Reforming health care should also involve you. Stay up to date on health care reform and other national issues by signing up for email updates directly from the White House. Click here to sign up.

If you would like to get more in-depth information about health reform and how you can participate, click here.


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Health Policy Report: White House Health Care Summit Summary
Yesterday’s White House health reform summit focused on four topics: cost containment, deficit reduction, expanding coverage, and insurance reform.
Click here to read more.

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The President’s Proposal
The President’s Proposal puts American families and small business owners in control of their own health care.
Click here to read the full proposal.

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Health Policy Report Special Budget Edition
February 1, 2010
Budget Summary
Overall 2011 Spending: $3.834 trillion.
2011 Discretionary Spending: $1.415 trillion.
2011 Projected Deficit: $1.267 trillion or 8.3 percent of GDP
10-year Deficit Reduction: $1.2 trillion, excluding war savings.
A three-year spending freeze on non-security discretionary spending which saves $250 billion over 10 years
Click here to read more information.
Click here to download a brief summary.
Click here to download a PDF of the budget.

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Senate Passes Health Reform Bill
Reform Bill On December 24th, with a vote of 60 to 39, the Senate passed the “Patient Protection and Affordable Care Act” after nearly one month of floor debate.
Click here to read more information.

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Reid's Health Bill Keeps Class Act, Expands Delivery Reforms, Tweaks IMAB, Leaves Out PBM Tax and SGR
Click here to read more information.

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Health Policy Report - Senate Update December 3, 2009
- Lack of Unanimous Consent Deal Muddles Senate Reform Process
- Mikulski Seeks to Reinsert Women’s Preventive Care Measure Into Health Bill
- McCain Offers First Republican Amendment
- Reid to Unveil New Public Option
- Reid to Add Wyden Amendment to Health Bill
Click here to read more information on the above topics.

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Click here to download a PDF NOTICE - Changes in Licensing Laws to Take Effect on January 1, 2010.

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Click here to download the side-by-side comparison of the Senate and House health reform bills.

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AMA Creates New CPT Codes for H1N1 Flu Immunizations
Click here for full details.

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Click here to view the Health Policy Report, October 29, 2009.

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 Attorney general announces historic nationwide reform of consumer reimbursement system for out-of-network health care charges
SYRACUSE, N.Y. (October 27, 2009) - Attorney General Cuomo today announced historic nationwide reform of the consumer reimbursement system for out-of-network health care charges. A new not-for-profit company, FAIR Health, Inc., and an upstate research network headquartered at Syracuse University will develop a new independent database for consumer reimbursement and a new website where for the first time consumers can compare prices before they choose their doctors.
Click here to read the full article.

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 Conrad: Two-Year Medicare Pay Fix
Compromise In The Works
A Senate compromise is in the works for a two-year, positive update for Medicare payments to doctors in light of waning support for an unpaid repeal of the current update formula, according to Sen. Kent Conrad (D-ND). Under the plan, which the Senate Budget Committee chair said he is negotiating with Sen. Charles Grassley (R-IA), a commission would make recommendations for a comprehensive new physician payment system during the two-year period.
Click here to read the full article.

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Click here to view the Health Policy Report, October 9, 2009.

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Summary of the Revised Mark as released by Senate Finance Chairman Max Baucus on Sept. 22, 2009.

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Health Reform Comparison Tool Now Reflects Proposal From Senate Finance Committee (Chairman's Mark)
The Foundation's interactive side-by-side health reform comparison tool now includes details from the proposal from the Senate Finance Committee, also known as the Chairman’s Mark, which will be considered by the committee next week. With the update, the online tool allows users to compare any or all of 12 different plans, including the plans approved by the Senate Health, Education, Labor and Pensions Committee and by the three House committees with responsibilities for health reform (H.R. 3200, America's Affordable Health Choices Act of 2009, also known as the House Tri-Committee bill).

Users can choose which proposals to compare, as well as specific characteristics about those proposals, including coverage, cost containment and financing. The tool also allows users to print out the comparison of all the plans together. The Foundation will continue to update the tool to reflect major new proposals and any significant changes to the plans already introduced.

