1) insurance market reforms (difference on how much or how little to regulate and whether or not to stop discrimination based on pre-existing conditions which hinges on requiring people to obtain coverage).

The research on how people feel about Medicaid generally shows that they are very pleased to have it, and it has been a big boost to their families. According to a Kaiser Family Foundation study, fully 95% of low-income parents who know about Medicaid/CHIP think they are good programs. In addition, nearly 9 out of 10 with uninsured children say they would enroll them if it was a possibility, and the vast majority would be interested in enrolling along with their child.  So, we were a bit surprised to hear Representative Roskam (Ill.) say, “it isn’t working for anybody” and shouldn’t be used to cover more people because it is a “weak foundation.”

As with all kinds of insurance, there are some issues with Medicaid, including that it often doesn’t pay providers as much as other public programs (CHIP, Medicare). This is a solvable problem. The House bill addressed the issue by providing federal funding to bring reimbursement rates in Medicaid for primary care services up to Medicare levels.  (President Obama acknowledged the problem after Representative Roskam spoke, but, notably, did not include this improvement in his own proposal.)

Finally, we also were a bit surprised to hear President Obama say that very poor people already have coverage through Medicaid, which is superior to the options available to working families. In fact, Medicaid does not cover adults without children, even if they are living in deep poverty (unless they are lucky enough to live in the handful of states with special waivers to do so). And, in most states, parents are not eligible for Medicaid even if they are well below the poverty line. The situation is much better for children. Due to Medicaid expansions for children and the CHIP, children in poor and low-income working families generally can qualify for coverage. The result is that children are far less likely to be uninsured than their parents and other adults.

4:05 pm Barrosso argues for high deductible plans/HSAs
The sharp philosophical differences between the two parties on coverage issues are clearly on display in this final segment of the summit. Senator Barrosso, a surgeon from Wyoming, made a pitch for America providing the best health coverage in the world, citing a Premier of Canada recently deciding to come here for heart surgery. He argued that we could hold down health care costs if people had more information on health care costs and more incentive to be “prudent purchasers,” such as provided under high deductible plans or HSAs. President Obama pushed back, arguing that most uninsured people in the United States aren’t premiers or sultans and don’t have much money with which to fill gaps in their health care coverage.

3:50 pm Moving to the topic of coverage – President’s goal to cover 30 million uninsured 
They are getting close to wrapping up, and just reaching the topic of coverage. President Obama kicked off the discussion, framing it as: can America, the wealthiest nation on earth, do what every other advanced nation does – make sure that every American has health insurance coverage? Before turning over to Senator Barrasso (Wyo.), President Obama made a pitch for acknowledging the reality that you can’t “waive a magic wand” and cover all of these people without it costing some money.

3:25 pm Debate over paying for reform continues
Discussion continues on what health reform would mean for our budget deficits if health reform passes, with Democrats arguing it will help immensely and Republicans taking the opposite position. Some of the most intense debate is over the appropriateness of using cuts to Medicare Advantage to help pay for reform. From a child and family health perspective, this part of the discussion can seem pretty far removed from what matters to kids and families. But, the question of how to pay for health reform, including major expansions in coverage for low-income families, long has been the key reason why it is so hard to enact.

3:00 pm Discussion turns to impact of health care on deficit
Vice President Biden discusses the impact of rising health care costs on the deficit and how we can “bend the cost curve.” Representative Paul Ryan (Wisc.) agrees that it is right to frame the debate on high costs and health inflation. However, there is disagreement between the parties on whether the President’s bill would reduce deficit (as the CBO as determined).

2:40 pm President says families with insurance already spend up to $1,100 a year on uninsured people
President Obama argues that “independent economists” think families with insurance already spend $1,000 to $1,100 on the cost of providing care to uninsured people. He says that, for example, the uninsured kid with asthma in Senator Coburn’s example, might well get care, but that the ER bill would end up being being paid for by families with insurance. Citing this kind of cost-sharing as a reason why an individual mandate or “responsibility” is required, the President admits he’s argued against such mandates on the campaign trail and had to be brought “kicking and screaming” to the conclusion that they were necessary.

