Doctors for America Weekly Update

[dhnpe...@aol.com]

Friends and Colleagues:

Weekly update from Doctors for America for you to browse through. I have been off the air a little bit due to a tough and busy 2 weeks. Hope that all of you had a great Thanksgiving holiday!

Don

The Audacity of Health Care for All

-----Original Message-----
From: Ali Khan, Doctors for America <in...@drsforamerica.org>
To: dhnpe...@aol.com
Sent: Thu, Dec 3, 2009 12:25 pm
Subject: Doctors for America Weekly Update

Dear donald,

Comprehensive health reform must accomplish three main objectives:  cost containment, improved access to health insurance coverage and improved quality of care.  Over the next three weeks the Doctors for America newsletter will examine each of these pillars and how they are addressed in the current health reform legislation.

Much has been written about the $848 billion dollar price tag that accompanies health care reform, so this week the Doctors for America newsletter will focus on the facts surrounding cost containment.  The non-partisan Congressional Budget Office estimated the Senate reform bill will reduce the deficit will also controlling the rising costs of premiums. Broader questions about how to control skyrocketing costs of care continue to remain front and center as the Senate opened debate this week on it's version of reform legislation.

Two cost containment solutions proposed in the Senate bill include establishing an Independent Medicare Advisory Board, and taxing high cost employer-based insurance coverage.

Physicians Making A Difference: Highlights from the last week - On November 25th, Doctors for America membership passed the 16,000 mark. - Dr. Zahid Imran (LA) attended a local pro reform rally and had a health reform "party" at his house where he collected 25 sigs for the Public Option petition.   - Dr. Hershey Garner (AR) was a part of a health care forum with premed students and former Senator David Pryor at the University of Arkansas in Fayetteville. - Doctors for America's board met in Boston November 22nd and November 23rd, and completed a training on how to better organize communities across our nation. - Dr Andrew Loehrer (IN), state director of Indiana, participated in a rally  the Saturday of the crucial Senate procedural vote. - Doctors for America launched its public option petition. - Dr. Sultan Rahaman (FL) reported on his meeting with Senator Nelson (D-FL) to the Seminole County Medical Society. - Dr. Julian Harris and Dr. Ricky Grisson (MA) planned and held a patient-doctor townhall in Boston on December 3rd. - New York City DFA members gathered to discuss policy over drinks on December 3rd. - Doctors for America, CIR, NPA and AMSA flyered commuters in Washington, DC and delivered posters that illustrated half a million doctors want reform this year to the Senate.    - Dr. Don Nguyen (OH) had a phone meeting to thank Representative Joseph Cao (LA), the lone Republican vote for the House version of health reform.   Top 3 Stories - NEJM - Controlling Health Care Spending - NY Times - Wrong Health Care Battle - NEJM - Getting the Facts Straight on Health Reform      What you can do this week Sign Up to Speak in Faith-Based Communities As physicians and physicians in training, our voice has the power not only to shape our profession, but to speak out for the core values of medicine in our communities. Many congregations are interested in understanding our health system's problems better, but need someone with first hand experience to talk to them. Are you willing to take your experience into the community? All you need is your own experience and a willingness to share with others. We'll provide you with orientation material and an orientation call to get you ready. Sign up on our site to get started. Sign up to speak in faith-based communities

