SenateFormer President Bill Clinton visited Senate Democrats on Capitol Hill this week, urging them to quickly pass health care reform by the end of the year. Senate Leadership continues to work pulling its final merged bill together and Majority Leader Harry Reid (D-NV) says that he will introduce the legislation on the Senate floor the week of November 16th.Under Senate rules, a 60-vote majority is required to move the bill forward before official debate can begin. It is likely that Democrats will receive the 60-votes needed to move the bill to the Senate floor, but it remains to be seen whether Reid has the full 60 votes to overcome a filibuster for bill’s official passage. Reid is still aiming to pass the legislation by the Christmas holiday.HouseAfter passing its health care reform legislation, the “Affordable Health Care for America Act” (H.R. 3962), the House of Representatives was quiet this week.Overview: Medicare Payroll in Senate Health Care Reform LegislationThe Senate’s health care reform legislation has still not yet been unveiled, but there are reports that an analysis from the Congressional Budget Office has found the bill to be more costly than expected, so Senate Democrats are already considering new ways to pay for the bill.One of the options is an increase to the Medicare portion of the payroll tax on individuals making $250,000 per year or more. Currently, workers and employers each pay a 1.45 percent payroll tax for Medicare and the new proposal would increase that to 2.5 percent payroll tax bracket for those making $250,000 per year or more.By including this new approach, it would allow the Senate to either reduce or eliminate altogether the controversial excise tax on “Cadillac” or high-cost insurance plans, passed in the Senate Finance Committee’s bill last month. Under legislation (S 1796) approved by the Senate Finance Committee, individual insurance plans costing more than $8,000 and family plans costing more than $21,000 would face a 40 percent excise tax on any amount above that level.

Popularity: unranked [?]

Health insurance reform, the big issue of the day, is slated to cost over one trillion dollars (to provide coverage for more Americans and address many of the problems inherent in the current system). Where is that money coming from—are we setting ourselves up for higher taxes merely to save pennies on health insurance?

Right now, one of the biggest issues in health care is the amount of money spent on insurance company subsidies. One of the plans being discussed presently would save $177 billion in these subsidies over the next decade. The argument being advanced is that by cutting and reducing these subsidies, money could be better spent on actual care for patients.

Money will also be help on improving preventative care, increasing technology within the health care system (ie, computerizing more records to better track patient care and monitor test resuts, previous procedures, etc), and working to reduce waste within the system (hospitals and outpatient procedures, first and foremost).

The difficulty is in the initial outlay of $100 billion being spoken of to provide the initial reforms…which will supposedly be offset by the savings in subsidies, for example. But there is no guarantee that over ten years those insurance subsidies will be effectively cut there is a history of planning for these types of cash inflows only to see the money go out, while the expenses remain the same. The insurance lobby (extremely powerful and in control of a great amount of money, by definition) will obviously fight strenuously to keep these subsidies, or at least a portion of them, and will have valid reasons for some of the subsidies to remain. Will Congress really be able to take them on and shut down the subsidies to reclaim that $100 billion?

Also, planning to recoup millions by eliminating waste in the system is a good goal (and certainly, improving technology will lead to an advance in patient care)—but assigning dollar figures to an elimination of “waste” is a tricky concept.

Overall, there is not doubt that the health care system needs to be fixed; it’s just important to think through both sides of the argument. Relying on future savings and promised cuts to subsidies is a fairly optimistic way to pay for a trillion dollar bill.

In the meantime Florida health insurance and Florida pubic assistance plans can be found at our Florida health insurance website. ECHealthInsurance.com donates much of its time to make health insurance available to those that don’t qualify for private plans. Please support us in our efforts in bringing reform and awareness to the Florida health insurance reform issue.

Popularity: unranked [?]

 

The new Health Minister announced the White Paper that lays out the future of the NHS over the course of this parliament (which is now a guaranteed 5 years).  He described this as a ‘blueprint’ for Health Policy up to the next General Election.  The main aim is to cut £20bn from the Health Budget over the next 4 years.  One of the main issues is the end of the current PCTs, which means that GPs will have direct control of the commissioning of services.  NHS Management costs are set to reduce by 45% as a part of this reduction.

 

This is considered by many to be the most radical NHS White Paper to date, and is expected to be well received by the Conservative back benches.  As for the Lib Dems, they had the abolition of StHAs as part of their 2010 manifesto, so this should sit well with them also.

 

Lansley said ‘the provision of healthcare service will be led by patients and professionals and not by politicians’.

