Melanie Jackson-Cracchiolo's Blog

Senator Feinstein of California does not support Public Option

Melanie — Thu, 10 Sep 2009 12:35:00 EDT

Please, all Californians, call Senator Dianne Feinstein and ask her to support public option. I got this from her website when I was directed by one of her staff on her beliefs about President Obama's Healthcare Reform. Please call her. Thanks, Melanie

What I Support : Senator Dianne Feinstein of Californa
I basically believe that reform should be incremental and should cover the following:

    * Allow people to keep their current healthcare coverage. Millions of Americans have insurance that meets their needs. In all of the proposals that Congress is considering, those happy with their current plan will be able to keep it.
    * Stop certain practices of insurance companies. Any bill should end discrimination based on preexisting conditions, stop insurance companies from dropping insurance when people become sick, and prevent the unreasonable denial of treatment. There must also be limits to out-of-pocket expenses to ensure that Americans are not driven into financial ruin by illness.
    * Control insurance premiums. Insurance premiums have doubled over the last 9 years, 3 times faster than wages. Meanwhile, the profits of the nation’s largest private insurance companies increased 428 percent from 2000 to 2008 (Health Care for America NOW). This is unacceptable. Insurance for healthcare is an urgent and universal need, but will not be sustainable and universal if the profit margin remains unconstrained.

In order to see that premiums are affordable, I believe that all non-direct healthcare costs (advertising, overhead, profits, and other administrative costs) should be limited and not exceed 10 percent. All premium rate adjustments should be subject to review and approval by a Health Insurance Rate Authority. Bottom line: your health insurance must remain affordable. Your premiums cannot be allowed to double again in the next nine years, as they have in the past nine.

Another way of stabilizing premium affordability is the public option. Depending how the competition is structured, this “option” could compel insurance companies to lower premiums to remain competitive. It remains a viable proposal. The public option should be one of a variety of choices for people who want improved coverage, giving them an option between a private insurance plan and a public one. The public option is simply that—an option. No one will be required to enroll in the public plan. Instead, it would offer consumers an additional choice as they select a health insurance policy. Instead of choosing between policies offered only by private insurance companies, people could choose to buy a public insurance plan. Those that prefer to buy private insurance could still do so.

The purpose of creating a public plan is to increase competition so that premium costs can be controlled. It is very clear that in the current market, private insurance companies do not control the price of premiums. The public option will not replace anyone’s private insurance coverage, but it could prevent future premium increases as private insurance companies lower their prices to compete with a public option. I am also open to considering a non-profit co-operative model, as long as it can accomplish the critical goal of controlling premium costs and spurring competition. Because insurance company profit taking has been so high, it will be very difficult to control premium costs without some non-profit option.

    * Save and improve Medicare. Medicare presents us with a looming and serious problem. In eight years, 2017, it will begin to run out of money. The cost of Medicare has more than doubled over the last decade, growing from $210.4 billion in 1997 to $431.2 billion in 2007. These rising costs are unsustainable, and they contribute to the burgeoning cost of entitlements.

According to the Congressional Budget Office, 56 percent of all dollars that the federal government is projected to spend in 2009 will be spent on entitlements (Medicare, Medicaid, Social Security, Veterans’ benefits). If you add interest on the debt, which will account for 5 percent of this year’s federal spending, 61 percent of everything the government spends cannot be controlled. That is because if you qualify for an entitlement, you receive it, regardless of cost. And the interest on the debt must be paid, which further jeopardizes the financial future of the county as the debt grows. Any health reform bill must revise and reform Medicare to eliminate duplication and waste, and to prevent this continuing cost explosion.   I cannot vote for a bill that will add a new entitlement, like a subsidy, that will grow over time.

One way of accomplishing Medicare reform is to create an Entitlement Commission to reform and control Medicare and Social Security. This Commission would retain independent actuaries to periodically and regularly review the system and periodically make recommendations to the Congress, which would vote them up or down.

