Many different polling outlets have released survey results showing broad support for health care reform and for a public insurance option that would control costs and bring coverage to the 50 million uninsured men, women, and children. A few highlights:

• 85 Percent Want Major Changes To Our Current System.  In the June 2009 New York Times poll, 85 percent of the public responded that it is necessary to make fundamental changes or else completely rebuild the US health care system.
• Americans Believe Health Care Reform Is an Immediate Priority. In the June 2009 Kaiser Family Foundation’s health care tracking poll, more than 60 percent of Americans have responded that “it is more important than ever to take on health care reform now” — rather than, “we cannot afford to take on health care reform right now” — consistently since October 2008.
• More Than Three-Quarters Support Plan that Would Give Americans Choice between Public and Private Insurance.  In the June 2009 Wall Street Journal Poll, when asked “How important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance,” 76 percent responded that it is “extremely important” or “quite important.”
• By Wide Margin, Americans Believe Government Would Do Better Job than Private Insurance Companies in Providing Coverage. In the June 2009 New York Times poll, Americans were asked whether government or private insurers would do a better job providing medical coverage. Americans strongly preferred government, by a 16-point margin — 50 to 34 percent.
• Six in Ten Americans Believe that Government Would do a Better Job than Private Insurers Holding Down Costs.  In the June 2009 New York Times poll, 59 percent of Americans said that government would do a better job than private insurers in holding down health care costs.
• More Americans Believe Public Plan Will Lower Costs and Increase Accessibility. In the June 2009 Wall Street Journal Poll, when given two options for describing the effect of the public plan, either “lower costs and provide health care for all Americans” or “Limit access to doctors and medical treatment options,” a plurality (47 percent) agreed that the public plan would lower costs and increase health care accessibility.
• Strong Majority Believe U.S. Would Be “Better Off” With Health Care Reform. In the June 2009 Kaiser Family Foundation’s health care tracking poll, a strong majority of Americans agreed that the country as a whole would be better off if Congress passed health care reform.
• Youth Support for Public Health Care Plan At Historic High. According to a May 2009 poll by the Center for American Progress and Glaser Progress Foundation, “Support for government health care plans among Millennial voters is at highs not seen before in any generation. In the 38-year history of the National Election Survey’s question assessing support for government health care plans over private health care plans, the level of support has never been higher than in 2008, when 61 percent of 18- to 29-year-olds supported a government health plan.”

Today, the Senate health committee’s leaders Chris Dodd (D-CT) and Ted Kennedy (D-MA) rolled out a revamped plan to overhaul health care that would cost $611 billion over 10 years – far less than their previous version – but would impose a tax on many employers. Key features of the plan include:

• Assessing a annual fee of $750 per full-time worker or $375 per part-time worker for employers who don’t offer health coverageCompanies with fewer than 25 employees would be exempt.

• A cost of $611 billion over 10 years, a reduction from their previous bill that the Congressional Budget Office estimated last month as costing $1 trillion over 10 years.

• Creation of a government health-insurance plan to be available nationwide. The Department of Health and Human Services would negotiate rates and premiums. A health insurance “gateway” would provide access to private insurance.

Dodd and Kennedy outlined their revised plan in a letter to colleagues.

“For the many Americans who have good coverage, nothing will change,” the senators wrote. “They will still be able to keep their doctor, their hospital and their insurance plan. What our proposal offers these families is stability; no longer will Americans with good health care have to worry about losing everything if they lose or change their job, or if someone in their family becomes sick or injured.”

President Barack Obama endorses the plan, saying it “reflects many of the principles I’ve laid out.”

Among them: changes that “will prohibit insurance companies from refusing coverage for people with pre-existing conditions, and the concept of insurance exchanges, where individuals can find affordable coverage if they lose their jobs, move or get sick.”

However, Obama stopped short of specifically endorsing the “fee” on employers.

The Kennedy-Dodd bill’s price tag would fall not only because of the new fee but also because they assume that fewer employers would drop coverage. The pair stressed the importance of private companies staying involved in health insurance and that employers “should still share in the responsibility for ensuring that everyone is covered.”

“The completed bill virtually eliminates the dropping of currently covered employees from employer-sponsored health plans,” they said. Their statement also projected that about 97 percent of Americans would have coverage under their plan.

