High Costs of Health Care Affect Us All

Staggering increases in insurance premiums over the past decade in Texas only further emphasize the need for comprehensive health care reform. Individuals who are insured are paying higher premiums, higher deductibles and out-of-pocket expenses while receiving fewer benefits. In the past nine years, 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. Furthermore, less than 50 percent of Texans receive health insurance from their employer. Texans who are insured are also footing the bill for the uninsured. According to the Baylor Health Care System in Dallas, insured patients are charged 150 percent of actual costs to cover costs for the uninsured.

To learn more about the effect of the uninsured on Texas families, read the Dallas Morning News article: Cost of Care: 'Vicious circle' of uninsured results in higher bills for health coverage, taxes in Dallas-Fort Worth.

Additionally, our current health care system rewards doctors and hospitals for the amount of procedures and tests they conduct instead of performance-based outcomes. This practice has caused health care spending to soar without yielding better results. According to the Commonwealth Fund, Texas ranks 46th in quality of care even though Medicare spending in the state is among the highest in the nation.

To learn more about increasing health care expenses, read the Dallas Morning News article: Dallas sees no relief in health care expenses as competition drives up costs.

Health reform will benefit all Texans and Americans. It will benefit the insured, uninsured and underinsured, along with local and state governments who often subsidize care for those without insurance. Health insurance reform will require personal responsibility, allow those without insurance to purchase quality, affordable care, and lower costs for all Texans.

In Washington, 564 amendments have been offered to the health care legislation introduced by Senator Max Baucus (D-Montana), Chairman of the Senate Finance Committee. You can read all the amendments here.

As this process moves relatively quickly, we will try to keep you up to date regularly. In an effort to keep informed, you may receive more emails from us than usual.

Harris County Will Benefit from Health Care Reform

The Texas congressional district with the highest insured population ranks 239th of 435 in the country. The highest ranking congressional district in Harris County ranks 244th of 435. Congressional districts in Houston have more residents without health insurance than any other metropolitan region in the country. Harris County alone has 1.3 million uninsured residents.

As the state with the largest uninsured population, we have the most to gain from federal health reform legislation. Individuals with health insurance will benefit from reform as well, since rising health care premiums are crushing family budgets. Texas families need access to quality, affordable health care now.

For your information, below I've included:

• An article from Saturday's Houston Chronicle that details Houston area congressional districts' health insurance standings as compared with the rest of the country,
• An article from Saturday's Houston Chronicle about a roundtable discussion in which I urge leaders of the Texas Medical Center to support health care reform.

To see a more detailed explanation from the U.S. Energy and Commerce Committee of how federal health reform legislation will benefit Harris County congressional districts, please click on the below links:

• John Culberson (TX-7)
• Kevin Brady (TX-8)
• Al Green (TX-9)
• Michael McCaul (TX-10)
• Sheila Jackson Lee (TX-18)
• Pete Olson (TX-22)
• Gene Green (TX-29)

I will keep you updated on this important policy matter as it continues to develop.

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City, state lag nation in health insurance
Houston congressional districts among worst 10 in U.S.

By RICHARD S. DUNHAM
WASHINGTON BUREAU

Aug. 29, 2009, 7:48AM

WASHINGTON — The Houston congressional delegation holds an ignominious honor: More of its districts have more people without health insurance than any other metropolitan area in the country.

Texas, which has the nation's highest rate of uninsured, has four districts among the worst 10 in the country for constituents who lack coverage, including those represented by Houston Democrats Gene Green and Sheila Jackson Lee.
Thirteen of Texas' districts — including the four in the Houston area — are in the bottom 30.

"It's not something that I'm proud of," said Rep. Al Green, D-Houston, whose district ranks 28th from the bottom.

Not a single Texas congressional district, even the state's wealthiest, ranks in the nation's top half. The ratings are based on a Houston Chronicle analysis of Gallup Poll data compiled by National Journal.

Eight of the 10 Texas districts with the highest uninsured rates are dominated by minority residents. The two majority-white districts in the bottom 10 list are in East Texas.

About 6 million Texans are uninsured, including one in five children. Harris County has more uninsured residents than any other Texas county — 1.3 million people — and Rep. Al Green says 500,000 more are underinsured.

The uninsured data include illegal immigrants, which skews the results in some Texas districts. But it doesn't fully explain the Lone Star State's uniformly low standing. Indeed, the state's wealthiest districts, including some with very few undocumented residents, rank far behind comparable districts in other states.

Jackson Lee, whose constituency is about 40 percent African-American and 36 percent Hispanic, calls the disparities in health coverage between wealthy Texans and poor minorities "a link for disaster and call for serious attention."

