The vote by the US House of Representatives on health care reform has been hailed by many as a victory for those many million Americans deprived of any sort of medical coverage. True, there are important, new developments, which Rose Ann DeMoro of the California Nurses Association does a very good job of explaining. Some of these measures were part of Obama’s electoral manifesto during the 2008 campaign.

Still, the conceiving of a tax-financed single-payer system, let alone a “socialized” one, is nowhere in sight. It still sounds bizzarre to people like myself, who live on the other side of the pond (where systems, it should be pointed out, differ both in terms of organization, financing and quality, but still rest on the principle of free, or almost free health care for all), that the largest economy in the world would choose not to grant what is considered as a right (generally enshrined in the Constitution) in most of the world’s advanced countries. Autocratic Germany passed the Health Insurance Bill in 1883, which was gradually extended to cover the entire population; Britain created the NHS in 1948; Italy officially created its in 1978, to make just a few examples. Too often have I listened to horror stories concerning many Americans (including personal friends) who developed serious illnesses and thanked fate for residing abroad, thus obtaining free health care in their new country of residence.

Now, the way this US bill was elaborated and passed represents, in my opinion, further corroboration of the fact that the US presidential system was devised, more than 200 years ago, to attain a specific goal: that is, preventing “radical” legislation from being passed by the political system. As I argue in my book The Roots of Contemporary Imperialism: The Founding Fathers, the U.S. Constitution, and 200 years of corporate dictatorship, the Founding Fathers were cunning enough to devise a system which would create “a path strewn with obstacles in the belief that it would encourage the kind of slow, deliberate politics that were their ideal,” as Daniel Lazare has argued; or, as Charles Beard has put it, “disintegration of positive action.” The political system they devised aimed at preserving the status quo, that is, domination by an already powerful business elite over the people. Only overwhelming popular pressure, extreme crises and the risk of implosion of the system have led to major legislative breakthroughs (or, rather, “concessions” from the elite), such as, to make just a few examples, the Sherman Antitrust Act of 1890, the National Labor Relations Act of 1935, the Minimum Wage Act of 1938 and the Civil Rights Act of 1964. Indeed, as street riots or a widespread popular rebellion directed toward obtaining a national health care system appear as a remote possibility, the vicissitudes of the health care bill show the truthfulness of such assertions.

Constitutional engineering alone does not explain the shortcomings of the presidential system.

There are three additional elements, not strictly related to the US Constitution, which nevertheless overlap and help create a situation in which:

* party nominees are not necessarily their parties’ leaders (as a result of primaries), and thus their political platforms do not necessarily tally with their parties’;
* with very few exceptions, only those “eager to ‘go along to get along,’ ” as William Domhoff has put it, that is, those willing to accept massive corporate donations will win a Congress seat or the presidency, a phenomenon which is obviously not just Republican, but regards Democrats as well, thus further alienating Democratic voters as well as potential ones;
* the electoral system, in joint action with the size of the US territory, stimulates fragmentation and therefore party weakness, thus resulting in lack of party discipline, a situation made even more serious by the influence of corporate interests on elected politicians.

