It’s already been a big week for anyone interested in health care, and as such, the blogosphere has been buzzing over all the news and developments. Last week was HHS Secretary nominee Tom Daschle’s Senate Health, Education, Labor, and Pensions committee hearing, yesterday President-elect Barack Obama announced his pick of William Corr to be Daschle’s deputy, and all week, Congress has been working on health care funding legislation, as Jacob Goldstein reported on the WSJ Health Blog:

…the House of Representatives is likely to vote today on a bill that would add about 4 million kids to the State Children’s Health Insurance Program, which already covers some 7 million kids in poor families. A companion bill is moving through the Senate. The program would be funded largely by a hike in cigarette taxes.
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Since Obama backs the expansion, the only remaining bone of contention seems to be whether states should have the option of covering the children of legal immigrants. The SCHIP plan will cost about $33 billion over four years. A bigger, quicker infusion of cash is likely to come from the big stimulus package Obama hopes to sign not long after he takes office. Word is, that plan will have $100 billion in aid to states to prop up Medicaid.

Taking a stand on a key element of the legislation, California National Organization for Women (NOW) wrote:

The new Congress has decided to take swift action on the State Children’s Health Insurance Program (SCHIP), the same program President Bush vetoed twice last year. This legislation expands health care for kids who are in working families that make too much to qualify for Medicaid, but who don’t make enough to afford private insurance. The SCHIP extension expires on March 31st, so we need Congress to move quickly.
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Currently, legal immigrant children and pregnant women must wait five years before they become eligible for federally funded Medicaid and SCHIP. Congress should include the “Legal Immigrant Children’s Health Improvement Act” (ICHIA) in SCHIP reauthorization to remove this arbitrary waiting period. No child should have to wait five years for basic health care… Including immigrant children and pregnant women in such programs helps to expand immunization and preventive care, and to control widespread health problems.

Blogging on The Huffington Post, Mario Solis-Marich called the SCHIP legislation the “first reality test” for Congressional Democrats on the “hot button issue” of immigration:

…what some politicos will focus on is a provision that will allow DOCUMENTED immigrant children to benefit from SCHIP. Children who are fully documented residents can receive SCHIP benefits now if they have been in the country for five years. The new SCHIP provisions will merely remove the five year waiting period… While it looks like the House will pass the bill as written easily the Senate may be a different story. Beltway insiders tell me that Senator Max Baucus (D-MT) is ready to complain about the immigrant provision and fight the bill if it somehow remains intact. This is where the test for Democrats is born.
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Every expert understands that containing emergency room costs is a key to any attempt at health care reform… the SCHIP provision to include as many currently uninsured children and children about to lose their healthcare coverage is a smart investment… If the future of these children or the overall savings of the program are not a big enough motivator there are others. Democratic leaders may ponder the impact of a low Latino turnout in the 2010 off year election and a potential opening for moderate Republicans into Latino family households. If the moral and fiscal imperatives of making SCHIP more inclusive are not strong enough the political reality should be.

At the Think Progress Wonk Room, Igor Volsky discussed the SCHIP legislation and Republican opposition to the immigration-related provision:

House Minority Leader John Boehner (R-OH) and Republican Whip Eric Cantor (R-VA) are calling on Speaker Nancy Pelosi (D-CA) and President-elect Barack Obama to continue denying health insurance to immigrant children. In a letter to the Democratic leaders, Boehner and Cantor stipulate that “only U.S. citizens and certain legal residents should be permitted to benefit from a program like SCHIP”…
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The Democrats’ bill to expand SCHIP is expected to give states the option of lifting the five year waiting period and allow as many as 400,000 children to apply for federal health programs… the argument for including tax-paying non-citizens in the SCHIP program is as much economic as it is moral. Forcing immigrant children to go five years without seeing a medical professional only increases SCHIP’s costs once the now sicker children become eligible for insurance… Luckily, most Americans support lifting the ban. According to a survey commissioned by the child advocacy group First Focus, 67 percent of Americans “favor eliminating the five-year waiting period for legal immigrant children, while 19 percent were opposed.”

On The Plank, Jonathan Cohn suggested potential political effects of the SCHIP legislation:

After some initial talk of folding S-CHIP into the stimulus package, its chief advocates both in the Obama transition team and on Capitol Hill have decided to pass it as a separate measure. This would allow them to extend the programs for five or six years, as originally planned, and to do so with a dedicated funding stream… Passing S-CHIP separately also promises certain political virtues. It would give Obama a clean, easy win early in his administration–something that would, ideally, help Obama build some political capital.

But it’s not a sure thing that it will be so clean and easy. The original S-CHIP measure, passed during the 1990s, barred even legal residents from claiming benefits until they’d lived in the U.S. for five years. House Democrats, who are supposed to vote on the measure Wednesday, have decided to strike that measure… I’ve heard Senate Democrats are leaning towards doing the same thing. But staffers I consulted said it wasn’t a done deal, in part because they worry Republicans would use the change to attack the issue. Even if those attacks couldn’t derail the S-CHIP expansion per se, it might stir up the kind of opposition that could stall their progress on other issues–not least among them, universal health insurance, an issue still on the docket for this year.

On MyDD, Jonathan Singer offered a different perspective on the situation:

Covering four million Americans without health insurance when somewhere between 45 million and 50 million are uncovered may seem like a small step — but it’s an important one. The measure of the success of the Obama administration will not be in legislation like the renewal and expansion of SCHIP, in lifting the ban on federal funding for stem cell research, or anything of the like. Yet that does not mean that such bills will not have an important impact on the lives of many Americans. What’s more, such legislation has the potential of helping build the momentum towards broader changes with wider impact — and greater historical importance — that could improve the lives of countless more Americans. And it doesn’t hurt that the Democrats’ SCHIP bill is widely popular with voters.

