Dr. Martin Luther King, Jr. said "of all the forms of inequality, injustice in health care is the most shocking and inhumane."
I believe that health care should be a right, not a privilege. Continuity of care is essential to leading a healthy life, and a strong public health care system is among the most important components of a homeland security strategy. Therefore, health care policy must be comprehensive, beginning with prenatal health care and continuing into a person’s golden years, and our system should work efficiently and effectively in so that it is prepared to deal with unforeseen events.
A sluggish economy and unemployment are leaving an increasing number of Coloradans without health insurance. And a number of economic and political factors have lead to double digit increases in health care premiums, higher out-of-pocket expenses, reduced coverage and less choice for consumers.
On the provider side, doctors and nurses tell me how crowded emergency rooms, wage issues, government regulation, and personnel shortages in the health care workforce have resulted in diminished access to health care services. In addition, many states are facing budget shortfalls as a result of the economic slowdown, just as families are turning to the state for Medicaid coverage. The Medicaid rolls are swelling and are already under severe financial pressure. This means extra expenses for Colorado’s Medicaid program at a time when members’ health care costs are exceeding the amount of money the state spends on Medicaid.
Something has to change.
The Federal government has a role to play in giving Americans greater access to quality, affordable health care. The debate over how to provide health care coverage to more people includes a combination of public and private initiatives.
Children’s Health Insurance (SCHIP)
I have been a strong supporter of the State Children’s Health Insurance Program (SCHIP) throughout my time in Congress. This program has enjoyed wide bipartisan support in Congress and among the nation’s governors because it is a cost-effective and efficient way to provide health coverage for children whose families cannot otherwise afford health insurance.
The majority of uninsured children are currently eligible for this coverage – but better outreach and adequate funding are needed to identify and enroll them. Congress worked to give states the tools and incentives necessary to reach millions of uninsured children who are eligible for, but not enrolled in, the program but unfortunately the President vetoed this legislation, because of his concern that an expanded program would give some middle-income families a helping hand they do not need. I disagreed strongly with the President’s rationale because we are not covering enough children, and there are safeguards in the law to prevent states from abusing the program. Giving working families an extra hand on health care coverage for children strikes me as a policy worth fighting for.
Right now, millions of children in America’s working families will not see doctors when they should and will not get medicines when they need them, because their parents just cannot afford private insurance. It costs less than $3.50 a day to cover a child through SCHIP. Insuring more children is also cost-effective for taxpayers who pick up the tab for indigent care in emergency rooms – the most expensive way to care for anyone.
Prenatal Care
Prenatal care is critical in the earliest stages of life. If we make sure that pregnant women have access to prenatal care, it will have an enormous impact on the futures of the mother, the child and the family. Congress should pass legislation that would make it easier for states to cover pregnant low-income women through the State Children’s Health Insurance Program (SCHIP). SCHIP is a federal program that provides health care for low-income children who don’t qualify for Medicaid. By covering pregnant women states would be able to reduce infant mortality and improve child health, while at the same time, optimize use of their SCHIP funds.
Coverage for the Uninsured and Underinsured
Much of the debate on health care has been around the Patients’ Bill of Rights, which I support. But we must not forget about the estimated 45 million Americans who have no health care at all.
If we want to solve our economic woes, we need to address the problem of the uninsured. One way we can put more confidence into our economy is to address healthcare affordability and access issues.
I believe we can achieve universal health coverage for less than half the cost of the tax cuts that the Republicans rammed through Congress and the President signed into law in 2003.
I support a comprehensive proposal that includes:
- Tax credits for low - and moderate - income workers and families.
- Expanded group purchasing pools that mirror the federal employees health plan
- A requirement that all Americans get health coverage, with support for employers so they can provide health care coverage.
Tax credits are a feasible solution to addressing the uninsured because they allow us to help the uninsured by cutting taxes - two ideas that lawmakers on the right and left can embrace. A health care tax credit is a way to provide targeted relief for the middle class and to stimulate the economy.