Helping the hospitals

The state's high uninsured population has become an issue as Congress considers comprehensive health-care reform. Gene Green says local lawmakers are working with the Texas Medical Center and its member institutions to ensure that area hospitals are reimbursed for serving uninsured Texans under any overhauled health-care system.

"I don't want whatever new system we have to hurt the (hospitals)," he said. "I want them to get paid."

Among Texas' 32 congressional districts, eight of the 10 with the highest uninsured rates are represented by Democrats. At the bottom of the list — for Texas and the nation — is Ruben Hinojosa's Rio Grande Valley district, where 46.4 percent of residents have no health-care coverage.

Gene Green's majority-Latino Houston district, with its 36.4 percent uninsured rate, is second worst in Texas and fifth worst in the country. Jackson Lee's central Houston district has a 29.7 percent uninsured rate, sixth worst in Texas and 19th worst in the U.S. The fourth Houston-area lawmaker in the bottom 30 is Rep. Kevin Brady, R-The Woodlands.
"Without reform," argues Rep. Charles Gonzalez, D-San Antonio, "the problem will only get worse."

‘Greatest health-care ...'

The 10 districts with the most insured residents — three in the Houston area — have Republican members of Congress. All of those suburban lawmakers oppose President Barack Obama's health-reform initiative.

The Texas district with the highest coverage levels is represented by a doctor, Michael Burgess of Lewisville. But Burgess' Dallas-area district ranks only 239th of the nation's 435 House districts. Houston's best-insured district is John Culberson's westside district.

It ranks 244th of 435 in the country.

Culberson calls American medical care "the greatest health-care system that the world has ever known."

To increase the number of insured Texans, Culberson would permit citizens to buy health insurance across state lines, allow small businesses to band together to purchase health insurance without federal restrictions and to expand the use of Health Savings Accounts. He warns that Democratic health-reform proposals will result in "the obliteration of the private sector."

richard.dunham@chron.com

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Lawmaker urges Med Center to back health overhaul

By Todd Ackerman

Aug. 28, 2009, 9:05PM

State Rep. Garnet Coleman called for Texas Medical Center leaders to support health-care reform efforts Friday, arguing that Congress needs to "get it done, not slow it down" and dismissing town hall opposition as orchestrated.

The Houston Democrat's appeal was a response to U.S. Sen. Kay Bailey Hutchison's July 27 news conference, where many medical center leaders urged Congress not to rush efforts to fix America's troubled health-care system. Coleman criticized the event at the time as an attempt to kill the effort.

"The time of leaving people without health insurance has gone on too long," said Coleman, a member of President Barack Obama's 32-person State Legislators for Health Reform. "Your being against the legislation is not going to kill it. People want change."

Coleman characterized as "planned and rolled out" the town hall meetings where opponents have fulminated against the House bill, pointing to Republican consultant Frank Luntz's "10 rules for stopping the Washington takeover of health care."

"This is not a spontaneous uprising," Coleman said, adding that the strategy was designed to affect polling, currently on a downward trajectory.

A lower profile

Coleman's news conference drew a lower profile group than Hutchison's event, which included many of the medical center's biggest names. There were only two big names at Coleman's event — University of Texas M.D. Anderson Cancer Center President Dr. John Mendelsohn and Harris County Hospital District President and Chief Executive Officer David Lopez.

Lopez was one of the most vocal advocates of slowing down the process — in July he said "the devil is in the details" and expressed concern to Hutchison that the House bill could have a negative effect on the district — but he said Friday he has now had a chance to study the bill and supports it.

Lopez was the only official to attend both news conferences. The other attendees Friday included representatives from Texas Children's Hospital, Shriners Hospital for Children, The Institute for Rehabilitation and Research, Prairie View A&M's College of Nursing and the Texas Medical Center, the corporation that manages the medical center.

At one point, Coleman asked how many had read the House bill, which is more than 1,000 pages long. Only a few raised a hand.

Coleman told those in attendance that the bill will be fine-tuned, noting that in his 18 years as a state legislator he's never seen a bill passed that was the same as originally written.

Coleman said the State Legislators for Health Reform, created in May, regularly brings back input to Obama about what people like and dislike about reform legislation.

todd.ackerman@chron.com

Opposition's Game Plan to Kill Federal Health Reform Legislation

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.

_________________________________________________________________

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)

_________________________________________________________________

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

Summary of America's Affordable Health Choices Act

With all the misinformation floating around about federal health reform, it is important that we know the facts. Below, I've included a summary of federal health insurance reform legislation that was prepared by the three U.S. House Committees that have been working on health reform. To download this summary as a PDF document click here. You can also read a synopsis of the bill from the Kaiser Family Foundation, an independent third party, here.

Health care reform legislation must still make its way out of both chambers, to a conference committee to reach a compromise, and back to both chambers for a final vote. This is standard procedure for crafting legislation in Congress. As legislation progresses through these various stages, I will keep you informed of any new developments.

