We are still in sight of the finish line for federal health reform, but we need your help to clear the final hurdles.   The election results from Massachusetts led a lot of people to speculate about the fate of reform. But we can’t let their negativity control the conversation.  Now is actually when it is most important to keep working for the health reform America—and Utah—desperately needs.
Utahns need to let our Members of Congress know that we need quality, affordable health care. The status quo is not a viable option.
The Congressional strategy is being worked out as we speak (pay attention to what the President says in his State of the Union speech on Wednesday).  One path forward is to have the House pass the Senate bill. There could also be an accompanying strategy to make fixes in the Senate bill by using the budget reconciliation process. We must deliver the message loud and clear that the House needs to bring health care reform across the finish line.
Contact Congressman Matheson TODAY.  You can reach him through the Capitol switchboard by calling 1-800-828-0498.
Here is a suggested message:
We need to reform the health care system – the status quo is not a viable option for America’s struggling families. Health care reform will stabilize families’ finances, reduce the risk of medical debt and provide peace of mind to Americans across the country. Congress is too close to meaningful reform not to finish the job. We urge you to pass the Senate bill.
Although the primary target is the House, it is important that the Administration also hears supportive messages. You can do this by calling the White House comments line at 202-456-1414 or 202-456-1111. Please be aware that wait times may be long. You can also send an electronic message at http://www.whitehouse.gov/contact.
Resources from Community Catalyst:
1.    The Path to Health Care Reform is Passing the Senate Bill
2.   Senate Health Care Reform Package Will Secure Coverage and Improve Quality of Care

This past Wednesday Health and Human Services Appropriations Committee adopted a 4%, or $23.5 million cut for fiscal year 2010. In preparing their recommendations the departments once again, made every effort to target administrative costs, and for his they should be commended. Unfortunately, though perhaps unavoidably, one of the casualties, media outreach for CHIP and the Utah Premium Partnership programs, may undermine the goals of state health reform. .   To minimize further cuts, the committee wisely included one of our Medicaid cost containment ideas, strengthening Medicaid’s Preferred Drug List.  But even these savings were not enough to offset the, full 4% cut without harming medically necessary services.  Thus, the Committee also recommended eliminating Medicaid dental and vision coverage for pregnant women and reducing reimbursement levels to outpatient hospitals, which could hamper Medicaid beneficiaries’ ability to find providers willing to see them. The full list of HHS Appropriations recommended cuts can be read here.

The committee’s recommendations add up to $15 million in ongoing cuts and $8 million in one-time cuts.  Therefore, the committee still has much work to do before reaching the 5% ongoing cut for FY2011 which legislative leadership has asked for.  The Executive Appropriations Committee (comprised of members of leadership) will be meeting early next week to adopt a final plan to trim the FY2010 budget to size.  HHS Appropriations will meet again on Tuesday, January 26 to begin the process of cutting the FY2011 ongoing base budget by a total of 5%.  During that meeting, cuts to Medicaid eligibility are likely to be considered.

It will take all of us to protect Medicaid in this session.  The Utah Medicaid Partnership will be meeting every Wednesday during the legislative session (Jan. 25th to March 11th) from 12:45 to 1:30 in the Olmsted Room, East building of the Capitol Complex. UMP’s next meeting is this Wednesday the 27th.  Please join us!

One of the obstacles facing consumers who participated in the pilot launch of the Exchange was the task of filling out the application and especially the health questionnaire. According to staff at the Office of Consumer Health Services (OCHS), 55% of participants found the Universal Health Application to be difficult to complete. Many cited as the reason for their difficulty redundant, intrusive, and/or unclear questions.

At the December 14th meeting of the Health System Reform Task Force, House Speaker David Clark asked that a group be put together through the Department of Insurance to fix the application. The deadline for the new, improved application is February 4th, which means everyone is working on a short timeline to create something that works. After the new application is completed, it will be field tested by OCHS to further refine the questions.

The goal is to have an application that is easy to understand and complete by the time the Exchange is opened to all small businesses later this spring.

