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Issue Position: Health Care

Issue Position

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Issue Position: Health Care

Quality, Affordable Health Insurance for All

Our health care system is in trouble: costs are rising at an unsustainable rate, too many Americans are uninsured, and our quality of care isn't up to par. High costs are making it increasingly difficult for Montana's families to afford comprehensive health insurance and Montana's rate of uninsured is growing rapidly. The United States spends twice as much on health care as any other country, but studies have shown that the quality of our care often lags.

Charting a Course for Health Care Reform

So how do we fix our health care system?

I see five broad principles of reform. As Chairman of the Finance Committee, with jurisdiction over the major public health insurance programs, I have begun a series of hearings to explore each principle in greater depth. By having an open and honest dialogue, I am confident that we can build momentum, find points of consensus, and bring about reform.

The first principle is universal coverage. Universal coverage is essential if we are to make meaningful progress on the other four principles. We cannot address the health care system, and leave a growing portion of the country behind. Though this much be a public and private sector mix.

The second principle is sharing the burden. Neither the employer-based system nor the individual market can fulfill the demand for affordable, portable, quality coverage. The way to ensure affordable coverage is to create pooling arrangements.

The third principle is controlling costs. America cannot sustain its current rate of growth in health care spending. Any serious proposal must reduce the rate of growth of health care costs. Our economy depends on it.

The fourth principle is prevention. American health care tends to address what happens when you are sick. By making prevention the foundation of our health care system, we can spare patients needless suffering. We can avoid the high costs of treating an illness that has been allowed to progress.

The fifth principle is shared responsibility. We want universal coverage. But the question is: Who will bear the burden of a new system? The answer is that everybody must shoulder the burden together. Health coverage is a shared responsibility and all should contribute.

I believe we can reduce the number of the uninsured by building on existing programs, but we must protect and strengthen these programs as we work towards broader reform.

Children's Health Insurance Program (CHIP)

Making sure Montana children have access to quality health care is one of my top priorities. The CHIP program currently provides health care insurance to over 13,000 low-income kids in Montana alone. The program covers over 6 million children nationwide and has lowered the number of uninsured children in the past ten years. This is a very important program.

I'm proud of the role I played in crafting the federal CHIP legislation when it was passed by Congress and signed into law in 1997.

I have continued to play a role in supporting the program, both nationally and in Montana Once CHIP became law; I worked with the Montana Legislature and former State Auditor Mark O'Keefe to find funding for Montana's share of CHIP.

When Montana submitted its CHIP application, I worked with Donna Shalala, then-secretary of the U.S. Department of Health and Human Services, to expedite the federal agency's review of the plan.

• In 1998, I worked to increase Montana's share of CHIP funding by nearly $2 million, by pushing a change in the way the U.S. Census Bureau counts uninsured Indian children. That amounted to an increase in CHIP funding for Montana of about 20 percent.

• In 2000, I helped broker a compromise between states that had spent all their CHIP funding and those that had not, allowing Montana to keep about $2.7 million in CHIP funds. Provisions of the CHIP law would have forced 40 states, including Montana, to surrender a total of $1.9 billion in CHIP funding.

• In 2004, I tried to broker a compromise to extend the availability of $1.1 billion in federal CHIP funds.

• In 2006, I co-authored a compromise that redistributed funds to protect a number of states against experiencing gaps in federal CHIP funding through May of 2007.

Reauthorization

After a successful ten year history, the CHIP program is up for reauthorization this year. This year, the program will be reauthorized. I know Montana and other states need more funds. Without additional funds by 2010, I am told Montana will have to trim its CHIP enrollment from 13,900 to 8,000 or 9,000. We cannot afford to lose ground in our fight to get kids health coverage. As Chair of the Finance Committee, I will work with my colleagues to develop a reauthorization plan that fully funds CHIP going forward and work to cover more eligible but unenrolled kids.

Medicare Prescription Drugs

Seniors should never have to choose between prescription drugs in their medicine cabinet and food on their table. We made significant progress when I worked together with members of Congress and the President to pass the Medicare prescription drug bill. In 2006, seniors finally began receive the help they need and deserve with their prescription drug costs. All 150,000 Montana seniors and disabled individuals are able to sign up for comprehensive drug coverage on a voluntary basis for a modest monthly premium ($22 on average in 2007). For individuals making less than about $13,500 a year, the drug coverage is stronger still. Roughly 45,000 to 50,000 Montana seniors are eligible to have co-payments as little as $1. They also have no or low monthly premiums, no or reduced deductibles, and no gaps in coverage. It's not a perfect benefit, but it's a solid start.

