Saxby Chambliss on Health Care
Republican Sr Senator; previously Representative (GA-8)
Create incentives for competition & consumer driven approach
Q: Do you support the Medicare Prescription Drug Benefit?
A: The Medicare Prescription Drug program (P.L. 108-173), which Sen. Chambliss voted for, modernizes Medicare from a 1965 era program to a program that will strengthen our private health care
system, creates incentives for competition and a consumer driven approach to health care, and gives our seniors the full measure of modern medicine that has been promised to them.
Source: Senior Citizens League Guide to the 2008 US Senate Campaigns
, Oct 10, 2008
Supported the Medicare Prescription Drug Benefit plan
Every Georgian deserves access to safe, quality, & affordable health care. That’s why I’ve supported reforms to protect patients and make health care coverage more affordable. Congress has risen to the occasion in the past. We all agreed that our seniors
deserved access to safe and affordable prescription drugs and we provided it. I actively supported the historic “Medicare Prescription Drug Benefit” and now seniors, like my 90-year-old mother, are able to receive prescription drug coverage under
Medicare for the first time in history. Now we need to consider options for making health care affordable for every American. If we win, the health care system and costs will come down. The debate will be hard and long and will very likely depend on
what you personally want. If you want choice, lower prices, more competition, flexibility, options, tax advantages and a health care relationship directly with your doctor, you will have to get involved and let your opinions be heard by Congress.
Source: 2008 Senate campaign website, www.saxby.org
, Aug 18, 2008
Fight the federal takeover of health care
The debate about extensive health care reform is just beginning in Congress. The ultra-liberal democrats continue to promote a total takeover of health care by the federal government. This is the wrong approach and I will continue to fight that type
The debate on health care reform will focus on health care tax overhauls, keeping the health decisions where they should be--between doctors & patients, empowering individuals with their health care savings & health care decision.
Source: 2008 Senate campaign website, www.saxby.org, “Issues”
, Mar 2, 2008
Expand tax-free medical savings accounts
Chambliss supports the following principles regarding health issues:
Source: Congressional 1998 National Political Awareness Test
, Nov 1, 1998
- Allow small business owners, the self-employed and workers whose employers do not provide health insurance to have the same deductibility for health costs as corporations and
- Expand eligibility for tax-free medical savings accounts, which would be taxed if used for any purpose other than medical costs.
- Establish limits on the amount of damages awarded in medical malpractice lawsuits.
Voted YES on the Ryan Budget: Medicare choice, tax & spending cuts.
Proponent's Arguments for voting Yes:
[Sen. DeMint, R-SC]: The Democrats have Medicare on a course of bankruptcy. Republicans are trying to save Medicare & make sure there are options for seniors in the future. Medicare will not be there 5 or 10 years from now. Doctors will not see Medicare patients at the rate [Congress will] pay.
[Sen. Ayotte, R-NH]: We have 3 choices when it comes to addressing rising health care costs in Medicare. We can do nothing & watch the program go bankrupt in 2024. We can go forward with the President's proposal to ration care through an unelected board of 15 bureaucrats. Or we can show real leadership & strengthen the program to make it solvent for current beneficiaries, and allow future beneficiaries to make choices.
Opponent's Arguments for voting No:
[Sen. Conrad, D-ND]: In the House Republican budget plan, the first thing they do is cut $4 trillion in revenue over the next 10 years. For the wealthiest among us, they
give them an additional $1 trillion in tax reductions. To offset these massive new tax cuts, they have decided to shred the social safety net. They have decided to shred Medicare. They have decided to shred program after program so they can give more tax cuts to those who are the wealthiest among us.
[Sen. Merkley, D-TK]: The Republicans chose to end Medicare as we know it. The Republican plan reopens the doughnut hole. That is the hole into which seniors fall when, after they have some assistance with the first drugs they need, they get no assistance until they reach a catastrophic level. It is in that hole that seniors have had their finances devastated. We fixed it. Republicans want to unfix it and throw seniors back into the abyss. Then, instead of guaranteeing Medicare coverage for a fixed set of benefits for every senior--as Medicare does now--the Republican plan gives seniors a coupon and says: Good luck. Go buy your insurance. If the insurance goes up, too bad.
Reference: Ryan Budget Plan;
; vote number 11-SV077
on May 25, 2011
Status: Failed 40-57
Voted NO on regulating tobacco as a drug.