These three elements overlap with constitutional ones, such as the rigid separation of powers: two separate Houses, elected in different ways and at different times; and an executive (that is, the President), elected by a state-based electoral college. Thus, the President is not guaranteed a majority in one House, let alone in both; or, the President might have a majority for a limited time, and then lose it at mid-term elections; or, he may have a majority for his entire term of office, but that does not guarantee party discipline or a common plan on specific issues (with Democrats being a perfect example, supporting, for instance, emancipation in the North and Jim Crow in the South). Also, the President is not even allowed to introduce bills into Congress, and therefore has to rely on Congressmen for that; and Congress is fragmented into countless committees and sub-committees, which in most cases do all the work and leave just the final yea or nay to the whole Chamber. Besides, once a bill is passed by one House, the other House will not vote on the same bill, but present its own and, after voting on it, a conciliation committee will meet to find an agreement between the two Chambers (further delaying as well as watering down legislation). Such a complicated, fragmented system cannot help becoming a prey to lobbies. The same applies to the European Union, where the system is absolutely unintelligible even to experts, and the overlapping of different bodies and levels of governance complicates things, and has paved the way for massive lobbying by corporate interests. In my book, I argue that a parliamentary system might mitigate this phenomenon. That is not to say that lobbying and compromise would disappear, far from that. In many parliamentary systems, committees are very powerful and bills are elaborated in closed committee meetings; filibuster is common practice (for example, by introducing hundreds or thousands of amendments, both within a committee or on the floor of the House, or giving endless speeches on each one of these amendments); there are coalitions and minority governments, which may slow down a government’s action, as this would need to reach compromises with its majority partners or other parties in Parliament; lobbying and electoral financing may be aggressive; and often bills have to be passed by both Houses of Parliament, although often the Upper House can only delay the passing of the bill, but not prevent it, and the government needs the confidence of the Lower House alone). After all, the existence of economic pressures on the part of powerful interests influencing the work of elected bodies is inborn to capitalistic systems, whether they are parliamentary or presidential democracies. However, when a party or coalition of parties presents a clear platform before an election, and wins a majority, and has the power to present a bill, the government’s bill, and defend it on the floor of a House wherein parties, rather than individual MPs, are the leading actors, then, things will be more clear and responsibility for failing to pass a certain piece of legislation will be more easily ascribable.

Now, Obama used to be in favor of single-payer when he was a state Senator. In a Youtube video, apparently dating back to 2003, he claimed that “I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. That’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we’ve got to take back the White House, we’ve got to take back the Senate, and we’ve got to take back the House.” Apparently, he has changed his mind. Changing one’s own mind is legitimate, obviously. However, what is strange is that Obama became less and less convinced about single payer as his political career went on, first at the US Senate, then as a candidate for the Democratic Party’s primaries, and then as party nominee (source). Obama’s change of heart, however, does not sound too outlandish. Money certainly talks: insurance companies contributed with some $2.3 million for his electoral campaign, and the health sector with almost $19.5 million. In the end, Obama’s platform on health care fully reneged on what he had previously backed as an Illinois senator, that is, single-payer.

The bill’s history is particularly telling in order to show US presidentialism’s shortcomings.

When Bill Clinton was president, the business world was adamantly opposed to health care reform. Thus, Bill’s plan was knocked down even by wide sectors of his own party.

Obama’s plan, however, is not really clear, because the US presidential system does not allow presidents to bring forward a clear and final proposal, “take it or leave it or I’ll ask the President/King/Queen to dissolve Parliament and we’ll go to new elections”, as might be the case in a parliamentary system. Obama made some more or less clear proposals during the electoral campaign, sure. However, the bill, or, better, bills dealing with health care reform have sprouted like mushrooms, in different centers of power. Obama may talk to Congressmen, visit Congress in order to convince recalcitrant Democrats (as he did on 7 November, a pretty unusual move), but still, he can hardly impose his will (if he has one on the issue) on his Congress majority.

The New York Times has given a detailed account of the bill’s history.

Thus, at the end of March 2009, and with the consent of the insurance industry, concerned about the growing costs of health care, the (all) Democratic chairmen of five Congressional committees had reached an agreement on legislation requiring everyone to carry insurance that employers should be required to help pay for, and allowing the government to offer a public health insurance plan as an alternative to private insurance.

However, while House Democratic leaders introduced a bill on 14 June, “which in addition to a public plan included efforts to slow the pace of Medicare spending, a tax on high-income people and penalties for businesses that do not insure their workers,” the seven members of the so-called Blue Dog coalition, consisting “of fiscally conservative Democrats, threatened to block the House bill. After a 10-day impasse, an agreement was reached that would cut the bill’s cost and exempt many small businesses from having to provide health benefits to workers. The bill was passed by the House Committee on Energy and Commerce on July 31 by a vote of 31 to 28, with five Democrats joining all the panel’s Republicans in opposition”. The agreement still envisaged the creation by the government of “a public insurance plan to compete with private insurers, but would negotiate rates with health care providers instead of using Medicare fee schedules to pay doctors and hospitals. States could, in addition, set up nonprofit cooperatives to offer coverage to individuals, families and small businesses.”

