Dear County Officials: The debate in Washington, DC, over how to fix America’s broken health system is reaching a critical
Dear County Officials: The debate in Washington, DC, over how to fix America’s broken health system is reaching a critical stage. Congressional committees are rolling out draft legislation as early as next week and leaders are planning to have votes by the end of July. NACo has been preparing for this debate. Under the leadership of President Elect Valerie Brown, NACo’s Health System Reform Working Group held three regional hearings to give county officials from around the country the opportunity to share their concerns. The group has summarized its conclusions in Restoring the Partnership for American Health: Counties in a 21st Century Health System (attached) which was approved by the Health Steering Committee and Board of Directors at the Legislative Conference in March. NACo has shared these principles with officials in the White House and the Department of Health and Human Services as well as with each member of the House and Senate. With all the voices and powerful interests demanding attention, however, we need your county to join us to make sure that reforms consistent with NACo principles are enacted, and enacted this year! Please consider taking the following actions to add your voice to NACo’s urgent call for the right kind of health reform: 1. Pass a resolution supporting passage of health reform this year to restore the partnership between counties and the federal government. Feel free to use the attached model. 2. Publicize your resolution through your local press. 3. Send copies of the resolution to: a. Each member of your Congressional delegation b. The White House: Michael A. Blake Deputy Associate Director Offices of Intergovernmental Affairs & Public Engagement [email protected] c. NACo: Paul V. Beddoe Associate Legislative Director ~ Health [email protected] We thank you for joining us in this effort and for your continued service to your communities through county government. Don Stapley President From NACo – July 7, 2009 Dear State Association Executives, As you know, health reform at the top of the agenda in DC right now. NACo is working to make sure that the changes Congress makes to our health system actually enhance our counties’ capacity to serve their populations. We face an uphill battle. According to yesterday’s Washington Post, the health-care industry is spending $1.4 million a day on lobbying. And they’ve hired over 350 former government staffers and retired Members of Congress to do that lobbying. We need your members to help us amplify our message by supporting it from home. One way they can do that is by adopting resolutions endorsing NACo’s health reform principles as set out in our white paper, “Restoring the Partnership for American Health: Counties in a 21st Century Health System” (attached). A couple weeks ago President Stapley sent out a memo (attached) to county board members and county administrators from active NACo counties asking them to adopt a model resolution (attached). A few have trickled in, but we need to do much better. Please note that this is not an endorsement of any particular plan – including the President’s – but rather calling for changes to the system that will work for counties. Would you consider sending out the request to your state association network and encouraging counties to adopt the resolutions? They should feel free to edit the model to reflect their own concerns and priorities. Have them then send copies on to your Congressional delegations, the White House and to me. As an incentive for you, President Elect Valerie Brown has asked me to let you know that she has a case of fine Sonoma County wine for the State Exec with the highest percentage of counties that adopt resolutions and send them on to us here in DC by the end of July. If you have any questions, please don’t hesitate to contact me. And stay tuned – I’m going to have other requests as we move ahead. See you in Tennessee! Paul V. Beddoe, Ph.D. Associate Legislative Director ~ Health Policy National Association of Counties (202) 942-4234 - voice (202) 942-4281 - fax (202) 550-8946 - mobile [email protected] THE BOARD OF COUNTY ________________ OF __________________COUNTY RESOLUTION NO. ______ A RESOLUTION URGING IMMEDIATE PASSAGE OF COMPREHENSIVE FEDERAL HEALTH REFORM LEGISLATION WHEREAS, experts from across the political spectrum agree that America’s health system is “broken” and unsustainable in its present configuration; and WHEREAS, families in ______________ County are experiencing this crisis right now, confronting the high cost of health care that threatens their financial stability, leaves them exposed to higher premiums and deductibles, and puts them at risk for a possible loss of health insurance; and WHEREAS, employer-sponsored health insurance premiums have nearly doubled in recent years making it increasingly difficult for employers, including county governments, to provide health insurance coverage for their employees and retirees; and WHEREAS, millions of Americans do not have health coverage, or have inadequate coverage and as our economic challenges multiply, the problem of health care access grows, further straining counties’ capacity to provide care for the uninsured, underinsured and medically indigent; and WHEREAS, <add local health and/or economic data>; and WHEREAS, county officials are elected to protect the health and welfare of their constituents: and WHEREAS, <add local county’s costs for meeting health obligations like indigent care, subsidies for hospitals and clinics, behavioral health, public health, jail health, non-federal share of Medicaid etc.