On a related topic, at Talking Points Memo Election Central, Elana Schor reported on the debate about which health care initiatives to include in the upcoming stimulus bill, plus Senator Ron Wyden’s (D-OR) take on the issue:

“If there can be two good wins on health care early,” [Wyden] told me during a sit-down interview in his office today, “on SCHIP and COBRA for the uninsured, it’s a bit of a down payment in terms of broader reform. It can build on that — on Democrats and Republicans finding common ground.” Wyden added that reforming health information technology, allowing all Americans to have an electronic medical record within five years, is also on track to be part of the stimulus, for one simple reason: “It’s a job creator.”
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Adding COBRA aid to the stimulus bill, however, thus helping laid-off workers afford to keep their health care, would be a key victory for Wyden. The idea has met with positive signals from Republicans, making COBRA aid a helpful first step towards amassing broad support for major health care reform later in the year… pointed to the benefit of starting small will convince ordinary voters as well as business interests that a broad health care bill is coming.

The National Journal Health Care Experts blog sparked a discussion about COBRA with their questions for this week:

What’s Wrong With COBRA?
Would it really do much good to extend the length of COBRA health insurance coverage as part of an economic stimulus package? Would people really sign up? Does COBRA ever really work well? … FamiliesUSA released a study Friday finding that COBRA costs on average eat up most unemployment benefits. Is it better to stick with Medicaid, or are there dangerous precedents in expanding Medicaid’s reach?

FamiliesUSA Executive Director Ron Pollack responded:

Clearly, COBRA is great in theory and lousy in reality. This needs to be fixed. Thankfully, the incoming Obama Administration and leaders in the Senate and House are considering immediate help for the recently unemployed as part of the economic recovery package that is the top priority for legislative action. That help may come in one or a combination of two forms. First, the recovery package may provide subsidies to make COBRA premiums more affordable; clearly, those subsidies need to be substantial if they are to achieve their purpose. Second, the recovery package may enable laid-off workers to gain temporary enrollment in the Medicaid program with the federal government picking up the full tab.

As important as these measures are, they are only short-term, partial fixes. The growing crisis makes abundantly clear why meaningful health care reform should be an early, top priority.

(Pollack’s response was also posted on the FamiliesUSA Stand Up For Health Care blog.)

As previously mentioned, funding for health information technology may also be included in the new administration’s stimulus package. On the New Health Dialogue blog, Paul Testa highlighted a key supporter of this plan: President-elect Barack Obama:

In a report… detailing the new administration’s plan to save or create at least 3 million jobs, Obama’s economic advisors estimated that at least 244,000 of those jobs would come in health care, a sector that could be spurred by stimulus investments in health IT. CNNMoney has an article yesterday enumerating both the promises and pitfalls of health IT. While noting that costs of full implementation are high (estimates range between $75-100 billion) the benefits may be higher. David Brailer, who was the National Coordinator for Health Information Technology from 2004 to 2006, estimates that health IT could save as much as $200-300 billion a year.
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Yet, a new report from the National Research Council warns: “Current approaches to U.S. health care information technology are insufficient.” They are are too monolithic and too often just mimic existing paper systems… The report reminds us that health IT must be incorporated within broader changes to our health care system. As [David] Kibbe writes in another post: “Health IT has increasingly become the glue between and across all health care supply chain, care delivery and financing enterprises.”

We agree that investments in health IT must include a broad array of components, such as decision support tools, incentives for adoption of electronic medical records, e-prescribing incentives, etc., and standards for interoperability and patient privacy. Fortunately, their potential is not lost on lawmakers. The Senate HELP committee will hold a hearing this Thursday at 10 am on Investing in Health IT: A Stimulus for a Healthier America.

At The Health Care Blog, Peter Schmidt discussed health IT funding possibilities:

While I generally agree with the predictions of doom and gloom for providers saddled with the burden of data entry, this creates a potentially huge opportunity for Health 2.0. As very publicly warned in this forum and others, a stimulus package focused entirely on existing EMR/HER technology would not only offer no proven health benefits (Linder, et al. Arch Intern Med. 2007) but also would financially harm clinical practice… This impact will fall disproportionately on primary care.
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One of two results will come from the Obama Health IT stimulus: either physicians will be overwhelmed with inefficient health databases, or Obama’s team will take the advice of Drs. Kibbe and Klepper and will earmark money for improving the process of health data collection as well as the medium for its storage. In the first case, Health 2.0 will come galloping to the rescue of physicians desirous of sharing the burden of data entry with their patients; in the latter, Health 2.0 will be integrated into the process.

That’s it for this week’s health care blog roundup. Dr. Val is hosting the Inauguration Day edition of Grand Rounds at MedPageToday. To contribute, read the Call For Submissions. And don’t miss our multimedia roundup later this week, right here at Disruptive Women in Health Care.

Related posts:

1. Blog Roundup: The Economic Stimulus Bills and Health Care
2. Blog Roundup: President Obama's budget plan for health care reform
3. Multimedia Roundup: Health Care Policy
4. Blog Roundup: The jury's still out on comparative effectiveness and the stimulus, but at least we know coffee is good for our health
5. Video blog roundup: Health care reform debate goes public

This entry was posted on Wednesday, January 14th, 2009 at 2:07 pm and is filed under Policy, Politics, Roundup. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.