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Health Care Reform: We Got it Done

Moments ago, the U.S. House passed historic health care legislation. With President Obama's signature, health care coverage will be the law of the land.

Thanks to the members of Texas' Democratic Congressional Delegation for providing the votes and the hard work that got reform across the finish line. Their votes will help clean up the health care crisis in Texas that Rick Perry and Republican leaders have refused to address.

After years of being victimized by the colossal abuses of the health care status-quo, Texans and Americans scored a victory. The health care legislation passed today will give health insurance access to 31 million Americans and most of our state's 6 million uninsured residents.

Today's accomplishments take the advantage away from the insurance companies and put it back in the hands of Texans and the American people. No longer will Americans be driven into debt by health care costs, be denied coverage based on a preexisting condition, and be indiscriminately dropped from their policy when they’re sick and need it most.

Because of our dismal health standings, Texas stands to gain the most from this legislation. I intend to work hard to ensure that this legislation is implemented effectively in our state, so that quality health care becomes more affordable and more accessible for all of our families.

This legislation moves Texas and America forward. Our country is back on the right path.

Statistics tell a sobering story in black and white

Cartoon by RJ Matson

The U.S. House is expected to vote on health care legislation tomorrow afternoon. As I've said before, Texas has the most to gain from reform given our dismal health standings. Today's Houston Chronicle ran an op-ed that I wrote on the subject. You can read it here, or below. You can also read a version of my op-ed in Spanish here.

The Congressional Hispanic Caucus (CHC) has endorsed the health care legislation because it will increase access to coverage to millions of Americans including 8.8 million Latinos. Texas Congressman Charlie Gonzalez, the First Vice Chair of the CHC, stated “We are ready to make the historic vote that will improve the health of all Americans, including Hispanic Americans.” To read the press release from the CHC in its entirety click here.

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Statistics tell a sobering story in black and white
Dems’ health plan good for people and for business

By STATE REP. GARNET F. COLEMAN
HOUSTON CHRONICLE

Statistics tell a story, and when you look at the troubling health care numbers in our state, it's clear what that story is: Everything's bigger in Texas.

Whether you're looking at the 1.3 million uninsured residents of Harris County or the 7 million insured Texans who spend 10 percent of their income on health care, it's clear our state needs to head in a new direction. And when you see that a leading Texas economist says spending on health care has a short-term multiplier effect — meaning federal health care legislation would result in more than $400 billion in economic activity in Texas — it's clear our state could greatly benefit from federal health care legislation.

For the 18 years I've served in the Texas Legislature, I've worked on health care issues in our state. I've worked with Republicans and Democrats, suburban, rural and urban members, doctors, nurses, patients and all the insurance company bureaucrats in between. I've seen the best and the worst of our health care system, and I've come to the same conclusion as most Americans: The current system is unsustainable and in dire need of reform.

As I said, statistics tell a story, and being first in the nation for the number of uninsured says there are leaders in Texas who are hostile to reform and unwilling to ensure their constituents have health care. Enrollment in the Children's Health Insurance Program just recently reached the same level where we were in 2003 when Republican lawmakers slashed hundreds of thousands of children off the rolls. If we're fighting to remain competitive with 2003 levels, it's clear that it's up to the president and Congress to enact reform that will benefit all Americans, but most especially Texans.

Because the majority of Texas businesses are small businesses, it's necessary to remove the great burden they face under current law. Federal reform will ease the struggle for small businesses that have to choose between increasing health premiums on their employees or dropping their coverage altogether.

At times this whole Sisyphean endeavor can seem dismaying. Seven different times, seven different presidents have pushed this huge health care reform boulder to the top of a steep hill, only to see it roll back down again, sending us back to the beginning. I'm determined not to let this be the eighth time.

It's necessary to pull our heads out of the daily grindings of process stories and legislative minutiae and remember why we're in this fight. All Americans have fallen victim to our current health care system, not just the ones who are uninsured. We've all heard the stories about insurance companies not playing fair. At a time these companies are reaping record profits, they are unscrupulously raising their rates on customers.

Out-of-control costs are adding another load to the backs of families strapped for cash in a tough economy. Insured individuals are paying higher premiums, higher deductibles and out-of-pocket expenses, while receiving fewer benefits. Furthermore, they carry the additional burden of paying for the care of the uninsured who may be only one illness away from bankruptcy.

These sobering statistics emphasize the need to rewrite the rules in favor of the American people. The health care legislation in Congress is a carefully crafted package that will insure 32 million Americans, give unprecedented security and stability to those with insurance and cut the federal deficit by $1.3 trillion.

Health insurance reform will provide immediate relief to Texas families by preventing insurance companies from inexplicably and excessively raising their rates. It will cap the amount of money an individual can spend on out-of-pocket expenses, eliminate lifetime and unreasonable annual limits on benefits and ensure that families aren't driven into debt by health care costs. Additionally, it will stop insurance companies from denying coverage based on pre-existing conditions and prohibit insurance companies from kicking people off their policies when they're sick and need it most.

It's beyond clear that Texas needs federal health care reform. We'll continue to fight on a state level regardless of the outcome, but we can't really win the fight against the worst practices of the insurance industry without the help of our elected members of Congress and people of good will.

Let's get it done.

Coleman, a Houston Democrat, is a member of President Barack Obama's 32-member White House Working Group of State Legislators for Health Reform. He is also the chair of the County Affairs Committee in the Texas House of Representatives, chair of Progressive States Network, chair of the Legislative Study Group and senior ranking member of the Public Health Committee.

