Affordable Health Care Act
Now, Democrats must steer a package of fixes to the healthcare bill through the Senate by using the arcane budget reconciliation process.
But the legislation would dramatically expand federal regulation of healthcare. Federal law would for the first time require insurance companies to cover all Americans, regardless of their health status, and would prohibit insurers from denying coverage to people who become sick.
Individuals would also be required to buy insurance. And large employers would have to provide employees with health benefits or in some cases face penalties.
The bill would open the nation’s 45-year-old Medicaid insurance program for the poor to all Americans earning less than 133% of the federal poverty line — $14,404 for an individual or $29,327 for a family of four.
The government would also create new state-based insurance marketplaces for millions who do not get coverage through work.
Commercial insurers would offer plans in these marketplaces, or exchanges, and be required to provide a minimum set of benefits, including mental health services, maternity care and preventive care.
The most expensive feature is a commitment by the federal government to provide nearly $500 billion in subsidies over the next decade to help millions of low- and moderate-income Americans buy insurance in an exchange.
To pay for their legislation, Democrats approved a new 3.8% tax on investment income for individuals earning more than $200,000 and couples earning more than $250,000. In 2018, people with high-end “Cadillac” health plans would be subject to a new tax on their benefits.
And medical device makers, pharmaceutical companies and insures would be subject to new excise taxes.
The bill would also cut more than $400 billion over the next decade in what Medicare pays to hospitals, nursing homes and insurance companies that provide Medicare Advantage plans, a provision that proponents hope would ultimately help make the system more efficient.
NAHU Comparison of HR 3590 & Reconciliation Package
House Approves Senate Health Reform, ‘Corrections’ Bills
Last night, the House voted 219-212 to approve the Senate health reform bill, which now goes to President Obama to be signed into law. Thirty-four Democrats and all Republicans voted against the legislation. The House also approved the so-called “corrections” legislation, which makes a series of changes to the Senate bill. New York Times et al.
This webpage reviews Obama’s Health plan as promoted on HIS website @ Barack Obama.com and his FAQ’s we simply cut and pasted them in. I put in my comments by interlineation with an indent and italicized them. We have added hyperlinks to further information, both in Obama’s proposal and our comments.
Please email your comments to Steve if you would like them incorporated on this page or need a specific answer or consultation. For general comments, please post to our blog @ http://steveshorr.blogspot.com/
Health care costs are skyrocketing. Health insurance premiums have doubled in the last 8 years, rising 3.7 times faster than wages in the past 8 years, and increasing co-pays and deductibles threaten access to care.1
Congressional Budget Office Review of the Affordable Health Choices Act 10 pages
Many insurance plans cover only a limited number of doctors’ visits or hospital days, exposing families to unlimited financial liability.
Check the OOP – Out of Pocket Maximum
Over half of all personal bankruptcies today are caused by medical bills.2
Lack of affordable health care
is compounded by serious flaws in our health care delivery system. About 100,000 Americans die from medical errors in hospitals every year.3 One-quarter of all medical spending goes to administrative and overhead costs, and reliance on antiquated paper-based record and information systems needlessly increases these costs.4
I’m all for that. Just check out THIS website. NO PAPER!!! Check out all the other places that are going electronic, even Court Forms. Appellate Briefs can be filed electronically Even CA law says that electronic filings are the same as paper. This is what HIPAA privacy law is trying to keep up with – how much easier it is for ANYONE to get your medical records, when they are available electronically, emailed or posted on the Internet vs. just on paper.
Tens of millions of Americans are uninsured because of rising costs. Over 45 million Americans5— including over 8 million children6—lack health insurance.
Try Healthy Families in CA
Eighty percent of the uninsured are in working families.7 Even those with health coverage are struggling to cope with soaring medical costs. Skyrocketing health care costs are making it increasingly difficult for employers, particularly small businesses, to provide health insurance to their employees.
Click here for Small Biz Proposals AB 1672 Guaranteed Issue Pre-X is usually waived.
Underinvestment in prevention and public health. Too many Americans go without high-value preventive services, such as cancer screening and immunizations to protect against flu or pneumonia. The nation faces epidemics of obesity
We must change our opinion of exercise. When I ride my bike rather than drive, I rarely see anyone else on a bike or even on the sidewalk. Restaurants often have portions that are too big. Do not be shy to ask for a take home box or split a meal. I have had people tell me that if you take a woman on a date, you must buy TWO meals. Here’s more on diet, nutrition and exercise.
and chronic diseases
CHCF articles on
Californians struggling to care for their chronic conditions
Better Chronic Disease Care
as well as new threats of pandemic flu and bioterrorism. Yet despite all of this less than 4 cents of every health care dollar is spent on prevention and public health.8 Our health care system has become a disease care system, and the time for change is well overdue.
OBAMA-BIDEN PLAN TO PROVIDE AFFORDABLE, ACCESSIBLE HEALTH CARE TO ALL
Barack Obama and Joe Biden’s plan strengthens employer–based coverage,
See our page on how to qualify for AB 1672
makes insurance companies accountable and ensures patient choice of doctor and care without government interference.