In the meantime, the Senate went its own way, as “the Health, Education, Labor and Pension committee worked on a bill with a public insurance plan, while the Senate Finance Committee, led by Senator Max Baucus, Democrat of Montana, worked on a bill that sought to avoid one, which Mr. Baucus thought was necessary to gain bipartisan support.” The Health Committee’s proposal saw the light of day on 2 July: “employers with 25 or more workers would have to provide coverage or pay the government an annual fee of $750 for each full-time worker and $375 for each part-timer. The government would pay the start-up costs for the public insurance option as a loan to be repaid, and premiums would be set up so that the option was ultimately self-sufficient.” The bill was passed on 15 July. However, Senator Baucus introduced another bill at the end of August, which “did not include a new government insurance plan to compete with private insurers,” and, “unlike the other bills … would impose a new excise tax on insurance companies that sell high-end policies. The bill would not require employers to offer coverage. But employers with more than 50 workers would have to reimburse the government for some or all of the cost of subsidies provided to employees who buy insurance on their own.” This proposal was passed on 14 October.

In the meantime, Obama, the President and therefore Head of the government, limited himself to a speech to a joint session of Congress in September, and to the aforementioned visit to centrist Democrats on 7 November.

So, the bill was passed at the House. However, further compromises had to be reached before the House could actually give its approval. In order to assuage conservative Democrats’ fears of losing their Congress seats, it was decided that the public option plan “will have to negotiate rates just as private insurers do, rather than offering a rate set slightly above what Medicare pays,” and “the plan will also confront strict controls on abortion. After heavy lobbying by Catholic bishops, the measure was amended to tighten restrictions on abortion coverage in subsidized plans bought through the insurance exchanges, to insure that no federal money is used to pay for an abortion. Both changes angered Ms. Pelosi’s base of liberal Democrats, but they chose to support the bill nonetheless.”

What will happen next? Senate majority leader Harry Reid has already “finessed the difference between a health committee bill that included a public option and a Finance Committee bill that favored a system of co-ops by announcing that the merged bill would include a government plan that would let states “opt out.” A Republican filibuster, however, is not too remote an option, as independent Senators such as Joseph Lieberman have already announced opposition to any bill containing a public option, and support from conservative Democrats is not guaranteed. There is widespread fear that the reform will lie dormant in Congress for a long time to come.

The future of the health care reform in the US is therefore still unclear. Anything might happen: a different version might be passed, after further negotiations between the two Chambers; or the reform might even be put off till doomsday. Still, that is exactly the kind of chaos the Founding Fathers wanted in order to preserve order and stability. Whatever happens at the Senate, health care is not the first victim of US presidentialism, nor will it be the last.

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I have received questions from many clients over the last several months asking about what health care reform means and what it will or will not do. Unfortunately, I myself have more questions than answers. Here are the questions I think we need to ask ourselves, and be able to answer, before deciding to either support, not support, or partially support “Reform”.

1. Which bill(s) are we referring to? There are over 6 bills circulating right now and the two front runners are likely to be merged soon.

2. What is the effect of the over 1,200 amendments to these bills? Will the amendments done at the request of the special interests neutralize any positive aspects intended? (Health Insurance Agents like myself just had a successful amendment added, can you guess what is was?)

3. What is the main problem we are trying to solve? Health Care spending or covering as many uninsured as possible? They are inversely related and none of the current bills adequately address both.

4. Do we want competition, regulation, de-regulation across state lines, etc.?

5. Will reform make us healthier, or just provide more customers to the health care and prescription drug industry?

6. Will the reform efforts help/make us change our lifestyles, the only way we will ever get healthier as a nation?

7. Should we bring back Richard Simmons and “Sweating to the Oldies”?

8. Would mandated insurance coverage for all be of enough benefit to outweigh the loss of personal choice?

I appreciate hearing so much feedback from all of you, so let me know what questions you think we should be asking!

