by M. Wuerker (in Politico March 5, 2009)

Many stakeholders and special interest groups may become uneasy as the Administration makes progress towards reforming health care. Considering the current state of the system, can we really make things worse or is there nowhere to go but up? Leave me a comment and tell me what you think about this week’s satire feature.

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Melody Barnes, Director of Domestic Policy during the White House Forum on Health Reform (photo by Pete Souza)

ARRA and You (Part I).  The “fierce urgency of now” is the concept that President Barack Obama used to explain why he would run for president. Yet it can also be used to characterize his motivation and subsequent actions in the push to reform health care.

With the new legislation, American Recovery and Reinvestment Act of 2009 coverage for millions was protected or extended.

1. Health insurance coverage for 7 million Americans was extended via insurance premium assistance for COBRA benefits.
2. Families are no longer in jeopardy of loosing current benefits from Medicaid and CHIP due to $15 billion in Federal Medical Assistance Percentage funding allocated to states.

Without pause, the President continues to move forward his agenda for reform. The release of a budget blueprint, proposes a $634 billion reserve fund to extend coverage to some of the 47 million Americans who are currently uninsured. “This is the first step towards getting health care reform done this year,” White House domestic policy adviser Melody C. Barnes told allies on one conference call. “We can’t underestimate the importance of rallying around this budget. It serves as a footprint for something bigger.” In contrast, others express doubts about the prospects for overhauling health care. For example, Sen. Mike Enzi, the senior Republican on the Senate Health, Education, Labor and Pensions Committee stated, “It needs to be done up front and quickly. I’m not so sure that we haven’t already lost that, with so many other things coming in and weighing us down.” As was the case in bringing a stimulus package into law, it appears the President will remain undaunted and continue to seize the opportunities created by environment, his political capitol, his strategic leadership and timing to accomplish the essential goals of his health agenda:

1. providing affordable, comprehensive and portable health coverage for every American;
2. modernizing the U.S. health care system to contain spiraling health care costs and improve the quality of patient care; and
3. promoting prevention and strengthening public health, to prevent disease and protect against natural and man-made disasters.

As he so aptly noted in his address to a joint session of the Congress,

“[Health-care costs are] one of the major reasons why small businesses close their doors and corporations ship jobs overseas…This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. ….Given these facts, we can no longer afford to put health-care reform on hold.”

So it is no surprise that on the following Thursday, March 5 the administration convened the White House Health Reform Summit. The event sought to convene the varied stakeholders in the health care reform debate and ultimately, get buy-in. The President stated, “I want to be very clear, at the outset, that while everybody has a right to take part in this discussion, nobody has the right to take it over and dominate.” Participants included leaders from the (American Medical Association) AMA and other medical specialty societies; trade groups for drug makers, insurance companies and hospitals; CEOs of companies including Pfizer and General Mills; advocacy groups such as the American Heart Association and American Diabetes Association; and unions such as SEIU and the Teamsters.

Lawmakers also met on Thursday as they have been given the task of working out the details and writing the actual legislation around several key principles set forth by the President:

• maintaining choice of insurance and doctors,
• ensuring affordable coverage,
• protecting Americans’ financial health,
• investing in prevention and wellness,
• improving patient safety and quality of care.

If you missed the live coverage on CSPAN, you can find a summary and important document links at the White House blog and continue to follow the entire process of health care reform at the newly launched HealthReform.gov. Opponents to the progress of health care reform will have take notice of “the fierce urgency of now” momentum and perhaps much more are already on the President’s side. Regional White House Forums on Health Reform are currently under way to expand upon what was gained at the White House forum.

Sources:

Obama Has Big Challenges In Overhauling Health Care {Obama Has Big Challenges In Overhauling Health Care (2009, February 21) [Electronic Version]. The Washington Post} and Obama Proposes $634 Billion Fund For Health Care {Connolly, C. (2009, February 26) Obama Proposes $634 Billion Fund for Health Care [Electronic Version]. The Washington Post, A01} and Brown, CB. Obama wants Congress to Weigh In (2009, March 6) Politico, p. 3 (Volume 3: Number 24)

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Health and the 44th Presidential Administration (Part III). In three nearly back-to-back announcements, President Obama is working prodigiously to fill his leadership roster for health care. Of course, the most newsworthy was his selection of Kansas Governor Kathleen Sebelius as Secretary-designate of the Department of Health and Human Services (HHS). The White House Office of Health Reform, however will be lead by Nancy Ann DeParle who headed up the Center for Medicare & Medicaid Services during the Clinton administration. The administration may deem DeParle, a Beltway-insider, as having a greater amount of political clout to handle what is sure to be high-stakes negotiation within the White House Office of Health Reform. Both women have a depth of experience in health care financing and health insurance, a stakeholder group incidentally with a powerful voice in previous rounds of the health reform debate.

