Tuesday, February 23, 2010

2/22/2010 - Finally....The President's Health Care Plan


2/22/2010 - Liability and Health News Update
Finally....The President's Health Care Plan

by Donna Baver Rovito
Editor, Liability and Health News Update
Author, Pennsylvania's Disappearing Doctors

This LIABILITY AND HEALTH NEWS UPDATE "newsletter" is a free service which I provide, as a volunteer, to help supply medical liability reform and health care reform news and information, legislative updates, and political insight to physicians, patients, liability reform and quality health care advocates. NO ONE pays me to do this. I am not employed by any physician or health care reform advocacy or liability reform organization, political party or candidate, although I volunteer for several. I am a quality health care, physician and patient advocate, breast cancer survivor, physician's spouse, journalist, political noisemaker, mom, and freelance writer. I am not nor will I ever claim to be unbiased (I am....biased, I mean), unlike many in the mainstream media. Most information in this newsletter is copied and pasted from other sources, and will always be identified with links. Opinions and clarifications are my own, and do not reflect the official position of any physician or patient advocacy organization, tort reform, or health care reform group unless stated as such. My opinions are placed in double parentheses (("my opinion")), italicized and appear in blue.
This Update is emailed to health professionals, physician and patient advocates, and others interested in ensuring access to quality medical care. Join our Google Group to ensure you get all issues ASAP:
http://groups.google.com/group/liabilityandhealthnewsupdate. It also appears on the following BLOG (when I remember to post it): http://liabilityandhealthnewsupdate.blogspot.com. If you'd prefer not to receive these periodic updates about health care issues in America, please hit "Reply" and put "Unsub health group" in the subject line and I'll remove your email address immediately. PLEASE FORWARD THIS IMPORTANT INFORMATION TO EVERY HEALTH CARE PROFESSIONAL OR PATIENT YOU KNOW, AND SEND ME MORE EMAIL ADDRESSES SO WE CAN GET THIS INFORMATION TO MORE OF THE PEOPLE WHO NEED IT.

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Obama’s Health Reform: Tax. Spend. Regulate. Mandate.
By Grace-Marie Turner
February 22, 2010

The much-awaited health reform plan the White House released this morning is little more than an amalgamation of the taxing, spending, mandating, and regulating policies of the bills that passed the House and Senate last year.

Instead of offering a genuinely fresh approach, Mr. Obama split the difference between two bad bills that are hugely unpopular with the American people. He would continue to mandate that both individuals and employers pay for health insurance or face fines and penalties. He would expand Medicaid – the most dysfunctional health program in the country. And he would increase fees on insurers and other health companies which will be passed along to consumers in the form of higher premiums.

The big new idea in the president’s plan is to federalize regulation of health insurance, creating a Health Insurance Rate Authority to conduct “reviews of unreasonable rate increases and other unfair practices of insurance plans.” This reflects the overall strategy to send more and more control over the health sector to Washington.

Mr. Obama clearly is not trying to bridge the divide between Republicans and Democrats as a starting point for a dialogue at the summit on Thursday. A separate document listing Republican ideas he would include focused almost exclusively on policies to crack down on waste, fraud, and abuse – good ideas but not enough.

In fact, the Obama plan snubs the GOP by calling for increased taxes on companies inside and outside the health sector and slapping a payroll tax on the non-wage interest and dividend income of wealthier Americans. These higher taxes will drive up the cost of health insurance, depress innovation, and delay the economic recovery.

The way the president has dealt with the Cornhusker Kickback, the Louisiana Purchase, and the Labor union exemption is to basically extend the sweetheart deals to others. All states get more favored treatment for expanding Medicaid, and the threshold is raised for taxing high-cost health plans and will be delayed until 2018.

The proposal that the president has outlined will cost even more than the Senate bill and will lead to exploding costs that will surely top its $2.5 trillion 10-year cost. Health spending will continue to rise, premium costs will increase, at least 24 million people will remain uninsured, and the subsidies to individuals and businesses will continue to allow politicians to pick winners and losers. Because the president’s plan is built upon the Senate bill, it therefore would continue the cuts to Medicare that will jeopardize care for seniors.

The Obama plan is not an improvement and offers Republicans little upon which to begin to build a conversation at Thursday’s summit that could lead to genuine compromise.

Galen Institute P.O. Box 320010 Alexandria, VA 703-299-8900 www.galen.org


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((One might wonder....where has THIS been for the past year?))

http://www.whitehouse.gov/health-care-meeting

The President's Proposal

The President will bring a comprehensive proposal to the bipartisan meeting that builds on the progress Congress has already made and aims to give the American people and small business owners more control over their health care choices.
The Bipartisan Meeting
We’re closer than ever to making reform a reality, and the next step in the process is an open bipartisan meeting to discuss additional Republican and Democratic ideas for making our health care system work better for the American people.
The meeting will be held on Thursday, February 25, and streamed live in its entirety here at WhiteHouse.gov.
Learn More

The President's Proposal
Overview
Improving Affordability and Accountability
Cracking Down on Waste, Fraud and Abuse
Ensuring Fiscal Sustainability
Other Policy Improvements
Title I. Quality, Affordable Health Care for All Americans
Title II. The Role of Public Programs
Title III. Improving the Quality and Efficiency of Health Care
Title IV. Prevention of Chronic Disease and Improving Public Health
Title V. Health Care Workforce
Title VI. Transparency and Program Integrity
Title VIII. Community Living Assistance Services and Supports Act (CLASS Act)
Title VII. Improving Access to Innovative Medical Therapies
Title IX. Revenue Provisions
Title X. Reauthorization of the Indian Health Care Improvement Act

The President’s Proposal puts American families and small business owners in control of their own health care.

Over the past year the House and the Senate have been working on an effort to provide health insurance reform that lowers costs, guarantees choices, and enhances quality health care for all Americans. Building on that year-long effort, the President has now put forth a proposal that incorporates the work the House and the Senate have done and adds additional ideas from Republican members of Congress. The President has long said he is open to any good ideas for reforming our health care system, and he looks forward to discussing ideas for further improvements from Republicans and Democrats at an open, bipartisan meeting on Thursday.
The proposal will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable, stabilizing family budgets, the Federal budget, and the economy:

It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.

It 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.

It 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.

It will end discrimination against Americans with pre-existing conditions.

It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years -- and more than $1 trillion over the second decade -- by cutting government overspending and reining in waste, fraud and abuse.

Key Provisions in the President’s Proposal:

The President’s Proposal builds off of the legislation that passed the Senate and improves on it by bridging key differences between the House and the Senate as well as by incorporating Republican provisions that strengthen the proposal.

One key improvement, for example, is eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid. For America’s seniors, the proposal completely closes the Medicare prescription drug “donut hole” coverage gap. It strengthens the Senate bill’s provisions that make insurance affordable for individuals and families, while also strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid to save taxpayer dollars. The threshold for the excise tax on the most expensive health plans will be raised from $23,000 for a family plan to $27,500 and will start in 2018 for all such plans. And another important idea included is improving insurance protections for consumers and creating a new Health Insurance Rate Authority to review and rein in unreasonable rate increases and other unfair practices of insurance plans.

Download the full PDF of the President's key improvements.
Read the Overview.
Read the President’s Proposed Policies to Improve Affordability and Accountability.
Read the President’s Policies to Crack Down on Waste, Fraud and Abuse.
Read the President’s Policies to Contain Cost and Ensure Fiscal Sustainability.
Read the President’s Other Proposed Policy Improvements.
Summaries of Key Elements of the President’s Proposal:
Title I: Quality, Affordable Health Care for All Americans
Title II: The Role of Public Programs
Title III: Improving the Quality and Efficiency of Health Care
Title IV: Prevention of Chronic Disease and Improving Public Health
Title V: Health Care Workforce
Title VI: Transparency and Program Integrity
Title VII: Improving Access to Innovative Medical Therapies
Title VIII: Community Living Assistance Services and Supports Act (CLASS Act)
Title IX: Revenue Provisions
Title IX. Revenue Provisions
The Act makes health care more affordable for families and small business owners by providing the largest middle class tax cuts for health care in American history. Tens of millions of families will benefit from new tax credits which will help them reduce their premium costs and purchase insurance. Families making less than $250,000 will see their taxes cut by hundreds of billions of dollars.
When enacted, health reform is completely paid for and will reduce the deficit by more than one hundred billion dollars in the next ten years.
Continue to Improved Enforcement and Closing Tax Loopholes
((Well, gee, that's as clear as....mud....))
Title X: Reauthorization of the Indian Health Care Improvement Act

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Morning Bell Newsletter from the Heritage Foundation
The White House Learned Nothing from Massachusetts

In July of this year, the American people were mostly undecided about Obamacare: equal numbers opposed and supported the health care bills that the White House was shepparding through Congress. But then August happened and informed Americans turned out at townhalls across the country to express their strong disapproval of Obamacare. The larger American public noticed and and pluralities of the American people began to oppose Obamacare. The White House concluded they had a "communications problem" so they scheduled a prime time speech in front of a rare Joint Session of Congress. But the President's speech arrogantly dismissed the concerns of the American people and after a brief uptick in support (from the low 40s to the mid 40s), opposition to the President's plan grew.Then in November, liberals lost governor's races in New Jersey and Virginia as opposition to President Obama's signature policy priority inched towards 50%.
Again the White House concluded that nothing was wrong with their policy agenda and they dismissed their setbacks in two states that had voted for President Barack Obama as local elections with weak candidates. Instead of rethinking their policies and procedures the White House doubled down and pushed for a speedy passage of Obamacare with as little debate as possible. Over the next two months the White House bought support for their health care plan with the Louisiana Purchase, the Cornhusker Kickback, and big labor tax breaks. And their behind-closed-doors, backroom-deal tactics almost worked ... until Massachusetts happened.Just like in August and November, Sen. Scott Brown's (R) upset win over Attorney General Martha Coakley (D) took the Obama administration completely by surprise.
Again, the White House concluded they had a "communications problem" so this time they scheduled a six-hour health care summit that is supposed to take place at The Blair House, across the street from the White House, this Thursday. But like everything else that has come out of the Obama administration during this health care debate, the President's effort to "seek common ground" at the summit is completely disingenuous. The New York Times reported this past Friday that the White House is drafting, and will release this morning, a final health care bill they expect Congress to pass quickly. And this bill is specifically designed to pass without any conservative support:

