The mission of VitalSigns is to bring you, our physician readers, relevant and valuable information tailored to your unique needs. Our primary focus over these past months has been health care reform legislation because it is so vital to your profession. There are still some miles to travel down that road and we will continue to keep you informed, but we'll also begin broadening the scope of VitalSigns to include other areas of interest to physicians. For example, we'll bring you news on the latest technologies that may have an impact on your practice, physician strategies for navigating the economic crisis, and profiles of your physician colleagues who are making a difference for you and the rest of the world. And when your colleagues are talking inside iMedExchange about topics that we think you'll find especially interesting we'll let you know so you can join the conversation if you like.
The election of Republican candidate Scott Brown to fill Ted Kennedy's senate seat last week was viewed by some as a referendum on health care reform. The Kaiser Family Foundation did some polling on this election and found that the driving forces behind Brown's election to be much more nuanced:
First, while health care policy did top the list of voting issues, the economy and general discontent with Washington also were significant factors for Brown voters. Second, and perhaps more importantly, Brown voters' top complaint about health reform was not about the substance of the legislation itself or its perceived impact on them or their families, but about a policymaking process that they seemed to think had gone badly wrong ... For Brown voters health reform became a reflection of, and in some ways a proxy for, deeper concerns about how Washington works today.
For the full story, click here.
The January 27 edition of the New England Journal of Medicine has a detailed article by Dr. Mark Pauly on health insurance reform, specifically on how to deal with higher risk individuals.
All U.S. health insurance reform proposals currently being discussed now include changes in the way insurers treat some people with above-average health risks. In most states, insurers who sellpolicies directly to individuals now charge premiums based to some extent on characteristics thought to predict the risk of high-cost conditions; insurers also exclude some or all preexistingconditions from coverage and simply refuse to cover some people. Without such "risk rating" and coverage exclusions, insurers would be subject to substantial adverse selection -- that is, consumers would seek them out primarily if and when they became ill and therefore represented higher risks to insurers -- which could lead insurers needing to cover their costs to charge premiums so high they would drive lower-risk consumers to choose minimal coverage or forgo insurance altogether.
Some states have decided that adverse selection is a lesser evil than people being left uninsured and have passed regulations that require insurance companies to charge the same premiums to everyone in a certain geographic area ( a practice called "community rating.") Dr. Pauly suggests an alternative approach: the guaranteed renewability policy. He argues that these policies, that already exists in today's insurance markets, are the best way to wring efficiency an efficacy from the system. In a nutshell, these policies charge a small premium for the right of the insured to continually renew his or her policy at the standard class rate even if they develop a high risk or chronic condition. The insured person benefits from the security of knowing that their insurance will not be cancelled or their rates raised because of serious illness and the insurance company benefits because people will purchase these policies while they low risk (young and healthy).
To read the article in its entirety, please click here.
President Obama devoted relatively little time to health care reform in Wednesday night's state of the union address. The topic of health care did not appear until thirty minutes into the address, a sign, according to The New York Times, "of how imperiled [the health care bill] had become:"
Mr. Obama's speech did nothing to resolve differences between the House and the Senate or to clarify the way forward. Just 20 weeks ago Mr. Obama stood in the same place and made an urgent plea to a joint session of Congress. "The time for bickering is over, the time for games has passed," he said on Sept. 9. "Now is the time to deliver on health care," he said then.
But on Wednesday health care was wedged into a catalog of presidential priorities, which included jobs, the economy, education, bank regulation, energy independence, deficit reduction and the war in Afghanistan. The change highlighted the risks for Mr. Obama in staking more of his political capital on legislation whose fate in Congress is uncertain -- a bill that divides the Democratic caucus, that is reviled by Republicans and that makes many independent voters nervous.
President Obama went on to state in his address that he had not clearly explained the benefits of health care reform to the public and blamed special interests, industry lobbyists and partisan politics for sidetracking healthcare reform. He stood by the health care reform bills that and urged both parties to take another look at the bill after "temperatures cool"
For the full story in the New York Times, click here .
Yesterday Politico covered 5 key health reform questions, saying that 'before Democrats can resuscitate their yearlong push for near-universal health coverage, it's time for a gut check'. Their questions are:
If you don't have 60, how about 51?How close will the House come to the Senate? Can you actually do a scaled-down bill, given how interconnected the legislation is? How many "yeses" have turned to "nos"? How hard will Obama push?