The Office of National AIDS Policy is set to be led by Jeffrey S. Crowley. With a background in public health, Crowley will bring the appropriate knowledge for managing the health of populations and the dynamics of epidemics in leading the effort to set an appropriate national policy. He will also serve as a member of the Domestic Policy Council. The President stated the following:

“In [AIDS and disability policy], we continue to face serious challenges and we must take bold steps to meet them. I look forward to Jeffrey’s leadership on these critical issues.”

Mary Wakefield has been appointed Administrator of the Health Resources and Services Administration (HRSA). President Obama made the following comments regarding her appointment:

“As a nurse, a Ph.D., and a leading rural health care advocate, Mary Wakefield brings expertise that will be instrumental in expanding and improving services for those who are currently uninsured or underserved. Under her leadership we will be able to expand and improve the care provided at the Community Health Centers which serve millions of uninsured Americans and address severe provider shortages across the country.”

For even more insight into this health braintrust, check out what’s on the bookshelf (a widget to the right) featuring books and articles with references and contributions from these political appointees. Several leaders are now in place and not a moment too soon. With the American Recovery and Reinvestment Act of 2009 now signed into law and the more recent unveiling of the budget proposal for 2010, there is plenty of (health care) work to be done.

Sources:

Sebelius at HHS at the White House Blog and Administrator of HRSA Announced and Obama Names Head of AIDS Policy Office and Obama Picks Kansas Governor Sebelius as Health Secretary – washingtonpost.com.

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44 to increase portions of health insurance and cover more currently uninsured children

Last week, by a margin of 66 to 32 votes (including 9 Republicans), the Senate approved expansion and reauthorization of SCHIP and today, President Obama signed that bill into law. This legislation was resurrected and revised after two vetos by former President Bush and began making its way through the Congress once again scarcely a week before the Inauguration. The critical health insurance program administered by the states, expands medical coverage to some 4 million children nation-wide whose parents do not qualify for Medicaid. This is estimated to bring the total number of children enrolled in the program to 11 million. Many of these families are newly unemployed or part of the legions of working poor in this country. With the passage of this law, we can count this as the first victory in the Obama plan to reform health care in this country.

Watch: Video of the signing ceremony at the White House

Sources:

Obama Views Children’s Health Bill as Step One at washingtonpost.com

Senate Approves Children’s Health Bill at NYTimes.com

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Health and the 44th Presidential Administration (Part II). The New York Times editorial is believed to have crystallized the issues of the current political climate and helped former Senator Tom Daschle choose to remove his name from further consideration and confirmation as Secretary of Health and Human Services.

Despite Daschle’s legislative policy expertise and significant history working on health policy issues, his work at Alston & Bird, LLP (though not as a registered lobbyist) and the mounting opposition from Senate Finance Committee Republicans may have ultimately proved an albatross to great to bear. Perhaps, it is ironic that the very attributes that would suggest former Senator Daschle would be a tremendous asset to shepherding and ultimately passing health care reform in America (ie. legislative policy expertise and significant familiarity with policy and industry stakeholders) is also the gauntlet that forced the President’s nominee and friend to fall short of the new ethical standards placed upon this administration.

What does this mean to the average health consumer?

Substantively, the elements of the Obama health plan will not change as the remainder of the President’s braintrust for health remains in tact. If former Senator Tom Daschle were the heart of that effort, then his former co-author, Dr. Jeanne Lambrew is (if at least in part) the brains of the effort. Only time will tell as elements of health reform begin to make their way through the legislative process if there exist another health care champion with the political moxie to accomplish what the Clintons could not back in the 1990’s—reform America’s health care system.

Read:

Editorial – The Travails of Tom Daschle – NYTimes.com.

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by Vic Harville Little Rock, Arkansas

Today’s House vote to expand SCHIP brings Americans one step closer to universal access to health insurance. With a vote of 289 to 139, the House passed a bill to expand the capacity of State Children’s Health Insurance Plans (SCHIP) from 6 to nearly 11 million enrollees. Earlier versions of this legislation were vetoed twice by President Bush but President-Elect Obama stated, “In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens.”

