To ecstatic applause from healthcare advocates, the California Senate breathed new life into national prospects for fundamental health reform by passing on a 22 to 14 vote a major bill to guarantee healthcare in the state through creating a Medicare for all system that would cover every Californian. SB 810, The California Universal Healthcare Act, authored by Sen. Mark Leno and sponsored by the California Nurses Association/National Nurses United (CNA/NNU), with broad support among many healthcare, community, and labor groups, will now proceed to a vote by the Assembly, which has passed similar legislation in the past. The bill would establish a single-payer system in California, modeled on the healthcare systems flourishing in virtually all other industrialized nations, where better patient outcomes are achieved at a fraction of the cost of the U.S. system. "It is unclear what the prospects are for health reform at the national level, " said CNA co-president Geri Jenkins, RN, "but this vote offers California the chance to chart a new course for the nation.
In his response to President Barack Obama's State of the Union address, Virginia Gov. Bob McDonnell said the nation cannot afford the Democratic agenda, including health care, The Associated Press/Wall Street Journal reports. "McDonnell said Democratic policies are resulting in an unsustainable level of debt. He said Americans wanted affordable health care, but they didn't want the government to run it" (1/28). Politico 's Live Pulse blog published the section of McDonnell's rebuttal that addresses health care policy and highlights programs that the Republicans are supporting. He said, "Republicans in Congress have offered legislation to reform healthcare, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes." He went on to say that the GOP approach involves "common sense reforms, " including putting an end to "frivolous lawsuits against doctors and hospitals that drive up the cost of your healthcare" (Frates, 1/27). Reuters reports that Republicans too were somewhat surprised at the message, they expected Obama to signal a start-over on health reform legislation.
News outlets report on state budget news in Kansas, Massachusetts, Idaho and Minnesota. Kansas Health Institute reports that the recession is crippling Kansas' safety-net system. "The Kansas unemployment insurance system is virtually broke at a time when Department of Labor officials say they need about $15 million a week to pay benefits to out-of-work Kansans. In addition, the Kansas Health Policy Authority is working keep up with surging applications for Medicaid and the Children's Health Insurance Program with a staff depleted by budget cuts. The backlog is now above 16, 000 though exact numbers won't be available until later this week, said Barb Langner, the agency's Medicaid director. A 10 percent cut in Medicaid reimbursement rates ordered by Gov. Mark Parkinson to help deal with an anticipated $400 million shortfall in state revenues is also taking its toll on Kansans and the agency's ability to provide needed services" (1/26). The Topeka Capital Journal reports that the Kansas state Senate Wednesday affirmed the $22 million in Medicaid cuts recommended by Gov.
"Laying out a possible path to approving healthcare legislation, House Speaker Nancy Pelosi (D-San Francisco) said Wednesday that the House should pass the Senate's version and then use a process known as 'budget reconciliation' to make the changes some lawmakers are demanding, " The Los Angeles Times reports. "But House and Senate leaders have not agreed on what later changes to make to the Senate bill. Among other things, House Democrats have demanded elimination of a new tax on high-end 'Cadillac' insurance plans. They also want more subsidies to help low- and moderate-income Americans buy health coverage, and more aid to help states expand Medicaid. The Senate version of the bill would give that extra aid only to a few states, including Nebraska" (Levey, 1/28). In an interview with Politico Wednesday, "Pelosi reiterated that ramming the existing Senate bill through the House is not an option. 'There is no support in my caucus in the present form, at this time, for the Senate bill, ' she said.
House Speaker Nancy Pelosi (D-Calif.) on Wednesday said that she could gather enough votes to pass the Senate's health care reform bill ( HR 3590 ) if the upper chamber agrees to make several changes to the bill through reconciliation, CongressDaily reports. While speaking to reporters before President Obama's State of the Union address, Pelosi said her chamber is not likely to pass the Senate's bill in its current form, but "we can pass this thing" by using reconciliation and a two-track approach to "resolv[e] some of the issues." Although several moderate Democrats earlier in the week said they were against using reconciliation, Pelosi argued that the procedural maneuver was "established for this purpose." Pelosi said that resolving the issue of abortion coverage restrictions -- which are different in each bill -- is "not the subject of our conversations at this time, " adding, "Right now, we're talking about affordability for the middle class, fairness for the states and how they help people have access to health care, those kinds of issues, how this is paid for.