President Obama Committed to Immigration Reform

Please see below a note from Rebecca Acuna, a member of my staff.
-Garnet Coleman

As someone who holds immigration reform close to my heart, it has been an honor to work for a legislator who shares the urgency in the matter. I've been fortunate enough to closely monitor immigration policy under the leadership of Representative Coleman

Because of his constant advocacy and work on behalf of all communities, Representative Coleman was selected to serve as a member of the working group, State Legislators for Progressive Immigration Reform. As a co-chair of the Progressive States Network, Representative Coleman plays a hand at spearheading efforts to tackle immigration reform at the state level. His deep grasp of the matter has lead him to work closely with the American Jewish Committee on their Bridging American Project, a task force aimed at making immigration reform a reality.

For those of us determined to see comprehensive immigration reform tackled this year, it was encouraging to learn that President Obama is committed to the issue and will not put it on the back burner. Congressman Luis Gutierrez, a champion of immigration reform who was withholding his vote on health care, agreed to cast a vote in favor of health care after meeting with President Obama to discuss immigration reform. After the meeting, Congressman Gutierrez said the President was committed to moving forward on a comprehensive immigration reform package as soon as possible.

On Sunday, thousands of immigrant rights reformers will convene at our nation's capital to urge swift action of humane, and comprehensive immigration legislation. We stand with these supporters and applaud their actions.

We will keep you up to date, as this important issue continues to develop.

Latest from Washington: Health Care Reform a Deficit Reducer

Cartoon by Mike Luckovich

I'm in Washington, D.C. meeting with our leaders in Congress as they prepare to take a final vote on health care reform. Today, the nonpartisan Congressional Budget Office reported that the health care bill passed by the Senate, along with the changes proposed in the reconciliation bill, will reduce the federal deficit by $1.3 trillion and insure 32 million Americans. These figures mean that this bill reduces the deficit by more than the versions already passed by the House and Senate, and insures more Americans than the Senate version. House Majority Leader Steny Hoyer correctly said that this health care legislation will be the largest deficit reducer in 17 years.

The current health care system is failing us. It's crippling family, state and federal budgets, and disproportionately hurting middle-income Texans. A report released yesterday by the Robert Woods Johnson Foundation showed that middle-income Texans are losing their health insurance at alarming rates. Between 2000 and 2008, 2.3 million middle-income Americans lost their health insurance. Texans accounted for 500,000 of that total, meaning that 1 in 5 middle-income Texans lost their health coverage. During the same time frame, family health insurance premiums in our state rose by 76 percent, although median incomes declined by 4 percent.

These final days are critical not only to the health care bill but also to Texans struggling under the current system. Please contact the following members of Congress and ask them to cast a final vote in support of health care reform.

Contact:
Representative Henry Cuellar	(202) 225-1640
Representative Lloyd Doggett	(202) 225-4865
Representative Charles A. Gonzalez	(202) 225-3236
Representative Al Green	(202) 225-7508
Representative Gene Green	(202) 225-1688
Representative Ruben Hinojosa	(202) 225-2531
Representative Sheila Jackson-Lee	(202) 225-3816
Representative Eddie Bernice Johnson	(202) 225-8885
Representative Solomon Ortiz	(202) 225-7742
Representative Silvestre Reyes	(202) 225-4831
Representative Ciro D. Rodriguez	(202) 225-4511

Houston Chronicle & Judson Robinson III: Pass Health Care Now

A Houston Chronicle editorial today urges Democrats in Congress to move at full speed to pass health care reform and lead us to a better, more secure future. The editorial highlights the risks that doing nothing would have on health care costs, individuals with pre-existing conditions, and our already unstable economy.

Also in today's Houston Chronicle is an op-ed by Houston Area Urban League President Judson Robinson III, in which he stresses the moral imperative of a just and equitable health insurance system and the necessity of being healthy to obtain and keep a job. He notes that health care reform legislation would be especially beneficial to our state, and even more so to Harris County, where more than half a million uninsured individuals reside.

I've included both pieces below.

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Showdown: Congressional Democrats should stand tall and back health care reform

Copyright 2010 Houston Chronicle
March 17, 2010, 12:29AM

It's crunch time on health care reform for congressional Democrats, especially those in the House of Representatives in potential swing districts. After months of discussion, an up or down vote on reform is likely to come before the end of the week.

Or perhaps not: The House Democratic leadership is considering using a procedure that would bypass a direct vote and spare vulnerable members the risk of an up or down vote. This is wrongheaded. As strongly as we support reform, we believe Congress should have the courage to vote on it directly. An end run would only stoke the already deep public cynicism about Washington's ways.

We understand the temptation. As a showdown approaches, undecided Democrats are being warned by Republicans, in no uncertain terms, that supporting their president on reform will cost them their jobs in November.

It may. But the greater risk by far, we would submit, is to do nothing.

Doing nothing would keep some 30 million Americans in a costly health care limbo that also would ramp up costs for millions more citizens with full insurance.

Doing nothing would only guarantee that health insurance costs continue to skyrocket with no relief in sight and no effective means of controlling them.

Doing nothing would mean that millions with pre-existing conditions would still be unable to qualify for coverage.

Doing nothing would hinder the all-important jobs recovery that making health care mobile and universally available would strongly support.

The Republicans have made their choice. They are in lock step against passage of the president's plan. That is not a pretty picture. It does not speak well for the health of our supposedly collegial political system. But it is also their right.

The Republican refuseniks have their reasons. Some are philosophical. Many have honest disagreements on approach, as was made clear in the recent health care summit.

But other GOP motives are unabashedly calculating and political, having nothing to do with health care. These are aimed squarely at winning back congressional seats in the November elections and, two years hence, defeating Barack Obama. The Republican leadership is persuaded that Obama is vulnerable on health care and can be taken down with a loss on this major pledge of his 2008 campaign.

We believe this is a bad bet and a narrowly self-interested approach that will be seen through and rejected by informed voters.

