Monday, June 22, 2009

NASUA Health Care Reform Update

June 22, 2009


WASHINGTON, DC – The Senate Health Education Labor and Pensions (HELP) Committee began hearings on health care reform last week amid reports of preliminary cost estimates by the Congressional Budget Office (CBO). Senator Edward Kennedy’s (D-MA) bill, the “Affordable Health Choices Act” was estimated to cost $1 trillion and cover only 16 million out of 47 million uninsured Americans. The Senate Finance Committee’s bill was estimated to cost $1.5 trillion. Neither of those proposals was complete when scored.

Finance Committee Chairman Max Baucus (D-MT), who was planning to release his draft legislation last week, delayed the release of that committee’s proposal to look for further savings. The Senate Finance Committee’s markup will also be delayed until possibly after the July 4 recess. The Senate HELP Committee, led by Senator Chris Dodd (D-CT) in ailing Chairman Kennedy’s absence, will continue its daily hearings beginning at 3 p.m. today through the end of the week. The committee’s archived hearings are available at: http://help.senate.gov/Hearings/2009_06_17_E/2009_06_17_E.html

House Democratic leaders from three committees of jurisdiction released an 852-page draft bill last week. It excluded provisions on how to pay for the bill due to divisions between House and Senate Democrats. Some revenue proposals include taxing employer sponsored health benefits, increasing the Medicare payroll tax, adding a “value-added” tax, and taxing soda and alcoholic beverages. The House bill includes a mandate on consumers to carry health insurance, and a mandate on employers to provide a health insurance benefit. It also provides for a public insurance option that would compete with private insurance plans.

The House Energy and Commerce Health Subcommittee will hold hearings on health reform on Tuesday and Thursday. The House Ways and Means Committee, which oversees taxes, Medicaid and Medicare, will hold a hearing on Wednesday morning in which it is expected to release some of the first revenue details for the House Democratic approach.

The President has said he would like to sign health care legislation by October, setting an ambitious timeline for Congress. To have a bill to the President by October, Democratic leaders in Congress aim to complete their committee work and vote on the bills in their respective chambers before the August recess. Differences between the final House and Senate bills – on how to fund the measure and what a public option would look like, for instance – could then be worked out in a conference committee in September. With timelines slipping in both chambers, that is proving to be an elusive goal.

NASUA will provide ongoing information about the health reform debate, the evolving health reform proposals, and instructions for advocacy efforts in upcoming email alerts. Please also check out the Project 2020 blog for updates on our legislation and health care reform.

Thursday, June 18, 2009

Surface Transportation Act of 2009

House Committee on Transportation and Infrastructure Chairman James L. Oberstar (D-MN) has released a white paper to outline plans for the new surface transportation authorization bill. The authorization bill is currently being drafted and will replace the current authorization, SAFETEA-LU, which is due to expire on September 30. Oberstar has promised that the new authorization will transform the way the federal government invests highway, safety, and transit funds.

The Surface Transportation Act of 2009 redefines the Federal role and restructures the Federal surface transportation by consolidating or terminating more than 75 programs. The consolidation creates Highway and Transit funding, each of which have four program categories.

Within transit funding, one of the program categories is providing mobility and access to transit-dependent individuals. Many of the current programs that assist aging Americans and individuals with disabilities are slated for consolidation into the access and mobility program or termination.

Programs slated for consolidation into the mobility and access program include:
• ADA Project Action
• Elderly Individuals and Individuals with Disabilities Program Section 5310
• Human Services Transportation Coordination
• Job Access and Reverse Commute Program
• National Technical Assistance Center for Senior Transportation
• New Freedom Program

Programs slated for termination include:
• Growing States and High Density States program
• Contracted Paratransit pilot program
• Elderly Individuals and Individuals with Disabilities pilot program
• Medical Transportation Demonstration Grants
• Over-the-Road Bus accessibility program

The news conference, originally set for Wednesday, June 17, occurred instead late in the afternoon on Thursday, June 18 at in the Rayburn House Office Building.

