Thursday’s 6+ hour bipartisan federal health reform summit focused on discussing each party’s solutions for cost containment, insurance reform, expanding coverage, and reducing the federal deficit.  A clear take-away message was how much consensus there really is in health reform–everything from stopping insurers from rescinding health plans to not having annual or lifetime benefit limits, and most fundamentally that as a nation we have to act and pass health reforms.

However, fundamental differences do exist.  Especially around whether or not the goal is to pursue comprehensive vs incremental change,  is expanding access or containing costs the top priority, and should government or markets set the standards.

However, almost each summit participant relayed a tragic story they had heard from one of their constituents—stories we hear every day in Utah from our families and neighbors. This fact alone underscores the need for Congress to pass comprehensive health care reform now; the consequences of nothing are too dire—for our families, for small businesses, for our economy, and for the fiscal soundness of our government.  But time is running out to pass reform; we cannot let the door close on this historic opportunity

Thursday night, UHPP hosted a discussion around the summit.  To watch the clips we showed at our event, click on the links to the video then jump to the time marks noted below

C-SPAN video of the 1st half of the event can be found here.
President Obama’s opening: 13:04 to 15:26
Senator Alexander’s opening: 20:34 to 26:00
Senator Coburn on containing cost: 59:19 to 64:25
Rep. Hoyer on containing costs: 71:02 to 75:04
President Obama on insurance reform: 125:12 to 126:09
Rep. Boustany on insurance reform: 126:51 to 133:13

C-SPAN video of the 2nd half of the event can be found here.
Senator Harkin on common areas & incrementalism: 10:19 to 12:49
Vice President Biden on Medicare: 46:00 to 29:25
President Obama’s closing: 179:21 to 197:20

Today marks the start of week 5 of the legislative session.  Legislators will now have floor time every afternoon from 2:00 to 4:00 in addition to their morning session 10:00 to 12:00.  Check out the latest edition of our bill tracker to see how health bills are progressing.

The Health and Human Services Appropriations Committee made recommendations to trim 5% from the Department of Health and Human Services’ budget.  As part of the package of $23.5 million in cuts, the Committee recommended two very harmful cuts to Medicaid eligibility:

1. Eliminating the Medicaid Medically Needy Program for children and pregnant women. Serving over 4,000 individuals every year, the program allows families with a seriously injured or ill child to qualify for Medicaid by ‘spending down’ their income to qualify for coverage on the rest of their healthcare bills.  These individuals are so desperate for health care that they are prepared to completely impoverish themselves in order to get help for the rest of their care. They have nowhere else to turn.
2. Reducing the asset limit for low-income pregnant women from $5000 to $3000.  The Utah Department of Health estimates that 5,600 women will lose their health benefits if this change is made.  Utah is one of only 7 states that look at a woman’s assets at all in determining eligibility. It bears noting that a $3,000 asset limit would be the most restrictive in the nation.

But Utahns are not standing idly by and letting these cuts go forward.  This past week Utah families, providers, and advocates came up to the Capitol to meet with legislators and show how important these programs are in terms of cost avoidance, furthering the goals of health reform, and economic recovery.

Some of the press coverage can be read here.    KCPW Deseret News Salt Lake Tribune

Now it’s YOUR turn to speak up for these basic human needs:  please contact members of the Executive Appropriations Committee and tell them that kicking seriously injured and ill children along with pregnant women off of Medicaid is no way to balance the budget.  Ask them to restore funding for the Medically Needy program and keep the asset limit for pregnant women at $5,000.

Call these numbers while the legislators are in session, generally M-F 8:00 AM to 5:00 PM:

House: (801) 538-1029                   House toll free: (800) 908-4261

Senate: (801) 539-1035                  Senate toll free: (800) 613-0677

When you call, ask for the legislator. If he or she does not answer, tell the operator you want to leave a message on their Blackberry. In that message, ask the legislator to call you back (leave your #).

A key provision of Speaker Clark’s HB294 is the expansion of the risk adjuster mechanism within the Exchange to the whole small group market in Utah.  This wonky term actually refers to a fundamental tool we must use to stabilize the Exchange and ensure it doesn’t become a magnet for sick Utahns.

A risk adjuster (RA) works by determining which insurance carriers are experiencing significant risk and the best way to mitigate that risk.  As a first step, carriers pay into a risk adjustment pool. Those funds are then redistributed to carriers that have attracted risk in excess of what was anticipated.  The redistribution of funds must be approved by the RA Board (RAB), which is comprised of insurance executives and others representing the state, businesses, and consumers.   To date, the RAB has not yet redistributed any funds.

If insurance companies are private businesses with a motive to make profits, why should the state penalize successful companies and help the weak ones? The answer is that the creation of the Exchange fundamentally altered the business model for insurance companies. With this alteration came a lot of uncertainty for insurers. To give these companies time to adjust their business practices to the new reality, it was important to have safeguards for insurers. Otherwise, there was a real risk those companies would pull out of the Exchange and maybe out of providing insurance in the small group market altogether. Thus the risk adjuster is in place to stabilize the private market so that it can serve as the main platform for state health reforms.