    * Expand healthcare coverage. With over 20 percent of Californians uninsured, healthcare reform must expand coverage to those who cannot currently afford it. Any expansion of coverage must be sustainable in the long-term, and be affordable without requiring adding costs to California and its counties, and without becoming another entitlement. This is difficult to do, and it remains to be seen how it will be accomplished.
    * Make prescription drugs more affordable for public hospitals and clinics. Currently, hospitals like San Francisco General Hospital and Harbor/ UCLA, as well as Federally Qualified Community Health Centers, are able to purchase some prescription drugs at a discounted price. However, these discounts apply only for prescription drugs used in outpatient care. This discount program should be expanded to cover drugs used for inpatient hospital care, and other facilities, like mental health clinics. This would allow healthcare providers to give patients more affordable access to the prescription medications that they need.
    * Health reform should include tort reform. I believe that medical malpractice reform must be included in health reform. Reforming medical malpractice in the correct manner can lower costs in the system, while still ensuring that injured parties are compensated fairly. The rapid escalation in health care spending is driven in part by defensive medicine. We can create incentives for doctors to provide efficient, high quality health care, but these efforts will not bear fruit if physicians feel compelled to order extra tests, images and procedures to protect themselves should there be a lawsuit.
    * Health reform should not address end of life care. I feel strongly that anything relating to end of life care does not belong in the bill. These are private family matters that do not require legislation.

Healthcare Reform “Musts”

    * Healthcare reform must contain and lower costs long-term. Any system that is created must be sustainable in both the short and long-term. I agree with President Obama that healthcare reform must not add to the federal deficit, and it must control the increase in healthcare spending in the long-term. It will do our Nation no good to expand coverage in the short-term, only to realize we cannot afford the policies we have adopted. So, the cost curve must not just go down for the initial period but be sustainable over time in the out years.
    * Healthcare reform must protect public hospitals, community clinics and county programs. Public hospitals, community clinics, and other county programs contribute substantially to healthcare across California. The Finance Committee is considering large cuts in payments (called Disproportionate Share Hospital payments, or DSH). As a former mayor, major cuts to public hospitals are unacceptable to me.

These payments are vital to the survival of publicly owned hospitals like San Francisco General Hospital, UCLA/Harbor Medical Center and UC San Diego Medical Center to cover the costs of providing care for the uninsured and undocumented. Many counties, including Los Angeles County, Riverside and San Francisco, are concerned that these payments will be reduced as a cost saving mechanism in the bill, and result in additional County costs. In California, these cuts could be in the hundreds of millions of dollars.

    * Healthcare reform must not create new financial burdens for the state or counties. California has been hard hit by the economic downturn and has sustained a systemic imbalance in its budget, which I anticipate will continue for the next year or so. Therefore, health reform must not add obligations that the state will be unable to pay.

If extending health care to the millions of currently uninsured is achieved by expanding Medicaid, the new cost to California would be approximately $2.05 billion per year, if the new eligibility level is set at 133 percent of the Federal Poverty Level ($14,404 per individual). Many California counties contribute to the cost of Medicaid, and they do not have extra funding to pay the cost for a program expansion. California still faces an ongoing financial emergency, so this becomes an important consideration. I could not support a bill that pushes additional costs on California state government or its counties.

    * Healthcare coverage must be truly affordable. Healthcare reform must also meet the needs of those living in high cost states like California. If individuals are required to purchase coverage, this coverage must not require them to spend a high percentage of their income. For example, I am led to believe that the bill under discussion could consider any health insurance plan to be affordable if it costs less than 15 percent of a family’s annual income. For a single parent of two children in California earning $55,000 per year, this could mean spending as much as $8,250 on health insurance premiums—with no additional help from the government. With the high cost of living in California, this could be very difficult for many families.

These concerns and others that develop must be addressed in the Finance Committee bill.   I will amend and change this paper as I learn more about the actual bill likely to come before the Senate. I thank you for reading this. Be assured that I want practical health reform to pass, but believe that the package must control the escalating cost of health insurance, increase coverage for those who do not have it, and contain costs.