To view the executive summary of the white paper:
http://transportation.house.gov/Media/file/Highways/HPP/Surface%20Transportation%20Blueprint%20Executive%20Summary.pdf

To view a full list of the programs slated for consolidation or termination:
http://transportation.house.gov/Media/file/Highways/HPP/Surface%20Transportation%20Blueprint%20Program%20Consolidation.pdf

To view a video of the news conference:
http://transportation.house.gov/

Wednesday, May 13, 2009

2009 Social Security and Medicare Boards of Trustees Annual Reports

The Trustees of the Social Security and Medicare trust funds have released their annual report summarizing the financial situations of both Medicare and Social Security. The 2009 report demonstrates that both the Social Security and Medicare programs remain in challenging financial situations as costs are not sustainable given the current program parameters.

Social Security's annual surpluses of tax income over expenditures are expected to fall significantly this year and to remain steady in 2010 due to the recession. They are expected to rise for a brief period before declining again. Cash flow deficits are projected beginning in 2016 as baby boomers become beneficiaries. The deficits will be alleviated by redeeming trust fund assets until reserves are exhausted (projected in 2037), at which point tax income would be sufficient to pay about three fourths of scheduled benefits through 2083.

Medicare's financial status is worse, and will become a problem before Social Security, as its problem is exacerbated by the rising costs of health care. In 2008 and again in 2009, Medicare's Hospital Insurance (HI) Trust Fund will pay out more in hospital benefits and other expenditures than it receives in taxes and other dedicated revenues. The difference will be addressed by redeeming trust fund assets. Growing annual deficits are projected to exhaust HI reserves in 2017, after which the percentage of scheduled benefits payable from tax income would decline from 81 percent in 2017 to about 50 percent in 2035 and 30 percent in 2080. In addition, the Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays provider fees and prescription drug costs will continue to require increases in costs for beneficiaries and the Federal government.

The Trustee reports concluded that both programs are facing serious financial challenges that need to be addressed quickly. Secretary Sebelius’ statement reads “this isn’t just another government report. It’s a wake up call for everyone who is concerned about Medicare and the health of our economy. And it’s yet another sign that we can’t wait for real, comprehensive health reform.”

The 2009 Trustees are:

Timothy F. Geithner, Secretary of the Treasury
Hilda L. Solis, Secretary of Labor

Kathleen Sebelius, Secretary of Health and Human Services
Michael J. Astrue, Commissioner of Social Security

There are two other currently vacant Trustee positions that are public representatives appointed by the President, subject to confirmation by the Senate.

To view a summary of the reports:

http://www.socialsecurity.gov/OACT/TRSUM/index.html

To view Secretary Sebelius’ statement on the reports:

http://www.hhs.gov/news/press/2009pres/05/20090512a.html

Tuesday, May 12, 2009

Senate Finance Committee – Roundtable Discussion on Financing Comprehensive Health Care Reform

Today the Senate Finance Committee held the last of three scheduled roundtable discussions on health reform. Today’s discussion focused on financing. There will be a closed-door Committee walk-through of this third element of tentative legislation on May 20.

The major themes of the financing discussion were:

• Extensive discussion of the current exclusion from income tax of employer sponsored health care. Senator Baucus stated that the exclusion would not be repealed but that modifications should be discussed. Some of the ideas for modification included capping the exclusion or linking it to income level. Some witnesses advocated phasing it out. There was some agreement that no single mechanism exists that will finance all of health reform.
• Another issue raised in the context of using the tax code to finance reform was geographic variation in health costs and whether geographic variation in the tax burden would be constitutional.
• There was some discussion of the reasons for geographic variation in health care costs and that the adherence of physicians to evidence-based guidelines is quite low. The need for developing compliance incentives was highlighted. The existence of integrated systems (Washington, Oregon, Minnesota) was noted as a mechanism that can make a difference in controlling costs.
• Comparative effectiveness research was discussed and a number of witnesses stated that it had an important role to play in ensuring that the care paid for is of high value and results in good outcomes.
• Bundled payments to hospitals, Medicare physician payment reform, and health information technology were all highlighted as areas where reforms can improve care, health outcomes, and result in savings.
• Employers do not want to abdicate their historic role in providing health insurance to their employees. Employers do want better alignment between cost and quality. Critically important to build on employer-sponsored system.

