Charles Rangel on Health Care Dem./Lib./Working-Families

Voted YES on regulating tobacco as a drug.

Opponent's argument to vote No:Rep. HEATH SHULER (D, NC-11): Putting a dangerous, overworked FDA in charge of tobacco is a threat to public safety. Last year, the FDA commissioner testified that he had serious concerns that this bill could undermine the public health role of the FDA. And the FDA Science Board said the FDA's inability to keep up with scientific advancements means that Americans' lives will be at risk.

Proponent's argument to vote Yes: Rep. HENRY WAXMAN (D, CA-30): The bill before us, the Waxman-Platts bill, has been carefully crafted over more than a decade, in close consultation with the public health community. It's been endorsed by over 1,000 different public health, scientific, medical, faith, and community organizations.

Sen. HARRY REID (D, NV): Yesterday, 3,500 children who had never smoked before tried their first cigarette. For some, it will also be their last cigarette but certainly not all. If you think 3,500 is a scary number, how about 3.5 million. That is a pretty scary number. That is how many American high school kids smoke--3.5 million. Nearly all of them aren't old enough to buy cigarettes. It means we have as many boys and girls smoking as are participating in athletics in high schools. We have as many as are playing football, basketball, track and field, and baseball combined.

Voted YES on expanding the Children's Health Insurance Program.

• Reauthorizes State Children's Health Insurance Program (SCHIP) through FY2013 at increased levels.
• Gives states the option to cover targeted low-income pregnant women
• Phases out coverage for nonpregnant childless adults.

Rep. FRANK PALLONE (D, NJ-6): In the last Congress, we passed legislation that enjoyed bipartisan support as well as the support of the American people. Unfortunately, it did not enjoy the support of the President, who vetoed our bill twice, and went on to proclaim that uninsured children can simply go to the emergency room to have their medical needs met. As the Nation moves deeper into a recession and unemployment rates continue to rise, millions of Americans are joining the ranks of the uninsured, many of whom are children. We can't delay. We must enact this legislation now.

Opponent's argument to vote No:Rep. ROY BLUNT (R, MI-7): This bill doesn't require the States to meet any kind of threshold standard that would ensure that States were doing everything they could to find kids who needed insurance before they begin to spend money to find kids who may not have the same need. Under the bill several thousands of American families would be poor enough to qualify for SCHIP and have the government pay for their health care, but they'd be rich enough to still be required to pay the alternative minimum tax. The bill changes welfare participation laws by eliminating the 5-year waiting period for legal immigrants to lawfully reside in the country before they can participate in this program. In the final bill, we assume that 65% of the children receiving the benefit wouldn't get the benefit anymore. It seems to me this bill needs more work, would have benefited from a committee hearing. It doesn't prioritize poor kids to ensure that they get health care first.

Voted YES on overriding veto on expansion of Medicare.

• Extends Medicare to cover additional preventive services.
• Includes body mass index and end-of-life planning among initial preventive physical examinations.
• Eliminates by 2014 [the currently higher] copayment rates for Medicare psychiatric services.

I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it because:
• It would harm beneficiaries by taking private health plan options away from them.
• It would undermine the Medicare prescription drug program.
• It is fiscally irresponsible, and it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem.

Proponent's argument to vote Yes: Sen. PATTY MURRAY (D, WA): President Bush vetoed a bill that would make vital improvements to the program that has helped ensure that millions of seniors and the disabled can get the care they need. This bill puts an emphasis on preventive care that will help our seniors stay healthy, and it will help to keep costs down by enabling those patients to get care before they get seriously ill. This bill will improve coverage for low-income seniors who need expert help to afford basic care. It will help make sure our seniors get mental health care.

Voted YES on Veto override: Extend SCHIP to cover 6M more kids.

CONGRESSIONAL SUMMARY: This Act would enroll all 6 million uninsured children who are eligible, but not enrolled, for coverage under existing programs.

PRESIDENT'S VETO MESSAGE: Our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. My Administration strongly supports reauthorization of SCHIP. [But this bill, even with changes, does not meet the requirements I outlined].

It would still shift SCHIP away from its original purpose by covering adults. It would still include coverage of many individuals with incomes higher than the median income. It would still result in government health care for approximately 2 million children who already have private health care coverage.

SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill protects health insurance coverage for some 6 million children who now depend on SCHIP. It provides health coverage for 3.9 million children who are eligible, yet remain uninsured. Together, this is a total of better than 10 million young Americans who, without this legislation, would not have health insurance.

The bill makes changes to accommodate the President's stated concerns.