These updated resources are available on the Foundation’s health reform gateway page which features the Foundation’s research, analysis and polling on health reform issues, insights from Kaiser President and CEO Drew Altman; and news summaries from Kaiser Health News, an editorially independent news service established by the Foundation.

Click here to download a PDF of Health Reform Side-by-side comparison.

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This Week in Health Care, September 16, 2009
Every week, Stateside Associates select some health care-related state events to highlight in This Week in Health Care.

To provide feedback, or for more information about these issues or Stateside Associates’ Health Care Practice, please contact Robert Holden at (703) 525-7466 or rah@stateside.com. If you prefer not to receive This Week in Health Care via e-mail, please let us know by responding to the same email address.

CONNECTICUT - FLORIDA - GEORGIA - KENTUCKY - MARYLAND - NEW HAMPSHIRE - OHIO - RHODE ISLAND - VIRGINIA - WASHINGTON

CONNECTICUT
The Department of Social Services will close the written comment period for proposed new regulations concerning the requirements for payment of behavioral health clinic services in the Medicaid program 09/17/09.

The regulations will add sections establishing the requirements for payment of behavioral health clinic services provided to individuals covered by the Medicaid program. The regulations: (1) add new definitions as necessary; (2) incorporate current practice; and (3) clarify the prior authorization process, documentation requirements, and billing procedures.
David Kennedy at dak@stateside.com

FLORIDA
The Negative Drug Formulary Committee is discussing the removal of Levothyroxine Sodium from the negative drug formulary. If a drug is on the negative drug formulary, a pharmacist cannot substitute a generically equivalent drug product for a prescribed brand name drug product. The Committee will hold a public meeting 09/26/09.
Becky Lukaesko at bl@stateside.com

GEORGIA
The Georgia Drug Utilization Review Board (Board) will meet 09/17/09. to discuss the following drugs for review: Banzel, Durezol, Firmagon (recent name branded for degarelix), Kapidex, Promacta, Toviaz, Uloric, and Xenazine. In addition, the Board will discuss the following Supplemental Rebate Drugs: Hepatitis C Agents, Sedative Hypnotic Agents, and Serotonin Norepinephrine Reuptake Inhibitor Agents. The full agenda is online, click here to download a PDF.
Becky Lukaesko at bl@stateside.com

KENTUCKY
The Kentucky Pharmacy and Therapeutics Committee (Committee) will meet 09/17/09. the Committee will be discussing New Class Reviews for Protein Tyrosine Kinase Inhibitors; Clinical Criteria Reviews for Ranexa™ and Lidoderm®; and Existing Class Reviews for Hepatitis C: Pegylated Interferons, Hepatitis C: Ribavirins, Antihyperkinesis Agents, Strattera® , Provigil® /Nuvigil® , Calcium Channel Blockers (DHP), ACE Inhibitors, ACE Inhibitor and Diuretic Combinations, Antibiotic Agents for Acne, Topical Retinoids, Oral Retinoids, Isotretinoin, Intranasal Corticosteroids, Endocrine and Metabolic Agents, and Immunologic Agents. The full agenda is online, click here to download a PDF.
David Kennedy at dak@stateside.com

MARYLAND
The Maryland Board of Pharmacy will meet 09/16/09. Among those items for discussion include revisions to Inpatient Institutional Pharmacy, Pharmacy Security, Pharmacy Equipment, Removal of Expired Prescription Drugs, Reinstatement of Expired Licenses for Pharmacists, Licensure by Reciprocity, Continuing Education for Pharmacists, Pharmaceutical Services to Residents in Long-Term Care Facilities as well as an increase in fees under COMAR 10.34.09, and amendments to the Recognized Pharmaceutical Specialties rules. The full agenda is online, click here to download.
Bonnie Kaufman at bk@stateside.com

NEW HAMPSHIRE
The New Hampshire Board of Pharmacy will meet 09/16/09. As part of its new business, the Board will discuss the ability of home health care / hospice nurses to organize prescription and non-prescription drugs into pill-planners for clients. In addition, the board will discuss unused prescription drugs. The full agenda is online, click here to download a PDF.
Melissa Martin at mpf@stateside.com

