Capital-area reaction to health reform victory spans elation, hesitation
CHARLES DHARAPAK Associated Press
Speaker Nancy Pelosi heads to the Capitol on Sunday to vote on health care. With her are Democratic congressmen, from left, Steny Hoyer, John Lewis and John Larson.
It was a watershed moment decades in the making, ending years of failure and frustration for longtime health care advocates like Beth Capell, who cried with joy Sunday.
Both sides of the health care debate called Sunday’s House vote historic. But, for Capell, she had a victory to savor: passage of federal legislation that would remake the country’s health care system and extend medical coverage to nearly all Americans.
“It’s a remarkable moment,” said Capell, a program manager for Health Access California. “It’s a transformational moment for America.”
Capell compared the passage with other key legislation that created Social Security and Medicare and ensured civil rights. “I’ve worked hard on this for a long time. It’s about all those people who have lacked health insurance when they should have had it,” she said.
For Patrick Johnston, president of the California Association of Health Plans, said passage means a difficult road ahead.
“There is a lot of work to be done in California,” Johnston said. “Health plans in California are ready to work with state and federal officials to implement the complexities of what will become the new law.”
But, he said, extending health coverage to the millions of uninsured, including the 8 million in California, does nothing to contain costs.
Many details aren’t fully resolved. The thorny issue of abortion, for example, won’t immediately fade, as abortion-rights advocates press for clarification about how the legislation could affect reproductive rights under Roe v. Wade, said Deborah Ortiz, vice president of public affairs for Planned Parenthood’s Mar Monte region.
“It is a compromise we can live with for today,” Ortiz said. “The bigger picture is that millions of people will finally have health care.”
Marty Keale, executive director of the Capitol Community Health Network, which represents Sacramento County’s largest nonprofit clinics, called it “an incredible day.”
“The United States has finally decided to catch up with the rest of the civilized world,” he said.
The complexities of the bill drew charges from Republicans that Democrats were being too hasty in pushing for passage.
In the closing minutes of the debate, Rep. Dan Lungren, R-Gold River, attempted a delay. Rep. Tom McClintock, R-Elk Grove, called the legislation a government takeover of the country’s health care system.
The fight isn’t over, McClintock said Sunday night. He predicted a battle in the U.S. Senate, where a reconciliation bill must be approved. He also predicted legal challenges.
On the House floor, Rep. Doris Matsui, D-Sacramento, noted the historic vote.
“I wasn’t here 10 or 20 years ago as the health care debate ebbed and flowed,” she said on the House floor. “But I am here today. And as an old friend said to me today, ‘There are not too many times in politics that you get to do something monumental.’ And this is the day.”
During her House floor speech, Matsui invoked the names of two Sacramentans, Tim Sullivan and Elizabeth Bell, to argue for passage.
“It’s really exciting she mentioned me, and that my voice was included,” said Bell.
Bell lost her health coverage through her parents’ plan when she turned 23. But her parents stepped in to pay her premiums. Shortly after, she developed a severe thyroid condition.
“For me, I’m really lucky that I have parents who are supporting me in this way,” said Bell, who hasn’t found a job with health benefits.
She wrote Matsui last year, during the height of last summer’s congressional town hall meetings, to share her story.
Sullivan called Matsui three days ago.
Sullivan has been unemployed since October and is relying on COBRA subsidies to hold on to his health insurance. He was a self-employed contractor until the housing downturn forced him out of private business.
“I’d rather work on my own,” said Sullivan.
“I want this bill to pass,” he said, as the House debate dragged into the night. “This system holds people back. This system discourages entrepreneurship. Someone like myself, who is 51, has to work for somebody to have health insurance.”
Under the bill, the self-employed would have access to a government-established insurance exchange from which they will be able to buy coverage.
The California Hospital Association had endorsed the federal legislation on Friday, said the group’s spokeswoman, Jan Emerson.
“This has been a long time coming,” Emerson said. “This is an important first step, and now the rest of the work needs to be done.”
Editor’s Note: An earlier version of this article said the California Association of Health Plans opposed the overhaul legislation. The association took no formal position. Corrected on March 22, 2010.
Obama offers to include GOP ideas in health bill
WASHINGTON – President Barack Obama offered Tuesday to include four Republican initiatives in his health care bill, but GOP leaders were unenthusiastic as Democrats prepared a last big push to get legislation passed.
Obama is expected to signal today how he wants Congress to proceed. By telling Republicans he wants to incorporate some of their suggestions, Obama can argue that the Democrats’ approach is bipartisan regardless of whether any Republicans vote for it in the end – and few if any were signaling Tuesday that they’re inclined to do that.
The Republican ideas Obama said he’s considering – ideas that GOP leaders offered at last week’s bipartisan health care summit – include conducting undercover investigations of health care providers that receive Medicare and Medicaid reimbursements.
Another would provide $50 million to states to pursue alternatives to medical malpractice litigation, a major Republican initiative.
Obama reiterated Tuesday that he wants a comprehensive health reform bill, not a series of incremental steps. “Piecemeal reform is not the best way” to make coverage more affordable, he said.