Democratic officials said the president’s proposal was being written so that it could be attached to a budget bill as a way of averting a Republican filibuster in the Senate. The procedure, known as budget reconciliation, would let Democrats advance the bill with a simple majority rather than a 60-vote supermajority.And a "simple majority" does not mean they need 51 Senators. The nuclear option the White House is now pushing, reconciliation, only requires the Obama administration to muster 50 votes before Vice President Joe Biden can cast a tie breaking vote in favor of a government takeover of health care. ((Al Gore did that so Bill Clinton could pass one of the largest tax increases in history - retroactively. I don't think you can call it a "mandate" if you have to call in a ringer for the tie-breaker...))
And since the nuclear option only requires 50 Democratic Senators for passage, Majority Leader Harry Reid (D-NV) has signaled that an outright government run health insurance company, the public option, will also be included in the final bill.There is a reason that the longer this health care debate has dragged on, more and more Americans have become solidly against Obamacare: the plan has been exposed as a welfare state takeover of our health care sector that can only be passed by the most partisan and venal tactics. If the President was capable of listening to the American people, and learning from August, November, and Massachusetts, then he would abandon the legislative disasters still pending in the House and Senate and start over. That is what the American people want.


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Video - Judge Andrew Napolitano

This is a fascinating video of Judge Andrew Napolitano's analysis of health care reform and your rights from a Constitutional standpoint. The video clip contains a political ad, which you can ignore. This is worth the 7 and a half minutes....

http://www.youtube.com/watch_popup?v=7n2m-X7OIuY



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Health Alert Why Can’t Republicans and Democrats Get Together on Health Reform?
http://www.john-goodman-blog.com/why-cant-republicans-and-democrats-get-together-on-health-reform/?utm_source=newsletter&utm_medium=email&utm_campaign=HA
Feb 18, 2010
by John Goodman

If I were Barack Obama, I would open the upcoming health care summit by arguing that on the fundamentals, the differences between the two parties are not that great. After all:
ObamaCare seeks to subsidize health insurance for people who can’t afford it; but most Republican bills have subsidies as well.

ObamaCare seeks to address the problem of pre-existing conditions; but many Republican plans also address this problem — often in similar ways.

ObamaCare would set up health insurance exchanges for people who must buy insurance outside the workplace; and so do many Republican plans.

ObamaCare has an individual mandate; but although Republican plans typically do not, they have an implicit “soft mandate” created by giving people financial incentives to obtain insurance.

Parenthetically, I think it is a mistake for Republicans to endorse some of these ideas, but arguably you can find all four — even in the Coburn/Ryan bill.

Obama might then say, “Since we agree on the fundamentals, why can’t we iron out the details?”
The answer is that these similarities are only superficial. Although it’s always hazardous to generalize about political parties, if you dig a bit deeper, you will discover a huge gulf separates most Republicans from most Democrats on health reform. Three issues in particular illustrate that fact. (Note: An earlier version of what follows appeared at the National Journal health blog.)
First, consider the health insurance benefit package and how it gets paid for. The Republican approach (as represented by Sens. McCain and Coburn and Rep. Ryan) is to equalize the tax subsidy — giving every family the same tax credit. But Republicans seem quite willing to allow people to buy very different benefit packages with their subsidy. By contrast, Democrats on Capitol Hill seem intent on equalizing benefits (virtually forcing everyone to have the same health insurance), but are willing to tolerate very substantial differences in tax subsidies — even for people at the same income level.

If you are prone to exaggeration, you could almost say that Republicans want everyone to have the same subsidy, but are indifferent about what people do with their subsidy; while the Democrats want everyone to have the same benefits, but are indifferent about how those benefits get paid for.
Consider that the Coburn/Ryan bill would effectively give every family $5,700 as a down payment on the health insurance plan of their choice. (To ease the transition, Newt Gingrich and I proposed to allow people to choose between the tax credit and the current tax system.) By contrast, ObamaCare would have radically different subsidies for a plan that everyone will be required to have. Take a family earning $100,000 in 2016. Under the Senate bill, this family’s only subsidy would come from the current income tax law. That would be a tax subsidy worth about $6,345 if they obtain health insurance through an employer, but only $1,980 if they buy their insurance in the newly-created health insurance exchange. A family earning $30,000 would get a subsidy of $13,536 in the exchange, but only $2,115 if the insurance were obtained at work.

It’s hard to imagine two more starkly different approaches to the issue of costs and benefits.

The second major difference relates to how the two parties envision that goals will be reached. Republicans tend to have far more faith in the power of economic incentives than in the effectiveness of regulation. A typical Republican view is: If you want to control costs, improve quality and create more access to care, patients, doctors and other entities must find the achievement of these goals in their self-interest. And if they are not in anyone’s self-interest, these goals are unlikely to be attained — no matter how much regulation there is.

Newt and I are proposing to go further than most Republican bills in Congress in this regard. We would like to give chronic patients more opportunities to manage their own care and let special needs health plans compete to meet their needs. We would also like to free doctors to repackage and reprice their services — offering e-mail and telephone consultations in place of some office visits, for example. Still, the principles are the same.

The approach of ObamaCare, by contrast, is very much command-and-control. It’s not an accident that there will be more than 100 new regulatory bodies under the House bill or that there is virtually nothing in either the House or Senate bills that would liberate doctors or patients and give them new opportunities to solve problems.

The White House really believes that people inside the Washington Beltway can determine best medical practices and force the entire country to abide by them by using Medicare’s power of the purse.

Again, it’s hard to imagine two more different approaches to public policy.

The third difference has to do with labor economics. Democrats at least talk as though they believe within the labor market there is potentially a gigantic free lunch. That government can create billions of dollars of (mandated) benefits for workers and no one will be harmed. Wages won’t go down. No jobs will be lost. Prices won’t rise. Output will not be reduced.

In the Senate bill, the employer of a $30,000 a year worker will be required to spend $12,595 on family coverage — an amount equal to more than 40% of the worker’s wage. Most Republicans seem aware that the worker’s wage must fall by 40% or (more likely) he will be laid off and become unemployed.

In general, ObamaCare would cause massive layoffs, draconian wage cuts and eventually a complete restructuring of the labor market. Republican approaches avoid these problems altogether.

It is hard to see how a gulf this wide can be bridged.

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From the Conservatives for Patients' Rights Newsletter
Feb. 22, 2010

The White House is unveiling its health care plan this morning, which is anticipated to include new government regulations over rate increases. Drudge Report posts that just in the health care summary, the word "tax" is used 35 times. Skepticism continues to surround President Obama's health care summit scheduled for this Thursday that will be aired on C-SPAN. "Indiana Representative Mike Pence said, 'The Democrats spell summit S-E-T-U-P. And all this is going to be is some media event used as a preamble to shove through ‘Obamacare 2-point-0.’”Similarly, the National Review Online offers advice on dealing with the president's politically motivated summit. "All the evidence of the last year suggests that this type of bipartisanship — a Republican surrender — is the only kind in which he is interested. Since Obama knows full well that no such deal is possible, the real purpose of his health-care summit is political. He must think that the Democratic proposal will look better in comparison to Republican ideas. He wants to make Democratic efforts to push through their bills seem like a reasonable response to the unreasonableness of Republicans.
Republicans, for their part, understand perfectly well that Obama is not going to be bargaining in good faith. But they think that the public will give him the benefit of the doubt, so they will attend the summit. There they should do what they can to frustrate the president's design." Despite concerns, Sen. Mitch McConnell has agreed to attend the summit. "Senate Majority Leader Mitch McConnell (R., Ky.) said on 'Fox News Sunday' that Republicans intended to take part in Thursday's televised summit, and he reiterated his call for Mr. Obama to scrap the Democrats' bill. 'The American people do not want this bill to pass,' he said."President Obama will address the National Governor's Association today, where he is expected to discuss education and health care. Governors look beyond Washington for health care reform. "'Most of what's called health-care reform can be done at the state level,' Rhode Island Gov. Donald Carcieri said on Sunday."

Obama proposal targets insurance-rate increases
Michael Shear and Dan Balz - Washington PostPresident Obama will call for new government power to regulate insurance-rate increases as part of comprehensive changes to the health-care system that the White House will unveil on its Web site Monday, senior officials said. The proposal -- part of a package that a top official said will serve as a "starting point" for the bipartisan health summit Thursday -- comes as Obama has pointed to recent rate increases as evidence that his proposed changes are necessary. Last week, Health and Human Services Secretary Kathleen Sebelius drew attention to a California health insurance company, Anthem Blue Cross, which planned rate increases of up to 39 percent. Obama mentioned the increases in his weekly radio address and at a town hall in Nevada.

