Hillary Clinton on Health Care Secretary of State; previously Democratic Senator (NY)

Sub-sections under Health Care:
• 1990s HillaryCare
• 2008 HillaryCare
• Voting Record
• Other issues under Health Care

Don’t legitimize end-of-life decision, but ok to help decide

A: This is one of those incredibly challenging issues. You know, the Terry Schiavo case posed that for many people. There wer people of good faith on both sides about what should happen to that woman’s life. And I don’t know that any of us is in a position to make that choice for families or for individuals, but I don’t want us also to condone government action that would legitimize or encourage end of life decisions. Somehow there has to be a framework for us to determine: How can people who are able to make these decisions on their own do so? Or if they are not, how best do we create a decision process for their families to try to decide? And now we are being faced with a lot of these difficult decisions because of what the world we live in today with modern technology and so much else. And we’re going to have to come to grips with them one way or another.

Decrease generic drug costs for developing countries

A: I believe that our government must do so much more to get generic drugs and low-cost drugs to people suffering. Not only from HIV/AIDS, but the range of diseases that affect disproportionately the poor. Our great pharmaceutical companies invent the compounds and put them together that the generics then are able to copy. But we need to do much more to get our pharmaceutical companies to work with us to get the drug costs down and to open the pathway for generic drugs. And that’s going to take presidential leadership. I commend Pres. Bush for his PEPFAR initiative [President’s Emergency Plan for AIDS Relief]. It was a bold & important commitment, but it didn’t go far enough in opening up the door to generics and getting the costs down. And as president, I will do that

Taxpayers pay for drug R&D, not drug companies

That’s why, while we’re looking at getting to universal health care, we also have to give Medicare the right to negotiate with drug companies to get the price down, to begin to rein in those costs across the board.

Need a health care system that manages chronic diseases

Universal health care is a core Democratic principle

Pledges to support $50B for AIDS relief in US and world

No parent should be told ‘no’ for healthcare for their kids

A: Well, I am very proud that we tried to provide universal health care to every American back in 1993 and 1994. I learned a lot from that, and I’m going to be presenting a plan next week that will be universal. It will cover everyone, and it will make it clear that we as a rich nation with the values that should be the best in the world will once & for all make it absolutely positive that everyone will have health care. Now it’s not only about the 47 million uninsured. Millions of insured Americans don’t get the health care they paid for. We have a lot of people who, all of a sudden, their child needs an operation and the insurance company won’t pay for it. Well, we’re going to make it clear that there will be no parent who ever is told no when it comes to getting health care for their children.

Local smoking bans ok, but no national ban

A: Well, we banned it in New York City. And people thought it would be a terrible idea, and everyone was really upset about it. And actually business at a lot of establishments, like restaurants and other places, increased, because many people felt more comfortable going when there was no smoking. I think that we should be moving toward a bill that I have supported to regulate tobacco through the FDA. And once it has those health warnings and once the FDA can regulate it, I think that will give a lot of support to local communities to make these, what are essentially zoning decisions. And I’d fully support that.

Q: But you’re not in favor of a national law to ban smoking in public places?

A: Not at this point. I think we’re making progress at the local level.

Outcry if AIDS were leading disease of young whites

A: Let me just put this in perspective. If HIV/AIDS were the leading cause of death of white women between the ages of 25 and 34, there would be an outraged outcry in this country.

I’m working to get Medicaid to cover treatment. I’m working to raise the budget for Ryan White, which the Bush administration has kept flat, disgracefully so, because there are a lot of women, particularly, who are becoming infected in poor rural areas as well as underserved urban areas in states where, frankly, their state governments won’t give them medical care.

So this is a multiple dimension problem. But if we don’t begin to take it seriously and address it the way we did back in the ‘90s, when it was primarily a gay men’s disease, we will never get the services and the public education that we need.

Electronic medical records save $120 billion in health care

Insurers must fund prevention without preexisting conditions

A: Well, let’s start with the insurance companies. The insurance companies make money by spending a lot of money and employing a lot of people to try to avoid insuring you, and then, if you’re insured, to try to avoid paying for the health care you received.. My office spends a lot of effort helping people who have insurance get health care. The insurance companies don’t want to pay for preventative health care because that’s like a lost amount of money because they’re not sure that the patient or the insured person will still be with them. That is upside down and backwards. So we could save money if we changed the incentive to require that preventative health care and wellness be covered and incentivized, and we could require that every insurance company had to insure everybody and no exclusions for preexisting conditions.