Congressional Democratic leaders agree, and are seriously considering using the controversial “reconciliation” process to get the bill through Congress by the end of this month. It was unclear whether Obama would recommend that approach today.
Reconciliation is a way to expedite Senate passage of legislation with 51 votes instead of the 60 usually required to shut off debate. Democrats now control 59 seats in the 100-member Senate.
Under one popular scenario being seriously discussed by Democratic leaders, the House of Representatives would pass the health care bill that the Senate adopted Dec. 24. A simple House majority, which next week would be 216 votes, would be needed to pass. Democrats control 254 of the 431 filled seats; four seats will be vacant.
In addition, both houses would take up separate reconciliation legislation that would make changes to the Senate bill sought by Obama and House Democrats. That bill also would require only simple majorities in both chambers to pass.
However, that process could create political problems.
It would require the House to vote on an $871 billion Senate bill that includes ideas many Democrats dislike, notably the lack of any government-run program, or public option. The House-passed version had a public option.
The Senate version also contains somewhat less restrictive abortion language. About 20 House Democrats are adamant that any bill contain strict limits.
The other political problem concerns how Democratic lawmakers, especially those from more conservative states and congressional districts, would explain to constituents why they voted for a process that Republicans say is simply “ramming the bill through Congress.”
“I don’t prefer reconciliation,” said Sen. Joe Lieberman, I-Conn. “This is so big a change that affects every American. This ought to be bipartisan.”
Better habits can help trim bloated health care system
We’ve resolved to eat better, lace up the running shoes, shed a few pounds, quit smoking and lead healthier lives.
If we could keep our promises beyond the first weekend of the new year, perhaps our health care system wouldn’t be as bloated as it is.
Indeed, some of the responsibility for health care costs sits squarely on the shoulders of consumers who make unhealthy choices – by supersizing meals, quenching thirst with sugar-laden sodas, filling lungs with tobacco and taking a less active role in maintaining their overall fitness.
“As important as health reform is, the real answer in reforming America’s health care system is to empower individuals to make better choices about what we eat and how we live,” said Daniel Zingale, a senior vice president at the California Endowment, a health foundation.
While debate remains in Congress over health care legislation, wellness advocates are hopeful that less controversial provisions promoting healthy living will remain in any bill that reaches the president’s desk.
“As preventable illnesses and injuries are the most significant drivers of increasing health care costs,” the Oakland-based Prevention Institute said in a letter to the White House, “it is essential that we reorient our health care system from an after-the-fact approach to one that focuses on keeping people healthy in the first place.”
The House bill includes $34 billion for a public health investment fund, including $15.4 billion for prevention and wellness programs.
The Senate bill is less generous, providing $15 billion for a prevention and public health fund, some of which could be used for so-called community transformation grants to fund parks and urban trails and to promote access to nutrition.
The Senate bill also would establish a national council that takes a broad approach to drafting a health care strategy that integrates transportation, agriculture, education and employment policies. And it would adopt California’s pioneering law requiring fast-food outlets and chain restaurants to provide nutrition information.
“This is the first time in recent history that community and government strategies will align to help support us in the resolutions we make on New Year’s Day,” said Larry Cohen, the Prevention Institute’s executive director.
Wellness and prevention have been “totally lost in the discussion over the health care bill,” Cohen said, “because it’s … been recognized by both sides as being worthwhile.”
Wellness programs spread
By 2017, U.S. health care could account for $4.3 trillion in annual spending, or a fifth of every dollar spent in the overall economy, according to the National Coalition on Health Care. Much of that could go to preventable conditions linked to obesity, smoking, diabetes and heart disease.
Indirect and direct costs of smoking are now $193 billion a year, about half spent on medical expenses, according to the U.S. Centers for Disease Control and Prevention.
In 2007, diabetes accounted for $116 billion. In 2009, heart disease was expected to cost the country $305 billion for care services, medication and lost productivity, according to the CDC.
Obesity costs the nation as much as $147 billion annually, according to a government study released in July.
In California, the national symbol for healthy living, one in every four people is now considered obese. In 1985, when the CDC began measuring the nation’s expanding girth, 9 percent of the state’s residents were classified as obese.
“Sugar-sweetened beverages are the single-biggest culprit in the obesity epidemic,” said Harold Goldstein, executive director of the Davis-based California Center for Public Health Advocacy.
“The simplest thing people can do is drink water instead of soda. It would save everybody money in these hard economic times … and it would have a dramatic impact on the obesity epidemic.”
For years, experts have preached healthy living to reduce the rates of chronic conditions.
To save on costs and boost productivity, employers and insurers over the years launched wellness programs to promote healthy habits.
The California Public Employees’ Retirement System, the nation’s second-largest purchaser of health care, has long promoted so-called wellness programs.
Last year, CalPERS posted the lowest increases for health premiums in 14 years, part of which it attributed to reduced use of health care services by its members.
“The effect of lifestyle decisions on health do matter in the overall control of health care costs,” said Patrick Johnston, president of the California Association of Health Plans. “What works financially for the individual also works for health plans. … Lower health care costs mean health insurance coverage can be more affordable, and if insurance is more affordable, more people can be covered.”