>; and WHEREAS, the National Association of Counties (NACo) Health System Reform Working Group, appointed by President Don Stapley in July 2008 and chaired by President-Elect Valerie Brown, has held three regional hearings to explore the health crisis and to hear what county officials believe should be done about it and has summarized its findings in Restoring the Partnership for American Health: Counties in a 21st Century Health System which was approved and adopted by resolution of the NACo Health Steering Committee and Board of Directors on March 9, 2009. NOW THEREFORE BE IT RESOLVED that the Board of County ______________ of __________________________ County endorses NACo’s health reform principles, as summarized in Restoring the Partnership for American Health: Counties in a 21st Century Health System; namely, that reform legislation should 1. restore the partnership between county and federal governments; 2. provide access to affordable, quality health care to all; 3. invest in public health, including health promotion and disease and injury prevention; 4. stabilize and strengthen the local health care safety net system, especially Medicaid and disproportional share hospital (DSH) payments; 5. invest in the development of the health professional and paraprofessional workforce; 6. ensure that county health agencies have the resources to meaningfully use health information technology; 7. enable elderly and disabled persons to receive the services they need in the least restrictive environment; and 8. reform the delivery and financing of health services in the jail system. BE IT FURTHER RESOLVED that the Board strongly urges the 111th Congress of the United States to enact comprehensive health reform legislation without delay before the end of its first session. APPROVED, ADOPTED AND PASSED, THIS ______ day of_______, 2009. THE BOARD OF COUNTY ____________________________ OF _____________________________ COUNTY By:____________________________________ , Chair APPROVED AS TO FORM: ATTEST: __________________________ , County Attorney ____________________________ , County Clerk 2 Restoring the Partnership for American Health Counties in a 21st Century Health System Full Partners: County governments are integral to America’s current health system and will be crucial partners in achieving successful reform. At the most basic level, county officials are elected to protect the health and welfare of their constituents. County governments set the local ordinances and policies which govern the built environment, establishing the physical context for healthy, sustainable communities. County public health officials work to promote healthy lifestyles and to prevent injuries and diseases. Counties provide the local health care safety net infrastructure, financing and operating hospitals, clinics and health centers. County governments also often serve as the payer of last resort for the medically indigent. County jails must offer their inmates health care as required by the U.S. Supreme Court. Counties operate nursing homes and provide services for seniors. County behavioral health authorities help people with serious mental health, developmental disability and substance abuse problems who would have nowhere else to turn. And as employers, county governments provide health benefits to the nearly three million county workers and their retirees nationwide. Clearly, county tax payers contribute billions of dollars to the American health care system every year and their elected representatives must be at the table as full partners in order to achieve the goal of one hundred percent access and zero disparities. Local Delivery Systems – Access for All: NACo believes that reform must focus on access and delivery of quality health services. Coverage is not enough. County officials, particularly in remote rural or large urban areas know that even those with insurance may have difficulty gaining access to the services of a health care provider, which can be exacerbated by the severity of their illness. Local delivery systems should coordinate services to ensure efficient and cost-effective access to care, particularly primary and preventive care, for underserved populations. County governments are uniquely qualified to convene the appropriate public and private partners to build these local delivery systems in a way that will respect the unique needs of individuals and their communities. A restored federal commitment to such partnerships is necessary for equity’s sake. Public Health and Wellness: NACo believes that a greater focus on disease and injury prevention and health promotion is a way to improve the health of our communities and to reduce health care costs. Disease and injury prevention and health promotion services can be delivered by a health care professional one patient at a time. Local health departments, in partnership with community based organizations and traditional health care providers, deliver community-based prevention services targeted at an entire population. Population-based prevention services can save money by keeping people healthy and reducing the costs of treating unchecked chronic disease. These critical services include assessment of the health status of communities to identify the unique and most pressing health problems of each community and health education to provide individuals with the knowledge and skills to maintain and improve their own health. The public health response to emergencies should be fully integrated into each county’s emergency management plan. Local public health considerations likewise should be systematically integrated into land use planning and community design processes to help prevent injuries and chronic disease. Policies are also needed to address health inequity, the systemic, avoidable, unfair and unjust differences in health status and mortality rates, as well as the distribution of disease and illness across population groups. Investing in wellness and prevention across all communities will result in better health outcomes, increased productivity and reduce costs associated with chronic diseases. Expanding Coverage: NACo supports universal health insurance coverage. Existing public health insurance systems should be strengthened and expanded, including Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP). As states and counties attempt to shoulder their legislatively mandated responsibilities to provide care for the indigent and uninsured, federal regulatory barriers should be removed to allow flexibility and innovation at the local level. Furthermore, in the effort to expand coverage, reformers should not forget that the coverage must be meaningful, without imposing additional mandates on county governments. The benefit package must be defined so as to provide the full range of services people need, including prevention services, full parity for behavioral health, substance abuse and developmental disability services. Barriers