Require electronic medical record for all federal healthcare

After Hurricane Katrina I went down to Houston to see the people who had been evacuated, most in them from the convention center. The elderly, the frail. People who were very dependent upon health care, their records were gone. Those 15 pieces of paper were destroyed. And a lot of doctors told me their biggest problem was trying to figure out what prescriptions to give to people. The only people they could help were the people who had shopped at chain drug stores because they had electronic medical records. If we had that for all of our health records, we’d get costs down & we’d have higher quality health care.

Increase America’s commitment against Global AIDS

FDA should compare drug effectiveness--not just safety

Hillary opposed the bill, on the grounds it was not comprehensive enough. She supported numerous amendments that would have enlarged the program and further increased government involvement in the dispensation of prescription drugs.

One of her amendments sought to order the National Institutes of Health to conduct and compile more drug studies, as well as to advise and inform patients and doctors about which drugs work best. The amendment was specifically aimed at increasing the government’s role in medicine. Clinton defended it by noting, “While the FDA is responsible for determining safety and effectiveness of prescription drugs compared to a placebo, there is no government entity responsible for examining whether drug A is more effective at treating a particular condition than drug B.”

Supply more medical needs of families, & insure all children

Healthcare system plagued with underuse, overuse, and abuse

I know what you're thinking. Hillary Clinton and health care? Been there, Didn't do that! The failure of the government to help contain health costs for employers has led to a fraying of the implicit social contract in which a good job came with affordable coverage. As a whole, our ailing health care system is plagued with underuse, overuse and misuse. In a fundamental way, we pay far more for less than citizens in other advanced economies get.

Fought for pediatric rule: new drugs tested for child safety

But her proposals reflect a minimalist bite-size strategy--her proposals have been very limited, mostly just nibbling around the edges.

Low-tech low-cost water treatment for developing world

Millions uninsured is source of America's healthcare crisis

Rising health care costs were sapping the nation's economy, undermining American competitiveness, eroding workers' wages, increasing personal bankruptcies & inflating the national budget deficit. As a nation, we were spending more on health care-- 14% of our GDP--that any other industrialized country.

This terrible cycle of escalating costs and declining coverage was largely the result of a growing number of uninsured Americans. Patients without insurance seldom could afford to pay for their medical expenses out-of-pocket, so their costs were absorbed by the doctors and hospitals that treated them. Doctors and hospitals, in turn, raised their rates to cover the expense of caring for patients who weren't covered or couldn't pay.

Recommended "managed competition"; not single-payer system

Bill and other Democrats rejected the single-payer and Medicare models, preferring a quasi-private system called "managed competition" that relied on private market forces to drive down costs through competition. The government would have a smaller role, including setting standards for benefit packages and helping to organize purchasing cooperatives. The cooperatives were groups of individuals and businesses forget for the purpose of purchasing insurance. Together, they could bargain with insurance companies for better benefits and prices and use their leverage to assure high-quality care.

Fund teaching hospitals federally because market fails

CLINTON: Senator Moynihan was absolutely right to propose a piece of legislation that would guarantee that our teaching hospitals will be funded to perform the functions that they do which can not be performed within the market at a profit, namely, training our doctors and nurses and providing health care for the sickest of the sick and doing the research we all benefit from.

LAZIO: You know, a New Yorker would never have made that proposal. Mrs. Clinton has had two opportunities - two opportunities to make policy: One on health care and one on education. And on health care it was an unmitigated disaster. It would have led to health care rationing. It would have destroyed teaching hospitals. It would have led to all types of unintended consequences, perhaps. But the bottom line is it would have been terrible for New York.

Regulate tobacco; fine of $3000 for every underage smoker

Be prepared with defenses against infectious disease

Medicare should be strengthened today

GOP overwhelmed by her health reform knowledge

"We had a good discussion," said the Speaker-to-be. "I begged her not to go for the whole reform package that puts at risk 1/7 of the American economy. My advice was to go for four small reforms to see what worked. Try ensuring portability of health insurance when people change jobs. See that preexisting conditions are covered. Take care of malpractice and tort reform. Create medical savings accounts. That sort of thing. If she tried to do it all, she would fail."

And fail she did, in dramatic fashion a few months later, just before the historic elections to come.

$100B to get started on healthcare reform

In the meeting when the question of cost arose, Hillary casually tossed out the $100 billion figure. Senator Jay Rockefeller, a close administration ally on health care reform, dropped his jaw. If they were planning to spend $100 billion, a large new unpopular tax would be unavoidable. After the meeting, Rockefeller had to be sent out to clean up the damage.

One of Hillary's staffers took her aside and expressed concern about using the $100 billion number. "That's the truth, and they'd better get used to it," Hillary replied.