‘A nation of sick care’
Ellen Wu, executive director of the Oakland-based California Pan-Ethnic Health Network, isn’t about to let the health care industry off the hook.
“Our health care system shares some of the responsibility for our increasing health care costs,” Wu said, noting that profit-minded industries make it difficult for people to access routine health care. “It’s a shared responsibility. We cannot expect individuals to be healthier without an environment that promotes health. … I think you have to give people the opportunity to live healthy.”
Communities need access to healthy food and safe public parks in which to exercise, she said.
“We are a nation of sick care. We don’t do health care,” she said. “Because we do sick care, that’s reflected in how we set everything up.”
Gaining health insurance will allow those who are now uninsured access to doctors for regular checkups and routine care that in the long run could relieve the need for expensive emergency room visits.
Even so, people will have to take a more active role in maintaining good health, Wu and others acknowledge.
Healthier lifestyles could reduce health care spending, but on a personal level folks will reap the benefits, too, in the form of fewer trips to the physician – meaning fewer co-pays and other out-of-pocket expenses – and less time away from work, said Dr. Lisa Liu, a physician at Kaiser Permanente’s Elk Grove medical offices.
“There is a linkage there between health care utilization and cost. As individuals, there are ramifications associated with bad habits. People need to take personal accountability for their health,” she said.
Setting goals is a good start, said Liu.
But “making them and keeping them are totally different. The challenge is picking the right resolution,” she said. “Simply saying ‘I’m going to lose weight,’ is just a wish and not an active plan. …
“New Year’s resolutions need to be reasonable and achievable.”
Some experts challenge White House claims of health reform cost savings
WASHINGTON – One of the White House’s biggest boasts about the health care legislation now moving through Congress is that it should reduce health care costs for both government and society.
Many prominent experts are skeptical, however, and some say that the Obama administration is wrong.
“There are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform,” Dr. Jeffrey Flier, dean of the Harvard Medical School, wrote in the Wall Street Journal on Nov. 18. “In discussions with dozens of health care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health care spending rather than restrain it.”
Most Capitol Hill Democrats cheered last week when the nonpartisan Congressional Budget Office estimated that the Senate bill, which lawmakers will begin to debate next week, should reduce federal budget deficits by $130 billion over the next 10 years and perhaps more after 2020, even as its costs are put at $848 billion over a decade.
Embedded in the CBO’s analysis were a lot of blinking yellow lights, however. The CBO figured that deficits would drop by $136 billion from 2010 to 2014, as tax increases go into effect but major health care changes don’t. However, once the policy changes start kicking in, beginning in 2014, the CBO estimated that the deficit would rise by about $6 billion over the next five years.
From 2020 to 2029, while the CBO said that health care savings should cause deficits to drop sharply, it also warned that any precise forecasts “would not be meaningful because the uncertainties involved are simply too great.”
As a result, “the honest answer is that nobody knows” whether meaningful savings are possible, said Robert Bixby, the executive director of the Concord Coalition, a bipartisan budget watchdog group.
Many of the same uncertainties cloud the nearer-term picture. Analysts ask how anyone can calculate patients’ medical needs in the future. Will the bulging, aging baby-boomer population create new strains on doctors and hospitals? What kind of medical advances could bring down costs – or increase them?
Those are just the health-related questions. Who’ll be president beyond 2012? Which party will control Congress? How will the economy perform?
“The problem is that historically, Congress has not been able to keep its word on constraining costs,” said Amitabh Chandra, a professor of public policy at Harvard University’s John F. Kennedy School of Government.
None of these questions is stopping the Obama administration and its supporters from insisting that health care costs can be brought under control.
Robert Greenstein, executive director of the Center on Budget and Policy Priorities, a liberal research group, called the bill “a stark and welcome change” because of its attempts to balance spending and revenues.
Other analysts, though, say that supporters lack strong answers to the most vexing questions.
Foremost is the future of the government-run health insurance plan, or public option, that would compete with the private sector. The Senate bill would permit states to opt out of the program.
The CBO predicted that the public plan is likely to charge higher premiums than private competitors do, as it absorbs consumers that private insurers don’t want. After the plan gets government start-up money, premiums are supposed to cover costs.
But, said Sen. Blanche Lincoln, D-Ark., “If in fact premiums don’t cover the cost of the public plan, it is taxpayers in this country who are faced with the burden of bailing it out.”
That raises another question: What if more people sign up than expected? How many people would need government subsidies, which are to go to those who earn less than 400 percent of the poverty level, or currently about $88,000 for a family of four? If the economy turns sour, the cost of that aid could soar.
The Obama administration says that savings would come not only from tax increases, but also from a series of changes in how doctors, hospitals and other health care providers are reimbursed. The public option would negotiate rates with providers, presumably resulting in rates that don’t grow more than the rate of inflation, rates that private insurers could be compelled to adopt.
The White House also cites three other major proposed changes in the way that doctors, hospitals and other providers are paid that could yield savings: more electronic record-keeping; new ways of promoting quality care; and an Independent Medicare Advisory Board that would recommend changes aimed at limiting the program’s growth.
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