These tax credits would be for individual and employer-sponsored health insurance to improve affordability for low - and moderate - income workers and families. The credits would help cover up to 65% of the cost of individual or employer-sponsored health care insurance and would be based on a percentage of the federal poverty level. The credits would be refundable to people who otherwise would owe no income tax. And since people are used to getting coverage at work, this plan would not upset the employment-based system.
Tax credits are only a piece of the pie. To make health insurance more available and affordable, the structure for purchasing health care coverage must be improved. As the second part of this plan, the federal government would provide grants to states to help them create purchasing pools so that everyone and every business in the state could choose among competing group insurance plans. A modified version of the federal employees' system would kick in as a backup if states didn't follow through. This proposal uses government financing and oversight to ensure affordability and access, but it relies on the private sector and competition to create innovation and control costs.
To solve the healthcare coverage problem, insurance has to be affordable, fair and accessible. Make no mistake; this will take time, effort and money. However, the payoff will be great.
First, universal coverage will bring down costs for those people who already have health insurance. As you know, many uninsured use the emergency room as their primary health care provider. Emergency room care is the most expensive form of health care. There is no such thing as uncompensated care, so the costs of caring for the uninsured are shifted to the private sector, which in turn results in higher rates for people who already have health insurance. So if we solve the problem of the uninsured, we'll lower costs for everyone.
Second, universal coverage will also help prevent and manage chronic diseases before they require extensive and costly care. A system that emphasizes early diagnosis, disease management and prevention will help control costs.
If we can’t get the $350 billion over ten years to implement this universal health care coverage plan, at a minimum we should help the unemployed keep their health coverage.
In 2002, Congress passed a bill to give a 65% tax credit to unemployed workers who lost their jobs due to foreign trade agreements so that they could continue their insurance coverage under COBRA. For $5 billion to $8 billion, we can extend that coverage to all laid-off workers who are receiving unemployment benefits. For just a fraction of the cost of the tax cuts that were enacted in 2003, we can make sure that people who already have health coverage don’t lose it, and that will provide some real confidence in and stimulus to our economy.
Not all people can get coverage through a tax credit or COBRA coverage. Many uninsured or underinsured Americans are working poor who would not benefit from tax incentives. Therefore we should look at expanding coverage under existing public programs. The community health center program has been one of the most successful health programs in our nation. Community health centers and rural health clinics play a critical role in health care for medically underserved rural and urban communities. Colorado is home to a number of health centers like The People’s Clinic, Clinica Campesina and SALUD. Without their presence, thousands of Coloradans would lose access to cost-effective primary and preventive care services. That’s why I support increased funding for the community health center program. President Bush has called for doubling the number of centers in the country, and Congress should provide the necessary funds to do that.
Shoring up our Public Health Care
Our public health system is a critical component of our nation’s homeland defense. In addition to being the health care safety-net for the poor, uninsured and elderly, our public health institutions – our hospitals, our emergency response teams – represent the infrastructure that would be the first to respond in the event of a terrorist attack. But over the years, we have severely weakened our public health system, and now we are playing catch up in our ability to respond to catastrophic events, whether natural or terrorist in nature.
Emergency rooms have become the primary care provider for thousands of uninsured Coloradans. But our hospitals are in no shape to deal with a surge in patients. In order to deal with tight budgets, hospitals have cut back on surplus supplies and space. Additionally, there is a huge nurse shortage in our health care delivery system. Studies estimate that our nation will be short 291,000 nurses by the year 2010.
There are several actions the federal government can take to strengthen public health. Congress should provide significant funding to help states develop and test systems to coordinate emergency care, increase hospital capacity, educate medical personnel, and train those people who are first to respond to emergencies. Congress should fully fund the Nurse Reinvestment Act in order to address the nursing shortage. And funds should also be provided to ensure that we have an adequate supply of vaccines and treatments for all Americans and plans for distributing and properly administering them.