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]]> http://www.klexus.com/confused-about-health-care-reform-youre-not-alone.html/feed 5 http://www.klexus.com/health-care-reform-bad-policy.html http://www.klexus.com/health-care-reform-bad-policy.html#comments Mon, 09 Nov 2009 03:13:02 +0000 admin http://www.klexus.com/?p=27

I’m a fan of the notion that the health care industry has gotten out of hand.  The system, including the pharmaceutical industry, needs some kind of reform to become more available, more cost-friendly, more efficient, and as silly as it sounds, healthier.  However, it’s for these reasons that I’m uneasy, as all Americans should be, with the current health care bill being muscled through the senate.

The senate health committee has already voted to pass the bill.  However, not only conservative but also many moderate members of senate committees are demanding changes, and this includes some Democrats.  This is a good indication that there could be some serious fundamental flaws.  It is also pushing wider the divide that causes a functional impasse between political parties.  It is irresponsible and reckless to deepen this divide, especially concerning such major issues.  Progress cannot be made, improvements cannot be added, and flaws cannot be corrected while some childish power struggle plays itself out.  The process is being rushed, almost as if to prove a point; everyone should stop what they’re doing, stop looking at the majority figures, and sit down together like adults and leaders to work something out.  It’s common sense.

The president was quoted as urging congress to “step up and meet our responsibilites” and saying the need “should provide urgency for both the House and the Senate to finish their critical work on health reform before the August recess”.  Why the rush?  It is not responsible to act so hastily.  This is a monumental issue of change in policies regarding one of the largest industries, in terms of size, money and necessity, in America.  Such an issue cannot be resolved overnight, a relatively close enough time frame to the one in which the President is expecting it to be done.  Mr. Obama, with all respect, this is not a national emergency; it needs to be done, but the necessity does not call for passing rash bills; instead, it calls for thoroughly thought through decisions, well made plans, and a lasting solution that won’t need to be fixed in the coming years or cause a scramble of new taxes to provide its funding.

This is going to affect every American, and it will do so for at least the next decade, potentially longer, into generations to come.  Punctuating the need for a slow down, New Hampshire Senator Judd Gregg called for “serious action by Republicans and Democrats” and “a pledge to put politics aside”.  Let’s face it, the politics of Washington’s residents does not have a rightful role to play, because it is, by all reason, the peoples’ decision.

Obama has also been pushing Senate Finance Committee chairman Max Baucus to have a bill ready by Friday.  But Baucus wants a bipartisan bill, and while he praised the efforts of the health committee, he stated, “That’s a partisan bill”.

Aside from this ridiculous attempt at a power show, the costs of the program are astronomical, and at the very least unreasonable.  Obama supports not “universal” health care, but a government run program to operate along side of, and compete with, private insurers, in theory reducing the costs full circle.  New concerns of overturning the current employer-based system of benefits has prompted the notion of government provided financial assistance for premiums to middle and lower class families.  Obama was quoted: “The American people need to recognize that there’s no such thing as a free lunch, right?  So we can’t just provide care to everybody at no cost whatsoever”.  Well, someone needs to recognize that there is already a similar and so-called unsustainable system in place: some people buy insurance; some people can’t afford private insurance and have government sponsored plans; the rest are left in limbo, many of whom work and actually pay taxed into the system, yet are unable to afford private insurance and do not qualify for the low income eligibility standards of Medicaid.

Theoretically, the new bill would eliminate that limbo crowd, making insurance more affordable and available to them.  however, the bill requires government to provide financial assistance to people and families who make up to four times the poverty level (approximately $88,000 a year for a family of four), encompassing most of the middle class.  In reality, this is the unsustainable system, and it is just asking for abuse.  People who truly do not need the assistance would certainly apply for and accept it, costing billions and causing families like mine to foot the tax bill for their health care.  That’s absurd.  My family of five has an annual income of around $29,000, and while it’s nowhere near a life of luxury, we buy our own insurance and pay our premiums with no government assistance.  So I’m positive that a family with one less member and almost three times the income could afford it.  It’s called personal responsibility, and people need to step up to it.  The government needs to expect people to step up to it.  I’m not saying there should be no assistance at all, but that income bracket needs to be lowered by about thirty grand.

