On Tuesday, Republican Scott Brown was elected to the U.S. Senate to represent Massachusetts, filling the late Senator Kennedy’s seat. Brown’s election to the Senate presents a new challenge to passing health reform through Congress, but contrary to the spin the media has taken on these events, national health reform is still well within our reach! If anything, this turn of events has galvanized the advocacy community to work even harder and more cohesively to continue moving the health reform process forward.

After a couple of days of regrouping and strategizing, a plan of action has coalesced for Americans who are outraged by the notion that health reform legislation might be stopped in its tracks.

Please remember today that no matter who employs you and what their position on health reform is, you can and must speak up as an American for health reform at this critical hour.

If you are angry that pursuit of the “perfect” has driven a stake through the heart of the GOOD, now is the time to take action in either your personal OR professional capacity and make sure YOUR voice is as clear as the Tea party folks were last summer.

1) CALL!

Following the lead of our national partners, we are urging Texans to call Congress every day until they get the job done!

Specifically, call your House member (Visit www.congress.org to find out who represents you)

Call Toll Free: 1-800-828-0498 (ask to be connected to the U.S. Representative’s office)

The message to the House:

1. Failure to pass real comprehensive health reform is not acceptable!
2. Pass the Senate Bill and we will stand by you.  Let us know how we can help.
3. We support your seeking “fixes” to the Senate bill through Budget Reconciliation, but do not let reform die!

Call the White House, too!
Although the primary target is the House, it is important that the Administration also hears supportive messages. You can do this by calling the White House comments line at 202-456-1414 or 202-456-1111. Please be aware that wait times may be long. You can also send an electronic message

2) WRITE!!

We encourage your organization to sign on to this letter to Members of Congress by Families USA using their online form

3) RALLY!!!

In Austin, MoveOn.org has scheduled a rally for Tuesday, January 26th at the Texas Capitol.  Click here for more information and to RSVP

South Gate of the State Capitol, 11th and Congress (Map)
Austin, TX 78701
Tuesday, January 26th, 12:00 PM

If you know of other health reform events happening in Texas, please share it with us so we can post it on our calendar.  We will forward more updates on actions in Texas as we receive them.

In Massachusetts, 98% of the people already have good insurance, and insurers can’t deny people based on pre-existing conditions.  It’s time the rest of the United States had the same access to good, affordable care.  Here in Texas, 6.1 million of us have no insurance, and one in 3 working-age adults and one in 5 children are uninsured.

We need real leadership from the President and Congress to get the job done, and pass reform to make decent, affordable health care available for every American.

Implementation of national health reform will require a significant amount of work at the state level.  The Texas Legislature will have to modify many state laws and pass several new ones, fix the state’s broken Medicaid eligibility system, and develop new revenue sources for funding needs related to national health reform.  Implementation will be a multi-year process.  To get the job done right, work on it should begin now.

This week the Texas Legislature took its first steps to help Texas prepare for implementation with the naming of House and Senate committees to monitor national health reform.

Speaker Straus named a 15-member House Select Committee on Federal Legislation. The committee’s work will include, “monitoring Congress’s health care reform efforts and their potential impact on the state’s health care system, health insurance regulation statutes and policies, Medicaid and children’s health insurance programs, eligibility system, workforce recruitment and retention, and health care financing mechanisms.”  Rep. John Zerwas will serve as chair and Rep. Garnet Coleman as co-chair.  Speaker Straus’ press release lists the full committee membership.

Senate interim charges released this week by Lt. Governor Dewhurst included the following joint charge on health reform to the Senate Health and Human Services Committee and the Senate State Affairs Committee.

Upon passage of federal legislation relating to reform of the health care industry and health insurance industry, study the implication of such legislation on Texas, the health care industry, and public and private insurance.  Study and monitor the implementation of the insurance regulatory changes, changes to the high risk pool, and any other insurance mandates.  Study the health care policy changes and the impact to the Medicaid and CHIP programs and the state budget.  Assess the impact to all state uninsured and uncompensated care programs and county programs for the uninsured, including county property tax programs to pay for the uninsured. Make recommendations for the efficient implementation of programs.

