By Jim McLean
KHI News Service
TOPEKA, Jan.
8
Fixing what ails the nation”s health-care system is job one for the newest member of the Kansas congressional delegation.
Democratic Congresswoman Nancy Boyda said nearly everyone she encountered in the
2nd District
during her campaign to unseat Republican Jim Ryun
from people on the street to business owners
listed the high cost of health care among their most pressing concerns.
“We”re going to hit a brick wall if we don”t do anything,” Boyda said. “We”re at a tipping point.”
National surveys back her up.
A poll conducted for the Kaiser Family Foundation in late October showed that nearly half of voters (46 percent) said the were “very worried” about having to pay more for their health care or insurance. That was a significantly higher percentage than those who said they were concerned about being unable to pay their mortgage or rent (27 percent), losing their job (22 percent) or being a victim of violent crime (20 percent).
Numbers compiled by the U.S. Census Bureau underscore people”s unease about the cost of health care. The number of uninsured Americans grew in 2005 to 46.1 million, up 1.3 million from the previous year and continuing an upward trend that began in 2000.
The number of Kansans who lack insurance remained at about 300,000 in 2005
about 11 percent of the population
though the number of uninsured children climbed by almost 1,500.
“We either get health care fixed, or I will feel like my being in Congress really hasn”t made a difference,” Boyda said.
The 2nd District covers the eastern third of the state, excluding the Kansas City metro area, from the Nebraska border to the Oklahoma line.
Boyda hasn”t yet endorsed a specific reform proposal, but some Democrats want to use their party”s regained control of Congress to push for universal health care. Sen. Ron Wyden, D-Oregon, has said he will introduce legislation to replace the nation”s employer-based health care system with one that, like
the new coverage program adopted in Massachusetts
, requires individuals to purchase coverage.
Under Wyden”s proposal, federal subsidies would make policies more affordable for low-income people and employers would use money they”re now spending to provide health benefits to increase employee wages under the theory that workers could use those dollars to purchase private insurance.
However, many Democrats agree with the prevailing view of Republicans that the nation can”t afford a universal coverage program without worsening the federal budget deficit. They favor a more limited approach, one that expands existing government programs to reduce the number of uninsured. But even those proposals are expected to be expensive.
Though higher than expected tax collections prevented the deficit from deepening in the most recent budget year, the nation”s overall debt stands at $9 trillion and interest on that debt grew by 23 percent last year, making it the fastest-growing part of the budget.
Competing priorities are also complicating the agenda-setting process. In addition to measures to reduce the number of uninsured, many Democrats are calling for legislation to close the so-called “doughnut hole” in the Medicare prescription drug program. The term refers to a gap in coverage that kicks in once a beneficiary”s annual drug purchases reach $2,250. Once that threshold is reached, a beneficiary must pay 100 percent of the cost of their prescription drugs until their expenses reach $5,100 when federal assistance resumes.
Closing the coverage gap would cost an estimated $5 billion annually.
Kansas 1st District Congressman Jerry Moran, a Hays Republican, said Democratic leaders should be careful not to promise too much. Reducing the number of uninsured and closing the gap in Medicare drug coverage will be difficult, he said, if Democrats intend to also honor their pledge to not deepen the federal budget deficit.
“My guess is not all of those promises can be kept,” Moran said. Kansas” big
1st District
starts at the Colorado border and covers nearly two-thirds of the state, reaching as far east as Emporia.
Still, Moran said, he shares Boyda”s desire to engage in a bipartisan discussion about how to cover the uninsured, control health care costs and make Americans healthier.
“I think it”s past time to have that discussion,” Moran said. “I don”t think there is a consensus on what the outcome should be.”
The Senate Health, Education, Labor and Pensions Committee, which includes U.S. Sen. Pat Roberts, R-Kan.,has scheduled early hearings on the issue of health care costs and the uninsured.
Kansas’ other U.S. senator Sam Brownback, a Topeka Republican, favors tax breaks to help make health coverage more affordable.
“We should offer tax breaks to individuals similar to those already offered to employers so that we can help make health care more affordable for low-income and uninsured Americans,” Brownback said in a press release issued last spring that outlined his health reform ideas.
Brownback”s plan also includes a proposal to list the costs of common medical procedures on a national Web site to help consumers make better choices.