Read the full story here.
Now that Brown has won, what are the democrats going do? That is unclear right now. According to the Wall Street Journal...
Party members clashed openly over what to do next. Sen. Max Baucus, a top Senate Democrat, appeared to throw cold water on a bill that would focus only on stiffer insurance regulations. Rep. Charles Rangel, chairman of the House Ways and Means Committee, scotched another idea, a complicated parliamentary maneuver to usher a bill quickly to the president's desk.
Read the full story here.In an interview with ABC News, President Obama said he would be open to scaling back the legislation in order to salvage it. "I would advise that we try to move quickly to coalesce around those elements in the package that people agree on," Mr. Obama said. White House Communications Director Dan Pfeiffer said later the president would prefer Congress to pass the comprehensive package, and hasn't given up on that option.
The results of yesterday's vote in Massachusetts have given Republicans 41 seats in the senate. This is a critical number because 41 votes allows them to block a new bill. It was expected that the health reform bill would need to be edited and passed through the senate again, since there were several issues that face opposition within the Democratic voters. To compensate for this opposition, there is a proposal that the House would then pass a second measure making changes to the Senate bill. That measure could then pass through the upper chamber at a later date under special budgetary rules known as reconciliation, which allow legislation to pass with a simple majority.Read the full story here, on The Hill.
Since Democrats and allied independents still control 59 seats, strategists believe it would be relatively easy to pass a second measure that would contain compromises reached between Senate and House negotiators, such as a limit on the tax imposed on high-cost insurance plans.
But Democratic lawmakers were split Tuesday evening over the prospect of passing the Senate bill and hoping for a later fix.
Today is the Massachusetts election that's being watched around the country. Politico summarizes the pressure being felt by the democrats...
Ever since health care reform flamed out in the 1990s, Democrats thought lots of things might derail their longtime dream this time around. Losing a Senate seat in liberal Massachusetts was not on the list.
But that is the harsh reality sinking in among Democrats -- that a Republican victory could spell the end of health reform because there is no good option to rescue the plan from this latest brush with political death.Publicly, the White House and top Democrats held firm to their stance that health care reform will pass this year. And Speaker Nancy Pelosi (D-Calif.) said Monday that Democrats will need to figure out a way to proceed if Republican Scott Brown wins, "but that doesn't mean we won't have a health care bill.""Let's remove all doubt that we will have health care one way or another," Pelosi told reporters in San Francisco.But privately, Democrats are getting cold feet about pushing ahead full bore on health care. Moderate Democrats who have long been skeptical of the administration's focus on the issue could begin to peel away in the face of a convincing loss for Democrat Martha Coakley, dealing a fatal blow to legislation that had no room for error in either chamber.
Read the full story here.
Since 2006, when Mitt Romney required all residents to purchase health insurance, Massachusetts has been a state to watch in health care reform. Scott Brown is running in Massachusetts' special election to fill Tedd Kennedy's open seat.
As the underdog GOP nominee in one of the most Democratic states in the nation, the state senator's message has been simple: If he upsets Democratic state Attorney General Martha Coakley in the Jan. 19 election to fill the seat once held by the late Sen. Ted Kennedy, he will provide the critical vote to halt the Democrats' health care bill once the final version is negotiated.
Read Politico's coverage here."If you feel that Washington and the health care bill that they're proposing is systemic of the problems in Washington and the failure to understand average people anymore, then you vote for me because as the 41st senator I can stop a lot of this stuff in its tracks," Brown told POLITICO. "I can actually force them to go back to the drawing board."