Obama to Seek to Curb on Insurance Hikes
Laura Meckley - Wall Street JournalSeeking to revive his stalled health-care legislation, President Barack Obama is proposing a new idea to address health costs, giving the federal government authority to block insurers from making premium rate increases. The move raises the ante after two weeks of presidential bashing of rate increases including WellPoint Inc.'s decision to raise premiums for some California customers by as much as 39%. WellPoint has defended its price increase as unavoidable in light of rising health costs. The president plans to include the idea in a legislative proposal to be released Monday, in advance of Thursday's bipartisan health-care summit, a White House official said Sunday.

Obama to Urge Oversight of Insurers’ Rate Increases
David Herszenhorn and Robert Pear - New York Times President Obama will propose on Monday giving the federal government new power to block excessive rate increases by health insurance companies, as he rolls out comprehensive legislation to revamp the nation’s health care system, White House officials said Sunday. The president’s legislation aims to bridge differences between the bills adopted by the House and Senate late last year, and to frame his debate with Republicans over health policy at a televised meeting on Thursday. By focusing on the effort to tighten regulation of insurance costs, a new element not included in either the House or Senate bills, Mr. Obama is seizing on outrage over recent premium increases of up to 39 percent announced by Anthem Blue Cross of California and moving to portray the Democrats’ health overhaul as a way to protect Americans from profiteering insurers.

Obama's day: Health care and governors
David Jackson - USA Today's The Oval Good morning from The Oval. Welcome to what could be one of those "pivotal weeks" for the Obama administration, as the president and his Republican opponents prepare for a health care summit on Thursday. Obama makes his opening bid this morning, posting a revised health care plan on the White House website. Part of that plan is a proposal for federal regulation of health insurance rate hikes. Health care will likely be a topic when Obama addresses the National Governors Association today, though his main thrust will be education policy. The governors, meanwhile, will be seeking attention and funds, as USA TODAY's Ken Dilanian reports.

President Hopes Health Care Reform Summit Will 'Cleanse' Health Care Reform Bill, Process
Jake Tapper - Political Punch A senior White House official tells ABC News that one of the president's goals for this week is to "cleanse" the health care reform bill and process. First, as ABC News previously reported, the president will today post the Senate health care reform bill and changes he would like to make to it -- such as stripping out special deals like the so-called "Cornhusker compromise," the deal secured by Sen. Ben Nelson, D-Neb., for the federal government to pay for his state's Medicaid expansion as required by the bill. Second, Thursday's bipartisan health care reform summit will be televised on C-SPAN.

The Early Word: Another Health Care Plan
Ashley Southall and Kate Phillips - New York Times' The Caucus President Obama plans to offer up his own health care proposal on Monday, a few days ahead of the health care summit he’s hosting on Thursday, which will be televised. Details of the president’s proposal will be posted at WhiteHouse.gov online at 10 a.m. Some provisions have already emerged, such as a proposal that would increase federal oversight of insurers to curb excessive rate increases, The Times’s Robert Pear and David Herszenhorn reported. The proposals under study by the White House are designed to bridge some gaps between the previous House and Senate bills.

Obama tries health care again, talks education
Associated PressPresident Barack Obama will unveil a new health care overhaul plan Monday, including a proposal to give federal authorities the power to limit rate hikes by health insurance companies. He is also meeting with the nation's governors at the White House. He will urge states to better prepare high school students for college and careers. Obama is also expected to praise the governors for working in tandem with his Race to the Top program to reward school systems that raise standards.

National Review: Reform's Long-Term Battle
The Editors - NRO President Obama would no doubt be delighted if Republicans were to accept the basic outlines of the Democratic health-care proposal: new regulations on insurers, a mandate that everyone buy insurance, and subsidies to help them do so. All the evidence of the last year suggests that this type of bipartisanship — a Republican surrender — is the only kind in which he is interested. Since Obama knows full well that no such deal is possible, the real purpose of his health-care summit is political. He must think that the Democratic proposal will look better in comparison to Republican ideas. He wants to make Democratic efforts to push through their bills seem like a reasonable response to the unreasonableness of Republicans.

Live From Washington! It's Obama Health Care Drama
ABC News Obama's main audience will be Democrats, who must overcome their divisions — and ease their qualms — to get a final bill. He will also tune his pitch to independents, who soured on the Democratic bills after initially being open to health care changes. Thursday's meeting at Blair House — the presidential guest quarters across from the White House — comes nearly a year after Obama launched his drive to remake health care at an earlier summit he infused with a bipartisan spirit. The president will point out that Republicans have supported individual elements of the Democratic bills.

Obama helped bring on healthcare backlash
Janet Hook - LA Times Reporting from Washington - As President Obama seeks to revive his moribund healthcare initiative -- and arrest the precipitous drop in his political fortunes -- he is struggling with the consequences of one of his most important early decisions: letting Congress take the lead in designing his signature policy proposal. Leaving it to Congress put an unusually glaring spotlight on how Capitol Hill does business. The spectacle of Congress' horse-trading, secrecy and gridlock has fueled today's virulent anti-Washington mood. The public's reaction was all the greater because Obama had campaigned on a promise to change the way Washington did business, and because healthcare reform engendered such personal high hopes and anxiety. The way voters saw it, the smoke-filled room was back -- and they did not like it.

States Look Beyond Washington on Health
Meena Thiruvengadam - Wall Street JournalSome governors, frustrated by halted federal efforts to overhaul the U.S. health-care system, are introducing their own changes at the state level. "Most of what's called health-care reform can be done at the state level," Rhode Island Gov. Donald Carcieri, a Republican, said on Sunday on the sidelines of an annual winter gathering of the National Governors Association here. The three-day meeting, which ends on Monday, is addressing state budgets and economic development, among other issues. But governors listed an overhaul of the health-care system as a top priority for discussion.

First Lady: Health Care "A We Thing"
CBS News Calling health care reform "a we thing," Michelle Obama says President Barack Obama is in that battle for keeps. She tells "Early Show" co-anchor Maggie Rodriguez, "We can't afford to … give up, not in this country. We're already seeing premiums going up for people who do have insurance. And there are still millions of Americans who are underinsured or uninsured." Mrs. Obama spoke with Rodriguez at Philadelphia's Fairhill Elementary School, where she was touting her first major initiative as first lady - her "Let's Move" campaign against childhood obesity -- an epidemic that leads to $147 billion in annual medical costs and an issue that goes hand-in-hand with health care reform.

Bipartisan Health Care Summit: A Meeting for 'Show'?
Fox News This is a rush transcript from "On the Record," February 19, 2010. This copy may not be in its final form and may be updated. GRETA VAN SUSTEREN, FOX NEWS HOST: The big February 25th health care huddle is right around the corner. Can we expect big results or just one big show? We spoke to Senator Jon Kyl who will be at meeting. (BEGIN VIDEOTAPE) VAN SUSTEREN: Senator, nice to see you sir. SEN. JON KYL, R - ARIZ.: Hi Greta, how are you? VAN SUSTEREN: I'm very well. Senator, February 25th, a lot of the American people have high hopes for this summit at the Blair House with President Obama. Should we be hopeful?

Latest Polling
Rasmussen ReportsFebruary 22, 2010 Forty-one percent (41%) Strongly Disapprove giving Obama a Presidential Approval Index rating of -19.


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Monday, February 22, 2010
Kaiser Daily Health Policy Report:
Check back on Kaiser Health News for the latest headlines
KHN Original Reporting & Commentary