Medicare Part D Improvements

I voted for the Medicare Part D program because I wanted to help Medicare beneficiaries afford their drugs. I plan to improve the Medicare drug benefit by making it easier for people with low-income to qualify for the extra help that is available to them. Many of the people who have not signed up for the benefit in Montana would be eligible for extra assistance—that means no premiums, deductible or co-pays. I plan to introduce legislation to make it easier for them to qualify for extra help. I also intend to require Medicare to do more to reach out and let people know that extra help is available. People with low incomes often need the most help buying their medicines. And I intend to make sure these folks know the extra help is there for them.

Also, I am disappointed that CMS has made the drug program needlessly complicated by approving so many drug plans - over 50 in Montana alone. Seniors have been overwhelmed not only by the number of choices, but by the variation among them. It is too hard to make apples-to-apples comparisons of what the plans offer and how they operate. I plan to introduce legislation to make it easier for seniors to shop for plans, get information from their plans and Medicare, and get their prescriptions filled. I also believe we need to provide more funds to State Health Insurance Assistance Programs to support their counseling and educational services.

Pharmacists in Montana have been hit hard by CMS' implementation of Part D. So I drafted and introduced S. 2664, the Pharmacy Access Improvement Act of 2006. The bill requires drug plans to reimburse pharmacies more quickly, conveniently and fairly. It also prohibits plans from "co-branding" - placing pharmacy names or logos on their identification cards - and establishes a process so retail pharmacists can get better dispensing fees for filling Medicare prescriptions.

Medicaid

Medicaid serves about 95,000 Montanans of modest means. I've seen first-hand the importance of Medicaid in providing quality health care for tens of thousands of Montana children, pregnant women, mothers, disabled persons, and senior citizens. During last year's budget debate, I successfully fought against drastic cuts in the Medicaid program. I am committed to strengthening and improving the Medicaid so it can continue to provide a safety net of health and long-term care services for future generations. With one in five Montanans uninsured, we should work to strengthen - not weaken - this critical part of our health care safety net. I want to look to ways to improve the program, investing in health information technology, promoting prevention, and finding ways to deliver quality long-term care services more efficiently to keep the program strong.
I worked hard on provisions in the 2002 trade bill that expanded assistance available to workers, farmers and ranchers who lose their jobs due to U.S. trade policy. That program, called Trade Adjustment Assistance, now provides assistance for 65 percent of health insurance premiums. While this program is still relatively new, I have heard some concerns from Montanans about how it's been implemented so far. This year, Congress will reauthorize Trade Adjustment Assistance. We will work together to improve this program to make sure it delivers on its promises of access to health services for displaced workers and retirees.

Rural Health Care Shortages & Critical Access Hospitals

One of Montana's most pressing health care problems is a shortage of nurses and other health professionals - particularly in rural areas. To help alleviate these problems, we need to ensure that rural health care gets a fair shake. That means making Medicare payments more equitable for rural providers, from hospitals to home health to physicians. It means making sure that Medicare reimbursement for physician care is sufficient to keep providers in our communities, serving their patients. And it means building on the progress of the Critical Access Hospital program and the Flex Grant.

The 2003 Medicare bill made significant progress in these areas. The bill not only added prescription drug coverage for seniors, but also contained many provider payment provisions critical to rural health care providers in Montana. The rural health funding increases in the bill were the largest package ever passed by Congress. These payment changes - which provide about $70 million in new funding to Montana hospitals and $45 million in new funds to Montana doctors - are important for maintaining access to care in Montana.

I was proud to have authored the legislation establishing Critical Access Hospitals (CAH) in 1997. This program allows small, rural hospitals proper reimbursement for their services as well as flexibility on Medicare regulations designed for larger facilities. The Critical Access Hospitals has helped reverse a two-decade long trend that closed hundreds of rural hospitals. Today, about 70% of all Montana facilities are Critical Access Hospitals s, and over 1000 exist nationwide. The Medicare prescription drug bill made several important expansions and provided reimbursement increases for this critical program. I'm also pleased this legislation reauthorized the Rural Hospital Flexibility Grant Program (Flex Grant), which helps ensure that Montana facilities have the resources to switch to Critical Access Hospitals status.