Congressional Summary:Amends the Federal Food, Drug, and Cosmetic Act (FFDCA) to provide for the regulation of tobacco products by the Secretary of Health and Human Services through the Food and Drug Administration (FDA). Defines a tobacco product as any product made or derived from tobacco that is intended for human consumption. Excludes from FDA authority the tobacco leaf and tobacco farms.
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.
Reference: Family Smoking Prevention and Tobacco Control Act;
; vote number 2009-S207
on Jun 11, 2009
Voted NO on expanding the Children's Health Insurance Program.
Proponent's argument to vote Yes:
- 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.
Reference: SCHIP Reauthorization Act;
; vote number 2009-S031
on Jan 29, 2009
Voted YES on overriding veto on expansion of Medicare.
Pres. GEORGE W. BUSH's veto message (argument to vote No):
- 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:In addition, H.R. 6331 would delay important reforms like the Durable Medical
Equipment, Prosthetics, Orthotics, and Supplies competitive bidding program. Changing policy in mid-stream is also confusing to beneficiaries who are receiving services from quality suppliers at lower prices. In order to slow the growth in Medicare spending, competition within the program should be expanded, not diminished.
- 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.
Reference: Medicare Improvements for Patients and Providers Act;
; vote number 2008-S177
on Jul 15, 2008
Voted YES on means-testing to determine Medicare Part D premium.
CONGRESSIONAL SUMMARY:To require wealthy Medicare beneficiaries to pay a greater share of their Medicare Part D premiums.
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
Bill S.Amdt.4240 to S.Con.Res.70
; vote number 08-S063
on Mar 13, 2008
Voted YES on allowing tribal Indians to opt out of federal healthcare.
TRIBAL MEMBER CHOICE PROGRAM: Members of federally-recognized Indian Tribes shall be provided the opportunity to voluntarily enroll, with a risk-adjusted subsidy for the purchase of qualified health insurance in order to--
- improve Indian access to high quality health care services;
- provide incentives to Indian patients to seek preventive health care services;
- create opportunities for Indians to participate in the health care decision process;
- encourage effective use of health care services by Indians; and
- allow Indians to make health care coverage & delivery decisions & choices.
SUPPORTER'S ARGUMENT FOR VOTING YES:Sen. COBURN: The underlying legislation, S.1200, does not fix the underlying problems with tribal healthcare. It does not fix rationing. It does not fix waiting lines. It does not fix the inferior quality that is being applied to a lot of Native Americans and Alaskans in this country. It does not fix
any of those problems. In fact, it authorizes more services without making sure the money is there to follow it.
Those who say a failure to reauthorize the Indian Health Care Improvement Act is a violation of our trust obligations are correct. However, I believe simply reauthorizing this system with minor modifications is an even greater violation of that commitment.
OPPONENT'S ARGUMENT FOR VOTING NO:Sen. DORGAN: It is not more money necessarily that is only going to solve the problem. But I guarantee you that less money will not solve the problem. If you add another program for other Indians who can go somewhere else and be able to present a card, they have now taken money out of the system and purchased their own insurance--then those who live on the reservation with the current Indian Health Service clinic there has less money. How does that work to help the folks who are stranded with no competition?
LEGISLATIVE OUTCOME:Amendment rejected, 28-67
Reference: Tribal Member Choice Program;
Bill SA.4034 to SA.3899 to S.1200
; vote number 08-S025
on Feb 14, 2008
Voted NO on adding 2 to 4 million children to SCHIP eligibility.
Allows State Children's Health Insurance Programs (SCHIP), that require state legislation to meet additional requirements imposed by this Act, additional time to make required plan changes. Pres. Bush vetoed this bill on Dec. 12, 2007, as well as a version (HR976) from Feb. 2007.
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]:
- It terminates the coverage of childless adults.
- 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.
- 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.
Reference: Children's Health Insurance Program Reauthorization Act;
Bill H.R. 3963
; vote number 2007-403
on Nov 1, 2007
Voted NO on requiring negotiated Rx prices for Medicare part D.
Would require negotiating with pharmaceutical manufacturers the prices that may be charged to prescription drug plan sponsors for covered Medicare part D drugs.
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.
Reference: Medicare Prescription Drug Price Negotiation Act;
Bill S.3 & H.R.4
; vote number 2007-132
on Apr 18, 2007
Status: Cloture rejected Cloture vote rejected, 55-42 (3/5ths required)
Voted YES on limiting medical liability lawsuits to $250,000.
