Issue Position: Healthcare
Issue Position
State of Healthcare in America. The Census Bureau estimated that 46.6 million Americans were uninsured in 2005, and the number is rising. This is a clear sign that our health care system is in need of serious reform.
Tort Reform. One of the primary factors that contribute to spiraling health care costs are malpractice suits against health practitioners and health organizations. Overall, class-action filings in the United States, which include medical malpractice suits, have increased by nearly 1,000 percent in recent years. In some areas, filings have increased as much as 4,000 percent. Unjustifiable recoveries for non-economic and punitive damages are commonplace. Lawyers claim outlandish fees and sue rich defendants based on wealth, not fault. Meritless lawsuits harass innocent physicians.
On average, rural Kentuckians have access to one primary care physician per 2,251 residents. In recent years, Kentucky has lost thirty-six percent of its practicing neurosurgeons, twenty-nine percent of its general surgeons and twenty-five percent of its obstetricians. Ultimately, abuses of our legal system increase physicians' liability insurance rates and drive qualified individuals out of the profession or out of Kentucky.
I strongly support tort reform that will prevent frivolous lawsuits and punish attorneys who go forum-shopping for friendly judges. Serious tort reform will lower malpractice costs for physicians and help to keep good doctors in Kentucky.
During the 109th Congress, I voted for the Help Efficient, Low-Cost, Timely Healthcare Act of 2005 (H.R. 5), which passed the House by a vote of 230-194. This legislation was based on the system used in California since 1975. This bill addressed many of the maladies that plague Kentucky's healthcare system by creating: (1) caps on non-economic and punitive damages; (2) limits on attorney contingency fees; (3) a standard for dividing liability based on fault; and (4) a timing requirement on the filing of medical malpractice claims. These provisions would reduce the burden of abusive malpractice litigation on healthcare in Kentucky and throughout the nation.
The Act would impose a $250,000 cap on non-economic damages. Non-economic damages are awards for pain and suffering. The bill does not affect awards for economic damages. Economic damages include medical expenses, lost wages, and rehabilitation costs. Recovery of quantifiable and justified economic damages remains limitless.
Unfortunately, the Senate did not consider H.R. 5, the HEALTH Act, before Congress adjourned on December 9, 2006, sine die ending the 109th Congress. Sine die is a Latin phrase meaning "without a day," used to describe the final adjournment of a Congress. As a result, all legislation introduced during the 109th Congress must be reintroduced during the 110th Congress and begin the legislative process again.
The Help Efficient, Low-Cost, Timely Healthcare Act of 2007 was introduced in the 110th Congress, but so far, there has been no consideration of the bill on either the House Committee on the Judiciary or the House Committee on Energy and Commerce that it was referred to. I will continue to support legislative initiatives that will lower malpractice costs for physicians in the 110th Congress should this legislation, or similar legislation come before the full House for a vote.
Association Health Plans (AHPs) for Small Businesses. Nearly sixty percent of the uninsured are employed by small businesses. Small businesses represent ninety-eight percent of new businesses in the United States and create two-thirds of new jobs. Unfortunately, rising health care costs are forcing more and more small businesses to stop offering insurance benefits to their employees. Surging health care costs also deter individuals from buying health insurance for themselves and their families.
Federally-regulated Association Health Plans (AHPs) would allow small businesses to negotiate for their health benefits through associations. AHPs will also make coverage more affordable by spreading risk among a much larger group, strengthening negotiating power with plans and providers, offering insurance across State lines and reducing administrative costs.
As a former small business owner I understand the cost and commitment required to provide health care insurance for employees. With that in mind, during the 109th Congress, I proudly cast my vote for H.R. 525, the Small Business Health Fairness Act of 2005, and was excited to see it pass with bi-partisan support. H.R. 525 would have provided for the establishment and governance of AHPs, under the sponsorship of trade, industry, professional, chamber of commerce or similar business associations.
Unfortunately, the Senate did not consider H.R. 525, the Small Business Health Fairness Act of 2005, before Congress adjourned on December 9, 2006, sine die ending the 109th Congress. Sine die is a Latin phrase meaning "without a day," used to describe the final adjournment of a Congress. As a result, all legislation introduced during the 109th Congress must be reintroduced during the 110th Congress and begin the legislative process again.
I look forward to supporting similar legislation in the 110th Congress that will make healthcare more affordable for our nation's small business employers and employees.
Health Savings Accounts (HSAs). HSAs are another tool to increase competition and lower costs. HSAs are optional tax free savings accounts designed to help individuals pay for health care expenses.