Kaiser Health did a recap today of several news agencies and their takes on what might change in the short term with the new health care reform bill. McClatchy examines benefits that "would take effect quickly and should produce a noticeable impact on consumers, according to many independent analysts and Democrats." The House and Senate bills "would bar lifetime limits on coverage, starting six months after the measure is enacted. They also would expand community health centers, where consumers could go for care, and would require health plans to allow young people, up to age 26 in the Senate bill and 27 in the House bill, to stay on their parents' policies. Age requirements now vary by state. Both bills provide immediate aid for the uninsured. The Senate bill includes $5 billion to help finance a temporary program that would provide coverage to uninsured people with pre-existing conditions, effective 90 days after the bill is signed" (Lightman, 1/5)
CNN: "Arguments over the massive overhaul of the health care system -- which congressional Democrats hope to pass by next month -- are expected to keep shaking up the country long after the vote." David Gergen, who worked in the Nixon, Ford, Reagan and Clinton administrations, explains that "unlike other major legislation which has passed with more bipartisan support, health care is going to remain a political football, and people are going to have a sense that it is not fully settled yet for a while" (Keck, 1/5).
Read Kaiser Health's full story here.
In a letter dated December 30th, and released today, C-SPAN asked to broadcast the health care negotions between the 2 houses. The head of cable network C-SPAN, which shows government proceedings, wrote a letter to Ms. Pelosi and other congressional leaders saying they should allow cameras at the discussions. That echoed a point Republicans have often made during the health-care debate, charging that Democrats were making too many decisions in private discussions...
In a letter to congressional leaders, C-SPAN Chief Executive Brian Lamb urged both chambers to allow C-SPAN cameras inside the talks, noting that the legislation "will affect the lives of every single American."
Read the full story, and discussion of the negotiations from the Wall Street Journal, here in Democrats Circle the Wagon as Health Talks Restart.
As both houses get ready to come back from their breaks, they are getting ready for negotiations where they will take their two bills and merge them into one. The Washington Post has a table comparing the bills in terms of their costs, impacts to various parties, and benefit packages. There's also an interesting break down of each representative, their vote on the bills, the percentage of uninsured people in their states, and the amount of contributions they've received from the health care industry. Here's the Senate breakdown, and here's the House of Representatives' breakdown.
On Christmas Eve, the health care reform bill passed by a vote of 60 - 39. Coverage from The Hill is here. Next up - the House and Senate negotiators will work in January to merge the 2 versions of the bill. Coverage from the Wall Street Journal, Senate, House to Haggle Over Differences is here. The most highly debated issue still pending, is that of abortion. Coverage of the abortion issue from Time is here. The GOP is pushing, and many are discussing, the issue of whether its even legal for the federal government to require people to have health insurance. Chicago Sun Times coverage is here.
The ongoing political effects of the bill and debate are being discussed, in terms of how this will affect party relations and strategy. 
Politico's coverage, Parties Risk It All on Health Care Reform is here.
Politico's coverage, Parties Risk It All on Health Care Reform is here. Specifically targeting consumers, Kaiser Health News has published a guide, The House, Senate and You: A New Guide to Health Care Reform, which can be found here.
A 60-39 vote has just ended the Republican's filibuster. The filibuster was the last stop for the health care reform bill before it's voted on. Recent procedural decisions - such as starting the debate and ending the filibuster - have required 60 votes, but passing the bill requires a simple majority. The final vote is scheduled for tomorrow, Christmas Eve day, at 7am. It has been 114 years since a vote was held on Christmas Eve. "Away from Capitol Hill, special deals on Medicaid obtained by some Democrats - notably Ben Nelson of Nebraska, who provided the crucial 60th vote - continued to provoke grumbling. Under the Senate bill the federal government will pay the entire cost of an expansion of Medicaid in Nebraska, unlike other states, which will have to start picking up a portion of the tab themselves after several years."
You can read the coverage from the Associated Press here.
Despite a dramatic few weeks, democrats have advanced their healthcare bill with a clean party-line vote of 60-40. The American Hospital Association has endorsed the bill, but the AMA has yet to officially declare their support for this version. Politico reports...
The Democratic Party's decades-long push to remake the U.S. health care system cleared a major hurdle early Monday morning, with the Senate voting to advance a massive $871 billion bill to extend coverage to nearly all Americans and tighten regulations on private insurers...
In the coming negotiations, the House will almost certainly be forced to give up the government-run insurance plan that is part of its bill. The idea failed in the upper chamber after centrists including Connecticut independent Joseph Lieberman drew a line in the sand against it.The final bill is also likely to embrace a version of the Senate's proposed tax on high-value insurance plans, rather than add a surtax on the wealthy, as the House wanted.
Read Politico's coverage here, and the Wall Street Journal article here.
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