1. Full Text: Obama's Health Care Proposal
2. Doctor Shortage Fuels Nurses' Push For Expanded Role
3. KHN Column - Malpractice Reform: A Test Case For Bipartisanship At The Health Summit
4. Political Cartoon: 'Clear!'
Health Reform
5. Obama's Health Plan Melds House, Senate Bills While Targeting Insurers' Rates
6. GOP Plans To Attend Health Summit As Obama Calls For Compromise
7. Governors On Health Reform: 'We Want In'
8. Public Option Again Gains Steam; Cadillac Tax Would Fall Equally On Non-Union Plans
9. Orszag Says Health Reform 'Absolutely' Still Possible; Enzi's Posture Offers Evidence Of Partisan Stalemate
Health Care Marketplace
10. Insurers Rebut Criticisms Of Profits, Rates
11. Nursing Workforce Issues: An Expanded Role For Nurse Practitioners, Calif. Doctors Sue For Supervision Of Nurse Anesthetists
12. Senate, FDA Reports Increase Concerns About Controversial Diabetes Drug
Quality
13. VA Focuses On Female Veterans' Struggles, Disability Claims Backlog
State Watch
14. Medicaid Cuts Hurt Calif. Dental Coverage, Drive Away Doctors in Okla.; Public Hospitals In NYC Fear Possible Reductions
15. Maine Studies Prospects For State Reform Efforts While N.Y. Experience Shows Impact Of Guaranteeing Access To Coverage
Editorials and Opinions
16. Today's Opinions And Editorials
KHN Original Reporting & Commentary
1. Full Text: Obama's Health Care Proposal
[Feb 22, 2010]Kaiser Health News reports the "proposal President Barack Obama will bring to his Thursday health 'summit' with Congressional leaders contains many of the ideas from the bills already passed by the Democratic House and Senate, including a mandate that individuals buy insurance and a promise to 'end discrimination' from pre-existing conditions." Read the full text of the proposal, as released by the White House.
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2. Doctor Shortage Fuels Nurses' Push For Expanded Role
[Feb 22, 2010]Kaiser Health News staff writer Andrew Villegas writes about developments regarding the physicians shortage is leading to a push for an expanded role for other health professionals. "There are no doctors in rural Tyrrell County, N.C. There is only Irene Cavall, a licensed nurse practitioner and the sole source of primary care for 4,000 residents spread out over 600 square miles (Villegas, 2/22). Read entire article.
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3. KHN Column - Malpractice Reform: A Test Case For Bipartisanship At The Health Summit
[Feb 22, 2010]In his latest Kaiser Health News column, done in collaboration with The New Republic, Jonathan Cohn writes: "Ever since President Barack Obama announced he'd be having a bipartisan meeting to talk about health care reform, Republicans have been denouncing it as a charade. He's not really interested in their ideas, they say. And he doesn't really want their support. But is the problem that Obama won't listen to the Republicans--or that the Republicans won't listen to Obama? One way to answer that question is to watch what happens at Thursday's health 'summit' meeting if discussion turns to medical malpractice reform (2/22). Read entire column.
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4. Political Cartoon: 'Clear!'Kaiser Health News provides a fresh perspective on health policy news with "Clear!" by Nick Anderson.
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Health Reform
5. Obama's Health Plan Melds House, Senate Bills While Targeting Insurers' Rates
[Feb 22, 2010]
The proposal President Barack Obama will bring to his Thursday health 'summit' with congressional leaders contains many of the ideas from the bills already passed by the Democratic House and Senate, including a mandate that individuals buy insurance and a promise to "end discrimination" from pre-existing conditions.
Link to the president's proposal
White House Web site: www.whitehouse.gov
In advance of the release, news organizations covered one aspect of the plan, a regulatory crackdown on insurers' rate hikes.
The New York Times: "Mr. Obama is seizing on outrage over recent premium increases of up to 39 percent announced by Anthem Blue Cross of California ..." (Herszenhorn and Pear, 2/21).
The Wall Street Journal: "The [House and Senate] Democratic health bills already envision some role for the government to control premium costs, through new exchanges where individuals and small businesses could buy insurance. One version would prevent any insurer that raised rates beyond a level that the government deemed unfair from selling policies in the exchange. Private insurance companies are now regulated by the states, which review proposed rate increases. Under the Obama proposal, the federal Department of Health and Human Services would gain the power to review and block premium increases" (Meckler, 2/22). Obama's plan would "set up a panel of experts" -- including doctors, economists and other stakeholders -- "charged with evaluating the healthcare market each year and determining what would constitute a reasonable rate increase," the Los Angeles Times reports. "Under the president's plan, rate increases outside the reasonable boundaries established by the board could be overruled by the [HHS] secretary, who would also have the power to require the insurer to revise its proposed rate changes or to order rebates for customers who overpaid" (Parsons, 2/22).
Politico: "White House officials have already begun urging Republicans to post their bills online as well -- a clever tactic by the White House, because Republicans ideas for reform were spread across several pieces of legislation, or fell far short of the Democrats' goal of insuring 31 million uninsured Americans. The main House Republican proposal, for instance, would only cover 3 million more Americans" (Brown, 2/21).
The Washington Post reports that, before the full plan was released, a spokesman for the House Republican leader John Boehner said, "At first glance, this seems to be an admission from the Obama administration that their massive government takeover of health care will, despite their promises, increase health care premiums for millions of Americans," since it suggests that insurers' rates would need to be actively controlled, even with reforms in place (Shear and Balz, 2/22).
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6. GOP Plans To Attend Health Summit As Obama Calls For Compromise
[Feb 22, 2010]President Barack Obama warned during the weekend that both Republicans and Democrats should be careful not to turn this week's health care summit into "political theater" but to work to find "common ground" on the issues, The Washington Post reports. "The Thursday event, scheduled to be televised live on C-SPAN, could prove a pivotal moment in the year-long effort to overhaul the health-care system. ... While the parties agree broadly that the health-care system is broken, they have found little consensus on more detailed questions, such as how best to provide insurance to people who don't have access to affordable coverage through an employer. Obama's plan is expected to provide subsidies to people who can't afford coverage, incentives for businesses to offer insurance and expanded Medicaid coverage for the poor" (Murray and Shear, 2/21).
Politico: "And yet Obama is unveiling a health care bill just days before the six-hour summit that wouldn't require a single GOP vote, with plans to short-circuit the Senate rules and push it through without Republicans if necessary. That's left some Republicans angrily questioning whether the summit is a sham and even Democrats uncertain and noncommittal." Democrats are using the summit as a way to get Republicans to talk and "to debunk many of the GOP's talking points about their bill by walking viewers through shortfalls in the Republicans' own legislation; for example, the House GOP bill covers about 3 million uninsured Americans while the Democrats' bills would cover more than 31 million" (O'Connor, 2/22).
The Los Angeles Times reports that GOP senators, who were publicly questioning their summit attendance, have decided to participate despite reservations -- "but the chamber's GOP leader is far from resigned to the Democrats' idea of cooperation on the hot-button issue." Senate Republican Leader Mitch McConnell said Sunday that Democrats were still acting "arrogant" in not tossing out reforms that have passed before and starting over. "Asked if the Republicans would slow down the consideration of health reform, McConnell said there were 'a variety of different options available'" (Parsons, 2/21).
Roll Call: "House Republican Conference Chairman Mike Pence (Ind.), who was not invited to attend the meeting with President Barack Obama at Blair House on Thursday, said on NBC's 'Meet the Press' that Democrats should scrap the House and Senate bills and use the summit to start over. ... 'But what we can't help but feel like here is that the Democrats spell summit S-E-T-U-P and all this is going to be just some media event used as a preamble to shove through Obama care 2.0. We aren't going to have any of it'" (Kucinich, 2/21).
The Washington Times: "But with the White House expected to release a plan it hopes Democrats can support and Republicans firmly opposed to any of the Democrats' proposals, few health policy experts or lawmakers expect the summit to lead to policy compromises. ... Republicans have steadfastly opposed a large comprehensive bill and prefer a step-by-step approach that includes proposals such as tort reform and allowing insurers to sell across state lines. They have several small-scale bills" (Haberkorn, 2/22).
Fox News on McConnell's comments on using budget reconciliation to pass reform and the summit: "'You know, we've witnessed the "Cornhusker kickback," the "Louisiana purchase," "the Gatorade," the special deal for Florida. Now they are suggesting they might use a device which has never been used the for this kind of major systemic reform. We know it would be -- the only thing bipartisan about it would be the opposition to it,' he said" (2/21).
Los Angeles Times, in a news analysis: Obama "is struggling with the consequences of one of his most important early decisions: letting Congress take the lead in designing his signature policy proposal.... That's one reason Obama has called a healthcare summit this week -- to try to renew the debate on more pristine terms. Even if nothing comes of the talks, they are designed to spotlight on national television precisely the bipartisan, high-minded debate that Congress' year-long process was not. ... Critics fault Obama and Congress for taking so long with the task, pointing to the standard set by President Lyndon B. Johnson, when such landmark measures as Medicare and the Voting Rights Act were passed seven months into 1965. ... At the healthcare summit Thursday, Democrats hope to neutralize complaints that the process so far has been too partisan and secretive. But hardly anyone in Washington expects major decisions or compromises to be made on camera" (Hook, 2/22).
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7. Governors On Health Reform: 'We Want In'
[Feb 22, 2010]"Some governors, frustrated by halted federal efforts to overhaul the U.S. health-care system" and by lingering budget shortfalls deepened by rising health costs, "are introducing their own changes at the state level," The Wall Street Journal reports. While some states, such as Massachusetts, have already taken on health care, others, such as Colorado, Pennsylvania and Republican-led Utah, are now tackling the issues, including cost. "Some governors suggested they may be better equipped to work with one another on health care than congressional leaders who have been at an impasse over federal legislation" (Thiruvengadam, 2/22). Governors continue to worry that some federal "reform proposals could deepen the budget woes that many states face," Reuters reports, adding: "Medicaid, the healthcare program for the poor jointly administered by the states and government, is already one of the largest single budget items for many states. Governors fear more people will be forced to rely on the program if they are compelled to get health insurance." The governors, who were meeting in Washington this weekend, plan to present that concern to President Obama Monday. But, "[o]n the other hand, they also fear that doing nothing will also worsen their financial situations" (Lambert, 2/21). Governors also used this weekend's meeting to tout "progress in their own jurisdictions to reduce healthcare costs and improve quality," according to Modern Healthcare. Gov. Deval Patrick challenged other states to catch up with Massachusetts' rate of insurance coverage, 98 percent. And, "Pennsylvania Gov. Edward Rendell said his state now requires that emergency department facilities provide a non-emergent care facility that's accessible around the clock," which saves money (Lubell, 2/21).
