Gordon Harold Smith on Health Care

Republican Jr Senator (OR)

Strengthened and protected federal health care programs

Smith believes no one should be priced out of quality health care. So he is advancing legislation that will lower the number of uninsured and drive health care costs down. Gordon has strengthened and protected federal programs like Medicare as well as vital safety-net like Medicaid and the State Children’s Health Insurance Program. Source: Campaign website, www.gordonsmith.com Aug 12, 2008

Voted YES on overriding veto on expansion of Medicare.

Congressional Summary:

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.

Pres. GEORGE W. BUSH's veto message (argument to vote No):

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.

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.

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; Bill HR.6331 ; vote number 2008-S177 on Jul 15, 2008

Voted NO 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

Reference: Bill S.Amdt.4240 to S.Con.Res.70 ; vote number 08-S063 on Mar 13, 2008

Voted NO on allowing tribal Indians to opt out of federal healthcare.

CONGRESSIONAL SUMMARY:

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 YES 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 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.
Status: Cloture rejected Cloture vote rejected, 55-42 (3/5ths required)

Reference: Medicare Prescription Drug Price Negotiation Act; Bill S.3 & H.R.4 ; vote number 2007-132 on Apr 18, 2007

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.

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.

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.

Reference: Medical Care Access Protection Act; Bill S. 22 ; vote number 2006-115 on May 8, 2006

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; Bill S.1/H.R.1 ; vote number 2003-262 on Jun 26, 2003

Voted YES on allowing reimportation of Rx drugs from Canada.

S. 812, as amended; Greater Access to Affordable Pharmaceuticals Act of 2002. Vote to pass a bill that would permit a single 30-month stay against Food and Drug Administration approval of a generic drug patent when a brand-name company's patent is challenged. The secretary of Health and Human Services would be authorized to announce regulations allowing pharmacists and wholesalers to import prescription drugs from Canada into the United States. Canadian pharmacies and wholesalers that provide drugs for importation would be required to register with Health and Human Services. Individuals would be allowed to import prescription drugs from Canada. The medication would have to be for an individual use and a supply of less than 90-days. Reference: Bill S.812 ; vote number 2002-201 on Jul 31, 2002

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

Vote to provide federal protections, such as access to specialty and emergency room care, and allow patients to sue health insurers in state and federal courts. Economic damages would not be capped, and punitive damages would be capped at $5 million. Reference: Bill S1052 ; vote number 2001-220 on Jun 29, 2001

Voted YES on funding GOP version of Medicare prescription drug benefit.

Vote to pass an amendment that would make up to $300 billion available for a Medicare prescription drug benefit for 2002 through 2011. The money would come from the budget's contingency fund. The amendment would also require a Medicare overhaul. Reference: Bill H Con Res 83 ; vote number 2001-65 on Apr 3, 2001

Voted NO on including prescription drugs under Medicare.

Vote to establish a prescription drug benefit program through the Medicare health insurance program. Among other provisions, Medicare would contribute at least 50% of the cost of prescription drugs and beneficiaries would pay a $250 deductible Reference: Bill HR.4690 ; vote number 2000-144 on Jun 22, 2000

Voted YES on limiting self-employment health deduction.

The Santorum (R-PA) amdt would effectively kill the Kennedy Amdt (D-MA) which would have allowed self-employed individuals to fully deduct the cost of their health insurance on their federal taxes.
Status: Amdt Agreed to Y)53; N)47 Reference: Santorum Amdt #1234; Bill S. 1344 ; vote number 1999-202 on Jul 13, 1999

Voted YES on increasing tobacco restrictions.

This cloture motion was on a bill which would have increased tobacco restrictions. [YES is an anti-smoking vote].
Status: Cloture Motion Rejected Y)57; N)42; NV)1 Reference: Motion to invoke cloture on a modified committee substitute to S. 1415; Bill S. 1415 ; vote number 1998-161 on Jun 17, 1998

Voted YES on Medicare means-testing.

Approval of means-based testing for Medicare insurance premiums.
Status: Motion to Table Agreed to Y)70; N)20 Reference: Motion to table the Kennedy Amdt #440; Bill S. 947 ; vote number 1997-113 on Jun 24, 1997

Invest funds to alleviate the nursing shortage.