Thank you,

Dianne Feinstein

She is a tough one to reach on this issue. She's stubborn. She's for reform but she hedges. Please call if you live in California. Or read what she believes and don't call....however, I think she should consider the public option. If you do too, please call.

Thank you!

melanie

Senator Feinstein of California does not support Public Option

Melanie — Thu, 10 Sep 2009 12:33:53 EDT

Senator Feinstein of California does not support Public Option

Melanie — Thu, 10 Sep 2009 12:31:30 EDT

What I Support : Senator Dianne Feinstein
I basically believe that reform should be incremental and should cover the following:

Allow people to keep their current healthcare coverage. Millions of Americans have insurance that meets their needs. In all of the proposals that Congress is considering, those happy with their current plan will be able to keep it.
Stop certain practices of insurance companies. Any bill should end discrimination based on preexisting conditions, stop insurance companies from dropping insurance when people become sick, and prevent the unreasonable denial of treatment. There must also be limits to out-of-pocket expenses to ensure that Americans are not driven into financial ruin by illness.
Control insurance premiums. Insurance premiums have doubled over the last 9 years, 3 times faster than wages. Meanwhile, the profits of the nation’s largest private insurance companies increased 428 percent from 2000 to 2008 (Health Care for America NOW). This is unacceptable. Insurance for healthcare is an urgent and universal need, but will not be sustainable and universal if the profit margin remains unconstrained.

In order to see that premiums are affordable, I believe that all non-direct healthcare costs (advertising, overhead, profits, and other administrative costs) should be limited and not exceed 10 percent. All premium rate adjustments should be subject to review and approval by a Health Insurance Rate Authority. Bottom line: your health insurance must remain affordable. Your premiums cannot be allowed to double again in the next nine years, as they have in the past nine.

Another way of stabilizing premium affordability is the public option. Depending how the competition is structured, this “option” could compel insurance companies to lower premiums to remain competitive. It remains a viable proposal. The public option should be one of a variety of choices for people who want improved coverage, giving them an option between a private insurance plan and a public one. The public option is simply that—an option. No one will be required to enroll in the public plan. Instead, it would offer consumers an additional choice as they select a health insurance policy. Instead of choosing between policies offered only by private insurance companies, people could choose to buy a public insurance plan. Those that prefer to buy private insurance could still do so.

The purpose of creating a public plan is to increase competition so that premium costs can be controlled. It is very clear that in the current market, private insurance companies do not control the price of premiums. The public option will not replace anyone’s private insurance coverage, but it could prevent future premium increases as private insurance companies lower their prices to compete with a public option. I am also open to considering a non-profit co-operative model, as long as it can accomplish the critical goal of controlling premium costs and spurring competition. Because insurance company profit taking has been so high, it will be very difficult to control premium costs without some non-profit option.

Save and improve Medicare. Medicare presents us with a looming and serious problem. In eight years, 2017, it will begin to run out of money. The cost of Medicare has more than doubled over the last decade, growing from $210.4 billion in 1997 to $431.2 billion in 2007. These rising costs are unsustainable, and they contribute to the burgeoning cost of entitlements.

According to the Congressional Budget Office, 56 percent of all dollars that the federal government is projected to spend in 2009 will be spent on entitlements (Medicare, Medicaid, Social Security, Veterans’ benefits). If you add interest on the debt, which will account for 5 percent of this year’s federal spending, 61 percent of everything the government spends cannot be controlled. That is because if you qualify for an entitlement, you receive it, regardless of cost. And the interest on the debt must be paid, which further jeopardizes the financial future of the county as the debt grows. Any health reform bill must revise and reform Medicare to eliminate duplication and waste, and to prevent this continuing cost explosion. I cannot vote for a bill that will add a new entitlement, like a subsidy, that will grow over time.

One way of accomplishing Medicare reform is to create an Entitlement Commission to reform and control Medicare and Social Security. This Commission would retain independent actuaries to periodically and regularly review the system and periodically make recommendations to the Congress, which would vote them up or down.