to cost-effective treatments, like living organ donation, should be removed. Maintaining a Safety Net: NACo believes that the intergovernmental partnership envisioned in the Medicaid statute should be restored and strengthened. Local safety nets constructed under Medicaid should not be dismantled to “pay for” universal coverage. We must not allow the safety net infrastructure to be undermined. County hospitals and health systems, in particular, will continue to need extra support to carry out their missions to reduce disparities and serve underserved populations. Health Workforce: NACo believes that the health professional and paraprofessional workforce must be supported and enhanced. Every effort should be made to recruit, train, license and retain health professionals, and allied professionals and paraprofessionals, on an expedited basis. A large body of evidence supports the contribution of direct care staff, nurses and nursing assistants, to quality outcomes. Funding for existing education and training programs – in secondary, post-secondary and vocational educational settings – should be increased and targeted towards initiatives to expand and diversify the health workforce. Partnerships between local economic developers and workforce development professionals should be encouraged to meet growing health care sector demand. Targeted incentives including scholarships, loan forgiveness and low-interest loan repayment programs should be developed to encourage more providers to enter and remain in primary care and public health careers. Primary care providers should be empowered to – and compensated for – case management services. Health IT: The federal government should support the integration of health information technologies into the local health care delivery system. NACo supports the President’s goal of implementing a nation-wide system of electronic health records in five years. NACo supports efforts to promote the use of a range of information technologies to facilitate appropriate access to health records and improve the standard of care available to patients, while protecting privacy. This includes deployment of broadband technologies to the widest possible geographic footprint. Other tools facilitate evidence-based decision making and e-prescribing. Using broadband technologies, telemedicine applications enable real-time clinical care for geographically distant patients and providers. Remote monitoring can also facilitate post-operative care and chronic disease management without hospitalization or institutionalization. Long Term Care: Federal policies should encourage the elderly and disabled to receive the services they need in the least restrictive environment. Since counties provide and otherwise support long term care and other community based services for the elderly and disabled, state and federal regulations and funding programs should give them the flexibility to support the full continuum of home, community-based or institutional care for persons needing assistance with activities of daily living. Nursing home regulatory oversight should be reformed in order to foster more person-centered care environments. Jail Health: Reforming America’s health care system must include reforms to its jail system. Counties are responsible for providing health care for incarcerated individuals as required by the U.S. Supreme Court in Estelle v. Gamble, 429 U.S. 97 (1976). This unfunded mandate constitutes a major portion of local jail operating costs and a huge burden on local property tax payers. The federal government should lift the unfunded mandate by restoring its obligation for health care coverage for eligible inmates, preconviction. Furthermore, a true national partnership is needed to divert the non-violent mentally ill from jail and into appropriate evidence-based treatment in community settings, if possible. Finally, resources should be made available to counties to implement timely, comprehensive reentry programs so that former inmates have access to all the health and social services, including behavioral health and substance abuse treatment, to avoid recidivism and become fully integrated into the community. C ou n t y of f ic ia l s FO R H E ALT H R E FO R M Reducing Costs, Preserving Choice, and Assuring Quality Affordable Health Care For All Americans 2009 Guide c o u n t y o f f i c i a l s FO R H E ALT H R E FO R M 2 0 0 9 G UI D E “I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.” – President Barack Obama, Address to Joint Session of Congress, February 24, 2009 I. Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 II. Top Line Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 III. Ways to Support the President’s Health Reform Agenda . . . . . . . . . . . . . . 2 IV. Background Information and Materials on Health Reform . . . . . . . . . . . 3 V. Suggested Discussion Questions for Health Reform Events . . . . . . . . . . . . 5 VI. Health Reform Talking Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 VII. Overview of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 COUNTY OFFICIALS FOR HEALTH REFORM GUIDE TO SUPPORTING THE PRESIDENT’S HEALTH REFORM AGENDA IN YOUR COMMUNITY Thank you for supporting President Obama’s commitment to passing health reform this year that reduces costs to make health care affordable; protects a patient’s choice of doctors, hospitals, and insurance plans; and assure quality affordable health care for all Americans. County governments are integral to our current health system and will be crucial partners in achieving successful reform. It is clear that health care reform can no longer wait. Rapidly escalating health care costs are crushing family, business, and government budgets. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than cumulative wage increases.1 This forces families to sit around the kitchen table to make impossible choices between paying rent or paying health premiums. Given all that we spend on health care, American families should not be presented with that choice. The United States spent approximately $2.2 trillion on health care in 2007, or $7,421 per person2 – nearly twice the average of other developed nations.3 Americans spend more on health care than on housing or food.4 If rapid health cost growth persists, the Congressional Budget Office estimates that by 2025, one out of every four dollars in our national economy will be tied up in the health system. This growing burden will limit other investments and priorities that are needed to grow our economy.5 Rising health care costs also affect our economic competitiveness in the global economy, as American companies compete against companies in other countries that have dramatically lower health care costs. The President has vowed that the health reform process will be different in his Administration – an open, inclusive, and transparent process where all ideas are encouraged and all parties work together to find a solution to the health care crisis. Working together with members of Congress, doctors and hospitals, businesses and unions, and other key health care stakeholders, the President is committed to making sure we enact health care reform this year. I. GOALS OF COUNTY OFFICIALS FOR HEALTH REFORM The goals of County Officials for Health Reform are: To create local momentum for the President’s health reform agenda and to educate communities on the need for health reform this year; To listen to the voices and health care concerns of your communities and to advance the President’s understanding of the health care problems Americans face and the solutions they propose; and To build support amongst peers and constituencies for the President’s health reform agenda. 1 II. TOP LINE MESSAGE The President is committed to enacting health reform this year that: III. Reduces costs to make health care affordable; Protects a patient’s choice of doctors, hospitals, and insurance plans; and Assures quality affordable health care for all Americans. WAYS TO SUPPORT THE PRESIDENT’S HEALTH REFORM AGENDA There are numerous ways that you can advance the President’s goal of enacting health reform this year that lowers costs; guarantees choice of doctors, hospitals, and insurance plans; and assures quality affordable health care for all Americans. Below are some possible ways to support the President’s health reform agenda, but please think of other initiatives in your communities that could also be helpful. Pass Local Resolutions of Support: Encourage local resolutions in support of the President’s health reform principles of lowering cost; protecting a patient’s choice of doctors, hospitals, and insurance plans; and assuring quality, affordable health care for all Americans. If appropriate, you could hold a hearing to allow your community members to speak up and offer their ideas for health reform this year. Generate Press Coverage: Using materials in this guide and on www.HealthReform.gov, we would appreciate your efforts to educate your community on the need for health reform this year and publicly demonstrate your support for the President’s health reform agenda. Possibilities include: writing an Op Ed or a letter to the editor for publication in your local papers; issuing press releases; holding press conferences; or appearing on local radio or television shows in support of health reform. This guide and www.HealthReform.gov include materials to support these activities. Host a Local Event: You could hold a community town hall or a roundtable discussion to demonstrate the need for health reform this year and hear directly from your citizens about their health care concerns and suggestions. Events could be held at a university auditorium, hospital, school, community health center, or even a meeting space at a local coffee shop, and you could potentially partner with an interested local non-profit organization. Suggested discussion questions for health reform events are included in this guide. After the event, you or your staff could submit a summary of your discussion through the “Contact Us—Share Your Story” feature on www.HealthReform.gov. If you are willing to demonstrate your public support for health reform this year through local resolutions, press activity, and local events, we want to hear about it and make sure others know of your work. Please email us at [email protected] and let us know how your efforts are going. As always, thanks for your help! 2 IV. BACKGROUND INFORMATION AND MATERIALS ON HEALTH REFORM The Obama Administration has numerous materials you can use to help demonstrate your support for the President’s health reform agenda, educate your community on the need for health reform this year, and engage your community in the health reform process. Administration’s Health Reform Website, www.HealthReform.gov: The website HealthReform.gov includes in-depth information and updates about health reform and provides information how Americans around the country can participate in the discussion. In addition to the specific features discussed below (Weekly Update, Statement of Support, and Reports), the website also includes: o Health reform quiz questions; o Updates on health reform announcements; o Videos and live web-streaming of Administration health reform events, such as the White House Forum on Health Reform, the five Regional White House Forums on Health Reform, and White House Health Care Stakeholder Discussions; o Stories from Americans around the country on why we need health reform this year; and o Summaries of articles discussing the need for health reform this year. Weekly Update on Health Reform: Each week, a new “Weekly Update on Health Reform” video is posted on www.HealthReform.gov featuring either Nancy-Ann DeParle, Counselor to the President and Director of the White House Office of Health Reform, or Health and Human Services Secretary Kathleen Sebelius. The Weekly Update on Health Reform is a short update for the American public on what the Administration worked on last week and what the Administration is doing this week on health reform. You can watch the video each week and encourage your local communities to watch the Weekly Updates as well. Statement of Support on HealthReform.gov: Encourage your communities to visit www.HealthReform.gov to sign the statement in support of the President’s principles for health reform this year. Joining the Discussion: The Administration encourages Americans around the country to contribute to the health reform discussion. You should encourage community members to share their stories and ideas about why we need health reform this year by going to the “Contact Us—Share Your Story” page