What percent of providers are opting out of Medicare, because of paperwork and low reimbursement levels?
Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options.
This sounds REALLY GREAT. A chicken in every pot. (President Herbert Hoover) King Henry IV
No loss to my business. We will have to look and see if the details will work.
LOWER COSTS TO MAKE OUR HEALTH CARE SYSTEM WORK FOR PEOPLE AND BUSINESSES – NOT JUST INSURANCE COMPANIES
Inefficient and poor quality care costs the nation at least $50 to $100 billion every year.9 Billions more are wasted on administration and overhead because of inefficiencies in the health care system.10 And given current trends, this problem will only get worse as health care spending is expected to double within the next decade.11
A growing body of research points to substantial opportunities to improve quality while reducing the costs of care. Health care systems in many parts of the country deliver high quality care to the populations they serve at half the cost of other equally renowned academic medical centers in other parts of the country.12 The key is to provide information, incentives and support to help physicians and others work together to improve quality of care while reducing costs.
Barack Obama and Joe Biden believe we must redesign our health system to reduce inefficiency and waste and improve health care quality, which will drive down costs for families and individuals. The Obama-Biden plan will improve efficiency and lower costs in the health care system by: (1) adopting state-of-the-art health information technology systems;
Competition is doing that right now.
How about if Obama’s as a “Test Run” lowers US Postal Service Costs. “Go Postal First” by Dave Petno NAHU 6/2009
(2) ensuring that patients receive and providers deliver the best possible care, including prevention and chronic disease management services;
How much “Big Brother” 1984 do we want. We are all adults here, shouldn’t we be responsible for our own health care treatment?
How many forms will doctors have to fill out to be able to treat you? What if a citizen does not comply with preventative care? What if he refuses to eat the proper diet to prevent obesity? Does that mean he will not get treatment?
Big Brother is a fictional character in George Orwell‘s novel Nineteen Eighty-Four, the enigmatic dictator of Oceania, a totalitarian state taken to its utmost logical consequence – where the ruling elite (‘the Party’) wield total power for its own sake over the inhabitants.
In the society that Orwell describes, everyone is under complete surveillance by the authorities, mainly by telescreens. The people are constantly reminded of this by the phrase “Big Brother is watching you”, which is the core “truth” of the propaganda system in this state. Big Brother’s physical characteristics are intended to resemble Joseph Stalin (citation needed], although in the film his moustache more closely resembles Adolph Hitler‘s.
(3) reforming our market structure to increase competition;
and offering federal reinsurance to employers to help ensure that unexpected or catastrophic illnesses do not make health insurance unaffordable or out of reach for businesses and their employees.
I do not understand what Obama is talking about. Here’s more from his FAQ’s
Obama’s plan includes a reinsurance pool for employers. If employer health care costs exceed a certain amount, the federal government will pick up the tab,
How much will that cost us?
as long as the employer agrees to pass the savings onto their employees.
I think we already have that in Employer Plans in CA as the best discount an employer can have is 10% off standard rates and the worst surcharge for having a lot of claims is 10%. This is known as the RAF factor.
That helps businesses who have that one sick employee to be able to continue offering health insurance to their employees and keep their doors open Barack Obama.com/
- INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS.
- Most medical records are still stored on paper, which makes them difficult to use tocoordinate care, measure quality, orreduce medical errors.
- Insurance Companies & HMO’s are already working on this!
- Processing paper claims also costs twice as much as processing electronic claims.13 Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.
- Private Enterprise is already doing this. If nothing else, check out THIS website!
- They will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. Barack Obama and Joe Biden willensure that these systemsare developedin coordination with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe Biden willensure that patients’ privacy is protected.
- We already have HIPAA Privacy Laws.
CHCF.org article on the Stimulus Bill & Privacy of Health Information in CA
- We already have HIPAA Privacy Laws.
- A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.14
- IMPROVE ACCESS TO PREVENTION AND PROVEN DISEASE MANAGEMENT PROGRAMS.
- Experts agree that several steps should be taken immediately to help patients get the care they need and to help providers improve medical practice. Barack Obama and Joe Biden will expand and support these and other efforts to lower costs and improve health outcomes.
Support disease management programs.
Over seventy-five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease, and high blood pressure.15 Many patients with chronic diseases benefit greatly from disease management programs, which help patients manage their condition and get the care they need.16 Barack Obama and Joe Biden will require that plans that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care and lower costs, as well.
Coordinate and integrate care.
Rates of chronic diseases have skyrocketed in the last 2 decades.17 Over 133 million Americans have at least one chronic disease.18 With proper care, the onset and progression of these diseases can be contained for many years. In addition to the needless suffering and early death they cause, these chronic conditions cost a staggering $1.7 trillion yearly.19 Barack Obama and Joe Biden will support providers to put in place care management programs and encourage team care through implementation of medical home type models that will improve coordination and integration of care of those with chronic conditions.
Require full transparency regarding quality and costs.