NPR interviewed Gov. Gary Herbert, R-Utah and Gov. Joe Manchin, D - W.Va., who said: "We've got to change health care. Health care has double digit inflation for every state. I don't believe that we've bottomed out as states. We know we have tougher times ahead of us." Herbert said: "I think some of the concerns that we have in Utah and other states is the overreach of the federal government. It's not like we're looking for anything. In fact, sometimes we're looking just, you know, kind of stay away" (Lyden, 2/21).
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8. Public Option Again Gains Steam; Cadillac Tax Would Fall Equally On Non-Union Plans
[Feb 22, 2010]The public option is gaining steam again, while a new study on the "Cadillac tax" suggests it would fall equally on union and non-union health plans. "The recess week ended up providing liberal activists and their allies on Capitol Hill with a surprise opportunity to breath life into the proposal to create a government-run health insurance plan -- a proposal that had been declared all-but-dead two months ago," The Hill reports. "Ironically, it's a shift that would have been unthinkable before Sen. Scott Brown (R-Mass.) won the late Sen. Edward Kennedy's (D-Mass.) seat in a special election last month." Without the crucial 60th vote to overcome a Republican filibuster, Democrats are turning to reconciliation, which requires only 51 votes and may give liberals an opportunity to insert the public option again. "Over the course of three days, 18 Democratic senators signed on to Sen. Michael Bennet's (D-Colo.) Wednesday letter to Majority Leader Harry Reid (D-Nev.), requesting a floor vote on the public option should the upper chamber consider a healthcare reconciliation bill. ... Even Reid appears to be on board." His office issued a statement Friday indicating Reid would "bring the public option to the Senate floor." In addition, the "Obama administration appears to be ready to give it a go. 'If it's part of the decision of the Senate leadership to move forward, absolutely,' Health and Human Services Secretary Kathleen Sebelius said on MSNBC Thursday" (Young, 2/20). Meanwhile, a new analysis studies another hot-buttom reform issue -- the so-called "Cadillac tax" and finds that "the conventional wisdom about the tax [on high-cost insurance plans] is wrong: The tax would actually fall equally on nonunion plans," The Washington Post reports. "At least 80 percent of the workers whose plans would be subject to the tax in 2019 would be in nonunion jobs, according to the analysis by Ken Jacobs of the University of California at Berkeley Labor Center and William H. Dow, a professor of health economics at Berkeley who was a member of President George W. Bush's Council of Economic Advisers. This impact is roughly in line with the overall breakdown of nonunion vs. union workers with employer-provided plans. And it would be true under both the version of the tax passed by the Senate and a more labor-friendly one the White House agreed to last month" (MacGillis, 2/22).
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9. Orszag Says Health Reform 'Absolutely' Still Possible; Enzi's Posture Offers Evidence Of Partisan Stalemate
[Feb 22, 2010]News outlets report on some of the major figures in the health care overhaul debate, including Peter Orszag, director of the White House Office of Management and Budget, and Sen. Mike Enzi, R-Wyo. Politico has an interview with Orszag, in which he says that "it is 'absolutely' still possible to pass a comprehensive health reform bill, insisting that 'to really reform the health care system' would be 'best for the economy and the American public'" (Allen, 2/22).
Roll Call reports that "[l]ongtime Capitol Hill observers say there's no better evidence of the bitter partisan stalemate that has enveloped Congress than the posture of Sen. Mike Enzi (R-Wyo.) during the past year's health care debate." Though considered one of the most conservative senators, Enzi had a "fruitful relationship with his Democratic counterpart on the HELP committee, the late Sen. Edward Kennedy (Mass.)" and "is driven by a simple, three-pronged mission statement that he relates during every weekly staff meeting: 'Do what's right, do your best, and treat others as they want be treated. ... So to hear Enzi boast of blocking legislation is rare and emblematic of the Senate logjam on health care reform. 'If I hadn't been a part of the debate, you would already have universal health care,' Enzi said last week, according to a report in the Casper Star-Tribune'" (Newhauser, 2/22).
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Health Care Marketplace
10. Insurers Rebut Criticisms Of Profits, Rates
[Feb 22, 2010]As the Obama Administration seizes on a proposed 39-percent rate hike by a California insurer earlier this month to rally new support for a health overhaul, that insurer's top executive is preparing to go before Congress, The Associated Press/Los Angeles Times reports. "At the heart of the debate is the question of what should be a fair profit for health insurers. WellPoint CEO Angela Braly will likely be grilled on the issue when she appears at a Congressional hearing Wednesday." The insurer will likely explain that it "underestimated the premiums it needed to collect in order to pay claims" for its California policy holders last year, resulting in millions of dollars in losses. "On top of that, WellPoint said hospital costs are rising an average of 10 percent a year and pharmaceutical costs are up 13 percent, and that must be factored into pricing. At the same time, the tough economy is forcing more healthy people to drop their individual insurance. That leaves a higher concentration of sick people who generate medical claims in their risk pools. All this leads to premium increases that could average 25 percent" (Murphy, 2/21). A recent report from Health Care for America Now, a pro-overhaul advocacy group, found that leading insurers increased their profits by an average of 56 percent in 2009, leading to a "banner year," despite the economy, The (Louisville, Ky.) Courier-Journal reports. But, the companies say the report is misleading, in part because last year's increase in profitability was a rebound for a below average 2008. Insurers also cited increased spending on "hospitals, doctor services and prescription drugs, and expensive technology" as the main cause of their rate increases (Howington and Ungar, 2/20).
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11. Nursing Workforce Issues: An Expanded Role For Nurse Practitioners, Calif. Doctors Sue For Supervision Of Nurse Anesthetists
[Feb 22, 2010]News outlets report on nursing workforce issues, including a push for an expanded role for nurse practitioners, supervision of nurse anesthetists and a trend toward delayed retirement. "Nursing leaders say large numbers of [nurse] practitioners ... will be needed to fill gaps in primary care left by an increasing shortage of doctors, a problem that would intensify if Congress extends health insurance to millions more Americans," Kaiser Health News reports. "Advocates say nurse practitioners have the extra education and training needed to perform a variety of services, including physical exams, diagnosis and treatment of common ailments and prescribing drugs. But the American Medical Association and doctors' groups at the state level have been urging state legislators and licensing authorities to move cautiously, arguing that patient care could be compromised." While the "battle has been waged for years" pressure is growing use nurse practitioners to fill the gap left by the growing shortage of primary care physicians (Villegas, 2/22). Meanwhile, doctors in California are suing to require nurse anesthetists be supervised, American Medical News reports. "Patient safety remains at risk unless a new California regulation allowing nurse anesthetists to administer anesthesia to hospital Medicare patients without physician supervision is withdrawn, according to a lawsuit initiated by two state physician organizations. The suit, filed Feb. 1 by the California Medical Assn. and California Society of Anesthesiologists, seeks to block Gov. Arnold Schwarzenegger's decision to opt out of a Medicare provision requiring physician supervision of certified registered nurse anesthetists" (Sorrel, 2/22).
The Virginian-Pilot: "About 30 percent of the state's registered nurses between ages 66 and 70 said they planned to work at least another five years, according to a recent survey by the Virginia Department of Health Professions. More than 40 percent of the state's licensed practical nurses in that age group said they would stay on the job another 10 years or more. The trend is helping to temporarily relieve the state's nursing shortage" (Jeter, 2/21).
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12. Senate, FDA Reports Increase Concerns About Controversial Diabetes Drug
[Feb 22, 2010]"Hundreds of people taking Avandia, a controversial diabetes medicine, needlessly suffer heart attacks and heart failure each month, according to confidential government reports that recommend the drug be removed from the market ... ," The New York Times reports. "The internal F.D.A. reports are part of a fierce debate within the agency over what to do about Avandia, manufactured by GlaxoSmithKline." Some within the agency think the drug should be withdrawn because "they believe there is a safer alternative." Others maintain that research so far is provides "contradictory information and that Avandia should continue to be an option for doctors and patients. GlaxoSmithKline said that it had studied Avandia extensively and that 'scientific evidence simply does not establish that Avandia increases' the risk of heart attacks. The battle has been brewing for years but has been brought to a head by disagreement over a new clinical trial and a Senate investigation that concluded that GlaxoSmithKline should have warned patients earlier of the drug's potential risks" (Harris, 2/19). The Wall Street Journal: "The FDA is trying to assemble a timeline of what the FDA knew of risks associated with Avandia ... and plans to call a meeting of an outside advisory committee in the next few months to look at recent information on the drug, which Glaxo reported as having global sales of 771 million ($1.2 billion) in 2009. According to a two-year investigation by the Senate Finance Committee, Glaxo knew about data linking Avandia to elevated risk of cardiovascular events for several years, but played down the information and tried to suppress doctors who raised concerns" (Mundy, 2/22). CNN: "The Senate committee investigation stems from concerns that Avandia and other high-profile drugs put 'public safety at risk because the FDA has been too cozy with drug makers and has been regularly outmaneuvered by companies that have a financial interest in downplaying or under-exploring potential safety risks,' the report states" (2/22). The Associated Press/Seattle Times: "In May 2007, the New England Journal of Medicine published an analysis of dozens of studies on nearly 28,000 people who had taken Avandia. The journal said there was a 43 percent higher risk of heart attack for those taking Avandia compared to people taking other diabetes drugs or no diabetes medication. The findings raised concerns because two-thirds of the people with Type 2 diabetes, the most common form, die of heart problems" (Ortutay, 2/21). The Boston Globe: "In the 2008 report, the FDA safety officers also said that a medical trial comparing Avandia with Actos that was being planned would be 'unethical and exploitive' because it would expose patients to unwarranted risks. That trial, called TIDE, which was planned to involve a total of 16,000 patients, is now under way" (Waters, 2/21).
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Quality
13. VA Focuses On Female Veterans' Struggles, Disability Claims Backlog