A larger bump in the road to health reform is the cost of the policies available to purchasers on the Exchange. Utah House Speaker David Clark has crafted a bill for this Legislative Session that is aimed at lowering premium costs on the Exchange. One very positive aspect of his bill will require all small businesses purchasing health insurance to do so through the Exchange. With all small businesses in one marketplace, it will be easier to treat those businesses as one large risk pool. This will allow the insurance community to assess and manage the risk of this super-sized pool. A larger pool generally means lower rates for members. The bill also goes one step further and prohibits insurance companies from charging premiums to individual members based on their current health status. Instead, the insurance companies will have to scale premiums to the health status of the entire pool.  These and other encouraging developments bring Utah several steps closer to enacting comprehensive health reforms.

While we’re excited about these aspects of the bill, there are still some bumps that need to be fixed before the Exchange can be truly consumer friendly. The largest of these bumps is the lack of clarity about the value a consumer is getting when they purchase a policy. When an insurance policy is created, it is assigned an actuarial value. This measure represents the percentage of average costs of healthcare for the average policy holder that the insurance company is anticipated to pay. So a policy with an actuarial value of 85%, means that holders of that policy, on average, will be paying 15% of their healthcare costs (including premiums) out-of-pocket and the insurance company will pay the rest. Generally, the higher the actuarial value, the lower the out-of-pocket costs for consumers.

Without some type of indicator to the consumer of the actual (or actuarial) worth of the policies being sold on the Exchange, we are concerned that people will be left over-sold and therefore under-insured. Consumers will factor in the monthly premium costs and determine how much they can afford but won’t be able to factor in the costs they will need to pay because their insurance policy does not cover certain things they need.

This Legislative Session could mark a turning point in our state’s commitment to enact reforms that expand access, contain costs and ensure quality.

It will be a busy and demanding legislative session for the MHN and communities dedicated to improving health equity. Once again Sen. Luz Robles is leading the charge to lift the 5-year wait period on lawfully present immigrants’ eligibility for Medicaid and CHIP.  A top priority for the MHN, Senate Bill 44 (SB44) has already attracted an impressive team of supporters, including Enrich Utah, the United Ways, and the Women’s Philanthropic Network, which is hosted by the United Way of Salt Lake.  No matter how worthy the cause or relevant to the state’s health reform goals, SB44 will be facing an uphill battle for funding. Please join us for weekly coordinating meetings every Wednesday at 3:00 pm in the Capitol Cafeteria (East Building). Get our factsheet here.

It’s an important, watershed year for health equity initiatives, with the introduction of the new, more robust framework for addressing disparities, Healthy People 2020, and emerging efforts to create a unified blueprint to address Utah disparities. To make the most of HP2020’s new emphasis on the socio-economic determinants of health, take a look at the recently released Proceedings from the MHN 2009 Summit.

The 58th Legislature convenes today for the 2010 General Session.  For the next 45 days, state policy and budgets will be decided.  The UHPP hopes to be a resource to you as you prepare to navigate the legislative session.  We have created a number of tools to help you advocate effectively for quality, affordable coverage for all Utahns.

Advocacy Training for Busy People

The UHPP, Utah Multicultural Health Network, and Enrich Utah are joining forces to offer a hands-on advocacy training. Here you will get the tools and inside tips you need to advocate effectively for the issues you care about.
What: Advocacy Training for Busy People!
When: Wednesday, January 27, 2010 at 7:00 PM
Where:  Board Room, Utah State Capitol (2nd floor on the east side)
RSVP to jessica@healthpolicyproject.org

UHPP Bill Tracker

Health care is certain to be a hot topic this legislative session.  We’ve created an easy tool to help you keep track of bills relating to health care policy—UHPP’s bill tracker! We’ll be updating it weekly.
Legislator Contact List and Vote Tracking Tool
Check out our handy 2010 spreadsheet of legislators and their contact information.  Use it to track your conversations with legislators, find out who sits on the committees that oversee health issues, count votes on bills, or mail merge to contact legislators individually!  To download in Excel, click here.