Health care quality and costs can vary tremendously among hospitals and providers; however, patients have limited access to this information.20
I’ve been complaining about that for a LONG time.
Cal Hospital Compare.org/
Barack Obama and Joe Biden will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care and costs. Health plans will be required to disclose the percentage of premiums that actually goes to paying for patient care as opposed to administrative costs.
That is already in every sales brochure in CA. The average is 80%.
ENSURE PROVIDERS DELIVER QUALITY CARE ¾ Promote patient safety.
Barack Obama and Joe Biden will require providers to report preventable medical errors, and support hospital and physician practice improvement to prevent future errors.
Align incentives for excellence.
National Health Insurance Exchange,
Comparative effectiveness reviews and research.
One of the keys to eliminating waste and missed opportunities is to increase our investment in comparative effectiveness reviews and research. This information is developed by reviewing existing literature, analyzing electronic health care data, and conducting simple, real world studies of new technologies. Barack Obama and Joe Biden will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have accurate and objective information to make the best decisions for their health and well-being.
Tackle disparities in health care. Although all Americans are affected by problems with our health care delivery system, an overwhelming body of evidence demonstrates that certain populations are significantly more likely to receive lower quality health care than others. Barack Obama and Joe Biden will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health, both of which play a major role in addressing disparities. They will also challenge the medical system to eliminate inequities in health care by requiring hospitals and health plans to collect, analyze and report health care quality for disparity populations and holding them accountable for any differences found; diversifying the workforce to ensure culturally effective care; implementing and funding evidence-based interventions, such as patient navigator programs; and supporting and expanding the capacity of safety-net institutions, which provide a disproportionate amount of care for underserved populations with inadequate funding and technical resources.
¾ Reform medical malpractice while preserving patient rights. Increasing medical malpractice insurance rates are making it harder for doctors to practice medicine22 and raising the costs of health care for everyone.23 Barack Obama and Joe Biden will strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance. Barack Obama and Joe Biden will also promote new models for addressing physician errors that improve patient safety, strengthen the doctor-patient relationship, and reduce the need for malpractice suits.
(3) LOWER COSTS BY TAKING ON ANTICOMPETITIVE ACTIONS IN THE DRUG AND INSURANCE COMPANIES. It is not right that Americans families are paying skyrocketing premiums while drug and insurance industries are enjoying record profits. These companies benefit most from the status quo and in many cases are the greatest obstacles to reform. The Obama-Biden plan will tackle needless waste and spiraling costs by increasing competition in the insurance and drug markets.
Increasing competition in the insurance industry. The insurance business today is dominated by a small group of large companies that has been gobbling up their rivals. In recent years, for-profit companies have bought up not-for-profit insurers around the country. There have been over 400 health care mergers in the last 10 years and just two companies dominate a full third of the national market.24
These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed, increasing over 87 percent over the past six years.25 Over the same time period, insurance administrative overhead has been the fastest-growing component of health spending. The 2007 Commonwealth Fund Commission on a High Performance Health System reported that between 2000 and 2005, administrative overhead – including both administrative expenses and insurance industry profits – increased 12.0 percent per year, 3.4 percentage points faster than the average health expenditure growth of 8.6 percent.26
And while health care costs continue to rise for families, CEOs of these insurance companies have received multi-million dollar bonuses.27 Barack Obama and Joe Biden will prevent companies from abusing their monopoly power through unjustified price increases. In markets where the insurance business is not competitive, their plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration. Barack Obama and Joe Biden’s new National Health Insurance Exchange will also help increase competition by insurers.
Prevent private insurance waste and abuse in Medicare. Medicare’s private plan alternative, called Medicare Advantage, was established to increase competition and reduce costs. But independent reports show that on average the government pays 12 percent more than it costs to treat comparable beneficiaries through traditional Medicare.28
Does this have anything to do with the EXTRA benefits that Medicare Advantage Plans have, like Preventative, Dental, Vision, lower Co-Pays, and Prescriptions Part D? These plans are generally FREE to the client. Click here to view Blue Shield Benefits,
These excessive subsidies cost the government billions of dollars every year and create an incentive structure that has led to fraudulent abuses of seniors. Barack Obama and Joe Biden believe we need to eliminate the excessive subsidies to Medicare Advantage plans and pay them the same amount it would cost to treat the same patients under regular Medicare.
Allow consumers to import safe drugs from other countries. The second-fastest growing type of health expenses is prescription drugs.29 Pharmaceutical companies should profit when their research and development results in a groundbreaking new drug. But some companies are exploiting Americans by dramatically overcharging U.S. consumers. These companies are selling the exact same drugs in Europe and Canada but charging Americans a 67 percent premium.30 Barack Obama and Joe Biden will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S.
Prevent drug companies from blocking generic drugs from consumers. Some drug manufacturers are explicitly paying generic drug makers not to enter the market so they can preserve their monopolies and keep charging Americans exorbitant prices for brand name products.31 The Obama-Biden plan will work to ensure that market power does not lead to higher prices for consumers. Their plan will work to increase use of generic drugs in the new public plan, Medicare, Medicaid, FEHBP and prohibit large drug companies from keeping generics out of markets.