A "cloture motion" cuts off debate. Voting YEA indicates support for the bill as written, in this case to cap medical liability lawsuits. Voting NAY indicates opposition to the bill or a desire to amend it. This bill would "provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system." It would limit medical lawsuit noneconomic damages to $250,000 from the health care provider, and no more than $500,000 from multiple health care institutions.
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:
Reference: Medical Care Access Protection Act;
Bill S. 22
; vote number 2006-115
on May 8, 2006
- 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 NO on expanding enrollment period for Medicare Part D.
To provide for necessary beneficiary protections in order to ensure access to coverage under the Medicare part D prescription drug program. Voting YES would extend the 6-month enrollment period for the Prescription Drug Benefit Program to the entire year of 2006 and allows beneficiaries to change plans once in that year, without penalty, after enrollment. Also would fully reimburse pharmacies, states and individuals for cost in 2006 for covered Medicare Part D drugs.
Reference: Medicare Part D Amendment;
Bill S Amdt 2730 to HR 4297
; vote number 2006-005
on Feb 2, 2006
Voted NO on increasing Medicaid rebate for producing generics.
Vote on an amendment that removes an increase in the Medicaid deduction rebate for generic drugs from 11% to 17%. The effect of the amendment, according to its sponsor, is as follows: "This bill eliminates the ability of generic drugs to be sold using Medicaid. Over half the prescription drugs used in Medicaid are generic. Because we have raised the fees so dramatically on what a generic drug company must pay a pharmacy to handle the drug, pharmacies are not going to use the generic. In the long run, that will cost the Medicaid Program billions of dollars. My amendment corrects that situation." A Senator opposing the amendment said: "This bill has in it already very significant incentives for generic utilization through the way we reimburse generics. Brand drugs account for 67% of Medicaid prescriptions, but they also account for 81% of the Medicaid rebates. This is reasonable policy for us, then, to create parity between brand and generic rebates. This amendment would upset that parity."
Reference: Amendment for Medicaid rebates for generic drugs;
Bill S Amdt 2348 to S 1932
; vote number 2005-299
on Nov 3, 2005
Voted NO on negotiating bulk purchases for Medicare prescription drug.
Vote to adopt an amendment that would allow federal government negotiations with prescription drug manufactures for the best possible prescription drug prices. Amendment details: To ensure that any savings associated with legislation that provides the Secretary of Health and Human Services with the authority to participate in the negotiation of contracts with manufacturers of covered part D drugs to achieve the best possible prices for such drugs under Medicare Part D of the Social Security Act, that requires the Secretary to negotiate contracts with manufacturers of such drugs for each fallback prescription drug plan, and that requires the Secretary to participate in the negotiation for a contract for any such drug upon the request of a prescription drug plan or an MA-PD plan, is reserved for reducing expenditures under such part.
Reference: Prescription Drug Amendment;
Bill S.Amdt. 214 to S.Con.Res. 18
; vote number 2005-60
on Mar 17, 2005
Voted YES on $40 billion per year for limited Medicare prescription drug benefit.
S. 1 As Amended; Prescription Drug and Medicare Improvement Act of 2003. Vote to pass a bill that would authorize $400 billion over 10 years to create a prescription drug benefit for Medicare recipients beginning in 2006. Seniors would be allowed to remain within the traditional fee-for-service program or seniors would have the option to switch to a Medicare Advantage program that includes prescription drug coverage. Private insurers would provide prescription drug coverage. Private Insurers would engage in competitive bidding to be awarded two-year regional contracts by the Center for Medicare Choices under the Department of Health and Human Services.Enrolled seniors would pay a $275 deductible and an average monthly premium of $35. Annual drug costs beyond the deductible and up to $4,500 would be divided equally between the beneficiary and the insurer. Beneficiaries with incomes below 160 percent of the poverty level would be eligible for added assistance.
Reference: Medicare Prescription Drug Benefit bill;
; vote number 2003-262
on Jun 26, 2003
Voted YES on allowing suing HMOs, but under federal rules & limited award.
Vote to adopt an amendment that would limit liability and damage awards when a patient is harmed by a denial of health care. It would allow a patient to sue a health maintenance organization in state court but federal, not state, law would govern.
Bill HR 2563
; vote number 2001-329
on Aug 2, 2001
Voted YES on subsidizing private insurance for Medicare Rx drug coverage.
