature could tell you, without the stimulus funds our state would have been over $12 billion in the hole. The stimulus served to create millions of jobs and stabilize the freefall that our businesses, and local and state governments were facing.

The administration has taken on wide ranging issues like health care, jobs and education, because taken as a whole, they will serve to move our country forward and keep us competitive across the globe. These issues filter down throughout every aspect of our lives – working together we can ensure that our future remains bright.

This was all capped off with a small reception of around 30 people hosted by Vice President Joe Biden and his wife, Dr. Jill Biden, at their home. Mayors, county commissioners and state legislators from around the country participated as we celebrated Black History Month.

It’s encouraging that the White House is reaching out so well to state and local officials to ensure they understand policies being worked on in Washington, D.C. and have a voice in the process. I’ll be in town for a couple more days, and I’ll continue to report back everything I hear.

We're Closer To Health Care Reform Than We've Been In Decades

Last night I landed in Washington, D.C. While I'm here, I'll be meeting with leaders to do whatever I can to aid in giving health care reform the push it needs to get over the finish line.

In part because of the work you and I have done, members of Congress have passed a health care bill out of both the House and the Senate. We've sent letters, made calls, met with leaders and voiced our support to anyone that will listen. Our efforts have had an effect. People are listening and are regrouping to close the deal.

To share our perspective on the health care challenges in our state, I sent a letter to the Secretary of Health and Human Services, Kathleen Sebelius. I wrote to ensure that the voices of Texans were heard above the din of Republican opposition from those like Governor Perry. Below you can read the letter I received in response from Secretary Sebelius. To view the full correspondence, click here.

Tomorrow, the President will convene a bipartisan summit on healthcare reform to break through the partisan logjam that has stalled us over the last few weeks. The meeting will be broadcast on national television Thursday at 9 a.m. I encourage you to tune in or watch it streamed live at WhiteHouse.gov. On Monday, the President laid out his vision for a health care reform bill that builds on the legislation passed by the Senate. You can read that plan here.

We've come too far to start over. Keep up the good work, and thank you for allowing me to serve you. I'll continue to keep you informed as we move forward.

Garnet

President Obama's Health Care Proposal

This morning, President Obama released a carefully crafted health care proposal that bridged the gap between the versions passed by the U.S. Senate and House. You can read that plan here. Understanding that we have come too far to start over, the President is pointing to his proposal as a starting point for the televised health care summit on Thursday.

The proposal would offer bigger subsidies to help working Americans purchase health coverage, and give billions in tax credits so small businesses could offer insurance to their employees. President Obama's plan would offer additional federal dollars to states for Medicaid expansion and ensure that all states are treated equally. It would stop deplorable insurance industry practices like denying coverage because of a pre-existing condition, and would give the federal government authority to stop egregious premium increases. Particularly during a recession, Americans understand the importance of this government oversight. Despite making massive profits, health insurance companies are enacting outrageous premium increases. Last week, Health and Human Services Secretary Kathleen Sebelius pressured a California health insurance company to delay a 39 percent premium increase it planned to implement on some of its customers.

President Obama has demonstrated his commitment to American families. His plan will help close the gap that has left millions of Americans uninsured and underinsured. It will also stabilize our economy by reducing the federal deficit by $100 billion over the next ten years.

Bipartisan Health Care Summit

A week from today, the White House will host a televised health summit with top Democratic and Republican leaders, in hopes of coming up with a deal to move forward with health care reform. House and Senate Democratic leaders have been crafting a proposal, and President Obama is expected to release a single Democratic plan for reform on Monday. There is currently an effort on the part of Democratic Senators to allow a vote in the reconciliation process to pass a public option. As of now, 18 Democratic Senators have signed a letter requesting the vote, and more are expected to sign. So far, Republicans have not submitted proposals to move forward on health care.

While our families, hospitals, and state and local governments continue to struggle with out of control health care costs, health insurance companies are reaping massive profits. The profits of the 5 largest health insurance companies increased 56%.

If our broken health care system is not reformed, American families will continue to see staggering health care costs and will remain at risk of losing their health care. The head of the National Association of Insurance Commissioners predicts that consumers in several states are about to get hit with increases of “20, 25, 30 percent.” Hospitals will continue to be burdened with tens of billions of dollars of uncompensated care to uninsured and underinsured patients.

Insurers across the country are spiking their rates despite the recession:

• In 2009, Blue Cross/Blue Shield of Michigan requested approval for premium increases of 56 percent for plans sold on the individual market.
• Anthem of Connecticut requested an increase of 24 percent last year, which was rejected by the state.
• In Maine, Anthem Blue Cross is seeking to raise rates by 23 percent this year---after jacking up their rates 32 percent last year.
• Regency Blue Cross Blue Shield of Oregon requested a 20-percent premium increase.
• UnitedHealth, Tufts, and Blue Cross requested 13- to 16-percent rate increases in Rhode Island.
• And rates for some individual health plans in Washington increased by up to 40 percent until Washington State imposed stiffer premium regulations.

It is time to pass health insurance reform that will rein in insurance companies, provide more affordable options, protect Americans from abusive insurance company practices and restrict how much of your premium dollars can be spent on profits and overhead.

Anniversary of SCHIP Reauthorization

Today marks the first anniversary of President Obama's reauthorization of the State Children's Health Insurance Program (CHIP). The expansion of the program was crucial to providing health insurance to children from working families, and is expected to cut the number of uninsured children in our country by half in the coming years.

The reauthorization of the program was one of President Obama's first orders of business upon taking office and was particularly meaningful after President George W. Bush twice vetoed similar legislation. President Obama called the expansion a down payment on quality, affordable health care for all Americans.