Allow Medicare to negotiate for cheaper drug prices. The 2003 Medicare Prescription Drug Improvement and Modernization Act bans the government from negotiating down the prices of prescription drugs, even though the Department of Veterans Affairs’ negotiation of prescription drug prices with drug companies has garnered significant savings for taxpayers.32 Barack Obama and Joe Biden will repeal the ban on direct negotiation with drug companies and use the resulting savings, which could be as high as $30 billion,33 to further invest in improving health care coverage and quality.
(4) REDUCE COSTS OF CATASTROPHIC ILLNESSES FOR EMPLOYERS AND THEIR EMPLOYEES.
Catastrophic health expenditures account for a high percentage of medical expenses for private insurers.34 In fact, the most recent data available reveals that the top five percent of people with the greatest health care expenses in the U.S. account for 49 percent of the overall health care dollar.35 For small businesses, having a single employee with catastrophic expenditures can make insurance unaffordable to all of the workers in the firm. The Obama-Biden plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers’ premiums. Offsetting some of the catastrophic costs would make health care more affordable for employers, workers and their families.
AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL
Barack Obama and Joe Biden will guarantee affordable, accessible health care coverage for all Americans. Currently, there are over 45 million Americans lacking health insurance, and millions more are at risk of losing their coverage due to rising costs.36 Rising costs are also a burden on employers, particularly small businesses, which are increasingly unable to provide health insurance coverage for their employees and remain competitive. Nearly two million fewer Americans receive health insurance coverage through their employers now compared to eight years ago,37 and this trend shows no sign of slowing down. It is simply too expensive for individuals and families to buy insurance directly on the open market and impossible for many with pre-existing conditions.
The Obama-Biden plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under the Obama-Biden plan, Americans will be able to maintain their current coverage, have access to new affordable options, and see the quality of their health care improve and their costs go down. The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit;
Sec. 3112. Small business health options program credit. Page 94 –
(4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.
- GUARANTEED ELIGIBILITY. Obama and Biden will require insurance companies to cover pre-existing conditions so all Americans, regardless of their health status or history, can get comprehensive benefits at fair and stable premiums.
- NEW AFFORDABLE, ACCESSIBLE HEALTH INSURANCE OPTIONS.
- The Obama-Biden plan will create a National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be provided for people and families who need it. Insurers would have to issue every applicant a policy and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency. Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent.
- TAX CREDITS FOR FAMILIES AND SMALL BUSINESSES.
- Barack Obama and Joe Biden understand that too many families that do not qualify for public health programs like Medicaid and SCHIP have trouble finding affordable health insurance.
Sec. 3112. Small business health options program credit. Page 94 –
They know from talking to small business owners across the nation that the skyrocketing cost of healthcare poses a serious competitive threat to America’s small businesses. The Obama-Biden health care plan willprovide tax credits
- View our website on Taxation
Sec. 3112. Small business health options program credit. Page 94 –
to all individuals who need it for their premiums. They will also create a new Small Business Health Tax Credit toprovide small businesses with a refundable tax credit of up to 50 percent on premiums paid by small businesses on behalf of their employees.
Sec. 3112. Small business health options program credit. Page 94 –
To be eligible for the credit, small businesses will have to offer a quality health plan to all of their employees
and cover a meaningful share of the cost of employee health premiums.
- EMPLOYER CONTRIBUTION.
- Large employers that do not offer meaningful coverage or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this requirement.
- REQUIRE COVERAGE OF CHILDREN.
- Barack Obama and Joe Biden will require that all children have health care coverage. Barack Obama and Joe Biden will expand the number of options for young adults to get coverage by allowing young people up to age 25 to continue coverage through their parents’ plans.
- EXPANSION OF MEDICAID AND SCHIP. Barack Obama and Joe Biden will expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net function.
- FLEXIBILITY FOR STATE PLANS. Due to federal inaction, some states have taken the lead in health care reform. Under the Obama-Biden plan, states can continue to experiment, provided they meet the minimum standards of the national plan.
PROMOTING PREVENTION & STRENGTHENING PUBLIC HEALTH
Covering the uninsured and modernizing America’s health care system are urgent priorities, but they are not enough. This nation is facing a true epidemic of chronic disease. An increasing number of Americans are suffering and dying needlessly from diseases such as obesity, diabetes, heart disease, asthma and HIV/AIDS, all of which can be delayed in onset if not prevented entirely. One in 3 Americans—133 million—have a chronic condition, and children are increasingly being affected.38 Five chronic diseases—heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes—cause over two-thirds of all deaths each year.39
In addition to the tremendous human cost, chronic diseases exact a tremendous financial toll on our health care resources. Care for patients with diabetes costs $130 billion each year alone, and this amount is growing.40 Tackling chronic diseases is also straining our public health departments and finances, which are already stretched too thin carrying out traditional public health functions, which include ensuring our water is safe to drink, the air is safe to breathe, and our food is safe to eat.