President Obama during his State of the Union speech on Wednesday is expected to propose a three-year freeze on federal funding for a range of domestic programs, administration officials announced on Monday, the New York Times reports. The spending freeze would not apply to entitlement programs in the federal budget -- such as Medicare, Medicaid and Social Security -- or any Veterans Affairs or national security-related initiatives under the Pentagon, the officials said. Administration officials added that in addition to the freeze, some programs will be cut (Calmes, New York Times, 1/26). The proposal would take effect Oct. 1 under the fiscal year 2011 federal budget -- which Obama is expected to unveil next week -- and apply only to specific domestic agencies whose budgets are approved by Congress annually (Feller/Taylor, AP/San Francisco Chronicle, 1/25). The officials noted that the portion of the budget that would be targeted for the spending freeze amounts to about one-eighth of the budget ( New York Times, 1/26).
New Medicare Quality Demonstrations In North Carolina, Indiana To Address Quality Improvement Efforts
Two demonstrations comprised of a community-wide health information exchange in Indiana and a consortium of several community care physician networks in North Carolina are being implemented to encourage the delivery of improved quality care to an estimated 130, 000 beneficiaries in those states, according to the Centers for Medicare & Medicaid Services (CMS). The demonstrations are part of the national, five-year Medicare Health Care Quality (MHCQ) demonstration mandated by Congress in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The Indiana and North Carolina demonstrations will make more effective use of best practice guidelines, encouraging shared decision making between providers and patients, and altering incentives for care delivery. Each demonstration uses a different approach but each is intended to improve quality of care received by Medicare beneficiaries at less cost to Medicare. The Indiana Health Information Exchange (IHIE) demonstration is the first large-scale Medicare study to examine the impact of a multi-payer, quality reporting and improvement, and pay-for-performance program.
The Los Angeles Times : "The two former owners of City of Angels Medical Center will pay $10 million as part of a consent judgment over allegations that they performed unnecessary medical work on homeless people recruited from skid row shelters as part of a Medicare fraud scheme." Authorities alleged that the center would charge the government for the treatments (Grad, 1/26). KTLA News reports on the same case: "Many of those homeless patients were paid around $100 to come into the hospital by recruiter Estill Mitts. He claims to have received $20, 000 a month in kickbacks for the delivery of between 30 and 50 patients a month." Mitts and the center's two owners have pleaded guilty to criminal charges and are awaiting sentencing (1/26). In a separate case, The (McAllen, Texas) Monitor reports on the sentencing of a Mexican man who rounded up patients in a health care fraud case. Prosecutors said Raul Torres, who sold trinkets at elderly day care facilities, used his ties in those centers to get patients for a doctor who has been convicted of fraudulently billing Medicare and Medicaid of more than $1 million.
NPR interviewed two leading health care experts - Uwe Reinhardt, a Princeton professor, and Gail Wilensky, an economist who ran Medicare under the first President Bush - to shed light on the current plight of pending health care overhaul. Defending the legislation, and expressing hope for its survival, Reinhardt says, "The idea of taking the Senate bill, have the House endorse it and then pass it into law is not as far-fetched as even the president [seems to have made] it appear, because the Senate bill does many of the things Americans want. Americans need help buying health insurance. Well, it does that. Americans don't want the premiums based on their own health status, the bill outlaws that. Americans don't want rescission, that is, having their insurance canceled after an illness strikes, this bill outlaws that." Wilensky, on the other hand, acknowledges the problems of health care, but says the overhaul plans fell short. She says, "There are three significant problems in health care.
Medicaid payments are coming under review by a new commission, American Medical News reports. "MACPAC was created by a provision of the Children's Health Insurance Program Reauthorization Act, signed by President Obama in February 2009. The act instructs the panel to examine the effect of Medicaid pay and other factors on the access and quality of care received by Medicaid and CHIP enrollees." Kaiser Family Foundation executive Diane Rowland will chair the panel. The panel has not yet gained federal funding (Trapp, 1/25). Another federal panel could be created to review overall federal spending, and a similar, unofficial taskforce has begun to coalesce that includes prominent former elected officials, The New York Times reports. The unofficial groups' "goal is to, by December, give Congress and Mr. Obama a multiyear plan to raise tax revenues and pare spending, especially for the Medicare and Medicaid programs, which are the biggest factors driving the projections of future high deficits, [former Senate Budget Chairman Pete Domenici, R-N.