Expand healthcare coverage. With over 20 percent of Californians uninsured, healthcare reform must expand coverage to those who cannot currently afford it. Any expansion of coverage must be sustainable in the long-term, and be affordable without requiring adding costs to California and its counties, and without becoming another entitlement. This is difficult to do, and it remains to be seen how it will be accomplished.
Make prescription drugs more affordable for public hospitals and clinics. Currently, hospitals like San Francisco General Hospital and Harbor/ UCLA, as well as Federally Qualified Community Health Centers, are able to purchase some prescription drugs at a discounted price. However, these discounts apply only for prescription drugs used in outpatient care. This discount program should be expanded to cover drugs used for inpatient hospital care, and other facilities, like mental health clinics. This would allow healthcare providers to give patients more affordable access to the prescription medications that they need.
Health reform should include tort reform. I believe that medical malpractice reform must be included in health reform. Reforming medical malpractice in the correct manner can lower costs in the system, while still ensuring that injured parties are compensated fairly. The rapid escalation in health care spending is driven in part by defensive medicine. We can create incentives for doctors to provide efficient, high quality health care, but these efforts will not bear fruit if physicians feel compelled to order extra tests, images and procedures to protect themselves should there be a lawsuit.
Health reform should not address end of life care. I feel strongly that anything relating to end of life care does not belong in the bill. These are private family matters that do not require legislation.

Healthcare Reform “Musts”

Healthcare reform must contain and lower costs long-term. Any system that is created must be sustainable in both the short and long-term. I agree with President Obama that healthcare reform must not add to the federal deficit, and it must control the increase in healthcare spending in the long-term. It will do our Nation no good to expand coverage in the short-term, only to realize we cannot afford the policies we have adopted. So, the cost curve must not just go down for the initial period but be sustainable over time in the out years.
Healthcare reform must protect public hospitals, community clinics and county programs. Public hospitals, community clinics, and other county programs contribute substantially to healthcare across California. The Finance Committee is considering large cuts in payments (called Disproportionate Share Hospital payments, or DSH). As a former mayor, major cuts to public hospitals are unacceptable to me.

These payments are vital to the survival of publicly owned hospitals like San Francisco General Hospital, UCLA/Harbor Medical Center and UC San Diego Medical Center to cover the costs of providing care for the uninsured and undocumented. Many counties, including Los Angeles County, Riverside and San Francisco, are concerned that these payments will be reduced as a cost saving mechanism in the bill, and result in additional County costs. In California, these cuts could be in the hundreds of millions of dollars.

Healthcare reform must not create new financial burdens for the state or counties. California has been hard hit by the economic downturn and has sustained a systemic imbalance in its budget, which I anticipate will continue for the next year or so. Therefore, health reform must not add obligations that the state will be unable to pay.

If extending health care to the millions of currently uninsured is achieved by expanding Medicaid, the new cost to California would be approximately $2.05 billion per year, if the new eligibility level is set at 133 percent of the Federal Poverty Level ($14,404 per individual). Many California counties contribute to the cost of Medicaid, and they do not have extra funding to pay the cost for a program expansion. California still faces an ongoing financial emergency, so this becomes an important consideration. I could not support a bill that pushes additional costs on California state government or its counties.

Healthcare coverage must be truly affordable. Healthcare reform must also meet the needs of those living in high cost states like California. If individuals are required to purchase coverage, this coverage must not require them to spend a high percentage of their income. For example, I am led to believe that the bill under discussion could consider any health insurance plan to be affordable if it costs less than 15 percent of a family’s annual income. For a single parent of two children in California earning $55,000 per year, this could mean spending as much as $8,250 on health insurance premiums—with no additional help from the government. With the high cost of living in California, this could be very difficult for many families.

These concerns and others that develop must be addressed in the Finance Committee bill. I will amend and change this paper as I learn more about the actual bill likely to come before the Senate. I thank you for reading this. Be assured that I want practical health reform to pass, but believe that the package must control the escalating cost of health insurance, increase coverage for those who do not have it, and contain costs.