On Sunday the New York Times published an editorial about the Medicaid expansion in Texas painting an inaccurate picture of what the actual cost to the state would be, and obscuring the potential benefits of the expansion to our economy:

The Texas cost estimate cited (“$20 billion…over a decade”) was drawn from an inflated agency analysis that adds mandated Medicaid expansion costs to a mixture of real and speculative non-reform Medicaid costs. The estimate projected Medicaid costs from 2014 to 2023, adding four years of Medicaid expansion to the 2010-2019 time frame for scoring reform bills. The agency also included costs to cover hundreds of thousands of Texas children eligible for Medicaid right now, but uninsured because of the crisis in Texas’ enrollment system. Covering these kids will entail real state budget costs, only avoided at present because of failed state policies. They do not belong on the national reform balance sheet. The agency also speculated the state might have to fully replace local revenues now used to fund special Medicaid hospital payments, and included those costs. Under House and Senate bills, Texas will gain $10 to $18 federal dollars for each new state dollar we must budget, a potential economic boon. But states view the coming costs of reform coverage through the lens of current hefty revenue gaps. Without short-term federal help with immediate Medicaid costs, states will be ill-prepared to handle the expanded Medicaid caseloads of health reform.

Key Common Ground in the House and Senate Health Reform Bills:

• 2010 Early Deliverables:  New high-risk pool; some immediate consumer protections and insurance reforms; premium rate disclosures and oversight;
• Major Coverage Reforms in 2013 or 2014:  Health Insurance Exchanges create marketplace for insurance under new reforms that prohibit denial or pricing based on health status; premium assistance and out-of-pocket caps, Medicaid expansion for poorest; individual and employer responsibility with exemptions for small firms and financial hardship; 
• Improved Medicare coverage for prescription drugs and preventive care
• Both bills fully paid for through budget savings and revenue increases:  both reduce federal deficit by more than $100 billion in the first 10 years, and continue to reduce it in the second decade.

Key Differences to Negotiate:

• Financing:  House progressive income taxes versus Senate excise taxes on high-cost health benefits.
• Affordability: House much better for low-income premiums and all incomes on cost-share and benefits; Senate premiums better for moderate-income.  Obvious solution = best of both bills, but where will the money come from?
• Exchanges and Insurance Regulation:  House bill tighter oversight, more consumer-friendly regulation of the insurance industry, Health Insurance Exchange greater negotiation power.
• Abortion:  Both bills prohibit direct federal support or subsidy for abortion coverage.  Issue is whether Exchanges can sell coverage that includes abortion as an “add-on” paid for by the consumer.
• Public Option:  House has a moderately weak model and Senate has none, though would have OPM contract with insurers to offer minimum of 2 plans that meet “qualified health plan” standards and at least one of these must be non-profit.
• Employer Responsibility:  House includes a “pay or play” provision, Senate charges employers penalties only if their employees actually access subsidized coverage.
• Undocumented immigrants:  Senate bill prohibits undocumented from buying insurance through the exchange, even with their own funds.  House does not and Congressional Hispanic Caucus opposes Senate language.
• Closing the Medicare Part D “doughnut hole”:  How to pay for this is the issue.

For more on the differences, see the Community Catalyst blog and the House Tri-Committee staff comparison of key differences

The national health reform debate has proved challenging for children’s health advocates who, on one hand support affordable comprehensive coverage for all Americans, but are also committed to protecting the hard-fought gains in coverage and cost protections for children in CHIP and Medicaid. As policymakers negotiate the merging of the two bills, we wanted to present a range views and enough specifics on children’s coverage provisions to fill you in on some of the major concerns and potential benefits of the proposed legislation.

The New York Times Prescriptions Blog post “Program for Children Has Uncertain Future”  provides a nice summary of some of the most pressing concerns regarding the future of CHIP. 

