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HEALTHCARE REFORM FREQUENTLY ASKED QUESTIONS
Q. Would you be willing to accept a public option as your health insurance plan yourself?
Let me be clear, the public option would be completely voluntary - no one would be required to enroll and it is not free - people would have the choice to buy it or buy private insurance. I share your desire to avoid disruptions in coverage for those who are insured and like the health coverage they have today. That is why if you like the coverage you have today, you can keep it.
Over the years, I have heard from countless West Virginians who have been unable to find affordable health care, or have figured out too late that the health insurance they had was inadequate for what they needed. I believe the inclusion of a strong public plan option in health care reform legislation is a must - it is the only effective way to provide consumers with a reliable, high quality, and affordable coverage option. The Congressional Budget Office estimates that the public option would result in billions of dollars of savings to taxpayers because it would force greater competition among private health plans, thereby bringing down costs for all consumers. More information about the public heath insurance option is available on the Alliance for Health Reform website at: http://www.allhealth.org/briefing_detail.asp?bi=152.
I believe so strongly in the public option that I have introduced legislation to create a public health insurance option, the Consumers Health Care Act (S. 1278), and I continue to strongly advocate for its inclusion in the final health care reform bill that goes to the President.
Q. Why wasn't the Secretary of the U.S. Department of Health and Human Services given the ability to negotiate directly with prescription drug companies for lower prices when the Medicare prescription drug program was created in 2003?
I have long felt that it was important for the Secretary to be able to negotiate for lower drug prices just like any other major purchaser in the marketplace and to help bring costs down for seniors. I have voted in support of price negotiation numerous times and have an amendment to the current health care reform legislation to do just that. Seniors are struggling to afford needed prescription drugs and this is one way to help.
Q. How can we more effectively dispel myths about health care reform?
I am trying to share as much information as I can about what is and is not being considered as part of health care reform. I am participating in events all over West Virginia, taking calls and questions from supporters and opponents alike, and have a new section on my website dedicated to health care reform.
As you know, there are a lot of myths out there about the impact of health care reform, including on seniors. If you are looking for fact sheets on the broad components of reform, helpful information is available at: http://www.whitehouse.gov/realitycheck/ and http://www.healthreform.gov.
For seniors, the Senate Aging Committee has compiled a fact sheet to dispel some of the common myths and it can be found at:
http://aging.senate.gov/issues/healthcare/factvsfiction.pdf.
Additionally, there is good information available for seniors at the following website: http://www.healthreform.gov/reports/seniors/index.html.
Q. Will health care reform revisit changes to the Medicare prescription drug program, or Medicare Part D?
Congress is considering improvements to the Medicare program to increase the quality of care for seniors, to make services more affordable (including prescription drug coverage), and to stabilize program financing so that Medicare will be around for seniors for many decades to come. I strongly support improving the Medicare prescription drug program for West Virginia's seniors and individuals with disabilities, which is why I have introduced the Medicare Prescription Drug Coverage Improvement Act (S. 1634). I intend to fight for the inclusion of this legislation in the final health care reform package.
Q. What is your position in ending the institutional bias in health care?
As you may be aware, the Community Living Assistance Services and Supports (CLASS) Act (S. 697) was introduced by the late Senator Edward Kennedy of Massachusetts on March 25, 2009, and currently has six cosponsors. Originally referred to the Senate Finance Committee for consideration, this legislation is also a part of the Senate Health, Education, Labor, and Pensions (HELP) Committee's health care reform proposal - the Affordable Health Choices Act. The CLASS Act creates a voluntary long-term care public insurance program that provides funds to help eligible individuals afford the costs of long-term care coverage. The new program would focus on home and community-based services and supports, an approach I wholeheartedly support as we try to move away from an institutional bias in long-term care.
The goals of this legislation are critically important. However, I do have concerns about the premium levels and overall sustainability of the long-term care program created by the CLASS Act. The Congressional Budget Office (CBO) has analyzed this proposal and concluded that the premium levels in the bill are not sufficient to support the program benefits, which would already be limited for enrollees with greater health care needs. The premium increase that would be necessary to sufficiently support the program benefits is likely be much more than most Americans, and West Virginians, could afford. The CBO also concluded that the program would not be solvent beyond the 10-year budget window. This means that the program would have an uncertain future from the start. You can review the complete CBO analysis at: http://www.cbo.gov/ftpdocs/104xx/doc10436/07-06-CLASSAct.pdf.