Speaker Clark’s HB294 has stimulated a good deal of misunderstanding and misinformation about the purpose of the risk adjuster. The bill language on this is deliberately vague because the risk adjuster mechanism is still under development.  While there are no guarantees that this expansion will work to equalize premiums inside and outside the Exchange, experience with risk adjustment mechanisms tells us this is the only way forward. Furthermore, there are no guarantees that the risk adjuster will do anything to lower premiums enough to entice the uninsured to obtain insurance–that’s actually what affordability provisions and individual mandates are for. What the risk adjuster might do is set up a laboratory to meet these goals by other means. In this, the risk adjuster is the latest in a long line of Utah government experiments meant to foster private sector innovation. In this respect, it is in good company with programs like USTAR (Utah Science, Technology and Research initiative) and Utah charter schools. Simply put, the Statewide RA exemplifies private market, state-based health reforms.  It is not socialized medicine or the single-payer conspiracy that some have claimed it to be. UHPP has authored a brief on the topic to explain what the risk adjuster is and is not, and what the expansion might do to stabilize the private market for small groups.  Read our new report here.

The future of federal health reform may be determined at the White House’s special bipartisan health reform summit this Thursday, 2/25.  The summit provides one final opportunity for bipartisan engagement in the reform process.  Moving forward, UHPP would like to see a stronger commitment to bipartisanship from both parties. However, comprehensive health reform cannot wait another year. This means it’s time to bring robust Republican proposals like Sen. Bennett’s Healthy Americans Act to the table for due consideration or possible integration into the other worthy proposals—like the one passed by the Senate on Christmas Eve.

Now we expect most of you won’t drop everything you are doing for a 4-hour date with C-SPAN.  But, if you want to catch more than the 30-second media sound byte, join us to watch and discuss the highlights! UHPP will edit the summit down to the essentials, with a special focus on members of Utah’s congressional delegation and possibilities for true bipartisanship.

What: Highlights of Bipartisan Health Reform Summit + Strategy Discussion

When: Thursday 2/25 6:30 to 8:00 PM

Where: Presentation Room, 1^st Floor of Utah’s Capitol

RSVP to events@healthpolicyproject.org TODAY for directions and more information.

This morning, the President released his own proposal, Stability & Security for All Americans.  This seeks to bridge some of the differences between the Senate and House bills which were passed late in 2009 while removing the distasteful deals that were made to win the support of Blue Dog Democratic senators late last year.  Learn more about his proposal here

Key elements include:

• Medicaid for everyone at or below 133 percent of federal poverty level
• Removes special Medicaid funding for Nebraska
• Raises funding for community health centers to $11 billion over 5 years
• Does not include a public option
• Sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.
• Brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
• Ends discrimination against Americans with pre-existing conditions.
• Closes the Medicare prescription drug “donut hole” coverage gap

A local drywall contractor Fred Ochsenhirt is unusual in his industry for offering health insurance to his 4 employees—and it’s a big challenge to compete with companies that don’t.  The slow-down in construction over the past year has significantly reduced the amount of work available, making it even more difficult to cover his portion (50%) of the premium. At the last renewal, premiums rose 20%, which means that coverage for a family with children now costs more than $1200 per month!

Unfortunately, this Utah small business owner’s story is all too common.  As our small businesses are tightening their belts, they either stop providing coverage or reduce the quality and scope of that coverage.  And most concerning of all, instead of giving merit or cost of living increases employers are redirecting that money to pay for skyrocketing health care premiums.

Reason #2 to support federal health reform: Health care reform will boost our nation’s economic health & support small businesses by…

• Creating 250,000 to 400,000 new jobs in the next ten years by lowering health care costs, which in turn lowers the cost of doing business;
• Reducing the deficit by $130 billion over the next 10 years, which puts our country on the path to long-term financial stability;
• Containing rising health care costs which hamper innovation and entrepreneurial efforts of our small businesses—the engine of our economy and recovery;
• Providing tax credits to help small businesses afford coverage for themselves and their employees.
• Ensuring affordable insurance choices for small business owners, encouraging  business development and expansion.

…AS IF you needed another reason to support comprehensive federal (and state) health reform!

Now is the time to email or call members of Utah’s congressional delegation and urge them to work with the President in passing comprehensive health reform!