Fact Sheets

UHPP is continually preparing materials to give you the latest nonpartisan information and talking points on critical health issues.  You’ll find factsheets to help you with advocacy, as well as in-depth issue briefs to give you a thorough explanation of the issues.  Check out our Publications Page for our latest materials.
Getting to the State Capitol
Public Transportation: If you are downtown, the UTA bus is a great option to get up to the Hill.  Route 500 will take you right to the East Building’s front door!  The Capitol is in the Downtown Free Zone and buses run every 15 minutes.  The bus schedule is posted here, along with the route map here.  UTA has a great trip planner tool, as well.
Driving from outside of Salt Lake: If coming from northbound I-15, take the 600 South exit, or if coming southbound, take the 400 S exit.  Head east to State Street. Turn left on State Street and head up the hill to the State Capitol. Turn right at the top of the hill.
Where to park?
If you must drive, a public parking lot is right next to the East Building (also known as the Senate Building).  There is also plenty of street parking on the east and north sides of the Capitol, though you should plan to walk a bit.  If parking in the neighborhoods to the west, make sure to check the signs for parking time limits.

The pundits and politicos are all reacting to Republican Scott Brown’s win of the Massachusetts Senate seat formerly held by the late Senator Ted Kennedy.  The election results leave the Democrats without 60 votes to withstand a promised filibuster. Many pundits predict that loss of this seat could kill health care reform. We say it’s way too early to throw in the towel.   Although the political landscape has changed, one fact remains the same: Utahns cannot wait for relief from skyrocketing health care costs and lack of coverage. Watch this video about an Orem woman who struggled to get coverage because of she is a cancer survivor. Stories like these underscore the need and the urgency to get started on federal health reforms, no matter how imperfect or watered down.

Tonight, Congressman Matheson is sponsoring a telephone townhall to discuss pressing national issues. With the final health care reform vote coming up soon, this is your chance to hear from the Congressman directly about what factors he is weighing in his decision.   You’ll also have the opportunity to ask questions and urge him to support the final consensus bill.  (Make sure you indicate right away you have a question to be high up in the queue!).
What:  Telephone Town Hall Meeting to discuss pressing national issues.
Who:    Congressman Jim Matheson and Utah constituents.
When:  January 20, 2010 7:00 PM – 8:00 PM
How:    To join the call at or after 7:00 PM, call (877) 229-8493. When directed, enter the PIN # 13304.  You’ll be able to listen in toll-free for as long as you like and, when prompted, ask the Congressman questions on the topic of your concern.
Where do we go from here?
Procedurally, the Brown victory leaves Congressional leaders a couple options to get across the finish line:

1. Pass the Senate bill without amendment in the House. It’s unclear whether the House can drum up 218 votes for the Senate bill, with possible defections coming from both the right and left of the Democratic caucus (again, Matheson is one of those swing votes).
2. Pass the Senate bill and amend in budget reconciliation.  After passing the Senate bill, the House could pass many of the compromises they have negotiated with the Senate over the last month through a budget reconciliation bill.  This bill would only need 51 votes in the Senate; however it would be tricky procedurally to ensure the bill meets the restrictions of budget reconciliation.
3. Go back and do a new bill via budget reconciliation: Starting entirely over with reconciliation is unlikely, as it would require a substantial rewrite of the bill, taking time that Congress is eager to devote to other issues. Still, starting over could bring a much needed, fresh look at Sen. Bennett’s Healthy Americans Act or other more bipartisan proposals.

Counting noses in the House: Matheson is Key as Potential Swing Vote

Having the Senate bill as the starting point creates a new dynamic.  Congressman Matheson has repeatedly expressed interest in the Senate’s more conservative approach. Rep. Matheson’s objections to the House bill–the public option, lack of a Independent Medicare Commission and tax on cadillac health plans, overall cost, and taxes–are not obstacles in the Senate version.

With all roads to victory requiring another vote in the House, securing 218 votes in that chamber has become a critical task.  When the House passed its version of reform in August, the victory margin was a mere 3 votes (if we count the recent resignations). Now, with one vacant Democratic seat and one Republican who is unlikely to provide the margin of victory, passage in the House is in jeopardy.  Leadership must find a way to keep every vote they had before, or persuade some members (like UT’s Rep. Matheson) who voted no the first time to vote YES.