OHIO
The Ohio Medicaid Drug Utilization Review Board (Board) will meet 09/16/09. The Board will discuss ophthalmic antibiotics, otic antibiotics, and proton pump inhibitors. The full agenda is online, click here to download a PDF.
David Kennedy at dak@stateside.com

RHODE ISLAND
The Rhode Island Department of Human Services' Drug Utilization Review Board (Board) will meet 09/16/09. The agenda includes a utilization review of insulin and insulin pens and muscle relaxants, as well as follow-up regarding Retrospective DUR efforts to address non-adherence, Duplicate antipsychotics, and utilization of Suboxone® and opiods. The full agenda is online, click here to download a PDF.
Robert Axelrod at ra@stateside.com

VIRGINIA
The Joint Commission on Technology and Science's Healthcare Subcommittee will meet 09/16/09 to hear a presentation on S.B. 1229. The legislation was referred to the Joint Commission on Technology and Science and the Joint Commission on Health Care by the Senate during the 2009 session in order for the Commissions to study the legislation and improve the bill.

S.B. 1229 adds protections to medical information by: 1) adding medical information and health insurance information to the definition of personal information, which requires an individual to be notified in the case of a database security breach; and 2) adding a corporation organized for the purpose of maintaining medical information to the definition of health care provider in the Health Records Privacy Act. Full text of S.B. 1229 online, click here to view.
Carly Simpson at cms@stateside.com

WASHINGTON
The Commissioner of Insurance is reviewing comments on new rules to implement Chapter 175, Laws of 2009 (SSB 5480). This legislation created the Washington Health Care Discount Plan Organization Act with an effective date of 07/26/09. The legislation gives the Insurance Commissioner the authority to adopt rules to establish the application process to obtain a discount plan organization license and to establish reporting and record keeping requirements. The preproposal notice is available online, click here to download a PDF.
Bonnie Kaufman bk@stateside.com

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Health Policy Report - Finance Committee Releases Health Reform Bill
The Senate Finance Committee released a draft health care bill that would cost an estimated $880 billion over 10 years and include language aimed at reducing medical liability lawsuits. Finance Chairman Max Baucus (D-MT) said the bill addresses a number of Republican concerns including blocking illegal immigrants from gaining access to subsidized insurance, urging limits on medical malpractice lawsuits, and banning federal subsidies for abortion. Senator Kent Conrad (D-ND) said bill would be fully offset by spending cuts or new revenues. Conrad said the draft bill would enable states to run demonstration projects with federal support to reduce medical liability lawsuits. Baucus said that state officials concerned about lawmakers’ proposed Medicaid expansion will be relieved by new analyses showing the non-federal share of the expansion will be less than many had feared. Baucus said that the expansion costs will be somewhat offset by the extending the Medicaid drug rebates to Medicaid managed care organizations. The bill did not have the support of the three Republicans that participated in the negotiations. The committee will markup the bill next week. The Chairman’s Mark is attached. (CQ 09/14) (Inside Health Policy 09/15) (WashPost 09/15)

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Baucus Releases Draft Health Reform Bill
Senate Finance Committee Chairman Max Baucus (D-MT) gave a draft health reform bill to the group of senators negotiating a bipartisan health reform package. The draft includes a cooperative alternative to a public insurance plan, at least $400 billion in Medicare cuts, and assessments on the insurance industry to fund reform. The draft legislation costs less than $900 billion over 10 years. The proposal includes market reforms that would ban insurers from denying coverage for pre-existing conditions, caps out of pocket expenses, and includes prevention and wellness provisions. It would also expand the Medicaid program to cover all people earning up to 133 percent of the federal poverty level (FPL). The proposal also would provide sliding-scale subsidies for people earning from 133 percent up to 300 percent FPL. The proposal includes a free rider proposal and an individual mandate. The proposal would also impose separate new fees on pharmaceutical companies, device manufacturers, and insurance companies to offset the cost of the bill. Baucus wants all six members to sign off on the package before the President’s speech tomorrow night. Click here for a copy of the proposal. (Inside Health Policy 09/08).