We believe it's a smart bet for wavering Democrats to stand with their president and accomplish this major policy objective.

We strongly encourage members of the Democratic rank and file to stand with their president and support health care reform in this critical hour.

This is one of those votes that will shape the American future, for better or worse. We believe a better, more secure future will result from a decision to take this step of reform.

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Health care reform: It's time to get the job done
By JUDSON W. ROBINSON III
March 17, 2010, 12:34AM

As president and CEO of the Houston Area Urban League, I personally experience the daily challenge of working with individuals seeking help in becoming more productive. We all benefit when these individuals seize opportunities to improve their status in life. At the Urban League, we focus on bringing personal and community economic empowerment to the most vulnerable Houstonians by hastening their pace toward self-sufficiency. The sooner people become self-sufficient, the more independent they become. The moral imperative of having a just and equitable health insurance system is one of the cornerstones of that empowerment.

There are many misconceptions about the intentions of the health care bill being debated in Washington, D.C. It is important to note the impact that passage of this legislation would have on real Houstonians, particularly those most in need.

The health care bill includes key, common-sense provisions that would ensure access to affordable coverage for Houstonians. These provisions include: prohibiting discrimination based on pre-existing conditions, ending the practice of dropping policyholders when they become seriously ill, ending lifetime caps on coverage, reducing out-of-pocket expenses and ensuring access to preventive care and expansion of Medicaid to many adults who live in poverty. Expanding Medicaid to low-income adults would be particularly beneficial to the health of our state, given that approximately 32 percent of Texas adults are uninsured. More than half a million of Texas' 6 million uninsured residents live in Harris County. Every day, 470 Texans lose their coverage as a result of rising premiums, obscene out-of-pocket expenses and being diagnosed with a catastrophic illness.

Certainly, the costs associated with coverage for the uninsured warrant close inspection, but so do the tremendous increases in premiums and the outrageous profits for some insurance companies. Long-term cost avoidance is critical to the public's welfare. According to the Congressional Budget Office, we will save approximately $118 billion over the next 10 years and another $600 billion over the second 10 years once health reform is enacted. The bills that have passed would cap consumer spending, ensuring that no one has to fear bankruptcy when paying for care. The bills passed by Congress would take great strides in providing Children's Health Insurance Program and Medicaid coverage to children from middle- and lower-income families while allowing small businesses affordable coverage for their employees. The legislation calls for expanding Medicaid eligibility to everyone who is living at or near poverty, which would increase access to affordable coverage and bring coverage to about a million low-income uninsured adults in Texas.

One of the issues we focus on at the Urban League is health education. We must do a better job of taking personal responsibility for our own health. Provisions of the health care reform legislation provide incentives for prevention of illness and for healthy eating.

This legislation is such a significant step forward that we must not lose sight of all the good it does. Never before has our country been this close to realizing the dream of health insurance reform. For 60 years, we have pursued a way to increase the likelihood of community wellness while enhancing the quality of life and care for our citizens. There is much work to be done in this country. Housing, education, the environment and, as we all know, jobs deserve a big slice of our focus. But to have a job, you have to be healthy. To keep a job, you must stay healthy. Let's get this done and move on to other pressing concerns facing Houstonians.

Affordable health care should not be the privilege of the fortunate few. It is the issue of our time, and Congress should deliver reform for the good of our country.

Robinson is president and CEO of the Houston Area Urban League.

Homeowner Insurance Rates Continue to Rise

State Farm Insurance announced that they are imposing a 4.5 percent rate hike on homeowners insurance a mere seven months after enacting an 8.8 percent rate increase. The Legislative Study Group, a House Caucus that I chair, compiled a policy update on homeowners insurance legislation in Texas and proposed solutions to the problem. You can also read a memorandum on the subject from Texas Watch here.

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LSG Policy Update: Homeowner Insurance Rates Continue to Rise

State Farm Increases Homeowner Insurance Rates

State Farm has announced that they will raise homeowner insurance rates by 4.5 percent in May. This comes on the heels of an 8.8 percent increase in October.1 Texas homeowners already pay the second highest insurance premiums in the country; such a steep rate increase hurts Texas homeowners financially as they navigate through the worst recession in a generation.

Unfortunately, this is not the first time that Texas homeowners have been charged excessive premiums. In November, State Farm was ordered to repay its customers $310 million for overcharging homeowners for coverage dating back to 2003.2 This sum was actually $700 million less than what consumer advocates and the state's Public Insurance Counsel recommended.

In addition, the policies provided by State Farm and other companies have cut back on the level of coverage provided to Texas homeowners, meaning Texans are effectively paying more while getting less.

Background on Insurance Legislation in Texas

As a result of a dramatic increase in mold claims prior to 2003, homeowner insurance rates were pushed to record heights. In response, legislators in the 78th Legislature passed SB 14, which, among other things, moved Texas to a "file and use" system.

Previously, rates were established by the Commissioner of the Texas Department of Insurance, and companies had to petition the department for approval to raise their rates above the established level. However, a loophole allowed most companies to shift their policies outside of the regulations, meaning consumers still saw high premiums.

The "file and use" system passed in 2003 did little to alleviate the problem. Under the new system, insurance companies were simply required to inform the department of a rate change before they implemented it. The department had no mechanism to regulate insurance companies as they implemented premium rates.

Texas homeowners have failed to see any significant relief from the rates that were in place prior to 2003.

Texas Department of Insurance

The Texas Department of Insurance has not undergone a sunset review since 1993. As mentioned previously, there have been many significant developments in the insurance market in Texas during that time.

The department was slated to undergo its review during the past legislative session, but the Legislature failed to act before adjourning Sine Die. A special session was called to pass a safety net bill that extended the life of the Department of Insurance and five other agencies until 2011.