2:35 pm Even the son of a Rockefeller can be uninsured
Senator Rockefeller (W.Va.) describes how his son, who was old enough to buy insurance on his own, decided that he didn’t really need it. Instead, he chose to go without insurance, apparently on the theory that he wouldn’t get sick. Senator Rockefeller says that such cases are one reason why the country needs to mandate that people secure coverage (and also that he and his wife insisted that his son buy coverage the next day). To help address the problem that young people often think they don’t need coverage — and also that they often don’t yet make enough money to buy it — one of the reforms included in leading health reform bills is whether to give families the option to add young adults up to age 25 or 26 to their parents’ insurance plans.

12:59 pm Break for lunch/House vote  

11:00 am Senator Coburn says kids can get care through ER; better preventive care needed
Senator Tom Coburn (Okla.) addresses President’s remarks on taking his daughters to ER. The Senator believes that children, even if uninsured, can get the care they need for asthma and meningitis by going to the ER. He also suggests that even if they get care in the ER, we don’t do a good job preventing acute asthma episodes. On this point, a recent study shows that uninsured children with asthma face barriers to care. However, enrollment in CHIP markedly helps kids get better treatment for asthma and obtain better outcomes.

10:48 am Reid shares story of father with sick child denied coverage
Senate Majority Leader Reid (Nev.) speaks about a restaurant owner in Reno, Nevada whose child was born with a cleft pallet. The insurer denied coverage saying the newborn had a pre-existing condition. He had paid his premiums and thought he had health insurance but now he’s stuck with $90,000 in medical bills and his daughter needs additional medical attention.

10:40 am Pelosi touts CHIPRA as early advance for health reform
House Speaker Pelosi (Calif.) says CHIPRA was a running start on expanding access and moves us forward on addressing affordability, accessibility, and accountability.

10:30 am Alexander wants to take step-by-step approach; believes Medicaid unfunded mandate
Senator Lamar Alexander (Tenn.) opens the day to describe the Republican perspective. They believe that the goal should be to reduce health care costs and move step-by-step towards that goal. The bills that have passed the House and Senate are not the way to do it. The country is too big and too diverse for a comprehensive approach to work. With step-by-step as their preferred way to go, he offered suggestions such as medical malpractice reform and buying coverage across state lines as the best way to increase access is to reduce costs. Senator Alexander also describes Medicaid expansion as an “unfunded mandate,” as one of the problems they see in the legislation, comparing “dumping” low-income people into a Medicaid program where 50% of doctors don’t take patients to buying them a bus ticket for a line that only runs half the time.

For remainder of day, we will not post on what everyone says – but only highlight when issues affecting children and families comes up.

10:20 am President Obama asks what would happen if I didn’t have “reliable” health care coverage for my daughters?
In his opening remarks, President Obama ties the need for health reform to the struggling economy. He believes it’s critical to look at fundamental problems that are hurting families and businesses, as well as having a profound impact on budgets at both a national and state level. Health care is one of the biggest drags on our economy and one of the biggest hardships that families face. Every American, whether or not he/she has coverage, is affected and the problem is only getting worse.

President Obama describes health care from the perspective of a parent. He remembers well facing the scary situations in which Malia and Sasha became sick and needed immediate health care. He remembers sitting in the ER and thinking “what would  happen if I didn’t have “reliable” health care coverage.”

The President wants the summit to focus not just on the differences, but where Democrats and Republicans agree, because there is significant agreement. As the day looks at lowering costs, ensuring the market works, addressing the long-term deficits, and providing more coverage, he wants to start where there is agreement and then focus on how to bridge the gaps where there isn’t.

Thursday, February 24, 10:08 AM