on www.HealthReform.gov. Health Reform Updates: Encourage your communities to sign up for health reform e-mail updates. Individuals can sign up for these updates by clicking “E-mail Updates” at the top right of www.HealthReform.gov. Reports on the Need for Health Reform This Year: The Department of Health and Human Services and the Office of Health Reform have released several reports that provide concise summaries on the need for health reform this year. These short reports are great handouts for health reform events and also provide background information for resolutions or Op Eds in 3 support of enacting health reform this year. All of the reports below, as well as future reports, are available on www.HealthReform.gov. The current reports include: o Americans Speak on Health Reform: Report on Health Care Community Discussions: This past December, the Health Policy Transition Team encouraged all Americans to host or attend a Health Care Community Discussion to “share their ideas about what’s broken and how to fix it.” Over 9,000 people in all 50 states and the District of Columbia signed up to host a Health Care Community Discussion, and the Health Policy Transition Team received 3,276 group reports as well as Participant Survey results from over 30,000 participants. This report summarizes what the Administration learned about the health care problems Americans face and the solutions they propose. o Report on the White House Forum on Health Reform: On March 5, President Obama convened a White House Forum on Health Reform to bring together leaders – business and labor, doctors and insurers, Democrats and Republicans, and Americans from around the country – to discuss the urgent need to pass health reform this year. This report summarizes the discussions at this event. o The Costs of Inaction: The Urgent Need for Health Reform: This report highlights the flaws in the health care system and demonstrates the cost of maintaining the status quo. Organized into three sections – Escalating Health Care Costs, Diminishing Access to Care, and Persistent Gaps in Quality – the report shows how the current system has failed millions of Americans and why we must enact health reform this year. o Helping the Bottom Line: Health Reform and Small Business: This report discusses how the high cost of health care burdens small businesses, weakens our economy, and leaves millions of Americans without the affordable health care they need and deserve. o Hard Times in the Heartland: Health Care in Rural America: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. This report provides insight into the current state of health care in rural areas and the critical need for health care reform. o Roadblocks to Health Care: Why the Current Health Care System Does Not Work For Women: Today there are 21 million uninsured women and girls, and this report discusses how our current system is leaving millions of women without the affordable, quality care they need. 4 V. SUGGESTED DISCUSSION QUESTIONS FOR HEALTH REFORM EVENTS The questions below could be used for any health reform events in your community. Overall Questions How can we reform our health care system at the national level to improve quality of care, lower costs for our families, and assure quality affordable health care for all Americans? What specific ideas do you have on this topic? What specific challenges are people/representatives facing on health care? Do you feel that this is an urgent problem requiring action this year? How can health care reform at the national level help support the work of our states to address the health care challenges our families are facing? What do you see as the highest priorities that we must address with health reform? Cost How are rising health care costs impeding businesses and families? What steps would you recommend taking to reduce overall costs and cost growth? Quality/Coverage/Access What types of prevention and wellness programs do you recommend/support? What types of incentives are needed to support healthy behaviors and value consciousness? What kinds of things can the public sector and the private sector do together to make America healthier and to increase access to coverage for more Americans? In terms of expanding coverage – what do you think the role of the public and private sectors should be? Process Questions How can Congress and the Administration better involve the American public in health reform? How are circumstances surrounding health reform different now as opposed to in 1993? What steps are you going to take to help enact health reform? VI. HEALTH REFORM TALKING POINTS Reform has been delayed for too long, and it cannot wait any longer. Every day in America, families are struggling with the crushing cost of health care that threatens their financial stability, leaves them exposed to higher premiums and deductibles, and puts them at risk for a possible loss of health insurance as employers struggle to provide adequate health care coverage. Americans value their relationship with their doctors and the care they receive, but as costs rise and insurance benefits erode, they are asking for reform that protects what works and fixes what is broken. 5 Since 2000, employer-sponsored health insurance premiums have nearly doubled, and health care premiums have grown three times faster than wages. Even for people with health care, all it takes is one stroke of bad luck to become one of the nearly 46 million uninsured – or the millions who have health care, but can’t afford it. Today, there are people who say we need to defer health care reform – that at a time of economic crisis, we’ll have to accept the status quo because we cannot afford to fix our health care system. What these people fail to acknowledge is that the skyrocketing cost of health care – costs that are straining family budgets, crippling businesses, and consuming government budgets – is one of the greatest threats there is to America’s fiscal health. That is why we cannot delay this discussion any longer. Health care reform is no longer just a moral imperative, it is a fiscal imperative. If we want to create jobs and rebuild our economy, then we must address the crushing cost of health care this year. While previous attempts at health care reform have failed, this time is different. This time, the call