Current and Upcoming Health Care Issues

As someone who worked hard to pass a Medicare prescription drug bill for many years, I'm proud of last year's Medicare bill. This bill holds the promise of providing long overdue prescription drug assistance to Montana's seniors. But it is not perfect. During the upcoming months, I'm committed to working closely with my colleagues on both sides of the aisle to make sure it's implemented fairly and to improve this historic benefit for our seniors.

One of Montana's most pressing health care problems is a shortage of nurses and other health professionals - particularly in rural areas. To help alleviate these problems, we need to ensure that rural health care gets a fair shake. That means making Medicare payments more equitable for rural providers, from hospitals to home health to physicians. It means making sure that Medicare reimbursement for physician care is sufficient to keep providers in our communities, serving their patients. And it means building on the progress of the Critical Access Hospital program and the Flex Grant. The 2003 Medicare bill made significant progress in these areas.

I'll also fight to reduce the number of those without health insurance. With Montana's rate of uninsured growing rapidly, we must do all we can to maintain existing coverage and expand it for those who lack insurance. I believe we can reduce the numbers of the uninsured by building on initiatives like CHIP and Medicaid, as well as through employer tax credits. As the Chairman of the Senate Finance Committee, with jurisdiction over the major public health insurance programs and the tax code, I'll continue to seek ways to reduce the number of uninsured.

The United States spends twice as much on health care as any other country, but studies have shown that the quality of care often lags. It's been found that Americans receive recommended care and treatment only about half the time. And these missed opportunities are expensive. Each year, inappropriate and poor-quality care costs the U.S. health system more than $1 billion in avoidable hospital bills and 41 million lost work days. We have a lot of work to improve our health system's quality - and to make sure we are getting good value for each dollar invested. I believe improving the quality of health care can reduce health care costs and stimulate our economy.

As a senior member of the Environment and Public Works Committee, it's been one of my top priorities to see that Libby, Montana residents get the assistance they need. Libby residents have been exposed to asbestos since 1963, when W.R. Grace purchased and began operating the Libby vermiculite mine. Reports estimate that up to 200 residents have died and hundreds more have become sick from asbestos-related diseases. At its peak, the now-defunct W.R. Grace mine in Libby produced about 80 percent of the world's supply of vermiculite, which is one of the most hazardous sources of asbestos.

I've repeatedly fought to help Libby receive millions in federal funds to provide health resources for the residents, including funds for Libby's Center for Asbestos Related Diseases. I'm encouraged that the Environmental Protection Agency's named Libby to the Superfund National Priorities List. This listing will help ensure that Libby continues to receive the necessary funding and assistance. I'll continue to stand up for the folks in Libby until the town is issued a clean bill of health.

Asbestos Related Diseases in Libby, Montana

As a senior member of the Environment and Public Works Committee, it's been one of my top priorities to see that Libby, Montana residents get the assistance they need. Libby residents have been exposed to asbestos since 1963, when W.R. Grace purchased and began operating the Libby vermiculite mine. Reports estimate that up to 200 residents have died and hundreds more have become sick from asbestos-related diseases. At its peak, the now-defunct W.R. Grace mine in Libby produced about 80 percent of the world's supply of vermiculite, which is one of the most hazardous sources of asbestos.

I've repeatedly fought to help Libby receive millions in federal funds to provide health resources for the residents, including funds for Libby's Center for Asbestos Related Diseases. I'm encouraged that the Environmental Protection Agency named Libby to the Superfund National Priorities List. This listing will help ensure that Libby continues to receive the necessary funding and assistance. I'll continue to stand up for the folks in Libby until the town is issued a clean bill of health.

Methamphetamine

Meth is a real scourge in our state and it isn't going away quietly. We have a real fight on our hands. Fighting meth is a very personal issue for me.

In early 2000, I first began to understand the dangers of this drug and I started to raise the issues back at home and on Capitol Hill. I brought then-Drug Czar Gen. Barry McCaffrey to Billings to hear his thoughts on methamphetamine use. That was seven years ago, and we're still fighting as hard as ever.

There are several key components to getting rid of meth in Montana and around the country - law enforcement, treatment, and prevention. I'm working on a three areas simultaneously.

Law Enforcement

Law enforcement officials need the tools to clean up the meth labs and stop the dealers from pedaling this very destructive drug. The main thing law enforcement officials need is money.