On the other hand, Obama suggests excluding “hardship cases” from a coverage mandate.  That’s hardly fair.  Nothing against people on welfare or other assistance who use it correctly (at one time I had my children on Medicaid, so I’m not judging anyone or putting anyone down), but these institutions are so widely abused.  While there are many who really need it and use it in its intended form–assistance–there are also many who use it as a means  of living.  For example, the purpose of food stamps is to supplement a family’s monthly food budget, but many of the parents nationwide who use food stamps, use them as the family’s SOLE monthly food budget.   This goes back to the “personal responsibility” concept, and a lack of it should not be considered “hardship”.  People who work and raise their kids, trying their best to give them a clean, safe, and comfortable living environment, yet struggle to pay their bills, is a hardship case, so exempt them.  But do not exempt those who consider waiting on a welfare “cash allowance” check to be a full time occupation and use that as their sole income; they should be able to use some of their cash allowance to help cover their premiums.

The finance committee is currently looking at options that could possibly raise $100  billion over the next ten years as partial funding of the bill, by imposing fees on health insurance companies.  Unspecific as to what kind of fees, two things are clear.  One, this would cover only a tiny fraction of the proposed $1 trillion worth of funding the bill requires.  Two, one of the main goals of the program is to reduce costs to Americans.  An explanation is needed as to how imposing fees would achieve this goal.  Logic tells us this will increase the industry’s costs, which will translate into higher costs for providers and buyers.  While I’d much rather see fees for them instead of taxes for us, it doesn’t quite fit that fees would help lower costs.

Under the bill, employers will face fines for not offering benefits.  Seems reasonable. However, this will punch small businesses, who do not qualify for much lower group rates that the larger companies get. This should only be included if insurance companies are willing to offer lower cost plans or there is a max limit named that the employers would have to pay into it.  While I’m in favor if this measure, it needs serious revisions to ensure the safety of small businesses.

Also, there is a proposed individual mandate, forcing Americans to buy coverage or face fines.  Fundamentally, this makes a lot of sense.  If more people are buying to it, this should lower everyone’s costs, and it avoides the costs associated with the uninsured going to emergency rooms and not paying the bill, which falls back on the insured.  However, I’m not comfortable with the government forcing me to buy anything.  Many accidents requiring ER visits are covered in other ways: work injuries are usually covered by workman’s comp, car accident injuries are usually covered by the car insurance’s bodily injury benefit.  As far as visits not covered in other ways, this is another issue entirely, having less to do with insurance and more to do with soaring costs of care.  An uninsured person could expect to see a bill of easily a couple thousand dollars.  If these unwarrented prices were lower, we could expect to charge patients at least half the cost at the time they are seen.  Some say this would prevent many people from going to an ER to have necessary or even life saving treatment.  Well I’m sorry.  Life isn’t free, neither are your injuries, get insurance or pay your bills.  Either way, that’s an individual’s choice to make.  The government has no place trying to force us to buy something.  If you pay your taxes, you can’t have someone claiming authority to tell you how to spend the rest of your money.

As for the TV ads scheduled to be airing, we as a people need to demand they be pulled.  Government, and its policies, are not products to be marketed and sold with advertisements.  Organizing for America, Obama’s campaign organization and now an offical member of the National Democratic Party, is refusing to release information concerning the funds and the cost of the ads.  TV advertising should not be allowed to be used during campaigns, and it certainly has no need to show up on my TV during a term to try and persuade me to support something and push my senators to pass it.