Barack Obama and Joe Biden believe that protecting and promoting health and wellness in this nation is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce, and federal and state and local governments. All parties must do their part, as well as collaborate with one another, to create the conditions and opportunities that will allow and encourage Americans to adopt healthy lifestyles.
- EMPLOYERS. Reduced workforce productivity from illness and disability represents an additional drain on business. To address employee health, an increasing number of employers are offering worksite health promotion programs, onsite clinical preventive services such as flu vaccinations, nutritious foods in cafeterias and vending machines, and exercise facilities. Equally important, many employers choose insurance plans that cover preventive services for their employees. Barack Obama and Joe Biden believe that worksite interventions hold tremendous potential to influence health and they will expand and reward these efforts.
- SCHOOL SYSTEMS.
- Childhood obesity is nearly epidemic,41 particularly among minority populations,42 and school systems can play an important role in tackling this issue. For example, only about a quarter of schools adhere to nutritional standards for fat content in school lunches.43 Barack Obama and Joe Biden will work with schools to create more healthful environments for children, including assistance with contract policy development for local vendors, grant support for school-based health screening programs and clinical services, increased financial support for physical education, and educational programs for students.
- Primary care providers and public health practitioners have and will continue to lead efforts to protect and promote the nation’s health. Yet, the numbers of both are dwindling,44 and the existing workforce is further challenged by inadequate training for new health threats such as bioterrorism and avian flu, antiquated funding and reimbursement mechanisms, and limited access to real-time information and technical support. Barack Obama and Joe Biden will expand funding—including loan repayment, adequate reimbursement, grants for training curricula, and infrastructure support to improve working conditions— to ensure a strong workforce that will champion prevention and public health activities.
- INDIVIDUALS AND FAMILIES.
- Preventive care only works if Americans take personal responsibility for their health and make the right decisions in their own lives – if they eat the right foods, stay active, and stop smoking.
- Barack Obama and Joe Biden will ensure that all Americans are empowered to monitor their health by ensuring coverage of essential clinical services in all federally supported health plans, including Medicare, Medicaid,SCHIP
- and the new public plan. Americans also benefit from healthy environments that allow them to pursue healthy choices and behaviors that can help ward off chronic and preventable diseases. Healthy environments include sidewalks, biking paths and walking trails;
- I do not see what we already have being used.
- local grocery stores with fruits and vegetables; restricted advertising for tobacco and alcohol to children; and wellness and educational campaigns. In addition, Barack Obama and Joe Biden will increase funding to expand community based preventive interventions to help Americans make better choices to improve their health.
- FEDERAL, STATE, AND LOCAL GOVERNMENTS.
- The federal government and state and local governments play critical roles across the full range of disease prevention and health promotion activities. First, working together, governments at all levels should lead the effort to develop a national and regional strategy for public health and align funding mechanisms to support its implementation. Second, the field of public health would benefit from greater research to optimize organization of the 3,000 health departments in this nation,45 collaborative arrangements between levels of government and its private partners, performance and accountability indicators, integrated and interoperable communication networks, and disaster preparedness and response. Third, the government must invest in workforce recruitment as well as modernizing our physical structures, particularly our public health laboratories. And finally, the government must examine its own policies, including agricultural, educational, environmental and health policies, to assess and improve their effect on public health in this nation. Barack Obama and Joe Biden will prioritize all of these activities, to ensure a 21st century public health system and healthy America.
Paid for by Obama for America
Printed in House
1 Kaiser Family Foundation and Health Research and Educational Trust. (2008). Employer Health Benefits 2008, http://kff.org/insurance/7527/index.cfm ; Bureau of Labor Statistics, Sept. 2008
2 David U. Himmelstein, Elizabeth Warren, Deborah Thorne, and Steffie Wooldhandler (February 2005). “Illness and Injury as Contributors to Bankruptcy,” Health Affairs, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.63v1
3 Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors; Committee on Quality of Health Care in America, Institute of Medicine (2000). To Err is Human. Washington, DC: National Academy Press.
4 Steffie Woolhandler, Terry Campbell, and David U. Himmelstein (2003) “Costs of Health Care Administration in the United States and Canada.” New England Journal of Medicine.
5Census Bureau, August 2008, http://www.census.gov/prod/2008pubs/p60-235.pdf
7 Kaiser Family Foundation, The Uninsured: A Primer (2006), http://kff.org/uninsured/upload/7451-021.pdf
8 Jeanne M. Lambrew, (April 2007). A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project, Brookings Institution. brookings.edu/
9 Commonwealth Fund, Why Not the Best? Results from a National Scorecard on U.S. Health Systems Performance, September 2006, http://www.cmwf.org/publications/publications_show.htm?doc_id=401577
10 Steffie Woolhandler, Terry Campbell, and David U. Himmelstein (2003) “Costs of Health Care Administration in the United States and Canada.” New England Journal of Medicine.
11 Office of the Actuary. (February 2007). National Health Expenditures http://www.cms.hhs.gov/
12 Dartmouth Atlas Project (2006), The Care of Patients with Severe Chronic Illness, http://www.dartmouthatlas.org/
13 Federico Girosi, Robin Meili, and Richard Scoville (2005), Extrapolating Evidence of Health Information Technology Savings and Costs. RAND, page 79.