[Feb 22, 2010]News outlets explore issues at the Department of Veterans Affairs, which is seeking to cut a backlog in disability claims and also address the needs of female veterans. CBS News: "More than 212,000 female service members have been deployed to Iraq and Afghanistan -- 11 percent of the total force. One hundred twenty have been killed in action and more than 600 wounded, but the losses don't end there." A recent report by the Iraq and Afghanistan Veterans Association called "Women Warriors" says "homelessness among young returning female fighters is on the rise" and "female veterans earn on average $10,000 a year less in civilian jobs than male vets, making it harder to afford a home. And less than 5 percent of the homeless shelters run by the Veterans Affairs Department offer women separate housing from men. ... The VA says on any given night there are an estimated 6,500 homeless female vets" (Mitchell, 2/21).
The (Connecticut) Day: The VA is trying to address backlogged disability claims. "The VA expects a 30 percent increase in benefit claims over last year's levels, and because of that the 2011 budget includes funding for hiring more than 4,000 additional claims processors." Tammy Duckworth, a U.S. assistant secretary of Veterans Affairs, "said the claims processing system was a lot of 'paper-based work' and hoped to speed up that process with the hiring of more workers and an eventual switch to an electronic record-keeping system in the next year or two. The electronic system would track a veteran from nearly the moment he or she files the first paperwork until the day he or she is buried, Duckworth said. It would eliminate the burden currently on veterans to prove certain injuries and health issues and eliminate bureaucratic delays" (Naughton, 2/20).
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NPR: "In California, it's been seven months since some 3 million poor and disabled adults lost their dental coverage to budget cuts. ... While the recession may be easing, California and other states across the country continue to face eye-popping budget deficits. As a result, states are cutting deep into public health programs, and dental benefits for Medicaid recipients top the list. ... Before the state budget cuts, Medicaid patients here could get annual exams, cleanings and, if needed, root canals to save their teeth. ... In interviews with dozens of dentists and safety-net clinics around California, providers say patients are forgoing routine cleanings and delaying care until the pain is unbearable. Dentists are offering discounts and payment plans, but they say few patients can afford them. Dental schools and free clinics are overrun, and some private dental offices and at least one community dental clinic have closed. Under federal law, dental coverage is considered an optional benefit that states don't have to provide when insuring poor or disabled residents" (Varney, 2/21).
The New York Times: "The city's public hospital system, the largest in the nation, is facing a fiscal crisis because New York State is threatening to cut its financing for the care of poor patients at a time when the number of uninsured patients has soared, city officials said Sunday. The cuts, included in Gov. David A. Paterson's executive budget proposal, could drain from the public hospitals up to $370 million, much of it in federal financing, and shift the money to programs in voluntary, or private, hospitals, the city officials said." State officials said the cuts are part of the state's effort "to close a huge deficit by pulling back on longstanding budget commitments. State budget officials said, however, that much of the proposed cutback was the result of federal stimulus money running out"(Hartocollis, 2/22).
The Associated Press/(Monroe, La.) News Star: Louisiana Gov. Bobby Jindal will most likely face "a budget battle this legislative session [with] health care providers, represented by several powerful lobbying groups with political sway at the Louisiana Capitol. While Jindal was making nice with higher education, he was proposing to cut payments to doctors, nursing homes, hospitals and other private providers in the state's Medicaid program. That would cut into the bottom line of businesses across the state. ... Jindal proposed a $24.2 billion budget for the 2010-11 fiscal year that begins July 1. ... The state's Medicaid program for the poor, elderly and disabled would receive the biggest hit if Jindal's budget recommendations are followed" (2/22).
Florida Health News: Florida will get "a refund of $282.5 million in overpayments to Medicare, thanks to a recalculation of drug premiums for low-income elderly and disabled patients. It couldn't have come at a better time, with state lawmakers facing a Medicaid budget shortfall that could top $1 billion next year, said Lori Parham, state director for AARP. ... This will provide some 'needed fiscal relief' and may reduce the threat of cuts to programs such as home- and community-based care for seniors. ... The U.S. Department of Health and Human Services is giving other states refunds, too, a total of $4.3 billion. HHS' Centers for Medicare and Medicaid Services says the states are getting back some of the money they paid as their share of Medicare drug-plan premiums for the so-called 'dual eligibles,' who have incomes so low they qualify for Medicaid. Medicare is a federal program, but Medicaid is jointly financed by the states and federal government" (Gentry and Saunders, 2/19).
The Associated Press/NBC Washington: "The Virginia House of Delegates proposes a dire new state budget that will cut Medicaid funding and eligibility, increase school class sizes and cut public school funding. The Appropriations Committee's spending blueprint through 2012 made public Sunday reflects many of the $2 billion in unprecedented cuts Republican Gov. Bob McDonnell suggested last week. ... The Senate Finance committee was expected to unveil a budget later Sunday that would cut less to public schools and to health care safety net programs" (Lewis and Potter, 2/21).
Muskogee (Oklahoma) Daily Phoenix: "The Oklahoma Health Care Authority Board approved a $17 million cut in the state's Medicaid program SoonerCare late last year and some effects have already been felt." Several doctors and dentists said they believe fewer health professionals will see SoonerCare patients because of the cuts and that patients are foregoing care or showing up with more severe health issues (Purtell, 2/22).
The (Spokane, Wash.) Spokesman-Review: A fund that covers the health care for state workers in Washington state is hemorrhaging funds after the state cut its premium payments and the fund spent down a surplus. "But the Health Care Authority's surplus disappeared faster than state officials expected. At the end of 2009, the balance sheet of the authority's Public Employees Benefit Board fund showed 'stunning declines in assets, capital and surplus, net income and cash provided by operations,' Insurance Commissioner Mike Kreidler warned in a letter to Gov. Chris Gregoire." Assets are down $200 million in 2009 with more liabilities than assets by $3 million. "The fund collects the premiums for state employees and pays out their medical and dental claims. Under the current contract, the state pays 88 percent of the premium and employees pay 12 percent." A strong surplus and economy meant a state budget was made to cut back state payments into the fund, now hurting the fund's viability (Camden, 2/20).
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15. Maine Studies Prospects For State Reform Efforts While N.Y. Experience Shows Impact Of Guaranteeing Access To Coverage
[Feb 22, 2010]In Maine, insurance regulators say measures aimed at expanding health coverage to more people in that state should wait for final action in Congress, The Associated Press/WBZ reports. A Maine report "released last week, stems from a 2009 law that asks the superintendent to review ways to improve the availability and affordability of Maine's individual health insurance market." In the report, the authors write that Maine's options to expand access and make coverage more affordable will depend on what Congress does. "Citing census data, the report says Maine has an uninsured rate of 9.6 percent, the sixth lowest in the nation and well below the national average of 15.4 percent. A recent public opinion survey by a Portland firm puts the state rate at 11 percent" (Adams, 2/20).
Los Angeles Times: New York's experience in trying to help the uninsured "offers a cautionary tale: Making isolated changes to the complex medical insurance system can have unwelcome consequences." After New York passed a law requiring health insurers to cover all applicants regardless of pre-existing condition, premiums went up significantly and "are now the highest in the nation by some measures, with individual health coverage costing about $9,000 a year on average. And nearly one in seven New Yorkers still lacks health coverage, a greater proportion than before the law was passed." So-called guaranteed issue provisions "became popular in the early 1990s, as states including New Jersey and Washington contended with insurance companies that were denying coverage to people with preexisting health problems. New York went further, becoming the first state to also include a 'pure community rating' requirement that prohibited insurers from varying premiums based on customers' age or health, another common industry practice." Individual market premiums have nearly tripled since 2001 in New York (Levey, 2/21).
Los Angeles Times, in a separate story: Beverage lobbyists who fought against inclusion of a soda tax to help pay for health reform are now facing a similar fight on the state level as states individually consider their own taxes on sugary, high-calories beverages to make up for shrinking budgets. "The next showdown could be in California, where legislators last week pledged to pass such a tax in light of new studies linking soft drink consumption to obesity in children and adults. One study suggests that obesity and related problems cost California alone $41 billion a year in medical expenses and reduced productivity." Twelve states in the past year have altered the tax treatment of soft drinks. "Nonetheless, Kevin Keane, a senior vice president for the American Beverage Assn., called the tax idea a 'money grab' that would hurt working families." (Geiger and Hamburger, 2/22).
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Editorials and Opinions
16. Today's Opinions And Editorials
[Feb 22, 2010]
How The GOP Can Fix Health Care The New York Times Contributors to this Times' piece include Mark McClellan, James P. Pinkerton, Charles Kolb, Newt Gingrich and Bill First, who writes: "You simply need to pay people to do a good job, demand measurable outcomes and adopt proven standards of practice and information technology" (2/21).
The Elephant At The Health Care Summit The Washington Post The summit will call attention to the elephant in the room that the most insipid commentary on the loss of bipartisanship pretends isn't there: There is no bipartisanship because Republicans have become an almost uniformly conservative party (E.J. Dionne Jr., 2/22).
Arena Digest: Reconciliation Pros, Cons Politico On health policy, liberals in Congress are at once imprisoned by their narrow ideological certitudes and emboldened by their firm conviction that the rest of us are simply incapable of grasping what's good for us (Bob Moffit, 2/22).
Malpractice Reform: A Test Case For Bipartisanship At The Health Summit Kaiser Health News The key is finding ways to fix the malpractice system so that it helps both physicians and the patients, rather than one at the expense of the other (Jonathan Cohn, 2/22).
Long-Term Care Hospitals Deserve Close Scrutiny St. Petersburg Times Due to the spiraling cost, Medicare imposed a three-year moratorium on new long-term care hospitals that will expire in December. This moratorium should be renewed, and new payment rules need to be adopted to take away the financial incentives to treat patients as profit machines (2/22).
Policy Changes Alone Won't Improve Health Outcomes The Oklahoman For the state to improve its health care ranking, a significant number of Oklahomans will need to change their diets, exercise frequently and give up tobacco (2/22).
Stop Medicare Advantage Plans From Exploiting Older Americans The Des Moines Register But the best way Congress can help seniors is to eliminate federal subsidies to private insurers offering Medicare Advantage plans. That would result in eliminating these plans because they would no longer be profitable for companies (2/22).