Senior Health Care
One of the greatest challenges we face in the 21st century is how we will deal with the aging of America. With the senior population on track to double over the next decade, we will need to enact reforms to deal with an increase in the utilization of health care services.
Many seniors have told me that they are having problems finding doctors. This has been in large part because of burdensome paperwork and low payments from the Medicare program. I support legislation that reforms the audit process and makes some broad regulatory reforms, changes billing practices, and increases education and communication to educate providers about proper documenting and billing procedures. This will allow doctors to spend more time with patients and less time filling out paperwork. Second, I support rolling back the physician payment cuts that the Bush administration enacted that took effect in January 2006.
Next, as I have traveled around the district, many senior citizens have told me about the great difficulty they face in buying prescription drugs. Insurer’s spending on drugs has shot up from $40 billion in 1996 to an estimated $118 billion in 2006. And several years ago, I released a report which shows that seniors in my district who don’t have drug coverage pay twice as much for the medicines as do people who do have coverage.
We have an obligation to our nation's seniors to provide them with the lifesaving treatments they need and deserve. No senior should be faced with the choice of buying food, paying the electric bill or buying critical life saving medicines.
As you know, in the early morning of November 22, 2003, the House of Representatives approved the new Republican Medicare reform law. I wanted to support a Medicare drug bill, but I couldn't support this one. Instead of giving us a foundation to build on, I am concerned it will negatively impact a very popular healthcare program for seniors in order to deliver an inadequate, unreliable and unfair drug benefit.
Under this law seniors will pay higher premiums, higher deductibles and higher prices for drugs. It has a huge gap in coverage, will force seniors into HMOs, and millions will lose drug benefits that they get through their retirement plans.
With the standard benefit, beneficiaries will be responsible for a $35 premium just for the drug benefit, a $250 deductible, 25% of drug costs from $251 to $2,250 and 100% of the costs for the next $2,850 (also known as the "donut hole"). Catastrophic coverage won't kick in until a senior has reached $5,100 in total drug costs. After that, the beneficiary would still pay 5% of the costs. Medigap policies will not be allowed to cover any of these costs. And if a drug is not on the list of preferred drugs, beneficiaries will be responsible for 100% of those costs.
The law prohibits the federal government from negotiating better drug prices for Medicare beneficiaries, and it prohibits Medicaid from filling in the gaps in the new drug benefit, as Medicaid does now. As a result, this bill could actually raise costs for more than 6 million low-income seniors and people with disabilities. And, the plan institutes an unfair asset test that denies help to many otherwise eligible low-income seniors.
The law will force seniors into HMOs. It grossly overpays private HMOs and PPOs and includes a $12 billion fund to encourage plans to participate in Medicare. Better benefits and lower premiums will only be available through private plans - not currently an option for most rural seniors. Seniors who have access to HMOs will be forced to give up their choice of physician or their preferred hospital to get better benefits.
As for retirement coverage, the Congressional Budget Office, estimates that about 2.7 million seniors will lose drug benefits that they get through their retirement plans. That's because employers that choose to take the new subsidy in the law are not required to maintain current levels of coverage. So corporations can get subsidies from the government and still cut benefits.
Also, insurance companies may offer separate drug plans, but they are not required to do so, even if they get subsidies from the government. In fact, $130 billion of the $400 billion allocated for the plan for the next ten years is all subsidies to insurance companies and drug makers. If privatization is such a good idea, why do insurance companies need large subsidies in order to participate in Medicare?
Finally, there is a new budget cap in the law which would trigger cuts in Medicare, including benefits cuts, payment cuts for hospitals, nursing homes, and home health providers, and increased cost-sharing.
I will work with my colleagues in Congress to repeal and replace some of the worst parts of this bill, such as the ban on Medigap policies. Seniors need a drug benefit that is fair, affordable and that delivers the drugs that their doctors prescribe. And, seniors must be able to keep their doctors and not be forced into an HMO in order to get a drug benefit.