Smaller steps to progress on health care

2007: recast 1990s disaster as experience to make it happen

She had recast her awful history with health care reform, unveiling her long-awaited plan in mid-September and getting rave reviews for her substantive prowess, the detail and clarity of her presentation, and her self-deprecating allusions to her disastrous attempt to overhaul the system as First Lady.

She's watched as Obama's campaign was hammered for producing a proposal that was an obvious rip-off of hers. She'd begun to defuse her rival's message, where she said, "change is just a word without the strength and experience to make it happen."

Hillary appointed 8 days after inauguration to health cmte

Bill and Hillary’s joint decision-making at the beginning of his presidency was as overt as it would ever be in the White House. “He would say, ‘Hillary thinks this. What do you think?’” said one insider. “They really were a partnership. She was the absolutely necessary person to bounce things up against. I sensed a tremendous need for each other.

Gore was the one most affected by Bill’s reliance on his wife. It was a given in the White House that everyone would ”just have to get used to“ the fact that Hillary, along with Bill and Gore, had to ”sign off on big decisions.“

A plan is necessary; but consensus is more necessary

A: Well, I’ve been at the gate and out of it for 14 years, and you know when we weren’t successful with the overall reform, I moved ahead and was one of the people responsible for the children’s health-insurance program and trying to make sure drugs were safe for kids, and dealing with aftereffects the Gulf War veterans suffered. So, I’ve stayed consistently focused on health care and am engaged right now in this battle with the president over his threatened veto of the children’s health-insurance program. But I learned, among other things, that we’ve got to build a consensus. A plan is necessary but not sufficient. We’ve got to have a political consensus in order to withstand the enormous opposition from those interests that will have something to lose in a really reformed health-care system.

1993:Ambitious role plagued from start by secrecy complaints

Bill and Hillary set two ambitious goals--rewriting the complex rules that governed 14% of the economy & meeting the deadline of delivering a proposal to Congress within 100 days.

The country seemed comfortable with the historic decision to put a First Lady in charge of a major policy challenge. It didn’t take long for the honeymoon to end. The Washington Times, in an article entitled “First Lady’s Task Force Broke Law on Secrecy,” claimed that reporters had been barred from the first meeting of the task force--an apparent violation of a law because Hillary was not a federal employee and the law allows outsiders to be kept out of advisory committee meetings only if all participants are federal employees.

1990s plan failed after big pharma & insurance worked on it

1990s healthcare reforms laid groundwork for today’s reforms

Still scarred from 1990s reform, but now doing it better

1997: Helped found State Children’s Health Insurance Program

More people read my health plan abroad than in the US

The previous month Hillary had been in the Ukraine touring a hospital, and the minister of health had taken out a copy of her Health Security Act and asked her to autograph it. The plan was brilliant, the minister said, and he hoped she knew how useful it was in guiding the Ukrainians as they attempted to figure out how to rebuild their health care system.

Hillary burst out laughing but the bitterness was evident: "I travel around the world, and this happened to me dozens of times now, somebody from another country tells me that they be read it and analyzed it. More people have read it in the Ukraine than read it in the US.

1993 health plan initially praised as moderate & workable

I proposed that all employers provide health insurance, as 75% of them were already doing, with a discount for small-business owners who otherwise couldn't afford the insurance. The subsidy would be paid for by an increase in cigarette taxes.

Hillary, and all those who helped, had crafted a plan that we could implement while reducing the deficit. And contrary to how it was later portrayed, health experts generally praised it at the time as moderate and workable. It certainly wasn't a government takeover of the health-care system, as its critics charged, but that story came later.

1990s reform called “secretive” but had 600 in working group

In addition to the President’s Task Force, we organized a giant working group of experts that would consider every aspect of health care. This group, comprising as many as 600 people, met regularly to debate and review specific parts of the plan in detail.

On February 24, we were dealt a blow that none anticipated. Groups affiliated with the health care industry sued the task force over its composition, claiming that because I was not a government employee, I was not allowed to chair or attend closed task force meetings.

It was a deft political move, designed to disrupt our work and foster an impression with the public and the media that we were conducting secret meetings.

We were trying to move too quickly on a bill that would fundamentally alter social and economic policy for years to come.

When last Republican backed out, HillaryCare died

Health care faded with barley a whimper. I still think that was the wrong call. Giving up without one last public fight demoralized Democrats and let the opposition rewrite history.

Despite failure, glad she tried system-wide reform

That said, I still believe we were right to try. Our work in 1993 and 1994 paved the way for what several economists dubbed the "Hillary Factor," the purposeful restraint on price increases during the 1990s. It also helped to create the ideas and political will that led to important smaller reforms in the years following.