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((NOT a source I generally quote, but this piece IS from the Huffington Post....))
Health Care Summit: See The Official Invitation, Format, Attendees
http://www.huffingtonpost.com/2010/02/12/health-care-summit-see-th_n_460801.html
First Posted: 02-12-10 05:30 PM Updated: 02-12-10 05:36 PM

The Obama administration has officially invited bipartisan leadership in Congress to attend a health care meeting at the Blair House on February 25. And as part of the process, they have asked Republican congressional leadership to produce "their own comprehensive bill" and place it "online as well."

In a letter from White House Chief of Staff Rahm Emanuel and HHS Secretary Kathleen Sebelius to the top ranking Democrats and Republicans in the House and Senate, the broad ground rules are set for what is sure to be a closely-watched summit.

The session will begin at 10:00 a.m. and be broadcast live in its entirety. Although it is impossible to include every House Member or Senator who has played a pivotal role in the health care debate, the President is inviting the most senior House/Senate bipartisan leadership, as well as the chairmen and ranking members of the committees that oversee health insurance reform legislation in both chambers... The President would like each of you to designate an additional four Members to attend the meeting and be available to participate. It is also important that each of you have one staff member specializing in health care policy in the meeting.

We will have a representative from the Office of Management and Budget to provide technical assistance, and hope that representatives from the Congressional Budget Office and the Joint Committee on Taxation will also be able to attend.

In addition to the President, attending and participating on behalf of the Administration will be the Vice President, Health and Human Services Secretary Kathleen Sebelius, and Nancy-Ann DeParle, Director of the Office of Health Reform.

The President will offer opening remarks at the beginning of the meeting, followed by remarks from a Republican leader chosen by the Republican leadership and a Democratic leader chosen by the Democratic leadership. The President will then open and moderate discussion on four critical topics: insurance reforms, cost containment, expanding coverage, and the impact health reform legislation will have on deficit reduction.

The rest of the letter contains the usual talking points and framing about the need to finalize reform. What seems worth watching is how GOP leadership responds to the request that a comprehensive counter-proposal be presented and posted online. House Republicans produced a short plan of their own. Senate Republicans have yet to do so.

And below is the list of the House and Senate lawmakers formally invited to the summit:

((I included this story, not to let you know who IS on the "A" list for Thursday's dog and pony show, but to let you know who is NOT....and the people whose input isn't important enough to solicit during the five hour Obamacare 2.0 show are....ALL THE DOCTORS IN CONGRESS. There are 16 of them, you know, 11 Republicans and five Democrats in the House, although I'm pretty sure that number has changed in light of the party switch of a Georgia physician/legislator, and two in the Senate.))

Senator Harry Reid, D-NV, Majority Leader
Senator Mitch McConnell, R-KY, Republican Leader
Senator Richard Durbin, D-IL, Majority Whip
Senator Jon Kyl, R-AZ, Republican Whip
Senator Max Baucus, D-MT, Chairman of the Finance Committee
Senator Chuck Grassley, R-IA, Ranking Member of the Finance Committee
Senator Tom Harkin, D-IA, Chairman of the Health, Education, Labor and Pensions Committee
Senator Mike Enzi, R-WY, Ranking Member of the Health, Education, Labor and Pensions Committee
Senator Christopher Dodd, D-CT, Member of the Health, Education, Labor and Pensions Committee
Speaker Nancy Pelosi, D-CA
Representative Steny Hoyer, D-MD, Majority Leader
Representative John Boehner, R-OH, Republican Leader
Representative James Clyburn, D-SC, Majority Whip
Representative Eric Cantor, R-VA, Republican Whip
Representative Charles Rangel, D-NY, Chairman of the Ways and Means Committee
Representative Dave Camp, R-MI, Ranking Member of the Ways and Means Committee
Representative Henry Waxman, D-CA, Chairman of the Energy and Commerce Committee
Representative Joe Barton, R-TX, Ranking Member of the Energy and Commerce Committee
Representative George Miller, D-CA, Chairman of the Education and Labor Committee
Representative John Kline, R-MN, Ranking Member of the Education and Labor Committee
Representative John Dingell, D-MI, Chair Emeritus of the Energy and Commerce Committee

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from Politico.com
Summit spin: Real effort or photo op?
((If that's a multiple choice question, I vote "B"))
http://www.politico.com/news/stories/0210/33251_Page2.html
By PATRICK O'CONNOR 2/22/10 5:05 AM EST

President Barack Obama has billed Thursday’s health care summit as a chance for lawmakers to “seek common ground” to solve a decades-old problem.

He doesn’t want political theater, he insists, but a serious effort to forge bipartisan consensus.
And yet Obama is unveiling a health care bill just days before the six-hour summit that wouldn’t require a single GOP vote, with plans to short-circuit the Senate rules and push it through without Republicans if necessary.

That’s left some Republicans angrily questioning whether the summit is a sham and even Democrats uncertain and noncommittal.

“I’m not terribly heartened by what I’ve heard over the past week,” said Georgia Rep. Tom Price, a conservative Republican who wasn’t invited to the health care talks at Blair House on Thursday. “I’m not certain what the White House is up to, but it appears they are trying to meld a bill together without, again, any input from Republicans. It doesn’t sound like bipartisanship. ... I’m afraid it’s just another photo op.”

House Minority Leader John Boehner’s spokesman, Michael Steel, said that “it would be baldfaced hypocrisy to continue hammering out the latest partisan backroom deal while preparing for a ‘bipartisan’ summit.”

The White House plans to release Obama’s bill Monday and previewed one aspect of it Sunday night – a proposal to give the federal government sweeping new authority to curb excessive rate hikes by the nation’s health insurance companies.

The proposal seems designed to play off voter anger toward recent double-digit increases by Anthem Blue Cross of California and adds a populist tinge to Obama’s proposal, of the president standing up to big insurance companies. The idea wasn’t included in either the House or Senate health reform bills that passed last year.

The Democrats’ push to reform the health care system has always moved on two tracks: the public track — what the president and others say in public — and the private one — what they negotiate behind closed doors.

But those two efforts seem at odds this week like never before, as Obama makes a final public pitch for bipartisan cooperation — with live TV coverage, no less — at the very moment he seems most prepared to abandon it completely. He’s trying to engage Republicans to make his case for reform but is laying the groundwork to go around them if they won’t sign on.

The White House's announcement of Obama's legislation Monday would serve as the template for a final bill, and barring any last-minute Republican conversions, Democrats would attempt to use a procedural tactic that only requires Democratic votes in the Senate to pass it.

An aide to Senate Majority Leader Harry Reid (D-Nev.) let reporters know last week that his boss wants to add a public option to the final bill if Democrats choose to pursue a once-arcane procedural maneuver called reconciliation, in which the ruling party only needs a simple 51-vote majority for passage.

But even Democratic leaders are queasy about whether they can muster the votes to pass it in the post-Massachusetts environment. Senate moderates, in particular, have rebelled against the idea of using reconciliation to pass reform.

And on a conference call last week, Democrats in the House agreed not to embrace the president’s plan until their rank and file has had a chance to review it this week after returning from recess, according to people on the call. As late as Sunday, four separate House aides said they didn’t know exactly what the White House is planning to propose.

The stakes for Obama couldn’t be higher. Despite a year of having sizable majorities in the House and Senate, he has been unable to bring fractious Democrats together to complete health reform. Now he and the party are heading into the 2010 midterm elections with little in the way of popular initiatives to show for a year in power, and the White House is anxious to pass a health care package filled with voter-friendly provisions.

Democrats are considering a reconciliation package that would include a tax on high-end health care plans that’s acceptable to organized labor, subsidies for lower—and middle-income households and more robust drug coverage for seniors. There would also be an increase in Medicare payroll taxes above what’s in the Senate bill.

The White House declined to comment specifically for this article. But press secretary Robert Gibbs has said the summit was a good-faith effort by the president to do exactly what Republicans were calling on him to do — meet in a public forum to hear out their ideas on reform, after months when Republicans criticized Obama for going it alone with Democrats.

Gibbs also rejected the notion the summit is a “trap” for Republicans. “How so? To go sit down with the president and talk about the [problem] that’s facing millions of people, including those that are getting letters each day about the rising cost of insurance?” Gibbs said. “Everybody that’s in Washington, that works in the executive branch and the legislative branch, was sent here as part of representative democracy to solve problems. That’s what this is intended to do.”

For Democrats, the summit is a chance to get Republicans out in the open talking about their ideas for improving the health care system. Given the complexity of the issue, Democrats hope to debunk many of the GOP’s talking points about their bill by walking viewers through shortfalls in the Republicans’ own legislation; for example, the House GOP bill covers about 3 million uninsured Americans while the Democrats’ bills would cover more than 31 million.

“We will have our bill, [the] GOP will have their bill, and we will go through them section by section,” one Democratic leadership aide in the House said. “The president puts his proposal out there, he defends it, describes it and forces his point.”

“Bottom line: The president will not be lectured by them that he wants a government takeover of health care,” the aide said.

The White House also has signaled that Obama will point to many areas of agreement with Republicans on health reform to show that their ideas are not that far apart. That would also allow him to make the case that Republicans are being obstructionist if they won’t sign on to a unified bill.
Republicans hope to use the televised session as a chance to question some of the president’s assertions about his bill or their own.