14 Federico Girosi, Robin Meili, and Richard Scoville (2005), Extrapolating Evidence of Health Information Technology Savings and Costs. RAND, page 36.
15 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia Johnson Chronic Conditions: Making the Case for Ongoing Care (2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
16 Center on an Aging Society at Georgetown University, Disease Management Programs: Improving Health and while Reducing Costs?, p4, (January 2004). http://hpi.georgetown.edu/agingsociety/pdfs/management.pdf
17 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia Johnson Chronic Conditions: Making the Case for Ongoing Care (2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
18 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia Johnson Chronic Conditions: Making the Case for Ongoing Care (2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
19 CMS. (February 2007). National Health Expenditures; Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia Johnson Chronic Conditions: Making the Case for Ongoing Care (2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation). 20 National Committee for Quality Assurance (2006), The State of Health Care 2006, ncqa.org
21 Jeanne M. Lambrew, (April 2007). A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project, Brookings Institution. http://www3.brookings.edu/views/papers/200704lambrew.pdf
22 Kenneth Thorpe (January 21, 2004), The Medical Malpractice ‘Crisis’: Recent Trends and the Impact of State Tort Claims, Health Affairs, http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.20v1/DC1#39
23 Department of Health and Human Services (March 3, 2003), Addressing the New Health Care Crisis: Reforming the Medical Litigation System to Improve the Quality of Care, http://aspe.hhs.gov/daltcp/reports/medliab.htm
24 Edward Langston, “Statement of the American Medical Association to the Senate Committee on the Judiciary, United States Senate” (September 6, 2006). Testimony. 25 Kaiser Family Foundation and Health Research and Educational Trust. (2006). Employer Health Benefits 2006, http://kff.org/insurance/7527/index.cfm
26 Karen Davis, Cathy Schoen, Stuart Guterman et al. (January 2007), Slowing the Growth of U.S. Health Care Expenditures: What are the Options? Commonwealth Fund
27 Forbes.com, 2007 CEO Executive Compensation – Health Care Equipment & Services, forbes.com/li
28 Glenn Hackbarth, Medicare Payment Advisory Commission (April 11, 2007), Testimony: The Medicare Advantage Program and MedPAC Recommendations, U.S. Senate Committee on Finance, medpac.gov/
29 Karen Davis, Cathy Schoen, Stuart Guterman et al. (January 2007), Slowing the Growth of U.S. Health Care Expenditures: What are the Options? Commonwealth Fund. 30 Patented Medicine Prices Review Board, Annual Report (Ottawa, Ontario: PMPRB, 2002), p. 23. 31 Marc Kaufman (April 25, 2006), “Drug Firms’ Deals with Allowing Exclusivity,” Washington Post, http://www.washingtonpost.com/wp-dyn/content/article/2006/04/24/AR2006042401508.html
32 Families USA (December 2005), Falling Short: Medicare Prescription Drug Plans Offer Meager Savings, http://www.familiesusa.org/assets/pdfs/PDP-vs-VA-prices-special-report.pdf
33 Roger Hickey & Jeff Cruz (April 2007), Waste and Inefficiency in the Bush Medicare Prescription Drug Plan: Allowing Medicare to Negotiate Lower Prices Could Save $30 Billion a Year, Institute for America’s Future, http://cdncon.vo.llnwd.net/
34 Mark W. Stanton and Margaret Rutherford (June 2006), The High Concentration of U.S. Health Care Expenditures. Agency for Healthcare Research and Quality. Research in Action Issue 19. 35 Mark W. Stanton and Margaret Rutherford (June 2006), The High Concentration of U.S. Health Care Expenditures. Agency for Healthcare Research and Quality. Research in Action Issue 19. 36 Census Bureau, “Census Bureau Revises 2004 and 2005 Health Insurance Coverage Estimates,” March 23, 2007. http://www.census.gov/Press-Release/www/releases/archives/health_care_insurance/009789.html
37 Census Bureau (2008), Income, Poverty, and Health Insurance Coverage in the United States: 2007. Table C-1. 38 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia Johnson Chronic Conditions: Making the Case for Ongoing Care (2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
39 CDC, http://www.cdc.gov/nccdphp/overview.htm40 CDC, http://www.cdc.gov/nccdphp/press/index.htm
41 NIH, Childhood Obesity, June 2002 Word on Health http://www.nih.gov/news/WordonHealth/jun2002/childhoodobesity.htm 42 CDC National Center for Health Statistics, http://www.cdc.gov/nchs/pressroom/06facts/obesity03_04.htm
43 GAO (2003), School Lunch Program: Efforts Needed to Improve Nutrition and Encourage Healthy Eating, http://www.gao.gov/new.items/d03506.pdf
44 The Robert Graham Center (October 2003), http://www.graham-center.org/x468.xml; Institute of Medicine (2002), The Future of the Public’s Health in the 21st Century, p.364.