 

The basics of the White Paper are set out below:

 

More power to GPs

The most contentious issues will be the compulsory devolvement of huge commissioning powers to GP and GP Consortia and the abolition of Primary Care Trusts (PCTs). None of this was proposed by the Conservatives when they were in opposition.  These decisions emerged after the General Election. There is concern that a large number of GPs do not want to take on commissioning functions, and in fact are ill-equipped to do so.

It is interesting therefore to note that the British Medical Association has welcomed today’s announcement.

 

More power to patients

The Government is going to launch HealthWatch England, a new ‘consumer champion’, which will sit within the Care Quality Commission (CQC). The White Paper provides an ethos for structural change; the NHS must be patient led and choices must be led by those at the frontline of delivering those services to patients, i.e. clinicians. On a national level, it will be able to propose CQC investigations of poor service. This organisation will help to strengthen the patient voice and ensure that patient feedback is heard at a local level. Patients will not only have power over the choice of GP they would like to attend (regardless of where they live), but will also have power over who has sight of their patient record.

 

Abolition of Primary Care Trusts (PCTs)

The complete removal of PCTs, instead of simply reducing their numbers, came as a big surprise when compared to the proposals contained in the Conservative manifesto from January 2010. However, it is in keeping with current measures when you look at the plan to reduce admin costs by 45%.  Some form of supervisory role is of course required, particularly in respect of GPs and other primary care services, and it is a role which Monitor (the body currently responsible for the regulation of Foundation Trusts) may find challenging.   

Abolition of Strategic Health Authorities (SHAs)

SHAs will be abolished as early as  2012. Their functions will be taken over by Monitor. Monitors’ remit will extend to establish it as the key economic regulator in healthcare.

 

 

Foundation Trusts

All NHS Trusts will become or be part of a Foundation Trust and this will be the preferred governance model for the health service. Trusts will be given more freedom to innovate to improve patient care. NHS staff will have the opportunity – where appropriate – to manage these organisations as ‘the largest social enterprise sector in the world’.

 

NHS Commissioning Board

A review of existing quangos is due to report in the autumn but the White Paper makes provision for a number of new bodies which will help implement this new, patient led vision of the NHS. The most vital is the NHS Commissioning Board which will act to ensure quality in commissioning and be responsible for commissioning certain services, such as community pharmacy, which GPs cannot commission. It will also be responsible for increasing patient choice through helping patients manage their personal health budgets. The intention is for this body to be fully operational in April 2012. The underpinning concept is to reduce the number of quangos but those that do exist will be interlinked and more accessible to patients.

 

Value based pricing

The White Paper confirms that the Government intends to move to value based pricing when the current Pharmaceutical Price Regulation Scheme (PPRS) runs out at the end of 2013. A reference is made to the Cancer Drugs Fund, which will operate from April 2011, but no further details are provided.

 

NICE

In a further strengthening of its powers, NICE will be in charge of developing new quality standards for all the main pathways of care. The paper estimates that NICE will develop up to 150 new quality standards over the next five years. This will position NICE as the key quality regulator building on Lord Darzi’s work on quality improvements, under the previous Government.

 

Scrapping targets

As mentioned in the NHS Operating Framework, targets with ‘no clinical justification’ will be scrapped (although not as many as were discussed in Opposition). There is a concession that some targets do work but the paper is not clear on which ones and a consultation is promised on new measureables.

 

Long Term Care

A Commission will be set up to look into long-term care from the Department of Health. This is in keeping with the move to strip away the Department’s NHS functions and replace them with longer term social care objectives.

 

Consultation

A number of consultation papers will be published in the near future, getting stakeholder views on policies including; commissioning for patients, freeing providers and economic regulation, the NHS outcomes framework, the framework for transition. This process will be an important part of the transition to the new system as will the proper management of the financial risk.

 

 

 

 

 

Legislation

Primary legislation will be required to make many of the proposed changes in the White Paper. The Health Bill announced in the Queen’s Speech provides for many of these reforms and is due to be introduced in late 2010. The main legislative reforms in the Bill will include: Making improvement in outcomes central to the NHS; Reforming NICE;  creating the independent NHS Commissioning Board; creating a framework for a comprehensive system of GP consortia; establishing HealthWatch; reforming the Foundation Trust model; developing Monitor’s role and reducing the number of arms length bodies in health. The Department of Health is taking comments on implementing all the changes in the Health Bill, which must be submitted by 5 October 2010. We can therefore deduce that the Health Bill will not be laid before Parliament before this date.  

 

 

 

 

Sources: white paper and Mr Lansleys press release.

Popularity: unranked [?]