All of this is to say: if there ever was a time to weigh in with Congressman Matheson and the rest of the delegation and urge their support of federal health reform, that time is now.   Please participate in the Congressman’s Telephone Townhall and call his office to let him know you want health reform this year.
D.C.: (202) 225-3011
Salt Lake: (801) 486-1236
St. George: (435) 627-0880

The 2010 General Session of the 58th Legislature convenes on Monday January 25th.  By making your voice heard in Utah’s Capitol, you can help us work towards achieving the goal of quality, affordable coverage for all Utahns.  Join us for a practical, hands-on advocacy training where you’ll get the tools and inside tips you need to advocate effectively for the issues you care about. Participants will also learn where key issues stand in week 1 of the legislative session.
What: Advocacy Training for busy people
When: Wednesday, January 27th at 7:00 PM
Where: Board Room, Utah State Capitol (2nd floor on the east side)
RSVP to jessica@healthpolicyproject.org

On Tuesday, the Health and Human Services Appropriations Committee began its deliberations on how to trim 4%, or $23.5 million, from the Department of Health and Department of Human Services’ fiscal year 2010 budgets.  After experiencing deep cuts over the last two years, there is little room to squeeze out savings without harming access to medically necessary care for Medicaid beneficiaries.

The proposals presented by the Department of Health (DOH) and the Department of Human Services (DHS) would cut costs by $15 million.  DOH would meet this target through administrative cuts including furloughs (unpaid days off) and the elimination of currently unfilled positions.  DHS presented a proposal that included a mix of job cuts and reductions in provider payments.

However, these proposals do not meet the Legislature’s 4% target.  So while it is likely HHS Appropriations will adopt the Departments’ recommendations, they will need to find additional cuts—somewhere.   For Medicaid these additional cuts likely mean significant reductions in provider reimbursement rates.

Looking ahead to FY2011, the situation becomes even more dire as the Legislature is seeking a total reduction of 5%.  Most of the cuts being considered for FY2010 are 1-time savings, which means they will not count toward the FY2011 5% goal.  As a result, deep cuts to Medicaid eligibility are being considered yet again, including elimination of the Breast and Cervical Cancer Treatment Program, Medically Needy Medicaid (all categories), and Foster Care Children’s Medicaid Expansion, and the scaling back of eligibility from 100% of poverty to 75% of poverty for people with disabilities and seniors.  In addition to these eligibility cuts, further cuts to provider reimbursement rates will likely be necessary to reach the Legislature’s goal.

NOW IS THE TIME to contact HHS Appropriations members and tell them the harmful impact these proposed cuts will have on Utah families.

Their contact information is below:

The Senate, House and White House are moving forward with negotiations on merging the two bills into one.  There are several key differences between the legislation that will need to be resolved, as we have discussed previously.  Once a compromise is negotiated, the bill will be sent to the Congressional Budget Office (CBO) for a score or cost/savings estimate.  As you know, that process could take up to a week or more.  As per custom, the House will then give its members 72 hours to review the legislation before voting on it.  The goal is to have the bill finalized before the President’s State of the Union; the two dates for the address being floated are Jan 26th or Feb 2nd, so things will begin moving quickly soon.

Both in Utah and nationally, over the last few weeks there has been much discussion about the United States Constitution, the powers of Congress and the respective roles of federal and state government and how health reform fits in this paradigm. It is an important discussion.  The public benefits from these occasional civic lessons about how their government works.  However, there are some who appear to be using the Constitution as a tool to create fear and beat down health reform as being un-American.  Their claims, however, appear to have little bases in the actual text of the Constitution.

In an effort to dispel the fear and demystify the Constitution, UHPP has decided to open up the text and juxtapose the critics’ claims with the powers afforded to Congress under this most American of documents.  Our full analysis can be read here.