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HCAA Grassroots Efforts
In response to the health care debate in Washington, HCAA, along with SIIA and SPBA, is taking a grassroots approach to getting our industry's voice heard by politicians. Click here for a list of key Senate and House members who will likely play a crucial role in whatever comes out of this debate. Whether these are your representatives or not, please take a moment and contact your representative and let him or her know where you stand.

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Notification of Fee Reduction and Paperless License
Click here for more information.

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Health Policy Report - Health Reform Update June 9, 2009
- Democratic Health Bills Begin to Emerge
- Senate HELP Committee Bill
- House Tri-Committee Health Plan
- Baucus and Conrad Introduce Comparative Effectiveness
Research Bill
Click here for more information on these updates.

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Health Policy Report Week of June 1
Click here to read news and legislative activity for the week of June 1, 2009.

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Health Care Reform Update (5/29/09)
• Senator Baucus has announced that health care reform is "on target" and a bill will likely be passed by the August Congressional recess. He did not detail what the plan would look like, but did add a public plan option was "likely" and a single payer system was "out".
• Unofficial summary of Kennedy's Health Reform Bill has Public Plan, Mandates
• The Senate Finance Committee has outlined policy options to pay for health care reform including reducing the federal tax exclusion for employer-provided health coverage, but there is substantial debate about whether the Senate and White House have the appetite to use this option for funding.
• Republicans have released their own reform bill, Patients' Choice Act, that features state-level insurance exchanges and individual tax credits, but no mandates.
• Many of the current reform proposals have implications to the self-funded market.
• Health care organizations say President Obama "substantially overstated" their promise in mid-May to cut health care expenses by $2 trillion in the next decade.

Click here for more information on these health care updates. (6/3/09)

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DataPath-Voice Special Alert
In an Alert released Friday, May 22nd, we informed you of proposals being considered by the Senate Finance Committee which could jeopardize the future of FSAs, HRAs, HSAs, and the health care system as we currently know it. As stated in that Alert, it is imperative that all of us in the Consumer Driven Health marketplace make our voices known as soon as possible, before the issue reaches the floors of the House and Senate. Click here to read the full alert and find out how you can take action. (6/01/09)

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Inside Health Reform - Vol. 1, No. 16
Click here to download a PDF of this issue. (6/01/09)

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Health Policy Report - Health Reform Update
The Senate Finance Committee has released a paper that outlines the options for financing health care reform. The paper is organized into four sections focusing on: health system savings, exploring current health care tax expenditures, lifestyle tax proposals, and revenue provisions presented in the Obama Administration’s budget. The Finance Committee will be meeting behind closed doors on Wednesday to discuss this various options include in the paper. Click here for more information. (5/19/09)

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Health Policy Report - Breaking Health Reform Update: Health Care Providers Present Cost-Savings Plan
Major representatives of the health care industry presented a plan to President Obama today to reduce the growth of health costs for the next 10 years. White House officials estimate this could save the nation $2 trillion or more. The plan was presented to Obama by five trade associations representing health insurers, hospitals, drug companies, doctors, and medical device makers. The proposal was brokered by Service Employees International Union and signed by Advanced Medical Technology Association, the American Hospital Association, the American Medical Association, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America. The move shows how the private sector is eager to appear cooperative as Congress tries to pass major health care legislation by the summer. According to a letter from the groups, they will promise to help reduce the growth of national health care spending by 1.5 percentage points in each of the next 10 years. White House officials said the savings could come from steps such as making payment systems more efficient and reducing administrative costs. Click here for more information. (5/13/09)

