Julia Carson on Health Care

Former Democratic Representative (IN-7, 1997-2007)

Voted YES 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 HR 4 ("First 100 hours") ; vote number 2007-023 on Jan 12, 2007

Voted NO on denying non-emergency treatment for lack of Medicare co-pay.

Vote to pass a resolution, agreeing to S. AMDT. 2691 that removes the following provisions from S 1932:

Allows hospitals to refuse treatment to Medicaid patients when they are unable to pay their co-pay if the hospital deems the situation to be a non-emergency
Excludes payment to grandparents for foster care

Reference: Reconciliation resolution on the FY06 budget; Bill H Res 653 on S. AMDT. 2691 ; vote number 2006-004 on Feb 1, 2006

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

Vote to pass a bill that would limit the awards that plaintiffs and their attorneys could be given in medical malpractice cases. The bill would limit non-economic damages, including physical and emotional pain to $250,000. The bill would also limit punitive damages to $250,000 or double economic damages, whichever amount is greater. Punitive damages would be banned against makers and distributors of medical products if the Food and Drug Administration approved those products. The bill would call for all states to set damage caps but would not block existing state statutory limits. The bill would cap attorneys' contingency fees to 40% of the first $50,000 in damages; 33.3% of the next $50,000; 25% of the next $500,000; and 15% of any amount in excess of $600,000. Reference: Medical Malpractice Liability Limitation bill; Bill HR 4280 ; vote number 2004-166 on May 12, 2004

Voted NO on limited prescription drug benefit for Medicare recipients.

Medicare Prescription Drug and Modernization Act of 2003: Vote to adopt the conference report on the bill that would create a prescription drug benefit for Medicare recipients. Starting in 2006, prescription coverage would be made available through private insurers to seniors. Seniors would pay a monthly premium of an estimated $35 in 2006. Individuals enrolled in the plan would cover the first $250 of annual drug costs themselves, and 25 percent of all drug costs up to $2,250. The government would offer a fallback prescription drug plan in regions were no private plans had made a bid.Over a 10 year time period medicare payments to managed care plans would increase by $14.2 billion. A pilot project would begin in 2010 in which Medicare would compete with private insurers to provide coverage for doctors and hospitals costs in six metropolitan areas for six years. The importation of drugs from Canada would be approved only if HHS determines there is no safety risks and that consumers would be saving money. Reference: Bill sponsored by Hastert, R-IL; Bill HR.1 ; vote number 2003-669 on Nov 22, 2003

Voted YES on allowing reimportation of prescription drugs.

Pharmaceutical Market Access Act of 2003: Vote to pass a bill that would call for the Food and Drug Administration to begin a program that would permit the importation of FDA-approved prescription drugs from Australia, Canada, the European Union, Iceland, Israel, Japan, Lichtenstein, New Zealand, Norway, Switzerland and South Africa. Reference: Bill sponsored by Gutknecht, R-MN; Bill HR.2427 ; vote number 2003-445 on Jul 24, 2003

Voted NO on capping damages & setting time limits in medical lawsuits.

Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2003: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. Limits the availability of punitive damages, and sets a 3-year limit for suing. Reference: Bill sponsored by Greenwood, R-PA; Bill HR 5 ; vote number 2003-64 on Mar 13, 2003

Voted NO 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 NO 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 NO 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 NO 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

Increase funding for AIDS treatment & prevention.

Carson adopted the CBC principles:

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.

Source: Congressional Black Caucus press release 01-CBC5 on Jan 6, 2001

More funding for Rx benefits, community health, CHIPs.

Carson adopted the CBC principles:

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.

Source: Congressional Black Caucus press release 01-CBC6 on Jan 6, 2001

MEDS Plan: Cover senior Rx under Medicare.

Carson adopted the Progressive Caucus Position Paper:

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

MEDS establishes an 80/20 outpatient prescription drug benefit under a new Medicare Part D that will be administered by the Health Care Financing Administration. The plan will cost similar to figures for the Bush prescription drug plan due to this plan’s emphasis on lowering the price of pharmaceuticals.