It is unfortunate that the TDI sunset bill did not reach the floor of the House for a vote. Since the 2003 session when lawmakers passed, and Governor Perry signed, the ineffective "file and use" system, lawmakers have proposed a "prior approval" system that could provide effective relief for Texas homeowners. Such legislation was drafted again this session as an amendment to be voted on by the House during floor debate on the sunset bill. Lawmakers that filed such amendments included Representative John Smithee and LSG members Representatives Jessica Farrar and Trey Martinez Fischer.

Similar bills were filed during the 81st session by LSG members Representatives Anchia, Coleman, Herrero, Martinez Fischer, Rose and Vaught. On the Senate side, Senators Van De Putte, Hinojosa, and LSG member Senator Ellis also filed legislation.

Ineffectiveness of Department

Since no legislation that gave such regulatory power to the Department of Insurance passed, insurance companies are free to continue raising rates. The Commissioner has been left only with the ability to write a disapproving letter to companies.

After State Farm informed the Department of Insurance that they would institute a 4.5 percent hike a mere seven months after an 8.8 percent hike, Mike Geeslin, the Commissioner of the Texas Department of Insurance, wrote in a letter to State Farm3:

"The timing of this filing causes me concern. State Farm Lloyds last rate change for its homeowners program was an increase of 8.8% effective September 1, 2009, for new business, and October 1, 2009 for renewal business. State Farm Lloyds has had this increase in effect for only seven months. Multiple rates increases within such a short period of time may indicate a lack of rate making discipline and lead to market instability.

Given that State Farm Lloyds is the market leader, writing nearly 30% of the homeowners market, other companies may follow suit which would lead to further market instability. It appears that the timing of this is not in the best interests of Texas consumers. Consumers deserve a stable and competitive market. It is my hope that State Farm Lloyds reconsider the timing of this filing and will voluntarily withdraw it."

(emphasis added)

Prior Approval

Currently, while acknowledging the damaging effect of multiple rate increases, the best that the Department of Insurance can do is ask State Farm to "voluntarily withdraw" their rate increase.

The Legislature should pass real insurance reform for Texas homeowners to rectify this disappointing lack of proper regulation. Included in such reform should be a "prior approval" provision, similar to the ones filed by lawmakers in past sessions. Such a system would require the Commissioner of Insurance to approve a rate increase before a company can implement it. This would ensure that insurance companies justify their rate increases, protecting policyholders from excessive charges.

Help Us Cross the Finish Line

The U.S. House of Representatives could cast its final vote on health care reform at the end of this week, and send it to the President's desk soon after. Thanks to the hard work of the Democratic leadership and members of the Texas delegation, millions of Texans are closer than ever to gaining access to affordable health coverage and having protection from some of the insurance industry's worst practices.

Please call the following members of Congress from Texas and thank them for supporting health care legislation which will improve the lives of Texans and Americans. Ask them to get us across the finish line and cast a final vote for health care reform.

Contact:
Representative Henry Cuellar	(202) 225-1640
Representative Lloyd Doggett	(202) 225-4865
Representative Charles A. Gonzalez	(202) 225-3236
Representative Al Green	(202) 225-7508
Representative Gene Green	(202) 225-1688
Representative Ruben Hinojosa	(202) 225-2531
Representative Sheila Jackson-Lee	(202) 225-3816
Representative Eddie Bernice Johnson	(202) 225-8885
Representative Solomon Ortiz	(202) 225-7742
Representative Silvestre Reyes	(202) 225-4831
Representative Ciro D. Rodriguez	(202) 225-4511

Lifelong Republican: Voting for Health Care Fiscally Disciplined

One in every six dollars in the U.S. economy is spent on health care. If we continue down our current path, one out of every three dollars will be spent on our health care system. This is not sustainable for our country's economy and for the budgets of American families. Transportation Secretary Ray LaHood, a lifelong Republican and fiscal conservative supports health care reform legislation "because it's a good bill." Calling it the fiscally disciplined thing to do, Secretary LaHood urges other Republicans to follow his lead.

Below, I've included Secretary LaHood's message to fiscal conservatives.

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On health care reform: this is a good bill

Yesterday, I voiced my support for health care reform with an op-ed in the Chicago Tribune. I am grateful to those who saw my speaking-out for what it was: a former legislator reaching out to Congress to step up and solve one of our nation's greatest problems. As I told FoxNews, "It's a matter of voting for a good bill."

Look, if you take even one step beyond the partisanship and dig down into the numbers, you will find that most Americans want health care reform. And if you want to know why this is a good health care reform bill, I recommend a recent informative article by the Associated Press.

Here's what I wrote in the Tribune:

I've been a Republican all my life, when I served in the Illinois legislature, when I worked for members of Congress and when I served in Congress. During the 2008 presidential election, I supported Republican Sen. John McCain. I have always been — and still am — a fiscal conservative, an advocate for a smart, but restrained, government.

For those reasons and others, most people wouldn't expect me to be an advocate for comprehensive health care reform. But the truth is, I believe there is no bigger issue to solve and no better chance to solve it than now.

If I were still a member of Congress, I would proudly vote for the bill that President Barack Obama is championing and I would urge my colleagues to do the same, not because I don't believe in fiscal discipline, but because I do.

We do not need to look that far down the road to see the pain that failure to pass health care reform will cause. Americans of every background, class, race and political persuasion are suffering. We have the best health care system in the world, yet more than 40 million Americans lack access to it, a reality that is morally reprehensible. Health care is an essential, as important as food, water and shelter. Those who don't have it are left without the tools to survive.

In the coming days, Congress has a chance to change that. The bill that will be voted on will reduce the deficit by about $1 trillion over the next two decades, and will reduce waste, fraud and abuse in the health care system. It will slow the rate of growth in health care costs and put America back on the path toward fiscal sustainability.