The remaining committee to weigh in with a plan will be a big one – the Senate Finance Committee. They are still in negotiation and will play a decisive role in any reform since they are responsible for providing the financial framework to pay for it. The House committees responsible for health care released their version two weeks ago.

From the Associated Press:

Legislators in more than a half-dozen states, their revenues evaporating in the recession, frantically worked to stave off government shutdowns and devastating service cuts. California failed to meet a midnight deadline and now may need to issue IOUs instead of paying bills.

Across the country, lawmakers were feeling the heat as their legislatures began the new fiscal year without a budget in place.

The end of June marked the end of the fiscal year in many states, meaning lawmakers worked late Tuesday to pass budgets in a year that has seen the recession take a devastating toll on government finances.

This will have profound impact on children as many states throughout the country are making cuts in education, health, and child safety programs.

The leadership of the House of Representatives and chairs of the House Ways and Means Committee, the House Energy and Commerce Committee and the House Education and Labor Committee unveiled health-care overhaul legislation that includes a new public health insurance plan and generous subsidies for low- and middle-income families to purchase health insurance.

“The approach that the three of us have taken in this process is one of the key factors that makes this year the year that we will finally fix our broken health care system,” said Education and Labor chairman George Miller, D-Calif.

President Barack Obama issued a statement praising the bill, saying it “would improve the affordability, availability, and quality of health care and represents a major step toward the our goal of fixing what is broken about health care while building on what works.”

The plan would:

• Provide subsidies on a sliding scale for families up to 400% of the poverty level, according to the outline. Under current poverty guidelines, individuals with income up to $43,000 would be eligible, and families of four with income up to $88,000 would be eligible.
• Establish credits that could be used to purchase insurance through a new government-run “exchange” that includes both private insurance and government plans.
• Cap out-of-pocket costs to policy-holders and prohibit insurers from denying coverage due to pre-existing conditions.
• Require firms to offer health insurance to their employees, or pay a fee of 8% of payroll, according to the outline. To avoid the fee, employer-sponsored health plans must meet minimum benefit and contribution requirements.
• Propose that firms contribute a minimum of 72.5% of premiums for individual employees, and 65% for family plans. At first, employees of large firms wouldn’t be eligible to purchase coverage through the new health-care exchange. But eventually, the option would be available to all employers for covering employees.
• Require individuals, by law, to purchase health coverage, or pay a penalty of 2% of adjusted gross income above an unspecified level. The fee could be waived in cases of hardship.
• Significantly expand Medicaid to cover individuals and families with incomes up to 133% of the poverty level.

The public option would be financed only by its premiums – not requiring additional government funding – and would be subject to the same regulatory requirements as private plans. The plan would pay doctors and hospitals at rates based on the payments given to health providers who accept Medicare.

The inclusion of a public insurance option marks a key difference between the House plan and a parallel effort being negotiated by leading Senate lawmakers. Those senators, led by Max Baucus, D-Mont., and Kent Conrad, D-N.D., have eschewed a public option in favor of regional co-operatives modeled on rural electric co-ops.

Bringing out the long knives the opposition will wield in this bloody battle:

America’s Health Insurance Plans, a leading insurers’ trade group, assailed the House proposal. “A government-run plan would dismantle employer-based coverage, add additional liabilities to the federal budget, and turn back the clock on efforts to improve the quality and safety of patient care,” said Robert Zirkelbach, a spokesman for AHIP.

Scott P. Serota, president and chief executive of the Blue Cross and Blue Shield Association, warned the bill “would underpay providers, creating major access issues.”

But the seniors’ lobbying group AARP called the House plan a “great starting point.”

“This bill would get us closer to abolishing discriminatory insurance market practices that use a person’s age to block access to health coverage or keep prices too high to make a difference,” said AARP Executive Vice President Nancy LeaMond.

The Georgetown University Center for Children and Families posted a really good analysis of the health care reform bill being debated in the Health, Education, Labor, and Pensions Committee.