The participants in today’s roundtable are listed below. Their written statements may be accessed at http://finance.senate.gov/sitepages/hearing051209.html
Stuart H. Altman - Professor of National Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Mass.
Joseph R. Antos - Scholar in Health Care and Retirement Policy, American Enterprise Institute
Katherine Baicker - Professor of Health Economics, Harvard School of Public Health
Leonard Burman - Director, Tax Policy Center, Urban Institute
Robert Greenstein - Executive Director, Center on Budget and Policy Priorities
Jonathan Gruber - Professor of Economics, Massachusetts Institute of Technology
Michael F. Jacobson - Executive Director, Center for Science in the Public Interest
James A. Klein - President, American Benefits Council
Edward Kleinbard - Chief of Staff, Joint Committee on Taxation
Gerald M. Shea - Assistant to the President, Governmental Affairs, AFL-CIO
John Sheils - Senior Vice President, The Lewin Group
Gail Wilensky - Senior Fellow, Project HOPE
Steven Wojcik - Vice President, Public Policy, National Business Group on Health

Thursday, May 7, 2009

Senate Hearing on Medicare and Medicaid Fraud

On Wednesday, May 6 the Senate Special Committee on Aging convened a hearing titled Catch Me If You Can: Solutions To STOP Medicare and Medicaid Fraud From Hurting Seniors and Taxpayer. The hearing was convened by Chairman Herb Kohl (D-WI) and Senator Mel Martinez (R-FL), Ranking Member of the Senate Special Committee on Aging. The hearing featured five expert witnesses from across the country to testify about their experiences with Medicare and Medicaid fraud, as well as their ideas for solutions. The major themes of the hearing included:

· A focus on prevention; identifying fraud when claims are made, before payments occur

· Implementation of stricter penalties for fraud

· Improved screening of enrollees

· Improved screening of providers

· Increased transparency in Medicare and Medicaid spending

· Increased transparency of reimbursements received by providers

The witnesses were:

R. Alexander Acosta, US Attorney for the Southern District of Florida, US Department of Justice, Miami, FL

Daniel R. Levinson, Inspector General, US Department of Health and Human Services, Washington, DC

James Frogue, Project Director, The Center for Health Transformation, Washington, DC

Robert A. Hussar, First Deputy Inspector General, Office of the Medicaid Inspector General, State of New York, Hauppauge, NY

Stephen C. Horne, Vice President, Master Data Management and Integration Services, Dow Jones Business and Relationship Intelligence, Edgewater, NJ


Senator Martinez and John Cornyn (R-TX) have introduced two efforts targeted at detecting and preventing Medicare and Medicaid waste, fraud, and abuse. The Seniors and Taxpayers Obligation Protection or "STOP" Act (S.975) will work to reduce the estimated loss of more than $60 billion every year by creating fraud prevention and detection systems. The Medicaid Accountability through Transparency or "MAT" Act (S.974) will require transparency in billing for services and medical equipment.


The STOP Act would require the Secretary of HHS to implement changes to the current system of using Social Security Numbers as the Medicare Beneficiary Identifier (MBI) on Medicare cards, seeking to reduce fraud and identity theft among seniors. In addition, the STOP Act will also help to improve HHS's detection methods and place billing statements under increased scrutiny. Items such as durable medical equipment are notoriously known to be falsely billed at taxpayer expense - often by fake companies with nothing more than a P.O. Box.


The MAT Act seeks to reduce the prevalence of fraud in the Medicaid program by requiring HHS to publicly disclose the Medicaid payment data it already collects. Under the language, the Secretary shall establish a publicly-accessible Web site containing non-aggregated Medicaid claim payment data which has been fully de-identified according to HIPAA law. This information must be provided in a format that is easily accessible, useable and understandable to the public and shall be updated at least once per calendar quarter.