The bill will give families and small business owners greater control over their own health care. It will expand coverage to more than 31 million Americans and will include tax credits to individuals, families and small businesses, giving them the same choices that members of Congress have to purchase private coverage. It will create state-based exchanges that will bring competition and transparency to insurance markets. And it will put in place common-sense rules of the road to hold insurance companies accountable and end some of the most outrageous practices of the insurance industry.

Never again will people be denied coverage because they have a pre-existing condition. Never again will insurance companies be able to raise rates unfairly — like the 60 percent hikes expected in Illinois.

While the ultimate vote on health care may not be bipartisan, the ultimate bill certainly is.

There are several Republican ideas in the bill. It allows Americans to buy health insurance across state lines. It increases the bargaining power of small businesses by allowing them to pool together — much like large corporations or labor unions — to bargain for a better insurance rate. It gives states the flexibility to come up with an alternate health care plan, and it gives them resources to reform our tort system by developing new ways to deal with medical malpractice.

I also feel compelled to remind my former colleagues that contrary to what many people have been saying, the bill explicitly prevents federal dollars from being used to fund abortion. It ensures not only that those seeking abortion coverage will be required to pay for it with their own money, but also that their personal money will never be commingled with federal funds. As a former congressman with a 100 percent pro-life voting record, I'm comfortable supporting this bill.

There isn't one member of Congress who represents a district that is without a health care crisis. There are good, hardworking men and women in every part of this country who work for a living, but not at a business that offers the opportunity to purchase health insurance. On their own, the cost of insurance is just plain out of reach.

During my time in Congress, I was known for reaching across the aisle. I did it not for the sake of bipartisanship alone, but in order to get important things done.

Now, my former colleagues have the opportunity to change the lives of their friends and neighbors for the better by voting for health care reform.

Senate Has Votes to Proceed Using Reconciliation

Senator Mark Begich, in a letter to a constituents, became the 50th Democratic Senator to signal that he was open to using reconciliation to clean up the health care reform bill already passed by the House and Senate. Speaker Pelosi will be able to use these developments to persuade her colleagues in the House to approve the health care bill already passed by the Senate. President Obama has urged the House to schedule a vote on health care by March 18.

Health care reform legislation already cleared both chambers, and with a 60-vote majority in the Senate. Reconciliation would be used only to amend the bill and ensure that all states are treated equitably. Although Republicans would like for you to think otherwise, reconciliation has been used 21 times since 1981, 16 times by Republicans. It was used by President Bush to pass his 2001 and 2003 tax cuts and his Medicare Part D plan. The New York Times chart below shows the major reconciliation bills passed by Congress.

I've also included an editorial from the New York Times that clearly outlines President Obama's health care plan, and the dire situation Americans will face if reform is not enacted.

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March 7, 2010
EDITORIAL
If Reform Fails

As the fierce debate on President Obama’s plan for health care reform comes to a head, Americans should be thinking carefully about what happens if Congress fails to enact legislation.

Are they really satisfied with the status quo? And is the status quo really sustainable?

Here are some basic facts Americans need to know as Congress decides whether to approve comprehensive reform or continue with what we have:

HOW REFORM WOULD WORK: Let’s be clear, the changes Mr. Obama and Democratic leaders in Congress are proposing are significant. But, despite what the critics charge, this is not a government takeover. And the program is not only fully paid for, it should actually reduce the deficit over the next two decades.

Under the new system, all people would be required to have health insurance or pay a penalty. If you are poor or middle class you would also get significant help through Medicaid coverage or tax credits to pay the premiums.

The legislation would create exchanges on which small businesses and people who buy their own coverage directly from insurers could choose from an array of private plans that would compete for their business. It would also require insurance companies to accept all applicants, even those with a pre-existing condition. And it would make a start at reforming the medical care system to improve quality and lower costs.

46 MILLION AND RISING: If nothing is done, the number of uninsured people — 46 million in 2008 — is sure to spike upward as rising medical costs and soaring premiums make policies less affordable and employers continue to drop coverage to save money.

The Congressional Budget Office projects 54 million uninsured people in 2019; the actuary for the federal government’s Centers for Medicare and Medicaid Services projects 57 million.

It should be no surprise that people without insurance often postpone needed care, and many get much sicker as a result. That is morally unsustainable. It is also fiscally unsustainable for safety net hospitals — which foist much of the cost on the American taxpayer when the uninsured end up in the emergency room. As the number of uninsured rises, that bill will rise.

The Senate’s reform bill would reduce the number of uninsured by an estimated 31 million in 2019. The Republicans’ paltry proposals would cut the number by only three million.

BUT I HAVE INSURANCE: While most Americans have insurance, many pay exorbitant rates because they have no bargaining power with insurers.

That includes many of the tens of millions who buy their own insurance — the unemployed, the self-employed, and those whose employers do not offer insurance. The recently announced plan by Anthem Blue Cross in California to raise annual premiums by 35 to 39 percent for nearly a quarter of its individual subscribers is a chilling harbinger of what is to come if reform fails.

There are another 48 million people who work in relatively small firms that often cannot get the better rates of large-group coverage. All of these groups should be able to get a better deal if they can buy their insurance through new, competitive exchanges.

If current trends continue, the number of underinsured Americans — those who have coverage too skimpy to pay substantial medical bills or protect them from high out-of-pocket spending — will also rise from an estimated 25 million in 2007 to 35 million in 2011, according to the Commonwealth Fund, a respected research organization.

That will increase the risk that this group will forgo needed care and will expose many more of them to potential bankruptcy if they cannot pay huge medical bills. Some 72 million adults currently have medical debt or problems paying their bills even though most of them have insurance. Reform would help them by setting minimum standards of coverage and providing subsidies to tens of millions of low- and middle-income people to help pay their premiums.