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:

Premiums would be $24/month in the first year and indexed to a pharmaceutical Sustainable Growth Rate, which will ensure that premiums or drug costs do not increase arbitrarily.

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:

Employers providing drug coverage equal to or better than the Medicare coverage receive an incentive payment to maintain such coverage. Source: CPC Press Release, MEDS Plan 01-CPC3 on Jan 31, 2001

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

Carson scores 100% 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

Improve services for people with autism & their families.

Carson co-sponsored improving services for people with autism & their families

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

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;
establish a multi-year demonstration grant program for states to provide evidence-based autism treatments, interventions, and services.
establish planning and demonstration grant programs for adults with autism;
award grants to states for access to autism services following diagnosis;
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;
make grants to protection and advocacy systems to address the needs of individuals with autism and other emerging populations of individuals with disabilities; and
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.
Directs the Comptroller General to issue a report on the financing of autism services and treatments.

Source: Promise for Individuals With Autism Act (S.937 & HR.1881) 07-HR1881 on Apr 17, 2007

Make health care a right, not a privilege.

Carson adopted the Progressive Caucus Position Paper:

All Americans, including the 44 million currently without health insurance, deserve to have the health care they need, regardless of ability to pay.
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.
Proposals should be rejected to change traditional Medicare from a defined benefit to a defined contribution or voucher system.
Balanced Budget Act cuts that are negatively affecting patient access to hospitals, nursing homes, and home health agencies must be restored.
Medicaid must have the resources to continue to provide coverage and care for low-income individuals, including children in the CHIP program.
Individuals with disabilities should retain their health benefits when they return to work and to have access to rehabilitative and other needed services.
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.

Source: CPC Position Paper: Health Care 99-CPC2 on Nov 11, 1999

Supported funding women's health needs.

Carson adopted the Women's Caucus policy agenda:

HR49—Treatment of Children’s Deformities Act—require coverage for congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease. (Kelly)
HR306—Genetic Information Nondiscrimination in Health Insurance Act—prohibit discrimination against individuals on the basis of genetic information. (Slaughter)
HR1285—Cancer Screening Coverage Act —require coverage of breast, cervical, prostate, and colorectal cancer screening. (Maloney/Kelly)
HR1388—Medicare Cancer Clinical Trial Coverage Act—officially expand Medicare coverage to clinical trials (N.Johnson/Cardin)
HR116—Breast Cancer Patient Protection Act—and HR383—Women’s Health and Cancer Rights Act—and HR1070—require coverage for a minimum hospital stay for mastectomies and treatment of breast cancer. (DeLauro/Kelly/Eshoo)
HR1816—Eliminate Colorectal Cancer Act—require coverage for colorectal cancer screenings. (Slaughter/McIntosh)
HR961—Ovarian Cancer Research and Information Amendments—provide for programs regarding ovarian cancer. (Mink)
HR845—Beneficiary Health Coverage Notification Rights Act—require notification of impending termination of coverage resulting from the failure of a group health plan to pay premiums. (Thurman)
HR1966—Asthma Awareness, Education and Treatment Act—carry out programs regarding the prevention and management of asthma and allergies. (Millender-McDonald)
H. Con. Res. 64—Cervical Cancer Public Awareness Resolution—recognizing the severity of the issue of cervical health. (Millender-McDonald)
H.Res. 19—expressing the seriousness of mental illness. (Roukema)
HR1899—The Health Care Worker Needlestick Prevention Act—require regulations to minimize the risk of needlestick injury to health care workers. (Roukema/Stark)

Source: Women's Caucus Agenda-106th Congress 99-WC2 on Jul 15, 1999

Supported funding older women's health.