On balance I think we made the right decision to try to reform the whole system. Someday we will fix the system. When we do it, it will be the result of more than fifty years of efforts by Harry Truman, Richard Nixon, Jimmy Carter and Bill and me. Yes, I'm still glad we tried.

1994 "Harry & Louise" ads exploited consumer fears

For the Gridiron Dinner, Bill and I decided to stage a parody of the insurance lobby's TV spot, with Bill playing "Harry" and me playing "Louise." It would give us a chance to expose the scare tactics employed by our opponents and have some fun:

Me: On page 3,764 that under the Clinton health security plan, we could get sick.

Bill: That's terrible.

Announcer: "Paid for by the Coalition to Scare Your Pants Off."

Our videotaped performance was widely covered, even replayed on several Sunday morning new shows.

1990s plan based on employer mandate

Learned lessons on health care; but hasn’t given up goal

1979: Developed program to deliver rural healthcare

1994: can't fix just part of problem; it's all or nothing

In early September 1994, it became clear that the president didn't have the votes even to get the health-care bill out of Senate committee. I warned Hillary that the failure to pass any health reform at all would seriously injure the administration in general and her reputation in particular. I suggested that she back a limited bill to ensure that workers could take health insurance with them when they changed jobs and that pre-existing conditions.

Hillary was adamant that she would not back such a bill, because "you can't fix part of the problem,. If you do this over here, it causes this bad reaction over there. You've got to do it all or do nothing." She also worried that the legislation I was suggesting might lead to higher premiums.

We need a movement to get healthcare done this time

2006: If I can't do universal coverage, why run?

Her new plan was carefully crafted and politically astute, offering detail where necessary and avoiding it where possible. Clearly, she had learned her lesson from the health care debacle. Since most people who have insurance want to keep what they have, she built her plan on the existing system of employer-based insurance, with alternatives for those who did not have insurance through their work. Her plan, unlike Obama's, imposed a mandate, requiring that everyone purchase some kind of insurance.

AdWatch: Got health insurance for six million kids

Include everyone, to avoid cherry-picking and its hidden tax

OBAMA: Sen. Clinton suggests that I want to leave 15 million people out. I dispute it, and I think it is inaccurate. The reason she thinks that there are more people covered under her plan than mine is because of a mandate.

CLINTON: The difference between Sen. Obama and myself is that I know, from the work I’ve done on health care for many years, that if everyone’s not in the system we will continue to let the insurance companies do what’s called cherry picking--pick those who get insurance and leave others out. We will continue to have a hidden tax, so that when someone goes to the emergency room without insurance-- 15 million or however many--that amount of money that will be used to take care of that person will be then spread among all the rest of us. In my plan there is enough money to provide the kind of subsidies so that everyone would be able to afford it.

Healthcare without mandate is like voluntary Social Security

OBAMA: I believe that if we make it affordable, people will purchase it. In fact, Medicare Part B is not mandated, it is voluntary.

Many uninsured are young & don’t think they need coverage

OBAMA: Which is why I cover them.

CLINTON: Except when the illness or the accident strikes. And what Sen. Obama has said, that then, once you get to the hospital, you’ll be forced to buy insurance, I don’t think that’s a good idea. We ought to plan for it, and we ought to make sure we cover everyone. That is the only way to get to universal health care coverage. But if we don’t even have a plan to get there, and we start out by leaving people, you’ll never ever control costs, improve quality, and cover everyone.

OBAMA: With respect to the young people, my plan specifically says that up until the age of 25 you will be able to be covered under your parents’ insurance plan, so that cohort that Sen. Clinton is talking about will, in fact, have coverage.

Make it illegal to discriminate against sick people

I want to take on the tough issues that face us now. I want to stop the health insurance companies from discriminating against people because they’re sick. You know, it’s unconstitutional to discriminate on the basis of race or gender or ethnic origin or religion, but it’s OK to discriminate against sick people. And we’re going to end that, because it’s time we said no more.

Tired of health insurance companies deciding who live or die

Universal health care will not work if it is voluntary

Mandate insurance AND make it affordable for all

CLINTON: Contrary to that description, we actually will make it affordable for everyone, because my plan lowers costs aggressively; and improves quality for everyone. And the way it covers all of those who wish to participate is that it will provide subsidies, and it will also cap premiums, because we want to make sure that it is affordable for all. So, when you draw the distinction that, “Well, it’s not affordable, therefore people will have to be made to get it,” well, the fact is, it has been designed to be affordable with health care tax credits.