The additional links below provide greater detail on the wide range of advocacy perspectives on the House and Senate proposals impact children’s coverage.

• December First Focus Report – “Children in Health Reform: Comparing CHIP to the Exchange Plans”
• First Focus Health Reform Resources
• December Center on Budget & Policy Priorities – “Vast Majority of Children Would Be As Well Off or Better Off Under House Health Bill Than Under Current Law”

We also recommend checking out Georgetown University’s Center for Children and Families (CFF) as an excellent resource for policy expertise and advocacy:

• Georgetown’s Center Children and Families website on health reform
• CFF Children’s Health Policy Blog: Say Ahhh!

Before the holidays Texas Voice for Health Reform worked with Texas organizations and advocates to participate in a national sign-on letter to Congress and President Obama on the importance of ensuring that the final health reform bill has strong affordability provisions.  Last week our national partners released this letter with 750 signatures from organizations, elected officials, congregations, and civic leaders nationwide, including more than 30 Texas signatures!  Read the final letter with all 750 signatures.

More information on affordability in health reform from Community Catalyst:

• Affordable Coverage Must Be a Priority in Merging the House and Senate Reform Bills
• Increasing Access to Health Care for African Americans Depends on Improving Affordability during the Merge of the House and Senate Bills    
• Increasing Access to Care for Hispanic Families Depends on Improving Affordability during the Merge of the House and Senate Bills 
•  $900 Billion is $900 Billion – or is it? Gross vs Net Spending and Why It Matters

 Health care debt is the number one cause of bankruptcy in the United States, accounting for 62% of US bankruptcies in 2007, compared with just 8% in 1981.  Most Americans experiencing medical bankruptcy are well educated, own homes, and had middle-class occupations before disaster struck—and three quarters had health insurance.  Because out-of-pocket costs for the insured are driving most U.S. bankruptcies, true affordability standards must be closely linked to caps on out-of-pocket spending, and minimum actuarial value standards for health plans.  Both chamber’s bills provide premium and cost-sharing subsidies, and cap out-of-pocket costs on a sliding scale, but the cost exposure for families varies considerably between the bills and across income groups. 

One of the factors behind out-of-pocket cost exposure is of course the extent to which the insurance plan covers the costs of care for the enrollee.  In health reform parlance, a measure of the average percentage of health care costs a particular plan would cover is called the “actuarial value” (detailed explanation here).  Both the Senate and House tie premium subsidies (a.k.a. “credits”) to Exchange plans that provide an average actuarial value of 70%; that is, would pay 70% of the costs of medical expenses for a typical population.  The House and Senate bills then add to the mix cost-sharing subsidies, which are applied to the 70% actuarial value plans to increase the actuarial value of the plan, and thus lower the out-of-pocket exposure of these low-income families.  The House bill offers these subsidies up to 400% FPL, but the Senate ends its cost-sharing subsidies at 200% FPL (good illustration in Table 2 here).

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CPPP Executive Director F. Scott McCown and CPPP Associate Director Anne Dunkelberg sent a letter to Texas’ congressional delegation to share recommendations on the highest priorities for Texas in merging the House and Senate health reform bills, including:

• Adopting the House bill’s stronger affordability measures for families below 250 percent of the federal poverty income guidelines; and
• Requiring the House’s much stronger standards for a Health Insurance Exchanges–whether through a single national exchange or state-level exchanges–to empower exchanges to negotiate with insurers and deliver better value to individuals and small businesses.

You can read the full letter here.

New Report takes a comprehensive look at the impact of health reform legislation has on reducing health care costs and premiums.

The confusion surrounding the definition of costs for the proposed health reform legislation has clouded the debate, making it difficult for most Americans to wrap their head around how health reform will help them. The government’s official scorekeeper, the Congressional Budget Office, has primarily focused its analysis on the impact of health reform on federal spending. While CBO projections suggest that both bills will lower deficits and maintain or lower premium costs for most Americans, this message has been lost in the sound bites.

read more…