Members of Congress and health policy analysts who favor more extensive reforms say proposals such as those being offered by Brownback would do little to reduce the number of uninsured or to make health coverage more affordable.
Negotiating Medicare drug prices
Moran is parting company with many of his Republican colleagues by supporting one of the action items on incoming Democratic Speaker Nancy Pelosi”s agenda: legislation requiring the federal government to negotiate prices for medications offered through the Medicare prescription drug program.
Moran said the 2003 legislation that created the drug program specifically prohibited price negotiation because the pharmaceutical industry opposed it. Instead, it allowed the private insurers that deliver the benefit to negotiate with manufacturers to obtain discounts, often in return for promoting particular drugs.
“The legislation was drafted in a way that was supported by the pharmaceutical industry,” he said. “We ought to be more focused on the taxpayer and the consumer.”
Moran and other supporters of price negotiations claim it will result in lower drug prices for the approximately 22.5 million Medicare beneficiaries enrolled in the program.
But the man who would oversee the negotiations doesn”t agree. Michael Leavitt, the secretary of Health and Human Services, recently told the New York Times, “I don”t believe I can do a better job than an efficient market.”
Boyda, a former pharmaceutical company executive, said she supports the price negotiation legislation, predicting it will be among the first measures passed by the new Congress.
“It”s going to happen in the first 100 hours,” she said.
Because of congressional schedules it may take members until Jan. 15 to complete their first 100 hours of work.
Revisiting the citizenship rule
Kansas officials, from Gov. Kathleen Sebelius to members of the
Kansas Health Policy Authority
, have called on Congress to review a new Medicaid proof-of-citizenship rule, which they say has slowed the eligibility determination process and resulted in 18,000 to 20,000 low-income people being dropped from or denied eligibility for the government insurance program.
“While we understand the purpose of the new law was to increase citizenship verification, we must point out the impact of the law in our state is falling disproportionately on eligible Kansans,” Connie Hubbell, chairwoman of the health authority, wrote in a
Dec. 7 letter
to members of the Kansas congressional delegation.
Hubbell and Marci Nielsen, executive director of the health authority, are among a group of state health officials scheduled to travel to Washington, D.C. in February to press their case with Kansas members of Congress.
Moran said he supports the intent of the new rule but wants to know more about the problems state officials say it is causing.
“I”m happy to listen to the arguments about why what we”re doing isn”t working,” Moran said. “But I support the concept of people having to demonstrate that they are eligible. I do think that services in the U.S. can be an inducement for people to come here.”
Boyda said she too is willing to listen, but she also wants to make sure that people who receive services from government programs are eligible for them.
Reauthorizing SCHIP
There is little doubt Congress will reauthorize the State Children”s Health Insurance Program, known as SCHIP. The question is, at what level?
Democrats have said they want to expand the $40 billion program, which provides health coverage to children whose families earn too much for Medicaid benefits but too little to afford private health insurance. In Kansas, children in families with annual incomes up to 200 percent of the federal poverty level $33,200 for a family of three qualify for SCHIP coverage.
Gov. Sebelius has proposed increasing SCHIP eligibility to
300 percent of FPL to help reach her goal of providing health coverage to all Kansas children up to age 5.
Currently, the SCHIP program provides health coverage to more than 4 million children nationwide and about 34,000 in Kansas.
Reauthorizing the SCHIP program at a higher level is among the top priorities of Kansas Action for Children, a non-profit advocacy organization.
“Without more money, Kansas will face an enormous shortfall,” said Shannon Cotsoradis, KAC”s associate director.
Sheldon Weisgrau, a policy analyst at the Kansas Health Institute, said because SCHIP is a block-grant program, state allocations over the past 10 years haven”t kept pace with rising health care costs.
“It will require more money just to continue serving the children already in the program,” Weisgrau said.
Roberts was among a group of senators who recently sent President Bush a letter urging him to support higher funding for SCHIP.
“We urged the president to ensure that his budget proposal provides enough federal funding to not only allow states to maintain their existing SCHIP caseloads, but also to allow states to expand their programs to cover more children and pregnant women,” Roberts said, describing the letter.
Moran wasn”t ready to predict how much Congress would increase SCHIP funding, but said he was confident the program would be reauthorized.
“I think there is broad recognition in Congress that the SCHIP program is valuable,” he said.
Jim McLean is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
jmclean@khi.org
or at 785-233-5443, ext. 110.