Smith co-sponsored the Nurse Reinvestment Act

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.

Source: Bill sponsored by 39 Senators 01-S706 on Apr 5, 2001

Tax credits for those without employee health insurance.

Smith adopted the Republican Main Street Partnership agenda item:

H.R. 1181 the Health Insurance Affordability and Equity Act
With 40 million Americans currently living without health insurance, Republican Main Street Partnership members have been leading the effort to find new and innovative ways to secure health care for our citizens. Easing the burden on businesses entering into insurance purchasing pools, and expanding the use of medical savings accounts (MSAs) have been included in previous economic stimulus packages. RMSP Congresswoman Nancy Johnson (CT) in conjunction with Representatives Jo Ann Emerson (MO), Melissa Hart (PA), Jim Kolbe (AZ), Connie Morella (MD), Doug Ose (CA), Marge Roukema (NJ), Rob Simmons (CT), Fred Upton (MI), and Jim Walsh (NY) introduced legislation that targets tax credits to those that are not offered employee provided health insurance, or are self employed.

Source: Republican Main Street Partnership Legislative Agenda 02-RMSP4 on May 24, 2002

Tax deduction for long-term care insurance.

Smith adopted the Republican Main Street Partnership agenda item:

H.R. 831/S. 621 the Long Term Care and Retirement Security Act.
Republican Main Street Partnership Senators Lincoln Chafee (RI), Susan Collins (ME), and Gordon Smith (OR) joined House of Representatives sponsors Reps. Charlie Bass (NH), Dave Camp (MI), Tom Davis (VA), Greg Ganske (IA), Ben Gilman (NY), Dave Hobson (OH), Steve Horn (CA), Nancy Johnson (CT), Sue Kelly (NY), Ray LaHood (IL), Connie Morella (MD), Deborah Pryce (OH), Jim Ramstad (MN), and Rob Simmons (CT) in securing health insurance for seniors and those in long-term care facilities. As new medicines and healthier lifestyles are extending life, more and more Americans need to prepare for their long-term health needs. This legislation allows a tax deduction on long-term care insurance premiums for taxpayers, including accelerated deductions persons for people 55 years of age and up.

Source: Republican Main Street Partnership Legislative Agenda 02-RMSP5 on May 24, 2002

Support telemedicine for underserved areas.

Smith adopted the Republican Main Street Partnership agenda item:

H.R. 2706, The Medicare Telehealth Validation (MTV) Act.
Republican Main Street Partnership members Congressman Doug Ose (CA) and Jo Ann Emerson (MO) have introduced this bill to increase the use of telehealth services under the Medicare program. Currently, telehealth services are restricted to use in certain geographically underserved areas. The MTV Act provides sufficient funding and regulatory relief to expand high technology medical diagnostic tools, across the Internet, to urban as well as rural underserved areas. The bill further provides for expansion of store-and-forward techniques, and for a study of the restrictions on telemedicine due to state licensing rules.

Source: Republican Main Street Partnership Legislative Agenda 02-RMSP6 on May 24, 2002

$350 billion for prescriptions for poor seniors.

Smith adopted the Republican Main Street Partnership agenda item:

Medicare Prescription Drug Benefit
One of issues to be addressed this year by Congress is that of providing a prescription drug benefit to our nation's Medicare beneficiaries. Legislation currently being drafted [by Republican Main Street Partnership members] intends to authorize $350 billion over the next 10 years to provide purchasing assistance for prescription medications. The benefit reaches out to low and moderate income seniors by extending coverage to incomes up to 150% of the poverty level. The bill could also include provisions to correct reimbursement reductions for physicians, nurses, hospitals, technicians, home health care providers, and long-term care facilities.

Source: Republican Main Street Partnership Legislative Agenda 02-RMSP7 on May 24, 2002

Rated 0% by APHA, indicating a anti-public health voting record.

Smith 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

Include mental health services under Medicare.

Smith co-sponsored including mental health services under Medicare

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

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

Source: Medicare Improvements for Patients & Providers Act (S.3101) 08-S3101 on Jun 6, 2008

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