Please know I have advocated for the creation of a long-term care infrastructure in this country throughout my career. I continue to believe that such a system is possible, but we must find a solution that is sustainable and affordable. Given your interest, I should tell you that on March 25, 2009, the Senate Finance Subcommittee on Health Care, of which I am Chairman, held a hearing titled, "The Role of Long-Term Care in Health Reform." Testimony from this hearing is available at: http://www.finance.senate.gov/sitepages/hearing032509.htm.
Q. Will illegal immigrants receive insurance?
I want to be very clear that health care reform will not provide health care benefits for illegal immigrants. Specifically, illegal immigrants will not be able to obtain health insurance through the state exchanges, nor will they qualify for federal health care tax credits or subsidies.
Q. Why would young adults need to be covered as part of health care reform?
One major proposal under consideration is a requirement that all Americans - including young adults - have some form of health insurance. This insurance would not be free. Those who can't afford it would be eligible for federal subsidies to help, but the basic responsibility would be on the individual. Americans between the ages of 18 and 29 are the most uninsured age group in the nation. More than 30 million young adults between the ages of 19 and 34 (46.8 percent) went without health insurance at some point during 2007 or 2008. Having health insurance is especially important for young adults -
many of whom end up getting their health care in hospital emergency rooms after a traumatic event, such as a car or ATV accident. Hospitals are the most costly settings to deliver health care, and the lack of insurance coverage among young adults increases the health insurance premiums of those who are insured. Requiring young adults to have health insurance will improve their health outcomes and lower the cost of coverage for all Americans.
Q. Why not fix health care for the 45 million Americans who are uninsured, and simply leave the rest of the system as it is today?
There is no question that we need to address the problem of 45 million Americans who are uninsured in this country. Our current system has so many gaps that millions go without coverage, including 250,000 people who are uninsured in West Virginia - some chronically uninsured, some from a job loss, some are students, and some have maxed out on their insurance limits. I have long supported universal health care - providing access to health care for every person in America through private markets and the kinds of public programs people count on today, like Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). But, it is important to note the difference between universal health care and national health care, which are very different ideas. National health care means providing government-run health insurance to everyone, a policy which works well in other countries, but in America is unrealistic and very expensive.
I share your desire to avoid disruptions in coverage for those who are insured and like the health coverage they have today. That is why I support one of President Obama's key principles for reform: If you like the coverage you have today, you can keep it. But, the fact is that the current problems within our health care system are not limited to the uninsured alone. Health care costs are spiraling out of control for all Americans and there are significant gaps in our current system that hurt even those who have coverage today. These economic burdens and gaps cannot be ignored.
For one, health care costs are increasingly unaffordable for individuals with insurance coverage. Over the years, I have heard from countless West Virginians who have been unable to find affordable health care, or have figured out too late that the health insurance they had was inadequate for what they needed. Roughly 17 percent of West Virginians have decided at one point or another not to visit a doctor because they could not afford it. Premiums for residents of West Virginia have risen 91 percent since 2000. Seventy-eight percent (78%) of people who cited medical expenses in their bankruptcy claims actually had health insurance coverage, and most of them had jobs. We must find a way to control skyrocketing health care costs, and there are several serious proposals under consideration to reduce costs and make health care more affordable - for families and for the system as a whole.
One proposal that is on the table is the creation of a public health insurance option, which I am a strong proponent of. I believe the inclusion of a strong public plan option in health care reform legislation is a must - it is the only effective way to provide consumers with a reliable, high quality, and affordable coverage option. The public option would be completely voluntary - no one would be required to enroll and it is not free - people would have the choice to buy it or buy private insurance. However, the public option would be a more stable and secure coverage option for those who cannot otherwise find affordable private insurance that meets their health care needs. The Congressional Budget Office estimates that the public option would result in billions of dollars of savings to taxpayers because it would force greater competition among private health plans, thereby bringing down costs for all consumers. More information about the public heath insurance option is available on the Alliance for Health Reform website at: http://www.allhealth.org/briefing_detail.asp?bi=152.