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Health Policy Report - Budget Overview: Obama Proposes to Cut 121 Programs
In the budget released today, President Obama proposes cutting or scaling back 121 programs, saving an estimated $17 billion in fiscal year (FY) 2010. About half of the savings would come from Defense programs and almost $12 billion would come from discretionary spending, officials said. Administration aides defended the proposed level of savings, which amounts to only about 0.5 percent of the $3.4 trillion budget Congress recently approved for FY 2010. The proposed savings do not include the more than $175 billion in savings over 10 years the administration proposed by requiring competitive bidding for Medicare Advantage plan. White House officials say the administration wants to measure programs by their outcomes, not by their intentions, but they understand that getting Congress to go along with cuts will be difficult. House Democratic Caucus Chairman John Larson (CT) said lawmakers might not agree with all the proposed cuts, but Democrats are aware that something needs to be done to rein in the budget deficit, expected to top $1.8 trillion in FY 2009. Republicans did not dismiss the proposed cuts, but argued that they are not sufficient. Overall, Obama wants to increase discretionary spending from last year’s levels, as do congressional Democrats. The money saved from the proposed program eliminations and reductions would be used to fund some of the president’s other priorities. (CongressDailyAM 05/07) (CQ 05/06) Click here for more information. (5/07/09)

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Baucus Lays Out Health Care Overhaul Details
By Drew Armstrong, CQ Staff
Sen. Max Baucus, D-Mont., said Friday that while he has not written off the idea of a government-run insurance plan for his health care overhaul proposal, it probably won’t be his first line of attack, preferring to focus instead on the system for self-insured companies.

At a breakfast with reporters hosted by the journal Health Affairs, Baucus laid out details of his health care overhaul plans, many of which he will share in greater depth in a closed-door session April 29 with Finance Committee members.

While a government-run insurance plan was still on the table, Baucus said “it might be a bit on the side of the table.” Instead, he said, he would focus on preserving the insurance system for self-insured companies while expanding private insurance and public programs such as Medicaid, the insurance program for the poor. “We’ll end up with more private insurance and more public insurance,” he said.

He later backed off that statement slightly, saying he might return to the government-run idea later on. Baucus has previously backed the idea of a government-run plan to compete with private insurers and drive down costs, but the political difficulty of the idea has put pressure on him to drop it. Many Republicans vehemently oppose any idea of a government-run insurance plan, while many of the left are demanding its inclusion.

His vision would make substantial changes to the insurance market, but with the goal of letting those who have insurance that they like keep it.

For many uninsured looking to buy coverage, Baucus would like to “set up a system similar to Massachusetts,” where people can buy insurance through a “connector” that offers standard minimum benefit plans with subsidies for those who cannot afford it.

It would be a national marketplace, Baucus said, or at least with a common national standard. “I think the whole system should be more national, and the benefits have to be more national. You can’t have benefits be one level in one state, and another level in other states.”

But he would try to make sure that it did not deeply impact companies that buy insurance already. Health care experts have theorized that any large change to the insurance market, especially with a government-run plan option, would result in some companies and people shifting from company-provided insurance to the independent or government market.

“The system I envision is where self-insured companies, ERISA companies, can keep their own plans and manage health insurance in the way that they have. We’re not going to change the ways self-insured companies handle health care for employees,” Baucus said.

Many large companies are self-insured. Instead of buying coverage directly from a health insurer, they take on the risk themselves and pay an insurer to administer the plan. To the employee, there is little difference, but the company can lower costs by taking on the risk itself. Companies that self-insure are governed by the Employee Retirement Income Security Act (PL 93-406), better known as ERISA.

Many smaller businesses, however, are not self-insured. For those companies and for people buying insurance on their own Baucus said, “we’ll set up a system similar to Massachusetts, where an individual looking for health insurance can go to the exchange and get health insurance from a health care company authoring insurance on the exchange, somewhat similar to the [Federal Employee Health Benefit Plan],” the system under which federal employees buy insurance, Baucus said.

“We have to reform the health care insurance market,” he continued, by eliminating insurance companies’ ability to deny coverage based on pre-existing conditions, along with other changes like guaranteeing people’s ability to buy coverage.

Baucus’ November “white paper” will serve as the foundation for the bill, he told reporters. Baucus is writing his own bill out of the Finance Committee, while Health, Education, Labor and Pensions Committee Chairman Edward M. Kennedy, D-Mass., is drafting a related but separate bill that will be combined with Baucus’ on the floor.

In his white paper, Baucus included the idea of a government-run insurance option that would compete, with some limits, with private insurers. He also proposed temporarily opening up Medicare enrollment for people between the ages of 55 and 65, and expanding Medicaid to cover 7.1 million more people.