Article 1 Section 8 of the United States Constitution defines the power of Congress to enact laws.  These powers are very broad, permitting the Congress to enact laws affecting everything from the military, tax policy, and economic activity.   Congress’ work on health reform (including such things as the mandate on individuals to purchase insurance, health insurance exchanges, and varied Medicaid payment levels to the states) fall well within these powers.
Ultimately, while critics of health reform may have strong arguments on policy grounds, their constitutional claims are misguided and distract from the very real need to solve the health care crisis that confronts us all.

Affordability: the keystone of health reform
Another hot issue dominating Congress’ negotiations is affordability.  Health reform can only succeed if it makes coverage truly affordable for families.  One of the most compelling arguments for federal government participation in health reform has always been that the federal government has the resources as well as the infrastructure to help Americans afford the cost of private health insurance. State governments can and should be working on reforming aspects of the healthcare system including insurance regulation, containing costs within their healthcare infrastructure and providing consumers with more education and tools to address lifestyle issues. However, most states (including Utah) do not have the resources to provide subsidies on a large scale or to expand their Medicaid programs in the best of times, let alone during an economic downturn, when these programs are most needed.

Beyond these practical considerations, there is a philosophical precedent to addressing affordability at the federal level. Our national approach to issues of public well-being has always been to allow the private marketplace to provide the goods and the government assists consumers in purchasing those goods. Homeownership is the best example of this philosophy. The private marketplace provides the goods—homes, financing, etc and then the government helps consumers have access to those goods through guarantees on mortgages, tax deductions for interest payments on mortgages, and rent subsidies for the lowest income residents. We, as a nation, decided this was a better approach than having the federal government plan, design and construct homes or neighborhoods.

A similar philosophy undergirds the affordability provisions within national reform. Most of the newly insured will pick up insurance in the private marketplace. Those who need it will get government-funded subsidies to help pay their portion of the premium.  Those without a reasonable offer of coverage in the workplace (most poor adults, including childless adults), will become eligible for Medicaid.

All of this sounds good in the abstract, but what about in practice? As the Senate and House complete their negotiations, differences around affordability will be a critical sticking point. The Senate bill provides somewhat better protections of middle income workers.  However, the House bill provides a stronger subsidy program, especially for those earning less than 200% of the poverty level–most of the uninsured.  In addition, the House offers better benefits to those that qualify for the subsidy and invests more resources into subsidies–$900 billion compared to the Senate’s $600 billion. A couple billion here, a couple billion there and pretty soon you’re talking real money!   There’s no question: the $300 billion difference between the two bodies could be the most difficult hurdle to overcome.  We urge the delegation to support the best elements of both approaches to create a final bill that will protect all Utah families from costs they cannot afford.

The Utah Multicultural Health Network (MHN) is on fire these days preparing for a busy legislative session but also gearing up for the introduction of Healthy People 2020, the nation’s 10-year blueprint and framework for eliminating health disparities. MHN will be working with the state’s Center for Multicultural Health and other key partners in DHS and DWS and the Federal Office of Minority Health’s Utah liaison to create, at long last:  an integrated blueprint. The idea here is to ‘sing off the same song sheet’ to the extent possible so that we might get more done and get underneath the more perplexing challenges related to the broader socio-economic determinants (SED) of health.

On December 17 MHN and UHPP convened a group of about 36 minority health leaders in the state. This group gave tremendous input on the Blueprint project and formed a working group to start work on the Blueprint. Stay tuned for further details about a community forum that will be organized to shape the draft Blueprint that this group come up with.

The good news is that the Healthy People 2020 framework places a heavy emphasis on SED: so we won’t be alone as we endeavor to create better economic and educational opportunity for all communities.

In the meantime, please take a moment to review these materials:

* MHN Policy Committee’s Draft Priorities for the 2010 Session of the Utah Legislature
* Healthy People 2020 Draft Objectives (NOTE: public comment period has been extended to February 12, 2010)
* National Partnership For Action Strategic Framework
These documents will be critical in the weeks and months ahead. Be sure also to register for the upcoming Advocacy Training for Busy People, an exciting collaborative effort between UHPP, MHN, and Enrich Utah (new name for Utah’s immigration coalition).  Lots to do together in 2010!

–Judi Hilman, Executive Director