for reform is coming from the bottom up, from all across the spectrum – from doctors, nurses, and patients; unions and businesses; hospitals, health care providers, and community groups; mayors, county officials, legislators, and governors; and Democrats and Republicans. In early May, many of these same stakeholders that led the charge to block reform in 1993 came together to say that reform can no longer wait. These industry groups – insurance companies and hospitals, drug companies and doctors, and labor – are coming together to do their part to reduce the annual health care spending growth rate. The same organization that brought us the famous Harry and Louise ads has now come together to acknowledge that even Harry and Louise want and need health care reform. Our community discussions will further the process of determining how we can lower costs; guarantee choice of doctors, hospitals, and insurance plans; and assure quality affordable health care for all Americans. The President’s goal is to enact health care reform by the end of this year. In the past few months, Congress and the President have done more to advance the goal of providing quality, affordable health care to all Americans than has been done in the past decade. They have provided and protected coverage for eleven million children from working families, and for seven million Americans who have lost their jobs in this downturn. They have made the largest investment in history in preventive care and wellness; invested in computerized medical records that will save money, eliminate waste, ensure privacy, and save lives; and launched a new effort to find a cure for cancer in our time. As well, Congress passed a budget that includes a historic commitment to health reform. This action is a key step forward, and it did not happen when we last attempted to reform health care 15 years ago. 6 The President acknowledges that all parties won’t always see eye to eye as the details of health care reform are determined. But there are many areas of agreement that do exist, and these will serve as the starting point of this process. We can all agree that we need to eliminate fraud, waste, and abuse in government health programs and hold insurance and drug companies accountable by ensuring that people are not overcharged for prescription drugs, or discriminated against for pre-existing conditions. We can agree that if we want to bring down skyrocketing costs, we’ll need to stress patientcentered care that invests in prevention and wellness so that we prevent the debilitating and costly treatments that increase costs. We can also agree that if we want to cover all Americans, we cannot make the mistake of trying to fix what is not broken. That is why if people have insurance and doctors they like, they will be able to keep them. Finally, we can agree that if we want to translate these goals into policies, we need a process that is as transparent and inclusive as possible. In this effort, every voice must be heard. Every idea must be considered. Every option must be on the table. Everyone must accept that no one will get everything they want, and no proposal for reform will be perfect. But when it comes to addressing our health care challenge, we can no longer let the perfect be the enemy of the essential. VII. OVERVIEW OF THE PROBLEM (from “The Costs of Inaction: The Urgent Need for Health Reform,” available at www.HealthReform.gov) 1. ESCALATING HEALTH CARE COSTS Families, business, and state and federal budgets are straining under skyrocketing health care costs. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than cumulative wage increases.6 The United States spent approximately $2.2 trillion on health care in 2007, or $7,421 per person.7 This comes to 16.2% of GDP, nearly twice the average of other developed nations.8 Health care costs doubled from 1996 to 2006, and they are projected to rise to 25% of GDP in 2025 and 49% in 2082.9 The rising cost of health care is driving up the cost of Medicare and Medicaid. As a result, the proportion of spending attributable to Medicare and Medicaid in the health system is expected to rise from 4% of GDP in 2007 to 19% of GDP in 2082, making it the principle driving force behind rising federal spending in the decades to come.10 Health care costs add $1,525 to the price of every General Motors vehicle. The company spent $4.6 billion on health care in 2007, more than the cost of steel.11 7 2. As a result of these crushing health care costs, American businesses are losing their ability to compete in the global marketplace. Health care at General Motors puts the company at a $5 billion disadvantage against Toyota, which spends $1,400 less on health care per vehicle.12,13 The average cost of an employer-based family insurance policy in 2008 was $12,680, which was nearly the annual earnings of a full-time minimum wage job.14 Half of all personal bankruptcies are at least partly the result of medical expenses.15 The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone.16 Eight in ten Americans are dissatisfied with the total cost of health care,17 and over half report paying for the cost of a major illness as a major problem.18 DIMINISHING ACCESS TO CARE Millions of Americans do not have health coverage, or have inadequate coverage. As our economic challenges multiply, the problem of health care access grows. 3. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%.19 An estimated 87 million people – one in every three Americans under the age of 65 – were uninsured at some point in 2007 and 2008.20 More than 80% of the uninsured are in working families.21,22 Children without insurance have decreased access to well-child care, immunizations, basic dental services, and prescription medication. Uninsured adults similarly have less access to needed preventive care, and when sick, they are more likely to experience poorer health outcomes.23 This in turn leads to lost workplace productivity and greater risk of illness and death, at a cost of $65 to $135 billion per year.24,25,26 However, when the uninsured do obtain health care coverage, access to effective clinical services and health outcomes improve.27 In the current economic crisis, even people with insurance are forgoing needed medical care, including prescription medications and doctor visits, because of inability