45 Bob Prentice and George Flores (December 15, 2006), Local Health Departments and the Challenge of Chronic Disease: Lessons From California, NIH, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1832141
A Quick Summary of the Affordable Health Choices Act
Senator Edward M. Kennedy, Chairman of the Health, Education, Labor and Pensions Committee (HELP), today released The Affordable Health Choices Act, legislation that aims to reduce health care costs, protect individuals? choices of doctors, hospitals and insurance plans and guarantee, quality and affordable health care for all Americans.
The Affordable Health Choices Act includes the following five major elements:
CHOICE: An important foundation of The Affordable Health Choices Act is the following principle: If you like the coverage you have now, you keep it. But if you don’t have health insurance or don’t like the insurance you have, our bill will give you new, more affordable options.
COST REDUCTION: The Affordable Health Choices Act will reduce health care costs through stronger prevention, better quality of care and use of information technology. It will also root out fraud and abuse and reduce unnecessary procedures.
PREVENTION: The best way to treat a disease is to prevent it from ever striking, which is exactly why The Affordable Health Choices Act will give citizens the information they need to take charge of their own health. The bill will make information widely available in medical settings, schools and communities. It will also promote early screening for heart disease, cancer and depression and give citizens more information on healthy nutrition and the dangers of smoking.
HEALTH SYSTEM MODERNIZATION: The Affordable Health Choices Act will take strong steps to see that America has a 21st-century workforce for a modern and responsive healthcare system. America must make sound investments in training the doctors, nurses, and
other health professionals who will serve the needs of patients in the years to come. It will make sure that patients? care is better coordinated so they see the right doctors, nurses and other health practitioners to address their individual health needs.
LONG TERM CARE AND SERVICES: The Affordable Health Choices Act will also make it possible for the elderly and disabled to live at home and function independently. It will help them afford to put ramps in their homes, pay someone to check in on them regularly, or any of an array of supports that will enable them to stay in their communities instead of in nursing homes. help.senate.gov/
‘America’s Affordable Health Choices Act of 2009’
Full Text 246 pages
Comparison of Senate Affordable Health Choices Act & HR 3200 America’s Health Choices Act of 2009
“SEC. 3112. SMALL BUSINESS HEALTH OPTIONS PROGRAM CREDIT.
Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to 50 percent on premiums paid by small businesses on behalf of their employees. Source: Text of Obama’s Summary
“(a) CALCULATION OF CREDIT.?For each calendar year beginning in calendar year 2010, in the case of an employer that is a qualified small employer, the Secretary shall make a payment in the amount described in sub14 section (b).
“(b) GENERAL CREDIT AMOUNT. For purposes of this section:
“(1) IN GENERAL. The credit amount described in this subsection shall be the product of?
“(A) the applicable amount specified in paragraph (2);
“(B) the employer size factor specified in paragraph (3); and
“(C) the percentage of year factor specified in paragraph (4).
“(2) APPLICABLE AMOUNT. For purposes of paragraph (1):
“(A) IN GENERAL. The applicable amount shall be equal to?
“(i) $1,000 for each employee of the employer who receives self-only health in surance coverage through the employer;
“(ii) $2,000 for each employee of the employer who receives family health insurance coverage through the employer; and
“(iii) $1,500 for each employee of the employer who receives health insurance coverage for two adults or one adult and one or more children through the employer.
“(B) BONUS FOR PAYMENT OF GREATER PERCENTAGE OF PREMIUMS. The applicable amount specified in subparagraph (A) shall be increased by $200 in the case of subparagraph
(A)(i), $400 in the case of subparagraph
(A)(ii), and $300 in the case of subparagraph
(A)(iii), for each additional 10 percent of the qualified employee health insurance expenses exceeding 60 percent which are paid by the qualified small employer.
“(3) EMPLOYER SIZE FACTOR.?
For purposes of paragraph (1), the employer size factor shall be the percentage determined in accordance with the following:
“(A) With respect to an employer with more than 10, but not more than 20, full-time employees, the percentage shall be 80 percent.
“(B) With respect to an employer with more than 20, but not more than 30, full-time employees, the percentage shall be 50 percent.
“(C) With respect to an employer with more than 30, but not more than 40, full-time employees, the percentage shall be 40 percent.
“(D) With respect to an employer with more than 40, but not more than 50, full-time employees, the percentage shall be 20 percent.
“(E) With respect to an employer with more than 50 full-time employees, the percent
age shall be 0 percent.
“(4) PERCENTAGE OF YEAR FACTOR.?
For purposes of paragraph (1), the percentage of year factor shall be equal to the ratio of?
“(A) the number of months during the tax able year for which the employer paid or incurred qualified employee health insurance expenses; and
“(c) DEFINITIONS AND SPECIAL RULES. For purposes of this section:
“(1) QUALIFIED SMALL EMPLOYER.?
“(A) IN GENERAL. The term ?qualified small employer? means an employer (as defined in section 3001(a)(4) of the Public Health Service Act) that?