To view the full testimony:

http://aging.senate.gov/hearing_detail.cfm?id=312599&

To view the legislation, search the bill number (S.974, S. 975) on www.thomas.gov

Tuesday, May 5, 2009

Senate Finance Committee Holds Second Roundtable on Health Care Reform

Today, May 5, 2009, the Senate Finance Committee held the second of three planned roundtable discussions on health care reform. The topic today was “Expanding Health Care Coverage.”

While there was agreement that the individual market needs reform and that all individuals should have health care coverage, there was no agreement about how these things should be accomplished.

There was some discussion of whether a public plan should be part of reform. Those opposed to a public plan expressed concern about whether there could be a level playing field for private plans and whether a public plan could effectively coordinate care and serve those with chronic illnesses. Those in favor of the public plan option stated that they believed such a plan could be fair and that the same set of rules could be designed to apply to both public and private plans.

Expansion of existing public programs was also discussed. Expansion of Medicaid to at least 100% of the federal poverty level was supported by many of the witnesses, including those opposed to a public plan. Senator Hatch noted that in his view, such an expansion, as well as a Medicare buy-in component, equated to a public plan. He expressed concerns about crowd out, additional stresses on these programs, as well as increased costs.

There was some discussion of long term care and the need to have the reformed system reflect the desires of individuals to receive services in their homes rather than in institutions. Senator Kerry mentioned his sponsorship of the Empowered at Home Act while Senator Cantwell talked about the efficiencies that could be realized if states have incentives to focus more on providing home care.

Other topics of discussion included: Small business and its ability to offer insurance to its employees; the importance of including oral health care in health plans, and addressed cost and provision of end of life care.

The list of witnesses and links to their written statements are available on the Senate Finance Committee’s website at:

http://finance.senate.gov/sitepages/hearing050509.html
Friday, May 1, 2009

LCAO Supports Increased Funding for OAA

On April 30, the Leadership Council of Aging Organizations (LCAO) sent a letter to the Hill, supporting increased funding for Older Americans Act programs. NASUA is one of the organizations that signed on to the letter. You can review the letter on NASUA's website at
http://nasua.org/issues/federal_policy/documents/Letter-LCAO-ComServ-OAAApril09FINAL.pdf

Thursday, April 30, 2009

Congress Approves Budget Resolution

On Wednesday, April 29, the Senate voted 53 to 43 to approve the Conference Committee Report for Senate Concurrent Resolution 13. The day before the House voted 233 to 193 to approve the same budget resolution conference report. The measure received no Republican support. Seventeen Democrats in the House and three in the Senate voted against it. The compromise includes $3.4 trillion in budget authority and $3.5 trillion in outlays for 2010, and $17.783 trillion in budget authority and $18.031 trillion in outlays over 2010-2014. The compromise also includes reconciliation provisions that will limit debate.

Budget Resolution Explanation
The budget resolution provides the overall framework of anticipated costs, revenues, surplus or deficit for the federal government. The budget resolution sets spending limits for annual discretionary spending, places limits on the amount of spending the authorizing committees can approve and establishes revenue targets for the tax writing committees. The resolution represents the agreement between the House and the Senate concerning the overall size of the federal budget and the makeup of the budget by functional categories. Twenty functional categories make up the budget without regard to the agencies that may oversee the individual programs. Amounts in the functional categories result in allocations to committees with jurisdiction over the spending.

Separate Process for Appropriations
Appropriations is a separate process and restrictions on appropriations include limits in the authorizing legislation as well as constraints on discretionary spending caps and budget allocations from the concurrent budget resolution. The House and Senate Appropriations Committees subdivide the amounts allocated under the budget resolution to their subcommittees. The sub-allocations are to be made as soon as practicable following this after agreement on the concurrent resolution.