The private session with Finance Committee members will focus on how care is delivered and paid for, with future sessions on other topics.

“We’re working on that,” Baucus said. “My problem is getting numbers from [the Congressional Budget Office]. That’s slowing us down a little bit.”

It will likely be the first time members have a chance to see details of what Baucus and the committee’s ranking Republican, Charles E. Grassley of Iowa, have planned.

Baucus wants to revamp health care payment systems like Medicare so they foster more efficient payment trends. Some areas of the country with efficient health systems spend far less to get the same quality of care as other, far more costly regions.’

Experts like former Congressional Budget Office director Peter R. Orszag, now the director of the White House Office of Management and Budget, have predicted that getting high-cost areas more in line with the country’s more efficient regions could save hundreds of billions of dollars.

“Our job is to transfer that more broadly to the rest of the country, mostly through Medicare,” Baucus said of the low-cost, efficient areas. “We’re really trying to get internal savings in the system.”

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New Model Language: COBRA Continuation Coverage Assistance Under The American Recovery And Reinvestment Act Of 2009
Click here for details. (3/19/09)

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Update on Final Rules Regarding ICD-10 Code Sets and Standards Governing Electronic Transactions
On January 15, the U.S. Department of Health and Human Services released two final rules that will facilitate the United States’ ongoing transition to an electronic health care environment through adoption of an updated set of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions.

In accordance with the White House Chief of Staff’s memorandum of January 20, 2009 entitled “Regulatory Review,” a determination has been made that the effective date will not be extended and the comment period will not be reopened for either of these rules.

The first rule finalizes new code sets to be used for reporting diagnoses and procedures on health care transactions.  This final rule replaces the ICD-9-CM code sets, developed nearly 30 years ago, with greatly expanded ICD-10 code sets.  The second final rule adopts updated versions of the standards governing electronic transactions under the authority of the Health Insurance Portability and Accountability Act of 1996.  The updated versions replace the current standards and will promote greater use of electronic transactions.  In response to public comments suggesting that more time would be needed for effective industry implementation, the final rules include later compliance dates.  More specifically, the final rules provide compliance dates of Jan. 1, 2012, for the transaction standards and Oct. 1, 2013, for the ICD-10 code set. (3/18/09)

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HIPAA Alert
Stimulus Bill Dramatically Modifies HIPAA Rules — Business Associates and Covered Entities Must Address New Requirements
Click here to download the article.

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Employee Benefits Alert
A Brave New World: The Stimulus Bill and Other Congressional Action Create New Obligations for Benefit Plan Sponsors.
Click here to download the article. (2/18/09)

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Health Programs to Get Boost From Stimulus

House Democrats released the details of the $825 billion economic stimulus package. House leaders plan to pump $157.5 billion into a wide variety of health care programs as part of the package. The largest chunk of the money, $95.6 billion, would go to state governments for Medicaid. It also would fund an expansion of Medicaid to cover low-income people who involuntarily lose their jobs through 2010. Democrats intend to spend $30.3 billion to allow people who lose their jobs to keep their employer-provided health insurance under a program known as COBRA. The stimulus bill would provide $20 billion for health providers to purchase electronic medical records systems, though it was not clear how that money would be distributed, whether it would be grants or loans, or how privacy issues would be addressed. The bill also includes $3 billion to encourage preventive health and wellness programs, $1.5 billion for community health centers, $1.1 billion for comparative effectiveness research, $600 million to train primary care physicians and doctors who agree to enter the National Health Service Corps, and $900 million for research into a vaccine for a hypothetical pandemic flu and into defenses against chemical and biological weapons. The House is expected to vote on this package during the week of January 26. (CQ 01/15)

Subtitle B—Health and Human Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH RESOURCES AND SERVICES

Health Information Technology
Recovery funding: $2 billion
The economic recovery bill provides $2 billion to jumpstart the investment in health information technology in order to curb health care costs and improve health care quality. This $2 billion investment will support the infrastructure necessary to allow for and promote the electronic exchange and use of health information consistent with the strategic plan outlined by the Office of the National Coordinator for Health Information Technology.