In Texas, 495,781 children rely on CHIP to access health care. January was the only month that Texas' enrollment levels exceeded 500,000 since 2003, when Republican lawmakers instituted enrollment barriers that purged hundreds of thousands of eligible children from the program. The federal government gives Texas $2.52 for every $1 we invest in the program.

During the 81st Legislative Session, I authored legislation to increase enrollment in and public awareness of CHIP. My bill would have insured an estimated 80,000 Texas children from working families by allowing their parents to buy in to the program. Despite bipartisan support in both the House and the Senate, political action by the Governor, conservative Republicans, and Senate leaders caused this bill to die in a Senate committee. As one of the original authors of CHIP in Texas, I will continue to work to eliminate the red tape that keeps eligible children from receiving health care.

Today, we have 495,781 reasons to thank President Obama.

DNC Appointment and Round-Up of Awards

The Democratic Legislative Campaign Committee (DLCC), a national organization that works to elect Democratic majorities in state legislative chambers across the country, has appointed me to serve as a member of the Democratic National Committee (DNC). I was appointed by virtue of my position as a current board member of the DLCC, where I've been representing the interests of Democratic state legislators nationally by helping to develop state-specific strategies that will enable Democrats to win state legislative seats and chambers. My appointment to the DNC is a responsibility that I take seriously, and I look forward to working with fellow members to continue to build on the successes of the Democratic Party. As a member of the DNC I'll have the opportunity to vote on party rules, work on the party platform, and, as a superdelegate, re-nominate President Obama and Vice President Biden in 2012.

Some of my colleagues in the Legislature were elected as DNC members through the Texas Democratic Party process. They include Senator Royce West, Representative Yvonne Davis, Representative Senfronia Thompson, and Council Member Sue Lovell.

Additionally, Speaker Straus has nominated me to serve on the Minority Health Advisory Committee of the National Conference of State Legislatures. Today, I'm flying to Tampa to meet with this committee and review and strategize on objectives that will move us toward health equity. I consider it a privilege that Speaker Straus has entrusted me with this duty, and will represent our state to the best of my abilities.

It is because of your support and participation that I have been able to best execute my responsibilities. This past year, I was deeply honored to receive the acknowledgment of many statewide organizations. Some of those recognitions include:

• Texas Medical Association's 2009 Friend of Medicine Award
• Texas Academy of Family Physicians' 2009 Patient Advocacy Award
• Texas Hospital Association's 2009 Advocacy Tribute Award
• Texas Association of Counties 2009 Champion of County Government Award
• Capitol Inside Honorable Mention in Best of the Legislature 2009
• Named 2009 People's Friend by the Texas Observer
• Mental Health America of Greater Houston 2009 Legislative Award
• Cenikor's Annual Elected Official Award, September 2009
• Harris County Medical Society's Patient Care Champion Award
• The Gathering Place's Founder's Award

Thank you for all the support you have given me throughout the years. Together, we can continue to work to move Texas forward.

Health Care and the Federal Budget

Yesterday, President Obama submitted his 2011 federal budget proposal to Congress. Included in the budget proposal are some critical investments to health care.

Because of today's tough economic times, more people are enrolling in Medicaid. President Obama's budget proposal allocates $25.5 billion for Medicaid assistance to help states maintain their Medicaid programs as they increase enrollment rates. Community health centers, which currently help millions of uninsured Americans access health care, will receive an infusion of $290 million to continue their work. Additionally, $995 million dollars will be allocated to increase the number of doctors and nurses in rural and underserved areas.

The administration proposed to extend the federal COBRA health insurance premiums that are currently provided to Americans who have been involuntarily terminated. Under the proposed budget, the federal government would subsidize 65% of health care premiums for individuals laid off through December 31, 2010.

Some other key provisions include:

• $110 million for continuing efforts to strengthen health IT policy, coordination, and research activities.
• $286 million for research that compares the effectiveness of different medical options, building on the expansion of this research begun under Recovery Act.
• New Medicare demonstration projects that evaluate reforms to provide higher quality care at lower costs, improve beneficiary education and understanding
• $20 million to fund a new effort in up to 10 of the largest U.S. cities to reduce the rates of morbidity and disability due to chronic disease.
• $10 million to improve workforce capacity of state and local health departments.
• $10 million for the federal employee workplace wellness initiative. This initiative will implement prototype wellness programs in select locations that will be rigorously evaluated for their ability to produce a healthier workforce and lower health care costs.

President Obama and his administration are committed to expanding access to coverage for those without insurance, and to provide security and stability to those who have it.

Texas and the Federal Budget

The President's budget also allocates funds to benefit Texas and Texas families. Some of the key investments for our state include:

• Tax cuts for 8.4 million families.
• $5 billion for schools, students, and teachers.
• $4.2 billion to fix and expand the state’s network of roads and highways, modernize airports, and expand water and sewer infrastructure.
• $2.5 billion in new funding for Pell Grants to help families pay for college.
• $1.5 billion for housing assistance.
• Extend for another year the broadest tax cut in American history – the Making Work Pay Tax Credit – for 8.4 million families in Texas.
• Increase the child care tax break by providing a 35 percent credit for middle-class families earning up to $85,000 a year and at least some additional credit to families earning up to $113,000. Families could claim up to $3,000 in expenses for one child or $6,000 for two children. Many middle-class families with two children will see value of the credit nearly double, from $1,200 to $2,100.
• Expand child care funding for working parents by adding $1.6 billion to the Child Care Development Fund, the largest one-year increase in 20 years, to serve an additional 235,000 children. For Texas, the Budget includes $603.1 million in child care assistance.
• Deploy future TARP funds to assist homeowners threatened with foreclosure and small businesses needing access to affordable credit.

Click here to learn more about the federal budget and its investments in Texas.