BUT I LIKE MY INSURANCE: Most Americans get their insurance through large companies, with large group bargaining power. While they complain about premiums and paperwork, most seem satisfied with their coverage.

For them the real fear is what happens if they lose their jobs or decide to change jobs. Will they be shut out of coverage because of a pre-existing condition or forced to pay high rates to buy their own insurance?

For this group, the real advantage of reform is security. If they get laid off, decide to be self-employed or switch to a smaller employer that offers no insurance, they will still be guaranteed coverage — even if they are a cancer survivor or have heart trouble or any other pre-existing condition. And they will be able to buy insurance on the exchanges.

I’M JUST WORRIED ABOUT COSTS: You should be. The cost of medical care is rising far faster than wages or inflation. And despite all of the talk about reform “bending the curve,” no one is yet sure how to do that.
Many reforms that people instinctively believe should cut costs — computerization of medical records, paying doctors for quality not quantity of services, and prevention programs to promote healthy living and head off costly illnesses — cannot yet be shown to lower costs.

Pending reform legislation, specifically the Senate bill, would launch an array of pilot projects to test reforms in delivering and paying for care. It would also create a special board to accelerate the adoption of anything that seemed to work. That seems a reasonable way to go and a lot better than standing by as costs continue to spiral out of control. The Republicans’ proposals — including their call to cap malpractice awards — would make only a small dent in the problem.

WHAT ABOUT THE DEFICIT?: Republican critics of health care reform have done an especially good job of frightening Americans with their talk of bankrupting the Treasury. The truth of the matter is that the pending reform legislation has been designed to generate enough revenue and savings to more than offset the substantial cost of expanding Medicaid and providing subsidies to the middle class.

The Congressional Budget Office estimated that the Senate bill would reduce deficits over the first 10 years by $132 billion and even more in the second decade.

What critics certainly do not talk about is what happens to the deficit if Medicare costs continue their relentless rise. That is something that should keep Americans up at night.

The pending reforms would cut the growth in Medicare spending per beneficiary in half — from 4 percent a year to 2 percent — by demanding productivity savings from Medicare providers and cutting unjustified subsidies to the private plans in Medicare.

There is some skepticism that Congress will stick to its guns if health care providers say they cannot survive on the reduced rations. But Congress has stood by most previous Medicare cuts (physicians excepted) and should have its spine stiffened by new pay-go rules requiring that any Medicare increases be offset by other savings or taxes.

If reform is defeated, it seems likely that most of the proposed experiments designed to cut costs — first within Medicare and then throughout the rest of the health care system — will die as well. The legislation needs to be passed to establish a structure to force continuing improvement over the years. That is the best chance of restraining soaring medical costs that threaten the solvency of families, businesses and the federal government.

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Any change as big as this is bound to cause anxiety. Republicans have happily fanned those fears with talk of “dangerous experiments” on the “best health care system in the world.” The fact is that the health care system is broken for far too many Americans. And the country cannot afford the status quo.

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This editorial is a part of a comprehensive examination of the debate over health care reform. You can read all of these editorials at: nytimes.com/edhealthcare2009.

Texans Avert Medicare Crisis

I wanted to bring to your attention the damage that our economy, Texans, and Texas doctors avoided this week because of swift action by President Obama and Senate Democratic leaders. Earlier this week, President Obama signed legislation that delayed a scheduled 21.2% cut in Medicare reimbursement rates and extended unemployment insurance and COBRA health benefits to Americans who lost their jobs. These vital programs faced an unnecessary and unexpected roadblock caused by Republican Senator Jim Bunning, who was more concerned with making a political point than with the well being of the American people.

The personal and fiscal impact of these programs to our state is immeasurable. Repealing the Medicare cuts alone will prevent a $980 million a year loss for care of elderly and disabled patients in our state, and they will prevent annual cuts averaging $20,000 to each Texas physician. The President's actions to avert Medicare rate cuts helped 215,760 employees, 2,455,457 Medicare patients, and 852,625 TRICARE patients in Texas.

On Wednesday, President Obama urged Congress to finish their work on health care and schedule an up or down vote. The President anticipates a health care vote in the House by March 18.

Trade Secretary Ron Kirk Comments on States' Rights & Secession Talk

As you know, in the past I've highlighted some of the troubling aspects of the new conservative movement sweeping our country - specifically the states' rights/secessionist rhetoric. The above picture was taken by a staff member of mine at a Tea Party at the Texas Capitol last year. People were marching in front of the State Capitol threatening bloodshed. I've said that leaders need to take responsibility for their words and actions, and refuse to associate in any way with others who seek to tear our country down by exploiting fear and hatred.

Unfortunately, some, like Governor Perry, have embraced language that caters to extremists to build support for their political campaigns. I've said before that states rights and secession have a history in our country that is negative; it is not something that befits our great country.

In that vein, I wanted to highlight comments made by former Dallas Mayor and current US Trade Representative, Ron Kirk. Kirk observes the same troubling root of states' rights/secession rhetoric, and is right to make these comments. I appreciate his frank statements, and encourage you to read the below article from the Dallas Morning News.

Ron Kirk is not amused by secession talk

Thursday, March 4, 2010
By JIM LANDERS / The Dallas Morning News

WASHINGTON – U.S. Trade Representative and former Dallas Mayor Ron Kirk tore into the Texas GOP fringe's flirtation with secession Wednesday, comparing such comments to a return to "the Jim Crow South."

"I know what it means for my parents' generation," Kirk, a black Democrat, said when asked about the issue. "And we fought too hard to get me to this point for me to be amused even a little bit by any of this states' rights, secession stuff."

