Obama, Coburn letters on health care
President Barack Obama sent a letter to congressional leaders regarding health care on Tuesday, and Sen. Tom Coburn, R-Muskogee, responded. Below are the letters:
March 2, 2010
Dear Speaker Pelosi, Senator Reid, Senator McConnell, and Representative Boehner:
Thank you again for the time, energy, and preparation you invested in last Thursday’s bipartisan meeting on health insurance reform. I have always believed that our legislative process works best when both sides can discuss our differences and common goals openly and honestly, and I’m very pleased that our meeting at Blair House offered the American people and their elected representatives a rare opportunity to explore different health reform proposals in extraordinary depth.
The meeting was a good opportunity to move past the usual rhetoric and sound-bites that have come to characterize this debate and identify areas on which we agree and disagree. And one point on which everyone expressed agreement was that the cost of health care is a large and growing problem that, left untended, threatens families, businesses and the solvency of our government itself.
I also left convinced that the Republican and Democratic approaches to health care have more in common than most people think.
For example, we agree on the need to reform our insurance markets. We agree on the idea of allowing small businesses and individuals who lack insurance to join together to increase their purchasing power so they can enjoy greater choices and lower prices. And we agree on the dire need to wring out waste, fraud and abuse and get control of skyrocketing health care costs.
But there were also important areas of disagreement. There was a fundamental disagreement about what role the oversight of the health insurance industry should play in reform. I believe we must insist on some common-sense rules of the road to hold insurance companies accountable for the decisions they make to raise premiums and deny coverage. I don’t believe we can afford to leave life-and-death decisions about health care for America’s families to the discretion of insurance company executives alone.
No matter how we move forward, there are at least four policy priorities identified by Republican Members at the meeting that I am exploring. I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit:
1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.
2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.
3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.
4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.
There are provisions that were added to the legislation that shouldn’t have been. That’s why my proposal does not include the Medicare Advantage provision, mentioned by Senator McCain at the meeting, which provided transitional extra benefits for Florida and other states. My proposal eliminates those payments, gradually reducing Medicare Advantage payments across the country relative to fee-for service Medicare in an equitable fashion (page 8). My proposal rewards high-quality and high-performing plans.
In addition, my proposal eliminates the Nebraska FMAP provision, replacing it with additional federal financing to all states for the expansion of Medicaid.
Admittedly, there are areas on which Republicans and Democrats don’t agree. While we all believe that reform must be built around our existing private health insurance system, I believe that we must hold the insurance industry to clear rules, so they can’t arbitrarily raise rates or reduce or eliminate coverage. That must be a part of any serious reform to make it work for the many Americans who have insurance coverage today, as well as those who don’t.
I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.
My ideas have been informed by discussions with Republicans and Democrats, doctors and nurses, health care experts, and everyday Americans – not just last Thursday, but over the course of a yearlong dialogue. Both parties agree that the health care status quo is unsustainable. And both should agree that it’s just not an option to walk away from the millions of American families and business owners counting on reform.
After decades of trying, we’re closer than we’ve ever been to making health insurance reform a reality. I look forward to working with you to complete what would be a truly historic achievement.
Sincerely, (President Obama)
COBURN’S LETTER:
March 2, 2010
President Barack Obama
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
Dear President Obama,
Thank you for the recent invitation to discuss health care at the White House with other congressional lawmakers. During that meeting I addressed the need for Congress and the Administration to seriously address fraud in public health programs, particularly Medicare and Medicaid, and suggested a few ideas.
You and many lawmakers agreed last Thursday about the need to reduce the massive costs associated with fraud and defensive medicine. According to last year’s report on American health care by Thomson Reuters, an estimated $175 billion is lost to fraud and abuse. And according to a recent Gallup survey of physicians, one in four health care dollars is spent due to the practice of defensive medicine.
After the White House health care summit, your staff contacted my office to ask for an amendment I filed during the mark-up of The Affordable Health Choices Act (S. 1679) in the Committee on Health, Education, Labor and Pensions. This amendment was one of the 210 amendments I filed during the Committee consideration of this legislation. This amendment would essentially establish direct the Secretary and Inspector General of the U.S. Department of Health and Human Services to establish a demonstration project using undercover health care providers acting as patients to root out fraud.