HR 4680, the Medicare Rx 2000 Act, would institute a new program to provide voluntary prescription drug coverage for Medicare beneficiaries through subsidies to private plans. The program would cost an estimated $40 billion over five years and would go into effect in fiscal 2003.
Reference: Bill sponsored by Thomas, R-CA;
Bill HR 4680
; vote number 2000-357
on Jun 28, 2000
Voted YES on banning physician-assisted suicide.
Vote on HR 2260, the Pain Relief Promotion Act of 1999, would ban the use of drugs for physician-assisted suicide. The bill would not allow doctors to give lethal prescriptions to terminally ill patients, and instead promotes "palliative care," or aggressive pain relief techniques.
Reference: Bill sponsored by Hyde, R-IL;
Bill HR 2260
; vote number 1999-544
on Oct 27, 1999
Voted YES on establishing tax-exempt Medical Savings Accounts.
The bill allows all taxpayers to create a tax-exempt account for paying medical expenses called a Medical Savings Account [MSA]. Also, the measure would allow the full cost of health care premiums to be taken as a tax deduction for the self-employed and taxpayers who are paying for their own insurance. The bill would also allow the establishment of "HealthMarts," regional groups of insurers, health care providers and employers who could work together to develop packages for uninsured employees. Another provision of the bill would establish "association health plan," in which organizations could combine resources to purchase health insurance at better rates than they could separately.
Reference: Bill sponsored by Talent, R-MO;
Bill HR 2990
; vote number 1999-485
on Oct 6, 1999
Rated 0% by APHA, indicating a anti-public health voting record.
Chambliss scores 0% by APHA on health issues
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.
Source: APHA website 03n-APHA on Dec 31, 2003
Establish a national childhood cancer database.
Chambliss co-sponsored establishing 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: Legislative Outcome: House version H.R.1553; became Public Law 110-285 on 7/29/2008.
Source: Conquer Childhood Cancer Act (S911/HR1553) 07-S911 on Mar 19, 2007
- activities that provide information on treatment protocols to ensure early access to the best available therapies and clinical trials for pediatric cancers;
- 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
- 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.
Expand medical savings accounts for employers & individuals.
Chambliss co-sponsored expanding medical savings accounts for employers
To expand the availability of medical savings accounts. Amends the Internal Revenue Code with respect to medical savings accounts to:
Source: Medical Savings Account Effectiveness Act (H.R.614) 1999-H614 on Feb 8, 1999
- repeal the limitation on the number of accounts;
- make all employers (currently limited to small employers) eligible to offer accounts;
- increase contribution deduction amounts;
- permit employer and employee contributions;
- reduce high deductible health plan deductibles; and
- permit accounts to be offered under cafeteria plans.
Establishment of Office of Health Care Fraud Prevention.
Chambliss signed establishing of Office of Health Care Fraud Prevention
- There is hereby established, in the Department of H, the Office of the Deputy Secretary for Health Care Fraud Prevention.
- The Office shall provide contracts for the design, development, and operation of a predictive model antifraud system, based on the risk level assigned to claims activity, and develop a comprehensive antifraud database for health care activities carried out or managed by Federal health agencies.
- The Office shall promulgate and enforce regulations relating to the reporting of data claims to the health care antifraud system.
SPONSOR'S INTRODUCTORY REMARKS:
Sen. LeMIEUX. The current proposal for health care is a $1 trillion proposal. If we spent as much time caring about the money we are spending now, as opposed to the money some in this Chamber want to spend, I suspect we could find plenty of money to either return to the people or to find money for these new programs.
Today, I wish to talk about just such an idea, an idea to recover some of the waste, fraud, and abuse that is currently happening in our current provision of health care--in Medicare and Medicaid. Estimates are that some $60 billion to a staggering $226 billion a year to waste, fraud, and abuse.
This health care proposal that we are discussing in the Senate is $1 trillion over 10 years. That is about $100 billion a year. We may be wasting $226 billion a year. If we captured just half of that, we might be able to pay for this program.
Why can't we do the same thing the credit card companies are doing for health care? Why can't we use a predictive modeling system that says a health care claim is not going to be paid when a red flag comes up? Right now we are on a pay-and-chase system. If we put this predictive modeling system in, it stops the fraud before it happens. The credit card industry benchmark is 0.1% while fraud losses in the health care business run from 3% to 14%.
Source: Prevent Health Care Fraud Act of 2009 (S.2128 & H.R.4222 ) 2009-S2128 on Oct 29, 2009
Page last updated: Mar 15, 2012