Cost savings are also possible in Medicare. By this, I do not mean charging seniors more for less. That is not a policy I would ever support. The proposal I have been working on, the MedPAC Reform Act (S. 1380) would prevent Medicare from becoming insolvent, which it is on track to do by 2017. It would distance the special interests from the process of determining Medicare payment, and instead allow independent experts to make the best decisions about how much we should pay Medicare providers. Gradually, these experts will carefully discipline the Medicare program, and do so without sacrificing access to necessary care for our seniors and individuals with disabilities.
An additional problem with the health insurance many West Virginians have today is that it is neither adequate nor accountable. Insurance companies currently use a variety of practices - such as pre-existing condition exclusions, limited benefit packages, and annual or lifetime caps - to limit what they have to pay out. As a result, many middle-class and working families who have paid their premiums faithfully for years abruptly find themselves with no protection. Too many big private health insurance companies only want health care reform to happen if it helps them earn maximum profits. Health care reform must include greater regulation of the insurance industry so that West Virginians, and all Americans, can have the peace of mind that comes from knowing that the insurance you buy today will be there when you need it tomorrow.
We should not be satisfied with health care reform that addresses only one a part of the problem. Congress should tackle 100 percent of the problem, and I believe we can do that while also preserving what is working in the system today.
Q. How will health care reform support the availability of family care physicians?
This is an important priority that I share, especially for rural areas like so much of West Virginia. Congress is considering several provisions as part of health care reform to increase access to primary care providers, like family physicians. Some of the ideas under consideration include increasing the student loan forgiveness for primary care physicians and strengthening programs like the National Health Service Corps, which seek to place physicians - including family doctors - in rural or underserved parts of the country and forgive them of their student loans entirely. Additionally, Congress is likely to include a fairly significant increase in Medicare reimbursement for primary care physicians, like family doctors, for the care they provide to patients. These reforms should go along way to strengthen the ability of our health care system to keep people well and prevent sickness, rather then simply treating patients once they become sick.
Q. Have you read the health care bill?
As Chairman of the Senate Finance Subcommittee on Health Care, I am always intimately involved in writing health care legislation before Congress - so, I have to know what is and is not in a bill. Although the Finance Committee's health care reform bill was not perfect, I voted for it because the status quo is even worse, and I believe we must move legislation forward with an eye on improving it. I should mention, however, that some of my proposals to preserve what works in today's system and improve what does not work were included: preserving the Children's Health Insurance Program (CHIP) so that every child has a healthy start in life, strengthening and expanding Medicaid, and limiting the amount that middle-class families can be charged out of pocket for health insurance are just a few. I will continue to have an integral role as health care reform moves to consideration by the full Senate, and in doing so, will work hard for health care reform that is available, affordable, and accountable. Rest assured, I will not vote for a health care reform package unless I believe it will improve care for all West Virginians and all Americans.
Q. I am a senior and happy with my current health care. Will I have to switch my insurance coverage?
As part of health care reform, Congress is considering improvements to the Medicare program to increase the quality of care for seniors, to make services more affordable (including prescription drug coverage), and to stabilize program financing so that Medicare will be around for seniors for many decades to come. As you may know, Medicare is projected to be insolvent by the year 2017. In order to protect the stability of Medicare and the security it provides seniors, health care reform will address significant inefficiencies that exist in the program today that lead to higher costs for seniors.
I share your desire to avoid disruptions in coverage for those who are insured and like the health coverage they have today. That is why I support one of President Obama's key principles for reform: If you like the coverage you have today, you can keep it. But, the fact is that the current problems within our health care system are not limited to the uninsured alone. Health care costs are spiraling out of control for all Americans and there are significant gaps in our current system that hurt even those who have coverage today. These economic burdens and gaps cannot be ignored.