During an interview with Nighline (ABC) last night, the President made comments of the effect that we should pay doctors more for thinking and less for doing.  It is a common government outcry that health care is highly inefficient.  Well, take a look around.  Government isn’t doing much better of a job.  In the process of making hurried decisions and uncalculated moves, common sense is being disregarded on many levels.  Between overhauling businesses, becoming a business that cannot be competed against, and tossing hard paid tax dollars, you’ll hear a lot of government trying to tell us what we want, what we need, and sometimes just saying what we want to hear in order to push things through.  One key component is being overlooked.  I’ve long been saying that the sovereign people need to muzzle it, because it has already gotten out of control, only to snowball.  This is just one area, a perfect opportunity for everyone to do just that, right here with the health care bill.  Government needs to do something that the people want and need, instead of constantly telling just what that something is.  This bill needs to be stopped in its tracks, the process slowed down, and it needs to actually be thought through.

Thanks for reading, and don’t forget to do your job as an American.  Contact your congress people, and let’s keep this place the greatest county to live.

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]]> http://www.klexus.com/health-care-reform-bad-policy.html/feed 5 http://www.klexus.com/health-care-reform-and-behavioral-health-responding-to-new-demands-and-emerging-health-crises.html http://www.klexus.com/health-care-reform-and-behavioral-health-responding-to-new-demands-and-emerging-health-crises.html#comments Tue, 30 Jun 2009 03:11:33 +0000 admin http://www.klexus.com/?p=12

All signs point to Congress passing a comprehensive health care reform bill in 2009, potentially expanding health insurance coverage to 46 million uninsured Americans. This objective will be achieved through a combination of Medicaid eligibility expansions as well as the creation of a new health insurance exchange – basically a new health insurance market place – for persons earning above 100% of the Federal Poverty Level. Premiums for participants in the exchange will be heavily subsidized by the federal government. In return for this expansion of coverage, Congress will be seeking opportunities to introduce greater provider accountability and consumer responsibility into the health care system, while promoting initiatives which increase efficiency and reduce medical errors.

Since many who receive care in CBHOs are low income uninsured (or underinsured) individuals, CBHOs and other community providers stand to greatly benefit from coverage expansions. However, confronted with a once-in-a-generation opportunity to secure significant additional resources for the public behavioral health system, many mental health organizations are pursuing a federal health care reform agenda which not only takes into consideration the overarching principles of the current health care reform debate, but strongly advocates for greater resources to community behavioral health providers to better equip them to address the health concerns of individuals with mental illness and substance use disorders.
What Factors are Driving Us?

The Substance Abuse and Mental Health Services Administration’s state survey shows that persons with serious mental illnesses served by public mental health agencies have the HIGHEST mortality rate of ANY population ANYWHERE in America’s public health system. Specifically, the average life expectancy for this population now rivals people living with HIV/AIDS. In addition, among psychiatric patients, the probability of dying is 55% higher for patients diagnosed as having substance use disorders than among those without a substance use diagnosis.

Provider Accountability
In order to stop the predicted cost growth in coming years, both the Obama Administration and Congress are committed to promoting evidenced-based practices and increasing provider accountability. This trend is reflected in new federal commitments of $1 billion for comparative effectiveness research and $20 billion to encourage the adoption and utilization of electronic health records. Both of these initiatives are based on several themes of the current health care debate: a.) provider accountability for clinical outcomes; b.) systemic application of evidenced-based interventions, c.) reduced reimbursement for sub-optimal outcomes, and d.) specific reporting of detailed encounter data.

To help community behavioral health providers prepare for a new era of accountability in health care while attempting to stem the mortality rates cited above, we are pursuing four priority initiatives:

Mental Health/Substance Use Disorders Included in Benefit Packages In the Exchange
Like the Massachusetts health care reform program, the Obama Administration endorses an approach that finances private health insurance for low income uninsured individuals via a health insurance exchange. Many private insurance companies, such as Blue Cross/Blue Shield and Aetna, would participate in this new program/health insurance market place. Many mental health organizations seek to ensure: mental health and substance abuse benefits are part of any nationwide minimum benefit package; comprehensive parity is applied to all benefit packages offered in the exchange or connector; enhanced case management must be provided to new enrollees with cognitive impairments to help them navigate the exchange/connector.