1. It terminates the coverage of childless adults in 1 year.
2. It prohibits States from covering children in families with incomes above $51,000.
3. It contains adequate enforcement to ensure that only US citizens are covered.
4. It encourages securing health insurance provided through private employer.

Voted YES on adding 2 to 4 million children to SCHIP eligibility.

Proponents support voting YES because:

Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill provides health coverage for 3.9 million children who are eligible, yet remain uninsured. It meets the concerns expressed in the President's veto message [from HR976]:

1. It terminates the coverage of childless adults.
2. It targets bonus payments only to States that increase enrollments of the poorest uninsured children, and it prohibits States from covering families with incomes above $51,000.
3. It contains adequate enforcement to ensure that only US citizens are covered.

Opponents recommend voting NO because:

Rep. DEAL: This bill [fails to] fix the previous legislation that has been vetoed:

• On illegal immigration: Would the verification system prevent an illegal alien from fraudulently using another person's name to obtain SCHIP benefits? No.
• On adults in SCHIP: Up to 10% of the enrollees in SCHIP will be adults, not children, in the next 5 years, and money for poor children shouldn't go to cover adults.
• On crowd-out: The CBO still estimates there will be some 2 million people who will lose their private health insurance coverage and become enrolled in a government-run program.

Veto message from President Bush:

Like its predecessor, HR976, this bill does not put poor children first and it moves our country's health care system in the wrong direction. Ultimately, our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. As a result, I cannot sign this legislation.

Increase funding for AIDS treatment & prevention.

HIV/AIDS Initiatives
The CBC’s Minority HIV/AIDS Initiative will focus on those areas hardest hit by the epidemic, many of which are in districts that we represent. The initiative will focus on prevention and treatment and we will also seek to re-direct and/or increase funding levels based on a detailed review of the implementation of the initiative. In addition, the CBC recognizes the devastating impact of HIV/AIDS on the global workforce, specifically in Africa, and on the allocation of resources of developing countries. Therefore, the CBC will continue its efforts to support a comprehensive global policy aimed at ending the scourge of HIV/AIDS around the globe.

More funding for Rx benefits, community health, CHIPs.

The Congressional Black Caucus is committed to improving America’s health care system by focusing on, among other items, the following issue areas:
• Eliminating Health Care Disparities.The CBC will emphasize the importance of eliminating health care disparities as it relates to access, treatment and availability in communities of color and other disadvantaged communities. The CBC will also ensure that America keeps its promise to our veterans, and will support funding for the best health care programs at our veterans’ hospitals.
• Patients’ Bill of Rights. The CBC will support a strong and enforceable Patients’ Bill of Rights that puts medical decisions back in the hands of doctors, and gives patients the right to seek damages when they are harmed by decisions influenced by non-medical professionals.
• Medicare Prescription Drug Benefit. The CBC supports a prescription benefit program for the Medicare program. The price of prescription drugs is too high for most seniors, and many seniors go without the necessary medication they need, or have to choose between conflicting priorities.
• Support for Health Providers in Underserved Communities. The CBC will support the development of networks of providers, community hospitals and health centers in underserved communities to increase the quality of care provided to patients. We will also seek funding and technical assistance to assist Community Health Centers in developing a system of comprehensive health services in both urban and rural communities.
• Healthy Children. The CBC will work to expand the Children’s Health Insurance Program. We will also focus on increasing immunization rates, better dietary and physical fitness programs, prevention of teenage pregnancies and anti-drug and smoking initiatives. In addition, we will support efforts to ensure that mental health is covered under basic health plans.

MEDS Plan: Cover senior Rx under Medicare.

Summary of the Medicare Extention of Drugs To Seniors Act (Meds)

Coverage:

• First-dollar 80%/20% benefit (may charge beneficiary less for generics)
• Catastrophic coverage begins at $2000 out-of-pocket.
• No beneficiary would have to spend more than $2288 for prescription drugs (including premium)

Prescription Drug Prices:

• (Reimportation) Beginning 2003, all FDA-approved prescription would be allowed for importation at world market prices after being tested for safety. Once fully implemented, Medicare could set fee schedules based on imported drug prices.
• (Allen Bill) To eliminate price discrimination, manufacturers would charge Medicare and its beneficiaries the price equal to the lower of either the lowest price paid for the drug by other Federal Government agencies or the manufacturer’s best price for the drug.
• (Reasonable Prices) Drugs developed with taxpayer funds would be subject to “reasonable price” agreements when patents are transferred to pharmaceutical companies.

Premiums and Low-income Assistance:

The Government would subsidize low-income beneficiaries to the following levels:
• 100% of the premium and cost sharing for beneficiaries below 135% of poverty.
• Partial subsidy on a sliding scale for those between 135% and 150%

Employer Incentive Program:

Limit anti-trust lawsuits on health plans and insurers.