During the Republican primary campaign, Gov. Rick Perry said he could understand why some anti-government Republicans spoke of returning Texas to its days as an independent republic because of a sense that Washington is intruding into state and private affairs.

Kirk compared such talk with the "states' rights" conservatism of the 1950s and 1960s that bridled against the federal government's efforts to desegregate the South.

Kirk, without mentioning Perry, said reporters should press the question of who would pay for the state's needs if it broke away.

"I wish those of you in the press would then ask, even though it's tongue in cheek, so what does this mean then, for a state that unfortunately ranks in the bottom, investment in education and health care for our kids, leads the nation in the number of people of unemployed, and you want to pull out of the country?" he said.

"Tell me where you're going to find the money to pay for Medicare with one of the highest-growing senior populations in the country," he said.

"In a state that's probably $2 billion underfunded in maintaining its own highways, and now you want to pull out of the United States and take away the billions of dollars you get from the federal [government] – how are you going to fix your infrastructure?"

Kirk, the highest-ranking Texan in the Obama administration, won two terms as Dallas mayor in the 1990s, then lost a race for U.S. Senate in 2002.

He was the Texas point man for Barack Obama's White House campaign in 2008.

Important Health Care Developments from the President

President Obama, promising to do everything in his power to make the case for reform, has urged Congress to finish their work on health care and schedule an up-or-down vote in the next few weeks. To reiterate what President Obama said, "Everything there is to say about health care has been said."

Health care reform legislation before Congress has already passed out of both chambers, and, with 60 votes in the Senate. The nonpartisan Congressional Budget Office reported that health care reform will reduce the federal deficit by $100 billion over the next ten years by cutting government overspending and reining in waste, fraud and abuse.

Last Monday, President Obama submitted his own health care proposal as a starting point for the health care summit last week. The President asked leaders of both parties to submit tangible policy ideas that will help the American people. Putting partisanship aside, President Obama embedded four health care ideas offered by Republicans at last week's summit into his proposal. They are:

1. Conducting undercover investigations of health care providers that receive Medicare reimbursements,
2. Investing $50 million in additional grants for pilot projects aimed at reforming the medical malpractice system,
3. Increasing Medicaid reimbursement rates to doctors, and
   
4. Expanding health saving accounts.

Members of both parties understand that our country is facing a serious problem. The proposal put forth by the President builds on and improves the current system. The plan ends some of the insurance industry's most despicable practices, reduces costs for people with insurance and makes coverage more affordable for people without coverage. It also sets up a new competitive insurance marketplace where small business owners and families can shop for the insurance plan that best fits their needs.

Health care legislation will give Americans more control of their health care, help provide coverage to 31 million Americans, and put our country on the path to a more sustainable economy. We can't waste more time. Congress needs to finish the job for the American people.

U.S. Senate Navigates Around Republican Roadblock

I know that tonight people are monitoring primary election results, but I wanted to forward you information that impacts Texans across the state. As you read in Chairman Dunnam’s email yesterday, Republican Senator Bunning, aided by some of his colleagues, was holding up unemployment benefits, health care for Americans who lost their jobs, transportation projects around the country, and was triggering a 21% cut in Medicare reimbursement rates to doctors. Because of Senator Bunning’s antics, 27,400 Texans and more than 200,000 Americans who are struggling in a tough economy, were at jeopardy of losing their much needed unemployment benefits.

Fortunately, moments ago the U.S. Senate passed legislation to navigate around the one man road block. President Obama just signed this legislation into law. Below, I’ve included an article from the New York Times with more details.

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Senator Relents, and Jobless Bill Passes

By CARL HULSE

WASHINGTON — The Senate headed reached a resolution of an impasse over unemployment pay on Tuesday night after Senator Jim Bunning, Republican of Kentucky, dropped his objection to extending jobless benefits in exchange for a largely symbolic vote on paying for the aid.

Mr. Bunning’s agreement to relent essentially short-circuited an intensifying political battle that had already resulted in 2,000 workers at the Department of Transportation being furloughed without pay and in the temporary cutoff of benefits to thousands of out-of-work Americans.

It came after Mr. Bunning’s fellow Republicans began to air their own concerns about how the Senate blockade had the potential to damage their political brand while also having a direct impact on their constituents. The Senate later voted 78 to 19 to renew the programs.
While Democrats hailed the progress, they also said Mr. Bunning’s decision to delay the aid had caused serious disruptions in federal programs and could create bureaucratic problems as people tried to reclaim their federal aid.

“Sometimes just because we have the power to do things, we ought to think twice before we use that power,” said Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate.

With Mr. Bunning’s battle quickly becoming a national cause célèbre, Senator Mitch McConnell of Kentucky, the Republican leader and Mr. Bunning’s home-state colleague, made clear earlier that Republicans were trying to end the stalemate.

And Senator Susan Collins of Maine, a moderate Republican colleague of the conservative Mr. Bunning, joined Democrats in trying to force the measure through, calculating that perhaps a plea from a fellow Republican would get him to change his position.

“When I was home this weekend, I talked to constituents who expressed their utter bafflement that Congress could not proceed on something that has widespread support,” Ms. Collins said.

While trying to blame Democrats for mishandling the entire matter, other Republicans also distanced themselves from Mr. Bunning, whom Democrats were holding up as the embodiment of what they say has been a maddening pattern of Republican obstruction in the Senate.

“This is one senator,” said Senator John Cornyn of Texas, a chief political strategist for Senate Republicans. “This does not represent the position of the caucus.”

Other party officials said that while the Bunning fight was not helpful, it probably would not do serious damage as long as it ended rapidly.