For example, Republicans want to remind viewers that Obama doesn’t share their view that the awards in malpractice lawsuits should be capped, even though he talks about tort reform. Likewise, when he says he favors giving people the right to buy insurance across state lines, he does so only if the secretary of Health and Human Services — not the states — have the authority to oversee those transactions.

Senate Minority Leader Mitch McConnell and his staff have been working closely with Boehner and his team, aides say, to make sure Republicans present a unified front.

Aides said Republicans also want to highlight divisions among Democrats on issues like support for a tax on high-end health care plans that Obama favors but others, such as Speaker Nancy Pelosi, have resisted.

The White House has also included Republicans in the planning process, reassuring them that the two parties will get equal time, even though Obama himself will moderate the discussion.

The top Republican leaders haven’t officially accepted their invites to the event, but most aides say their bosses would attend, despite criticism from the far right that they’re just going to be used as props in the president’s push to get health care back on track.

“Many of our constituents say, ‘Why are you going to fall into this trap? It’s clearly a trap,’” Price said on C-SPAN’s “Newsmakers” on Sunday. “But I think it’s always important to talk and demonstrate that you’re willing — that we are willing and we have been desirous of for the past year —to work with the president and the majority party.”

Chris Frates contributed to this report.

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((A letter from a Pennsylvania physician....))

President Barack Obama
1600 Pennsylvania Avenue
NWWashington, D.C. 20500
February 20, 2010
Dear President Obama,

I write to you from the front line of the health care debate. I am a Physiatrist (physician specializing in rehabilitation), working in a private practice as well as consulting at a major trauma center.

It fills me with hope that the health care bill will be sorted out, line by line, in front of the public this week. I urge you not to let political partisanship interfere with this important opportunity, and urge a serious discussion of several items not mentioned in the bill:

· Pre-Taxed, Medical Savings Accounts should be allowed, and permitted to carry over from year to year. Increase the maximum annual contribution from $2500 to $5000. This encourages people to save for health care expenses and eliminates the worry that if they do not use that money in one year that it will disappear.

· A portable, low cost, high deductible, low premium insurance plan should be offered to everyone, including the uninsured. This would be for catastrophic or high cost procedures, hospitalizations, and surgeries. Medical Savings Accounts will allow people to put pre-taxed money into an account which they can use for office visits, less costly tests and deductibles. Over time, they can build up a significant amount in the MSAs to be used only for health related costs. The purpose and result would be to drastically reduce insurance premiums.

· I treat many uninsured young people in auto-related accidents. In Pennsylvania, the minimum requirement for medical/health coverage associated with auto insurance is only $5000. I suggest that this minimum required medical-auto coverage be increased to at least $100,000. Premiums for Medical-Health-Auto insurance are low (my premium is about $10 a month for 1 million dollars of coverage), making it a very inexpensive means of having coverage for any auto-related health care needs. Public awareness could be increased about this easy option.

· Medical Liability Reform is essential to any health care improvement plan. Expensive medical tests are routinely ordered, often to look for highly unlikely abnormalities, to avoid the possibility of lawsuits. Defensive medicine is not in the best interest of the patients or the physicians.

I appreciate your consideration. Thank you.

Sincerely,
((Name withheld to preserve the doctor's privacy))


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from the New York Times
Obama to Urge Oversight of Insurers’ Rate Increases
http://www.nytimes.com/2010/02/22/health/policy/22health.html?partner=rssnyt&emc=rss
M. HERSZENHORN and ROBERT PEAR
Published: February 21, 2010

WASHINGTON — President Obama will propose on Monday giving the federal government new power to block excessive rate increases by health insurance companies, as he rolls out comprehensive legislation to revamp the nation’s health care system, White House officials said Sunday.

The president’s legislation aims to bridge differences between the bills adopted by the House and Senate late last year, and to frame his debate with Republicans over health policy at a televised meeting on Thursday.

By focusing on the effort to tighten regulation of insurance costs, a new element not included in either the House or Senate bills, Mr. Obama is seizing on outrage over recent premium increases of up to 39 percent announced by Anthem Blue Cross of California and moving to portray the Democrats’ health overhaul as a way to protect Americans from profiteering insurers.

Congressional Republicans have long denounced the Democrats’ legislation as a “government takeover” of health care. And while they are likely to resist any expansion of federal authority over existing state regulators, they will face a tough balancing act at the meeting with the president to avoid appearing as if they are willing to allow steep premium increases like those by Anthem.
Republican leaders had not formally accepted the president’s invitation to the meeting. But the Senate Republican leader, Mitch McConnell of Kentucky, said on Sunday that he would attend. “I intend to be there, and my members will be there and ready to participate,” Mr. McConnell said on Fox News.

The president’s new provision also seemed to offer Republicans an opening for a new line of criticism — that Mr. Obama and Democrats are anticipating the possibility of hefty price increases for health insurance even after their big legislation is adopted.

Mr. McConnell said the president, in proposing a new version of the Democrats’ legislation, seemed to prejudging the outcome of the session. “If they are going to lay out the plan they want to pass four days in advance,” he said on Fox, “What are we discussing on Thursday?”

The White House has held details of Mr. Obama’s bill extremely tight, leaving even top Democrats in Congress anxiously awaiting the text to be released Monday. But administration officials said it would incorporate legislation proposed last week by Senator Dianne Feinstein, Democrat of California, in response to the Anthem increases. Officials said it would “help make sure that people are not unfairly subject to arbitrary premium hikes.”

Anthem, California’s largest for-profit insurer, has announced premium increases for nearly 700,000 customers, citing the soaring costs of medical care and the effects of a weak economy in which many younger and healthier people are dropping insurance. But the increases, far outpacing the rate of medical inflation, led to outrage among officials in Sacramento and Washington.

The Obama administration has sought to portray the situation as a warning of what could happen to many more Americans if Congress does not act to overhaul the health system.

The president’s bill would grant the federal health and human services secretary new authority to review, and to block, premium increases by private insurers, potentially superseding state insurance regulators. The bill would create a new Health Insurance Rate Authority, made up of health industry experts that would issue an annual report setting the parameters for reasonable rate increases based on conditions in the market.

Officials said they envisioned the provision taking effect immediately after the health care bill is signed into law.

The legislation would call on the secretary of health and human services to work with state regulators to develop an annual review of rate increases, and if increases are deemed “unjustified” the secretary or the state could block the increase, order the insurer to change it, or even issue a rebate to beneficiaries.

The new rate board would be composed of seven members, including consumer representatives, an insurance industry representative, a physician and other experts like health economists and actuaries, the White House said. The board’s annual report would offer guidance to the public and states on whether rate increases should be approved.

But the focus on rate increases is also spotlighting questions about whether the Democrats’ plans do enough to control rising health costs. Anthem and other insurers say they do not.

And it is unclear if the new powers or the rate board would have much long-term impact. The Democrats’ legislation ultimately seeks to sharply curtail the existing individual insurance market in which companies like Anthem Blue Cross now sell their policies. Instead, such policies would be heavily regulated by the federal government and sold through new insurance exchanges, where consumers could compare prices and benefits packages and choose policies that best fit their needs.

The president’s bill, like the measures adopted by the House and Senate, is expected to require most Americans to obtain insurance, and would provide new federal subsidies to help moderate-income people afford to buy private coverage.

And though Americans have heard officials in both parties talk for nearly a year about “President Obama’s health care plan,” the legislation unveiled on Monday will actually be the first comprehensive proposal put forward by the White House.

Senator Feinstein, in an interview, pointed to the $12.2 billion in profits reaped by the five biggest private insurers in 2009. “When you look at the profits in ’09, up 56 percent over the year before,” she said, “you begin to understand that something is going on that is not in the interests of the American people.”

Ms. Feinstein said that only 25 states allowed their insurance commissioners to regulate rates and that California was not one of them. “For the life of me, I am not sure why not,” she said. “The time has come for the secretary of health and human services to step into this.”

Mr. Obama has portrayed Thursday’s meeting as a chance to break the partisan gridlock that has stalled any progress on health care this year. He has called on the Republicans to come forward with proposals of their own.

But absent some dramatic turnabout by Republicans, Democratic leaders will have only one other possible path — approving changes to the Senate bill by attaching them to an expedited budget measure, precluding a Republican filibuster in the Senate. Even many Democratic lawmakers are skeptical that the complex health care legislation can be moved through using that parliamentary maneuver.

And many have been reluctant to say they would support a compromise measure without first knowing what was in it.

Leaders of the National Governors Association meeting in Washington on Sunday expressed frustration that they had been largely shut out of negotiations over the future of the health care system, even though they would be responsible for carrying out many of the changes envisioned by federal officials. They said they wanted more of a voice in shaping those changes.

“It’s important that governors be at the table and bring our perspective to the debate,” said Gov. Jim Douglas of Vermont, a Republican who is chairman of the National Governors Association.
Mr. Douglas said governors were deeply involved in discussions with Congress and Mr. Obama on the economic stimulus law adopted early last year. But he said, “We have not had that kind of relationship in the current debate” on health care.

Gov. Phil Bredesen of Tennessee, a Democrat, said: “Governors have something unique to contribute. Washington, D.C., is full of think tanks, theoreticians and advocacy groups. Governors are the ones whose feet are on the ground. We have a sense of what will work and what won’t work. Our perspective is not the only one. But we can bring some practicality to this discussion.”

Mr. Douglas, Mr. Bredesen and two other governors — Joe Manchin III of West Virginia, a Democrat, and Michael Rounds of South Dakota, a Republican — spoke at a news conference at the winter meeting of the governors association. They and other governors plan to convey their concerns to Mr. Obama at a White House meeting on Monday.

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