Budget Resolution Not Law
Budget resolutions do not have the force of law. Spending, revenue and public debt laws necessary to implement decisions agreed to in the budget resolution are enacted subsequently and separately. The budget includes direction both for discretionary spending (spending that is not mandated by existing law and is made available through annual appropriations) and mandatory spending (spending that is mandated in laws other than appropriations). Legislation must be consistent with the allocations and aggregate levels of spending and revenue. These are enforceable by points of order made during floor consideration of legislation.

Reconciliation
Reconciliation instructions in budget resolutions identify committees that must recommend changes to laws affecting revenues or direct spending (mandatory spending) programs within their jurisdiction. Reconciliation includes limitations on debate and on the types of amendments that may be considered.

Health Care Reform
The compromise budget resolution contains the principles of the President’s health care reform agenda as well as the health care reform reserve fund. The reconciliation process that would place limits on debate could be used if key committees (Senate Finance, Senate Committee on Health Education, Labor and Pensions, House Energy and Commerce, House Ways and Means, House Education and Labor) submit their recommendations to their respective chamber budget committees by October 15. The key elements of the President’s health reform include: (1) protect families' financial health including restraining the growth of health premiums and other health-related costs;(2) make health coverage affordable to businesses (in particular to small business and individuals who are self-employed), households, and governments, including by reducing wasteful and inefficient spending in the health care system with periodic reports on savings achieved through these efforts, and by moving forward with improvements to the health care delivery system, including Medicare;(3) aim for quality, affordable health care for all Americans;(4) provide portability of coverage and assurance of coverage with appropriate consumer protections;(5) guarantee choice of health plans and health care providers to Americans;(6) invest in prevention and wellness and address issues of health disparities;(7) improve patient safety and quality care, including the appropriate use of health information technology and health data, and promote transparency in cost and quality information to Americans; or (8) maintain long-term fiscal sustainability and pays for itself by reducing health care cost growth, improving productivity, or dedicating additional sources of revenue; by the amounts provided in such legislation for those purposes, provided that such legislation would not increase the deficit over the period of the total of fiscal years 2009 through 2019.

LIHEAP
The conference agreement includes the President’s request of $3.2 billion for LIHEAP in 2010. The agreement also includes a discretionary cap adjustment for an additional $1.9 billion if the President’s funding level of $3.2 billion is in an appropriations measure.

Community Development Block Grant
The conference agreement includes increased funding which could include full funding for CDBG.

Social Security
The Social Security Administration funding level in the conference agreement assumes the President’s full request for an adjustment for program integrity efforts including SSI redeterminations and SSI asset verification. It also reflects the President’s full request for more resources to address the backlog of disability claims and hearings.

To view the budget resolution visit http://thomas.loc.gov and search by bill number (SCR 13). The conference committee report is also available at the same site.


Spending in 2010 Concurrent Budget Resolution
In billions
Budget authority = BA
Outlays = OT

Mandatory Spending

Agriculture BA 17.559
OT 17.734

Commerce & Housing Credit BA 50.984
OT 75.553

Transportation BA 56.715
OT 2.233

Community & Regional BA 0.378
Development OT 2.399

Health BA 325.753
OT 324.079

Medicare BA 444.068
OT 444.228

Income Security BA 472.062
OT 470.879

Social Security BA 697.336
OT 695.343

Veterans Benefits BA 53.102
OT 52.994

Discretionary Spending

Agriculture BA 6.131
OT 6.217

Commerce & Housing Credit BA 13.391
OT 13.459

Transportation BA 31.436
OT 93.462

Community & Regional BA 17.930
Development OT 26.904

Health BA 58.556
OT 64.806

Medicare BA 5.600
OT 5.570

Income Security BA 64.778
OT 69.323

Social Security BA 6.072
OT 6.057

Veterans Benefits BA 53.396
OT 52.584

Wednesday, April 29, 2009

Leadership Council of Aging Organizations Sends Health Reform Recommendations

The Leadership Council of Aging Organizations(LCAO), of which NASUA is a member, has sent recommendations to Congress on key elements of upcoming health reform initiatives. While we are encouraged that the principles of Project 2020 are included under Chronic Care Supports & Services, because of the unfunded mandates throughout, NASUA abstained from supporting the recommendations as a whole. The recommendations focus on the following five areas:

Under-65 Population

Recommendations include offering a nationwide plan, setting premiums by community, keeping health care affordable, and elimination of the two year waiting period for SSI and Medicare

Medicare

Recommendations include addressing gaps in coverage, maintain choice of providers, expand access, improve prescription drug coverage, align payments to Medicare Advantage, and provide enhanced coverage for low-income beneficiaries

Medicaid

Recommendations include expanding eligibility to a simpler, more uniform system; incentivize states to cover more people; provide permanent additional federal funding; create an automatic trigger for FMAP increases; and reverse punitive DRA asset transfer provisions of the DRA

Chronic Care Supports & Services

Recommendations include expanding access to home based services; expand access and eligibility to Medicaid and non-Medicaid Home and Community based services to reach parity with institutional care, including Project 2020 principles; and improve the quality of life for nursing home residents

Systemic Reform

Recommendations include instituting care coordination, supporting a well trained workforce, improving caregiver support programs and employing Health information technology

The actual document can be viewed on the LCAO page of the NASUA website:

http://www.nasua.org/issues/federal_policy/LCAO_materials.html

Tuesday, April 21, 2009

Senate Finance Holds First Roundtable On Health Care Reform

Today the Senate Finance Committee held the first of three scheduled roundtable discussions on health reform. The first topic area considered was delivery system reform. The second roundtable will address coverage expansion and will be held on May 5. The third and final roundtable on financing will take place on May 14. Committee walk-throughs of tentative legislation will follow each roundtable with a mark-up expected in June.

After brief opening remarks from Senator Max Baucus and Senator Charles Grassley, the roundtable discussion began and was moderated by John Iglehart, founding editor of Health Affairs.

The major themes of the delivery system reform discussion were:

- Discussion of integrated systems like Geisinger Health System and tested care coordination models for adults with chronic conditions (such as the Advance Practice Nurse Transitional Care Model)

- Reforms of current payment system including bonus payments for primary care physicians, bundling of payments, revise process for setting relative values in Medicare, paying for outcomes

- Reform CMS to remove silos; should be a source of innovation and the best place in government to work; less prescriptive legislation with latitude to make decisions, subject to proper oversight; ability to implement successful pilots and demonstrations more quickly without having to seek additional authorization; public-private partnerships; leverage Medicare and Medicaid

- Health IT: electronic medical records, use data to educate providers about how they compare to their peers (e.g., hospital readmission data)

- Workforce: increase use of advance practice nurses, overcome barriers that prevent academic medical centers from valuing primary care as a specialty; possibly create commission to study workforce shortage and make recommendations to Congress

- Patient-centered model; medical home

-Individual choice, supported with information so that patients can make informed, evidence based choice; importance of comparative effectiveness research; provide incentives for patients to make healthy choices (Safeway example: financial incentives to lose weight, quite smoking)

- Importance of care coordination and availability of home and community based services (Washington state was the example cited and discussed by Senator Cantwell and Mark McClellan as a model that could save billions if implemented nationwide)

- Prevention of fraud and abuse: scrutinize providers and suppliers before enrollment; establish payment methodologies that are reasonable and reflect the marketplace; require compliance plans; vigilant monitoring (better data systems); respond quickly to detected fraud

The participants in today’s roundtable are listed below. Their written statements may be access at http://finance.senate.gov/sitepages/hearing042109.htm:

Allan M. Korn, M.D., Senior Vice President, Chief Medical Officer, Office of Clinical Affairs, Blue Cross Blue Shield Association, Washington, DC

Glenn M. Hackbarth, J.D., Chairman, Medicare Payment Advisory Commission, Washington, DC

Peter V. Lee, J.D., Executive Director, National Health Policy, Pacific Business Group on Health, San Francisco, CA

Mark B. McClellan, M.D., Director, Engelberg Center for Health Care Reform, Brookings Institute, Washington, DC