SEC.9202. HEALTH INFORMATION TECHNOLOGY
This general provision provides short-term authority to spend the $2 billion provided in the economic recovery bill. The Office of the National Coordinator for Health Information Technology will be able to use these funds to invest in health information technology (IT) architecture supporting the nationwide electronic exchange of health information, including health information exchanges; to support training of health care professionals who will be instrumental in improving the quality of health care through the electronic exchange of information; and to provide grants to institutions and providers to acquire health IT products if the products are certified as meeting the Office’s standards. Health IT is an essential tool in transforming the healthcare system – to improve the quality and efficiency of healthcare, to reduce its costs, and to protect the privacy and security of personal health information. Investments in health IT also have the potential to ameliorate some of the biggest job casualties in the current economic downturn. Research conducted by Oregon Health and Science University in 2008 showed that to achieve the full benefits of health IT, an additional 40,000 IT professionals will be required. Investing in the retooling of IT professionals from other industries to work in health IT will also benefit the educational sector training this group.

Community Health Centers (CHCs) Health Care Services
Recovery funding: $500 million
With additional economic recovery funding, CHCs will be able to provide needed care to uninsured and underserved rural and urban populations. CHCs are an important element of any effort to provide health care coverage for the unemployed and uninsured, serving low-income families as a medical home and generating savings for the overall health care system. A February 2008 George Washington University study showed that a $250 million annual increase could support care for an additional 1.8 million people in the low-income communities where CHCs are located. More than 400 applications submitted earlier this year for new or expanded CHC sites remain unfunded – all of which committed to providing care within 90 days. Recovery funding will support many of these applications, and will be used to maintain services at these new sites in FY 2010.

Training for Primary Care Physicians and Nurses
Recovery funding: $600 million
A key component of attaining universal health care reform will be ensuring the supply of primary health care providers – family medicine, internal medicine, pediatricians, dentists, and nurses. Funding for health professions training for these disciplines has withered in the past decade. The $600 million provided will double annual funding for training primary care doctors and dentists, as well as double support for nursing programs such as nurse scholarships, nurse faculty loans, and advanced nursing. The increased funding will also increase the number of health care providers that can be supported through the National Health Service Corps program.

States that are moving toward universal coverage have already discovered the painful reality that coverage doesn’t address the problem of the long waits or refusals for service that patients experience because of primary care doctor shortages. HHS estimates that 7,000 additional primary care physicians currently are needed in rural and inner-city areas and that by 2020 there will be a shortage of 66,000 primary care doctors nationwide. For the past decade, the U.S. has experienced a significant shortage of nurses, a shortage that HHS projects will grow to more than one million by 2020. This funding is a first step to rebuild the training infrastructure and support students who can revitalize the primary care supply line. Funds provided in FY 2010 will provide the second year of support for the new programs supported by FY 2009 funding.

Comparative Effectiveness Research
Recovery funding: $1.100 billion
The Agency for Healthcare Research and Quality (AHRQ) began a Comparative Effectiveness
Research program after passage of the Medicare Modernization Act of 2003 to conduct, support, or synthesize unbiased research about the comparative effectiveness of different healthcare interventions. By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed. Substantially increasing the Federal investment in comparative effectiveness research has the potential to yield significant payoffs in reducing health care expenditures and improving quality.

Prevention and Wellness Fund
Recovery funding: $3.000 billion
In 2005, U.S. health care expenditures totaled almost $2 trillion – 15 percent of the gross domestic product. The leading causes of death in the U.S. are preventable chronic diseases, such as cardiovascular disease and diabetes, which account for 75 percent of U.S. healthcare costs.

Making increased investments in preventing diseases, rather than simply caring for those who are already sick is estimated in numerous studies to be one of the most effective ways to reduce healthcare spending, potentially saving billions of dollars per year. Within the total for the Prevention and Wellness Fund, funds are reserved for the discretionary immunization program that provides funding to public health departments to operate childhood, adolescent, and adult immunization programs. In addition, funds are provided for the Preventive Health and Health Services Block Grant, which will provide needed resources at State and local public health departments. Funds are also provided for healthcare-associated infection prevention programs and for evidence-based clinical and community-based prevention and wellness strategies and public health workforce development activities. These funds are to be distributed according to the public health priorities of the Secretary of Health and Human Services and the Director of the Centers for Disease Control and Prevention.