To view a playbook of the opposition's game plan to kill this legislation, click here.

For more information, you can also read the following publications by the Commonwealth Fund:

• Failure to Protect: Why the Individual Insurance Market Is Not a Viable Option for Most U.S. Families [The findings underscore the need for an expansion of affordable health insurance options, particularly during a time of mounting job losses.]
• Paying the Price: How Health Insurance Premiums Are Eating Up Middle-Class Incomes--State Health Insurance Premium Trends and the Potential of National Reform [The rapid rise in health insurance premiums has severely strained U.S. families and employers in recent years]
• How Health Care Reform Can Lower the Costs of Insurance Administration [The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration.]

I will keep you updated on this important policy matter as it continues to develop.

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America’s Affordable Health Choices Act provides quality affordable health care for all Americans and controls health care cost growth. Key provisions of the bill released today include:

• COVERAGE AND CHOICE
• AFFORDABILITY
• SHARED RESPONSIBILITY
• CONTROLLING COSTS
• PREVENTION AND WELLNESS
• WORKFORCE INVESTMENTS

I. COVERAGE AND CHOICE
The bill builds on what works in today’s health care system and fixes the parts that are broken. It protects current coverage – allowing individuals to keep the insurance they have if they like it – and preserves choice of doctors, hospitals, and health plans. It achieves these reforms through:

• A Health Insurance Exchange. The new Health Insurance Exchange creates a transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers. It works with state insurance departments to set and enforce insurance reforms and consumer protections, facilitates enrollment, and administers affordability credits to help low- and middle-income individuals and families purchase insurance. Over time, the Exchange will be opened to additional employers as another choice for covering their employees. States may opt to operate the Exchange in lieu of the national Exchange provided they follow the federal rules.
• A public health insurance option. One of the many choices of health insurance within the health insurance Exchange is a public health insurance option. It will be a new choice in many areas of our country dominated by just one or two private insurers today. The public option will operate on a level playing field. It will be subject to the same market reforms and consumer protections as other private plans in the Exchange and it will be self-sustaining – financed only by its premiums.
• Guaranteed coverage and insurance market reforms. Insurance companies will no longer be able to engage in discriminatory practices that enable them to refuse to sell or renew policies today due to an individual’s health status. In addition, they can no longer exclude coverage of treatments for pre-existing health conditions. The bill also protects consumers by prohibiting lifetime and annual limits on benefits. It also limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors. Under the proposal, premiums can vary based only on age (no more than 2:1), geography and family size.
• Essential benefits. A new independent Advisory Committee with practicing providers and other health care experts, chaired by the Surgeon General, will recommend a benefit package based on standards set in the law. This new essential benefit package will serve as the basic benefit package for coverage in the Exchange and over time will become the minimum quality standard for employer plans. The basic package will include preventive services with no cost-sharing, mental health services, oral health and vision for children, and caps the amount of money a person or family spends on covered services in a year.

II. AFFORDABILITY
To ensure that all Americans have affordable health coverage the bill:

• Provides sliding scale affordability credits. The affordability credits will be available to low- and moderate- income individuals and families. The credits are most generous for those who are just above the proposed new Medicaid eligibility levels; the credits decline with income (and so premium and cost-sharing support is more limited as your income increases) and are completely phased out when income reaches 400 percent of the federal poverty level ($43,000 for an individual or $88,000 for a family of four). The affordability credits will not only make insurance premiums affordable, they will also reduce cost-sharing to levels that ensure access to care. The Exchange administers the affordability credits with other federal and state entities, such as local Social Security offices and state Medicaid agencies.
• Caps annual out-of-pocket spending. All new policies will cap annual out-of-pocket spending to prevent bankruptcies from medical expenses.
• Increased competition: The creation of the Health Insurance Exchange and the inclusion of a public health insurance option will make health insurance more affordable by opening many market areas in our country to new competition, spurring efficiency and transparency.
• Expands Medicaid. Individuals and families with incomes at or below 133 percent of the federal poverty level will be eligible for an expanded and improved Medicaid program. Recognizing the budget challenges in many states, this expansion will be fully federally financed. To improve provider participation in this vital safety net – particularly for low-income children, individuals with disabilities and people with mental illnesses – reimbursement rates for primary care services will be increased with new federal funding.
• Improves Medicare. Senior citizens and people with disabilities will benefit from provisions that fill the donut hole over time in the Part D drug program, eliminate cost-sharing for preventive services, improve the low-income subsidy programs in Medicare, fix physician payments, and make other program improvements. The bill will also address future fiscal challenges by improving payment accuracy, encouraging delivery system reforms and extending solvency of the Medicare Trust Fund.