Republicans were not just unhappy that the back-and-forth was allowing Democrats and editorial writers around the country to portray them as heartless curmudgeons, denying jobless aid to struggling Americans while Mr. Bunning complained that late-night debate was preventing him from watching a college basketball game.

The attention to the impasse was also cutting into Republican efforts to focus on the evolving Democratic strategy on the health care overhaul, which Republicans are trying to portray as an end-run around Senate rules. Instead, Democrats were having a field day citing Mr. Bunning’s repeated objections as evidence of how Republicans abuse the rules to delay needed legislation, helping them build a case in favor of using any available tools to overcome such opposition.

Complicating the situation was the fact that Mr. McConnell and Mr. Bunning have a tortured relationship because Mr. McConnell was instrumental last year in making it difficult for Mr. Bunning to seek a third term. The rift left Mr. McConnell with little leverage to apply to get his fellow Kentuckian to retreat.

Not all senators were engaged in Bunning-bashing. “He’s my hero this week,” said Senator Jim DeMint, the conservative Republican from South Carolina, who said Mr. Bunning was exposing Democratic hypocrisy of embracing budget controls but adding spending like the employment aid to the deficit. “We have to quit complaining about unsustainable debt and passing new spending programs every week.”

The fight spread to the House as well, with Representative John A. Boehner of Ohio, the Republican leader, saying Mr. Bunning has “got a legitimate argument that he’s making.”

At the same time, dozens of House Democrats sharply criticized Mr. Bunning, with Representative John Yarmuth of Kentucky saying he was “embarrassed that a senator from Kentucky is holding our government hostage.”

Last week the House passed the bill at issue, which provided a 30-day extension of unemployment benefits, health insurance subsidies for the jobless, the highway construction program and a handful of other expiring programs to allow Congress to work out more permanent legislation. Mr. Bunning almost immediately began lodging his objections, insisting that the unemployment help be offset by money from other sources.

As a result, the programs lapsed as of Sunday, forcing the Department of Transportation to furlough 2,000 workers without pay on Monday and shut down dozens of construction projects.

In addition, jobless benefits began running out for thousands of workers across the country, though a broader measure now before the Senate would restore them retroactively.

Even as negotiations toward a resolution continued, a parade of Senate Democrats kept up vigorous expressions of displeasure with Mr. Bunning.

“I come to the floor of the Senate to say to my colleague from Kentucky,” Senator Barbara A. Mikulski, Democrat of Maryland intoned Tuesday with a bit of biblical fervor, “let the unemployment bill go.”

Peter Baker and Robert Pear contributed reporting.

From the Desk of Representative Jim Dunnam

Please see the note below from my colleague in the Texas House, Representative Jim Dunnam of Waco.
- Garnet Coleman

March 1, 2010

As chair of the House Select Committee on Federal Economic Stabilization Funding, it's my job to monitor Washington, D.C. and keep Texas House members and Texans informed of federal actions that will impact them. Last week, the U.S. Senate was expected to pass legislation that would extend unemployment benefits, COBRA health insurance, as well as funds for the Highway Trust Fund and Medicaid reimbursements for physicians.

Because it's so urgent that the American people receive their unemployment benefits, the Senate was set to pass the bill through what's called "unanimous consent", which means everyone agrees to pass the bill. However, one Republican Senator from Kentucky, Jim Bunning, stood in the way and objected to its passage. Because of this one man roadblock, Texans and Americans across the country are set to lose their jobless aid today. Doctors are being instructed to not submit reimbursement claims under Medicaid for 10 days, to allow time to work around Senator Bunning's delays. Republican Senators have yet to reel in their colleague, and because of his publicity stunt, hundreds of thousands of Americans are feeling the pinch.

This epitomizes what it means to be from the Party of No, and shows how out of touch Senator Bunning and his Republican colleagues really are with the American people. Senate Democrats are scheduling a vote on the bill to go around the obstructionism and should be able to pass the legislation this week. In the meantime, this act of callous disregard will cause serious harm to Americans looking for work.

For your reference, below is an editorial from the New York Times, detailing the situation.



Clueless in Kentucky
Editorial February 27, 2010

Kentucky has lost about 60,000 jobs since the end of 2008. In December, its unemployment rate stood at 10.7 percent, the highest since 1983. So what exactly is going on in the minds of Kentucky's two Republican senators, Mitch McConnell and Jim Bunning?

This week, Mr. Bunning single-handedly shot down a one-month extension of unemployment benefits, along with a federal subsidy for the unemployed to maintain health coverage. Two weeks earlier, Mr. McConnell, the minority leader, objected to a one-week extension to give senators time to draft a longer-term package.

It should be a no-brainer to extend unemployment insurance when around 1 out of every 10 workers is unemployed. Standard unemployment benefits end at 26 weeks, yet 6.3 million workers have been out of work for more than 27 weeks. Congress has provided a series of extensions, and without another one, 400,000 people will lose their benefits in a matter of weeks.

Senator Bunning once cared about the unemployed. When the benefit was due to expire in November, he joined a unanimous vote to extend it until the end of February. "Kentucky has been hit hard by the current economic downturn," he said at the time. It still is, but Mr. Bunning refused to consider the extension unless it was paid for with funds from the fiscal stimulus plan. For years, Mr. Bunning didn't seem to have a problem with blowing up the deficit for the Iraq war and tax cuts. Now he's a deficit hawk when it comes to average Americans.

Maybe he's preoccupied. At one point during a debate on the issue Thursday night, he complained about missing the Kentucky-South Carolina basketball game.

Democrats must now defeat Republican attempts to lace the benefits extension with things like protecting the rich from the estate tax. To avoid a repeat of this nonsense every few weeks, unemployment benefits should be extended until the end of the year. Perhaps by Monday somebody can educate Senators Bunning and McConnell about Kentucky's unemployment rate.