So, before jumping into some of the blow-by-blow of what this bill means for kids, it is worth stepping back to say that if health reform were to follow the path outlined in the HELP bill, it would be a major, transformative step forward.  Millions of Americans would secure health coverage.  And, our health care delivery system would begin to move toward the much-discussed (but little acted upon) goal of delivering more cost-effective, high quality health care that focuses on preventing disease rather than merely treating it.

In four key areas, they detail the bill’s strengths and shortcomings.

1.  Does it build on affordable coverage pathways for all children?

The good news is that the bill proposes to expand Medicaid to 150 percent of the federal poverty level (FPL) for everyone (except it fails to mention legal immigrants, a shortcoming we’ll have more to say on in future posts); retain any Medicaid coverage – such as for children — already in place at levels above 150 percent of the FPL; and create a new a subsidy program to help families with income up to 500 percent of the FPL purchase coverage.

The bad news is that it fails to address the future of the CHIP program, a critical component of coverage for millions of low-income children.  While not under the jurisdiction of the HELP committee, the members could (and did on other topics, such as Medicaid) outline what they thought should happen to it.  With CHIP on the chopping block in states such as California, it is a dangerous time to leave its future unspecified. 

2.  Beyond insurance — Does it ensure children get the care that they need?

The HELP bill is strong and sweeping in its efforts to modernize and reform the health care delivery system, calling for creation of a national strategy to improve the quality of care; making major new investments in workforce training; promoting the use of preventive care; and creating a grant program for medical homes.

On the other hand, the HELP bill potentially does not go as far as is needed in covering other, non-preventive services, that children require.  Under the bill, health plans are expected to cover pediatric services as a “general category”.  But, it doesn’t put much meat on the bone, leaving it up to a Medical Advisory Council to provide more detail on what must be covered.  So, for example, we know that a child with speech delays would be able to get a screening for a hearing problem under the HELP proposal, but can’t be certain that if the screening shows an issue, that the child would be able to get a hearing aid.

3. Does it create a unified “no wrong door” enrollment and renewal process?

The coverage system proposed by HELP – and by every other major committee considering the issue – is a patchwork of employer-based coverage, Medicaid, and presumably CHIP (although see above).  Increasingly, we’re concerned that families will find it extremely hard to navigate this three-part system, leaving them at risk of ending up in a no-mans land without any coverage.  The best way to prevent this is to create a unified, simplified application and renewal process in which families can get coverage regardless of whether they initially apply via a Gateway, a Medicaid agency, or a CHIP agency.  In other words, there should be no wrong door into health coverage, a particularly important point if, as the HELP bill proposes, people face a mandate to secure coverage.

The HELP bill moves in the “no wrong door” direction, calling for Gateways to have responsibility to “assist” uninsured people in signing up for coverage.  But, as we’ve learned from the experience of Medicaid and CHIP, an “assist” might not be enough when people must navigate multiple programs — if a family has applied for coverage, the family should actually be enrolled in coverage.  It may be necessary to create simpler rules for establishing eligibility in Medicaid, CHIP, and the Exchange across the country such as requiring electronic verification of income data when feasible and requiring 12-months of continuous coverage in Medicaid, CHIP and the proposed subsidy program.  Promoting simplification and creating automated processes along with providing assistance are critical in order to ensure that we are not adding red tape that makes getting and keeping coverage more onerous.

4.  Does it strengthen financing for public programs – the backbone of coverage for low-income children?

This is an easy one…. The HELP bill does not address these issues, even via “assumption,” presumably because they are well outside its jurisdiction.

We’d love to know what others are thinking.  In the meantime, people may also find helpful the thoughtful comments of the American Academy of Pediatrics and the March of Dimes, both of which are acutely focused on the needs of children and pregnant women in health reform.

Originally posted on Fox-7 News:

A not-for-profit organization just got news that their budget will likely be slashed. This means closures and layoffs throughout Illinois are likely.

Fox 7 met with people from the Children’s Advocacy Center who believe these budget cuts will hurt children the most.

Behind closed doors, in a children friendly room, victims of sexual or physical abuse tell trained professionals what happened to them. “Children need this center without it, they would have to tell their story in places that are not comfortable to them,” said Sheryl Woodham with CAC.

The Senate Finance Committee “has postponed the markup of its health care reform bill until after the Fourth of July recess,” Roll Call reports.

The markup was expected to begin next Tuesday.