Carson adopted the Women's Caucus policy agenda:

HR762—Lupus Research and Care Amendments of 1999—A bill to provide for research and services with respect to lupus. (Meek)
HR925—Osteoporosis Early Detection and Prevention Act of 1999—A bill to require that health insurance plans provide coverage for qualified individuals for bone mass measurement. (Maloney/Morella)
HR933—Osteoporosis Federal Employee Health Benefits Standardization Act of 1999—A bill to ensure that coverage of bone mass measurement is provided under the health benefits program for federal employees (Morella)
HR1187—Medicare Medical Nutrition Therapy Act of 1999—A bill to provide for coverage under part B of the Medicare Program of medical nutrition therapy services furnished by registered dietitians and nutrition professionals. (N. Johnson)
HR2294—Osteoporosis Education and Prevention Act of 1999—A bill to amend the Older Americans Act of 1965 to help prevent osteoporosis. (Berkley/Roukema/DeLauro/Maloney)
HR2471—Public Health Osteoporosis Screening, Diagnosis, and Treatment Act of 1999—A bill to amend the Public Health Service Act to provide for screenings, referrals, and education regarding osteoporosis. (E.B. Johnson/Kelly)

Source: Women's Caucus Agenda-106th Congress 99-WC3 on Jul 15, 1999

Supported funding Prenatal and Postpartum Care.

Carson adopted the Women's Caucus policy agenda:

HR 1843—Mothers and Newborns Health Insurance Act—improve prenatal care and delivery of healthy babies by enrolling pregnant women under state CHIP programs and allowing the option of automatically enrolling the babies born to those women in CHIP. (Hyde/Lowey)
HR2538—Folic Acid Promotion and Birth Defects Prevention Act—provide for a national folic acid education program to prevent birth defects. 70% of neural tube birth defects could be prevented if women of childbearing age consumed 400 micrograms of folic acid daily. The problem is that a majority of women are still not aware of the benefits of folic acid, nor are they consuming the recommended daily amount. (Roybal-Allard/Emerson)
H. Res. 163—raise awareness of post partum depression. Approximately 400,000 women experience post partum depression each year. More than just the “baby blues,” the more extreme cases of post partum depression can result in sadness, fatigue, anxiety, irritability, and low self esteem in new mothers. The resolution provides statistics, and provides recommendations on how the US can work to reduce its incidence, including providing information, training of medical providers, and screening of new mothers for symptoms for early detection of the problem. Additionally, the resolution calls on the U.S. to begin to collect data on post partum depression, so that we can measure its extent. (Capps-Kingston)
HR1848—Right to Breastfeed Act—ensure a woman’s right to breastfeed her child on any part of federal property (federal parks, federal buildings, and national museums) where she and her child have a right to be. (Maloney/Morella/Roybal-Allard) [STATUS: enacted as part of the FY2000 Treasury-Postal Appropriations bill]

Source: Women's Caucus Agenda-106th Congress 99-WC5 on Jul 15, 1999

Supported funding Family and Children's Coverage.

Carson adopted the Women's Caucus policy agenda:

HR 1806—Access to Women’s Health Care Act —provide women in managed care plans with direct access to ob/gyn services and the option of choosing their ob/gyn provider (including non-physicians specialists) as their primary care provider. (Lowey/Lazio)
HR 1636—Teen Pregnancy Reduction Act—The federal government spends more than $200 million annually specifically for teen pregnancy programs or services. These amounts demonstrate a significant investment in a national effort to prevent teen pregnancy. However, we know very little about the effectiveness of teen pregnancy prevention programs because adequate evaluation is not taking place. In an effort to bolster evaluation of teen pregnancy prevention programs of every type, the bill would provide for both a substantial investment in rigorous, scientific evaluation as well as the dissemination of information on programs, models and processes that have proven effective in preventing teen pregnancy. (Lowey/Castle)
HR 827—Improved Maternal and Children’s Health Coverage Act of 1999—expand health coverage for uninsured children by improving the outreach to an enrollment of children into Medicaid and the State Children’s Health Insurance Program (S-CHIP). (DeGette)
HR 1085—Healthy Kids Act 2000—improve health care for pregnant women and newborns by ensuring direct access to obstetric and gynecological care for women and pediatric care for children, by giving states greater flexibility by allowing them to enroll income-eligible pregnant women in State Children’s Health Insurance Program (CHIP) and by increasing enrollment of Medicaid-eligible women. This bill also includes sections for pediatric medical education, public health promotion, and research. (Emerson)

Source: Women's Caucus Agenda-106th Congress 99-WC6 on Jul 15, 1999

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