For one, health care costs are increasingly unaffordable for individuals with insurance coverage. Over the years, I have heard from countless West Virginians who have been unable to find affordable health care, or have figured out too late that the health insurance they had was inadequate for what they needed. Roughly 17 percent of West Virginians have decided at one point or another not to visit a doctor because they could not afford it. Premiums for residents of West Virginia have risen 91 percent since 2000. Seventy-eight percent (78%) of people who cited medical expenses in their bankruptcy claims actually had health insurance coverage, and most of them had jobs. We must find a way to control skyrocketing health care costs, and there are several serious proposals under consideration to reduce costs and make health care more affordable - for families and for the system as a whole.
Cost savings are possible in Medicare. By this, I do not mean charging seniors more for less. That is not a policy I would ever support. The proposal I have been working on, the MedPAC Reform Act (S. 1380) would prevent Medicare from becoming insolvent, which it is on track to do by 2017. It would distance the special interests from the process of determining Medicare payment, and instead allow independent experts to make the best decisions about how much we should pay Medicare providers. Gradually, these experts will carefully discipline the Medicare program, and do so without sacrificing access to necessary care for our seniors and individuals with disabilities.
More information about the impact of health care reform on Medicare is available at: http://www.healthreform.gov/reports/seniors/index.html.
The Senate Aging Committee has also compiled a fact sheet to dispel some of the common myths and it can be found at:
http://aging.senate.gov/issues/healthcare/factvsfiction.pdf.
Q. What are the status of and your opinion on incentive-based provider reimbursement?
There is no question that we must improve the quality of care provided through our nation's health care system. Incentive-based provider reimbursement, or tying Medicare reimbursement for providers more closely to the quality of care provided and health outcomes of patients, is one mechanism being discussed. However, these initiatives are far from perfect, and I have repeatedly raised concerns about this approach to improving quality and efficiency. Attempting to measure all providers in a category with the same quality yardstick is problematic because all providers are not the same. We know that all doctors are not the same just like all hospitals are not the same. Some doctors see more uninsured and Medicaid patients than others. Some doctors are located in rural areas while others are in urban areas. I believe we should support quality initiatives that move our health system forward in a manner that takes into account the unique but important differences between providers, such as provider size, administrative overhead, geographic location, and patient case mix. I also believe that we should not simply reward already high-performing providers that don't actually improve clinical quality care above their current levels. These are important considerations that I am fighting to address as part of health care reform.
In order to effectively address quality improvement in Medicare, I feel strongly that Congress must create a more coordinated federal infrastructure for quality improvement. This is crucial to the long-term success of federal initiatives to improve quality of care in federal programs and to make the best use of limited tax dollars. While some federal entities, like the Agency for Health Research and Quality (AHRQ), are clearly coordinating with other federal and private entities on quality efforts, there is no formal process in place for defining quality, setting priorities, communicating those priorities, and translating those priorities and research into tests for quality improvement initiatives and full implementation and evaluation. Additionally, we need to make certain providers and patients alike have the resources and guidance to effectively achieve the quality improvement goals put forth for them. For all of these reasons, I have introduced the National Health Care Quality Act (S. 966), legislation that would create a coordinated quality improvement infrastructure and provide critical support and resources to providers and communities in West Virginia. I will continue to fight for its inclusion in final health care reform.
Q. Will health care reform legislation make it illegal for existing insurance companies to sign up new policyholders?
I want to assure you that it will not. In fact, health care reform will create new opportunities for existing health insurance companies to sign up new enrollees. Health care reform seeks to build on the current system and provide consumers with a mix of additional public and private health insurance options from which to choose. Consumers who like the health insurance coverage they have today will be able to keep it. And, insurance companies providing coverage today will be able to provide coverage to millions of new enrollees - many of whom are uninsured or underinsured today. Health care reform will make coverage more affordable through the use of subsidies to help consumers pay their monthly premiums which will allow millions of Americans, and thousands of West Virginians, to purchase private insurance they could not previously afford. In exchange for access to this large new customer base, insurance companies will be required to end practices that hurt consumers.
Insurance companies currently use a variety of practices - such as pre-existing condition exclusions, limited benefit packages, and annual or lifetime caps - to limit what they have to pay out. As a result, many middle-class and working families who have paid their premiums faithfully for years abruptly find themselves with no protection. Too many big private health insurance companies only want health care reform to happen if it helps them earn maximum profits. Health care reform must include greater regulation of the insurance industry so that West Virginians, and all Americans, can have the peace of mind that comes from knowing that the insurance you buy today will be there when you need it tomorrow.