That's why I fought so hard to get Montana included in Rocky Mountain HIDTA. It was a long struggle, but I was committed to twisting arms at every level until we were included in HIDTA. It took a full two years, but we finally got it done. Now Montana receives money for law enforcement to target meth use.

Ever since I got Montana included in Rocky Mountain HIDTA we've been fighting to keep Congress from cutting those important HIDTA dollars. Between HIDTA and Byrne grant funding I've brought more than $2 million to date to Montana. I led the effort to keep HIDTA funding steady and you can count on me to continue working to bring more dollars to our state to fight meth.

Prevention

Two years ago I launched a state-wide public service campaign last year that included a 30-second television spot highlighting the dangers of meth use. I also kicked off my own meth tour traveling around the state, holding meetings with students, and talking about the dangers of meth. Last year, I worked even harder on prevention and have already spoken to more than 2500 high school students about meth during my meth prevention school assemblies. I brought Montana Meth Project founder Tom Siebel with me to show the students the new Montana Meth ads that are working to make sure the message "not even once," is on the minds of all young people.

Every time I meet with students I'm amazed by how many students are affected by meth. They have friends that have tried it or are hooked. And then there are those whose parents are addicted.

In the coming year I'll continue to meet with kids and their teachers, but I'm also going to meet with parents as well. One of the best ways to keep kids off meth, to prevent them from trying it even once, is to get the parents involved. Parents need to talk to their kids about the dangers of meth. Parents need to stay involved in their kids' lives. And I want to be there, to help participate in the dialogue between parents and kids about how awful meth is and how it can ruin families.

We had a major victory last year in the fight against meth - we successfully got pseudophedrine, one of the key ingredients of meth, off the shelves and behind the counter. I had been fighting for this move for some time now and am glad we succeeded. This was a huge step. Law enforcement officials said that this was a big victory and it's one we'll continue to build on.

Treatment

We also must focus on treatment for meth abusers. We need to get those who are addicted to meth the medical care and treatment they need and deserve so they can kick the habit and get back on track. Last Year, I worked with Senators Grassley, Rockefeller, Snowe and Hatch to have the Child and Family Services Improvement Act of 2006 passed and signed into law. This law creates a competitive grant program to help people, addicted to meth and other substances, receive treatment for the entire family including therapeutic services for their children. So I'm committed to preventing another generation from falling victim to meth and to working to providing more options for those who are hooked on meth to help them get clean and stay clean.

The best way to knock out this awful drug is by working together - sharing ideas, talking about what works and what doesn't.

Health Information Technology

The United States spends about twice as much per person on health care as other industrialized countries. And yet our health outcomes are often lacking, and an estimated 47 million of us have no coverage at all. We need to get more out our health care dollar. A good way to do that is to improve the use of health information technology (IT). Doing so can reduce costs, improve quality and help patients make better decisions about their health care.

Expanding use of health IT will make our health care system more efficient, reduce errors and help bring down costs. Health IT also provides a platform for standardizing and collecting data to move toward paying for performance - another way to improve efficiency and decrease costs. The health care industry lags behind other industries in incorporating IT, and the U.S. is far behind other industrialized countries in adopting health information technology.

In 2005, I supported the Wired for Health Care Quality Act (S. 1418), which passed the Senate. This bill took several positive steps toward HIT adoption, including: development of standards for interoperability of HIT systems; improvements in government use of HIT; and development of strong privacy protections for electronic patient data. Unfortunately, the Senate and the House could not reach compromise on the bills they each passed, so the 109th Congress did not produce health IT legislation. I am optimistic that we can get legislation through in the 110th Congress.

I will continue to work to improve the use of health IT, so that Montanans receive the best care possible. In an effort to build grassroots support for health IT coordination in Montana, I established the Montana Health IT Task Force in January 2006. The Task Force and its workgroups have met several times since then, and over 130 Montana health care stakeholders are represented. The Task Force will continue to work to achieve its mission, and I invite your ideas on ways to improve it and to advance the ball on health IT generally.

I am very proud of the efforts underway in Montana to bring the health care system into the 21st Century. However, the U.S. health care system needs to modernize and use all the tools at its disposal to create a more efficient, effective system, which is why I remain committed to working on meaningful health IT legislation. I will continue to work for legislation that provides financial support so that providers in Montana and across the country, especially rural physicians, can afford to adopt IT.


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