SEC.9201. FEDERAL COORDINATING COUNCIL FOR COMPARATIVE EFFECTIVENESS RESEARCH
The recovery package includes bill language establishing the Federal Coordinating Council for Comparative Effectiveness Research to coordinate comparative effectiveness and related health services research and to advise the President and Congress on strategies with respect to the infrastructure needs of comparative effectiveness research within the Federal government. (1/27/09)

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Think Before Dumping Employer-Based Insurance (letter to the editor by SIAA Chief Operating Officer Mike Ferguson published in the Wall Street Journal)

Ezekiel Emanuel and Senator Ron Wyden made a game attempt to discuss employer-sponsored health insurance plans in a historic perspective - but they selected the wrong period for their argument in favor of individually purchased health insurance ("Why Tie Health Insurance to a Job?" WSJ December 10, 2008).

Arguing their case based on events more than 60 years in the past, Emanuel and Wyden mislead readers about the modern business reasons that employer-sponsored health insurance makes sense today. Their case is akin to judging today's automobile industry by cars of the 1940s.

The modern era of employer-sponsored health plans began with passage of the Employer Retirement Income Security Act (ERISA) in 1974. That federal law enabled employers to provide health benefits to their employees across state lines without being subject to the confusing and often wasteful patchwork of requirements that vary from state to state. This fueled a dramatic growth in health care coverage provided by self-insured employers.

Today, more than 70 million Americans receive their health benefits through self-insured, employer-sponsored health care plans, which clearly is a success story not given sufficient attention.

Moreover, employer-led practices have provided improved employee wellness (disease prevention), better management of chronic diseases, and tangible incentives for high performing health care providers. These innovations would be lost to people were the employer-sponsored health system to be dismantled as Emanuel and Wyden propose.

If the millions of people now covered by employer plans were dumped on the open market, they would also find their benefits decline, costs escalate and their choices of coverage narrow. The traditional commercial health insurance companies would be free of restraint on costs and coverage practices. Employees know that their health plans are important and valuable to them.

Even Mssrs. Emanuel and Wyden acknowledged that only 17% of Americans said they would prefer to buy insurance on their own (quoting the Kaiser Health Tracking Poll of 2008).

Reform of the U.S. health care system should focus on ways to control the costs of medical care and drugs; extend health coverage to the uninsured population and install a health care information technology system to improve service and efficiency. All of that can be done while preserving employer-sponsored health care, which is the part of the system that really works.

Michael W. Ferguson

Mr. Ferguson is chief operating officer of the Self-Insurance Institute of America, Inc., of Simpsonville, SC. Self-Insurance Institute of America, Inc. (11/16/08)

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Ohio Advisory Committee on Eligibility and Real-Time Claim Adjudication Recommendations Due January 1, 2009

As part of Ohio H.B. 125, an advisory committee was formed to recommend standards to the General Assembly that would allow providers to determine, at the time of the enrollee’s visit, their eligibility for services covered by the payer by exchanging real time information on eligibility and claim adjudication. Also up for debate is whether or not the time period should be shortened after which claims paid for ineligible employees and dependents by insurers and TPAs may not be “taken back” if eligibility was confirmed on the date of service. The advisory committee is made up of members from a wide range of entities that would be affected by recommendations to standardize the exchange of information. There are also sub-committees looking at such things as dispute resolution over enrollee eligibility for services received. The recommendations of the advisory committee will be watched closely as other states consider if the recommendations presented for exchange of real time eligibility and claim adjudication, as well as the other issues considered, can be applied in their state. (11/13/08)

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 "We are members of other associations, but we are consistently extremely satisfied with the HCAA. Many of the other association conferences or meetings do not always benefit us as their topics are not always relevant to our business – or the speakers only provide a one-sided view of the issue. HCAA is always on the cutting edge and they show you the pros and cons of every issue, the ramifications and the benefits."

– Leah Ann Zogg, CEO Employee Benefits Consultant, California