Tom Vilsack on Health Care Democratic IA Governor

Focus on curing incurable diseases that drive up health cost

Focus on wellness as part of universal coverage

A: We absolutely do need universal coverage. 47 million Americans do not have health insurance coverage, which means that they don't stop getting sick; they don't stop getting health care; they actually get it in the most ineffective and expensive way: in an emergency room. We can stop that, and we can create a more efficient health care system.

But it is much more than universal coverage. It is actually incorporating wellness into the system, at every level -- from the moment a child is born. So there are ways to do this without necessarily raising the tax burden on folks and certainly on working folks. You know, when working folks hear about tax increases, their interpretation is they may be next. And I think our party can do a better job being innovative and creative. We can look inside the budget.

Help Medicare by sharing data & providing long-term homecare

A: Medicare's a much more difficult issue than Social Security. First and foremost, we have to stop paying for services and we have to start paying for results. We know today because we have inadequate data about our health care system, that in some communities you're more likely to get surgically worked on for a back injury than I might in some other community. [We should] take data and information about what works and what was the most efficient way of providing health care. That's one strategy.

Another strategy is to make sure that we have a long-term care system that encourages people to stay in their homes with greater dignity, provides assisted living as an alternative, and only puts folks in nursing homes when they want to be and when they need to be. You can do a substantial amount of work in that regard.

Disapprove inefficient uses of tobacco prevention dollars

Supports changes to the new Medicare law

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.

No federal pre-emption of employee health plan regulation.

The Issue

NGA’s Position

The Governors support efforts designed to enable small employers to join together to participate more effectively in the health insurance market. In fact, Governors have taken the lead in facilitating the development of such partnerships and alliances. However, these partnerships must be carefully structured and regulated by state agencies in order to protect consumers and small businesses from fraud and abuse and underinsurance. NGA opposes attempts to expand federal authority under ERISA. The Governors have identified the prevention of such federal legislation in the 107th Congress as a top legislative priority.

States have the primary responsibility for health insurance regulation. Across the nation, Governors are working to protect consumers and patients and to properly regulate the complicated health insurance industry.

Maintain Medicare funding of HMO benefits.

• WHEREAS, Medicare premiums paid to Health Maintenance Organizations (HMO) are set at 95% of the current fee-for-service Medicare spending on residents of the county where the HMO is to be offered; and
• WHEREAS, The lack of readily accessible medical care in some areas results in lower utilization of medical services and lower Medicare spending; and
• WHEREAS, The combination of the Medicare HMO premium formula and differences in medical care service utilization results in fewer medical benefits for many Medicare HMO participants in rural, and other low medical care utilization areas; and
• WHEREAS, Medicaid will likely be used to fill the coverage gap in these areas, requiring additional state money; and
• WHEREAS, Language in the 1997 Balanced Budget Act was designed to address these inequities; now therefore be it,
• RESOLVED, That the Midwestern Governors’ Conference encourages Congress to continue its effort to address these inequities, and to resist efforts to reverse the changes made to Medicare HMO premiums in the Balanced Budget Act of 1997.

Protect state tobacco settlement funds from federal seizure.

As you know, preserving and protecting the state tobacco settlement funds is the nation’s Governors’ highest priority. We strongly urge you to reach final agreement and pass the conference report on the emergency supplemental appropriations bill soon, and to retain the Senate provision that protects our settlement funds from federal seizure.

Many of our state legislatures are currently in session, and some have already completed work on their budgets. Therefore, it is critical that conferees reach agreement quickly on this issue. Governors are unified in their commitment to ensuring that the funds remain in the states and that there be no restrictions on states’ ability to tailor spending to meet the needs of their citizens.

We offer our strongest support for conferees to recede to the Senate version of the bill containing the Hutchison/Graham bipartisan tobacco recoupment protection legislation.