Senator Orrin Hatch
D.C.:(202) 224-5251
Salt Lake: (801) 524-4380
Provo: (801) 375-7881
St. George: (435) 634-1795
Email Through Website

Senator Bob Bennett
D.C.: (202) 224-5444
Salt Lake: (801) 524-5933
Provo: (801) 851-2525
St. George: (435) 628-5514
Email Through Website

Congressman Rob Bishop
D.C.: 202-225-0453
Ogden: 801-625-0107
Brigham City: 435-734-2270
Salt Lake: 801-532-3244
Email Through Website

Jim Matheson
D.C.: (202) 225-3011
Salt Lake: (801) 486-1236
St. George: (435) 627-0880
Price: (435) 636-3722
Email Through Website

Congressman Jason Chaffetz
D.C.: (202) 225-7751
Provo: (801) 851-2500
West Jordan: (801)282-5502
Email through website

Check out this recent report on Utah HMOs serving 40% of Utahns with insurance coverage, including enrollees in Medicaid and CHIP managed care (Molina and Healthy U only).  In this yearly report, state averages are compared with national averages. Key findings include:

• Commercial HMOs had the most room for improvement, scoring above the national average on only 30% of the measures reported. Commercial HMOs have room for improvement in cancer screenings (colorectal, breast, and cervical).

• CHIP did reasonably well when compared to the national averages, exceeding the national averages on 50% of the measures reported. CHIP excelled in both childhood immunizations and appropriate treatment for children with upper respiratory infections.

• Medicaid HMOs scored above the national averages on over 60% of the measures reported. While Medicaid HMOs excelled in some areas including adult’s access to preventive services, they also have areas that need improvement, such as Chlamydia screening in women.

It’s nice to see Utah’s Medicaid managed care plans comparing well against national average, though we are only seeing part of the story.  While there is reason for confidence, the quality of care received by Medicaid beneficiaries enrolled in Select Access (part of Select Health, which is ultimately part of Intermountain Healthcare) is difficult to measure and this is because this plan is not on a capitated or full risk basis. One reason to return all of Medicaid and CHIP to capitated managed care is for the sake of quality comparisons like the HEDIS measures that are used in this report.

We hit the half-way point to the session this week.  Legislation is moving quickly.  Check out the latest edition of our health bill tracker

Last week the Health and Human Services Appropriations Committee made recommendations to trim 5% from the Department of Health and Human Services’ budgets.  Sadly, as part of the package of $23.5 million in cuts, the Committee recommended two very harmful cuts to Medicaid eligibility.

First, the committee recommended eliminating the Medicaid Medically Needy Program for children and pregnant women.  The Medically Needy Program, which serves over 4,000 individuals every year, allows families with a seriously injured or ill child to qualify for Medicaid by ‘spending down’ their income to qualify by paying the state or using their excess income to pay some of their healthcare bills.   These individuals are so desperate for health care that they are prepared to completely impoverish themselves in order to get help for the rest of their care.

Second, the committee recommended reducing the asset limit for low-income pregnant women from $5000 to $3000.  The Utah Department of Health estimates that 5,600 women will lose their health benefits if this change is made.  Utah is one of only 7 states that look at a woman’s assets at all in determining eligibility. It bears noting that a $3,000 asset limit would be the most restrictive in the nation.

In addition to making it more difficult to qualify for expecting mothers to qualify Medicaid, the committee recommended dumbing down the benefit package by eliminating dental and vision coverage.  Dental care in particular is critical to both containing costs and improving the health of newborns.

If these cuts are adopted by the Executive Appropriations Committee and the full Legislature, nearly 10,000 low income Utahns would join the ranks of the uninsured.  As Utah tries to prove it is a leader in health care reform, such a move is totally unacceptable.

It is imperative that we contact members of the Executive Appropriations Committee and tell them that kicking seriously injured and ill children along with pregnant women off of Medicaid is no way to balance the state budget.  Ask them to restore funding for the Medically Needy program and keep the asset limit for pregnant women at $5,000.

On Wednesday the Utah Medicaid Partnership will be holding a press conference highlighting the impacts of the following proposed Health Human Services Appropriations budget cuts (described in another blog post here) on low-income families:  UMP is very concerned about:

• Elimination of the Medically Needy program for children and pregnant women (4,000 children and pregnant women); this is the group of children facing catastrophic medical situations and pregnant women who now have the option to ‘spend down’ their income into Medicaid eligibility. The state is moving to eliminate this option for these desperate families.
• Reduction of the asset limit for pregnant women from $5000 to $3000 (5600 fewer mothers would qualify for Medicaid under this proposal), diminishing their access to cost-effective prenatal care.
• Medicaid optional services (PT, OT, Audiology, eyeglasses, dental services) will not be restored.
• Provider reimbursement rates remain low, leaving Medicaid beneficiaries with diminished access to cost-effective care.

The press event will be from 1:15 pm to 1:45 at the State Capitol in the Senate Building’s Olmsted Room. Medicaid beneficiaries, providers and advocates will be on hand to discuss the impact of Medicaid eligibility cuts and services reductions on the lives of Utah families.

For those who can stay after, we will be meeting with legislators afterward to discuss revenue alternatives to proposed cuts in eligibility.