The Medicare Modernization Act of 2003 contained provisions allowing individuals to use HSAs. Individuals covered by a health plan with an annual coverage deductible of at least $1,000 for individuals and $2,000 for families may establish a HSA. Funds saved by the individual in the HSA can be used to pay for health care services before the deductible is reached and to cover out-of-pocket expenses. Qualifying health plans cover expenses beyond the annual deductible. The most important part of HSAs is that the individual owns the account and can transfer money in the account from year to year and job to job. While HSAs are not the right option for everyone, it is my hope that HSAs are, increasingly, an option available to more employees.
Tax Incentives for Individual Health Policies. Individuals and families who pay the full costs of their own health insurance should be provided with targeted tax credits to make this option more affordable. Providing tax credits for the cost of health insurance will incentivize enrollment in private health plans and reduce the burden on hospitals and the health insurance pool in general.
Government-sponsored Health Insurance. Government-sponsored health insurance has proven to be disastrous in many countries. For example, in Canada, the average patient waits 17 weeks for a specialty consultation. In Britain, 800,000 individuals are waiting for hospital care. The most effective way to remedy the health care crisis is to put incentives and cost-saving proposals into place that enable the marketplace to function. Competition in the free market helps to keep costs down, while ensuring that products are available to meet the needs of consumers.
Pricing Transparency. One key to keeping costs down and enabling the free market is pricing transparency of health care services, prescription drugs and other related products. Most consumers do not have a realistic understanding of how much medical procedures cost. Pricing transparency encourages personal responsibility and will allow for price-shopping for non-emergency medical procedures. This will also force health care providers to re-evaluate cost-structures to ensure there is a direct correlation between the price charged and the service and quality provided.
Average Manufacturer's Price (AMP) Reimbursement for Pharmacists. In 2005, President Bush signed into law S. 1932, the Deficit Reduction Act. This bill affects pharmacies across the 4th District by altering the Medicaid reimbursement method for pharmacists. Last year, based on input from Fourth District pharmacists, I joined twenty-two of my colleagues in calling on U.S. Secretary of Health and Human Services Michael O. Leavitt and Dr. Mark McClellan, then the Administrator of the Centers for Medicare and Medicaid Services (CMS), to clarify those changes.
In December 2006, CMS announced the proposed changes that would direct manufacturers on how to calculate Average Manufacture Price (AMP). However, the proposed rule allows manufacturers to include mail order sales and pharmacy benefit manager rebates in the calculation of the AMP, resulting in an AMP that does not accurately reflect the prices paid by retail pharmacies.
Recognizing the problem this rule would create for our local pharmacists, I joined sixty-nine of my colleagues in writing to Leslie Norwalk, Acting Administrator of the Center for Medicare and Medicaid Services (CMS) expressing my concern with this proposed rule. A final rule is expected to be published by July 1st of 2007. If the final rule does not solve the problem with the way AMP is defined, then we will consider a legislative solution to force CMS into the proper course of action.
From assisting with the purchase of over-the-counter medications and supplements to helping identify potential drug interactions, pharmacists play an important role in the daily lives of patients taking prescription medications. I look forward to continuing to address the concerns of pharmacists in the Fourth District.
Physician Reimbursement Rates for Medicare. As you may know, Medicare payments for the services of physicians and certain non-physician practitioners are made on the basis of a fee schedule. The fee schedule, in place since 1992, is intended to relate payments for a given service to the actual resources used in providing that service. The intent of the formula is to place a restraint on overall increases in Medicare spending for physicians' services.
In 2002, during the 107th Congress, there was a reduction of 5.4 percent in physician reimbursements. Another reduction was planned for 2003, but technical complications resulted in an increase of 1.6 percent. The Medicare Modernization Act of 2003 prevented any further cuts through 2005 and actually provided for increases of 1.5 percent in 2004 and 2005. Most recently, the Deficit Reduction Act included a provision that froze payment rates for 2006 at the 2005 level.
For 2007, the payment rate was scheduled to be reduced by 5.1%. I was concerned about the impact such a cut would have on the ability of physicians to provide care. For that reason, I joined a bipartisan group of lawmakers in sending a letter to Speaker J. Dennis Hastert and Minority Leader Pelosi during the 109th Congress asking them to address this issue.
I am happy to report that Congress acted on this critical issue for physicians and patients before adjourning the 109th Congress. I was proud to join 367 of my colleagues in passing H.R. 6111, the Tax Relief and Health Care Act, on December 8, 2006. The omnibus tax and health care package prevented any reduction in the physician fee schedule.
The bill also directs the Department of Health and Human Services to implement a system for reporting on quality of care. Any physician electing to participate by supplying this information will receive a 1.5% update bonus payment from July to December 2007.
I am committed to working with physicians, hospitals, the Centers for Medicare and Medicaid Services and other healthcare stakeholders on long-term ways to improve physician payments in the future without adding to overall Medicare costs.
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