to pay copayments and deductibles.28 In the past 4 years, the number of people above 200% of the poverty line who spend more than 10% of their income on health care has more than tripled. About half of them report difficulty paying bills.29 People with insurance also report difficulty accessing care when they live in areas with high uninsurance rates, and physicians in these regions believe that they cannot make medical decisions in the best interest of their patients.30 PERSISTENT GAPS IN QUALITY In spite of the vast resources invested, the health care system has not yet reached the goal of high-quality care. Across 37 performance indicators, the United States achieved an overall score of 65 out of a possible 100.31 8 Only 60% of obese adults were given advice on exercise, and just over half of children received advice on healthy eating.32 Hospitals, on average, have still not met recommended targets for treating heart attacks in a timely manner.33 If all states improved diabetes control to the level of the top four best performing states, at least 39,000 fewer patients would have been admitted for uncontrolled diabetes in 2004, potentially saving $216.7 million.34 Patient safety initiatives have the potential to save thousands of lives. Up to 98,000 Americans die each year as a result of medical errors, more than motor vehicle accidents, breast cancer, and AIDS.35 The United States also lags behind other nations in the use of error-reducing techniques, such as health information technology.36 Disparities in care among different subpopulations must be addressed. Ethnic and racial minorities are often less likely to receive recommended care, as are people with lower income or lower educational status.37 They are also more likely to be uninsured, more likely to leave the emergency room without being seen, and more likely to experience poor communication with their physicians.38 HEALTH INSURANCE COVERAGE OF THE TOTAL POPULATION, STATES (2006-2007), U.S. (2007) Medicare Other Public Insurance Total Population 39,296,423 36,155,452 3,253,122 298,215,356 592,260 621,825 41,597 4,542,036 Percent Uninsured Uninsured Employer Individual Medicaid United States 15.3% 45,657,193 159,311,384 14,541,782 Alabama 13.6% 618,913 2,495,543 171,898 Alaska 17.7% 115,824 353,556 24,822 78,798 42,926 36,920 652,846 Arizona 19.6% 1,237,322 3,006,581 258,341 1,007,333 729,679 68,883 6,308,138 Arkansas 17.5% 485,849 1,294,972 127,632 440,675 380,969 46,820 2,776,917 California 18.5% 6,701,890 17,772,178 2,420,619 5,793,999 3,200,361 274,296 36,163,342 Colorado 16.9% 813,188 2,737,376 334,677 408,037 433,325 97,111 4,823,714 Connecticut 9.4% 325,516 2,113,966 139,521 396,535 458,715 24,549 3,458,802 Delaware 11.7% 100,560 510,142 25,358 93,589 119,306 8,630 857,585 District of Columbia 10.6% 60,803 302,773 32,667 118,630 56,767 3,487 575,128 Florida 20.7% 3,738,230 8,500,588 950,809 1,727,980 2,889,417 222,872 18,029,897 Georgia 17.7% 1,660,156 5,165,605 340,362 1,143,260 925,891 137,426 9,372,700 Hawaii 8.3% 103,025 763,405 42,851 136,415 154,028 35,746 1,235,471 Idaho 14.7% 217,759 804,937 95,190 160,530 189,631 16,127 1,484,175 Illinois 13.7% 1,737,876 7,381,685 565,817 1,452,029 1,437,483 67,254 12,642,143 Indiana 11.6% 732,256 3,832,574 241,215 685,776 774,590 27,811 6,294,222 9 Iowa 9.9% 291,009 1,722,416 167,032 371,479 376,990 10,528 2,939,454 Kansas 12.6% 340,373 1,486,043 174,793 315,874 349,542 42,776 2,709,402 Kentucky 14.6% 604,929 2,130,397 171,941 637,491 560,977 45,793 4,151,528 Louisiana 20.2% 848,463 1,924,791 193,756 661,582 541,974 25,967 4,196,532 Maine 9.1% 118,935 687,310 63,175 246,605 176,773 17,166 1,309,964 Maryland 13.8% 769,007 3,394,077 219,516 489,195 644,463 49,543 5,565,801 Massachusetts 7.9% 498,451 3,777,434 280,693 979,539 786,682 12,756 6,335,555 Michigan 11.0% 1,096,821 5,761,698 379,262 1,279,096 1,378,958 44,400 9,940,235 Minnesota 8.8% 453,544 3,154,070 325,149 581,320 626,320 24,515 5,164,919 Mississippi 19.8% 572,555 1,293,798 130,481 550,649 300,617 41,011 2,889,110 Missouri 13.0% 750,218 3,122,307 321,795 722,692 828,154 45,025 5,790,191 Montana 16.4% 153,006 447,965 75,774 116,615 124,316 13,511 931,186 Nebraska 12.8% 224,689 1,015,327 128,522 158,499 196,497 29,041 1,752,575 Nevada 18.4% 468,808 1,463,174 109,964 171,322 305,448 28,359 2,547,075 New Hampshire 11.0% 143,754 846,833 59,065 82,576 167,552 8,669 1,308,450 New Jersey 15.6% 1,344,323 5,176,338 290,752 701,556 1,054,727 27,746 8,595,443 New Mexico 22.8% 441,351 819,437 95,016 306,512 235,428 40,349 1,938,093 New York 13.6% 2,590,364 9,915,597 672,495 3,641,829 2,166,402 59,349 19,046,037 North Carolina 17.2% 1,547,212 4,510,282 435,781 1,185,291 1,138,071 153,565 8,970,201 North Dakota 11.2% 68,412 343,475 62,847 53,523 76,622 8,032 612,912 Ohio 10.9% 1,229,769 6,580,161 484,430 1,457,308 1,422,018 112,076 11,285,761 Oklahoma 18.5% 646,363 1,672,318 142,019 470,767 461,432 98,994 3,491,892 Oregon 17.4% 648,169 1,943,329 231,049 410,084 457,012 39,072 3,728,717 Pennsylvania 9.8% 1,206,115 7,089,670 648,477 1,486,994 1,853,004 32,155 12,316,416 Rhode Island 9.7% 101,869 589,274 43,493 187,363 114,510 9,058 1,045,567 South Carolina 16.2% 696,484 2,197,541 178,889 593,484 560,653 72,549 4,299,599 South Dakota 11.0% 85,566 421,830 63,647 77,433 111,964 16,731 777,171 Tennessee 14.1% 845,728 3,004,975 306,748 886,699 821,009 140,469 6,005,629 Texas 24.9% 5,832,884 10,918,949 1,043,274 2,902,073 2,426,647 282,240 23,406,068 Utah 15.1% 391,392 1,542,039 181,458 243,067 218,913 16,926 2,593,795 Vermont 10.7% 66,140 331,851 22,454 114,255 76,646 4,703 616,049 Virginia 14.2% 1,070,636 4,404,621 299,998 595,747 890,563 252,464 7,514,029 Washington 11.7% 741,450 3,636,450 328,871 800,480 717,922 134,592 6,359,764 West Virginia 13.8% 249,384 915,965 36,304 295,357 283,410 21,501 1,801,922 Wisconsin 8.5% 465,762 3,349,515 292,561 654,387 665,968 39,608 5,467,801 Wyoming 14.2% 72,811 279,398 35,251 48,066 69,566 9,046 514,138 Sources: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2007 and 2008 Current Population Survey (CPS: Annual Social and Economic Supplements). Notes: Percentages may not sum to 100% due to rounding effects. For current Medicaid and Medicare enrollment figures, please refer to the Medicaid & CHIP and “Medicare” sections, respectively, which report enrollment data from the Centers for Medicare and Medicaid Services (CMS). CHIP and individuals eligible for both Medicare and Medicaid (dual eligibles) are included in Medicaid. Other Public (Federal) includes individuals covered through the military or Veterans Administration in federally-funded programs such as TRICARE (formerly CHAMPUS) as well as some non-elderly Medicare enrollees. 