Health care tax credit ensures affordability

Insurance companies cannot deny people coverage

Condemns insurers as motivated by greed

American Health Choices Plan: keep yours or pick Congress’

But if you are one of those 47 million uninsured, or if you are one of the many millions more who actually have insurance except when you really need it and the insurance company won’t pay for what your doctor has prescribed, you will now have the same choices that are available to members of Congress, because we will open up the plan that members of Congress have and give you a health choices menu to choose from.

We will also provide a health care tax credit for those who cannot, on their own, afford it or who don’t have employer help. Similarly, I will provide a new small business health care tax credit because a lot of small businesses tell me that they’d love to be able to help provide health care for their employees, but they just can’t afford it, and we’re going to make it affordable.

Pay for health plan by $52B tax repeal & $77B efficiencies

A: In our system, we have a lot of inefficiencies. Let’s take electronic medical records, because if we were to have a system where everyone had a private, confidential health care record--this is something that I’ve worked on with Newt Gingrich--we would see that we would save a lot of money. If we better managed chronic care, we would save money, because right now we don’t, and we pay a big price for it. My plan has about $52 billion in tax cuts, by moving the tax rates back to the pre-Bush era. And yes, taxes will go up on people making $250,000, but most Americans will see a net tax decrease.

Mandated responsibility by individuals, industry & employers

• You mandate that all Americans would have to buy insurance or face penalties, even young people who may not want it.
• You mandate that large businesse would have to insure employees or pay a tax.
• And you mandate that insurance companies would have to offer coverage to all applicants no matter how sick they are.

A: Well, there is certainly a shared responsibility that goes with having a health care system that both can afford to provide quality affordable health care for everyone and puts responsibility on everyone in our country. Individuals will have to have insurance, but we’re going to make it affordable. The health care industry, the drug industry, are going to have to change the way they conduct business. Business will take responsibility, but within a system that will actually get their costs down.

Since 1993, new consensus developed on need for healthcare

A: I’m proud that we tried in ‘93. Obviously, we made a lot of mistakes. [With my new plan], if you’re one of the 47 million Americans without health insurance, then you are going to have access to the same health choices menu that members of Congress do. I proposed that back in ‘93, and ran into a firestorm of opposition from the Congress. But I think a lot has changed in the last 14 years. A consensus has developed about what we need to do to try to reach quality, affordable healthcare. A consensus has developed because people who didn’t approve of what we were trying to do or who were on the sidelines have seen what has happened. It is not only a moral imperative that we try to cover everyone, it is now an economic necessity.

Include insurance industry in discussions, but rein them in

A: Well, I can’t say how you prevent people who have legitimate businesses in America from participating in the political process. It’s somewhat silly to suggest that talking to people is somehow out of bounds. My coverage plan dramatically reins in the influence of the insurance companies, because frankly I think that they have worked to the detriment of our economy & our healthcare system.

Q: Because of your long history, do you take contributions from insurance companies?

A: Well, I take from executives or people that work for them, just like I do from every part of the economy. What’s important here is, can you put together a strong enough political coalition to withstand their understandable efforts? In American democracy, everybody gets to express an opinion, and some unfortunately have a disproportionate opinion, and that’s why it takes a lot of strength & experience to stand up to them. And I think I have proven that.

Universal health care coverage by the end of my second term

A: We already spend more money than anybody else in the world, by about $800 billion, and we have 47 million uninsured. We’re also at a competitive disadvantage because other countries either provide health care or don’t, and our companies are trying to be competing in a global economy. So I want to figure out how we provide universal health care without putting billions more into the system. Let’s get prescription drug prices down by negotiating with the drug companies, for example. I am going around the country, and I’m asking people’s advice, then I’m going to be proposing a specific plan. You know, President Kennedy said in his inauguration that he wanted to have a man on the moon by the end of the decade. Well, I want to have universal health care coverage by the end of my second term.

I have the expertise to achieve universal healthcare for all

We need a uniquely American solution to health care

CLINTON: We need a uniquely American solution to our health care challenges. [For example], I have pushed to have a big pool that small businesses could participate in, like we do in the federal government. Small businesses should be able to join together like the Federal Employee Health Benefit Plan. There are pieces of things we should do now, but there’s no doubt that we need to have a national conversation-the payers, the employers, the doctors, the nurses, and those of us in public life--we need to get this fixed, once and for all.

SPENCER: I believe in the concept of health savings accounts. That creates jobs instead of punishing corporations and providers of jobs. Cut the taxes, and let them set up health savings accounts. With regards to the small business pools, small business owners say they are not getting help from Sen. Clinton to create associations so they can get the same rate as IBM and General Motors on health insurance. That’s what we need to do.