“(i) purchases health insurance coverage for its employees in a small group market in a State that meets the requirements of subparagraph (B) for the year involved;
“(ii) pays or incurs at least 60 percent of the qualified employee health insurance expenses of such employer, or who is self-employed; and
“(I) an employer that?
“(aa) employed an average of 50 or fewer full-time employees during the preceding taxable year; and
“(bb) had an average wage of less than $50,000 for full time employees in the preceding taxable year; or
“(II) a self-employed individual that had?
“(aa) not less than $5,000 in net earnings or not less than $15,000 in gross earnings from self-employment in the preceding taxable year; and
“(bb) not greater than $50,000 in net earnings or not greater than $150,000 in gross earnings from self-employment in the preceding taxable year.
“(B) LIMITATION. An employer may not receive a credit under this section for more than three consecutive years.
“(2) QUALIFIED EMPLOYEE HEALTH INSURANCE EXPENSES.?
“(A) IN GENERAL. The term ?qualified employee health insurance expenses? means any amount paid by an employer or an employee of such employer for health insurance coverage under this Act to the extent such amount is for coverage?
“(i) provided to any employee (as defined in subsection 3001(a)(3) of such Act), or
“(ii) for the employer, in the case of a self-employed individual.
“(B) EXCEPTION FOR AMOUNTS PAID UNDER SALARY REDUCTION ARRANGEMENTS.?
No amount paid or incurred for health insurance coverage pursuant to a salary reduction arrangement shall be taken into account for purposes of subparagraph (A).
“(3) FULL-TIME EMPLOYEE. The term ?full time employee? means, with respect to any period, an employee (as defined in section 3001(a)(3)) of an employer if the average number of hours worked by such employee in the preceding taxable year for such employer was at least 35 hours per week.
“(d) INFLATION ADJUSTMENT.?
“(1) IN GENERAL. For each calendar year after 2009, the dollar amounts specified in subsections (b)(2)(A), (b)(2)(B), and (c)(1)(A)(iii) (after the application of this paragraph) shall be the amounts in effect in the preceding calendar year or, if greater, the product of?
“(A) the corresponding dollar amount specified in such subsection; and “(B) the ratio of the index of wage inflation (as determined by the Bureau of Labor Statistics) for August of the preceding calendar year to such index of wage inflation for August of 2008.
“(2) ROUNDING. If any amount determined under paragraph (1) is not a multiple of $100, such amount shall be rounded to the next lowest multiple of $100.
“(e) APPLICATION OF CERTAIN RULES IN DETERMINATION OF EMPLOYER SIZE. For purposes of this section:
“(1) APPLICATION OF AGGREGATION RULE FOR EMPLOYERS. All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as 1 employer.
“(2) EMPLOYERS NOT IN EXISTENCE IN PRECEDING YEAR. In the case of an employer which was not in existence for the full preceding taxable year, the determination of whether such employer meets the requirements of this section shall be based on the average number of full-time employees that it is reasonably expected such employer will employ on business days in the EmployER’s first full taxable year.
“(3) PREDECESSORS. Any reference in this subsection to an employer shall include a reference to any predecessor of such employer.”.
(b) DISCLOSURE OF INFORMATION TO PROVIDE PREMIUM PAYMENTS.?
(1) IN GENERAL. Subsection (l) of section 6103 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:
“(21) VOLUNTARY AUTHORIZATION FOR INCOME VERIFICATION.?
“(A) VOLUNTARY AUTHORIZATION. The Secretary shall provide a mechanism for each taxpayer to indicate whether such taxpayer authorizes the Secretary to disclose to the Secretary of Health and Human Services (or, pursuant to a delegation described in subsection (d)(4)(B), to a State or a Gateway (as defined in section 3101 of the Public Health Service Act) return information of a taxpayer who may be eligible for credits under section 3111 of the Public Health Service Act.
“(B) PROVISION OF INFORMATION. If a taxpayer authorizes the disclosure described in subparagraph (A), the Secretary shall disclose to the Secretary of Health and Human Services (or, pursuant to a delegation described in subsection (d)(4)(B), to a State or a Gateway) the minimum necessary amount of information necessary to establish whether such individual is eligible for credits under section 3111 of the Public Health Service Act.
“(C) RESTRICTION ON USE OF DISCLOSED INFORMATION. Return information disclosed under subparagraph (A) may be used by the Secretary (or, pursuant to a delegation described in subsection (d)(4)(B), a State or a
Gateway) only for the purposes of, and to the extent necessary in, establishing the appropriate amount of any payments under section 3111 of the Public Health Service Act.”.
(2) CONFORMING AMENDMENTS.?
(A) Paragraph (3) of section 6103(a) of such Code is amended by striking “or (20)” and inserting “(20), or (21)”.
(B) Paragraph (4) of section 6103(p) of such Code is amended by striking “(l)(10), (16), (18), (19), or (20)” each place it appears and inserting “(l)(10), (16), (18), (19), (20), or (21)”.
(C) Paragraph (2) of section 7213(a) of such Code is amended by striking “or (20)” and inserting “(20), or (21)”.
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