As members of the House and Senate work to craft a mutually acceptable economic recovery plan, everyone is talking about the good and the bad of the health care provisions in each version of the bill. MedPage Today correspondent Emily P. Walker explained:

The Senate version would provide $1 billion less for technology upgrades than the House version, but $19 billion is still a significant outlay to make upgrades in the medical record system that many healthcare providers have long been calling for.
…
The Senate bill allocated about $19 billion to upgrade hospitals’ electronic records systems and limited how much an individual hospital could receive to $1.5 million. The House version allocated $20 billion and contained no cap on individual hospitals’ share.
…
The Senate’s stimulus package also includes $8 billion more for the National Institutes of Health than the House version, a total $10 billion. It would go toward facility upgrades, equipment, and research.
…
The Senate version dropped nearly all the money contained in the House version that would have gone toward preventing illness through health screenings, education, immunizations and nutrition counseling.
…
One area where the Senate was more generous was a provision allowing higher payments to hospitals who take in a disproportionate number of low-income, Medicaid, and uninsured patients. This provision was not in the House bill.

At Talking Points Memo DC, Elana Schor detailed key differences between the two stimulus bills’ COBRA and Medicaid provisions:

The House stimulus provides $40 billion to create a 65% government subsidy for COBRA, the health insurance program for unemployed Americans — but the Senate centrists sliced that in half for their stimulus, cutting COBRA to $21 billion or a 50% subsidy.
…
But how many people would get health care under the 65% [House COBRA] subsidy? Pelosi asked the non-partisan Congressional Budget Office that question, and she got her answer last night. 7 million adults and dependent children would get the subsidized COBRA by the end of this year… Another 1.2 million people also would get health coverage under the House stimulus, the CBO said, thanks to a provision that secures Medicaid coverage for low-income workers who lose their jobs and have no other option. Unfortunately, the Senate didn’t touch the Medicaid issue in their stimulus.

(Read the letter from CBO to Speaker Pelosi here [PDF])

On The Health Care Blog, National Partnership for Women & Families HIT Project Director Eva Powell offered her take on the economic stimulus and health care information technology:

We know that HIT is a tool, and that like any tool, it must be used properly to be most effective. Consumer and patient advocates view the privacy issue as part of the framework required for effective use of HIT.
…
Years of discussing how best to approach the privacy issues in HIT and HIE, and many attempts to write legislation haven’t yielded many solutions. Previous attempts either seemed to be mere tinkering that didn’t result in meaningful protection, or seemed to be overreaching attempts likely to create unintended barriers to safe and effective health care. Finally, consumer advocates and privacy advocates feel that the privacy provisions included in the House version of the Economic recovery bill offer a solid start for addressing privacy issues in an electronic health care environment. These provisions lay an important foundation for building a framework of privacy protections… This foundation includes:

1. Closing a loophole in the HIPAA Privacy Rule that allows direct marketing to individuals using their personal health information without their knowledge or permission.
2. Giving patients the right to be notified if their personal health information is breached.
3. Requiring providers to account for disclosures of personally identifiable health information so that individuals and organizations can be held accountable in the event of a breach of information.
4. Giving patients the right to obtain an electronic copy of their health information for a reasonable cost.
5. Improving enforcement of privacy violations.

…
The lingering question about health reform is one of will. Amidst all the discussion about reform and indications of a unique opportunity to make innovative changes, is there actually a will on the part of all stakeholders to do what’s in the best interest of achieving better health and health care, or will we continue to cling to the interests that have prevented positive change in the past? Perhaps the issue of privacy protections in the stimulus bill is the first test of our collective will.

Ezra Klein pointed out that “some fairly important public health measures were eliminated from the stimulus when Susan Collins and Ben Nelson worked their centrist magic”:

The cuts came in comparative medical research, smoking cessation, HIV prevention and testing, diabetes screening and detection, pandemic flu preparedness, health information technology, and much else. So yes, in case you’re wondering, the centrist compromises not only cut jobs and increased the long-term cost of health care, but also ensured the preventable deaths of thousands of people.
…
In response to these cuts, Harold Pollack and more than 600 other health care practitioners, scholars, and analysts have signed a letter opposing the cuts. It’s the sort of document that the conference committee should take seriously. The sums being discussed are fairly small in terms of the stimulus, but would do quite a lot to harm the affected communities at a time when the social supports they rely on will be falling out from beneath them… A decent society doesn’t spent $70 billion on an upper-class tax cut and then cut costs around around the edges by eliminating public health programs that save the lives of the working poor and ease the lives of the chronically ill.

At The Corner, William Winkenwerder, Jr. and Grace-Marie Turner criticized the health care-related aspects of the stimulus bill, particularly the House version:

As part of the stimulus bill, the House wants to pump least $160 billion into our already-bloated health sector… The health-related provisions take a sharp turn toward greater government control over our health sector, without any hearings or serious debate in Congress and without telling the American people what the changes would mean for their personal health care.
…
For starters, the bill would create a 15-member federal health board, composed entirely of federal employees appointed by the president, charged with running “comparative effectiveness” research to assess which drugs and other medical treatments are most effective.
…
The bill would also establish a $400 million slush fund, which the secretary of health and human services would use to give government, not doctors and patients, more control over health-care decisions.

There will be a substantial burden on employers: The bill would impose a back-door mandate for them to continue providing health insurance to workers long after those workers have left.
…
Also, having already repositioned SCHIP as a program for middle-income children, Congress wants to do the same with Medicaid. The House bill would have the federal government pay 100 percent of the costs for states to extend Medicaid coverage to unemployed workers and their families, no matter what the families’ income or assets. Under this definition, President Bush and members of his cabinet would be eligible for Medicaid.

Finally, the bill would allocate more than $20 billion to health information technologies, despite the fact that no one has been able to come up with a workable plan to spend even a fraction of that amount wisely.
…
The U.S. already spends $2.2 trillion a year on health care, and it is widely acknowledged that we are not getting anything close to our money’s worth… The health-related provisions of this bill are too consequential to be rushed through in this gigantic spending bill.

At his Healthcare IT Blog, healthcare journalist Neil Versel took issue with a Chicago Tribune lead editorial’s characterization of the proposed “expansion of health-care entitlements” in the House stimulus bill:

According to the Trib: “The House version of the stimulus package would … shower $20 billion on computer experts to help doctors convert to electronic medical records. That will create jobs but probably not quickly enough to make a difference in this struggling economy.”

To me, the word “shower” suggests an undeserved windfall. Yes, there are risks of wasting $20 billion on a poor implementation of health IT, but are people really seeing this as a giveaway simply meant to create work? This is about reining in runaway healthcare spending and, ultimately, saving lives, right?

Right?

Finally for this week, reminding us about another critical ongoing issue on The Treatment blog, Jonathan Cohn explains what the Obama administration can learn from baseball “as they assemble a team to manage what would’ve been Daschle’s portfolio.”

TNRtv: What Baseball Teaches Us About Health Care Reform

Related posts:

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

This entry was posted on Wednesday, February 11th, 2009 at 1:55 pm and is filed under Cost, 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.