Specifically, the current crisis in unemployment has left an increasing number of families in the difficult position of making too much to qualify for Medicaid but too little to pay the extremely expensive premiums for health insurance offered through COBRA once an employee has lost his or her job. Combine this fact with the trend for health insurance policies toward providing less comprehensive coverage for greater and greater premiums. The result is millions of children who have fallen through the cracks in a fragmented system. This program, originally created with the Balanced Budget Act of 1997 has sought to remedy the problem of uninsured children since it’s inception. Passage of this new legislation will go further towards accomplishing that goal, as well as accomplishing one of the three key pillars of the proposed Obama-Biden administration’s health care plan—universal access to care.

Sources:

Long Stalled by GOP, Expansion of Children’s Health Insurance Program Is Approved In House

Department of Labor http://www.dol.gov/dol/topic/health-plans/cobra.htm

Kaiser Family Foundation http://www.kaiseredu.org/topics_im.asp?id=704&imID=1&parentID=65

Source: Jim Wilson/The New York Times

Last Thursday, in a press conference from Chicago, President-elect Obama’s announcement of former Senator Tom Daschle as designate for Secretary of the Department of Health and Human Services was of little surprise. This has been speculated upon and anticipated for weeks since the election.

The announcement of more significance was the formation of the White House Office of Health Reform. As Director of this new office, Senator Daschle will have dual posts in the new administration. Dr. Jeanne Lambrew, a health policy expert will serve as the Deputy Director. Establishing an Office of Health Reform within the White House suggest the President-elect fully comprehends that the magnitude of the task of reforming America’s health care system is greater than that which can be met by the handful of individuals who will serve on his Domestic Policy Council. And, as the name reveals, these individual are responsible not simply for health care but all domestic policies. Obama stated, “[Daschle] will be responsible not just for implementing our health care plan — he will also be the lead architect of that plan.” Hopefully this newly formed Office of Health Reform will be used to formulate strategy and inject continuity and integration into a process—legislative policy-making—which by its very nature is incremental and piece-mill. I believe such coordination and systems thinking is essential to the successful reform of health care in America.

The Obama brain-trust for health policy also includes Daschle staff alumni Mark Childress and Bill Corr each formerly having served as Cheif Counsel and bring a wealth of legislative experience to this endeavor. Experience that will be highly valuable in shepherding reform legislation through Congress. Subject matter experts include Dr. David Cutler, a health economist, Dr. Nicole Lurie, a physician-scientist noted for her research in the areas of health care disparities and public health preparedness and Dr. Jonathan Moreno, a bioethicist. Together with Dr. Lambrew, these experts have proposed linking medical payment to improved health care outcomes (and not simply the medical intervention), emphasis on prevention, and coordinating care through disease management programs as key goals for health care reform. Each of which is difficult to attain in the absence of an integrated health care delivery system. (More on the details of the Obama health plan and further integration of the system to follow in Part II of this post).

Watch the press conference

Read a transcript of the press conference

Additional Sources:

Change.gov:

Department of Health and Human Services Team Leads

Health Policy Working Group

Lembrew, J. “Dear 44: Take a Pragmatic Approach” Politico.com posted July 7, 2008.

Lowenstein, R. “The Quality Cure” in The New York Times Magazine. March 13, 2005.

Earlier this week, President-elect Obama announced former Senator Tom Daschle as his designated nominee for Secretary of the Department of Health and Human Services. This Washington Post article discusses the dual role Daschle will serve not only as top administrator of the executive branch health care programs and services but also as the lead architect in the reform of the system as well. This is an enormous task, to say the very least. Yet it is one that the President-elect has identified as being a key element toward our economic recovery.

During the press conference Obama states, “Now, some may ask how, at this moment of economic challenge, we can afford to invest in reforming our health care system. Well, I ask a different question — I ask how we can afford not to.

Right now, small businesses across America are laying people off or shutting their doors for good because of rising health care costs. And some of the largest corporations in America — including major American car makers — are struggling to compete with foreign companies unburdened by these costs. Instead of investing in research and development, instead of expanding and creating new jobs, our companies are pouring more and more money into a health care system that is failing too many families.

So let’s be clear: if we want to overcome our economic challenges, we must also finally address our health care challenge.”

Sources:

HHS Will Be Shepherding Health-Care Reform – washingtonpost.com.

President-elect Obama Nominates Senator Daschle as Secretary for HHS, press conference transcript

UPDATE February 3, 2009: Former Senator Tom Daschle removed his name from further consideration for confirmation as Secretary of Health and Human Services amid criticism surrounding delayed payment of taxes in excess of $100,000.00 and the perception of ethical impropriety due to his former work with health care industry clients at the firm Alston & Bird, LLP.