OFFICIAL CONGRESSIONAL SUMMARY:

• Delineates the relationship between the antitrust laws and negotiations between groups of health care professionals and health plans and health care insurance issuers.
• Applies the "rule of reason" standard to negotiations between a health plan and two or more physicians.
• Awards attorneys' fees to a substantially prevailing plaintiff only when the defendant's conduct was unreasonable or in bad faith.
• Prohibits tying arrangements (linking the participation in one product line to participation in another) between a health plan and health care professional.
• Excludes from this Act any negotiations or agreements including Medicare, Medicaid, SCHIP, or other federal programs.

EXCERPTS FROM CONGRESSIONAL FINDINGS:

Congress finds the following:
1. A large number of Americans receive their health care coverage from managed health care plans.
2. The market power of insurance companies has increased tremendously since the early 1990's, due to mergers and acquisitions.
3. Health plans improperly manipulate the practice of medicine through such mechanisms as inappropriately making medical necessity determinations, and knowingly denying and delaying payment.
4. The intent of the antitrust laws is to encourage competition and protect the consumer, and the current per se standard for enforcing the antitrust laws in the health care field frequently does not achieve these objectives.
5. An application of the "rule of reason" will tend to promote both competition and high-quality patient care.
6. In any action under the antitrust laws challenging a health plan, conduct shall not be deemed illegal per se, but shall be judged on the basis of its reasonableness, taking into account all relevant factors affecting competition and proposed contract terms.

LEGISLATIVE OUTCOME: Referred to the House Committee on the Judiciary; never called for a House vote.

Include mental health services under Medicare.

A bill to extend expiring provisions under the Medicare program, to improve beneficiary access to preventive and mental health services, to enhance low-income benefit programs, and to maintain access to care in rural areas, including pharmacy access.

• Provides for gradual elimination of co-payment rates for Medicare psychiatric services.
• Provides for application of a full low-income subsidy assets test under the Medicare Savings Program.
• Eliminates Medicare part D (Voluntary Prescription Drug Benefit Program) late enrollment penalties paid by subsidy-eligible individuals.
• Authorizes awarding grants to states for increasing the delivery of mental health services or other health care services to meet the needs of veterans of Operation Iraqi Freedom and Operation Enduring Freedom living in rural areas.
• Legislative Outcome: Medicare Improvements for Patients and Providers Act of 2008: Related bills: H.R.6212, H.R.6331; became Public Law 110-275 on 7/15/2008.

Expand the National Health Service Corps.

A bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs. Amends the Public Health Service Act to:
1. increase and extend the authorization of appropriations for community health centers and for the National Health Service Corps scholarship and loan repayment program for FY2010-FY2015, and provide for increased funding for such programs in FY2016 and each subsequent fiscal year; and
2. revise and expand provisions allowing a community health center to provide services at different locations, adjust its operating plan and budget, enter into arrangements with other centers to purchase supplies and services at reduced cost, and correct material failures in grant compliance.

Make health care a right, not a privilege.

The Progressive Caucus is united in its goal of making health care a right, not a privilege. Every person should have access to affordable, comprehensive and high-quality medical care. We must use our health care dollars efficiently and ensure public accountability in all medical decisions. Based on this goal, we support the following principles:
1. All Americans, including the 44 million currently without health insurance, deserve to have the health care they need, regardless of ability to pay.
2. Medicare must remain solvent and available for the millions of seniors and individuals with disabilities who rely on the program. The Progressive Caucus supports expanding the program to cover prescription drugs and other needed products and services for beneficiaries. We support a Medicare buy-in for individuals age 55 and older. We support lowering out-of-pocket costs for seniors who currently pay, on average, 20% of their income for health care.
3. Proposals should be rejected to change traditional Medicare from a defined benefit to a defined contribution or voucher system.
4. Balanced Budget Act cuts that are negatively affecting patient access to hospitals, nursing homes, and home health agencies must be restored.
5. Medicaid must have the resources to continue to provide coverage and care for low-income individuals, including children in the CHIP program.
6. Individuals with disabilities should retain their health benefits when they return to work and to have access to rehabilitative and other needed services.
7. Funding and outreach and other programs serving low-income Americans should be expanded. Examples of such programs are the Children’s Health Insurance Program (CHIP); Qualified Medicare Beneficiary (QMB), Specified Low-income Medicare Beneficiary (SLMB), and Qualified Individuals programs; transitional funds for Medicaid recipients who are also welfare-to-work recipients; and for HHS for mental health outreach for the elderly.