Q. How can one respond to those who speak about "death panels?"
As your question implies, some opponents of health care reform have incorrectly characterized the legislation as allowing the creation of so-called "death panels." This is absolutely not true. Health care reform will help seniors, and people of all ages, make informed decisions about their care at all stages of life.
Although the opponents of reform have not clearly articulated exactly what they mean by this "death panels" rhetoric, they have often referenced a provision in an earlier House health care reform package that originated from my bipartisan legislation to improve care at the end of life - the Advance Planning and Compassionate Care Act (S. 1150). My legislation seeks to empower people of all ages to make their own health care choices, in consultation with their doctors. It would simply compensate physicians for conducting an advance planning consultation, only at a patient's request, once every five years. There is no requirement in the health care reform legislation before Congress for Medicare beneficiaries to complete an advanced care directive or living will.
For your reference, I have attached a fact sheet from the Senate Aging Committee that addresses this issue: http://aging.senate.gov/issues/healthcare/factvsfiction.pdf.
Additionally, there is also information available to counter the "death panels" rhetoric at: http://www.whitehouse.gov/realitycheck/.
Q. Will�� retirees enrolled in Coventry's Advantra Freedom Medicare Advantage Prescription Drug Plan be allowed to go back into West Virginia's Public Employees Insurance Agency (PEIA) if an insurance company is not found to replace Coventry Health Care, which has elected to exit the private fee-for-service Medicare market, effective January 1, 2010?
In a May 14, 2009, press release, PEIA Director Ted Cheatham indicated that,"if no viable alternative is available, the Medicare retirees will be returned to PEIA for their health care coverage, effective January 1, 2010." That press release is available on the state's website at: http://www.wv.gov/news/administration/Pages/PEIAFinanceBoardApprovesPlanToTransitionRetirees.aspx. However, on August 26, 2009, WV PEIA announced plans to contract with Humana to administer a new Medicare Advantage private fee-for-service plan to retirees, effective January 1, 2010.
I have heard from retirees across our state who are upset about the changes to PEIA health coverage for retirees, and I want you to know that I share that frustration. When the 2003 Medicare prescription drug law, which I did not support, was debated in Congress, proponents of expanding the role of private plans in Medicare argued that such plans would introduce competition into Medicare and, therefore, be more efficient. That efficiency has not been realized. Proponents also argued that private plans could provide extra benefits to enrollees beyond those available in traditional Medicare, such as lower co-payments at the doctor's office and prescription drug coverage. Instead, some Medicare recipients are paying more for their health care benefits and receiving less.
Medicare Advantage was touted as a cost-effective program, so it does not make fiscal sense that these private plans would actually require beneficiaries and taxpayers to invest more. I am hopeful that Congress will address these issues as a part of health care reform.
Q. Will Medicare-based reimbursement rates being discussed for use by a public health insurance option drive up the cost of private health insurance coverage, since private plans would have to make up the difference for lower provider reimbursement rates under the public option?
Arguments against a public option on the grounds of cost-shifting are unsubstantiated. Such cost-shifting arguments have been debunked by the national authority on Medicare payment-��� the Medicare Payment Advisory Commission (MedPAC). MedPAC argues that "high profits from non-Medicare sources permit hospitals to spend more." Hospitals with the greatest resources are less aggressive about containing costs and therefore have the highest Medicare 'losses' (the difference between Medicare rates and a hospital's average costs). MedPAC explained this cycle in its March 2009 report to Congress, which is available online at: http://www.medpac.gov/documents/Mar09_EntireReport.pdf.
MedPAC reported, "While insurers appear to be unable or unwilling to 'push back' and restrain payments to providers, they have been able to pass costs on to the purchasers of insurance and maintain their profit margins." The real issue is not whether private plans pay doctors and hospitals more than government programs, but what is a fair rate based on the actual cost of providing quality care. MedPAC concluded, "Increasing Medicare payments is not a long-term solution to the problem of rising private insurance premiums and rising health care costs. In the end, affordable health care will require incentives for health care providers to reduce their rates of cost growth and volume growth."