Federal Status for Behavioral Health Organizations
A new federal definition for Federally Qualified Behavioral Health Centers (FQBHC) that would a) establish federal status for CBHOs who volunteer to meet the standards of an FQBHC, b) provide a definition for such an entity that clearly identifies treatment objectives and updates the minimum core services required, and c) establish clearly-defined national standards for this entity. In return for this new federal status, providers working within FQBHCs will be asked to meet new provider accountability standards (as mentioned previously).

SMI Healthcare Home Demo to Support Co-Location of Primary Care in CBHOs
The Mental Illness Chronic Care Improvement Act of 2009 was introduced in the Senate (S. 1136) on May 21, 2009 by Senator Debbie Stabenow and in the House on June 26, 2009 (H.R. 3065) by Representative Janice Schakowsky. This bill would among many other things, co-locate primary care capacity in Community Mental Health Centers and other community-based mental health and substance abuse providers. This integrated treatment approach is aimed squarely at reducing the mortality and morbidity rates among clients in the public behavioral health system. While mental health organizations have been able to engineer a new $7 million SAMHSA program in 2008 with a similar structure and treatment goals, this demo, targeted to Medicaid beneficiaries, will more directly impact the single largest purchaser of mental health and addiction disorders.

Inclusion of CBHOs in Federal HIT Funding Initiatives
The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was enacted as part of the economic recovery bill passed by Congress earlier this year. It creates a new $17 billion Medicare and Medicaid reimbursement system to help physicians, hospitals and Community Mental Health Centers purchase and maintain health information technology for the purpose of widespread adoption and utilization of electronic health records. Although psychiatrists may access these incentive payments, CBHOs, as facilities, are not eligible for this funding. Many mental health organizations are seeking inclusion of CBHOs in any federal HIT initiatives to ensure that individuals with mental illnesses and addictions have access to the benefits of HIT via the providers that serve them.

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California officials and advocates are offering different predictions about how the House’s recently passed health care reform bill (HR 3962) will affect California and the rest of the country, The Hill’s “Blog Briefing Room” reports.

California Lawmakers

California Democratic Reps. Dennis Cardoza and Jim Costa praised the House’s health reform bill for allocating new funds to support California health care programs.
r />The two lawmakers pledged their support for the bill shortly before the House vote.

After the bill’s passage, Costa announced that he had managed to secure funding for a medical school at UC-Merced with a residency program in Fresno. He said the bill also includes training programs and additional incentives designed to bring more health workers to the San Joaquin Valley.

Cardoza praised the bill’s passage but said additional work will be necessary to lower the legislation’s cost and limit its impact on small businesses (O’Brien, “Blog Briefing Room,” The Hill, 11/9).

Rep. Elton Gallegly (R-Calif.) did not vote for the House reform measure. He said the bill would drive up insurance premiums, raise taxes and increase unemployment levels.

Abortion Coverage Concerns

Rep. Lois Capps (D-Calif.) voted for the House bill because she said it would expand insurance coverage, reduce health care costs and repair the country’s health insurance system.

However, Capps expressed disappointment that the final version of the bill removed her provision about funding for abortion services (Collins, Ventura County Star, 11/8).

Instead, the House version of the bill includes an amendment by Rep. Bart Stupak (D-Mich.) that explicitly bars a public health insurance option from covering abortion services.

Although Rep. Jane Harman (D-Calif.) initially voted for the House measure, she said she might withdraw her support if the final bill includes the Stupak amendment (AP/”KPCC News,” Southern California Public Radio, 11/7).

Additional Support for the Bill

Anthony Wright of the advocacy group Health Access California said the House measure will extend coverage to five million Californians who currently lack health insurance. He added that the measure also would help certain populations afford and maintain their insurance coverage (Weiss [1], “KXJZ News,” Capital Public Radio, 11/9).

Gov. Arnold Schwarzenegger (R) also issued a statement reiterating his support for national health care reform and announcing that he was “very encouraged” by progress in Congress.

Medi-Cal Cost Concerns

However, Schwarzenegger also said a final reform package should not require states to pay an unfair share of the costs (Office of the Governor release, 11/7).

Kim Belshé, secretary of the California Health and Human Services Agency, said the state currently is struggling to pay for Medi-Cal, its Medicaid program.

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