Thank you,

Dianne Feinstein

Familiar Players in Health Bill Lobbying

Melanie — Wed, 08 Jul 2009 03:15:50 EDT

Familiar Players in Health Bill Lobbying
Firms Are Enlisting Ex-Lawmakers, Aides

By Dan Eggen and Kimberly Kindy
Washington Post Staff Writers
Monday, July 6, 2009

The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records.

The tactic is so widespread that three of every four major health-care firms have at least one former insider on their lobbying payrolls, according to The Washington Post's analysis.

Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.

The push has reunited many who worked together in government on health-care reform, but are now employed as advocates for pharmaceutical and insurance companies.

A June 10 meeting between aides to Baucus, chairman of the Senate Finance Committee, and health-care lobbyists included two former Baucus chiefs of staff: David Castagnetti, whose clients include PhRMA and America's Health Insurance Plans, and Jeffrey A. Forbes, who represents PhRMA, Amgen, Genentech, Merck and others. Castagnetti did not return a telephone call; Forbes declined to comment.

Also inside the closed committee hearing room that day was Richard Tarplin, a veteran of both the Department of Health and Human Services and the Senate, where he worked for Christopher J. Dodd (D-Conn.), one of the leaders in fashioning reform legislation this year. Tarplin now represents the American Medical Association as head of his own lobbying firm, Tarplin Strategies.

"For people like me who are on the outside and used to be on the inside, this is great, because there is a level of trust in these relationships, and I know the policy rationale that is required," Tarplin said in explaining the benefits of having government experience.

But public interest groups and reform advocates complain that the concentration of former government aides on K Street has distorted the health-care debate, and that it further illustrates the problem posed by the "revolving door" between government and private firms.

"The revolving door offers a short cut to a member of Congress to the highest bidder," said Sheila Krumholz, executive director of the Center for Responsive Politics, which compiled some of the data used in The Post's analysis. "It's a small cost of doing business relative to the profits they can garner."

Aides to Baucus and other lawmakers bristle at any suggestion of special treatment for former staff members. Baucus spokesman Scott Mulhauser said the senator "remains committed to working with a variety of stakeholders" as the Finance Committee attempts to come up with a bill this summer.

"The senator and his staff meet daily with individuals, nonprofits and interests from across the health-care spectrum, and are proud that all interests are treated equally and that no one receives special treatment of any kind," Mulhauser said. "As a result, the Finance Committee has been praised by members of Congress and the media for its uniquely inclusive and transparent health-care reform process."

The Post examined federally required disclosure reports submitted by health-care firms that spent more than $100,000 lobbying in the first quarter of this year. It used current and past filings to identify former lawmakers, congressional staff members and executive branch officials.

The analysis identified more than 350 former government aides, each representing an average of four firms or trade groups. That tally does not include lobbyists who did not report their earlier government experience, such as PhRMA President W.J. "Billy" Tauzin, a former Republican congressman from Louisiana. Federal law does not require providing such detail.

Overall, health-care companies and their representatives spent more than $126 million on lobbying in the first quarter, leading all other industries, according to CRP and Senate data. PhRMA led the pack in spending and employs 49 former government staff members among its 136 lobbyists, according to The Post's analysis. Dozens of other former insiders are employed as lobbyists by Pfizer, Eli Lilly, the AMA and the American Hospital Association, each of which spent at least $3.5 million on lobbying from January through March.

The aim of the lobbying blitz is simple: to minimize the damage to insurers, hospitals and other major sectors while maximizing the potential of up to 46 million uninsured Americans as new customers. Although many firms have vowed to help cut costs, major players such as PhRMA, America's Health Insurance Plans and others remain opposed to the public-insurance option, a key proposal that President Obama has endorsed.

Several major Democratic bills include such a plan, but Baucus's committee -- which is acting as the central broker in the debate -- has not committed to the idea. Instead, the Finance Committee has focused recently on private-insurance cooperatives and other proposals seen as more palatable to the insurance industry and centrist Democrats. More than 50 former employees of the committee or its members lobby on behalf of the health-care industry, records show.