Additionally, the Congressional Budget Office has indicated that many hospitals negotiate higher payments with private insurers as a form of price discrimination to maximize profits. They demand higher reimbursements from health insurers because they can, not because they are shifting costs. Hospitals have had a greater ability to do this as mergers have given them greater leverage over private insurance companies. A public option would not have these profit-maximizing incentives.
As stated previously, I believe that private insurance provider payments are not the appropriate standard for public insurance provider payments. Medicare Advantage, the private health insurance alternative for those eligible for Medicare, is a good example. This program costs taxpayers an average of 12 percent more per Medicare beneficiary than traditional Medicare coverage, and provides very little in the way of meaningful extra benefits. Unfortunately, this is just one example of private health plans' failure to use their market power to contain costs. Instead, private health plans consistently pass higher costs onto consumers while simultaneously increasing their profits. A public health insurance option, like the one I have proposed in my Consumers Health Care Act (S. 1278), would pay providers adequately and efficiently, would be non-profit, and would use premium dollars for actual medical care instead of shareholder profits.
More specifically, the provider payment rates for the first two years of my public health insurance option would be based on Medicare provider payment rates, including new delivery models enacted as part of health care reform to incentivize higher quality care. However, my plan does include an important provision which would give the Administrator of the public plan the authority to increase or decrease these rates as necessary in order to achieve an adequate network of providers for patients, which is an important safeguard for rural areas. For subsequent plan years beyond the first two years, the public plan would be required to determine competitive provider payment rates based on public and private best practices, integrated models of care delivery (such as medical home and chronic care coordination), evidence-based practices, quality improvement, and the use of health information technology.
Q. Will tort reform be a part of health care reform?
Discussions about whether or not tort reform will be included in the final health care reform legislation are ongoing; no final decisions have been made. However, the President has renewed an idea considered by the Bush Administration to authorize demonstration projects in individual states to test new and innovative ideas around malpractice reform. In fact, President Obama has directed the Secretary of the U.S. Department of Health and Human Services to move forward with these demonstration projects immediately.
Of course, tort reform alone can not fix the problems that truly plague our health care system, including the spiraling cost of care, the practice of medicine, and the uninsured and underinsured. Malpractice costs represent less than two percent of total health care spending, and medical malpractice claims represent only one-fifth of one percent of health care costs. The cost of health care has not decreased in any of the 46 states that have enacted medical malpractice reform, including West Virginia. We need to balance all of these factors as we look for ways to improve quality of care and patient safety, while reducing spiraling health care costs.
Q. How do we overcome the influence of pharmaceutical and health insurance corporations on the Congress?
This is something I have given a great deal of thought to. As you may know, right now Congress has the sole authority to change the manner in which public health care programs, like Medicare, deliver care. Despite the clear evidence about how to improve the delivery of care to Medicare beneficiaries and eliminate waste in the program, members of Congress face unyielding pressure from the health care industry to pick and choose which expert recommendations they consider. This routinely leads to the passage of laws that put the interests of industry over the needs of patients. In my view, we need an objective expert entity in place that can efficiently and consistently develop and implement payment policies for Medicare providers.
I have introduced legislation - the MedPAC Reform Act (S. 1380) - to create such an independent entity. My legislation would empower an already trusted and objective body, the Medicare Payment Advisory Commission (MedPAC), to implement evidence-based recommendations for improving the Medicare program. I believe this would be a much more sensible approach to developing and implementing Medicare policies that improve provider payments and patient health outcomes. It is my goal to incorporate this legislation into the broader health care reform bill, in order to further insulate our health care system from the negative effects of special interests.
As for the influence of pharmaceutical companies, I can tell you that I have long felt that it was important for the Secretary of the U.S. Department of Health and Human Services to be able to negotiate directly with prescription drug companies for lower drug prices just like any other major purchaser in the marketplace and to help bring costs down. I have voted in support of price negotiation numerous times and have an amendment to the current health care reform legislation to do just that. People, especially seniors, are struggling to afford needed prescription drugs and this is one way to help.
