The Battle of Capitol Hill: Health Care Reform

Although President Barack Obama’s proposed plan for health reform attempts to cover people with chronic disease, experts say it is too early to tell how it will affect these individuals, or how it will insure them once the legislation is passed.

“Even though there’s a lot of discussion about health care reform, is it about health care insurance reform or delivery reform?” says Sam Giordano, Executive Director of the American Association for Respiratory Care and a member of the COPD Foundation Board of Directors. “One thing we know is that a successful reform to a health care system has got to do a better job at helping patients with chronic diseases manage their own diseases.”

COPD Foundation President John Walsh agrees, and says it is important for individuals with chronic diseases to be their own advocate in the health care system.

“Taking responsibility to assist and manage your care is becoming more and more critical,” he says. “It’s important the community remains vigilant in making certain that we have a voice in protecting the interests and individuals with COPD and other chronic conditions.”

Obama, who made health care reform a sticking point in his 2008 presidential run, has created eight principles in his proposal.

According to Obama, health care reform should:

Reduce long-term growth of health care costs for businesses and government
Protect families from bankruptcy or debt because of health care costs
Guarantee choice of doctors and health plans
Invest in prevention and wellness
Improve patient safety and quality care
Assure affordable, quality health coverage for all Americans
Maintain coverage when you change or lose your job
End barriers to coverage for people with pre-existing medical conditions

Giordano says although Obama has identified some goals he wants health care reform to achieve, the specifics of achieving these goals are elusive.

“Right now, nobody disagrees with the goals,” Giordano says. “Who doesn’t want complete coverage for everybody? Who doesn’t want insurance companies to throw you out of their plan? It doesn’t mean it will get passed. And then if that’s the case, how are the insurance companies going to stay viable?”

Kevin Cain, Assistant Vice President of Government Affairs and Programs at the National Health Council, says the bill will be beneficial for people living with chronic disease if it eliminates some key barriers: pre-existing conditions and life-time and annual restrictions.

“The things that are in there for people with chronic diseases and disabilities are huge and tremendously important,” Cain says. “Different people interact with the health care system in different ways.”

Cain says this legislation is their “best shot” and remains optimistic. The legislation, however, is held up in both the Senate and House of Representatives, which will wait to bring it to a vote until after their August congressional recess.

On the day the House adjourned, health care reform legislation cleared the last of three committees, resulting in a compromise between House Democrats and the Blue Dog Democrats. “The Blue Dogs” is a group of 52 fiscally conservative Democrats who threatened to block the bill because they said it was too expensive and failed to help the health care system.

Legislation faces another wait in the Senate. The Senate Health, Education, Labor, and Pensions (HELP) Committee approved their health care reform plan in mid-July. However, the day before the House adjourned for their recess, Chairman of the Senate Finance Committee Max Baucus (D-Montana) announced the bipartisan group of six senators would not release a draft of their plan, delaying the Senate vote as well.

Baucus did, however, provide some details to the COPD Digest about the legislation that his committee is working on.

“Chronic conditions like chronic obstructive pulmonary disease, diabetes, cancer and heart disease make up 90 percent of health care spending. To lower those costs and improve patient health, the Finance Committee is working to craft a bill that promotes healthy lifestyles, primary care and prevention,” Baucus said in a statement to the Digest. “This investment will help patients and their doctors prevent and detect chronic conditions early on, when they are easier and less costly to treat.”

Baucus also says the Finance Committee bill will encourage doctors to work in teams to help patients manage their chronic conditions.

“These provisions will save our health care system billions of dollars and improve patients’ lives.”

Cain says the delay in the House and Senate does not also mean the end of the legislation.

“This is part of the legislative system. We have to make a lot of desperate people happy, move a lot of pieces on the chess board,” he says. “We’re talking about one-sixth of the economy—that’s a heavy lift. And I think that at the end of the day, we’ll get a bill that does really good things.”

According to Giordano, if all the insurance challenges were met today and coverage was extended to all Americans, the next step would be to figure out if the plan was doing the best thing for the patient. That, he says, is where the concept of Comparative Effectiveness Research comes in.

Under the American Recovery and Reinvestment Act—better known as the Stimulus Package—$1.1 billion was appropriated in spending to Comparative Effectiveness Research (CER). The research analyzes clinical practice, trying to determine which treatment plans are most efficient and effective.

Cain says the National Institutes of Health, the Agency for Healthcare Research and Quality (a part of the Department of Health and Human Services) and HHS Secretary Kathleen Sebelius are the entities controlling the CER research.

“Decisions of how it will be spent are being made now, deciding what kind of research should be done,” Cain says. He added that CER provisions will be included in the health care reform legislature.

“What we’re hoping the new legislation does is create a separate entity that allows more input for patients and physicians and other interested parties in the research, rather than having it all done by current agencies,” he says.

Walsh says the current situation involving CER has little focus on comparative care.

“I really think we have to make certain that CER translates to better care,” he says. “We’re committed to continuing to invest our representation in this legislative process, and in continuing the dialogue on the appropriate use and application of CER initiatives.”

CER promises to be one of the important steps in the massive revamping of America’s health care system. Katherine Baicker, a professor in the Department of Health Policy and Management at the Harvard School of Public Health, says the first step in finding effective, universal coverage is to start by uncovering what does not work in current practices.

“Right now, we have a real inefficient distribution of health care resources,” Baicker says. “The goal is to redistribute a higher value from the system. That means that people will have real, long-term insurance protection. Right now, people are at risk of losing their insurance if they retire. In a reformed system, we’d like to see people be able to change insurance carriers or jobs without the risk of being underwritten.”

Baicker says health care reform should provide individuals with protection, preventing them from having to pay more if they fall ill.

“At the same time, insurers should be paid more for enrolling sick populations, so they can compete to offer high-quality care,” she says. “We don’t want insurers to avoid the chronically ill. We want them to compete to provide the highest value benefit.”

Baicker says people with chronic diseases already know they fall into a higher-expenses-than-average category, so they are particularly concerned about the price of insurance premiums.

“Policy is an issue people are very concerned about,” Baicker says. “Reform should address [the question], ‘How do you make sure that people have long-run protection?’ But people are understandably very nervous about the prospect of rationing. People worry that a big, government program is going to say, ‘You can have this, but you can’t have that.’ ”

For some people living with chronic diseases, such as 62-year-old Mary Ellen Oliver of Seaside, OR, their health care in the near future remains a top worry.

In Oliver’s situation, she is covered under Consolidated Omnibus Budget Reconciliation Act (COBRA) insurance until she turns 65, through union benefits from her previous job in purchasing in the San Bernardino Community College District in California.

After that, she says she is waiting to see what will happen.

“I’m running scared between now and then. At the rate we are going right now, I know that any medical plan will cost me $300 to $400 a month,” Oliver says. “In just three years I’ll be on Medicare which will cover 80 percent [of health insurance] for me, but the other 20 percent will be coming out of my own pocket. It’s pretty stiff.”

Oliver, who estimated her care cost close to $7,000 annually, says she has been watching the health care reform debate closely, and is concerned about the people who do not have coverage.

“I’m not sure how they’re going to cover it,” says Oliver, who is covered by Blue Cross Blue Shield. “The problem I see is that the money has to come from somewhere, but who’s going to pay for it? How’s it going to be paid for?”

Oliver says she does not think there has been a viable health care reform plan yet, and said she can only prepare herself for what comes next, whatever that may be.

“I look more toward the future and wonder what’s going to happen next week, next year, and prepare myself now for then,” she says. “Sometimes I worry myself sick. Tomorrow is always today.” n