Health care initiatives are her first priority in Senate

She called for expanding eligibility for the government-run Children’s Health Insurance Program. Her plan, she said, would enable roughly five million more children to enroll. Clinton also proposed financial bonuses as a reward to states that aggressively enroll more children in the program. And she called for establishing a new national health insurance program for low-income families that is modeled after a NY program. She offered no details in her speech.

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 NO on means-testing to determine Medicare Part D premium.

SUPPORTER'S ARGUMENT FOR VOTING YES: Sen. ENSIGN: This amendment is to means test Medicare Part D the same way we means test Medicare Part B. An individual senior making over $82,000 a year, or a senior couple making over $164,000, would be expected to pay a little over $10 a month extra. That is all we are doing. This amendment saves a couple billion dollars over the next 5 years. It is very reasonable. There is nothing else in this budget that does anything on entitlement reform, and we all know entitlements are heading for a train wreck in this country. We ought to at least do this little bit for our children for deficit reduction.

OPPONENT'S ARGUMENT FOR VOTING NO: Sen. BAUCUS: The problem with this amendment is exactly what the sponsor said: It is exactly like Part B. Medicare Part B is a premium that is paid with respect to doctors' examinations and Medicare reimbursement. Part D is the drug benefit. Part D premiums vary significantly nationwide according to geography and according to the plans offered. It is nothing like Part B.

Second, any change in Part D is required to be in any Medicare bill if it comes up. We may want to make other Medicare changes. We don't want to be restricted to means testing.

Third, this should be considered broad health care reform, at least Medicare reform, and not be isolated in this case. LEGISLATIVE OUTCOME:Amendment rejected, 42-56

Voted YES on requiring negotiated Rx prices for Medicare part D.

Proponents support voting YES because:

This legislation is an overdue step to improve part D drug benefits. The bipartisan bill is simple and straightforward. It removes the prohibition from negotiating discounts with pharmaceutical manufacturers, and requires the Secretary of Health & Human Services to negotiate. This legislation will deliver lower premiums to the seniors, lower prices at the pharmacy and savings for all taxpayers.

It is equally important to understand that this legislation does not do certain things. HR4 does not preclude private plans from getting additional discounts on medicines they offer seniors and people with disabilities. HR4 does not establish a national formulary. HR4 does not require price controls. HR4 does not hamstring research and development by pharmaceutical houses. HR4 does not require using the Department of Veterans Affairs' price schedule.

Opponents support voting NO because:

Does ideological purity trump sound public policy? It shouldn't, but, unfortunately, it appears that ideology would profoundly change the Medicare part D prescription drug program, a program that is working well, a program that has arrived on time and under budget. The changes are not being proposed because of any weakness or defect in the program, but because of ideological opposition to market-based prices. Since the inception of the part D program, America's seniors have had access to greater coverage at a lower cost than at any time under Medicare.

Under the guise of negotiation, this bill proposes to enact draconian price controls on pharmaceutical products. Competition has brought significant cost savings to the program. The current system trusts the marketplace, with some guidance, to be the most efficient arbiter of distribution.
Status: Cloture rejected Cloture vote rejected, 55-42 (3/5ths required)

Voted NO on limiting medical liability lawsuits to $250,000.

Proponents of the motion recommend voting YEA because:
• Many doctors have had to either stop practicing medicine due to increased insurance premiums.
• Patients are affected as well--due to rising malpractice rates, more and more patients are not able to find the medical specialists they need.
• The cost of medical malpractice insurance premiums are having wide-ranging effects. It is a national problem, and it is time for a national solution.
• I am pleased that S. 22 extends liability protections to all health care providers and institutions.
• These bills are a commonsense solution to a serious problem, and it is time for us to vote up or down on this legislation.

Opponents of the motion recommend voting NAY because:
• We have virtually no evidence that caps on economic damages will actually lower insurance rates. And in my view, these caps are not fair to victims.
• If we want to reduce malpractice insurance premiums we must address these problems as well as looking closely at the business practices of the insurance companies. What we shouldn't do is limit the recovery of victims of horrible injury to an arbitrarily low sum.
• This is obviously a complicated issue. This is the kind of issue that needs to be explored in depth in our committees so that a consensus can emerge. So I will vote no on cloture, and I hope that these bills will go through committees before we begin floor consideration of this important topic.

Voted YES on expanding enrollment period for Medicare Part D.

Voted YES on increasing Medicaid rebate for producing generics.

Voted YES on negotiating bulk purchases for Medicare prescription drug.

Voted NO on $40 billion per year for limited Medicare prescription drug benefit.