Q. What will be the impact of health care reform on Medicare?
As part of health care reform, Congress is considering improvements to the Medicare program to increase the quality of care for seniors, to make services more affordable (including prescription drug coverage), and to stabilize program financing so that Medicare will be around for seniors for many decades to come. As you may know, Medicare is projected to be insolvent by the year 2017. In order to protect the stability of Medicare and the security it provides seniors, health care reform will address significant inefficiencies that exist in the program today that lead to higher costs for seniors.
In addition, cost savings are possible in Medicare. By this, I do not mean charging seniors more for less. That is not a policy I would ever support. The proposal I have been working on, the MedPAC Reform Act (S. 1380) would prevent Medicare from becoming insolvent, which it is on track to do by 2017. It would distance the special interests from the process of determining Medicare payment, and instead allow independent experts to make the best decisions about how much we should pay Medicare providers. Gradually, these experts will carefully discipline the Medicare program, and do so without sacrificing access to necessary care for our seniors and individuals with disabilities.
More information about the impact of health care reform on Medicare is available at: http://www.healthreform.gov/reports/seniors/index.html.
Q. What is standing in the way of a single-payer system, which is also known as national health care?
I have long supported universal health care, providing access to health care for every person in America through private markets and the kinds of public programs people count on today, like Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). But, it is important to note the difference between universal health care and national health care, which are very different ideas. National health care means providing government-run health insurance to everyone, a policy which works well in other countries, but in America is unrealistic and very expensive. In addition, there is no viable proposal being considered by Congress to create single-payer, government-run health care.
I want to avoid disruptions in coverage for those who are insured and like the health coverage they have today. That is why I support one of President Obama's key principles for reform: If you like the coverage you have today, you can keep it. But, the fact is that the current problems within our health care system are not limited to the uninsured alone. Health care costs are spiraling out of control for all Americans and there are significant gaps in our current system that hurt even those who have coverage today. These economic burdens and gaps cannot be ignored.
For one, health care costs are increasingly unaffordable for individuals with insurance coverage. Over the years, I have heard from countless West Virginians who have been unable to find affordable health care, or have figured out too late that the health insurance they had was inadequate for what they needed. Roughly 17 percent of West Virginians have decided at one point or another not to visit a doctor because they could not afford it. Premiums for residents of West Virginia have risen 91 percent since 2000. Seventy-eight percent (78%) of people who cited medical expenses in their bankruptcy claims actually had health insurance coverage, and most of them had jobs. We must find a way to control skyrocketing health care costs, and there are several serious proposals under consideration to reduce costs and make health care more affordable - for families and for the system as a whole.
One proposal that is on the table is the creation of a public health insurance option, which I am a strong proponent of. I believe the inclusion of a strong public plan option in health care reform legislation is a must - it is the only effective way to provide consumers with a reliable, high quality, and affordable coverage option. The public option would be completely voluntary, no one would be required to enroll and it is not free. Rather, people would have the choice to buy it or buy private insurance. However, the public option would be a more stable and secure coverage option for those who cannot otherwise find affordable private insurance that meets their health care needs. The Congressional Budget Office estimates that the public option would result in billions of dollars of savings to taxpayers because it would force greater competition among private health plans, thereby bringing down costs for all consumers. More information about the public heath insurance option is available on the Alliance for Health Reform website at: http://www.allhealth.org/briefing_detail.asp?bi=152.
I believe so strongly in the public option that I have introduced legislation to create a public health insurance option, the Consumers Health Care Act (S. 1278), and I continue to strongly advocate for its inclusion in the final reform bill that goes to the President.
Q. What is the status of S. 960, the Medicare Early Access Act?
With the aging of the baby boom generation, the number of people between the ages of 55 and 64 is expected to increase significantly. In 1999, there were 23.1 million Americans in this age group. This number is expected to increase to 35 million Americans by the year 2020. People between the ages of 55 and 65 are the fastest growing group of uninsured Americans. These individuals often have a difficult time buying health insurance on their own because they tend to have more chronic health problems that can result in either the denial of coverage, limited coverage, or very expensive policies. Unless we undertake positive changes to address the barriers facing the growing number of uninsured in this age group, this problem will only get worse.
