Norm Coleman on Health Care Republican Sr Senator (MN)

Address fraud and abuse in our Medicare program

A: One of the most important programs for seniors is Medicare, which provides health insurance coverage for approximately 45 million elderly and disabled Americans. With that in mind, I have consistently supported preserving seniors’ access to the benefits they have been promised, but have also been compelled to look at reforming this valuable program to ensure it’s long-term sustainability. For example, I’ve introduced legislation along with Senator Carl Levin to address fraud and abuse in our Medicare program. I’ve also crossed party lines to support legislation that prevented reimbursement cuts that could reduce seniors access to physicians, lowered Part B co-payments, increased support for low-income seniors, and improved the Medicare Part D program. By providing seniors with high-quality, low-cost care when they are well, we can reduce costly hospital visits later on.

Favors some type of universal coverage

A: You’ve got to figure out a way to get it done. Paul Wellstone’s been there for twelve years and for twelve years and it hasn’t gotten done. Even if you allow businesses the opportunity to consolidate, with all the mandates you have, health care is still not going to be affordable.

Coleman said government needs to work with businesses to develop a plan, and that he would favor some type of universal coverage

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 YES 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 NO 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--
1. improve Indian access to high quality health care services;
2. provide incentives to Indian patients to seek preventive health care services;
3. create opportunities for Indians to participate in the health care decision process;
4. encourage effective use of health care services by Indians; and
5. 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

Voted YES on adding 2 to 4 million children to SCHIP eligibility.

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]:

1. It terminates the coverage of childless adults.
2. 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.
3. 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.

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 YES 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 NO on increasing Medicaid rebate for producing generics.

Voted NO on negotiating bulk purchases for Medicare prescription drug.

Voted YES on $40 billion per year for limited Medicare prescription drug benefit.

Tax credits for those without employee health insurance.

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.

Tax deduction for long-term care insurance.

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.

Support telemedicine for underserved areas.

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.

$350 billion for prescriptions for poor seniors.

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.

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

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.