Voted YES on allowing reimportation of Rx drugs from Canada.

Voted YES on allowing patients to sue HMOs & collect punitive damages.

Voted NO on funding GOP version of Medicare prescription drug benefit.

Establish "report cards" on HMO quality of care.

Promote Universal Access and Quality in Health Care
That more than 40 million Americans lack health insurance is one of our society’s most glaring inequities. Lack of insurance jeopardizes the health of disadvantaged Americans and also imposes high costs on everyone else when the uninsured lack preventive care and get treatment from emergency rooms. Washington provides a tax subsidy for insurance for Americans who get coverage from their employers but offers nothing to workers who don’t have job-based coverage.

Markets alone cannot assure universal access to health coverage. Government should enable all low-income families to buy health insurance. Individuals must take responsibility for insuring themselves and their families whether or not they qualify for public assistance.

Finally, to help promote higher quality in health care for all Americans, we need reliable information on the quality of health care delivered by health plans and providers; a “patient’s bill of rights” that ensures access to medically necessary care; and a system in which private health plans compete on the basis of quality as well as cost.

Goals for 2010
• Reduce the number of uninsured Americans by two-thirds through tax credits, purchasing pools, and other means.
• Create a system of reliable “report cards” on the quality of care delivered by health plans and providers.

Invest funds to alleviate the nursing shortage.

• Amends Medicare to provide for nurse education training payments to qualified entities.
• Amends Medicaid to temporarily increase the matching rate for Medicaid nurse aide training and competency evaluation programs.
• Amends the Internal Revenue Code to provide for the exclusion from gross income of amounts received under the National Nursing Service Corps Scholarship Program.
• Amends the Public Health Service Act to: (1) develop and issue public service announcements that advertise and promote the nursing profession, highlight the advantages and rewards of nursing, and encourage individuals from diverse communities and backgrounds to enter the nursing profession; and (2) award grants to designated eligible educational entities in order to increase the number of nurses.
• Establishes a National Nurse Service Corps Scholarship program that provides scholarships to individuals seeking nursing education in exchange for service by such individuals in areas with nursing shortages. Authorizes appropriations.

Let states make bulk Rx purchases, and other innovations.

To: The Honorable Tommy G. Thompson, Secretary, Department of Health & Human Services

Dear Secretary Thompson:

As you know, prescription drug costs have been surging at double-digit rates for the last six years. The average annual increase 1999 through 2003 was a massive 16%, seven times the rate of general inflation.

These increases fall hardest on senior citizens and the uninsured. Their health needs are often great, and their low incomes often make these products unaffordable. They have no ability to use their combined purchasing power to negotiate reasonable prices. Taxpayers pay tens of billions of dollars for the purchase of drugs by Medicaid—an expense that could be reduced significantly if states are permitted to negotiate for the best prices from drug manufacturers.

As you know, the Supreme Court has just ruled that Maine's innovative program to reduce prescription drug costs for the uninsured and senior citizens is not a violation of the Medicaid law. As a result of this decision, Maine can use the combined buying power of Medicaid and individuals purchasing drugs on their own to negotiate lower prices with drug manufacturers. Twenty-nine other states supported the position taken by Maine, and there is broad interest in many states in initiating similar programs.

The Supreme Court's ruling, however, left open the possibility that if the Department of Health and Human Services makes a finding that the Maine program violates the Medicaid statute, the Department's action would be upheld by the Court. We urge you not to intervene to block Maine's program or similar statutes in other states that achieve savings for taxpayers, the elderly, and the uninsured. Such programs must be carefully implemented to assure that the poor are not denied access to needed drugs, but there is no justification for the federal government to deny states the ability to negotiate lower drug prices on behalf of their neediest citizens.

Rated 100% by APHA, indicating a pro-public health record.

The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.

The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.

End government propaganda on Medicare bill.

Recently, the U.S. Department of Health and Human Services (HHS), through a public relations firm, distributed Video News Releases (VNRs) to numerous local television news stations across the country. These VNRs contain pre-scripted news story packages and B-Roll designed to influence local news station to run stories complimentary of the new Medicare law recently signed by President Bush. However, these VNRs may mislead many news stations because they do not identify that they are produced by the government. In addition, these materials are currently being evaluated to determine whether they are illegal "covert propaganda."

We urge you to immediately warn stations not to use these materials and pull any stories that use them.