It is ironic that Medicare will pay for a senior's care following a stroke but will not pay for the anti-hypertension drugs that prevent them. Medicare should be updated with a prescription drug benefit, but not this one. I'd like your thoughts and ideas on what you need in a Medicare drug benefit proposal, and look forward to working on a bill that is fiscally responsible and fair to seniors.
Long-Term Care
I support bipartisan legislation to provide an above the line deduction – available to everyone regardless of whether they itemize – for long-term care insurance premiums to help offset the costs of purchasing a long-term policy. The proposal would also give caregivers an annual tax credit of $3,000 to help cover the costs associated with caring for a sick relative living in the caregiver’s home.
Mental Health Care
I am cosponsor of the Paul Wellstone Mental Health Equitable Treatment Act, bipartisan legislation that prohibits group and individual health plans from imposing treatment limitations or financial requirements on the coverage of mental health benefits and on the coverage of substance abuse and chemical dependency benefits if similar limitations or requirements are not imposed on medical and surgical benefits.
Mental illness is an illness and needs to be treated like other illnesses, like hypertension, cancer, or heart disease. There is no scientific justification for treating mental and physical health differently. The Surgeon General’s Report on Mental Health in 1999 states that diagnoses of mental disorder made using specific criteria are as reliable as those for general medical disorders. Most people who suffer from mental illness can live normal lives if they receive treatment but most can’t receive treatment if their insurance won’t pay for it.
Also, businesses will save millions of dollars in productivity and missed workdays due to mental illness. A small investment in insurance coverage can pay big dividends with healthier and more productive workers. An employer that would refuse to lose a valued worker to heart disease or cancer shouldn’t lose a worker to clinical depression or alcoholism.
Medical Research
I supported the bipartisan initiative to double the budget for the National Institutes of Health by 2003. This increased funding for NIH will undoubtedly help researchers find new treatments and possible cures for these and other life-threatening diseases, such as heart disease, Alzheimer’s, Parkinson’s, AIDS/HIV, diabetes, Lupus and breast cancer.
Now is not the time to retreat on our commitment to biomedical research. I support an 8 - 10% increase in funding for NIH. Recently, the President and Congress proposed only a 1% increase for NIH. That is not enough to keep up with inflation and grant renewal costs, and definitely little or nothing left over for new or expanded research efforts.
Avian Flu Preparedness
Despite widespread warnings from scientists and health professionals across the globe that an influenza outbreak is an imminent threat to public health, the United States remains dangerously under-prepared for a possible pandemic. The Centers for Disease Control and Prevention (CDC) estimates that in the U.S. alone, 25% of the population, or 67 million people, could become ill in an avian flu outbreak.
That is why I joined several of my colleagues in asking key lawmakers on the Senate and House Appropriations Committees to include $4 billion in a 2006 defense spending bill for avian influenza surveillance, detection and preparedness. This funding would be used to detect and contain an avian flu outbreak around the world, including the purchase of adequate stockpiles of antiviral medications.
In addition, in October 2004, I fought for $450 million for the CDC’s Strategic National Stockpile (SNS), a national repository of drugs and medical supplies that can be used to respond to a national health emergency, of which $75 million could be used for medications to respond to pandemic influenza. Also, in March 2005, I urged Health and Human Services Secretary Mike Leavitt to implement all aspects of the department’s “Pandemic Influenza Preparedness and Response Plan,” including ongoing efforts to develop an effective vaccine and take immediate steps to increase the U.S. stockpile of antivirals.
Should a pandemic reach our shores, it is absolutely critical that the United States have enough vaccine and antiviral medications to help prevent widespread infection among the American public. You can be sure I will continue to monitor the situation and do what I can to protect the public health.
Our nation’s health care delivery system is in critical condition and needs life support. The steps I’ve outlined above, taken together, can go a long way in making healthcare coverage more affordable, strengthening our health care safety net, and making our homeland more secure.