10 1 Kaiser Family Foundation Employer Health Benefits 2008 Annual Survey, Chart 1.9, available at http://ehbs.kff.org/ 2 Office of the Actuary, Centers for Medicare and Medicaid Services, National Health Expenditure 2. Data for 2007. U.S. Department of Health and Human Services, available at http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage. 3 Organisation for Economic Cooperation and Development. OECD Health Data 2008. 4 McKinsey Global Institute, Accounting for the Cost of Health Care in the United States (Washington, DC: McKinsey Global Institute, January 2007). 5 P.R. Orszag, Growth in Health Care Costs: Statement Before the Committee on the Budget, 4. United States Senate (Washington, DC: Congressional Budget Office, Jan 31 2008), available at http://www.cbo.gov/doc.cfm?index=8948. 6 Kaiser Family Foundation & Health Research and Educational Trust, Employer Health Benefits 2008 Annual Survey. (Menlo Park, CA: Kaiser Family Foundation, 2008). http://ehbs.kff.org/?page=abstract&id=1 7 Office of the Actuary, Centers for Medicare and Medicaid Services, National Health Expenditure Data for 2007. U.S. Department of Health and Human Services. http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage 8 Organisation for Economic Cooperation and Development. OECD Health Data 2008. 9 P.R. Orszag, Growth in Health Care Costs: Statement Before the Committee on the Budget, United States Senate, (Washington, DC: Congressional Budget Office, Jan 31 2008). http://www.cbo.gov/doc.cfm?index=8948 10 P.R. Orszag, Growth in Health Care Costs: Statement Before the Committee on the Budget, United States Senate, (Washington, DC: Congressional Budget Office, Jan 31 2008). http://www.cbo.gov/doc.cfm?index=8948 11 R. Wagoner, Testimony before the House Financial Services Committee, December 5, 2008. http://thinkprogress.org/2008/12/05/gm-health-care-reform/ 12 R. Wagoner, Testimony before the House Financial Services Committee, December 5, 2008. http://thinkprogress.org/2008/12/05/gm-health-care-reform/ 13 G.F. Will. There’s more health care than steel in GM price tag. Deseret News, May 1, 2005. http://findarticles.com/p/articles/mi_qn4188/is_20050501/ai_n14608247 14 Kaiser Family Foundation & Health Research and Educational Trust, Employer Health Benefits 2008 Annual Survey. (Menlo Park, CA: Kaiser Family Foundation, 2008). http://ehbs.kff.org/?page=abstract&id=1 15 Himmelstein, D, E. Warren, D. Thorne, and S. Woolhander, “Illness and Injury as Contributors to Bankruptcy, “ Health Affairs Web Exclusive W5-63, 02 February , 2005. 16 Employee Benefit Research Institute, Savings Needed to Fund Health Insurance and Health Care Expenses in Retirement, (Washington, DC: EBRI Issue Brief #295, July 2006). 17 Gallup Poll. Nov. 11-14, 2007. http://www.pollingreport.com/health3.htm 18 Pew Research Center for the People & the Press survey. March 8-12, 2006. http://www.pollingreport.com/health3.htm 19 Kaiser Family Foundation, The Uninsured: A Primer, Key Facts about Americans without Health Insurance, (Menlo Park, CA: Kaiser Family Foundation, 2008). 20 Families USA and The Lewin Group. Americans at Risk: One in Three Uninsured. http://www.familiesusa.org/assets/pdfs/americans-at-risk.pdf 21 Kaiser Family Foundation, The Uninsured: A Primer, Key Facts about Americans without Health Insurance, (Menlo Park, CA: Kaiser Family Foundation, 2008). 22 Families USA and The Lewin Group. Americans at Risk: One in Three Uninsured. http://www.familiesusa.org/assets/pdfs/americans-at-risk.pdf 23 Institute of Medicine, America's Uninsured Crisis: Consequences for Health and Health Care. (Washington, DC: National Academies Press, February 2009). 24 Institute of Medicine, Hidden Costs, Value Lost: Uninsurance in America. (Washington, DC: National Academies Press, June 2003). 25 S. Dorn, “Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality” (Washington, DC: The Urban Institute, 2008). 11 26 J. Hadley, “Insurance Coverage, Medical Care Use, and Short-Term Health Changes Following an Unintended Injury or the Onset of a Chronic Condition,” JAMA 2007; 297 (10) : 1073-1084;. 27 Institute of Medicine, America's Uninsured Crisis: Consequences for Health and Health Care. (Washington, DC: National Academies Press, February 2009). 28 The Kaiser Commission on Medicaid and the Uninsured. Snapshots from the Kitchen Table: Family Budgets and Health Care. http://www.kff.org/uninsured/7849.cfm (accessed March 13, 2009). 29 C. Schoen, S.R. Collins, J.L. Kriss, et al. How many are underinsured? Trends among U.S. adults, 2003 and 2007. Health Affairs 2008; 27(4): w298-w309. http://content.healthaffairs.org/cgi/reprint/hlthaff.27.4.w298v1?ijkey=rhRn2Tr4HAKZ.&keytype=ref&siteid=health aff 30 Institute of Medicine, America's Uninsured Crisis: Consequences for Health and Health Care. (Washington, DC: National Academies Press, February 2009). 31 The Commonwealth Fund. Why Not the Best? Results from a National Scorecard on U.S. Health System Performance. July 17, 2008. http://www.commonwealthfund.org/Content/Publications/FundReports/2008/Jul/Why-Not-the-Best--Results-from-the-National-Scorecard-on-U-S--Health-System-Performance-2008.aspx (accessed March 13, 2009). 32 Agency for Healthcare Research and Quality. National Healthcare Quality Report 2007. 33 Agency for Healthcare Research and Quality. National Healthcare Quality Report 2007. 34 Agency for Healthcare Research and Quality. National Healthcare Quality Report 2007. 35 Institute of Medicine, To Err is Human: Building a Safer Health Care System (Washington, DC: National Academies Press, 2000). 36 G.F. Anderson et al., “Health Care Spending and Use of Information Technology in OECD Countries,” Health Affairs 2006; 25(3): 819-831. 37 Agency for Healthcare Research and Quality. National Healthcare Disparities Report 2007. 38 Agency for Healthcare Research and Quality. National Healthcare Disparities Report 2007. 12
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