I am pleased that you may be willing to consider this idea on fraud, but it alone is insufficient to staunch the flow of taxpayer dollars into the hands of criminals. I would encourage you to adopt other proposals that, I believe, would help lower the costs associated with fraud and defensive medicine.
Medicare and Medicaid Payment Reform.
· I cosponsored two bills, one with Sen. LeMieux (S. 2128) and another with Sen. Cornyn (S. 975) which would change the way Medicare and Medicaid dollars go out the door. These bills would change the current enforcement culture of “pay and chase,” to one of “check and pay” where real-time data verification technology would ensure claims are not fraudulent before they are paid.
· My own health reform bill, the Patients’ Choice Act was introduced in May 2009 with Senator Richard Burr (R-NC) and Representatives Paul Ryan (D-WI) and Devin Nunes (D-CA would use private sector technologies to significantly reduce waste, fraud and abuse.
· Members of Congress should look to the credit card industry as a model of fraud containment. This industry processes over $2 trillion in payments every year from 700 million credit cards being used at millions of vendors to buy countless products. Yet, fraud in that industry is about one percent. In contrast, fraud in Medicare and Medicaid is ten times higher, costing American taxpayers an estimated $1 trillion each decade.
· Any reforms to Medicare should use Medicare savings to extend Medicare solvency. Medicare is not a piggy bank which can be used to pay for massive new subsidies to millions of Americans
Defensive Medicine Reform
· I am pleased that you have indicated you may support funding to states demonstrations for resolving medical malpractice disputes, including health courts. Certainly it is much better to reduce defensive medicine costs to make health care more affordable, rather than to raise taxes nearly half a trillion dollars as Congressional plans would require.
· A recent Gallup survey revealed that nine out of 10 physicians reported practicing defensive medicine. The Patients’ Choice Act would encourage states to develop alternatives to tort litigation for medical malpractice claims. Qualifying health care panels would be composed of medical experts and attorneys appointed by the state who would review health care claims and make a determination as to the liability of the parties involved. Parties would be able reject the determination and file a claim relating to the injury in a state court, but any party filing in state court would forfeit awards from the panel determination.
· There are other good ideas which have been proposed which will empower states, not the federal government, and give patients and physicians more control over health care.
Unfortunately, the health care bills in Congress would make the current problems worse, cutting roughly half a trillion dollars from Medicare, without needed reforms preventing fraud or ensuring Medicare reimburses physicians. The Majority in the Senate authored over 10,000 pages of health reform legislation in 2009, but the mere inclusion of a few ideas from the other side of the aisle does not make the process or legislative product bipartisan.
Mr. President, I’m concerned an all-or-nothing reconciliation strategy will give the American people nothing. Legislation that addresses the massive costs associated with fraud and defensive medicine, on the other hand, would give the American people the kind of targeted, common-sense reform they desire. Reducing the costs associated with fraud and defensive medicine would be significant step in the right direction toward lower costs and improved access.
As you know, many Americans with extensive business experience, such as Warren Buffet, are urging us to pursue a Plan C. I agree and am willing to sit down with lawmakers from both sides of the aisle to work on step-by-step reforms which lower cost, not quality, and increase access, not taxes. Yet, creating a massive new entitlement when our current entitlement programs are bankrupt is reckless. The American people want Congress to start over in part because they understand that Congress is using Enron-style accounting gimmicks to hide the $2.3 trillion cost for implementing the Senate bill.
As last week’s summit showed, both parties do agree about many areas of reform. I appreciate the positive words you and other Democrats expressed about the need to reduce the costs associated with fraud and defensive medicine. We should continue to make progress, not cut off our discussions with a strategy that will go nowhere.
Finally, I would respectfully remind you that the American people have already spoken not just in polls but in elections. In fact, a recent CNN poll recently indicated that 7 in 10 Americans want Congress to start over on health care, or quit working on the issue altogether. I admire those who pursue their convictions but health care is an issue too big in its scope for either side to pursue an all-or-nothing strategy. I, and many Republicans, have set aside visions for one-shot comprehensive reform. I respectfully encourage you to do the same. Together, we can achieve serious health care reform that will lower costs and improve access for millions of Americans.
Sincerely,
Tom Coburn, M.D.
U.S. Senator
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