III. SHARED RESPONSIBILITY
The bill creates shared responsibility among individuals, employers and government to ensure that all Americans have affordable coverage of essential health benefits.

• Individual responsibility. Except in cases of hardship, once market reforms and affordability credits are in effect, individuals will be responsible for obtaining and maintaining health insurance coverage. Those who choose to not obtain coverage will pay a penalty of 2.5 percent of modified adjusted gross income above a specified level.
• Employer responsibility. The proposal builds on the employer-sponsored coverage that exists today. Employers will have the option of providing health insurance coverage for their workers or contributing funds on their behalf. Employers that choose to contribute will pay an amount based on eight percent of their payroll. Employers that choose to offer coverage must meet minimum benefit and contribution requirements specified in the proposal.
• Assistance for small employers. Recognizing the special needs of small businesses, the smallest businesses (payroll that does not exceed $250,000) are exempt from the employer responsibility requirement. The payroll penalty would then phase in starting at 2% for firms with annual payrolls over $250,000 rising to the full 8 percent penalty for firms with annual payrolls above $400,000. In addition, a new small business tax credit will be available for those firms who want to provide health coverage to their workers. In addition to the targeted assistance, the Exchange and market reforms provide a long-sought opportunity for small businesses to benefit from a more organized, efficient marketplace in which to purchase coverage.
• Government responsibility. The government is responsible for ensuring that every American can afford quality health insurance, through the new affordability credits, insurance reforms, consumer protections, and improvements to Medicare and Medicaid.

IV. PREVENTION AND WELLNESS
Prevention and wellness measures of the bill include:

• Expansion of Community Health Centers;
• Prohibition of cost-sharing for preventive services;
• Creation of community-based programs to deliver prevention and wellness services;
• A focus on community-based programs and new data collection efforts to better identify and address racial, ethnic, regional and other health disparities;
• Funds to strengthen state, local, tribal and territorial public health departments and programs.

V. WORKFORCE INVESTMENTS
The bill expands the health care workforce through:

• Increased funding for the National Health Service Corp;
• More training of primary care doctors and an expansion of the pipeline of individuals going into health professions, including primary care, nursing and public health;
• Greater support for workforce diversity;
• Expansion of scholarships and loans for individuals in needed professions and shortage areas;
• Encouragement of training of primary care physicians by taking steps to increase physician training outside the hospital, where most primary care is delivered, and redistributes unfilled graduate medical education residency slots for purposes of training more primary care physicians. The proposal also improves accountability for graduate medical education funding to ensure that physicians are trained with the skills needed to practice health care in the 21st century.

VI. CONTROLLING COSTS
The bill will reduce the growth in health care spending in a numerous ways. Investing in health care through stronger prevention and wellness measures, increasing access to primary care, health care delivery system reform, the Health Insurance Exchange and the public health insurance option, improvements in payment accuracy and reforms to Medicare and Medicaid will all help slow the growth of health care costs over time. These savings will accrue to families, employers, and taxpayers.

• Modernization and improvement of Medicare. The bill implements major delivery system reform in Medicare to reward efficient provision of health care, rolling out innovative concepts such as accountable care organizations, medical homes, and bundling of acute and post-acute provider payments. New payment incentives aim to decrease preventable hospital readmissions, expanding this policy over time to recognize that physicians and post-acute providers also play an important role in avoiding readmissions. The bill improves the Medicare Part D program by creating new consumer protections for Medicare Advantage Plans, eliminating the “donut hole” and improvinglow-income subsidy programs, so that Medicare is affordable for all seniors and other eligible individuals. A centerpiece of the proposal is a complete reform of the flawed physician payment mechanism in Medicare (the so-called sustainable growth rate or “SGR” formula), with an update that wipes away accumulated deficits, provides for a fresh start, and rewards primary care services, care coordination and efficiency.
• Innovation and delivery reform through the public health insurance option. The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar. It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value-based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans.
• Improving payment accuracy and eliminating overpayments. The bill eliminates overpayments to Medicare Advantage plans and improves payment accuracy for numerous other providers, following recommendations by the Medicare Payment Advisory Commission and the President. These steps will extend Medicare Trust Fund solvency, and put Medicare on stronger financial footing for the future.
• Preventing waste, fraud and abuse. New tools will be provided to combat waste, fraud and abuse within the entire health care system. Within Medicare, new authorities allow for pre-enrollment screening of providers and suppliers, permit designation of certain areas as being at elevated risk of fraud to implement enhanced oversight, and require compliance programs of providers and suppliers. The new public health insurance option and Health Insurance Exchange will build upon the safeguards and best practices gleaned from experience in other areas.
• Administrative simplification. The bill will simplify the paperwork burden that adds tremendous costs and hassles for patients, providers, and businesses today.