Earlier this year, I reintroduced S. 960, which would allow individuals between the ages of 55 and 64 to buy into the Medicare program early. The bill also includes a 75% refundable tax credit that would make it even more affordable to obtain this coverage. This legislation, which is cosponsored by Senators Brown and Cardin, has been referred to the Senate Finance Committee, where it is now pending.
I have also worked to make certain that as we move forward in the health care reform debate this group has access to generous subsidies to purchase coverage through newly-created health insurance exchanges. I'm proud that many of the insurance reforms that I've championed - reforms that would make it illegal for any insurance company to deny coverage based on age or pre-existing conditions and further limits the amount that an insurance company can charge you for such factors - are included in the health care reform proposals currently under consideration by Congress.
Q. What will health care reform do to slow the costs of health coverage for small business owners?
Small business owners face substantial barriers to providing health insurance coverage for themselves and for their employees. They are often the hardest hit by rising health care costs, and the ongoing economic downturn has forced many small employers to increase employee cost-sharing, cut benefits or discontinue coverage altogether. As more companies pass the costs of health insurance on to their employees, more American workers are joining the ranks of the uninsured because they cannot afford the higher premiums, deductibles, and co-pays. In order to help small businesses and their employees access affordable, high-quality health insurance, I believe Congress should seek to build upon models of dependable insurance coverage that offer tough consumer protections and adequate regulatory standards.
Small businesses in West Virginia are suffering right now - health care reform can help to stop that suffering. Some small business will be eligible for tax credits to help them continue to offer health insurance to their employees, or offer it for the first time. Health care reform will also give small firms a choice of multiple insurance plans at a lower cost and of a higher quality than what's currently in their market, which is exactly what they need in times like these. These plans would be available within a health insurance exchange, or marketplace, which allows small businesses to not only pool their resources to get a better deal on health coverage, but also more easily shop for different coverage options that include greater protections against harmful insurance company practices that currently limit or deny access to necessary medical care.
Q. How did you make the decision to support health care reform?
I sincerely believe that we are at a turning point, not just in Congress, but in West Virginia and across the country. We have a profound opportunity to fix a broken health care system, rein in runaway health care costs, and make life better for hundreds of thousands of West Virginians. So many individuals in our communities feel alone in their struggles with this broken system. Just one serious illness threatens to send their entire world tumbling down. And, these are people we know: a husband or a wife, a son or a daughter, a mom or a dad, a church member or a co-worker.
The growing and deeply felt insecurity of being one step removed from a medical and financial disaster runs like a common thread throughout our country and is particularly acute in West Virginia. The instability that so many West Virginians face in our current system and the economic pressure of spiraling health care costs are why I so strongly support comprehensive health care reform. Every decision I make in the Senate on the subject of health care is guided by three basic objectives: availability, affordability, and accountability. The time is now for Congress to submit a plan to the President that achieves these reform goals. I firmly believe we cannot afford to wait.
Although the Finance Committee's health care reform bill was not perfect, I voted for it because the status quo is even worse, and I believe we must move legislation forward while continuing to improve it. I should mention, however, that some of my proposals to preserve what works in today's system and improve what does not work were included: preserving the Children's Health Insurance Program (CHIP) so that every child has a healthy start in life, strengthening and expanding Medicaid, and limiting the amount that middle-class families can be charged out of pocket for health insurance are just a few. I will continue to have an integral role as health care reform moves to consideration by the full Senate, and in doing so, will work hard for health care reform that is available, affordable, and accountable. Rest assured, I will not vote for a health care reform package unless I believe it will improve care for all West Virginians - and all Americans.
Q. What will health care do to deal with obesity problems?
As part of health care reform, Congress is considering multiple policies to shift the focus of our health care delivery system from one that simply treats illness to one that promotes prevention and wellness. I believe that a strong emphasis on prevention and wellness in health care reform is one way to address the obesity epidemic. West Virginia ranks among the nation's leaders for obesity, with 67 percent of the population either overweight or obese. Aside from the personal ramifications of obesity, chronic diseases such as this cost the state $8.1 billion in lower productivity. Therefore, I am pleased that as part of health care reform Congress is considering options for promoting greater consumer education and engagement regarding prevention and healthy living in the community, including workplace wellness initiatives. |