Deploying former government officials is a key strategy for pressing such positions on Capitol Hill, according to industry lobbyists, many of whom discussed the issue on the condition of anonymity. They say that legislative or administration experience helps ensure that policies considered by Congress do not imperil health-care interests, which account for about one-sixth of the U.S. economy.

At the same time, these lobbyists say, a personal connection to lawmakers and their staffs does not guarantee success.

"If anyone thinks hiring a former staffer for Baucus or [Charles] Schumer or Blanche Lincoln is going to get them what they want, they are crazy," said one health-care lobbyist who used to work on the Finance Committee, referring to several key Democratic senators. "If we were being judged on that, a lot of us should be fired."

William K. "Billy" Wynne, a former Baucus health counsel who now works for the Health Policy Source lobbying firm, said that "there's nothing insidious" about medical companies and groups hiring former legislative staff members. He also notes that he is subject to a two-year limit on contacts with Baucus's office.

"The technical processes of the House and Senate are not intuitive or widely known," Wynne said. "Like with any service, people who have experience are going to be valuable to people who don't."

Some trade groups and companies appear to emphasize hiring lobbyists with legislative or executive experience. Wellpoint, one of the world's largest insurance conglomerates, employs 11 lobbyists with government experience and three with none. One of its veterans is Stephen Northrup, who worked for several years for Sen. Mike Enzi (R-Wyo.), including a year as his health policy director on the Senate Health, Education, Labor and Pensions Committee.

"I think the experience on Capitol Hill gives you a better appreciation of the challenges that members and staff face," said Northrup, who began his Washington career as a lobbyist before entering government. "Every institution has its own rhythm. You need to understand when people need information."

The personal and professional ties between lawmakers, their staffs and lobbyists are often complex. Consider the case of Tarplin and his wife, Republican lobbyist Linda Tarplin. The two worked on opposite sides of the Family Medical Leave Act debate in the 1990s, and each has held high-ranking HHS positions -- he for Bill Clinton and she for George H.W. Bush.

Now they run their own health-care lobbying firms, drawing on their connections. Last year, Richard Tarplin's firm reported $650,000 in lobbying income and his wife's firm -- Tarplin, Downs and Young -- reported $3.5 million.

"We have been in situations that are much more combative than this," Linda Tarplin said of the health-care fight. "Both Democrats and Republicans want health-care reform. The rub has always been they tend to get there in different ways."

At least eight former HHS appointees have also crossed over into health-care lobbying, representing more than 25 companies with a stake in the reform legislation. Most were presidential appointees with high-ranking positions, such as the Tarplins.

A few have also cycled back into government. Jack Charles Ebeler, a former Clinton HHS official, left his job as president and chief executive of the Alliance of Community Health Plans a few months ago to become senior adviser for health policy on the House Energy and Commerce Committee.

Financial disclosure statements show that Ebeler received consulting fees over the past two years from UnitedHealth Group, Academy Health, the Medicare Rights Center, the Center for Health Care Strategies and the International Foundation of Employee Benefit Plans. Ebeler declined interview requests by The Post.

One of the most prominent examples of Washington's revolving door is Tauzin, who took the $2.5 million-a-year job as head of PhRMA in 2005 after shepherding a Medicare prescription drug plan through Congress.

Uproar over the appointment led Congress in 2007 to pass a bill barring former members from bringing clients onto the House and Senate floors and from lobbying their friends in members-only gyms. The legislation also forbade direct lobbying contacts with former colleagues for a year in the House and two years in the Senate; efforts to enact a wider ban went nowhere.

Tauzin and other lobbyists rebuff critics, arguing that it is unsurprising that those with experience on Capitol Hill should then draw on that background.

"Is it a distortion of baseball to hire coaches who have played baseball? Is it a distortion of universities to hire from academia?" Tauzin asked rhetorically. "The bottom line is that people work in the fields in which they have experience. Somehow there are people who think that's unusual for politics, but I think it's pretty normal."

Graphics editor Karen Yourish, database editor Sarah Cohen and research editor Alice Crites contributed to this repor

Familiar Players in Health Bill Lobbying

Melanie — Wed, 08 Jul 2009 03:14:53 EDT