Key Policy Developments 1.  CBO The Congressional Budget Office released a new report on Monday that the Senate health reform bill would significantly reduce costs for many people who buy health insurance on their own (on the “individual” insurance market). CBO also estimates that premiums for the majority of Americans who receive coverage from their employer would not substantially change.  The CBO analysis compares premium rates under current laws and how they would change if the legislation would be fully implemented. For those who buy insurance on their own, approximately 18 million Americans will qualify for affordability credits (those making less than $73K for a family of three) and will see their premiums fall 59 percent. For those who get their insurance through their larger employer - which account for nearly 70% of Americans- they would see their premiums hold steady or drop by up to 3 percent.   Small employers, representing 13 percent of the market, would see premiums fall by up to 2 percent. About 12 percent of very small employers - those with generally lower wages - would qualify for tax credits, causing their premiums to fall by 8 percent to 11 percent. At the same time, the legislation would fine people who don’t enroll, with some exemptions. The Senate penalty would phase in, from $95 per person the first year - 2014 - to $750 per person by 2016. Read the full CBO report here: CBO Or more from the NY Times: NY Times (12/01) 2. Independent Medicare Advisory Board To address the issue of escalating Medicare costs and the looming insolvency of the Medicare hospital insurance fund in 2017, the Senate health reform bill establishes an Independent Medicare Advisory Board (IMAB). The 15-member Medicare Advisory Board would be required to recommend changes to the Medicare program “to reduce excess cost growth and improve quality of care for Medicare beneficiaries” if Medicare cost were projected to be high.  In an attempt to shield the proposals from the political process, the board’s proposals would be automatically implemented by HHS unless Congress blocks them and produces legislation with the same savings. Current bill language prohibits IMAB from making recommendations that would ration care, raise taxes, raise premiums, increase cost sharing, restrict benefits, or modify eligibility criteria.  Additionally, IMAB cannot regulate physician or hospital payment until 2020. CBO estimates IMAB will save Medicare $23 billion from 2015-2019.  The board would be made up of physicians and non-physicians appointed by the President and confirmed by the Senate to serve six-year year terms. Read more about IMAB and other cost cutting measures: NY Times (11/25) 3. Excise Tax Taxing employer-based insurance coverage receives mixed reviews from economists, unions and health care proponents. Under the current exemption, employers buy health insurance benefits with pre-tax dollars for their employees, who then accept lower wages in exchange for coverage.  The Senate health reform bill a proposes a new 40-percent excise tax on any high-cost insurance policies, or “Cadillac” plans. Any portion of health insurance benefits currently valued above $8,000 for individuals and $21,000 for families would be subject to the tax, which would be paid by insurance companies.   Over time, some economists argue this would create an incentive for employers and insurers to keep health benefits below the tax threshold - transferring the savings to employees in the form of taxable cash wages to subsidize the costs of health reform.  Others argue that taxing benefits will not drive down costs and will create a new burden on more workers when the inevitably rising cost of coverage creeps closer and closer to the "luxury" level the tax is intended for - ultimately shifting the burden to workers who have worked alongside their unions to negotiate good benefits through their contract negotiations. The House health reform bill does not include this provision excise tax. To read more about the excise tax proposal, go to: Washington Post (10/20)

Thank you to all of you who emailed us to let us know what you've been up to. Your e-mails provide the content for the "Physicians Making a Difference" section.

Thank you, also, for your feedback. Let us know how we can improve this newsletter. Remember, you can share this newsletter via facebook, twitter, or linkedIn. You can also download this newsletter as a PDF or listen to it via iTunes.

Sincerely,

Ali Khan and the Doctors for America Team

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Doctors for America is a grassroots group of over 16,000 physicians and medical students in all 50 states. Together we are committed to building a health system that works better for us and better for our patients. To stop receiving these messages, please click here: drsforamerica.org/cgi-bin/unsubscribe.pl?id=VpImvbzFJb9y. To contact us please e-mail in...@drsforamerica.org

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[dhnpe...@aol.com]

Friends and colleagues:

Weekly update from Doctors For America. Important information on the Public Option so-called Compromise. Why not have both Medicare expansion to patients between 55-64 yrs old and a public option?

Best,

Don Nguyen

The Audacity of Health Care for All

-----Original Message-----
From: Ali Khan, Doctors for America <in...@drsforamerica.org>
To: dhnpe...@aol.com
Sent: Thu, Dec 10, 2009 3:15 pm
Subject: Doctors for America Weekly Update

Dear donald,

This week, we focus on the important and timely topic of access to care and coverage for our patients.  The issues of abortion, a public option compromise and health insurance exchanges have all been a part of headlines around the nation.  While debate on controversial amendments dominated the Senate floor this week, the legislation continues to move closer to a final vote, expected in the next 2 weeks.

As the Senate continues to work, the Doctors for America field team has focused on building stronger communities so physicians can continue to share their voices in this process and build a grassroots base of physician support for health reform.  Look for updates on visits to Rhode Island and Connecticut soon.

Physicians Making A Difference:

Highlights from the last week

-Dr. Milan de Vries and Dr. Alice Chen visited Baton Rouge and New Orleans, Louisiana to meet and help organize local physicians and medical students there.  They joined Dr. Zahid Imran in gathering dozens of signatures for the Public Option Campaign. -Dr. Heidi Sinclair (LA) wrote to Senator Landrieu on behalf of Louisiana’s Doctors for America to thank her for her continued support of moving the health reform bill forward. -Dr. Philip Caper (ME) published a piece about how the practice of medicine has changed over the last generation. -Dr. Zaneb Beams (MD) was interviewed by the Baltimore Business Journal about Health IT and small businesses. -Dr. Chris Hughes (PA) was a guest on KDKA radio’s Mike Pintek Show. -Dr. Mandy Krauthamer Cohen (DC) attended an event at the White House where President Obama announced new funding for Community Health Centers. -Dr. Arthur Yeager’s (NJ) letter to the editor, “A Health Care Battle on Many Fronts” was published in the New York Times.  -Dr. Jan Sarnecki’s (WI) letter to the editor, Doctors see need for health care reform, was published in the Appleton Post Crescent. -Dr. Megan Sarnecki (MT) spoke to about 150 people at the Holy Spirit Episcopalian Parish in Missoula about Health Care Reform last month. -Columbia University Hospital residents Drs. Sasha Cornell and Bernard Ashby (NY) organized a Health Reform Happy Hour to sign the public option petition and begin building the Columbia University community. -Medical Student Jesse Powell’s (UT) email outreach to the University of Utah helped push the state into the lead of all other mountain west states for Public Option signatures.   Top 3 Stories Latest from Atul Gawande and the New Yorker: How the Senate bill would contain the cost of healthcare   Urban Institute Report: Getting to a Public Option that Contains Costs: Negotiations, Opt-Outs and Triggers Commonwealth Fund and David Cutler: Why Health Reform Will Bend the Cost Curve

What you can do this week

Take 2 minutes to get the facts on why health reform can't wait. Watch the video. Share it with your friends and family, write a letter to the editor about how it reflects your experiences, or are you yourself one of those statistics?

Key Policy Developments 1. Public Option Compromise As has been widely reported, the Gang of 10 Senators – 5 moderate Senators and 5 progressive Senators - has reached a compromise on the public option in order to move the health reform process forward.  While exact details will not be released until the Congressional Budget Office (CBO) completes their cost analysis, many of the overarching elements have been reported. The compromise would empower  the Office of Personell and Management to select insurance plans for consumers in the health insurance exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would be offered on the exchanges in every state. If insurance companies don't step up to offer such plans, that will trigger a national public health insurance option. For uninsured people aged 55-64, an option to buy-in to Medicare will be available in 2011, three years before health insurance exchanges will open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance. However, after the exchanges launch, a Medicare option would be offered in the exchanges, where people could pay into it with their subsidies. Lastly, in addition to the new insurance options, there will be new, strengthened insurance regulations – though details are scarce on what this might be. The compromise language was sent to CBO for analysis and it is expected to be unveiled this weekend or early next week. Read more about a possible Medicare buy-in for people ages 55 to 64: Kaiser Family Foundation For more information on the compromise: New York Times   2. Exchanges: The Best Kept Secret of Why the Reform Bill will Improve Health Care The involvement of the Office of Personnel and Management (OPM) in a possible compromise proposal in the Senate, returned focus to a central element of both the House and Senate reform bills - insurance exchanges. In the compromise, OPM, which manages the insurance exchange in which Federal employees purchase insurance, would also be tasked with selecting one or more non-profit plans to be included in a new exchange.   Both the House and Senate bills use such exchanges to improve access to insurance for individuals not covered by employer-sponsored plans and for small businesses. Consumers would be able to chose from among the plans offered in the exchange, all of which would have to offer certain minimum benefits and which would not be allowed to discriminate based on factors such as pre-existing conditions. This direct competition would increase consumer power, help control rising premiums, and spur innovation.   More reading: Ezra Klein 3.  Abortion Funding Restriction Amendment Fails The Senate voted Tuesday against adding tougher abortion insurance restrictions to the health care bill. The amendment proposed by Senator Ben Nelson (D-NE), was tabled (or set aside) by a vote of 54 to 45 with two Republicans Senators Susan Collins and Olympia J. Snowe of Maine, joining 50 Democrats and two independents to defeat the Nelson proposal.   The Nelson amendment would have barred any health plan from covering abortion procedures that was in any part funded by new federal subsidies - mirroring restrictions included in the House health reform bill proposed by Rep. Bart Stupak (D-MI). Under existing federal law, generally referred to as the Hyde amendment, government money cannot be used to pay for abortions, except with rare exceptions for rape, incest and the health of the mother. The language in the Senate bill would allow private plans to cover abortions. The bill would require at least one government-approved plan in each state to cover abortions and at least one government-approved plan in each state not to cover abortions.  Federal dollars could not be used to pay for abortions, so the Senate bill would require insurance plans to segregate privately paid premiums to use that money for abortions.   While the vote to table the amendment was a victory for the pro-choice community, the issue remains a sticking point as the House version of the health reform bill contains more stringent funding language.  Once in conference committee, the differences in language will have to be reconciled. Read more about the politics of the abortion discussion in health reform: NEJM