Mississippi Gov. Haley Barbour joined Senate Republicans on Thursday in blasting Democrats’ plan to overhaul the nation’s health care system                          “The longer it’s out there, the worse it stinks,” Barbour said of the Senate health care reform bill.Democratic leaders in the Senate had hoped to bring the bill up for a vote by Christmas. But that may not be possible as they struggle to win more support for the measure amid Republican delay tactics.Any legislation passed by the Senate would have to be reconciled with a health care reform bill the House passed last month.The Senate measure would spend $848 billion over 10 years and would insure 31 million people who don’t have coverage now.Both bills would expand Medicaid and create health insurance exchanges where coverage would be available for small businesses and workers not offered insurance through an employer. The bills would penalize individuals who don’t buy insurance and employers who don’t offer it. It also would bar insurers from denying coverage based on pre-existing conditions.Barbour and other governors have complained about the cost to their states of expanding the Medicaid program. Barbour has said it could cost Mississippi taxpayers $1.3 billion over the next 10 years. Medicaid is one of the most costly programs in state budgets, he said Thursday.”States don’t have this money. In fact, we’re already cutting our budgets,” Barbour said.He said he may have to cut $715 million from next fiscal year’s budget. Unlike federal lawmakers, he said, governors must balance their budgets.Supporters of the health care reform bill say it would particularly benefit southern states, which tend to have a higher proportion of uninsured residents and a higher incidence of health ailments such as obesity.”We expect the number of uninsured people to grow by 30 percent in 29 states,” said Nancy-Anne DeParle, the White House adviser on health care reform. “Unfortunately, the southern states are the ones … where it will grow by the (highest) percentage.”Families USA, a national health care advocacy group that supports health care reform, released a report Wednesday saying 359,000 Mississippians would gain health insurance coverage under the Senate bill. Without it, the report said, 93,000 residents could lose coverage by 2019 and the number of uninsured state residents could increase from about 532,000 to about 625,000.”The consequences of inaction are very severe for people in Mississippi and across the country,” Ron Pollack, executive director of Families USA, said in a statement. “If the Senate fails to act, Americans will continue to struggle and a growing number of them will face the devastating effects of going without coverage.”Republicans say the health care reform bill would cost too much, expand the government’s role in health care and increase premiums for seniors enrolled in Medicare.

Popularity: unranked [?]

The health care reform bill – all 1,990 pages of it – came to Elm Grove on Saturday, and the overwhelming sentiment from constituents of Republican U.S. Rep. Jim Sensenbrenner who gathered at the village hall was clear: No thanks.More than 200 people packed the boardroom and overflowed into the hallway at Elm Grove Village Hall to weigh in on the proposal and other federal issues in an afternoon meeting held by Sensenbrenner. Sitting behind a two-sided printout of the bill that measured more than 4 inches high, Sensenbrenner fielded questions and comments from residents of his congressional district.”This is not about health care – this is about control of our lives,” Valerie Linton of Sussex told the crowd.One by one, residents of the largely Republican district blasted the reform bill crafted by Democrats.”If this is so great, why don’t the Congress people go into the plan?” asked J.F. Rennebohm of Elm Grove.Some in the crowd said they were worried about the debt being incurred by the federal government and the costs it would impose on future generations of Americans.Sensenbrenner, who held a similar town hall meeting attended by about 30 people in Brown Deer earlier in the day, said the bill would put the country on the path to health care rationing.”We should not put some bureaucrat between a patient and their physician,” Sensenbrenner told the audience.Supporters of the health care reform legislation were rare, with only two speaking in favor of it during the hour-and-a-half meeting. One man carried a sign that read, “Health Insurance Reform Now,” but he did not speak to the group.Told of the strong turnout and opposition to the health care reform measure at Saturday’s meeting, Mike Tate, chairman of the Democratic Party of Wisconsin, said “It must be Halloween” because Sensenbrenner and the industry were scaring people about what health insurance reform means.”The Democratic Congress is hard at work putting together a proposal that will finally make health insurance a reality for people that are uninsured and make better coverage a reality for those that are underinsured,” Tate said.Before the meeting, Sensenbrenner delivered a printout of the hefty bill to the Elm Grove Library for perusal by constituents.In an interview, Sensenbrenner called the health care reform bill “a government takeover of health insurance.” He said the public option included in it probably would lead employers to stop offering health insurance to workers.”I’m very, very fearful that it will encourage employers to drop their employee health insurance programs and pay an 8% tax that is levied on those employers that do not provide health insurance, because most employer-provided health insurance costs a lot more than 8% of payroll,” Sensenbrenner said. “And by dumping their employees into the government option, they can improve the bottom line.”

Popularity: unranked [?]