Lewis Morris, J.D., Chief Counsel to the Inspector General, Office of Counsel to the Inspector General, Washington, DC

Mary D. Naylor, Ph.D., FAAN, RN, Marian S. Ware Professor in Gerontology, University of Pennsylvania School of Nursing, Philadelphia, PA

Debra Ness, President, National Partnership for Women and Families, Washington, DC

Frank G. Opelka, M.D., FACS, Vice Chancellor for Clinical Affairs, Professor of Surgery, Office of the Chancellor, Louisiana State University, Health Science Center, New Orleans, LA

Glenn Steele Jr., M.D., PhD, President, Geisinger Health System, Danville, PA

John Tooker, M.D., MBA, FACP, Executive Vice President/Chief Executive Officer, American College of Physicians, Philadelphia, PA

Richard J. Umbdenstock, FACHE, President and CEO, American Hospital Association, Washington, DC

Ron Williams, Chairman and CEO, Aetna Inc., Hartford, CT

Paul J. Diaz, J.D., President and CEO, Kindred Healthcare Inc., Louisville, KY

Thursday, April 16, 2009

Health Care Reform Newsmakers Series

The Kaiser Family Foundation, Families USA and the National Federation of Independent Business are sponsoring a series of “reporters only” briefings regarding health care reform. Wednesday, April 15, Nancy-Ann DeParle, Director of the White House Office of Health Care Reform was the featured guest. Ms. DeParle was administrator of the Health Care Financing Administration - what is now the Centers for Medicare and Medicaid Services - during the Clinton administration. She also worked at the Office of Management and Budget and in the private sector.

In introductory remarks, Ms. DeParle noted that unlike the health care reform efforts of the ‘90s, this time more groups are at the table and no one wants the status quo. Every group wants to lower costs for businesses and for families. Reporters quizzed Ms. DeParle on a number of aspects of reform. Some of the questions and answers are summarized below.

1. Does the administration support taxing health benefits? Ms. DeParle responded that the president wants to build on the current employer based plans.

2. What options are being considered to lower Medicare costs? Ms. DeParle replied that options for lowering costs to Medicare include more equitable payments to Medicare Advantage Plans, bundling payments to hospitals to create incentives to reduce readmissions, promoting comparative effectiveness so that physicians and patients are able to make better decisions that will reduce costs in the long run, encouraging health information technology to improve care, lower costs and reduce errors, and emphasizing wellness and prevention to reduce utilization.

3. How do you respond to questions that have been raised about the public plan option? Ms. DeParle related that confusion exists about what a public plan is. She mentioned that often the concern is not whether a public plan should be available but the details of how a public plan will work. Some concerns have been raised about payment rates and options available. She noted that examples already exist including the state health plans that administer health coverage for state employees and use private health plans.

4. Will the administration support continuation of fee for service plans? Ms. DeParle reminded the audience that the president wants to strengthen fee for service and change incentives such as the bundling of payments to hospitals to avoid readmissions. She said that the emphasis on health information technology (HIT) assumes a robust private fee for services system. She noted that HIT is not a silver bullet but thinks that HIT will provide overall improvements to care and will lower administrative costs.

5. How does the concept of a medical home fit into the reform plan? Ms. DeParle noted that the idea is to create a less fragmented health care experience for patients with a medical clinician coordinating care so that patients are referred to the right specialists and are prescribed the right medications.

6. How will we pay for the reform? Ms. DeParle said that some “game changers” are included in the plan such as HIT and emphasis on wellness and prevention that will generate savings.

7. What strains do you foresee for the health care system if the 45 million uninsured suddenly have health care coverage? Ms. DeParle reminded the reporters that when Medicare began in July of 1966 millions of older adults were added to the health care system without overwhelming it. She also noted that different parts of the country have different capacities and that we need to make additional investments in the health care workforce.

In closing, Ms. DeParle reiterated that health care reform is one of the most important issues we are facing as a nation. It is clear that we all want better health care outcomes and stability in costs.