These tapes can be identified as follows: Two English-language versions begin with B-Roll of video slides promoting the new Medicare law, followed by interview soundbites from Tommy Thompson, Secretary of the Department of Health and Human Services and Leslie Norwalk, Acting Deputy Administrator of the Centers for Medicare and Medicaid (CMS). Following these soundbites, a complete television news package is run, with a voice-over by a fictional reporter named "Karen Ryan." Following the news package, more B-Roll is provided, including scenes of President Bush's rally at the signing of the bill, scenes from a pharmacy and scenes of seniors playing table games.

It is critical to the credibility of an independent news media that covert government propaganda be rejected for use by news organizations. We also believe that honest government should not resort to such deceptive tactics, and it is our belief that these materials violate the above-mentioned Federal law. Thank you for your cooperation with this request.

Sponsored bill for mental health service for older Americans.

OFFICIAL CONGRESSIONAL SUMMARY: A bill to provide for mental health screening and treatment services, and to provide for integration of mental health services and mental health treatment outreach teams.

SPONSOR'S INTRODUCTORY REMARKS: Sen. CLINTON: This bill is an effort to improve the accessibility and quality of mental health services for our rapidly growing population of older Americans. As we look forward to increased longevity, we must also acknowledge the challenges that we face related to the quality of life as we age. Chief among these are mental and behavioral health concerns.

It is estimated that nearly 20% of Americans age 55 or older experience a mental disorder. It is anticipated that the number of seniors with mental health problems will increase from 4 million in 1970 to 15 million in 2030. Mental disorders do not have to be a part of the aging process because we have effective treatments for these conditions. But in far too many instances our seniors go undiagnosed and untreated because of the current divide in our country between health care and mental health care.

That is why I am reintroducing the Positive Aging Act. This legislation would strengthen the delivery of mental health services to older Americans. Specifically, the Positive Aging Act would fund grants to states to provide screening and treatment for mental health disorders in seniors. It would also fund demonstration projects to provide these screening and treatment services to older adults residing in rural areas and in naturally occurring retirement communities, NORC's.

I believe that we owe it to older adults in this country to do all that we can to ensure that high quality mental health care is both available and accessible. This legislation takes an important step in that direction.

LEGISLATIVE OUTCOME:Referred to Senate Committee on Health, Education, Labor, and Pensions; never came to a vote.

Improve services for people with autism & their families.

Amends the Public Health Service Act to require the Secretary of Health and Human Services to:

1. convene, on behalf of the Interagency Autism Coordinating Committee, a Treatments, Interventions, and Services Evaluation Task Force to evaluate evidence-based biomedical and behavioral treatments and services for individuals with autism;
2. establish a multi-year demonstration grant program for states to provide evidence-based autism treatments, interventions, and services.
3. establish planning and demonstration grant programs for adults with autism;
4. award grants to states for access to autism services following diagnosis;
5. award grants to University Centers of Excellence for Developmental Disabilities to provide services and address the unmet needs of individuals with autism and their families;
6. make grants to protection and advocacy systems to address the needs of individuals with autism and other emerging populations of individuals with disabilities; and
7. award a grant to a national nonprofit organization for the establishment and maintenance of a national technical assistance center for autism services and information dissemination.
8. Directs the Comptroller General to issue a report on the financing of autism services and treatments.

Establish a national childhood cancer database.

Conquer Childhood Cancer Act of 2007 - A bill to advance medical research and treatments into pediatric cancers, ensure patients and families have access to the current treatments and information regarding pediatric cancers, establish a population-based national childhood cancer database, and promote public awareness of pediatric cancers.

Authorizes the Secretary to award grants to childhood cancer professional and direct service organizations for the expansion and widespread implementation of:
1. activities that provide information on treatment protocols to ensure early access to the best available therapies and clinical trials for pediatric cancers;
2. activities that provide available information on the late effects of pediatric cancer treatment to ensure access to necessary long-term medical and psychological care; and
3. direct resource services such as educational outreach for parents, information on school reentry and postsecondary education, and resource directories or referral services for financial assistance, psychological counseling, and other support services.

Preserve access to Medicaid & SCHIP during economic downturn.

A bill to preserve access to Medicaid and the State Children's Health Insurance Program during an economic downturn.

• Economic Recovery in Health Care Act of 2008 - Prohibits finalizing, implementing, enforcing, or otherwise taking any action, prior to April 1, 2009, on any changes to Medicaid programs or State Children's Health Insurance Program (SCHIP).
• Amends the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 to extend through April 1, 2009, the moratorium relating to the cost limit for providers.
• Amends the Medicare, Medicaid, and SCHIP Extension Act of 2007 to extend through April 1, 2009, the moratorium relating to rehabilitation services, school-based administration, and school-based transportation.
• Provides for state fiscal relief through a temporary increase of Medicaid federal medical assistance percentage (FMAP).